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Comando Brigata Alpina "Julia", Udine, Italy Ospedale di San Vito al Tagliamento, San Vito al Tagliamento, Italy
Correspondence to: Luca Mascitelli, MD, Comando Brigata Alpina, Sanitary Service, Via S Agostino, 8, Udine 33100, Italy; e-mail: lumasci{at}libero.it
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 evidence2345 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
References
Kagoshima University Hospital, Kagoshima, Japan
Correspondence to: Wataru Matsuyama, MD, PhD, Division of Respiratory Medicine, Respiratory and Stress Care Center, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima 890-8520, Japan; e-mail: vega{at}xa2.so-net.ne.jp
To the Editor:
We appreciate the thoughtful comments by Mascitelli et al on our article in CHEST (December 2005)1 demonstrating 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,234 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-
, 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
This article has been cited by other articles:
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  L. Mascitelli, F. Pezzetta, R. Tkacova, and P. Joppa Inhibition of the Renin-Angiotensin System in Patients With COPD and Pulmonary Hypertension Chest, March 1, 2007; 131(3): 938 - 939. [Full Text] [PDF]
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