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ACE and response to pulmonary rehabilitation in COPD: two observational studies
  1. Samantha S C Kon1,
  2. Caroline J Jolley2,
  3. Dinesh Shrikrishna1,
  4. Hugh E Montgomery3,
  5. James R A Skipworth3,
  6. Zudin Puthucheary2,
  7. John Moxham1,
  8. Michael I Polkey1,
  9. William D-C Man1 and
  10. Nicholas S Hopkinson1
  1. 1NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
  2. 2Department of Respiratory Medicine, King's College Hospital, London, UK
  3. 3Institute for Human Health and Performance University College, London, UK
  1. Correspondence to Dr Nicholas S Hopkinson; n.hopkinson{at}


Introduction Skeletal muscle impairment is an important feature of chronic obstructive pulmonary disease (COPD). Renin–angiotensin system activity influences muscle phenotype, so we wished to investigate whether it affects the response to pulmonary rehabilitation.

Methods Two studies are described; in the first, the response of 168 COPD patients (mean forced expiratory volume in one second 51.9% predicted) to pulmonary rehabilitation was compared between different ACE insertion/deletion polymorphism genotypes. In a second, independent COPD cohort (n=373), baseline characteristics and response to pulmonary rehabilitation were compared between COPD patients who were or were not taking ACE inhibitors or angiotensin receptor antagonists (ARB).

Results In study 1, the incremental shuttle walk distance improved to a similar extent in all three genotypes; DD/ID/II (n=48/91/29) 69(67)m, 61 (76)m and 78 (78)m, respectively, (p>0.05). In study 2, fat free mass index was higher in those on ACE-I/ARB (n=130) than those who were not (n=243), 17.8 (16.0, 19.8) kg m−2 vs 16.5 (14.9, 18.4) kg/m2 (p<0.001). However change in fat free mass, walking distance or quality of life in response to pulmonary rehabilitation did not differ between groups.

Conclusions While these data support a positive association of ACE-I/ARB treatment and body composition in COPD, neither treatment to reduce ACE activity nor ACE (I/D) genotype influence response to pulmonary rehabilitation.

  • Pulmonary Rehabilitation
  • COPD Pathology

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  • Contributors NSH, WD-CM, HM, MIP and JM conceived the study. SSCK, CJJ and DS collected data. JRAS and ZP performed genotyping. NSH and SSCK produced the first draft which all authors subsequently contributed to and approved in this final version. NSH is guarantor for the study.

  • Funding Medical Research Council (grant number G0701628) and British Lung Foundation (grant number TC 04/4).

  • Competing interests HM has held a consultancy with ARK therapeutics relating to ACE-I and muscle efficiency. The other authors have no conflicts of interest to declare.

  • Ethics approval Ethics Committee of King's College Hospital (05/Q0703/134).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Requests for data sharing can be made to the corresponding author.

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