Chronic Obstructive Pulmonary Disease

COPD: Effectiveness of Therapies (2007-2008)

• Intervention
  What effect does the consumption of milk and milk products have on mucus production for patients with COPD?

  • Conclusion

    Authors of a narrative review published in 2005 of 49 references concluded that while some people may perceive some aspects of mucus production after consuming milk and milk products (either cow's or soy), there is no significant effect of milk and milk product consumption on mucus production or various lung function parameters.  Further research on milk and milk product consumption on mucus production in people with COPD is needed. 

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What effect does the consumption of milk and milk products have on mucus production for patients with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Wuthrich B, Schmid A, Walther B, Sieber R.  Milk consumption does not lead to mucus production or occurrence of asthma.  J Am Coll Nutr 2005;24(6 Suppl):547S - 55S. 
  • Search Plan and Results: COPD: Milk and Dairy 2006
     
  What effect does consumption of omega-3 fatty acids have on patients with COPD?

  • Conclusion

    Six studies regarding the consumption of omega-3 fatty acids and COPD were reviewed.  One randomized trial reports improvements in subjects with COPD after consuming an omega-3 fatty acid-rich supplement.  Five epidemiological studies report inconsistent findings regarding a relationship between overall fish intake and COPD mortality, pulmonary function, and symptoms.  Further research on the consumption of fatty acids and COPD is needed.        

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What effect does consumption of omega-3 fatty acids have on patients with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Matsuyama W, Mitsuyama H, Watanabe M, Oonakahara K, Higashimoto I, Osame M, Arimura K.  Effects of omega-3 polyunsaturated fatty acids on inflammatory markers in COPD.  Chest 2005;128:3817-3827. 
      • Shahar E, Boland LL, Folsom AR, Tockman MS, McGovern PG, Eckfeldt JH for the Atherosclerosis Risk in Communities Study Investigators.  Docosahexaenoic acid and smoking-related chronic obstructive pulmonary disease.  Am J Respir Crit Care Med 1999;159:1780-1785.
      • Tabak C, Feskens EJ, Heederik D, Kromhout D, Menotti A, Blackburn HW.  Fruit and fish consumption:  a possible explanation for population differences in COPD mortality (The Seven Countries Study).  Eur J Clin Nutr 1998;52(11):819-25. 
      • Tabak C, Smit HA, Rasanen L, Fidanza F, Menotti A, Nissinen A, Feskens EJM, Heederik D, Kromhout D.  Dietary factors and pulmonary function:  a cross-sectional study in middle aged men from three European countries.  Thorax 1999;54:1021-1026.
      • Tabak C, Smit HA, Heederik D, Ocke MC, Kromhout D. Diet and chronic obstructive pulmonary disease: independent beneficial effects of fruits, whole grains, and alcohol (the MORGEN study).  Clinical and Experimental Allergy 2001;31:747-755.
      • Walda IC, Tabak C, Smit HA, Rasanen L, Fidanza F, Menotti A, Nissinen A, Feskens EJM, and Kromhout D.  Diet and 20-year chronic obstructive pulmonary disease mortality in middle-aged men from three European countries.  European Journal of Clinical Nutrition 2002; 56(7):638-643.
  • Search Plan and Results: COPD: Omega-3 Fatty Acids 2006
     
  What relationship do antioxidants, such as vitamins A, C and E and flavonoids, have on pathogenesis and/or exacerbations in patients with COPD?

  • Conclusion

    Eight studies regarding the relationship between antioxidants and COPD were reviewed.  Six studies report reduced serum and/or tissue levels of vitamins A, C and/or E in people with COPD.  Three studies regarding supplementation report insignificant effects, however these studies were limited in scope, duration and power.  Further research on the relationship between antioxidants and COPD is needed.   

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What relationship do antioxidants, such as vitamins A, C and E and flavonoids, have on pathogenesis and/or exacerbations in patients with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Agacdiken A, Basyigit I, Ozden M, Yildiz F, Ural D, Maral H, Boyaci H, Ilgazli A, Komsuoglu B. The effects of antioxidants on exercise-induced lipid peroxidation in patients with COPD. Respirology 2004;9:38-42.
      • Calikoglu M, Unlu A, Tamer L, Ercan B, Bugdayci R, Atik U.  The levels of serum vitamin C, malonyldialdehyde and erythrocyte reduced glutathione in chronic obstructive pulmonary disease and in healthy smokers.  Clinical Chemistry and Laboratory Medicine 2002; 40, 1028-1031.
      • Cerda B, Soto C, Albaladejo MD, Martinez P, Sanchez-Gascon F, Tomas-Barberan F, Espin JC.  Pomegranate juice supplementation in chronic obstructive pulmonary disease: a 5-week randomized, double-blind, placebo-controlled trial. European Journal of Clinical Nutrition 2006, 60:245-253.
      • Couillard A, Koechlin C, Cristol JP, Varray A, Prefaut C.  Evidence of local exercise-induced systemic oxidative stress in chronic obstructive pulmonary disease patients. European Respiratory Journal 2002; 20:1123-1129.
      • Daga MK, Chhabra R, Sharma B, Mishra TK. Effects of exogenous vitamin E supplementation on the levels of oxidants and antioxidants in chronic obstructive pulmonary disease.  Journal of Bioscience 2003, 28:7-11.
      • Gosker HR, Bast A, Haenen G, Fischer M, van der Vusse GJ, Wouters E, Schols A.  Altered antioxidant status in peripheral skeletal muscle of patients with COPD. Respiratory Medicine 2005; 99:118-125.
      • Igishi T, Hitsuda Y, Kato K, Sako T, Burioka N, Yasuda K, Sano H, Shigeoka Y, Nakanishi H, Shimizu E.  Elevated urinary 8-hydroxydeoxyguanosine (8-OHdG) a biomarker of oxidative stress, and lack of association with antioxidant vitamins in chronic obstructive pulmonary disease.  Respirology 2003; 8:455-460.
      • Tug T, Karatas F, Terzi SM. Antioxidant vitamins (A, C and E) and malondialdehyde levels in acute exacerbation and stable periods of patients with chronic obstructive pulmonary disease. Clinical and Investigative Medicine 2004; 27:123-128.
  • Search Plan and Results: COPD: Antioxidants 2006
     
