Patient's awareness on COPD is the strongest predictor of persistence and adherence in treatment-naïve patients in real life: a prospective cohort study.

BACKGROUND: There is little evidence about the factors that predict persistence/adherence in treatment-naïve patients with COPD in clinical practice. The aim of this study was to evaluate persistence and adherence levels among treatment-naïve patients diagnosed with COPD who had a prescribed inhaled medication, using data from real-world clinical practice. METHODS: Multicentric study with a 6 month-followed-up period. Patients were considered persistent if they collected all their inhaler refills. In a random sample of patients, we evaluated adherence using the Test of Adherence to Inhalers (TAI). We assessed Health Related Quality of Life (HRQL) with St George's Respiratory Questionnaire (SGRQ). RESULTS: Of the 114 patients included, 46 (40.4%) were defined as persistent. Patients who had awareness about COPD (adjusted RR 2.672, 95% CI 1.125-6.349) were more likely to be persistent; patients with multidose DPI were less likely to be persistent that those with single dose DPI (adjusted RR 0.341, 95% CI 0.133-0.877). Higher levels of SGRQ total were associated with a lower probability of persistence (adjusted RR 0.945, 95%CI 0.894-0.998). Patients who had had an appointment with their GP in the previous six months were more likely to be persistent (adjusted RR 3.107, 95% CI 1.022-9.466). Patients who had awareness about COPD and those with lower symptom SGQR score were more likely to be adherent (24/25, 96.0% vs 16/22, 72.7%, p = 0.025, and mean 29.1, sd 19.4 vs mean 41.4, sd 15.9, respectively, p = 0.026, respectively). CONCLUSIONS: Less than 50% of patients were defined as persistent. Patients' awareness of their disease and levels of HRQL were associated with high rate of persistence and adherence. In addition, frequent visits to general practitioner, increases the rate of persistence to treatment.

The associations between dietary pattern of chronic obstructive pulmonary disease patients and depression: a cross-sectional study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common lung disease during middle age which one of its complications is depression. Depression is considered one of the major causes of severe disability worldwide. One of the factors that affect the severity and incidence of this disease is a lifestyle, especially dietary pattern. On the other hand, some studies showed the relationship between dietary patterns and depression. The present study aims to investigate the dietary patterns of people with chronic obstructive pulmonary disease and its association with depression. METHODS: The present cross-sectional study was performed on 220 patients (mean ± SD age = 54.58 ± 5.08) with chronic obstructive pulmonary disease (56.6% men, 43.4% women) from Tabriz, Iran. Questionnaires of general information, food frequency, Beck depression and physical activity were completed. The dominant dietary patterns were determined by factor analysis, and their relationship with depression was discussed by regression analysis. RESULTS: Three dominant dietary patterns were identified as healthy, unhealthy, and mixed dietary patterns. An inverse relationship was found between healthy and mixed dietary patterns with depression. There is no meaningful connection between unhealthy dietary patterns and depression. Depression had a significant inverse relationship with physical activity. There was no relationship between dietary patterns and Forced Expiratory Volume for 1 s (FEV1) and Forced Vital Capacity (FVC) criteria. A positive and significant relationship was observed between mixed dietary patterns with FEV1/FVC. CONCLUSION: Inverse relationships exist between healthy dietary patterns and depression in patients with COPD, and improves the function of the lungs. Further studies are needed to show the exact relationship between diet and COPD depression.

Host, Gender, and Early-Life Factors as Risks for Chronic Obstructive Pulmonary Disease.

Although smoking results in lung pathology in many, still not all smokers develop chronic obstructive pulmonary disease (COPD). Roughly a quarter of patients with COPD have never smoked. An understanding of both host and environmental factors beyond smoking that contribute to disease development remain critical to understanding disease prevention and ultimately effectively intervene. In this article, we summarize host factors, including genetics and gender, as well as early-life events that contribute to the development of COPD.

Fortified whey beverage for improving muscle mass in chronic obstructive pulmonary disease: a single-blind, randomized clinical trial.

