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Patients with chronic obstructive pulmonary disease (COPD) show systemic consequences, such as chronic systemic inflammation leading to changes in the airway, airway penetrability, and endothelial function. Endothelial dysfunction is characterized by a list of alterations of endothelium towards reduced vasodilation, proinflammatory state, detachment and apoptosis of endothelial cells, and development of atherosclerosis. COPD-induced endothelial dysfunction is associated with elevated cardiovascular risk. The increment of physical activities such as pulmonary rehabilitation (PR) training have a significant effect on COPD, thus, PR can be an integrative part of COPD treatment. In this narrative review the focus is on the function of endothelial inflammatory mediators [cytokines, chemokines, and cellular proteases] and pulmonary endothelial cells and endothelial dysfunction in COPD as well as the effects of dysfunction of the endothelium may play in COPD-related pulmonary hypertension. The relationship between smoking and endothelial dysfunction is also discussed. The connection between different pulmonary rehabilitation programs, arterial stiffness and pulse wave velocity (PWV) is presented. Endothelial dysfunction is a significant prognostic factor of COPD, which can be characterized by PWV. We discuss future considerations, like training programs, as an important part of the treatment that has a favorable impact on the endothelial function.

Background: Chronic obstructive pulmonary disease (COPD) may have considerable cardiovascular risk. Physical activity has a paramount role in COPD treatment. Our aim was to evaluate the applicability of arteriograph in COPD and measure the effectiveness of pulmonary rehabilitation on endothelial function., Methods: A total of 40 patients with COPD (FEV 1 : 45.43±20.20%pred, BMI: 27.99±6.98 kg/m 2 , male: female was 21:19, age: 65.47±7.39 years) participated in a 4-week rehabilitation program. We used a patented, invasively validated Arteriograph. Blood pressure, pulse, augmentation index (AIX), pulse wave velocity (PWV), diastolic area index (DAI) were registered with functional measurements in pulmonary rehabilitation., Results: Pulmonary rehabilitation was effective in 6 minutes walking distance (6MWD: 335.32±110.43 vs. 398.32±126.21 m), maximal inspiratory pressure (MIP: 57.72±22.69 vs. 63.63±18.01 cmH 2 O), chest wall expansion (CWE: 2.84±1.26 vs. 4.00±1.76 cm), breath holding time (BHT: 25.77±10.63 to 29.21±11.60 sec) and grip strength (GS: 24.87±11.88 vs. 27.03±11.43 kg) (P<0.05). Improvement in quality of life was monitored by COPD assessment test marker (CAT: 17.00±8.49 vs. 11.89±7.31, P<0.05). Systolic (133.38±22.15 vs. 126.48±20.22 mmHg) and diastolic blood pressure (76.95±14.37 vs. 75.4±12.7 mmHg) showed a reduction tendency. Pulse also decreased (76.95±14.37 vs. 72.53±13.65 bpm). AIX levels showed slight improvement (3.54±35.59% vs. 2.93±30.79%); 23 patients peripheral circulation progressed. The PWV data showed abnormal elasticity with minimal change (11.74±2.13 vs. 11.4±2.73 m/s); although 20 patients showed improvement. DAI detected slightly diminished coronary circulation with moderate improvement (43.32±6.81 vs. 47.1±7.01 m/s)., Conclusions: Elevated arterial stiffness, high PWV turned the COPD patients to the high/very high-risk cluster. Rehabilitation resulted significant improvement in MIP, CWE, BHT, 6MWD, CAT with mild, but favorable changes in blood pressure, pulse, AIX, PWV. As a consequence of the four weeks rehabilitation period overall quality of life improved and cardiovascular risk showed a reduction tendency in COPD., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.