Optimizing oral nutritional drink supplementation in patients with chronic obstructive pulmonary disease

Nutritional support is indicated in some patients with chronic obstructive pulmonary disease to restore nutritional status and improve functional capacity. However, the efficacy of nutritional supplements is sometimes disappointing, partly owing to a compensatory drop in habitual food intake. We retrospectively studied the effect of nutritional drink supplements, differing in portion size and energy content, on weight gain and body composition. Thirty-nine patients with stable chronic obstructive pulmonary disease, participating in an 8-week pulmonary rehabilitation programme and eligible for nutritional support, were studied. Group A (n 19) received three portions of 125 ml (2380 kJ), whereas group B (n 20) received three portions of 200 ml (3350 kJ) daily. The macronutrient composition of the regimens was similar (20 % protein, 60 % carbohydrates and 20 % fat). Lung function, body weight, body composition (by bio-electrical impedance analysis), habitual dietary intake (by dietary history) and resting energy expenditure (by ventilated hood) were determined. Weight gain was compared with expected weight as predicted by a computer simulation model. Although patients in both groups significantly increased in weight, this increase was higher in group A (A, 3.3 (sd 1.9) kg; B, 2.0 (sd 1.2) kg; P=0.019), while receiving less energy. The observed weight gain in group A was similar to that expected, but in group B it was lower than expected (P<0.001). In both groups, fat-free mass and fat mass were gained in a ratio of 2:1, fat-free mass increasing primarily during the first 4 weeks. This study illustrates that there might be an optimum for the portion size of nutritional drink supplements in chronic obstructive pulmonary disease and that more is not always better.     

Energy balance in depleted ambulatory patients with chronic obstructive pulmonary disease: the effect of physical activity and oral nutritional supplementation

Patients with chronic obstructive pulmonary disease (COPD) often suffer from weight loss. The aim of the present study was to gain insight into the energy balance of depleted ambulatory COPD patients, in relation to their habitual level of physical activity and consumption of oral nutritional supplements. Clinically stable and weight-stable patients (n 20; BMI 19.8+/- SD 2.0 kg/m2) were studied 1 and 3 months after rehabilitation or recovery in the clinic and were at random assigned to a control or intervention group with regard to nutritional supplementation. Energy intake was measured with a 7 d food record. Energy expenditure was estimated from a simultaneous 7 d assessment of physical activity with a tri-axial accelerometer for movement registration in combination with measured BMR. Body mass was measured at several time points. The body mass remained stable in both groups after 1 or 3 months and mean energy balances were comparable for both groups. The mean body-mass change between month 1 and 3 was negatively related to the mean physical activity level (r -0.49; P=0.03). Weight change over the 3 months was negatively associated with the physical activity level. These results suggest that knowledge about the individual physical activity level is necessary for the estimation of the energy need of the COPD patient.     

Vitamin E and vitamin C supplementation in patients with chronic obstructive pulmonary disease

The purpose of this study was to determine whether vitamin E or vitamin C supplementation alters the DNA damage of whole blood white blood cells (WBC) in patients with chronic obstructive pulmonary disease (COPD). Thirty-five patients with stable COPD were recruited in this randomized and placebo-controlled study. Patients were randomly assigned to placebo (n = 8), 400 mg/day vitamin E (E400, n = 9), 200 mg/day vitamin E (E200, n = 9), or 250 mg/day vitamin C (C250, n = 9) for 12 weeks. The results showed that vitamin E or C supplementation did not significantly change the mean level of endogenous DNA breakages. Whereas, after 12 weeks of vitamin supplementation, the H2O2-induced DNA breakages were significantly suppressed by 45%, 59%, and 52%, respectively, in E400, E250 and C250 groups (p < 0.05). In addition, neither the level of thiobarbituric acid-reactive substances (TBARS) nor spirometric parameters were significantly changed after 12 weeks of supplementation. In conclusion, vitamin E or C supplementation for 12 weeks may improve the resistance of DNA in whole blood WBC against oxidative challenge, although more research is needed to demonstrate the beneficial effect on slowing the decline of lung function in patients with COPD.     

观察综合性肺康复疗法在慢性阻塞性肺病稳定期患者治疗中的疗效

目的采用综合性肺康复法为COPD(慢性阻塞肺病)患者进行治疗,对其稳定期的治疗效果进行观察与探讨。方法选取该院2008年1月—2011年1月收治过的符合COPD相关诊断标准的患者,共88例,将其进行随机分组,分为两组,观察组与对照组各分有患者44例,于患者的稳定期开始,进行治疗。结论进行综合性肺康复治疗在COPD患者的稳定期具有非常重要的意义。     

氟康唑治疗老年慢性阻塞性肺疾病患者肺部真菌感染的疗效分析

目的 分析氟康唑治疗72例老年慢性阻塞性肺疾病患者并发肺部真菌感染的疗效及其安全性.方法 对2008年1月-2010年12月老年慢性阻塞性肺疾病住院患者肺部真菌感染的临床资料进行回顾性分析.结果 72例应用氟康唑治疗肺部真菌感染的患者,治愈率为76.4％,显效率为16.7％,无效率为6.9％;不良反应发生率为22.2％,无严重不良反应发生.结论 氟康唑治疗老年慢性阻塞性肺疾病患者肺部真菌感染安全有效.     