BACKGROUND: The development of effective nutritional supports for patients with chronic obstructive pulmonary diseases (COPD) is still challenging. This study was conducted to investigate the efficacy of daily consumption of fortified whey on inflammation, muscle mass, functionality, and quality of life in patients with moderate-to-severe COPD. METHODS: A single-blind, randomized trial study was performed on patients with COPD (n = 46). Participants in the intervention group (n = 23) daily received 250 ml of whey beverage fortified with magnesium and vitamin C for 8 weeks. Any changes in inflammatory cytokines (including interleukin- 6 (IL-6) and tumor necrosis factor (TNFα)) were the primary outcomes and the secondary outcomes were fat-free mass, handgrip strength, malnutrition, glutathione and malondialdehyde serum concentrations, and health-related quality of life (HRQoL). Body composition and muscle strength were measured by Bioelectrical Impedance Analysis (BIA) and hydraulic hand dynamometer, respectively. Fat-free mass index (FFMI) was also calculated. RESULTS: At the end of the study, 44 patients were analyzed. There were significant decreases in IL-6 concentrations in the intervention group compared to the control group. Also, FFMI, body protein, and handgrip strength increased significantly in the intervention group with significant changes between two groups. Moreover, improvement in health-related quality of life was observed in the intervention group compared to the control group. There were no significant changes in other study variables. CONCLUSIONS: This novel nutritional intervention decreased inflammatory cytokines levels, improved indices of skeletal muscle mass and muscle strength, and ultimately, increased HRQoL in patients with moderate-to-severe COPD. Thus, it is suggested to do further studies to assess the effects of nutrition intervention on COPD progression. TRIAL REGISTRATION: IR.SUMS.REC.1396.85 ( https://www.irct.ir/ ).

Education Program for Male Patients with Chronic Obstructive Pulmonary Disease to Change Dietary Behavior.

Patients with chronic obstructive pulmonary disease (COPD) need to maintain proper eating behavior in order to maintain muscle mass and prevent weight loss. In this study, we measured the effects of a support program on patient attitude, social influences, and self-efficacy and aimed to positively change their dietary behavior. We recruited male patients from two Japanese outpatient clinics and assigned each to an intervention or a control group. The intervention group participated in a support program and was assisted in acquiring knowledge and skills related to adopting and maintaining suitable eating behavior. Data were gathered through medical records, patient interviews, self-assessment questionnaires, and anthropometric measurements. The follow-up period was approximately 15 weeks. The final sample comprised 22 participants, with 11 each in the intervention and control groups. In the intervention group, the body weight was maintained. However, there were statistically significant improvements in energy intake and dietary measures such as eating fresh foods, compared with the control group. The intervention was observed to increase both meal suitability and energy intake among participants. Future support programs should also incorporate participants' physical activity levels, and the effects should be studied over a longer period.

A clinical trial to evaluate the effect of the Mediterranean diet on smokers lung function.

Data on the association between lung function and some dietary patterns have been published. However, it is not yet well known if whether the Mediterranean Diet (MD) pattern can preserve or improve lung function. Our purpose is to evaluate the effect of increased MD adherence on lung function in smokers. A multicenter, parallel, cluster-randomized, controlled clinical trial is proposed. A total of 566 active smokers (>10 packs-year), aged 25-75 years will be included, without previous respiratory disease and who sign an informed consent to participate. Twenty Primary Care Centres in Tarragona (Spain) will be randomly assigned to a control or an intervention group (1:1). All participants will receive advice to quit smoking, and the intervention group, a nutritional intervention (2 years) designed to increase MD adherence by: (1) annual visit to deliver personalized nutritional education, (2) annual telephone contact to reinforce the intervention, and (3) access to an online dietary blog. We will evaluate (annually for 2 years): pulmonary function by forced spirometry and MD adherence by a 14-item questionnaire and medical tests (oxidation, inflammation and consumption biomarkers). In a statistical analysis by intention-to-treat basis, with the individual smoker as unit of analysis, pulmonary function and MD adherence in both groups will be compared; logistic regression models will be applied to analyze their associations. We hope to observe an increased MD adherence that may prevent the deterioration of lung function in smokers without previous respiratory disease. This population may benefit from a dietary intervention, together with the recommendation of smoking cessation.

Role of Diet in Chronic Obstructive Pulmonary Disease Prevention and Treatment.

