Serum lipidomics in patients with sarcoidosis before and after pulmonary rehabilitation

This study aimed to determine the use of lipid profiling to assess the effects of pulmonary rehabilitation on patients with sarcoidosis. Serum was collected from 14 patients with newly diagnosed II stage of sarcoidosis (up to 6 months, aged 34–63 years) before and after pulmonary rehabilitation in the Department of Lung Diseases and Tuberculosis between November 2015 and December 2017. Before and after pulmonary rehabilitation all patients had evaluated: - fatigue by Fatigue Assessment Scale (FAS) - the level of dyspnea by The Medical Research Council (MRC) questionnaire - forced vital capacity, forced expiratory volume during the first second, total lung capacity, and transfer factor for carbon monoxide (TLCO) - mobility by the 6-minute walk test (6MWT) - muscle strength: the maximal isometric grip strengths of the left and right hands by hydraulic hand dynamometer and expressed in kilograms (kg), respiratory muscle force by the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). - blood analysis: serum glucose, urea, creatinine, total protein, C-reactive protein (CRP), angiotensin converting enzyme (ACE), total protein, total cholesterol (TCH), triglycerides (TG), low-density lipoprotein concentration (LDL-c), and high-density lipoprotein concentration (HDL-c), the markers of inflammation and cell damage (sICAM-1, TNF-a, and IL-6), myosin and myoglobin. Intervention Patients were encouraged to start a 3-week physical training program (5 days a week), which was supervised by a physical therapist and based on their physical performance assessed at baseline. The exercise program included three major components, namely, aerobic endurance training (stationary cycling or treadmill up to 30 min/day), inspiratory muscle training, and peripheral muscle strength training (three sets of 15–20 repetitions of five different exercises). The resistance level was individualized for each patient (in accordance with patient preference), reassessed, and adjusted after every session using the Borg Rating of Perceived Exertion. Inspiratory muscle training was introduced using the Threshold IMP (Healthdyne Technologies, Great Britain) and consisted of six courses of inspiratory exercises with five inspiratory maneuvers in each series and 1 min of rest between them. After completing the exercises, the subjects were required to cool down for 5 min. All exercise modalities were progressed regularly by an experienced exercise physiologist to maintain dyspnea Borg RPE score of 13-15. Pulse-oximetry was used to monitor peripheral oxygen saturation levels during exercises. Supplemental oxygen use during training was commensurate with current prescriptions. It was provided during training if SpO2 on room air was below 88% whilst exercising and was titrated to maintain a SpO2 above 90%. During exercises pulse was monitored continuously, and patients were encouraged to increase their effort to 70% of Pulse max according to the Karvelen’s formula.