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Does branched-chain amino acid supplementation improve pulmonary rehabilitation effect in COPD?
de Bisschop, C, Caron, F, Ingrand, P, Bretonneau, Q, Dupuy, O, Meurice, JC
Respiratory medicine. 2021;:106642
Abstract
BACKGROUND Muscle wasting is frequent in chronic obstructive lung disease (COPD) and associated with low branched-chain amino acids (BCAA). We hypothesized that BCAA supplementation could potentiate the effect of a pulmonary rehabilitation program (PRP) by inducing muscular change. MATERIALS AND METHODS Sixty COPD patients (GOLD 2-3) were involved in an ambulatory 4-week PRP either with BCAA oral daily supplementation or placebo daily supplementation in a randomized double-blind design. Maximal exercise test including quadriceps oxygenation measurements, functional exercise test, muscle strength, lung function tests, body composition, dyspnea and quality of life were assessed before and after PRP. RESULTS Fifty-four patients (64.9 ± 8.3 years) completed the protocol. In both groups, maximal exercise capacity, functional and muscle performances, quality of life and dyspnea were improved after 4-week PRP (p ≤ 0.01). Changes in muscle oxygenation during the maximal exercise and recovery period were not modified after 4-week PRP in BCAA group. Contrarily, in the placebo group the muscle oxygenation kinetic of recovery was slowed down after PRP. CONCLUSION This study demonstrated that a 4-week PRP with BCAA supplementation is not more beneficial than PRP alone for patients. A longer duration of supplementation or a more precise targeting of patients would need to be investigated to validate an effect on muscle recovery and to demonstrate other beneficial effects.
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Intestinal function is impaired in patients with Chronic Obstructive Pulmonary Disease.
Kirschner, SK, Deutz, NEP, Jonker, R, Olde Damink, SWM, Harrykissoon, RI, Zachria, AJ, Dasarathy, S, Engelen, MPKJ
Clinical nutrition (Edinburgh, Scotland). 2021;(4):2270-2277
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Abstract
BACKGROUND & AIMS Gastrointestinal symptoms are prevalent extrapulmonary systemic manifestations of Chronic Obstructive Pulmonary Disease (COPD), but have been rarely studied. We dissected the perturbations in intestinal function in human patients with COPD using comprehensive metabolic and physiological approaches. METHODS In this observational study, small intestinal membrane integrity and active carrier-mediated glucose transport were quantified by sugar permeability test in 21 clinically stable patients with moderate to severe COPD (mean FEV1, 41.2 (3.2) % of predicted) and 16 healthy control subjects. Protein digestion and absorption was analyzed using stable tracer kinetic methods. Plasma acetate, propionate, and butyrate concentrations were measured as markers of intestinal microbial metabolism. RESULTS Compared with healthy controls, non carrier-mediated permeability was higher (0.062 (95% CI [0.046, 0.078]) vs. 0.037 (95% CI [0.029, 0.045]), P = 0.009) and active glucose transport lower in COPD (31.4 (95% CI [23.4, 39.4])% vs. 48.0 (95% CI [37.8, 58.3])%, P = 0.010). Protein digestion and absorption was lower in COPD (0.647 (95% CI [0.588, 0.705]) vs. 0.823 (95% CI [0.737, 0.909]), P = 0007), and impairment greater in patients with dyspnea (P = 0.038), exacerbations in preceding year (P = 0.052), and reduced transcutaneous oxygen saturation (P = 0.051), and was associated with reduced physical activity score (P = 0.016) and lower quality of life (P = 0.0007). Plasma acetate concentration was reduced in COPD (41.54 (95% CI [35.17, 47.91]) vs. 80.44 (95% CI [54.59, 106.30]) μmol/L, P = 0.001) suggesting perturbed intestinal microbial metabolism. CONCLUSIONS We conclude that intestinal dysfunction is present in COPD, worsens with increasing disease severity, and is associated with reduced quality of life.
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Chronic Obstructive Pulmonary Disease: A 2019 Evidence Analysis Center Evidence-Based Practice Guideline.
