Nutritional support may be useful for people with stable chronic obstructive pulmonary disease

Key message: Nutritional supplementation should be considered in the management of malnourished people with stable chronic obstructive pulmonary disease, as there is growing evidence that it is beneficial in improving their weight, respiratory muscle strength and quality of life.

Adequate nourishment is a basic requirement for all of us and for those with chronic illnesses it can be a very significant factor, having considerable impact on their health and survival. About a third of people with chronic obstructive pulmonary disease (COPD) have some degree of malnutrition, which can contribute to reduced lung function and ability to exercise and a poorer quality of life. There is evidence that people with COPD and low body weight need more health care, including treatment in hospital. Nutritional support may be an important component in the management of COPD.

The Cochrane Airways Group has now updated their review on the impact of nutritional supplementation (any caloric supplementation given for at least two weeks) for people with stable COPD. They included 17 randomized controlled trials (RCTs) with 632 people (this update included four additional RCTs and data were updated for one other RCT). Thirteen studies took place in outpatient departments and 15 used oral supplementation.

What did they find?

Significant improvements following supplementation in:

•  weight, especially in malnourished patients
• measures of lean body mass
• respiratory muscle strength
• walking (measured by six minute walk test)
•  overall health-related quality of life

How good is the evidence?

• None of the outcomes is supported by high quality evidence. A few outcomes were supported by moderate quality (including weight gain) and most by low quality evidence, so it is likely that future research may change estimates of the effectiveness of nutritional supplementation for this population
• There were small numbers of people in the studies
• 5 RCTs combined nutritional supplementation with exercise, so any effects could be due to either or both of these components
• The studies used different ways of measuring and reporting health-related quality of life

This adds to a growing body of evidence that nutritional support for people with stable COPD and low body weight improves their weight, muscle strength and quality of life and it is hoped that this will result in a reduced need for hospitalization. The reviewers suggest that this should be explored in future trials, along with the effectiveness of nutritional supplementation for people with acute COPD. Nutrition is one aspect of COPD management covered in the NHS Improvement COPD clinical pathway, which is a really nicely presented document full of useful resources. You can access it from the link below, after the links to the review and its Cochrane summary.

Links:

Ferreira IM, Brooks D, White J, Goldstein R. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD000998. DOI: 10.1002/14651858.CD000998.pub3.

Cochrane summary: http://summaries.cochrane.org/CD000998/nutritional-supplementation-for-stable-chronic-obstructive-pulmonary-disease

NHS Improvement – Lung. Managing chronic obstructive pulmonary disease (COPD) as a long term condition. http://www.improvement.nhs.uk/ePublications/managingCOPD/