Chronic obstructive pulmonary disease is one of the leading causes of morbidity and mortality worldwide and a growing healthcare problem. Identification of modifiable risk factors for prevention and treatment of COPD is urgent, and the scientific community has begun to pay close attention to diet as an integral part of COPD management, from prevention to treatment. This review summarizes the evidence from observational and clinical studies regarding the impact of nutrients and dietary patterns on lung function and COPD development, progression, and outcomes, with highlights on potential mechanisms of action. Several dietary options can be considered in terms of COPD prevention and/or progression. Although definitive data are lacking, the available scientific evidence indicates that some foods and nutrients, especially those nutraceuticals endowed with antioxidant and anti-inflammatory properties and when consumed in combinations in the form of balanced dietary patterns, are associated with better pulmonary function, less lung function decline, and reduced risk of COPD. Knowledge of dietary influences on COPD may provide health professionals with an evidence-based lifestyle approach to better counsel patients toward improved pulmonary health.

Insufficient intake of energy and protein is related to physical functional capacity among COPD patients referred to municipality based pulmonary rehabilitation.

BACKGROUND: Malnutrition is frequent in COPD. Malnourished patients participating in pulmonary rehabilitation (PR) may benefit less and even worsen prognosis. The aim of this study was to investigate energy and protein intake in outpatients with COPD referred to municipality based PR and to investigate the relation to functional capacity. METHODS: COPD patients referred to PR at five Danish municipals were assessed for energy and protein intake by self-reported intake record and 24-hour recall by a dietician. Nutritional status was assessed by BMI, weight loss, and eating validation scheme, functional status by 30-seconds chair stand (30s-CST), and 6-minutes walking test (6MWT), and severity of disease by FEV1 and mMRC. RESULTS: We included 79 patients (41% male and 73% above 65 + y). Ninety-six% had a FEV1 below 80%, 59% had a mMRC-score of 3 + and 14% had a BMI below 20 kg/m2. Fifty-one % and 41% of the patients had insufficient intake of protein and energy, respectively, defined as an average intake below the 75% of the recommended. Kruskal Wallis test showed a significant positive association between protein intake and 30s-CST (p = 0.012) and 6MWT (p = 0.024) but no association with energy intake. CONCLUSIONS: Among patients with COPD referred for PR, there is a high prevalence of insufficient intake of energy and protein. This causes concern, as the physical training, which is the main component of PR, is likely to be futile unless the patients obtain a sufficient intake of energy and protein during the pulmonary; rehabilitation program.

Dietary intake of fatty acids and its relationship with FEV1/FVC in patients with chronic obstructive pulmonary disease.

BACKGROUND & AIMS: The deterioration of pulmonary function has been associated with increased levels of systemic inflammation that can be stimulated by consumption of saturated fatty acids and trans fats. We hypothesized that fatty acids intake impact on pulmonary function. However, evidence about the impact of different types of fatty acids on pulmonary function in patients with chronic obstructive pulmonary disease (COPD) is limited and heterogeneous. The aim of this study was to evaluate the association between intake of fatty acids and pulmonary function in patients with COPD. METHODS: Cross sectional study of patients diagnosed with COPD. The relationship between consumption of fatty acids and the FEV1/FVC ratio obtained by spirometry was assessed. Patients with exacerbations during the prior 2 months, diagnosis of asthma or administration of a dietary supplement were excluded. RESULTS: A simple linear regression showed that for each gram of carbohydrates and total l fatty acids intake, the FEV1/FVC ratio decreased -0.03 ml (ß: -0.03, 95% CI -0.06 to -0.01, p = 0.008) and -0.009 ml (ß: -0.00, 95% CI -0.02 to 0.00, p = 0.031) respectively. Pentadecanoic acid (C15:0) was associated with an increase of 0.47 ml in the FEV1/FVC ratio for each milligram intake (ß: 0.47, 95% CI 0.04 to 0.91, p = 0.031). Subsequently, when adjusted for calories intake, an increase of 0.53 ml was observed in the FEV1/FVC for each milligram of C15:0 fatty acid intake (ß:0.53, 95% CI 0.09 to 0.97, p = 0.018). CONCLUSION: A positive association was observed between pentadecanoic acid and the FEV1/FVC ratio with a beneficial effect on patients with COPD.