Hanson, C, Bowser, EK, Frankenfield, DC, Piemonte, TA
Journal of the Academy of Nutrition and Dietetics. 2021;(1):139-165.e15
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder in which patients are at high risk for both pulmonary and systemic complications of their disease. Medical nutrition therapy by a registered dietitian nutritionist can be an integral component of lifestyle treatment targeted at maintaining and improving outcomes, such as lung function, mortality, and quality of life. The Academy of Nutrition and Dietetics (Academy) convened an expert workgroup to conduct a systematic review to update the COPD Evidence-Based Nutrition Practice Guideline. This publication outlines the Academy's Evidence Analysis Library methods used to complete the systematic review and guideline and examines the recommendations and supporting evidence. A total of 14 recommendations were developed based on evidence from eight conclusions. Using the Nutrition Care Process as a framework for practice, recommendations rated as strong included assessing and monitoring and evaluating body weight and medical nutrition therapy by a registered dietitian nutritionist. Weak recommendations included predicting resting and total energy expenditure. All other recommendations were rated as fair. These included individualizing the calorie prescription and macronutrient composition of the diet; assessing and monitoring and evaluating energy intake, serum 25-hydroxyvitamin D levels, and frequency of exacerbations; and determining need for vitamin D supplementation. Fewer than one-third of the systematic review's conclusions could be used to support the recommendations due to conflicting results or limited or no evidence available. The Evidence Analysis Library 2019 COPD Evidence-Based Nutrition Practice Guideline is a valuable resource for registered dietitian nutritionists and other health care professionals caring for those with COPD.
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Specialized oral nutritional supplement (ONS) improves handgrip strength in hospitalized, malnourished older patients with cardiovascular and pulmonary disease: A randomized clinical trial.
Matheson, EM, Nelson, JL, Baggs, GE, Luo, M, Deutz, NE
Clinical nutrition (Edinburgh, Scotland). 2021;(3):844-849
Abstract
BACKGROUND & AIMS Oral Nutritional Supplements (ONS) are used to treat malnutrition and improve clinical outcomes in malnourished patients. Poor handgrip strength (HGS) is associated with an increased risk of mortality, disability and other adverse health consequences. This analysis examined the effect of a specialized ONS on HGS and its relationship to nutritional status in hospitalized, older adults with malnutrition who were participants in the NOURISH trial. METHODS We enrolled older (≥65years), malnourished (Subjective Global Assessment [SGA] class B/C) adults hospitalized for cardiovascular and pulmonary events: congestive heart failure, acute myocardial infarction, pneumonia and/or chronic obstructive pulmonary disease exacerbation in a double-blind, randomized, placebo-controlled trial (NOURISH study). During hospitalization and until 90 days after discharge, participants received standard-of-care plus a high protein and beta-hydroxy-beta-methylbutyrate containing ONS (S-ONS; n = 328) or a placebo supplement (n = 324), aimed at 2 servings/day. HGS was evaluated by dynamometer at baseline, hospital discharge, day (d) 30, d60, and d90 post-discharge. RESULTS Post hoc, repeated measures analysis of data at discharge, d30, d60, and d90 showed significantly higher HGS in the S-ONS vs. the placebo group in the evaluable group (Least Squares Means ± Standard Error: (23.25 ± 0.25 vs. 22.63 ± 0.25, p = 0.043). At d90, there was a significant positive association between HGS and nutritional status (SGA) improvements in the entire cohort: 49% of participants with increased HGS from discharge had improved nutritional status versus 31% with unchanged or decreased HGS (p = 0.003). HGS and the scores on the Katz index of independence in activities of daily living (ADL) were positively associated at all visits including all ITT subjects (Pearson's r range: 0.24 to 0.34, all p < 0.0001). CONCLUSIONS S-ONS provided during hospitalization and up to 90 days post-discharge improves HGS in malnourished older adults following cardiovascular and pulmonary events and may contribute to improvement in patients' overall recovery. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov NCT01626742.
