Pınar ERGÜN, Fatma ŞENGÜL, Dicle KAYMAZ, Nurcan EGESEL, Filiz TAŞDEMİR, İpek CANDEMİR

Pulmoner rehabilitasyon programını tamamlayan koah tanılı olgularda oral nütrisyonel destek; altı ay ve bir yıllık takipleri

Pulmoner rehabilitasyon programını tamamlayan koah tanılı olgularda oral nütrisyonel destek; altı ay ve bir yıllık takipleriGiriş: Oral nütrisyonel destek (OND), multidisipliner pulmoner rehabilitasyon (PR) programının önemli bileşenidir ve vücut kompozisyonu bozukluğu olan kronik obstrüktif akciğer hastalığı (KOAH) tanılı olgularda endikedir. Bu çalışmada PR programını tamamlayan KOAH tanılı olgularda 5-8 ay verilen OND tedavisinin etkisini değerlendirmek amaçlanmıştır.Materyal ve Metod: Ayaktan takipli 8 hafta süren PR programına tamamlayan 41 stabil KOAH tanılı olgu onamları alınarak sonuçları kaydedildi. Olgular, OND tedavi süresine göre gruplandırıldı. Grup 1: 2 ay, grup 2: 5 ay, grup 3: 8 ay süre ile OND alanlardanoluşmaktaydı. Tüm olguların PR programı öncesi, sonrası, 3 ve 6. aydaki solunum fonksiyonları, egzersiz kapasitesi, yaşam kalitesi vevücut kompozisyonundaki değişimler, 20 olguda ise 1 yıllık takip sonuçları incelenmiştir.Bulgular: Tüm gruplarda egzersiz kapasitesi, dispne algısı ve vücut kitle indeksinde PR sonrası elde edilen kazanımların 3 ve 6. aylarda korunduğu izlendi. Yaşam kalitesi grup 1'de 6 ay boyunca korunurken, diğer iki grupta 6. ayda bozulsa da PR öncesi değerlerinedüşmedi. OND süresinden bağımsız olarak PR kazanımları benzer olarak görülmüştür. Bir yıllık takibi olan 20 olguda ise dispnealgısı, vücut kompozisyonunda ise elde edilen kazanımlar korunurken hem egzersiz kapasitesi, hem de yaşam kalitesinde azalmaizlendi. Egzersiz kapasitesi PR öncesi değerlere göre daha az olarak bulunmuştur.Sonuç: Multidipliner kapsamlı PR programı sonrası KOAH tanılıolgularda dispne algısı, egzersiz kapasitesi, yaşam kalitesindekikazanımların vücut kompozisyonlarından ve OND süresindenbağımsız olarak altı ay süre ile devam ettiği ve ayrıca, birinci yıldavücut kompozisyonları, dispne algısı, yaşam kalitesinde kazanımlarkorunurken egzersiz kapasitesinde başlangıçtan daha az olduğugörülmüştür.

Oral nutritional supplement in patients with COPD who completed PR program: six months and one year follow ups

Introduction: Oral nutritional supplement (ONS), an important part of multidisciplinary pulmonary rehabilitation (PR) program, is indicated according to body composition abnormalities in the patients with chronic obtructive pulmonary disease (COPD). We evaluated efficacy of oral nutritional supplement (ONS) during 5-8 months in patients with COPD who completed PR program. Materials and Methods: The data of 41 patients with stable COPD were recorded after the approval had been taken. Patients were grouped according to ONS duration. Group 1 consisted of patients who took ONS during 2 months, group 2: 5 months, group 3: 8 months. In all patients, pulmonary function tests, quality of life, exercise capacity and body composition datas were recorded before and after PR program, at 3rd, 6th month and in 20 patients 1 year follow-up visit. Results: In all groups, improvements after PR in exercise capacity, dyspnea, and body composition sustained at 3 and 6 month. Quality of life was protected in group 1 during six month, in other groups it was over values before PR despite loss at 6. month. All improvements after PR were similiar between groups. In 20 patients with one year follow up, while the improvements in dyspnea and body composition were preserved, both exercise capacity and quality of life decreased, exercise capacity was lower than values before PR. Conclusion: In patients with COPD, after multidisplinary PR program, the improvements in dyspnea, exercise capacity, quality of life were maintained during six months regardless of body composition and ONS duration. Furthermore, while the improvements in body composition, dyspnea, quality of life were protected, exercise capacity was found to be lower than baseline.

