Immunomodulatory effects of two different physical therapy modalities in patients with chronic obstructive pulmonary disease

Sherin Hassan M Mehani, Sherin Hassan M Mehani

Abstract

[Purpose] Counteracting the systemic cytokine release and its inflammatory effects by improving respiratory muscle strength and controlling lung inflammation may be important for improving immune system in patients with chronic obstructive pulmonary disease, So the aim of the present study was to evaluate the effect of low level laser therapy and inspiratory muscle training on interleukin-6 (IL-6) as a marker of inflammation and CD4+/CD8+ ratio as a marker for T Lymphocytes in these patients. [Subjects and Methods] Forty male patients with stable COPD participated in the study, their ages ranged between 55-65 years. They were randomly divided into group (A) who received inspiratory muscle training and group (B) who received low level laser (LLL) acupuncture stimulation for about 8 week. [Results] There was a reduction in the concentration of plasma IL-6 associated with an increase in CD4+/CD8+ ratio in both groups, but laser was superior to inspiratory muscle training. IL-6 and CD4+/CD8+ were negatively correlated. [Conclusion] Both inspiratory muscle training and low level laser therapy are effective physical therapy modalities in promoting immune disturbances. The results also supported the superior role of LLLT over IMT in managing immune disturbances.

Keywords: Immunity; Inspiratory muscle training; Low level laser therapy.

