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 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 Nutritional modulation as part of the integrated management of chronic obstructive pulmonary disease

2003 ◽  
Vol 62 (4) ◽  
pp. 783-791 ◽  
Author(s):  
Annemie Schols
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Weight Loss ◽  
Dietary Intake ◽  
Pulmonary Disease ◽  
Systemic Inflammation ◽  
Integrated Management ◽  
Fat Free Mass ◽  
Functional Improvement ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Weight loss is a frequent complication in patients with chronic obstructive pulmonary disease (COPD) and is a determining factor for functional capacity, health status and mortality. Weight loss in COPD is a consequence of an inbalance between increased energy requirements and dietary intake. Both metabolic and mechanical inefficiency may contribute to elevated energy expenditure during physical activity, while systemic inflammation has been associated with hypermetabolism at rest. Disease-specific symptoms and systemic inflammation may impair appetite and dietary intake. Altered intermediary metabolism may cause disproportionate wasting of fat-free mass in some patients. A combination of nutritional support and exercise as an anabolic stimulus appears to be the best approach to obtaining marked functional improvement. Patients responding to this treatment even demonstrated a decreased mortality. The effectiveness of anti-catabolic modulation requires further investigation.

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.

The Prognostic Value of Hypophosphatemia in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Azza A. Abd Elalim ◽  
Ramy M Wahba ◽  
Tarek S Shabana ◽  
Sarah T.S Dabbour
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
High Energy ◽  
Chronic Obstructive ◽  
Close Monitoring ◽  
Obstructive Pulmonary Disease ◽  
Ventilation Duration ◽  
Phosphorus Levels

Abstract Background Phosphorus (P) is an important electrolyte that plays a significant role in different physiological processes especially muscle contraction and adenosine triphosphate high energy bonds. Low phosphorus level in blood may increase the exacerbation of chronic obstructive pulmonary disease, need, and duration of mechanical ventilation. Objective To examine the prognostic effects of hypophosphatemia in COPD patients and evaluate the correlation between phosphorus levels and severity of attacks, need for mechanical ventilation, duration of The ICU stays and mortality. Methods This study was performed on 72 patients with acute exacerbation of COPD admitted in chest department and respiratory ICU in Ain Shams University Hospital in the period between June 2019 & March 2020. Results The study showed Low blood phosphorus levels contribute to an increase in: COPD flare-up with high statistically significant value (p &lt; 0.001), also the need for ventilation, duration of ventilation, duration of hospitalization, days in intensive care units and finally increased rate of mortality were statistically significant value p-value (0.002, 0.024, 0.021 & 0.001) respectively. Conclusion Close monitoring and careful adjustment of disorders correlated to electrolyte such as phosphorus, are crucial and may improve prognosis and also increase the survival rate of patients with COPD.

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