Impacto da reabilitação pulmonar nos marcadores inflamatórios e capacidade funcional de pacientes com bronquiectasias não fibrocísticas

Abstract

Background: Bronchiectasis are characterized by irreversible dilation of the bronchial lumen that promotes greater inflammation and damage to the airways, generating a vicious cycle of ''microbial load, response to inflammation, bronchial clearance impaired by lung damage'', which evolve with increased morbidity and mortality, progressive decline in lung function andquality of life. It has several etiologies that qualify them as Fibrocystic and Non-Fibrocystic Bronchiectasis (BNFC). It is recommended for these patients to participate in pulmonar rehabilitation (PR) programs or practice regular exercise regardless of its severity, aiming to improve exercise tolerance and quality of life. However, there is no scientific evidence on th effects of RP on inflammatory markers in individuals with bronchiectasis. Objectives: To evaluate the impact of PR on inflammatory markers and functional capacity in patients with BNFC. Methods: This is a controlled, open and randomized clinical trial from January 2017 to March 2020. Patients with clinically stable, severity-independent BNFC were submitted to a PR program (GRP) or a control group (CG). Forty-one patients were evaluated, 20 for the GRP and 21 for the CG. The PR protocol consisted of a 12-week multidisciplinary program with 3 sessions per week involving physical training, nutritional support, psychological counseling and health education. The GRP and CG were paired with regard to sociodemographic data and received guidance on the home use of the high-frequency oral oscillation technique, autogenous drainage and informed about the importance of practicing physical activities in their daily routine. Inflammatory markers (C-reactive protein, Fibrinogen and Albumin), exercise tolerance, quality of life (QL), fatigue, anxiety, depression and dyspnea were measured before and after the study protocol. Results: There was a reduction in fibrinogen in the groups (p<0.001), but more extensive for the GRP and with a significant difference between groups (p<0.0001). There were also significant improvements in QoL, increased exercise tolerance, reduced levels of fatigue, anxiety and dyspnea after PR, with a significant difference in the comparison of intergroup mean differences (p<0.0001). The CG improved QoL, increased the distance walked in 6 minutes, and reduced levels of fatigue and dyspnea. Conclusion: PR improved fibrinogen levels, functional exercise capacity, respiratory and peripheral muscle strength, QoL, dyspnea sensation, fatigue and anxiety levels in patients with BNFC