CHEST Guidelines-Response_chest

Response_chest_18

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The letter to the editor by Drs. I-Hsuan Wu and Jin-Shang Wu addresses comments made by Drs. Andreas and Reinhardt regarding their study on the association between restrictive spirometry patterns (RSP) and arterial stiffness. The original study was cross-sectional, limiting the ability to establish causality between RSP and arterial stiffness. The authors acknowledge that while there is a proposed link involving systemic inflammation, data on systemic inflammation parameters were unavailable. They also mention studies that suggest a pro-inflammatory state could precede RSP, which may then lead to metabolic syndrome, diabetes, and cardiovascular disease.<br /><br />The letter highlights the potential connection between restrictive lung disease, sympathetic activation, and increased arterial stiffness. Sympathetic activation, linked to conditions like COPD, is noted to be independent of aortic pulse wave velocity, a measure of arterial stiffness. A particular study cited suggests a relationship between RSP and sympathetic hyperactivity in heart failure patients, although direct evidence of this association with arterial stiffness is lacking. The authors recognize the role of the autonomic nervous system in managing inflammation and immune responses, suggesting a possible reciprocal causation between systemic inflammation and sympathetic hyperactivity.<br /><br />Drs. Wu agree that sympathetic activation may be implicated in the linkage between restrictive lung disease and arterial stiffness, potentially leading to cardiovascular diseases. However, they emphasize the need for further studies to verify whether sympathetic activation and increased vascular smooth muscle tone contribute to the increased arterial stiffness observed in RSP.<br /><br />This exchange underscores ongoing research efforts to understand the complex interactions between respiratory function, systemic inflammation, autonomic nervous system activity, and cardiovascular health.

Keywords

restrictive spirometry patterns

arterial stiffness

systemic inflammation

sympathetic activation

cardiovascular disease

autonomic nervous system

restrictive lung disease

vascular smooth muscle

metabolic syndrome

cross-sectional study