Whole body protein anabolism in COPD patients and healthy older adults is not enhanced by adding either carbohydrates or leucine to a serving of protein.

BACKGROUND & AIMS: Carbohydrates (CHO) and leucine (LEU) both have insulinotropic properties, and could therefore enhance the protein anabolic capacity of dietary proteins, which are important nutrients in preventing muscle loss in patients with Chronic Obstructive Pulmonary Disease (COPD). LEU is also known to activate protein anabolic signaling pathways independent of insulin. Based on our previous findings in COPD, we hypothesized that whole body protein anabolism is enhanced to a comparable extent by the separate and combined co-ingestion of CHO and LEU with protein. METHODS: To disentangle the protein anabolic effects of CHO and/or free LEU when co-ingested with a high-quality protein, we studied 10 patients with moderate to very severe COPD and dyspnea (GOLD: II-IV, mMRC dyspnea scale ≥ 2), at risk for muscle loss, and 10 healthy age- and gender-matched controls. On four occasions, in a single-blind randomized crossover design, each subject ingested a drink containing 0.6 g/kg fat-free mass (ffm) hydrolyzed casein protein with, a) no add-ons (protein), b) 0.3 g/kg ffm CHO (protein + CHO), c) 0.095 g/kg ffm leucine (protein + LEU), d) both add-ons (protein + CHO + LEU). Whole body protein breakdown (PB), protein synthesis (PS), and net protein balance (= PS - PB) were measured by IV primed and continuous infusion of L-[ring-2H5]-phenylalanine and L-[13C9,15N]-tyrosine. L-[15N]-phenylalanine was added to the protein drinks to measure splanchnic extraction. RESULTS: In both groups, whole body PS, PB and net protein balance responses were comparable between the four protein drinks, despite higher postprandial plasma LEU concentrations for the LEU supplemented drinks (P < 0.05), and higher insulin concentrations for the CHO supplemented drinks as compared to the protein only drink (P < 0.05). CONCLUSIONS: Adding CHO and/or LEU to a serving of high-quality protein does not further augment whole body protein anabolism in dyspneic COPD patients at risk for muscle loss or healthy older adults. TRIAL REGISTRY: ClinicalTrials.gov; No. NCT01734473; URL: www.clinicaltrials.gov.

Dietary nitrate improved exercise capacity in COPD but not blood pressure or pulmonary function: a 2 week, double-blind randomised, placebo-controlled crossover trial.

Dietary nitrate may improve exercise tolerance in some healthy and clinical populations. Existing data regarding dietary nitrate in COPD is inconsistent. We conducted a 14d double-blind, randomised, placebo-controlled, crossover trial of daily nitrate-rich beetroot juice (BRJ; 12.9 mmol) versus nitrate-depleted BRJ (PL; 0.5 mmol). At baseline and after each condition, we assessed functional capacity (incremental shuttle walk test; ISWT), ambulatory blood pressure, pulmonary function, quality of life as well as exhaled nitric oxide (eNO), and plasma nitrate/nitrite (NOx). Eight subjects with COPD completed the trial. BRJ supplementation was associated with significantly increased NOx (p < .05) and a 14.6% increase in ISWT distance (+56 m, p = .00004) as well as a trend towards increased eNO compared to PL. There was no other differences. Dietary nitrate appears to have ergogenic effect in subjects with mild-moderate COPD. This effect does not appear to be related to altering blood pressure or pulmonary function.

EPOC y nutrición / No disponible

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EPOC y nutrición / No disponible

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Alteración nutricional del paciente con EPOC. Etiopatogenia. Consecuencias de la desnutrición en el paciente con EPOC / Nutritional alteration in copd. etiopathogenesis. consequences of malnutrition

Se analizan los parámetros de desnutrición y de composición corporal en los pacientes con EPOC (sarcopenia, IMC, porcentaje de masa libre de grasa) así como los mecanismos etiopatogénicos que conducen a esta situación y las características propias de la enfermedad que dificultan la adecuada ingesta de nutrientes y por tanto la cobertura de unas necesidades de aporte energético que están ya de por si aumentadas en el paciente con EPOC. Se resalta la importancia del conocimiento de la composición corporal como factor predictor de supervivencia y el interés que suscitan los distintos perfiles nutricionales para establecer fenotipos en función de su riesgo nutricional

