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Correspondence |

Renin-Angiotensin System Blockade and COPD FREE TO VIEW

Luca Mascitelli, MD; Francesca Pezzetta, MD
Author and Funding Information

Affiliations: Comando Brigata Alpina “Julia”, Udine, Italy,  Ospedale di San Vito al Tagliamento, San Vito al Tagliamento, Italy,  Kagoshima University Hospital, Kagoshima, Japan

Correspondence to: Luca Mascitelli, MD, Comando Brigata Alpina, Sanitary Service, Via S Agostino, 8, Udine 33100, Italy; e-mail: lumasci@libero.it



Chest. 2006;129(6):1734-1735. doi:10.1378/chest.129.6.1734
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Published online

To the Editor:

In a recent article in CHEST (December 2005),1 Matsuyama et al found that nutritional support with a diet that is rich an omega-3 polyunsaturated fatty acids had antiinflammatory effects and improved exercise tolerance in patients with COPD. However, they did not mention whether the studied population was receiving treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers.

Increasing evidence25 has suggested that renin-angiotensin system blockade exerts an antiinflammatory action in many systems. Furthermore, in COPD patients, lower ACE activity has been shown to be associated with improved pulmonary hemodynamic variables and improved tissue oxygenation during exercise.6

Therefore, therapy with ACE inhibitors or angiotensin II type 1 receptor blockers, which should be recommended in most patients with COPD, might have been a confounder in the study by Matsuyama and colleagues.1

Matsuyama, W, Mitsuyama, H, Watanabe, M, et al (2005) Effects of omega-3 polyunsaturated fatty acids on inflammatory markers in COPD.Chest128,3817-3827. [CrossRef] [PubMed]
 
Constantinescu, CS, Ventura, E, Hilliard, B, et al Effects of the angiotensin converting enzyme inhibitor captopril on experimental autoimmune encephalomyelitis.Immunopharmacol Immunotoxicol1995;17,471-491. [CrossRef] [PubMed]
 
Krootila, K, Oksala, O, Van Dickhoff, K, et al Effect of captopril on ocular irritative response to topical neutral formaldehyde and YAG-laser capsulotomy in the rabbit.J Ocul Pharmacol Ther1995;11,243-252. [CrossRef] [PubMed]
 
Fliser, D, Buchholz, K, Haller, H, et al Antiinflammatory effects of angiotensin II subtype 1 receptor blockade in hypertensive patients with microinflammation.Circulation2004;110,1103-1107. [CrossRef] [PubMed]
 
Graninger, M, Reiter, R, Drucker, C, et al Angiotensin receptor blockade decreases markers of vascular inflammation.J Cardiovasc Pharmacol2004;44,335-339. [CrossRef] [PubMed]
 
Kanazawa, H, Hirata, K, Yashikawa, J Effects of captopril administration on pulmonary hemodynamics and tissue oxygenation during exercise in ACE gene subtypes in COPD patients: a preliminary study.Thorax2003;58,629-631. [CrossRef] [PubMed]
 
To the Editor:

We appreciate the thoughtful comments by Mascitelli et al on our article in CHEST (December 2005)1demonstrating that nutritional support with an omega-3 polyunsaturated fatty acid (n-3 PUFA)-rich diet had antiinflammatory effects on and improved exercise tolerance in patients with COPD. As suggested by Mascitelli et al, rennin-angiotensin system blockade has an antiinflammatory effect on several organs,24 and in COPD patients the administration of angiotensin-converting enzyme (ACE) inhibitor was suggested to be associated with pulmonary hemodynamic variables and the state of tissue oxygenation during exercise.5 Actually, 12 patients in a group receiving a diet rich in n-3 PUFA and 13 patients in a group receiving a diet that was not rich in n-3 PUFA were treated with ACE inhibitors or angiotensin II type 1 receptor blockers. However, in a multiple regression analysis, this factor did not show significance for changes in inflammatory markers (ie, leukotriene B4 in sera, p = 0.452; leukotriene B4 in sputum, p = 0.543; interleukin-8 in sputum, p = 0.671; tumor necrosis factor-α, p = 0.518).

Therefore, we think that the reported antiinflammatory effect of nutritional support with a diet rich in n-3 PUFA in COPD patients in our study was not influenced by therapy with ACE inhibitor or angiotensin II type 1 receptor blocker medication. However, we cannot conclude that this is the case because it is possible that we had a negative regression result due to there being too few subjects in the study. In addition, we did not perform a power calculation. Therefore, we recommend performing a larger and longer study in the future that will include this issue.

