Nutritional support in chronic obstructive pulmonary disease (COPD): an evidence update

Area of Science:

• Pulmonary Medicine
• Nutritional Science
• Metabolic Adaptations

Background:

• Chronic obstructive pulmonary disease (COPD) extends beyond pulmonary effects, causing systemic inflammation and significant extrapulmonary complications.
• These complications include altered metabolism, increased nutritional needs, reduced exercise capacity, and impaired nutrient intake, leading to multifaceted nutritional depletion.
• Nutritional depletion in COPD manifests as weight loss, sarcopenia (loss of muscle mass), and pulmonary cachexia, exacerbated by inflammation and resulting in loss of both fat-mass (FM) and fat-free mass (FFM).

Purpose of the Study:

• To review the complex nutritional challenges in COPD patients.
• To evaluate the efficacy of nutritional support, particularly oral nutritional supplements (ONS).
• To explore the necessity of multi-modal interventions for addressing sarcopenia, frailty, and cachexia in COPD.

Main Methods:

• Literature review on the pathophysiology of nutritional depletion in COPD.
• Analysis of evidence regarding the impact of oral nutritional supplements (ONS).
• Discussion of multi-modal strategies including nutritional therapy, hormonal support, and exercise training.

Main Results:

• Oral nutritional supplements (ONS) can effectively address energy and protein imbalances, improving nutritional status and functional capacity in COPD patients.
• However, ONS alone may not fully address the underlying causes of sarcopenia, frailty, and cachexia.
• A comprehensive approach is needed to tackle specific nutrient deficiencies, hormonal changes, and incorporate targeted exercise.

Conclusions:

• Nutritional support via ONS offers benefits for COPD patients, but a multi-modal strategy is essential for treating sarcopenia, frailty, and cachexia.
• Interventions should be tailored to the disease course, addressing energy/protein balance, nutrient deficiencies, and incorporating exercise.
• A holistic, disease-course-based approach is crucial for effectively managing the pervasive issue of nutritional depletion in COPD.