Pharmacological therapy of chronic obstructive pulmonary disease

None of the available drugs for chronic obstructive pulmonary disease is able to reduce the progressive decline in lung function which is the hallmark of this disease. Smoking cessation is the only intervention that has been shown so far to reduce disease progression. The current pharmacological therapy for chronic obstructive pulmonary disease is largely symptomatic and is based on bronchodilators including selective beta2-adrenoceptor agonists (short- and long-acting), anticholinergics, theophylline, or a combination of these drugs. Due to the lack of efficacy, side effects at high doses, and high costs, glucocorticoids should not be used routinely for management of stable chronic obstructive pulmonary disease, although they are effective for exacerbations. New pharmacological strategies for chronic obstructive pulmonary disease are needed because the current management is inadequate.     

慢性阻塞性肺病患者营养素摄入和营养状态的研究

通过对34例慢性阻塞性肺部疾病(COPD)患者每日膳食中营养素摄入量的调查和营养状态评定表明,虽然患者的习惯饮食中热量摄入超过被推荐的标准供应量(RDA),但仍普遍存在营养不良.研究提示,给与COPD患者合理的营养支持能改善营养不良,增强治疗效果,对预后产生积极作用.     

Circulating ghrelin in patients with chronic obstructive pulmonary disease

OBJECTIVE: Unexplained weight loss is common in patients with chronic obstructive pulmonary disease (COPD). Because ghrelin plays an important role in energy homeostasis, this study investigated the plasma level of ghrelin in COPD. METHODS: Plasma ghrelin levels and levels of leptin, tumor necrosis factor-alpha, and C-reactive protein were measured in 29 patients with COPD and 17 healthy controls. Body composition was assessed with bioelectrical impedance analysis. RESULTS: Body mass index and percentage of body fat were lower in patients who had COPD than in healthy controls. Plasma ghrelin and leptin concentrations were significantly lower in patients who had COPD than in healthy controls (ghrelin: 0.25+/-0.22 ng/mL versus 0.43+/-0.24 ng/mL, P=0.013; leptin: 1.77+/-0.70 ng/mL versus 2.85+/-0.96 ng/mL, P=0.000). In contrast, tumor necrosis factor-alpha and C-reactive protein were significantly higher in those with COPD than in controls. Plasma ghrelin (log transformed) was positively correlated with body mass index and percentage of body fat in patients with COPD but negatively correlated in control subjects. Plasma ghrelin was negatively correlated with tumor necrosis factor-alpha and C-reactive protein in COPD. CONCLUSION: Plasma ghrelin level was decreased in COPD and this is different from other weight-loss diseases. These data suggest that decreased ghrelin and other factors may contribute to alterations in metabolic status during inflammatory stress in this disease.     

团体认知行为疗法对老年慢性阻塞性肺疾病患者的干预效果研究

目的探讨团体认知行为疗法对老年慢性阻塞性肺疾病(COPD)患者焦虑、抑郁、自我效能及生活质量的干预效果.方法采用方便抽样的方法,选取2017年9月至2018年9月山西省某三级甲等医院呼吸与危重症医学科收治的276例老年COPD患者为研究对象,按入院时间将患者分为实验组(n=132)和对照组(n=144),对照组接受常规护理和健康教育,实验组在常规护理基础上增加团体认知行为干预,在干预前、干预后、干预后1个月使用抑郁自评量表、焦虑自评量表、一般自我效能量表、生活质量量表评价干预效果.结果干预前两组患者焦虑自评量表、抑郁自评量表、一般自我效能量表及生活质量量表评分差异均无统计学意义(P>0.05);干预后、干预后1个月两组患者焦虑自评量表、抑郁自评量表、生活质量量表、一般自我效能量表评分均优于干预前,且差异均具有统计学意义(P<0.05).结论团体认知行为疗法可缓解老年COPD患者的焦虑、抑郁症状,提升自我效能感,改善其生活质量.本研究为老年COPD患者心理护理方法的改进提供了科学依据,同时为其他慢病人群的护理管理和健康教育提供参考.     