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Pre-existing COPD is associated with an increased risk of mortality and severity in COVID-19: a rapid systematic review and meta-analysis.
Rabbani, G, Shariful Islam, SM, Rahman, MA, Amin, N, Marzan, B, Robin, RC, Alif, SM
Expert review of respiratory medicine. 2021;(5):705-716
Abstract
Objectives: The objective of this systematic review and meta-analysis was to investigate COVID-19 mortality and severity among patients with pre-existing COPD.Methods: We performed systematic searches in Ovid Medline, Embase via Ovid, PubMed, and Scopus from 15 December 2019 to 7 July 2020. Studies which reported the association and presented data on risk estimate (Hazard Ratio [HR]) with 95% confidence intervals (95%CIs) were extracted. A random-effects model was used to obtain the pooled estimates, and a pooled Risk Ratio (RR) was calculated. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale.Results: Our meta-analysis showed an increased likelihood of mortality in COVID-19 patients with pre-existing COPD (RR 3.18, 95% CI 2.11-4.80, HR 1.90, 95%CI 1.11-3.26). Furthermore, the pooled estimate for the association between pre-existing COPD and severity due to COVID-19 was also significant (RR 3.63, 95%CI 2.48-5.31). Males had an increased risk of mortality (RR 1.20, 95%CI 1.12-1.29) compared to females.Conclusion: We found that patients with pre-existing COPD had more than 3 times higher risk of mortality and severe COVID-19. There is a need to identify patients with pre-existing COPD during the pandemic so that early interventions can be aimed at this group of patients.
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The Impact of Pulmonary Rehabilitation on 24-Hour Movement Behavior in People With Chronic Obstructive Pulmonary Disease: New Insights From a Compositional Perspective.
Burge, AT, Palarea-Albaladejo, J, Holland, AE, Abramson, MJ, McDonald, CF, Mahal, A, Hill, CJ, Lee, AL, Cox, NS, Lahham, A, et al
Journal of physical activity & health. 2021;(1):13-20
Abstract
BACKGROUND Physical activity levels are low in people with chronic obstructive pulmonary disease, and there is limited knowledge about how pulmonary rehabilitation transforms movement behaviors. This study analyzed data from a pulmonary rehabilitation trial and identified determinants of movement behaviors. METHODS Objectively assessed time in daily movement behaviors (sleep, sedentary, light-intensity physical activity, and moderate- to vigorous-intensity physical activity) from a randomized controlled trial (n = 73 participants) comparing home- and center-based pulmonary rehabilitation was analyzed using conventional and compositional analytical approaches. Regression analysis was used to assess relationships between movement behaviors, participant features, and response to the interventions. RESULTS Compositional analysis revealed no significant differences in movement profiles between the home- and center-based groups. At end rehabilitation, conventional analyses identified positive relationships between exercise capacity (6-min walk distance), light-intensity physical activity, and moderate- to vigorous-intensity physical activity time. Compositional analyses identified positive relationships between a 6-minute walk distance and moderate- to vigorous-intensity physical activity time, accompanied by negative relationships with sleep and sedentary time (relative to other time components) and novel relationships between body mass index and light-intensity physical activity/sedentary time. CONCLUSION Compositional analyses following pulmonary rehabilitation identified unique associations between movement behaviors that were not evident in conventional analyses.
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In People With COPD, There Is Limited Evidence That Exercise Training Reduces Sedentary Time, and Behavior Change Techniques Are Poorly Reported: Systematic Review and Meta-Analysis.
