scholarly journals Pulmonary Rehabilitation: The Reference Therapy for Undernourished Patients with Chronic Obstructive Pulmonary Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Nikolaos Samaras ◽  
Dimitrios Samaras ◽  
Arnaud Chambellan ◽  
Claude Pichard ◽  
Ronan Thibault
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Muscle Mass ◽  
Pulmonary Rehabilitation ◽  
Randomized Clinical Trials ◽  
Fat Free Mass ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Oral Nutritional Supplements

Chronic obstructive pulmonary disease (COPD) combines the deleterious effects of chronic hypoxia, chronic inflammation, insulin-resistance, increased energy expenditure, muscle wasting, and exercise deconditioning. As for other chronic disorders, loss of fat-free mass decreased survival. The preservation of muscle mass and function, through the protection of the mitochondrial oxidative metabolism, is an important challenge in the management of COPD patients. As the prevalence of the disease is increasing and the medical advances make COPD patients live longer, the prevalence of COPD-associated nutritional disorders is expected to increase in future decades. Androgenopenia is observed in 40% of COPD patients. Due to the stimulating effects of androgens on muscle anabolism, androgenopenia favors loss of muscle mass. Studies have shown that androgen substitution could improve muscle mass in COPD patients, but alone, was insufficient to improve lung function. Two multicentric randomized clinical trials have shown that the association of androgen therapy with physical exercise and oral nutritional supplements containing omega-3 polyinsaturated fatty acids, during at least three months, is associated with an improved clinical outcome and survival. These approaches are optimized in the field of pulmonary rehabilitation which is the reference therapy of COPD-associated undernutrition.

scholarly journals Development and Preliminary Evaluation of the Effects of an mHealth Web-Based Platform (HappyAir) on Adherence to a Maintenance Program After Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

10.2196/18465 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e18465 ◽  
Author(s):  
Begoña Jiménez-Reguera ◽  
Eva Maroto López ◽  
Shane Fitch ◽  
Lourdes Juarros ◽  
Marta Sánchez Cortés ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Care Plan ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Web Based ◽  
Maintenance Program ◽  
Copd Patients

Background Pulmonary rehabilitation is one of the main interventions to reduce the use of health resources, and it promotes a reduction in chronic obstructive pulmonary disease (COPD) costs. mHealth systems in COPD aim to improve adherence to maintenance programs after pulmonary rehabilitation by promoting the change in attitude and behavior necessary for patient involvement in the management of the disease. Objective This study aimed to assess the effects of an integrated care plan based on an mHealth web-based platform (HappyAir) on adherence to a 1-year maintenance program applied after pulmonary rehabilitation in COPD patients. Methods COPD patients from three hospitals were randomized to a control group or an intervention group (HappyAir group). Patients from both groups received an 8-week program of pulmonary rehabilitation and educational sessions about their illness. After completion of the process, only the HappyAir group completed an integrated care plan for 10 months, supervised by an mHealth system and therapeutic educator. The control group only underwent the scheduled check-ups. Adherence to the program was rated using a respiratory physiotherapy adherence self-report (CAP FISIO) questionnaire. Other variables analyzed were adherence to physical activity (Morisky-Green Test), quality of life (Chronic Obstructive Pulmonary Disease Assessment Test, St. George’s Respiratory Questionnaire, and EuroQOL-5D), exercise capacity (6-Minute Walk Test), and lung function. Results In total, 44 patients were recruited and randomized in the control group (n=24) and HappyAir group (n=20). Eight patients dropped out for various reasons. The CAP FISIO questionnaire results showed an improvement in adherence during follow-up period for the HappyAir group, which was statistically different compared with the control group at 12 months (56.1 [SD 4.0] vs 44.0 [SD 13.6]; P=.004) after pulmonary rehabilitation. Conclusions mHealth systems designed for COPD patients improve adherence to maintenance programs as long as they are accompanied by disease awareness and patient involvement in management. Trial Registration ClinicalTrials.gov NCT04479930; https://clinicaltrials.gov/ct2/show/NCT04479930

scholarly journals Neuromuscular electrostimulation as an adjuvant therapy to pulmonary rehabilitation programs in chronic obstructive pulmonary disease

