ABSTRACT
The impact of oral nutritional supplementation during an acute exacerbation of COPD on functional status was assessed through measuring change in lung function, strength testing, and general well-being. Subjects hospitalized for an acute exacerbation of COPD (n = 33) were randomized to extra nutritional support or the regular hospital care. They consumed an additional 10 kcal/kg/d. Outcome measures were measured at 2 wk as change scores. Forced vital capacity (% predicted) improved in the treatment group as compared with the control group (+8.7% versus -3.5%, p = 0.015), and change in FEV1 was in the same direction but not significantly different (p = 0.099). There were no changes in handgrip strength or respiratory muscle strength, but there was a trend towards more improvement in the general well-being score (+11.96 versus -10.25, p = 0.066). Almost all subjects were in negative nitrogen balance, indicating muscle wasting. The degree of muscle wasting was strongly correlated with the dose of corticosteroids (r = 0.73, p < 0.005). In conclusion, it is difficult to prevent important muscle wasting in patients with COPD treated with corticosteroids, but some small gains were observed with increased dietary intake.
Subject(s)
Activities of Daily Living , Enteral Nutrition/standards , Health Status , Lung Diseases, Obstructive/therapy , Acute Disease , Adrenal Cortex Hormones/adverse effects , Adult , Aged , Aged, 80 and over , Energy Intake , Female , Forced Expiratory Volume , Hand Strength , Humans , Length of Stay , Lung Diseases, Obstructive/physiopathology , Male , Middle Aged , Quality of Life , Respiratory Muscles , Vital CapacityABSTRACT
The CASPAR education-prevention program was initiated when experimental results indicated that a 5-hr alcohol education curriculum at a Catholic high school was able to reduce frequent intoxication among teenagers. Attempts to institutionalize such a program in the public schools shows that (1) alcohol education can generate widespread community and school support; (2) workshops can successfully train teachers to adopt a decision-making approach, though close supervision is needed to ensure that this approach is adhered to in classroom teaching; (3) the CASPAR model of alcohol education produces classroom situations conducive to many children feeling free to express alcohol-related concerns; (4) trained teachers can serve as intermediaries between students with alcohol-related concerns and community resources, in particular those resources that are designed to help children from families with alcoholism; (5) the CASPAR curriculum, implemented by trained teachers, produces statistically significant knowledge and attitude gains, whereas alternate programs such as a special-events approach produce smaller knowledge gains and little attitude change; and (6) to a considerable extent, knowledge and attitude gains persist over time, although retention is greater on knowledge items and among older students. The results suggest that there may be a behavioral impact of instruction in the form of reduced alcohol misuse among teenagers, although if there is, it requires intensive and repeated exposure and can be demonstrated in these data only among younger students while they remain in junior high school. Although such results may be viewed as less supportive than the original experiment with which this work began, they do suggest that alcohol education remains an effective prevention strategy.