Diaphragm dysfunction in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterised by alterations in the airways and lung parenchyma resulting in an increased respiratory workload. Besides an increased load and hyperinflation of the thorax, additional factors, such as systemic inflammation, oxidative stress, hypoxia and loss of muscle mass, further have a negative influence on diaphragm contractility. The diaphragm seems to adapt only partly to the altered circumstances to which it is exposed. As a consequence, several morphological, biochemical and functional alterations occur in the diaphragm, resulting in diaphragm dysfunction. In an appropriately selected group of patients, the function of the diaphragm can be improved by respiratory muscle training, oral nutritional therapy or hormonal interventions.     

煤工尘肺合并慢性阻塞性肺病患者的营养状况比较与分析

对246例稳定期煤工尘肺合并慢性阻塞性肺病(COPD)Ⅰ级、Ⅱ级、Ⅲ级及Ⅳ级四组患者的相关营养指标进行分析,煤工尘肺合并COPDⅣ级患者胖瘦程度、免疫功能及蛋白质营养状况等方面指标均低于其余三组患者。提示临床工作中应重视尘肺合并COPD患者,尤其是肺功能较差患者的营养状况,处于稳定期时给予恰当的营养支持治疗至关重要。     

Resting energy expenditure in patients with chronic obstructive pulmonary disease

Resting energy expenditure (REE) was measured in 68 patients with stable chronic obstructive pulmonary disease (COPD) and in 34 weight-stable, age-matched (65 +/- 8 y; means +/- SD) healthy control subjects. Fat-free mass (FFM) determined by bioelectrical resistance explained 84% of the variation in REE in the control group but only 34% in the COPD patients. REE could not reliably be predicted from regression equations either developed in healthy subjects or in COPD patients. REE adjusted for FFM was significantly higher (P less than 0.05) in weight-losing (n = 34) than in weight-stable (n = 34) patients (6851 +/- 781 and 6495 +/- 650 kJ/d, respectively). Pulmonary function was more compromised in weight-losing patients. Adjusted REE in weight-stable patients was significantly higher (P less than 0.01) than in the healthy control group (6131 +/- 405 kJ/d). In patients with COPD, factors in addition to FFM are important determinants of REE. A disease-related increase in REE develops, which may contribute to weight loss in COPD in combination with a lack of an adaptive response to undernutrition in weight-losing patients.     

Dietary problems in patients with severe chronic obstructive pulmonary disease

Background and aims Low body weight and low fat-free mass-index (FFMI) are common in patients with severe chronic obstructive pulmonary disease (COPD). Several factors seem to contribute. The aims of the present observational study were to investigate dietary problems in patients with severe COPD and to compare dietary problems to nutritional status, energy intake and smoking habits. Methods Nutritional status was assessed in 73 stable outpatients using body mass index and FFMI by single-frequency bioelectrical impedance. Lung function, smoking habits, energy intake and dietary problems were also assessed. Results The most frequently reported dietary problems were ‘anorexia’, ‘dyspeptic symptoms other than diarrhoea’, ‘slimming’, ‘fear of gaining weight’, ‘dyspnoea’, ‘diarrhoea’, ’depression, anxiety, solitude’. Smoking habits and gender had impact on the kind of dietary problems reported. Reporting two dietary problems correlated to low FFMI, whereas reporting one or more dietary problems correlated to decreased energy intake. Conclusion Dietary problems are common in the group studied and related to smoking habits and gender. Dietary problems affect energy intake and FFMI negatively. It is important to recognize dietary problems and to offer intervention of the dietary problems as a part of the dietary intervention.     

Clinical value of anthropometric estimates of leg lean volume in nutritionally depleted and non-depleted patients with chronic obstructive pulmonary disease

This study aimed to investigate the clinical usefulness of an anthropometrically based method for estimating leg lean volume (LLV) in patients with chronic obstructive pulmonary disease (COPD) who presented or not with nutritional depletion. We prospectively evaluated a group of forty-eight patients (thirty-eight males) with moderate to severe COPD (Global Initiative for Chronic Obstructive Lung disease stages II-IV) who underwent a 6 min walking test and knee isokinetic dynamometry. Leg lean mass (muscle mass plus bone) was determined by dual-energy X-ray absorptiometry (DEXA) with derivation of its respective volume: these values were compared with those obtained by the truncated cones method first described by Jones and Pearson in 1969. As expected, depleted patients (n 19) had reduced exercise capacity and impaired muscle performance as compared to non-depleted subjects (P < 0.01). The mean bias of the LLV differences between anthropometry and DEXA were 0.40 litre (95 % CI - 0.59, 1.39) and 0.50 litre (95 % CI - 1.08, 2.08) for depleted and non-depleted patients, respectively. Anthropometrically and DEXA-based estimates correlated similarly with muscle functional attributes. A ROC curve analysis revealed that leg height-corrected LLV values had acceptable sensitivity and specificity to identify depleted patients (area under the curve 0.93 (range 0.86-1.00); P < 0.001). Moreover, patients with LLV 相似文献   