References
Matsuyama, W, Mitsuyama, H, Watanabe, M, et al Effects of omega-3 polyunsaturated fatty acids on inflammatory markers in COPD.Chest2005;128,3817-3827. [CrossRef] [PubMed]
 
Constantinescu, CS, Goodman, DB, Ventura, ES Captopril and lisinopril suppress production of interleukin-12 by human peripheral blood mononuclear cells.Immunol Lett1998;62,25-31. [CrossRef] [PubMed]
 
Guba, M, Steinbauer, M, Buchner, M, et al Differential effects of short-term ace- and AT1-receptor inhibition on postischemic injury and leukocyte adherencein vivoandin vitro.Shock2000;13,190-196. [CrossRef] [PubMed]
 
Krootila, K, Oksala, O, Von Dickhoff, K, et al Effect of captopril on ocular irritative response to topical neutral formaldehyde and YAG-laser capsulotomy in the rabbit.J Ocul Pharmacol Ther1995;11,243-252. [CrossRef] [PubMed]
 
Kanazawa, H, Hirata, K, Yoshikawa, J Effects of captopril administration on pulmonary haemodynamics and tissue oxygenation during exercise in ACE gene subtypes in patients with COPD: a preliminary study.Thorax2003;58,629-631. [CrossRef] [PubMed]
 

Figures

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References

Matsuyama, W, Mitsuyama, H, Watanabe, M, et al (2005) Effects of omega-3 polyunsaturated fatty acids on inflammatory markers in COPD.Chest128,3817-3827. [CrossRef] [PubMed]
 
Constantinescu, CS, Ventura, E, Hilliard, B, et al Effects of the angiotensin converting enzyme inhibitor captopril on experimental autoimmune encephalomyelitis.Immunopharmacol Immunotoxicol1995;17,471-491. [CrossRef] [PubMed]
 
Krootila, K, Oksala, O, Van Dickhoff, K, et al Effect of captopril on ocular irritative response to topical neutral formaldehyde and YAG-laser capsulotomy in the rabbit.J Ocul Pharmacol Ther1995;11,243-252. [CrossRef] [PubMed]
 
Fliser, D, Buchholz, K, Haller, H, et al Antiinflammatory effects of angiotensin II subtype 1 receptor blockade in hypertensive patients with microinflammation.Circulation2004;110,1103-1107. [CrossRef] [PubMed]
 
Graninger, M, Reiter, R, Drucker, C, et al Angiotensin receptor blockade decreases markers of vascular inflammation.J Cardiovasc Pharmacol2004;44,335-339. [CrossRef] [PubMed]
 
Kanazawa, H, Hirata, K, Yashikawa, J Effects of captopril administration on pulmonary hemodynamics and tissue oxygenation during exercise in ACE gene subtypes in COPD patients: a preliminary study.Thorax2003;58,629-631. [CrossRef] [PubMed]
 
Matsuyama, W, Mitsuyama, H, Watanabe, M, et al Effects of omega-3 polyunsaturated fatty acids on inflammatory markers in COPD.Chest2005;128,3817-3827. [CrossRef] [PubMed]
 
Constantinescu, CS, Goodman, DB, Ventura, ES Captopril and lisinopril suppress production of interleukin-12 by human peripheral blood mononuclear cells.Immunol Lett1998;62,25-31. [CrossRef] [PubMed]
 
Guba, M, Steinbauer, M, Buchner, M, et al Differential effects of short-term ace- and AT1-receptor inhibition on postischemic injury and leukocyte adherencein vivoandin vitro.Shock2000;13,190-196. [CrossRef] [PubMed]
 
Krootila, K, Oksala, O, Von Dickhoff, K, et al Effect of captopril on ocular irritative response to topical neutral formaldehyde and YAG-laser capsulotomy in the rabbit.J Ocul Pharmacol Ther1995;11,243-252. [CrossRef] [PubMed]
 
Kanazawa, H, Hirata, K, Yoshikawa, J Effects of captopril administration on pulmonary haemodynamics and tissue oxygenation during exercise in ACE gene subtypes in patients with COPD: a preliminary study.Thorax2003;58,629-631. [CrossRef] [PubMed]
 
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