Malnutrition and the Respiratory System

Rochester, Dudley F.; Esau, Sharon A.

doi:10.1378/chest.85.3.411

Cited by 120 publications

(44 citation statements)

References 25 publications

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“…We found a similar trend in the values of PImax and PEmax: which were lower in non-reversible capo (although this did not achieve significance) and there was a negative correlation between these measurements of muscle strength with TNF-a concentrations in plasma. This is not surprising as a decrease of fat-free mass can cause a decrease of the muscular strength and so a decrease in the values of the PImax and PEmax (6). Indeed, we confirmed a strong correlation between .…”

Section: Discussionsupporting

confidence: 78%

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Inflammation, Oxidative Stress and Systemic Effects in Mild Chronic Obstructive Pulmonary Disease

Barbaro

Carpagnano

Spanevello

et al. 2007

Int J Immunopathol Pharmacol

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Chronic obstructive pulmonary diseases (COPD) is a pulmonary disease characterized by systemic abnormalities. The aim of this study is to investigate inflammation and systemic effects in mild COPD. Twenty-seven mild stable smoking related COPD patients and 15 age-matched healthy subjects were enrolled in the study. IL-6, TNF-a and IL-4 in plasma, sputum and exhaled breath condensate were measured. We also measured exhaled nitric oxide (NO) and pH in sputum and in breath condensate. Moreover, fat-free mass, body mass index (BMI), respiratory muscle strength, plasma oxidative stress and C-reactive protein (CRP) were measured. Higher concentrations were found of CRP, of diacron reactive oxygen metabolites (DROMs) and ofIL-6, TNF-a and IL-4 either in plasma or in supernatant of induced sputum or in exhaled breath condensate of COPD subjects compared to healthy controls. Furthermore, higher concentrations were observed of exhaled NO and lower exhaled pH in breath condensate of COPD when compared with healthy subjects. In the group of COPD patients, the subjects with airway reversibility showed an increase of sputum eosinophils and exhaled NO, whereas the subjects without airway obstruction reversibility showed an increase in sputum neutrophils, TNF-a and IL-6. We also found a trend towards a decrease in fat-free mass and respiratory muscle strength in COPD compared to healthy subjects and a negative correlation between these systemic indices (fatfree mass, maximal inspiratory pressure, maximal expiratory pressure) and TNF-a concentrations in the blood, sputum and breath condensate. We conclude that mild COPD subjects present an increase in inflammatory markers in blood and in airways of similar pattern and furthermore, the neutrophilic pattern of airway inflammation observed in the group of COPD subjects without an airway obstruction reversibility makes it more likely that systemic features are present.Chronic obstructive pulmonary disease (COPD) is usually considered to be a pulmonary disease (1). However, recent studies have demonstrated several extra-pulmonary abnormalities, particularly in more severely affected patients, that suggest the necessity of a wider definition of this disease (2). Several systemic features have been described in COPD patients, including systemic inflammation and oxidative stress, skeletal muscle dysfunction (SMD), weight loss, atherosclerosis and osteoporosis (3-5).

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Section: Discussionsupporting

confidence: 78%

“…These systemic effects may have an adverse effect on the quality of life and may contribute towards the mortality of COPD (6)(7)(8). Systemic inflammation and oxidative stress appear to be risk factors for the majority of the systemic complications in COPD patients (9).…”

mentioning

confidence: 99%

Inflammation, Oxidative Stress and Systemic Effects in Mild Chronic Obstructive Pulmonary Disease

Barbaro

Carpagnano

Spanevello

et al. 2007

Int J Immunopathol Pharmacol

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“…[18][19][20] The consequence of this deterioration may be reduced muscle strength, including weakness of both the inspiratory and expiratory muscles. 21 Experimental exercise models in mice use either voluntary or forced activity. Forced models, such as treadmill running, use aversive stimuli to induce exercising.…”