  What effect does nutritional supplementation have on patients with COPD?

  • Conclusion

    In the inpatient setting, nutritional supplementation for 7 - 12 days results in increased energy intake and weight maintenance as nutritional needs may be higher during hospitalization.  In the outpatient setting, nutritional supplementation results in increased energy intake, with weight gain more likely when combined with exercise. Authors of a Cochrane review published in 2005 of 12 studies concluded that nutritional supplementation for greater than 2 weeks had no significant effect on anthropometric measures, lung function or exercise capacity in patients with stable COPD. Three studies report conflicting findings regarding the effect of macronutrient composition of supplementation on lung function.  Further research on the effect of nutritional supplementation and macronutrient composition in people with COPD is needed.        

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What effect does nutritional supplementation have on patients with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Akrabawi SS, Mobarhan S, Stoltz RR, Ferguson PW.  Gastric emptying, pulmonary function, gas exchange, and respiratory quotient after feeding a moderate versus high fat enteral formula meal in chronic obstructive pulmonary disease patients.  Nutrition 1996;12(4):260-5.
      • Broekhuizen R, Creutzberg EC, Weling-Scheepers CA, Wouters EF, Schols AM.  Optimizing oral nutritional drink supplementation in patients with chronic obstructive pulmonary disease.  Br J Nutr 2005;93(6):965-71.
      • Cai B, Zhu Y, Ma Y, Xu Z, Zao Y, Wang J, Lin Y, Comer GM.  Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients.  Nutrition 2003;19(3):229-232.
      • Creutzberg EC, Wouters EF, Mostert R, Weling-Scheepers CA, Schols AM.  Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease.  Nutrition 2003;19(2):120-7.
      • Ferreira IM, Brooks D, Lacasse Y, Goldstein RS, White J.  Nutritional supplementation for stable chronic obstructive pulmonary disease.  Cochrane Database Syst Rev 2005 Apr 18;(2):CD000998.
      • Forli L, Pedersen JI, Bjortuft O, Vatn M, Boe J.  Dietary support to underweight patients with end-stage pulmonary disease assessed for lung transplantation.  Respiration 2001;68(1):51-7.
      • Planas M, Alvarez J, Garcia-Peris PA, de la Cuerda C, de Lucas P, Castella M, Canseco F, Reyes L.  Nutritional support and quality of life in stable chronic obstruction pulmonary disease (COPD) patients.  Clin Nutr 2005;24(3):433-41.
      • Schols AM, Slangen J, Volovics L, Wouters EF.  Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.  Am J Respir Crit Care Med 1998;157(6 Pt 1):1791-7.
      • Schols AM, Soeters PB, Mostert R, Pluymers RJ, Wouters EF.  Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease.  A placebo-controlled randomized trial.  Am J Respir Crit Care Med 1995;152(4 Pt 1):1268-74.
      • Thorsdottir I, Gunnarsdottir I. Energy intake must be increased among recently hospitalized patients with chronic obstructive pulmonary disease to improve nutritional status.  J Am Diet Assoc 2002;102(2):247-249. 
      • Vermeeren MA, Wouters EF, Nelissen LH, van Lier A, Hofman Z, Schols AM.  Acute effects of different nutritional supplements on symptoms and functional capacity in patients with chronic obstructive pulmonary disease.  Am J Clin Nutr 2001;73(2):295-301.
      • Vermeeren MAP, Wouters EFM, Geraerts-Keeris AJW, Schols AMWJ.  Nutritional support in patients with chronic obstructive pulmonary disease during hospitalization for an acute exacerbation:  a randomized controlled feasibility trial.  Clin Nutr 2004;23(5):1184-92.
  • Search Plan and Results: COPD: Nutritional Supplementation 2006
     
  What is the evidence for use of supplemental oxygen in people with COPD?

  • Conclusion

    Authors of a Cochrane review published in 2005 of 31 studies concluded that ambulatory oxygen, defined as the use of supplemental oxygen during exercise and the activities of daily living, improves exercise performance in people with moderate to severe COPD.  Research regarding the effect of supplemental oxygen on food intake and nutritional status is needed.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence for use of supplemental oxygen in people with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bradley JM, O'Neill B.  Short-term ambulatory oxygen for chronic obstructive pulmonary disease.  Cochrane Database Syst Rev 2005 Oct 19;(4):CD004356.
  • Search Plan and Results: COPD: Supplemental Oxygen 2006