Exploring the effects of inhaled corticosteroids on endothelial function in COPD patients undergoing an intensive pulmonary rehabilitation program

<bold>Background.</bold> Chronic obstructive pulmonary disease (COPD) has been associated with subclinical atherosclerosis and endothelial disfunction, with an overall increase in cardiovascular risk. In a previous study, we demonstrated that COPD patients undergoing an intensive pulmonary rehabilitation (PR) program improved their endothelial function assessed through flow-mediated dilation (FMD). The current study aims at investigating the possible effect of baseline inhaled corticosteroid (ICS) therapy on variations in FMD before and after PR. <bold>Methods.</bold> We retrospectively evaluated COPD patients referred to our centre between august 2020 and September 2022 for a 35-session PR program. We evaluated the baseline inhaled therapy at admission, baseline FMD values and FMD values at discharge. <bold>Results.</bold> 50 COPD patients were included in the final analysis. The patients were divided into two groups according to the presence or absence of an ICS in the stable maintenance therapy at admission (ICS+ or ICS-, respectively). The ICS+ Group consisted of 27 patients (16 males, 59.3%), while the ICS- group consisted of 23 patients (14 males, 60.9%). At baseline, there was no difference between the two groups in the median FMD values [3.12% (0.95 – 5.29) in the ICS+ vs. 3.39% (2.13 – 4.65) in the ICS-, p = 0.429]. FMD improved in both groups after PR (p always < 0.001), however with no significant difference in the variation of FMD (ΔFMD) between the two groups (p = 0.555). <bold>Conclusions.</bold> Our study underscored a significant impact of PR on endothelial function, with an overall improvement in FMD values regardless of the inhaled drug regimen at admission.