Coll, F, Cavalheri, V, Gucciardi, DF, Wulff, S, Hill, K
Physical therapy. 2021;(7)
Abstract
OBJECTIVE In people with chronic obstructive pulmonary disease (COPD), the authors sought to explore (1) the effect of any intervention on the time spent in sedentary behavior and, (2) which behavior change techniques (BCTs) have shown promise in achieving this lifestyle target. METHODS Five electronic databases were searched on January 7, 2021. Studies were included if they (1) recruited people with stable COPD, (2) applied an intervention ≥4 weeks, and (3) measure sedentary time (ST) before and after the intervention period using wearable technology or via self-reports of television viewing. The primary analyses were restricted to data reported in randomized controlled trials (RCTs). All BCTs described during the intervention periods were mapped using an established taxonomy. RESULTS Of the 1142 records identified, 8 were RCTs, of which 6 had exercise training as the intervention. Random effects meta-analysis of data from 4 of these 6 trials that implemented exercise training showed no clear effect on ST (mean difference, -3.4 minutes; 95% CI, -27.9-21.0 minutes). Commonly mapped BCTs in the majority of studies included action planning and instruction on how to perform the behavior. Of all the BCTs mapped, 25% were reported with sufficient information to be graded "beyond reasonable doubt." CONCLUSION Despite robust evidence that exercise training improves functional outcomes and reduces dyspnea, this intervention does not seem to translate into behavior change. The primary analysis demonstrated that, in adults with COPD, the effect of exercise training on ST was, at best, uncertain. The BCTs embedded within the interventions were often poorly reported. Future RCTs are required that appropriately report BCT and ST to improve the precision of our estimate of the effect exercise training may have on ST, and BCTs used during intervention periods need to be reported with greater specificity. IMPACT In people with COPD, there is currently limited evidence to suggest that exercise training will reduce sedentary behavior. To move this area of research forward, BCTs embedded within these interventions need to be described with greater precision. LAY SUMMARY In people with COPD, interventions such as exercise training do not seem to produce a reduction in sedentary behavior (ie, time spent sitting or lying down) during daily life. The techniques used to help people change their sedentary behavior were poorly reported, so we do not know what exactly was done and therefore cannot know what may have worked well.
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Short Physical Performance Battery: Response to Pulmonary Rehabilitation and Minimal Important Difference Estimates in Patients With Chronic Obstructive Pulmonary Disease.
Stoffels, AA, De Brandt, J, Meys, R, van Hees, HW, Vaes, AW, Klijn, P, Burtin, C, Franssen, FM, van den Borst, B, Sillen, MJ, et al
Archives of physical medicine and rehabilitation. 2021;(12):2377-2384.e5
Abstract
OBJECTIVE To determine the response to a pulmonary rehabilitation (PR) program and minimal important differences (MIDs) for the Short Physical Performance Battery (SPPB) subtests and SPPB summary score in patients with chronic obstructive pulmonary disease (COPD). DESIGN Retrospective analysis using distribution- and anchor-based methods. SETTING PR center in the Netherlands including a comprehensive 40-session 8-week inpatient or 14-week outpatient program. PARTICIPANTS A total of 632 patients with COPD (age, 65±8y; 50% male; forced expiratory volume in the first second=43% [interquartile range, 30%-60%] predicted). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Baseline and post-PR results of the SPPB, consisting of 3 balance standing tests, 4-meter gait speed (4MGS), and 5-repetition sit-to-stand (5STS). The chosen anchors were the 6-Minute Walk Test and COPD Assessment Test. Patients were stratified according to their SPPB summary scores into low-performance, moderate-performance, and high-performance groups. RESULTS 5STS (∆=-1.14 [-4.20 to -0.93]s) and SPPB summary score (∆=1 [0-2] points) improved after PR in patients with COPD. In patients with a low performance at baseline, balance tandem and 4MGS significantly increased as well. Based on distribution-based calculations, the MID estimates ranged between 2.19 and 6.33 seconds for 5STS and 0.83 to 0.96 points for SPPB summary score. CONCLUSIONS The 5STS and SPPB summary score are both responsive to PR in patients with COPD. The balance tandem test and 4MGS are only responsive to PR in patients with COPD with a low performance at baseline. Based on distribution-based calculations, an MID estimate of 1 point for the SPPB summary score is recommended in patients with COPD. Future research is needed to confirm MID estimates for SPPB in different centers.
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The efficacy of vitamin D therapy for patients with COPD: a meta-analysis of randomized controlled trials.
