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Chronic obstructive pulmonary disease patient journey: hospitalizations as window of opportunity for extra-pulmonary intervention

Lainscak, Mitja; Gosker, Harry R.; Schols, Annemie M.W.J.

Current Opinion in Clinical Nutrition & Metabolic Care: May 2013 - Volume 16 - Issue 3 - p 278–283
doi: 10.1097/MCO.0b013e328360285d
TRANSLATIONAL RESEARCH IN WASTING DISEASES: Edited by Vickie E. Baracos, Didier Attaix and Claude Pichard

Purpose of review Hospitalizations due to exacerbation of chronic obstructive pulmonary disease (COPD) are a major burden for patient and healthcare system. Extra-pulmonary needs and resulting interventions are poorly investigated.

Recent findings COPD induces nutritional issues, body composition changes and limits patient exercise capacity. The COPD patient journey can be accelerated through exacerbations during which disease-related detrimental factors such as systemic inflammation, hypoxia, inactivity, and glucocorticosteroid treatment converge and intensify, which acutely and often irreversibly worsens patient condition. Specific needs during exacerbations reach beyond the respiratory system, thus clinicians should comprehensively evaluate patients and identify potent and feasible metabolic and anabolic intervention targets. General and specific nutritional support appear feasible and with potential to cover for the changed bodily requirements during exacerbation. Adjunctive physical exercise or neuromuscular electrical stimulation may prevent the muscle loss.

Summary Hospitalizations should be considered as a window of opportunity for detailed patient assessment and implementation of tailored extra-pulmonary adjunctive strategies with long-term implications. Nutritional assessment and support as well as physical exercise appear promising but should be investigated in adequately designed and conducted trials.

aDivision of Cardiology, University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia

bApplied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany

cDepartment of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands

Correspondence to Mitja Lainscak, MD, PhD, FESC, Associate Professor of Internal Medicine, Division of Cardiology, University Clinic Golnik, Golnik 36, SI-4204 Golnik, Slovenia. Tel: +386 31 379 533; fax: +386 4 25 69 117; e-mail:

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