Nutritional Support

Several controlled studies have evaluated the effect of nutritional support in COPD in either outpatients or inpatients, and their outcome was related to the overall energy intake achieved. Weight gain was only achieved by substantially increasing energy intake by more than 30% above the usual intake, amounting to more than 45 kcal/kg per day. Moreover, improvement in muscle function or exercise tolerance occurred only with concomitant weight gain. In one of these controlled studies, oral supplementation was given for 3 months to ambulatory malnourished patients with chronic obstructive lung disease. Daily energy intake increased by 48% above the usual intake and corresponded to 47 kcal/ kg on average. The authors reported a mean weight gain of 4.2 kg, an increase in maximal respiratory pressures and in handgrip and stemomastoid strength, and a decrease in stemomastoid muscle fatigability; similar improvements were not observed in a control group. However, these improvements were not maintained when oral supplementation was discontinued. In another study, six malnourished patients received an additional 1000 kcal via a nasogastric tube for 16 days, whereas a control group of four received only an additional 100 kcal. A weight gain of 2.4 kg, and improvements in respiratory muscle strength and endurance were seen in the fed patients but not in the control group. Other studies have not demonstrated improvements in weight gain or muscle performance and have been less successful in increasing energy intake.

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