Réhabilitation respiratoire et prise en charge nutritionnelle dans la bronchopneumopathie chronique obstructive

Pulmonary rehabilitation is an effective therapeutic approach in chronic obstructive pulmonary disease (COPD) in term of improvement of the quality of life, dyspnea and exercice performance. It also has economical implications by reducing exacerbations, the number and the duration of the hospitalizations. Pulmonary rehabilitation is currently recommended among COPD patients presenting dyspnea, an impaired exercice performance or a reduction in their daily activity in connection with their disease inspite of an optimal treatment based on nicotinic weaning, bronchodilatators, and prevention of the infections. Pulmonary rehabilitation program may include cycle ergometry and inspiratory muscle training associated with an educational program concerning the disease and the nutritional aspects. It is recommended to carry out a precise nutritional evaluation comprising in addition to the recent weight history, a body mass index measurement (BMI) and a fat-free mass determination by impedancemetry if the BMI is between 21 and 26 kg/m². Smoking cessation, treatment of the bronchial infection and fractionned hypercaloric dietary intake are recommanded during the rehabilitation program. An oral supplementation near to 500 kcal/j, privileging the carbohydrates, is proposed in COPD patients during the rehabilitation program in case of BMI < 21 kg/m². In the litterature, this oral supplementation associated with the rehabilitation is likely to improve the outcome of training and the pronostic of the disease. In combinaison with the exercice training, anabolic steroids may have positive effects on body weight and fat-free mass by improvements in inspiratory muscle strength or exercice capacity. Nevertheless, further research is needed to confirm the effects of this anabolic intervention in term of efficacity and safety.     

Métabolisme des nutriments au cours de l'insuffisance respiratoire chronique

The effect of oxygen in modulating metabolism has been largely investigated in vitro and in animal studies, but very little in humans. This paper focuses on recent literature regarding pathological and physiological situations characterized by chronic exposure to hypoxia, particularly in patients with chronic respiratory insufficiency and in healthy subjects staying at high altitude. The latest allow for very interesting comparison because they do not experience comorbidities observed in patients with chronic respiratory insufficiency and therefore provide a unique model to assess the specific effect of hypoxia on human body and metabolism.     

Oxygène, stress oxydant et supplémentations antioxydantes ou un aspect différent de la nutrition dans les maladies respiratoires

Dioxygen is an element essential to our survival, our life, our development, our capacity of adaptation. Nevertheless, dioxygen is also at the origin of toxicity, acidity, deterioration, degeneration. Indeed, when the metabolism of dioxygen is altered, as in the respiratory diseases, an “oxidative stress” can appeared and induced metabolic anomalies associated with important consequences. Oxidative stress is defined as an imbalance between pro-oxidant (reactive oxygen species) and antioxidant factors, in favour of the former. The genomic, metabolic and functional modifications induced by oxidative stress were implied in the development of various degenerative diseases. Antioxidant treatments, in a nutritional or pharmacological way, appeared consequently as new potent therapies. In this review, the role of dioxygen in the cellular metabolism, and in the production of the reactive oxygen species is discussed. The negative effects of the oxidative stress on the organism are reported. Finally, the results of the studies on the nutritional antioxidant treatment firstly in the degenerative diseases, secondly in a chronic respiratory disease, the chronic obstructive pulmonary disease, are discussed in a last part.