Late Breaking Abstract - An exercise training program improves endothelial function in COPD patients

COPD is associated with increased cardiovascular (CV) mortality. An early manifestation in the pathogenesis of CV diseases is the endothelial dysfunction; the gold standard for its measurement is the flow-mediated dilatation (FMD). It is known that an active lifestyle has a favorable effect on FMD also in COPD (retrospective studies), however no prospective study has evaluated the effect of an exercise training program (ET) on FMD. Aim: to evaluate the impact of a supervised endurance ET on FMD in COPD. Methods: 11 COPD patients (4F/7M) were recruited. Patients who agreed to participate at ET were assigned to the training group (Ex, n=6) and the others to the control group (C, n=5). The Ex exercised on a treadmill 50 min, twice a week for 8 weeks. At the beginning (T0) patients performed spirometry, 6MWD, measurement of physical activity (SenseWear Armband) and FMD. At the end of the program (T1) FMD and spirometry were repeated. Furthermore, Ex performed an incremental cycling test at T0 and T1 to assess VO2max. Results: No differences in age (Ex:66±10, C:69±8yr), BMI (Ex:30±3, C:28±4kg/m2), pulmonary function [FEV1(%) Ex:54±14, C:60±16] and 6MWD (Ex:356±90, C:406±49m) were found between the groups at T0; C were a little more active than Ex (1.3±0.2 vs 1.1±0.1 METs respectively;p=0.03). No difference was found in FMD at T0 after adjustment for physical activity (Ex:4.2±0.54, C:4.05±0.62%). FMD improved significantly in the Ex (+2.74±1.33%, p=0.004) but not in the C (-0.09±0.21, p>0.05); t test between groups p=0.0001. Conclusion: These preliminary data show that after 8 weeks of ET a significant improvement in FMD was found in trained COPD and can be considered another positive effect of pulmonary rehabilitatio

Growth and Nutritional Status of Tibetan Children at High Altitude

Growth and development are clearly affected by high-altitude exposure to hypoxia, nutritional stress, cold or a combination of these factors. Very little research has been conducted on the growth and nutritional status of children living on the Tibetan Plateau. The present study evaluated the environmental impact on human growth by analyzing anthropometric characteristics of Tibetan children aged 8–14, born and raised above 4000 m altitude on the Himalayan massif in the prefecture of Shegar in Tibet Autonomous Region. Data on anthropometric traits, never measured in this population, were collected and the nutritional status was assessed. A reference data set is provided for this population. There was no evidence of wasting but stunting was detected (28.3%). Children permanently exposed to the high-altitude environment above 4000 m present a phenotypic form of adaptation and a moderate reduction in linear growth. However, it is also necessary to consider the effects of socioeconomic deprivation

Alpine altitude climate treatment for severe and uncontrolled asthma: An EAACI position paper

Currently available European Alpine Altitude Climate Treatment (AACT) programs combine the physical characteristics of altitude with the avoidance of environmental triggers in the alpine climate and a personalized multidisciplinary pulmonary rehabilitation approach. The reduced barometric pressure, oxygen pressure, and air density, the relatively low temperature and humidity, and the increased UV radiation at moderate altitude induce several physiological and immunological adaptation responses. The environmental characteristics of the alpine climate include reduced aeroallergens such as house dust mites (HDM), pollen, fungi, and less air pollution. These combined factors seem to have immunomodulatory effects controlling pathogenic inflammatory responses and favoring less neuro-immune stress in patients with different asthma phenotypes. The extensive multidisciplinary treatment program may further contribute to the observed clinical improvement by AACT in asthma control and quality of life, fewer exacerbations and hospitalizations, reduced need for oral corticosteroids (OCS), improved lung function, decreased airway hyperresponsiveness (AHR), improved exercise tolerance, and improved sinonasal outcomes. Based on observational studies and expert opinion, AACT represents a valuable therapy for those patients irrespective of their asthma phenotype, who cannot achieve optimal control of their complex condition despite all the advances in medical science and treatment according to guidelines, and therefore run the risk of falling into a downward spiral of loss of physical and mental health. In the light of the observed rapid decrease in inflammation and immunomodulatory effects, AACT can be considered as a natural treatment that targets biological pathways. Keywords: altitude; asthma; climate; environment; pulmonary rehabilitation

Alpine altitude climate treatment for severe and uncontrolled asthma: an EAACI position paper

Currently available European Alpine Altitude Climate Treatment (AACT) programs combine the physical characteristics of altitude with the avoidance of environmental triggers in the alpine climate and a personalized multidisciplinary pulmonary rehabilitation approach. The reduced barometric pressure, oxygen pressure, and air density, the relatively low temperature and humidity, and the increased UV radiation at moderate altitude induce several physiological and immunological adaptation responses. The environmental characteristics of the alpine climate include reduced aeroallergens such as house dust mites (HDM), pollen, fungi, and less air pollution. These combined factors seem to have immunomodulatory effects controlling pathogenic inflammatory responses and favoring less neuro-immune stress in patients with different asthma phenotypes. The extensive multidisciplinary treatment program may further contribute to the observed clinical improvement by AACT in asthma control and quality of life, fewer exacerbations and hospitalizations, reduced need for oral corticosteroids (OCS), improved lung function, decreased airway hyperresponsiveness (AHR), improved exercise tolerance, and improved sinonasal outcomes. Based on observational studies and expert opinion, AACT represents a valuable therapy for those patients irrespective of their asthma phenotype, who cannot achieve optimal control of their complex condition despite all the advances in medical science and treatment according to guidelines, and therefore run the risk of falling into a downward spiral of loss of physical and mental health. In the light of the observed rapid decrease in inflammation and immunomodulatory effects, AACT can be considered as a natural treatment that targets biological pathways

