Pulmonary Rehabilitation* Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines

Andrew L. Ries, MD, MPH, FCCP (Chair); Gerene S. Bauldoff, RN, PhD, FCCP; Brian W. Carlin, MD, FCCP; Richard Casaburi, PhD, MD, FCCP; Charles F. Emery, PhD; Donald A. Mahler, MD, FCCP; Barry Make, MD, FCCP; Carolyn L. Rochester, MD; Richard ZuWallack, MD, FCCP; Carla Herrerias, MPH

Disclosures

CHEST. 2007;131(5):4S-42S. 

In This Article

Nutritional Supplementation in Pulmonary Rehabilitation

Poor nutritional status is associated with increased morbidity and mortality in patients with moderate-to-severe COPD.[179] Prior studies have investigated the effects of dietary supplementation on patients with COPD, as summarized in a relatively recent metaanalysis.[180] Summary data indicate that nutritional support/supplementation does not have a clinically significant effect on lung function or functional abilities. No studies have evaluated the effects of behavioral weight management (gain or loss) among patients with COPD.

There remains very little information regarding the effects of nutritional supplementation used in conjunction with a comprehensive pulmonary rehabilitation program. Only one study[181] has investigated the effects of nutritional supplementation administered during a comprehensive pulmonary rehabilitation program. In this double blind, randomized trial, 85 patients with chronic lung disease were randomized to receive either (1) carbohydrate supplementation or (2) a nonnutritive placebo during a 7-week pulmonary rehabilitation program. The aim was to augment exercise performance with the use of carbohydrate supplementation. Outcomes measured included physical performance, health status, and body weight and composition. Twenty-five patients were unable to complete the study and were not included in the final analysis. Significant increases in shuttle walk distance and HRQOL (as measured by the CRDQ) were noted in both groups. In well-nourished patients (ie, body mass index > 19 kg/m[2]), improvement in shuttle walk performance was significantly greater in the nutritionally supplemented group (mean difference between groups, 27 m; 95% confidence interval, 1 to 53 m; p < 0.05). The increase in shuttle walk performance correlated with increases in total carbohydrate intake.

The overall effects of nutritional supplementation in this single study are difficult to determine given the significant number of patients who did not complete the study and the fact that improvement was noted in both experimental groups. This study suggests that exercise-training results in a negative energy balance that can be overcome by supplementation, and in selected patients, may improve the outcome of training.

23. There is insufficient evidence to support the routine use of nutritional supplementation in the pulmonary rehabilitation of patients with COPD. No recommendation is provided.

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