Acute effects of different nutritional supplements on symptoms and functional capacity in patients with chronic obstructive pulmonary disease

BACKGROUND: Use of nutritional supplements in depleted patients with chronic obstructive pulmonary disease (COPD) requires optimization between positive effects on outcome and potential acute adverse effects on metabolism and exercise performance. OBJECTIVE: The aim of this study was to investigate the acute effects of nutritional supplements on metabolism and exercise capacity in stable COPD patients. DESIGN: In part 1, the effects of 3 different energy loads (placebo, 1046 kJ, and 2092 kJ) with a normal distribution of macronutrients were investigated in 14 COPD patients. In part 2, the effects of a fat-rich compared with a carbohydrate-rich supplement (both 1046 kJ) were studied in 11 COPD patients. The study was performed in a randomized, double-blind, crossover fashion. Metabolic and ventilatory variables were measured postprandially and during a submaximal cycle endurance exercise test. RESULTS: Overall, no immediate negative effects of the supplements were found in part 1. A slight but significant postprandial increase in respiratory quotient was found after the 1046-kJ and 2092-kJ supplements compared with placebo. There was no significant difference in metabolism or exercise capacity after a fat-rich or carbohydrate-rich supplement. Surprisingly, the change in shortness of breath (postprandial compared with preprandial) was significantly greater after the fat-rich supplement. CONCLUSIONS: An energy load up to 2092 kJ had no adverse immediate effect in COPD patients compared with placebo. The subjects who consumed the fat-rich supplement experienced more shortness of breath than did the subjects who consumed the carbohydrate-rich supplement.     

慢性阻塞性肺疾病患者呼吸机相关肺部感染的临床研究

目的研究慢性阻塞性肺疾病(COPD)患者实施机械通气过程中并发呼吸机相关肺部感染(VAP)的病原菌分布和相关危险因素,为临床治疗VAP提供参考依据。方法选取2012年1月-2016年1月128例实施机械通气的COPD患者为研究对象,观察COPD患者接受机械通气过程中的VAP发生率,对发生VAP的相关因素进行单因素和多因素logistic回归分析,同时患者留取合格痰标本进行痰培养检测病原菌分布情况。结果128例COPD患者发生VAP 88例,VAP发生率为68.75%;88例VAP患者痰标本共培养出病原菌125株,其中革兰阴性细菌103株占82.4%,革兰阳性细菌3株占2.4%,19株真菌占15.2%;COPD患者实施机械通气后发生VAP的独立危险因素为气管插管、合并糖尿病、机械通气持续时间≥3d、吸烟史以及留置胃管;VAP患者的病死率为31.8%,明显高于非VAP患者的7.5%。结论 COPD患者实施机械通气VAP发生率高,发生VAP的相关危险因素较多,临床应针对感染病原菌合理应用抗菌药物。     

Long-term hospital treatment for patients with chronic obstructive pulmonary disease

The aim of this study is to describe the long-term hospital treatment provided for chronic obstructive pulmonary disease (COPD) patients in Finland in 1972-2001 and changes over that period. Data on all treatment periods for persons aged over 45 years with a primary or secondary diagnosis of COPD (International Classification of Diseases - ICD 8: 491 and 492, ICD 9: 491, 492 and 496, ICD 10: J41-J44) beginning in the years 1972-2001 were gathered from the treatment register of the Finnish National Research and Development Centre for Welfare and Health and examined particularly with respect to long treatment periods (over 90 days). A total of 10,176 long treatment periods were recorded as having begun during the years in question. The number of treatment periods for men dropped by 65.8% over the time interval 1972-2001, while that for women increased by 4.7%. The number of treatment periods in university and central hospitals dropped by 97.6%. The total number of hospitalization days in the long treatment periods over the years 1972-2001 was 3,844,521, the men accounting for 82.9% in 1972-1976 and 67.3% in 1997-2001. The number of days required by men dropped by 82.1% and that for women by 57.8%. The number of days in university and central hospitals decreased by 98.4%, and that in health centre hospitals by 47.6%. COPD is a cause of repeated hospitalization, but it less and less often leads to long-term hospital treatment nowadays. The number of treatment days required for men has fallen more rapidly than that for women, and both the lengths and numbers of treatment periods have decreased at all levels of hospital, although with a tendency for treatment to be concentrated nowadays in the health centre hospitals. Long-term treatment for COPD has virtually disappeared from the sphere of specialized health care. The trends observed here are attributable to marked changes in the structure of the health service, with more accent being placed on open care, and a decrease in the numbers of male smokers.