Section: Functional Evaluation Of a Genetic Emphysema Model M Yoshidamentioning

confidence: 99%

Functional evaluation of pallid mice with genetic emphysema

Yoshida

Shoji

Kenzaki

et al. 2009

Laboratory Investigation

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Studies on pallid mice models of genetic emphysema have conventionally focused on morphological or biochemical evaluations. However, it is important to consider the functional aspects. We evaluated the exercise capacity and respiratory function in male pallid mice and male C57BL/6J mice at 3, 6, 12, and 15 months of age. The functional evaluations were conducted using a treadmill and a pulmonary function analysis device. The morphology of the lungs was analyzed on the basis of mean linear intercept (Lm) values. The body weights of the pallid mice at 12 and 15 months were significantly lower than those of the age-matched C57BL/6J mice. The pallid mice showed deterioration in exercise capacity from 6 months, as indicated by the trends in running distance. At 6, 12, and 15 months, the pallid mice showed significantly higher pulmonary compliance and significantly lower forced expiratory volume in 20 ms (FEV 20 ms )/vital capacity (VC) values in comparison with the corresponding values for the C57BL/6J mice. In the morphological analysis of the pallid mice, emphysema was detected from 12 months, and the mice showed a significantly larger Lm at 12 months. The exercise capacity and lung function in the pallid mice significantly deteriorated from 6 months, at which time no pathological changes in the lung were detected. The deterioration in the exercise capacity and pulmonary function preceded the microscopic morphological changes.

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“…Factors related to the nutritional status are considered as an independent influence on the course of stable COPD [5]. Poor nutritional status can adversely affect pulmonary function, not only by impairment of respiratory muscle strength and exercise tolerance [21,22], but also by decreased ventilatory drive and altered lung defence mechanisms [23]. Percentage of IBW was previously found to be an important predictive factor for admission into the ICU [6].…”

Section: Discussionmentioning

confidence: 99%

Acute exacerbations in patients with COPD: predictors of need for mechanical ventilation

Vitacca¹,

Clini²,

Porta³

et al. 1996

European Respiratory Journal

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Predictive factors in mechanically-ventilated patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) have been extensively studied but not in spontaneously breathing patients. The aim of this retrospective study was to evaluate the contribution of parameters of respiratory mechanics, clinical and nutritional status in predicting the need for mechanical ventilation (MV) in COPD patients treated with medical therapy for an acute exacerbation.Anthropometric data, Acute Physiology and Chronic Health Evaluation (APACHE) II score, bedside spirometry, breathing pattern, respiratory mechanics and blood gases were measured in 39 COPD patients upon hospital admission for exacerbation of their disease. Fourteen patients in whom MV was necessary were compared with 25 patients in whom medical therapy was enough for a good outcome.The discriminant analysis showed, with decreasing order of power, that nutritional prognostic index (NPI), APACHE II score, forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio, vital capacity (VC) (% predicted) and FVC (% pred) provided a significant distinction between the two groups. The discriminant equation considering NPI, and FVC (% pred) could correctly predict the success in 76% of the patients. A multiparametric stepwise regression analysis showed that APACHE II score was significantly correlated with NPI, VC (% pred), pressure time index (PTI) and duty cycle, i.e. fraction of inspiration to duration of total breathing cycle (tI/ttot).In conclusion, underlying general conditions as assessed by malnutrition and APACHE II score were shown to be unfavourable indices of outcome for chronic obstructive pulmonary disease patients who experienced an exacerbation of their disease and were treated with medical therapy. Flow limitation data as assessed by the forced expiratory manoeuvre may provide additional information.

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Malnutrition and the Respiratory System

Cited by 120 publications

References 25 publications

Inflammation, Oxidative Stress and Systemic Effects in Mild Chronic Obstructive Pulmonary Disease

Inflammation, Oxidative Stress and Systemic Effects in Mild Chronic Obstructive Pulmonary Disease

Functional evaluation of pallid mice with genetic emphysema

Acute exacerbations in patients with COPD: predictors of need for mechanical ventilation

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