Figures

Fig. 1.
Fig. 1.
Flow chart for study procedure

References

    1. Khan JH, Lababidi HM, Al-Moamary MS, et al. : The Saudi guidelines for the diagnosis and management of COPD. Ann Thorac Med, 2014, 9: 55–76.
    1. Ben Abdallah FC, Taktak S, Chtourou A, et al. : Burden of chronic respiratory diseases (CRD) in Middle East and North Africa (MENA). World Allergy Organ J, 2011, 4: S6–S8.
    1. Daldoul H, Denguezli M, Jithoo A, et al. : Prevalence of COPD and tobacco smoking in Tunisia—results from the BOLD study. Int J Environ Res Public Health, 2013, 10: 7257–7271.
    1. Hatipoğlu U, Aboussouan LS: Chronic obstructive pulmonary disease: an update for the primary physician. Cleve Clin J Med, 2014, 81: 373–383.
    1. Casadevall C, Coronell C, Ramírez-Sarmiento AL, et al. : Upregulation of pro-inflammatory cytokines in the intercostal muscles of COPD patients. Eur Respir J, 2007, 30: 701–707.
    1. Pinto-Plata VM, Livnat G, Girish M, et al. : Systemic cytokines, clinical and physiological changes in patients hospitalized for exacerbation of COPD. Chest, 2007, 131: 37–43.
    1. Karadag F, Kirdar S, Karul AB, et al. : The value of C-reactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease. Eur J Intern Med, 2008, 19: 104–108.
    1. Bailey KL, Goraya J, Rennard SL: The role of systemic inflammation in COPD. In: Nici L, Zu-wallack R, Chronic obstructive pulmonary disease co morbidities and systemic consequences. New York: Human Press, 2012, pp 15–30.
    1. Hansson GK: Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med, 2005, 352: 1685–1695.
    1. Sabit R, Thomas P, Shale DJ, et al. : The effects of hypoxia on markers of coagulation and systemic inflammation in patients with COPD. Chest, 2010, 138: 47–51.
    1. Pini L, Valsecchi A, Boni E,, et al. : Acute dynamic hyperinflation and systemic inflammation in stable COPD patients. Am J Respir Crit Care Med, 2010, 181: A 2907.
    1. Sharma G, Hanania NA, Shim YM: The aging immune system and its relationship to the development of chronic obstructive pulmonary disease. Proc Am Thorac Soc, 2009, 6: 573–580.
    1. Calabrese F, Giacometti C, Beghe B, et al. : Marked alveolar apoptosis/proliferation imbalance in end-stage emphysema. Respir Res, 2005, 6: 14.
    1. Jelley-Gibbs DM, Dibble JP, Filipson S, et al. : Repeated stimulation of CD4 effector T cells can limit their protective function. J Exp Med, 2005, 201: 1101–1112.
    1. Ekberg-Jansson A, Andersson B, Avrå E, et al. : The expression of lymphocyte surface antigens in bronchial biopsies, bronchoalveolar lavage cells and blood cells in healthy smoking and never-smoking men, 60 years old. Respir Med, 2000, 94: 264–272.
    1. Toumpanakis D, Kastis GA, Zacharatos P, et al. : Inspiratory resistive breathing induces acute lung injury. Am J Respir Crit Care Med, 2010, 182: 1129–1136.
    1. Pedersen BK, Febbraio MA: Muscle as an endocrine organ: focus on muscle-derived interleukin-6. Physiol Rev, 2008, 88: 1379–1406.
    1. Kashanskaia EP, Fedorov AA: [Low-intensity laser radiation in the combined treatment of patients with chronic obstructive bronchitis]. Vopr Kurortol Fizioter Lech Fiz Kult, 2009, (2): 19–22 (in Russian).
    1. de Lima FM, Villaverde AB, Albertini R, et al. : Dual Effect of low-level laser therapy (LLLT) on the acute lung inflammation induced by intestinal ischemia and reperfusion: action on anti- and pro-inflammatory cytokines. Lasers Surg Med, 2011, 43: 410–420.
    1. Oliveira MC, Jr, Greiffo FR, Rigonato-Oliveira NC, et al. : Low level laser therapy reduces acute lung inflammation in a model of pulmonary and extrapulmonary LPS-induced ARDS. J Photochem Photobiol B, 2014, 134: 57–63.
    1. Bjordal JM, Johnson MI, Iversen V, et al. : Photoradiation in acute pain: a systematic review of possible mechanisms of actions and clinical effects in randomized placebo-controlled trials. Photomed Laser Surg, 2006, 24: 158–168.
    1. Chow RT, Johnson MI, Lopes-Martins RA, et al. : Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet, 2009, 374: 1897–1908.
    1. Aimbire F, Lopes-Martins RA, Castro-Faria-Neto HC, et al. : Low-level laser therapy can reduce lipopolysaccharide-induced contractile force dysfunction and TNF-alpha levels in rat diaphragm muscle. Lasers Med Sci, 2006, 21: 238–244.
    1. American Thoracic Society / European Respiratory Society Task Force: Standards for the diagnosis and management of patients with COPD, version 1.2. New York: American Thoracic Society, 2009, pp 100 −132.
    1. Mesquita R, Donária L, Genz IC, et al. : Respiratory muscle strength during and after hospitalization for COPD exacerbation. Respir Care, 2013, 58: 2142–2149.
    1. Mills DE, Johnson MA, McPhilimey MJ, et al. : The effects of inspiratory muscle training on plasma interleukin-6 concentration during cycling exercise and a volitional mimic of the exercise hyperpnea. J Appl Physiol 1985, 2013, 115: 1163–1172.
    1. Borg E, Borg G, Larsson K, et al. : An index for breathlessness and leg fatigue. Scand J Med Sci Sports, 2010, 20: 644–650.
    1. Ribeiro JP, Chiappa GR, Neder JA, et al. : Respiratory muscle function and exercise intolerance in heart failure. Curr Heart Fail Rep, 2009, 6: 95–101.
    1. Vassilakopoulos T, Divangahi M, Rallis G, et al. : Differential cytokine gene expression in the diaphragm in response to strenuous resistive breathing. Am J Respir Crit Care Med, 2004, 170: 154–161.
    1. Oh-ishi S, Kizaki T, Ookawara T, et al. : Endurance training improves the resistance of rat diaphragm to exercise-induced oxidative stress. Am J Respir Crit Care Med, 1997, 156: 1579–1585.
    1. Yfanti C, Fischer CP, Nielsen S, et al. : Role of vitamin C and E supplementation on IL-6 in response to training. J Appl Physiol 1985, 2012, 112: 990–1000.
    1. Dumitru L, Iliescu A, Dinu H, et al. : Disability in COPD and chronic heart failure is the skeletal muscle the final common pathway? Maedica (Buchar), 2013, 8: 206–213.
    1. Sigala L, Zacharatos P, Toumpanakis D, et al. : Differentially regulate cytokine expression in the diaphragm in response to resistive breathing: the role off oxidative stress. Am J Physiol Integr Comp Physiol, 2011, 300: R 1152–R 1162.
    1. Sigala I, Zacharatos P, Boulia S, et al. : Nitric oxide regulates cytokine induction in the diaphragm in response to inspiratory resistive breathing. J Appl Physiol 1985, 2012, 113: 1594–1603.
    1. Barreiro E, de la Puente B, Minguella J, et al. : Oxidative stress and respiratory muscle dysfunction in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2005, 171: 1116–1124.
    1. Brilla L R: Perspectives on breathing in sports and health. J Sport Med Doping Stud, 2012, 2: 1000 e 121.
    1. Witt JD, Guenette JA, Rupert JL, et al. : Inspiratory muscle training attenuates the human respiratory muscle metaboreflex. J Physiol, 2007, 584: 1019–1028.
    1. Romer LM, McConnell AK: Specificity and reversibility of inspiratory muscle training. Med Sci Sports Exerc, 2003, 35: 237–244.
    1. Katsaounou P, Karatza MH, Kollintza A, et al.: The immune response to strenuous resistive breathing. Am J Respir Crit Care Med, 2001, 163: A 621.
    1. Domagała-Kulawik J, Hoser G, Dabrowska M, et al. : Increased proportion of Fas positive CD8+ cells in peripheral blood of patients with COPD. Respir Med, 2007, 101: 1338–1343.
    1. Bolton CE, Evans M, Ionescu AA, et al. : Insulin resistance and inflammation—a further systemic complication of COPD. COPD, 2007, 4: 121–126.
    1. Rafiq R, Aleva FE, Schrumpf JA, et al. : Prevention of exacerbations in patients with COPD and vitamin D deficiency through vitamin D supplementation (PRECOVID): a study protocol. BMC Pulm Med, 2015, 15: 106.
    1. Davidson WJ, Verity WS, Traves SL, et al. : Effect of incremental exercise on airway and systemic inflammation in patients with COPD. J Appl Physiol 1985, 2012, 112: 2049–2056.
    1. de Lima FM, Aimbire F, Miranda H, et al. : Low-level laser therapy attenuates the myeloperoxidase activity and inflammatory mediator generation in lung inflammation induced by gut ischemia and reperfusion: a dose-response study. J Lasers Med Sci, 2014, 5: 63–70.
    1. Miranda da Silva C, Peres Leal M, Brochetti RA, et al. : Low level laser therapy reduces the development of lung inflammation induced by formaldehyde exposure. PLoS One, 2015, 10: e0142816.
    1. Silva VR, Marcondes P, Silva M, et al. : Low-level laser therapy inhibits bronchoconstriction, Th2 inflammation and airway remodeling in allergic asthma. Respir Physiol Neurobiol, 2014, 194: 37–48.
    1. Peron JP, de Brito AA, Pelatti M, et al. : Human tubal derived mesenchymal stromal cells associated with low level laser therapy significantly reduces cigarette smoke-induced COPD in C57 BL/ 6 mice. PLoS One, 2015, 10: e0136942.

Source: PubMed

3
Iratkozz fel