2020 ◽  
pp. 80-84
Author(s):  
Daniel TRĂILĂ ◽  
Camelia PESCARU ◽  
Noemi SUPPINI POROJAN ◽  
Camil MIHUTA ◽  
Patricia HOGEA ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Muscle Mass ◽  
Pulmonary Rehabilitation ◽  
Rehabilitation Program ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Lower Extremity Muscle ◽  
Group B ◽  
Neuromuscular Electrostimulation

Introduction. Chronic obstructive pulmonary disease (COPD) is commonly associated with a vicious circle of sedentary lifestyle - deconditioning - muscular dysfunction. High-frequency neuromuscular electrostimulation has demonstrated beneficial effects among subjects with muscle weakness. This study aimed to evaluate the benefits of merging pulmonary rehabilitation program (PRP) with neuromuscular electrostimulation in patients with very severe COPD. Material and methods. The study included 38 males with clinically stable COPD, who were divided in 2 groups: group A-19 patients that underwent a PRP of 5 sessions/week for 4 weeks and group B-19 patients that underwent intercostal and lower extremity muscle electrostimulation (5 sessions/week for 4 weeks, 60 min /session) in association with the same type of PRP. Saint Georges’s Respiratory Questionnaire (SGRQ), Modified Medical Research Council (mMRC) dyspnea scale, spirometry, maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax), six minutes walking test (6MWT) and bio-electrical impedance were examined before and after the intervention. Results. Electrostimulation applied in group B increased muscle mass (50.15 ± 0.61kg vs 53.97 ± 0.87kg, p<0.001)., PEmax (5.41 ± 0.25 vs post 6.79 ± 0.22, p<0.0003) and improved mMRC score (2.68 ± 0.15 vs 2.10 ± 0.15, p<0.0109), 6MWT (369.6 ± 10.77m vs post: 445.6 ± 6.03 m) and SGRQ (61.32 ± 1.83 vs. 44.95 ± 1.94, p<0.0001). In group B only SGRQ score (55.05 ± 1.32 vs. 50.05 ± 1.51, p=0.018) was improved after PRP. Conclusion. A protocol which combines PRP with neuromuscular electrical stimulation in patients with very severe forms of COPD, has grater beneficial effect on dyspnoea, exercise tolerance, muscle mass toning and quality of life, compared with PRP alone.

scholarly journals ‘Mind the gap’: the importance of managing malnutrition in chronic obstructive pulmonary disease

2019 ◽  
Vol 28 (22) ◽  
pp. 1442-1449
Author(s):  
Alison Burton Shepherd ◽  
Karen Bowell
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
High Energy ◽  
Economic Effects ◽  
Fat Free Mass ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Oral Nutritional Supplements ◽  
Improve Compliance ◽  
Poor Outcomes

Malnutrition is linked to poor outcomes in patients with chronic obstructive pulmonary disease (COPD), and reduced fat free mass and low BMI are independent risk factors for increased mortality. However, weight loss is not inevitable and can be prevented or reversed so screening for malnutrition is essential. The latest guidelines for managing malnutrition in COPD recommend first-line nutritional support. In particular, patients with a BMI <20 kg/m2 should be prescribed oral nutritional supplements (ONS), which have been shown to significantly improve outcomes. However, this guidance is often not implemented locally, increasing the likelihood of malnutrition, hospital admission and increased healthcare costs. Ready-prepared, low-volume, high-protein, high-energy drinks can improve compliance with ONS, particularly in people who are unable to tolerate high volumes. ONS therefore play an important role in managing malnutrition in COPD, helping to reduce its physiological and economic effects.

scholarly journals Association of energy and protein intakes with length of stay, readmission and mortality in hospitalised patients with chronic obstructive pulmonary disease

2018 ◽  
Vol 119 (5) ◽  
pp. 543-551 ◽  
Author(s):  
Arora R. Ingadottir ◽  
Anne M. Beck ◽  
Christine Baldwin ◽  
C. Elizabeth Weekes ◽  
Olof G. Geirsdottir ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Protein Intake ◽  
Nutritional Risk ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Oral Nutritional Supplements