The parameters of malnutrition and body composition are analyzed in patients with COPD (sarcopenia, BMI,% fat-free mass) as well as their etiopathogenic mechanisms. Also the characteristics of the disease that hinder adequate nutrient intake and therefore the coverage of energy needs that are already increased in the patient with COPD. The importance of knowledge of body composition as a predictor of survival and the interest of the different nutritional profiles raise to establish phenotypes based on their nutritional risk is highlighted

Evaluación nutricional en el paciente con EPOC. Fenotipos metabólicos / Nutritional status in COPD patients. Metabolic phenotypes

La desnutrición es un problema presente en una tercera parte de los pacientes con EPOC moderada-grave, lo cual influye en su calidad de vida. Existen diferentes métodos de screening y de valoración del estado nutricional, y se han identificado distintos fenotipos metabólicos en pacientes EPOC. La evaluación del estado nutricional debe realizarse en estos pacientes para un adecuado manejo terapéutico del mismo

Malnutrition is present in at least one third of moderate to severe COPD patients, and it has effects on their quality of life. There are several nutritional screening tests, as well as tests to know the nutritional status, which can identify different metabolic phenotypes in COPD patients. The evaluation of the nutritional status should be done in every COPD patient to treat them correctly

Recomendaciones dietéticas y suplementos nutricionales en la EPOC / Dietary recommendations and nutritional supplements in COPD

La evaluación y el tratamiento médico nutricional deben formar el manejo integral de los pacientes con EPOC. Con ello se pretende prevenir y tratar la desnutrición. La adaptación de la dieta oral a los requerimientos y las características clínicas de cada paciente representa la base del tratamiento nutricional. Cuando estas recomendaciones no resultan suficientes, los suplementos nutricionales orales pueden contribuir a que el paciente alcance sus requerimientos nutricionales. La nutrición parenteral se reserva para los casos en los que exista una contraindicación para la utilización de la vía digestiva (íleo, perforación o hemorragia digestiva)

The evaluation and nutritional medical treatment should form the integral management of patients with COPD. This is intended to prevent and treat malnutrition. The adaptation of the oral diet to the requirements and clinical characteristics of each patient represents the basis of nutritional treatment. When these recommendations are not enough, oral nutritional supplements can help the patient reach their nutritional requirements. Parenteral nutrition is reserved for cases in which there is a contraindication for the use of the digestive tract (ileus, perforation or gastrointestinal bleeding)

Tratamiento farmacológico de la desnutrición en la EPOC / Drug therapy for malnutrition in COPD

El tratamiento farmacológico de la desnutrición en la enfermedad pulmonar obstructiva crónica (EPOC) es un campo de conocimiento controvertido y limitado por la escasa evidencia científica generada. Sus objetivos se centrarían en reducir inflamación, estrés oxidativo y pérdida progresiva de la masa muscular esquelética. Varias vías fisiopatológicas se han propuesto como dianas terapéuticas. Desde un punto de vista teórico, se ha planteado la posible eficacia de fármacos orexígenos (progestágenos, ciproheptadina y cannabinoides) esteroides anabolizantes (nandrolona), moduladores selectivos de los receptores de andrógenos, hormonas peptídicas (somatotropina -GH- y grelina), antiinflamatorios (talidomida, celecoxib y ácidos grasos omega 3, entre otros), aminoácidos y metabolitos activos (L-carnitina, creatina, leucina y β-hidroxi-β-metilbutirato), vitamina D, antioxidantes (vitaminas A, E, ácido alfa lipoico, resveratrol y N-acetil-cisteína) e inhibidores de la miostatina. Solo se han publicado datos con algunos de estos fármacos, y las guías de práctica clínica aún no reconocen su papel en esta patología

