Blood Flow during Handgrip Exercise in COPD: Effect of Vitamin C

Chronic obstructive pulmonary disease (COPD) is associated with vascular dysfunction, possibly related to increased oxidative stress. Exercise hyperemia may similarly be impaired, which could have implications for exercise limitations in COPD. We tested if brachial blood flow (BBF) was reduced during handgrip exercise in COPD and if this response would be improved after vitamin C infusion.

Doppler ultrasound was used to measure brachial blood flow and vascular conductance (BBF and BVC, respectively) during mild, rhythmic handgrip exercise (EX) under conditions of sham-saline and vitamin C. Measures of flow-mediated dilation (FMD) and nitroglycerine-mediated dilation were used to assess endothelial-dependent and independent dilation, respectively. Biomarkers of antioxidants (vitamin C, superoxide dismutase [SOD], catalase), oxidative stress (malondialdehyde [MDA], advanced oxidation protein products [AOPP]), and nitric oxide metabolism (NOx) were measured in blood plasma.

Ten COPD patients with moderate COPD and 10 healthy age-matched controls participated. COPD patients had similar increases in BBF and BVC during EX, compared with controls. Vitamin C was not found to have an effect on blood flow parameters during exercise (P > 0.05). Markers of endothelial-dependent dilation (FMD) and nitroglycerin-mediated dilation were similar between groups at baseline; FMD improved similarly in both groups after vitamin C.

Moderate COPD patients have a preserved BBF response during handgrip exercise and do not exhibit endothelial dysfunction. Despite an increase in endothelial-dependent dilation after vitamin C, BBF remained unchanged, suggesting a limited impact of endothelial-derived NO in determining the blood flow response to handgrip exercise in older individuals. COPD patients of moderate severity, screened for cardiovascular disease, do not exhibit endothelial dysfunction and have similar exercise blood flow responses to healthy controls.