Nutritional Therapy for COPD: What Is the Present State of Nutritional Therapy and Is There a Possibility of Developing
Cachexia associated with advanced lung disease has been recognized as “pulmonary cachexia syndrome.” Manangement for pulmonary cachexia syndrome is important in COPD, because cachexia is an independent predictor of mortality. In meta-analysis reported in
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Nutritional Therapy for COPD: What Is the Present State of Nutritional Therapy and Is There a Possibility of Developing New Drugs? Takao Tsuji
Abstract Cachexia associated with advanced lung disease has been recognized as “pulmonary cachexia syndrome.” Manangement for pulmonary cachexia syndrome is important in COPD, because cachexia is an independent predictor of mortality. In meta-analysis reported in 2012, nutritional support is effective to improve anthropometric measures and exercise capacity in patients with COPD. COPD is treatable disease, but its airflow limitation is not fully reversible, therefore, nutritional therapy preventive to COPD is warranted. In the study reported in 2015, the Alternate Healthy Eating Index 2010 diet score was associated with a lower risk of newly diagnosed COPD. A better approach would be to incorporate multimodal therapy, which would target simultaneously multiple underlying pathophysiological processes. Important management adjunct to nutritional supports is integrated disease management (IDM). IDM is to establish a program of different components of care in which several healthcare providers collaborate to provide efficient and good quality of care. IDM will help to develop new drugs targeting pulmonary cachexia syndrome in patients with COPD. Integrated nutritional therapy including bronchodilator and exercise program is warranted to answer the question: “Is there a possibility of developing new drugs for cachexia in COPD?” Keywords Cachexia • Pulmonary cachexia syndrome • Nutrition • AHEI-2010 • Integrated nutritional therapy
T. Tsuji, M.D (*) Department of Respiratory Medicine, Institute of Geriatrics, Tokyo Women’s Medical University, 2-15-1 Shibuya, Shibuya-ku, 150-0002 Tokyo, Japan e-mail: [email protected] © Springer Science+Business Media Singapore 2017 H. Nakamura, K. Aoshiba (eds.), Chronic Obstructive Pulmonary Disease, Respiratory Disease Series: Diagnostic Tools and Disease Managements, DOI 10.1007/978-981-10-0839-9_10
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T. Tsuji
Introduction
Cachexia is an independent predictor of mortality in patients with COPD. Among patients with COPD who meet the definition of cachexia based on a low lean body mass index, the median survival is reduced by almost half from about 4 to 2 years. Manangement for cachexia is important in patients with COPD, and nutritional support is expected to improve cachexia. In 2000, a meta-analysis of randomized controlled trials showed nutritional support had no effect on improving anthropometric measures, lung function, or functional exercise capacity in patients with COPD [1]. However, in meta-analysis reported in 2012, nutritional support is effective to improve anthropometric measures and exercise capacity in patients with COPD [2, 3]. To answer the question “What is the present state of nutritional theapy and is there a possibility of developing new drugs?”, we refer to the mechanism of pulmonary cachexia syndrome in COPD and mention the nutritional theapy and medication.
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Pulmonary Cachexia Syndrome in CO
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