Drug therapy for malnutrition in chronic obstructive pulmonary disease (COPD) is a controversial and limited field of knowledge due to scarce generated scientific evidence. Its objectives would be reducing inflammation, oxidative stress and progressive skeletal muscle mass loss. Several pathological ways have been proposed as therapeutic target. From a theoretical point of view, the possible efficacy of different drugs has been studied. Among them: orexigenic drugs (progestagens, cyproheptadine and cannabinoids), anabolizing steroids (nandrolone), selective androgen receptor modulators, peptidic hormones (somatotropin -GH- and ghreline), anti-inflammatories (thalidomide, celecoxib and omega 3 fatty acids), amino acids and active metabolites (L-carnitine, creatin, leucin and β-hydroxy β-methylbutyrate), vitamin D, antioxidants (vitamins A, E, alpha-lipoic acid, resveratrol and N-acetyl-cysteine) and myostatin inhibitors. Studies have been published with some of these drugs, but the different clinical guidelines do not recognize their role in this entity

Effect of Oligomeric Proanthocyanidin on the Antioxidant Status and Lung Function of Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND/AIM: Evidence exists that oxidative stress and oxidative damage play a pivotal role in chronic obstructive pulmonary disease (COPD). Oligomeric proanthocyanidins (OPCs) extracted from grape seeds have been shown to exhibit antioxidant capabilities greater than those of vitamin C and E. The objective of this study was to evaluate the effects of OPCs on antioxidant status and lung function in patients with COPD. PATIENTS AND METHODS: Patients were supplemented with 150 mg/day OPC (n=13) orally or with a placebo (n=14) for 8 weeks in a randomized double-blind clinical design. Changes in anthropometric values, lung function, oxidative state, and lipid profiles were assessed after OPC or placebo treatment for 8 weeks. RESULTS: The results showed that OPC supplementation significantly reduced the concentration of malondialdehyde, superoxide dismutase, and total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio. The concentration of HDL-C significantly increased in the OPC-treated group. The plasma triglyceride, TC and low-density lipoprotein cholesterol values and the activities of catalase and glutathione peroxidase also decreased, but did not significantly differ between the OPC- and placebo-treated groups. Lung function was not significantly different between the two groups after 8 weeks. CONCLUSION: OPC supplementation was effective in increasing the antioxidant capacity, in addition to improving the lipid profiles in patients with COPD.

The relationship between Vitamin D status and exacerbation in COPD patients- a literature review.

OBJECTIVE: To investigate the relationship between Vitamin D and exacerbation in COPD patients. METHODS: The PubMed database was searched for articles published from 2012 onwards using search terms related to Vitamin D and exacerbation in COPD patients. Meta-analysis, clinical trials, observational studies, and human studies were included. Non-English articles or articles with full text unavailable were excluded; a total of 15 articles were selected. RESULTS: The association between exacerbation frequency and Vitamin D levels in observational studies remains controversial, however, meta-analysis revealed a negative association between serum Vitamin D and exacerbation. Also, two clinical trials showed that Vitamin D3 supplementation in COPD patients reduced the risk of moderate and severe exacerbation. Vitamin D binding protein (VDBP) polymorphisms seem to affect patient exacerbation susceptibility. CONCLUSIONS: Few studies in literature have data related to diet, 25-hydroxyVitamin D [25(OH)D] and polymorphism in COPD exacerbation. One clinical trial indicates Vitamin D supplementation plays a role in COPD patients with hypovitaminosis D in preventing exacerbations. Further studies are needed to elucidate the role of Vitamin D in this population and to establish the best marker for Vitamin D, which patient subgroups will benefit, and the best supplement dosage without leading to toxicity.

Vitamin D supplementation in respiratory diseases: evidence from randomized controlled trials.

Pulmonary diseases are one of the most important causes of morbidity and mortality. Although vitamin D is best known for its role in calcium, phosphorus, and bone homeostasis, it has gained attention in the recent years because of a wide range of extraskeletal effects, including its immunomodulatory and antibacterial potential. Vitamin D deficiency is highly prevalent in chronic pulmonary diseases such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, tuberculosis, and asthma, and several clinical studies have been conducted investigating the effect of vitamin D supplementation on disease outcomes. In this review, we searched for positive evidence on vitamin D supplementation from randomized controlled trials and elaborated on the optimal serum vitamin D levels and dosing regimens for an effective intervention. While vitamin D supplementation seems to be beneficial as an add­on treatment for adult patients with asthma and a potent intervention to reduce exacerbations in patients with COPD, there is little evidence for its therapeutic use in cystic fibrosis, pneumonia, and tuberculosis.