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Could exercise help prevent virus-related COPD exacerbations?

Holy Grail: Could exercise help prevent virus-related COPD exacerbations?

The Aim 

To help prevent & treat respiratory infections or lung diseases.

What are the mechanisms and interventions for respiratory infections & lung disease? 

COPD exacerbations are often caused by viral infections, such as the common cold and influenza. People with COPD are susceptible to exacerbations due to imbalanced responses to viral infections, where deficient anti-viral immunity precedes excessive activation of the immune system and causes lung inflammation and symptoms. Whilst current treatments like steroid inhalers can help reduce symptoms in people with COPD, these drugs are immunosuppressive and can increase risk of secondary infection. Complementary treatments are needed that reduce reliance on steroids. Our research has shown that exercise programs can reduce the number of people experiencing a COPD exacerbation. The mechanisms underlying this protection are not clear.

Assess whether exercise has anti-viral & anti-inflammatory effects in COPD. 

This project will recruit 30 people with COPD who have frequent exacerbations. Half of these people will receive an exercise program, the other half will be on a waiting list for eight weeks. Using bronchoscopy, we will collect lung immune cells at the start of the project and after 8 weeks, we will measure whether exercise can boost anti-viral responses of lung cells. Additionally, mice with COPD will either undergo treadmill running or rest alongside steroid or no-steroid treatment before infection with viruses that cause exacerbations. Mice lung tissue will be used to test if exercise reduces inflammation during an exacerbation & increases anti-viral immunity with or without steroid treatment. 

Are there any proposed mechanisms behind exercise’s potential anti-viral & anti-inflammatory effects in COPD?

I hope to have a more definitive answer on this at the end of the project. There is accumulating evidence to suggest that exercise alone has independent effects on exacerbations versus other interventions it may be delivered alongside (e.g. education) in COPD. I think this is at least partly due to exercise modulating the immune system. My view is informed by two key areas. Firstly, prior research has shown regular exercise in previously-sedentary populations can result in reduced severity of self-reported respiratory infections and improved immune responses to viral vaccines (e.g. influenza). Secondly, previous research has shown that people living with COPD are more physically inactive than age-matched healthy counterparts & that this physical inactivity may be linked to systemic inflammation. Our project will test the effects of exercise on aspects of the immune system that have been shown to be linked with increased susceptibility to exacerbations.

How could this work affect patient care & how long until it does? 

Unlike a brand-new drug or treatment, our work shouldn’t take long to affect patient care. If successful, I hope within 5 years. This is because exercise programs are already being used in the care of people with COPD. The key difference would be how the exercise programs are delivered. Currently, people with COPD are usually referred by their clinicians for exercise treatment to help with breathlessness or exercise intolerance. Confirming exercise’s anti-viral & anti-inflammatory effects in COPD would support exercise treatment in those susceptible to frequent exacerbations. Unfortunately, we know that too-few people living with COPD are currently able to access exercise treatments. Our work showing will provide a strong call for increased provision of exercise programs. Because exacerbations are a leading cause of preventable hospitalisations in chronic disease & represent major costs of COPD treatment in health services.

What drew you to this line of research? 

Avoiding exacerbations & hospitalisations are outcomes that matter most to people with COPD. Our research has shown that exercise programs can help people with COPD avoid exacerbations & hospitalisations. My PhD was all about understanding the link between changes in the immune system with exercise & risk of respiratory infection, albeit in a different population (endurance athletes).  I wanted to understand why people with COPD are susceptible to respiratory infections that are a major cause of exacerbations.