Nutritional assessment and therapy in COPD: a European Respiratory Society statement

Abstract

Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of costeffectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk. @ERSpublications Metabolism and nutrition: shifting paradigms in COPD management

Oxidant status, iron homeostasis, and carotenoid levels of COPD patients with advanced disease and LTOT

“…The impact of dietary habits, nutritional status, and nutritional interventions is increasingly emphasized due to the possible role these may play on COPD outcome and prognosis [3,4]. Several studies have evaluated the impact of nutritional therapy in COPD patients [3–5].…”

Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective

“…Nevertheless, cachexia management is still poorly implemented in clinical practice. In 2014, the European Respiratory Society published a statement on nutritional assessment and therapy in COPD including a nutritional risk stratification diagram based on assessment of BMI, weight changes, and body composition, which could be useful in patient counselling 24. In order to increase overall survival and compress morbidity, a multi‐modal intervention approach is needed, which should target the discussed factors involved in cachexia (Figure 1).…”

“…However, this might underestimate low muscle mass in the increasing proportion of overweight to obese COPD patients 23. The recent European Respiratory Society statement on nutritional assessment and therapy in COPD24 proposed dual‐energy X‐ray absorptiometry (DEXA) as the most appropriate method for body composition analysis in COPD, mostly because it combines screening for osteoporosis with assessment of FM and FFM at the regional level in addition to whole body level. Consequently, body composition assessed by DEXA also allows measurement of appendicular skeletal muscle mass (ASM), which has been demonstrated to be stronger related to physical functioning than total FFM 23.…”

Estimación de actividades preventivas en pacientes con enfermedad pulmonar obstructiva crónica. Estudio ADEPOCLE

“…En general, la evidencia indica que una dieta bien equilibrada es beneficiosa para todos los pacientes con EPOC, no solo por sus potenciales beneficios pulmonares, sino también por sus beneficios metabólicos y sobre el riesgo cardiovascular (17). En nuestro entorno, el 88,76% (84,82-90,7) de los pacientes con EPOC sigue una dieta equilibrada.…”