PDF

___

Maltais F. Body composition in COPD: looking beyond BMI. Int J Tuberc Lung Dis 2014;18:3-4.
Vilaró J, Ramirez-Sarmiento A, Martínez-Llorens JM, Mendoza T, Alvarez M, Sánchez-Cayado N. Global muscle dysfunction as a risk factor of readmission to hospital due to COPD exacerbations. Respir Med 2010;104:1896-902.
Creutzberg Woulters EF, Mostert R, Weling-Scheepers CA, Schols AM. Efficacy of nutritional supplementation therapy in depleted patients with COPD. Nutrition 2003;19:120- 7.
Collins PF, Elia M, Stratton RJ. Nutritional support and functional capacity in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Respirology 2013;18:616-29.
Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157:1791-7.
Steiner MC, Barton R, Singh S, Morgan M. Nutritional enhancement of exercise performance in COPD: a randomised controlled trial. Thorax 2003;58:745-51.
Hsieha MJ, Yanga TM, Tsai Y. Nutritional supplementation in patients with chronic obstructive pulmonary disease. J For Med Assoc 2016;11:595-601.
Whittaker JS, Ryan CF, Buckley PA, Road JD. The effects of refeeding on peripheral and respiratory muscle function in malnourished COPD patients Respir 1990;142:283-8.
Ischaki E, Papatheodorou G, Gaki E, Papa I, Koulouris N, Loukides S. Body mass and fat-free mass indices in COPD: relation with variables expressing disease severity. Chest 2007;132:164-9.
Abbatecola AM, Fumagalli A, Spazzafumo L, Betti V, Misuraca C, Corsonello A, et al. Body composition markers in older persons with COPD. Age Ageing 2014;43:548-53.
Costa T, Costa FM, Moreira CA, Rabelo LM, Boguszewski CL, Borba WZ. Sarcopenia in COPD: relationship with COPD severity and prognosis. J Bras Pneumol 2015;41:415-21.
Günay E, Kaymaz D, Selçuk NT, Ergün P, Sengül F, Demir N. Effect of nutritional status in individuals with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation. Respirology 2013;18:1217-22.
Hany H, Kamal E. Body mass index and its relation to GOLD stage in chronic obstructive pulmonary disease patients. Egyp J Chest Dis and Tuber 2016;65:411-4.
Ferreira IM, Brooks D, White J, Goldstein R. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012;12:12-98.
Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. http://goldcopd.org.
Sabino PG, Silva BM, Brunetto AF. Nutritional status is related to fatfree mass, exercise capacity and inspiratory strength in severe chronic obstructive pulmonary disease patients. Clinics 2010;65:599-605.
Xizheng S, Jinming L, Yanrong L, Xiaowen X, Zhiqing H. Relationship between nutritional risk and exercise capacity in severe chronic obstructive pulmonary disease in male patients. Inter J COPD 2015;10:1207-12.
Schols AM, Soeters PB, Mostert R. Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebocontrolled randomized trial. Am J Respir Crit Care Med 1995;152:1268-74.
Pothirat C, Chaiwong W, Phetsuk N, Liwsrisakun C, Bumroongkit C, Deesomchok A, et al. The Relationship between Body Composition and Clinical Parameters in Chronic Obstructive Pulmonary Disease. J Med Assoc Thai 2016;99:386-93. 20. Weekes CE, Emery PW, Elia M. Dietary counselling and food fortification in stable COPD: a randomised trial. Thorax 2009;64:326-31.
Sugawara K, Takahashi H, Kasai C, Kiyokawa N, Watanabe T, Fujii S, et al. Effects of nutritional supplementation combined with low-intensity exercise in malnourished patients with COPD. Respir Med 2010;104:1883-9.