Nutritional supplementation during pulmonary rehabilitation in COPD: Asystematic review

摘要

Uptake of nutritional supplementation during pulmonary rehabilitation (PR) for peoplewith chronic obstructive pulmonary disease (COPD) has been limited by an absence ofrigorous evidence-based studies supporting use. The objective was to report and summarisethe current evidence supporting the use of nutritional supplementation to improve outcomesduring PR in stable COPD patients. A systematic search was conducted up to 7 August 2019(registration number CRD42018089142). The preferred reporting items for systematic reviewsand meta-analyses guidelines were used. Six databases were included: Medical LiteratureAnalysis and Retrieval System Online or MEDLARS Online, Allied and Complementary MedicineDatabase, the Cochrane Database of Systematic Reviews, Excerpta Medica dataBASE,Cumulative Index of Nursing and Allied Health Literature and Web of Science. Thissystematic search generated 580 initial matches, of which 22 studies (917 COPDparticipants) met the pre-specified criteria and were included. Sixteen of 19 studies thatused nutritional supplements in addition to PR did not show additional benefit compared toPR alone when measuring exercise capacity. Nutritional supplements significantly increasedbody weight in 7 of 11 studies. Body mass index increased significantly in two of sixstudies. Handgrip strength did not improve, while quadriceps muscle strength significantlyimproved in 3 of 11 studies. Four of eight studies showed a significant improvement ininspiratory muscle function. Only 2 of 14 studies demonstrated a significant improvementin quality of life with supplementation in addition to PR. There remains insufficientevidence on the effect of nutritional supplementation on improving outcomes during PR inpatients with COPD due to heterogeneity in supplements, outcome measures and PRprogrammes. Therefore, controversy remains and further research is needed.