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 Something done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. 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 Randomization is the process of randomly dividing into groups the people taking part in a trial. One group (the intervention group) will be given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group). A trial in which a group (the ‘intervention group’) is given a intervention being tested (for example a drug, surgery, or exercise) is compared with a group which does not receive the intervention (the ‘control group’). (RCTs) with 632 people (this update included four additional RCTs and Data is the information collected through research. 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 are measures of health (for example quality of life, pain, blood sugar levels) that can be used to assess the effectiveness and safety of a treatment or other intervention (for example a drug, surgery, or exercise). In research, the outcomes considered most important are ‘primary outcomes’ and those considered less important are ‘secondary outcomes’. is supported by high quality evidence. A few Outcomes are measures of health (for example quality of life, pain, blood sugar levels) that can be used to assess the effectiveness and safety of a treatment or other intervention (for example a drug, surgery, or exercise). In research, the outcomes considered most important are ‘primary outcomes’ and those considered less important are ‘secondary 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 The ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms. of nutritional supplementation for this The group of people being studied. Populations may be defined by any characteristics e.g. where they live, age group, certain diseases.
- 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 Clinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known., along with the The ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms. 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.
Ferreira IM, Brooks D, White J, Goldstein R. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database of In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2012, Issue 12. Art. No.: CD000998. DOI: 10.1002/14651858.CD000998.pub3.
NHS Improvement – Lung. Managing chronic obstructive pulmonary disease (COPD) as a long term condition. http://www.improvement.nhs.uk