The extrapulmonary impact of COPD
COPD causes the bronchioles (airways of the lungs) to become inflamed and obstructed. In addition, the alveoli (air sacs in the lungs) become permanently damaged. However, COPD is not just a disease of the lungs, it also has a significant extrapulmonary component. The forced expiratory volume at 1 second (FEV1) is commonly used to evaluate lung function, and although FEV1 is a useful diagnostic tool, it is a poor predictor of COPD disease status and outcome. 6
In COPD patients, there is commonly a degenerative cycle of decline in their health over time. The decreasing lung function causes patients to establish a more sedentary lifestyle as they struggle for breath in their usual daily activity. This reduction in exercise output causes a loss of the patient’s muscle mass and therefore a decline in their maximal oxygen consumption capacity (VO2max). The reduction in VO2max makes existing physical activity harder, putting more stress on the lungs, worsening lung function further.
This extrapulmonary effect of COPD shows that addressing the patient’s underlying physical capacity may have benefits to the patient by delaying COPD disease progression and improving quality of life. 7
Levels of physical activity in COPD patients are strong predictors for their disease prognosis. Poor physical performance is associated with an increased risk of morbidity and mortality 8 and may even impact on the rate of lung function decline. 6
The International GOLD guidelines for COPD management highlight that a multimodal approach to COPD treatment, ie nutritional intervention and exercise, is a valid aspect of COPD treatment alongside existing lung disorder management (eg bronchodilators). Respifor® provides the opportunity for clinicians to integrate this ready to use nutritional solution into current treatment programmes. 2
References:
2. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Available at http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=2003 [Accessed August 2009]
6. Polkey M, Rabe K. European Respiratory Journal 2009;33:227–229
7. Garcia-Aymerich J et al. Chest 2009; in press
8. Celli BR et al. New England Journal of Medicine 2004;350:1005–1012