Exercise and sports pulmonology: Pathophysiological adaptations and rehabilitation

Introduction This book provides an innovative and comprehensive overview of the relationship between lung and exercise, both in healthy, active subjects and in subjects with chronic respiratory diseases. It investigates in detail the central role of the lungs during exercise and illustrates the impact of respiratory impairment due to both acute and chronic lung diseases on performance. Further, the book presents the latest evidence-based findings, which confirm that exercise is an effective and safe form of prevention and rehabilitation in respiratory diseases. The first section describes the changes in the respiratory system during exercise and the contribution of respiration to exercise, while readers will learn how to perform a respiratory assessment in the second section. The third section addresses a broad range of chronic respiratory diseases and the (in)ability of those affected to play sports and perform exercise, thus providing a basis for individual assessments. The last two sections focus on respiratory training, rehabilitation and the relationship between respiration and the environment, e.g. in high-altitude and underwater sports. The book will appeal to a wide readership, including pulmonologists, sport medicine physicians, physiotherapists and trainers, as well as instructors and students in exercise science

Thoraco-abdominal coordination and performance during uphill running at altitude

Introduction Running races on mountain trails at moderate-high altitude with large elevation changes throughout has become increasingly popular. During exercise at altitude, ventilatory demands increase due to the combined effects of exercise and hypoxia. Aim To investigate the relationships between thoraco-abdominal coordination, ventilatory pattern, oxygen saturation (SpO2), and endurance performance in runners during high-intensity uphill exercise. Methods Fifteen participants (13 males, mean age 42±9 yrs) ran a “Vertical Kilometer,” i.e., an uphill run involving a climb of approximately 1000 m with a slope greater than 30%. The athletes were equipped with a portable respiratory inductive plethysmography system, a finger pulse oximeter and a global positioning unit (GPS). The ventilatory pattern (ventilation (VE), tidal volume (VT), respiratory rate (RR), and VE/VT ratio), thoraco-abdominal coordination, which is represented by the phase angle (PhA), and SpO2 were evaluated at rest and during the run. Before and after the run, we assessed respiratory function, respiratory muscle strength and the occurrence of interstitial pulmonary edema by thoracic ultrasound. Results Two subjects were excluded from the respiratory inductive plethysmography analysis due to motion artifacts. A quadratic relationship between the slope and the PhA was observed (r = 0.995, p = 0.036). When the slope increased above 30%, the PhA increased, indicating a reduction in thoraco-abdominal coordination. The reduced thoraco-abdominal coordina- tion was significantly related to reduced breathing efficiency (i.e., an increased VE/VT ratio; r = 0.961, p = 0.038) and SpO2 (r = -0.697, p<0.001). Lower SpO2 values were associated with lower speeds at 20% slope 40% (r = 0.335, p<0.001 for horizontal and r = 0.36, p<0.001 for vertical). The reduced thoraco-abdominal coordination and consequent reduction in SpO2 were associated with interstitial pulmonary edema. Conclusion Reductions in thoraco-abdominal coordination are associated with a less efficient ventilatory pattern and lower SpO2 during uphill running. This fact could have a negative effect on performance

Esercizio fisico in condizioni ambientali estreme

L’ambiente di montagna presenta delle caratteristiche, sempre più evidenti col progredire della quota, che possono essere schematizzate come segue: riduzione della pressione barometrica e della pressione d’ossigeno, responsabili della progressiva ipossiemia;riduzione della temperatura di circa 1°C ogni 150m; riduzione dell'umidità assoluta dell’aria, cioè la massa di vapore acqueo presente per unità di volume nell’atmosfera. Questo fenomeno, insieme all’iperventilazione ipossica, può essere causa di disidratazione dell’organismo; riduzione della densità dell'aria, che ha conseguenze positive sulla meccanica respiratoria. Contemporaneamente incrementa la viscosità cinematica dell’aria. L'esposizione a condizioni climatiche ed ambientali diverse da quelle abituali costituisce per l'organismo un evento stressante, in misura tanto maggiore quanto maggiori sono le difficoltà d’adattamento. Per questo motivo l’ambiente d’alta quota costituisce da sempre una sfida non solo per l’alpinista ma anche per il fisiologo ed il medico per i quali è molto importante la conoscenza della fisiopatologia dell’alta quota. Vengono approfonditi gli adattamenti all'esercizio acuto e cronico dell'apparato cardiorespiratorio e neuro-muscolo-scheletric