Nutritional status and muscle dysfunction in chronic respiratory diseases: stable phase versus acute exacerbations

Abstract

Nutritional abnormalities are frequent in different chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), interstitial fibrosis and lung cancer, having important clinical consequences. However, nutritional abnormalities often remained underdiagnosed due to the relative lack of awareness of health professionals. Therefore, systematic anthropometry or even better, assessment of body composition, should be performed in all patients with chronic respiratory conditions, especially following exacerbation periods when malnutrition becomes more accentuated. Nutritional abnormalities very often include the loss of muscle mass, which is an important factor for the occurrence of muscle dysfunction. The latter can be easily detected with the specific assessment of muscle strength and endurance, and also negatively influences patients' quality of life and prognosis. Both nutritional abnormalities and muscle dysfunction result from the interaction of several factors, including tobacco smoking, low physical activity-sedentarism, systemic inflammation and the imbalance between energy supply and requirements, which essentially lead to a negative balance between protein breakdown and synthesis. Therapeutic approaches include improvements in lifestyle, nutritional supplementation and training. Anabolic drugs may be administered in some cases.

Keywords: Nutritional abnormalities; diet; exercise; low body weight; lung diseases; muscle dysfunction; muscle mass; prognosis.

Figure 1

Different factors that contribute to nutritional abnormalities and/or muscle dysfunction. Note the relevant role of exacerbations, when many of the factors involved in nutritional abnormalities increase their influence. The most relevant clinical consequences of nutritional abnormalities and muscle dysfunction are also shown.

Figure 2

Techniques and the most relevant variables used for nutritional and muscle function assessments. Note that both abnormalities are closely related since the presence of malnutrition often contributes to the occurrence of muscle dysfunction. FFMI, fat-free mass index; DEXA, dual-energy X-ray absorptiometry; CT, computed tomography; MRI, magnetic resonance imaging; CASCO, CAchexia SCOre; MCASCO, mini-CASCO score; MVV, maximum voluntary ventilation; MSV, maximum sustainable ventilation.