Li, X, He, J, Yu, M, Sun, J
Annals of palliative medicine. 2020;(2):286-297
Abstract
BACKGROUND Many studies have demonstrated that vitamin D has clinical benefits when used to treat patients with chronic obstructive pulmonary disease (COPD). However, most of these studies have insufficient samples or inconsistent results. The aim of this meta-analysis was to evaluate the effects of vitamin D therapy in patients with COPD. METHODS We performed an electronic literature search of the databases PubMed, China National Knowledge Internet (CNKI), Embase, Web of Science and Wanfang Data. Meta-analysis was carried out by Review Manager Version 5.3 (Revman 5.3), and standardized mean difference (SMD) and mean difference (MD) were used to assess the efficacy of vitamin D therapy in patients with COPD. RESULTS A total of 25 articles involving 2,670 participants were included in this study. The overall results showed a statistical significance of vitamin D therapy in patients with COPD on forced expiratory volume in 1 second (FEV1) (SMD: 1.21, 95% CI: 0.76-1.66, P<0.01), FEV1/FVC (SMD: 1.07, 95% CI: 0.56-1.58, P<0.01), Exacerbations (SMD: 0.39, 95% CI: 0.23-0.64, P<0.01), Sputum volume (SMD: -6.02, 95% CI: -8.25 to 3.79, P<0.01), 6-minute walk distance (6MWD) (MD: 8.82, 95% CI: 1.67-15.98, P=0.02) and COPD assessment test (CAT) score (SMD: -1.19, 95% CI: -1.74 to 0.63, P<0.01). CONCLUSIONS Our analysis indicated that vitamin D used in patients with COPD could improve the lung function (FEV1, FEV1/FVC), 6MWD and reduce acute exacerbation, sputum volume and CAT score.
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Vitamin D Metabolism Is Dysregulated in Asthma and Chronic Obstructive Pulmonary Disease.
Jolliffe, DA, Stefanidis, C, Wang, Z, Kermani, NZ, Dimitrov, V, White, JH, McDonough, JE, Janssens, W, Pfeffer, P, Griffiths, CJ, et al
American journal of respiratory and critical care medicine. 2020;(3):371-382
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Rationale: Vitamin D deficiency is common in patients with asthma and chronic obstructive pulmonary disease (COPD). Low 25-hydroxyvitamin D (25[OH]D) levels may represent a cause or a consequence of these conditions.Objectives: To determine whether vitamin D metabolism is altered in asthma or COPD.Methods: We conducted a longitudinal study in 186 adults to determine whether the 25(OH)D response to six oral doses of 3 mg vitamin D3, administered over 1 year, differed between those with asthma or COPD versus control subjects. Serum concentrations of vitamin D3, 25(OH)D3, and 1α,25-dihydroxyvitamin D3 (1α,25[OH]2D3) were determined presupplementation and postsupplementation in 93 adults with asthma, COPD, or neither condition, and metabolite-to-parent compound molar ratios were compared between groups to estimate hydroxylase activity. Additionally, we analyzed 14 datasets to compare expression of 1α,25(OH)2D3-inducible gene expression signatures in clinical samples taken from adults with asthma or COPD versus control subjects.Measurements and Main Results: The mean postsupplementation 25(OH)D increase in participants with asthma (20.9 nmol/L) and COPD (21.5 nmol/L) was lower than in control subjects (39.8 nmol/L; P = 0.001). Compared with control subjects, patients with asthma and COPD had lower molar ratios of 25(OH)D3-to-vitamin D3 and higher molar ratios of 1α,25(OH)2D3-to-25(OH)D3 both presupplementation and postsupplementation (P ≤ 0.005). Intergroup differences in 1α,25(OH)2D3-inducible gene expression signatures were modest and variable if statistically significant.Conclusions: Attenuation of the 25(OH)D response to vitamin D supplementation in asthma and COPD associated with reduced molar ratios of 25(OH)D3-to-vitamin D3 and increased molar ratios of 1α,25(OH)2D3-to-25(OH)D3 in serum, suggesting that vitamin D metabolism is dysregulated in these conditions.