AbstractLow energy and protein intakes have been associated with an increased risk of malnutrition in outpatients with chronic obstructive pulmonary disease (COPD). We aimed to assess the energy and protein intakes of hospitalised COPD patients according to nutritional risk status and requirements, and the relative contribution from meals, snacks, drinks and oral nutritional supplements (ONS), and to examine whether either energy or protein intake predicts outcomes. Subjects were COPD patients (n 99) admitted to Landspitali University Hospital in 1 year (March 2015–March 2016). Patients were screened for nutritional risk using a validated screening tool, and energy and protein intake for 3 d, 1–5 d after admission to the hospital, was estimated using a validated plate diagram sheet. The percentage of patients reaching energy and protein intake ≥75 % of requirements was on average 59 and 37 %, respectively. Malnourished patients consumed less at mealtimes and more from ONS than lower-risk patients, resulting in no difference in total energy and protein intakes between groups. No clear associations between energy or protein intake and outcomes were found, although the association between energy intake, as percentage of requirement, and mortality at 12 months of follow-up was of borderline significance (OR 0·12; 95 % CI 0·01, 1·15; P=0·066). Energy and protein intakes during hospitalisation in the study population failed to meet requirements. Further studies are needed on how to increase energy and protein intakes during hospitalisation and after discharge and to assess whether higher intake in relation to requirement of hospitalised COPD patients results in better outcomes.

scholarly journals Using Telehealth Technology to Deliver Pulmonary Rehabilitation to Patients with Chronic Obstructive Pulmonary Disease

2011 ◽  
Vol 18 (4) ◽  
pp. 216-220 ◽  
Author(s):  
Michael K Stickland ◽  
Tina Jourdain ◽  
Eric YL Wong ◽  
Wendy M Rodgers ◽  
Nicholas G Jendzjowsky ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Primary Outcome Measure ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

BACKGROUND: Pulmonary rehabilitation (PR) is an effective therapeutic strategy to improve health outcomes in patients with chronic obstructive pulmonary disease (COPD); however, there is insufficient PR capacity to service all COPD patients, thus necessitating creative solutions to increase the availability of PR.OBJECTIVE: To examine the efficacy of PR delivered via Telehealth (Telehealth-PR) compared with PR delivered in person through a standard outpatient hospital-based program (Standard-PR).METHODS: One hundred forty-seven COPD patients participated in an eight-week rural PR program delivered via Telehealth-PR. Data were compared with a parallel group of 262 COPD patients who attended Standard-PR. Education sessions were administered two days per week via Telehealth, and patients exercised at their satellite centre under direct supervision. Standard-PR patients viewed the same education sessions in person and exercised at the main PR site. The primary outcome measure was change in quality of life as evaluated by the St George’s Respiratory Questionnaire (SGRQ). A noninferiority analysis was performed using both intention-to-treat and per-protocol approaches.RESULTS: Both Telehealth-PR and Standard-PR resulted in clinically and statistically significant improvements in SGRQ scores (4.5±0.8% versus 4.1±0.6%; P<0.05 versus baseline for both groups), and the improvement in SGRQ was not different between the two programs. Similarly, exercise capacity, as assessed by 12 min walk test, improved equally in both Telehealth-PR and Standard-PR programs (81±10 m versus 82±10 m; P<0.05 versus baseline for both groups).CONCLUSION: Telehealth-PR was an effective tool for increasing COPD PR services, and demonstrated improvements in quality of life and exercise capacity comparable with Standard-PR.

scholarly journals The Effect of Ophiocephalus Striatus Extract on suPAR, Neutrophil Levels and Lung Diffusion Capacity (DLCO) in Stable Chronic Obstructive Pulmonary Disease (COPD) Patients with Muscle Wasting

2019 ◽  
Vol 39 (2) ◽  
pp. 79-87
Author(s):  
Sasongko Adhi Nugroho ◽  
Teguh Rahayu Sartono ◽  
Susanthy Djajalaksana ◽  
Harun Al Rasyid
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Muscle Wasting ◽  
Fat Free Mass ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Diffusion Capacity ◽  
Copd Patients

Background: Muscle wasting is one of the extrapulmonary manifestation which influence quality of life in Chronic Obstructive Pulmonary Disease (COPD) patients. It caused by imbalance of protein metabolism in skeletal muscle. This study aimed to evaluate the effect of Ophiocephalus striatus extract on neutrophil count, soluble urokinase-type plasminogen activator (suPAR) level, diffusion capacity of lung for carbon monoxide (DLCO) and quality of life in stable COPD patients with muscle wasting. Methods: Clinical pre and post quasi experimental study was conducted to 32 stable muscle-wasted COPD patients from Pulmonary Outpatient Clinic Saiful Anwar Hospital Malang, determined by The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016, Bioelectrical impedance analysis (BIA) dengan fat-free mass (FFM)

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