Responsiveness to pulmonary rehabilitation in COPD is associated with changes in microbiota
Authors: Melo-Dias Sara , Cabral Miguel , Furtado Andreia , Souto-Miranda Sara , Mendes Maria Aurora , Cravo João , Almeida Catarina R. , Marques Alda , Sousa Ana 
Published: November 2022

AbstractBackgroundPulmonary Rehabilitation (PR) is one of the most cost-effective therapies for chronic obstructive pulmonary disease (COPD) management. There are, however, people who do not respond to PR and reasons for non-response are mostly unknown. PR is likely to change the airway microbiota and this could play a role in its responsiveness. In this study we have explored the association between PR effectiveness and specific alterations in oral microbiota and inflammation.MethodsA prospective longitudinal study was conducted. Data on exercise capacity, dyspnoea, impact of disease and 418 saliva samples were collected from 76 patients, half of whom participated in a 12-weeks PR programme. Responders and non-responders to PR (dyspnoea, exercise-capacity and impact of disease) were defined based on minimal clinically important differences.ResultsChanges in microbiota, includingPrevotella melaninogenicaandStreptococcuswere observed upon PR.Prevotella, previously found to be depleted in severe COPD, increased during the first month of PR in responders. This increase was negatively correlated withStreptococcusandLautropia, known to be enriched in severe cases of COPD. Simultaneously, an anti-inflammatory commensal of the respiratory tract,Rothia,correlated strongly and negatively with several pro-inflammatory markers, whose levels were generally boosted by PR.Conversely, in non-responders, the observed decline inPrevotellacorrelated negatively withStreptococcusandLautropiawhose fluctuations co-occurred with several pro-inflammatory markers.ConclusionsPR is associated with changes in oral microbiota. Specifically, PR increases salivaryPrevotella melaninogenicaand avoids the decline inRothiaand the increase inStreptococcusandLautropiain responders, which may contribute to the benefits of PR.Notation of prior abstract publication/presentationS. Melo-Dias, M. Cabral, A. Furtado, S. Souto-Miranda, J. Cravo, M. A. Mendes, C. R. Almeida, A. Marques,A. Sousa, 2022,“Responsiveness to pulmonary rehabilitation is related with changes in oral microbiota of people with COPD”(Oral communication in 38° Congresso de Pneumologia,November 2022)S. Melo-Dias, M. Cabral, A. Furtado, S. Souto-Miranda, J. Cravo, M. A. Mendes, C. R. Almeida, A. Marques, A. Sousa, 2022,“Pulmonary rehabilitation changes the oral microbiota of people with COPD”(Oral communication inERS International Congress, September 2022)S. Melo-Dias, M. Cabral, A. Furtado, S. Souto-Miranda, C. R. Almeida, A. Marques, A. Sousa, 2022,“The Effectiveness of pulmonary rehabilitation in COPD is associated with specific shifts in oral microbiota”(Poster presentation in the7thmeeting of International Society for Evolution, Medicine and Public Health, July 2022)A. Furtado, S. Melo-Dias, M. Cabral, A. Marques, A. Sousa, 2021,“The effect of pulmonary rehabilitation in salivary microbiota of people with chronic obstructive pulmonary disease: A longitudinal study”(Poster presentation inIV International Conference - “Microbiota and Health”, 22 October 2021)