Prognostic Value of Nutritional Depletion in Patients With COPD Treated by Long-term Oxygen Therapy

Chailleux, E; Laaban, J. P.; Veale, D

doi:10.1378/chest.123.5.1460

Cited by 181 publications

(128 citation statements)

References 20 publications

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“…CRF is known to exert a detrimental effect on long-term outcome in various pulmonary disorders (Chailleux et al, 1996), but only limited data are available regarding the occurrence of CRF in relation to body composition. In COPD, we found values of BMI o20 kg/m 2 in about 16% of patients, similar to values observed in patients with COPD recruited for negative pressure ventilation (GrayDonald et al, 1996) or with current LTOT (Chailleux et al, 2003). When taking FFMI and cut-off values validated in large populations (o17.4/15.0 kg/m 2 for male/female patients), the frequency of malnutrition in COPD rose to 35.4%.…”

Section: Discussionsupporting

confidence: 86%

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

et al. 2007

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Objective: While malnutrition, especially fat-free mass index (FFMI), is a predictor for mortality in chronic obstructive pulmonary disease (COPD), less information on prevalence and mechanisms is available in patients with chronic respiratory failure (CRF) due to restrictive thoracic diseases (RTD). Design and setting: Cross-sectional study of patients consecutively admitted to an in-patient primary pulmonary centre. Subjects: One hundred and thirty-two patients (30% RTD; 70% COPD) with CRF and intermittent non-invasive positive pressure ventilation. Interventions: Malnutrition was quantified by bioelectrical impedance analysis or body mass index (BMI), and its relationship to laboratory, lung function, inspiratory muscle and blood gas parameters and 6-min walking distance (6-MWD) was assessed. Results: Malnutrition in terms of BMIo20 kg/m 2 occurred in 16.1% of patients with COPD but none of those with RTD. FFMIo17.4 (o15.0 in female patients) kg/m 2 was found in 35.4 and 30.7%, respectively. FFMI was correlated with airway obstruction (sR aw , r ¼ À0.50; FEV 1 /VC, r ¼ À0.28; Pp0.01 each) and lung hyperinflation (intrathoracic gas volume, r ¼ À0.41; total lung capacity (TLC), r ¼ À0.50; Pp0.001 each) in COPD, and with lung restriction in RTD (TLC, r ¼ 0.40; P ¼ 0.011). Furthermore, malnourished patients showed a higher inspiratory load (P 0.1 ) and reduced 6-MWD in both groups. In COPD, only hyperinflation and P 0.1 were independently related to FFMI. Conclusions: Malnutrition as indicated by low FFMI was similarly prevalent in patients with CRF and COPD or RTD, but inadequately represented by BMI. The correlations between lung function impairments specific for the disease and FFMI emphasized the link between malnutrition and respiratory mechanical load irrespective of its aetiology.

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Section: Discussionsupporting

confidence: 86%

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

et al. 2007

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“…Interestingly, there was a U-shaped relationship between BMI and mortality, with increased mortality at high as well as low BMI levels, suggesting that malnutrition either manifested as obesity or cachexia increases all-cause mortality in mild to moderate COPD. In patients with severe COPD (requiring O 2 supplementation), Chailleux and colleagues (10) (4) demonstrated a correlation between decreasing body weight and mortality. However, this relationship did not reach statistical significance in the most severely obstructed patients (FEV 1 , 35% predicted).…”

Section: Epidemiology and Prognostic Significance Of Undernutrition Imentioning

confidence: 99%

Nutritional Aspects of Chronic Obstructive Pulmonary Disease

King¹,

Cordova²,

Scharf³

2008

Proceedings of the American Thoracic Society

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It is clear that being underweight is a poor prognostic sign in chronic obstructive pulmonary disease (COPD). It is also clear that undernutrition is at least in part associated with the severity of airflow obstruction. While both weight and body mass index are useful screening tools in the initial nutritional evaluation, fat-free mass (FFM) may be a better marker of undernutrition in patients with COPD. The causes of cachexia in patients with COPD are multifactorial and include decreased oral intake, the effect of increased work of breathing due to abnormal respiratory mechanics, and the effect of chronic systemic inflammation. Active nutritional supplementation in undernourished patients with COPD can lead to weight gain and improvements in respiratory muscle function and exercise performance. However, long-term effects of nutritional supplementation are not clear. In addition, the optimal type of nutritional supplementation needs to be explored further. The role of novel forms of treatment, such as androgens or appetite stimulants designed to increase FFM, also needs to be further studied. Thus, in the absence of definitive data, it cannot be said that long-term weight gain, either using enhanced caloric intake, with or without anabolic steroids or appetite stimulants, offers survival or other benefits to patients with COPD. However, there are indications from singlecenter trials that this is an avenue well worth exploring.

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“…Therefore, NIV is currently widely used as a first line treatment in patients with severe COPD-AE. The clinical features demonstrated to have an association with the development of COPD-AE include a history of prior COPD-AE, hypercapnia, a lower forced expiratory volume in one second (FEV1) % predicted, the BODE (body mass index (BMI), airflow obstruction, dyspnea and exercise capacity) index, an impaired health status, hypoxemia, pulmonary hypertension and comorbidities (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Although clinical predictors of the development of COPD-AE have been investigated in a number of previous studies, those affecting the need to initiate NIV in stable COPD outpatients who develop COPD-AE have not been sufficiently studied.…”

Section: Introductionmentioning

confidence: 99%

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2013

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Objective Predictors of the need to initiate noninvasive ventilation (NIV) in stable COPD outpatients with acute exacerbation of chronic obstructive pulmonary disease (COPD-AE) are insufficiently defined. The objective of this study was to investigate predictors of the need to initiate NIV in stable COPD-AE outpatients. Methods A total of 140 consecutive stable COPD outpatients who were hospitalized for COPD-AE for the first time were retrospectively examined. Demographic and clinical parameters measured in the stable state were evaluated, including data for arterial blood gases, the pulmonary function, body mass index and dyspnea scores. Results Of the 140 patients included, NIV was used in 32 (23%) patients. In a univariate Cox proportional hazards analysis, the baseline partial pressure of arterial carbon dioxide (PaCO2) (hazard ratio (HR), 1.14 per mmHg; 95% confidence interval (CI), 1.08-1.21) and forced expiratory volume in one second (FEV1)% predicted (HR, 1.03 per %; 95% CI, 1.01-1.05) were identified to be significant predictors. A multivariate logistic regression analysis showed only the PaCO2 (HR, 1.18 per mmHg; 95% CI, 1.12-1.26) to be a significant predictor. Conclusion Our results suggest that the PaCO2 measured in the stable state is an independent significant predictor of the need to initiate NIV in COPD-AE patients who are hospitalized for the first time.

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Prognostic Value of Nutritional Depletion in Patients With COPD Treated by Long-term Oxygen Therapy

Cited by 181 publications

References 20 publications

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

Nutritional Aspects of Chronic Obstructive Pulmonary Disease

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

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