Resolution of muscle wasting during an acute exacerbation of chronic obstructive pulmonary disease (COPD).

摘要

Weight loss and depletion of fat-free mass commonly occurs in patients with COPD. The objective of the study was to determine the magnitude and duration of protein depletion during an episode of acute exacerbation. Fifteen patients (9 women and 6 men) admitted for an acute exacerbation of COPD participated in a descriptive study that prospectively measured individual nitrogen balance over a 6-week follow-up period using repeated nitrogen balance tests.;The mean nitrogen balance in hospital was -13.20 +/- 11.63 g N/day. Only 2 patients achieved a positive nitrogen balance by 2 weeks post-admission and 4 more patients by 4 weeks post-admission. At 6-weeks post-admission, 7 patients (47%) were still in negative nitrogen balance (-10.75 +/- 9.34 g N/day). Protein and energy intakes were significantly higher in patients who achieved a positive nitrogen balance (1.7 +/- 0.5 g protein/kg/day and 120 +/- 30% of estimated energy expenditure (1.7 x REE)) than patients who remained in a negative nitrogen balance (1.3 +/- 0.6 g protein/kg/day and 70 +/- 20% of estimated energy expenditure). There were no significant changes in weight or handgrip strength over the follow-up period. No effect of cumulative or daily corticosteroid doses on nitrogen balance or changes in handgrip strength were found.;In conclusion, the catabolic stress of an acute exacerbation on nutritional status is remarkable. Patients admitted for an acute exacerbation of COPD are in severe negative nitrogen balance, which improves very slowly post-discharge. A negative nitrogen balance is prolonged in patients who have a decreased protein and energy intake.