Essential amino acid supplementation in patients with severe COPD: a step towards home rehabilitation

Abstract

Background. Pulmonary Rehabilitation (“Rehabilitation”) can improve both lung function and quality of life in patients suffering from chronic obstructive pulmonary disease (COPD) even if only a very small proportion of patients have access to Rehabilitation. Supplementation of Essential Amino Acids (EAAs) might allow COPD patients to achieve some typical Rehabilitation outcomes such as a better physical performance and an improved health status. Methods. 88 COPD out-patients (GOLD class 3-4) with a body mass index (BMI) <23 Kg/m2 were randomised to receive EAAs (n=44) or placebo (n=44) for twelve weeks. Primary outcome measures were changes in both physical activities in daily life (measured by Sense Wear Armband in terms of mean steps walked in one week) and in quality of life (measured by the St George’s Respiratory Questionnaire, SGRQ). Results. After 12 weeks, the physical performance was significantly increased vs baseline only in patients who received EAAs (1140.33 ± 524.69 and 638.68 ± 662.1 steps/day, respectively; p=0.02), being also the comparison vs the placebo group highly significant (p=0.003). Similarly, the SGRQ score improved significantly only in EAA patients (69.35 ± 9.51 vs baseline 72.04 ± 8.62; p<0.01), and changes were significantly different from those measured in the placebo group (p<0.001). Furthermore, when compared to those who received placebo, EAAs patients significantly increased their fat-free mass (p=0.04), muscle strength (p<0.01), saturation of oxygen (p=0.05), serum albumin (p<0.001), and also ameliorated their original cognitive dysfunction (p=0.02). Conclusions. Oral supplementation with EAAs contribute to improve the daily-life performance in domiciliary severe COPD patients who can not enter any Rehabilitation programme, together with their quality of life; nutritional and cognitive status, and muscle strength.

A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD

“…This could be related to specific nutrient effects on lower limb muscle metabolism resulting in decreased muscle fatigue or via the observed improvement in respiratory muscle function. Dal Negro et al 15 reported increased number of steps after EAA supplementation in domiciliary severe COPD patients. Alternatively, a positive effect of n‐3 fatty acid enriched protein‐dense supplements could be implicated as in cachectic patients with pancreatic cancer n‐3 FA supplementation also increased physical activity level assessed by doubly labelled water independent of muscle mass 24.…”

“…Indeed, patients with advanced COPD and muscle wasting are reported to have low plasma levels of BCAAs (especially leucine) compared with age‐matched controls,7, 14 which could reflect a deficient state in muscle,7 but no evidence for a deficient BCAA state was found in our NUTRAIN patients with less advanced COPD. In a sample of 88 patients with severe COPD (GOLD 3–4) and BMI <23 kg/m 2 not receiving exercise training, 12 weeks of supplementation with an EAA (4 g/day) mixture high in leucine led to higher FFM and muscle strength compared with an isocaloric placebo 15. Nonetheless, these patients were characterized by lower protein intake at baseline (1.0 ± 0.2 g/kg) than the current study population (1.4 ± 0.1 g/kg BW).…”

Essential Amino Acids and Exercise Tolerance in Elderly Muscle-Depleted Subjects with Chronic Diseases: A Rehabilitation without Rehabilitation?

“…Preliminary results show positive effects of EAAs on exercise intolerance. In Tables 1 and 2, the amino acid mixture used in these studies and their respectively changes in certain exercise variables after chronic amino acid supplementation are reported, after evaluation from the original investigations [8–10]. …”

“…Some studies [7–10] have found that chronic oral supplementation of essential amino acids (EAAs) (8 g/d over 1–3 months) significantly improves exercise intolerance of elderly patients with severe CHF/COPD, living at home or admitted to a Rehab setting.…”

Unaffected Arm Muscle Hypercatabolism in Dysphagic Subacute Stroke Patients: The Effects of Essential Amino Acid Supplementation

“…This fact has been amply documented in animal [24–27] and human studies, both in healthy subjects [28, 29] and in those suffering from chronic diseases associated with muscle depletion and different from stroke [30–33]. …”