الفهرس 
CHRONIC OBSTRUCTIVE PULMONARY DISEASEOnly 14 pages are availabe for public view
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Abstract
The nutritional status of patients with COPD has been considered an important factor that influences the experiencing symptoms and prognosis of the disease (Ferreira et al., 2005).
Approximately 20–40% of COPD patients have been reported as being underweight or malnourished (Raguso & Luthy, 2011).
Pulmonary system abnormalities certainly limit exercise in patients with COPD (Amann et al., 2010); however, peripheral muscle abnormalities also negatively impact exercise performance and activities of daily living (Richardson et al., 2004).
COPD is a progressive, chronic disease, in which the patient’s nutritional status is critical for optimizing outcomes. Malnutrition coupled with advancing COPD can lead to worsening respiratory muscle function, dyspnea, and exercise capacity (Anker et al., 2009).
The study was conducted upon fifty COPD participants diagnosed according to GOLD (2010) with a confirmed diagnosis by history, physical examination, radiological and spirometric data (post-bronchodilator forced expiratory volume in the first second to forced vital capacity ratio (FEV1/FVC) ≤0.70) when they were considered to be in a clinically stable condition. We recruited them from the pulmonary outpatient clinic of the Chest department at Ain Shams University Hospital, as well as COPD inpatients at the time of discharge. participates had completed questionnaire to assess their nutrition, their life style as regard daily activities, and then performing the cycle ergometry CPET.
Exclusion criteria:
Very severe cases.
Cases in exacerbations.
Cases in respiratory failure.
Cases with decompensated co-morbid diseases.
Exclusion criteria for CPET included unstable cardiac disease e.g. myocardial infarction (<3 months), uncontrolled hypertension, angina, neuromuscular conditions that would interfere with the exercise test, and/or if they were unable to follow instructions.
All participants had been subjected to:
Full history, full clinical examination.
Radiological evaluation: postero-anterior and lateral views.
Laboratory investigations:
CBC, ESR, SGOT, SGPT, Urea, Creatinine, FBS, 2 hours post prandial blood sugar, total plasma protein, serum albumin level, ABG.
Spirometric grading according to GOLD 2010 (including FVC%, FEV1%, FEV1/FVC and FEF 25-75%), since all cases were COPD diagnosed by post-bronchodilator forced expiratory volume in the first second to forced vital capacity ratio (FEV1/FVC) ≤0.70 and no substantial improvement in FEV1 after taking 400 mcg of nebulized salbutamol.
Calculation of BMI and grading all patients according to their BMI (below normal, normal, overweight and obese) according to (NIH) (NHLBI, 2000).
Baseline Modified Medical Research Council (mMRC) dyspnea scores were performed to all patients
Nutritional and life style questionnaire.
CPET cardiopulmonary exercise testing.
The current study revealed:
Underweight COPD participants had presented 28% by their BMI.
The most common associated co morbidities were hypertension and diabetes; there were no significant differences between participants with or without co morbidities.
The most common Causes of termination of CPET were dyspnea and fatigue, participants who stopped because of dyspnea had significantly higher duration after diagnosis of COPD and mMRC score but who stopped because of fatigue had significantly higher protein intake, spirometric parameters.
There were significant positive correlations between mMRC scale and (duration after diagnosis of COPD, age of the participants).
As regard mMRC scale relations: there were significant positive correlations between it and (duration after diagnosis of COPD, age of the participants and GOLD score) and significant negative correlations between it and (VO2 Max, VO2/Kg, test duration, spirometric parameters, Calorie intake, BMI, EER%, Carbohydrate intake, Protein intake, & serum total plasma protein).
As regarding exercise capacity: there were significant negative correlations between VO2 Max & VO2/Kg and (GOLD score, BMI, duration after diagnosis of COPD, and age of the participants) and significant positive correlations between VO2 Max & VO2/Kg and (spirometric parameters, calorie intake, EER%, carbohydrate intake and protein intake).
According to CPET duration there were significant negative correlations between it and (GOLD score, age of the participants, and duration after diagnosis of COPD) and significant positive correlations between it and (spirometric parameters, Carbohydrate intake, and serum total plasma protein).
Desaturated participants during CPET had significantly higher age, duration after diagnosis of COPD, and mMRC score however they had significantly lower Carbohydrate intake, spirometric parameters.
Participants with daily activities had significantly higher Protein intake, total calorie intake, EER%, serum total plasma protein, spirometric parameters and CPET parameters however they had significantly lower BMI, age, duration after diagnosis of COPD and mMRC score.
Ex-smoker participants had significantly higher spirometric parameters, protein intake, total calorie intake, EER% and serum total plasma protein. However, they had significantly lower BMI, duration of COPD and mMRC score.
Compliant participants to their medications had significantly higher protein and carbohydrate intake, total calorie intake, EER%, serum total plasma protein and spirometric parameters. However, they had significantly lower age, BMI, duration after diagnosis of COPD and mMRC score.
Participants with average nutrition had significantly higher CPET parameters & spirometric parameters however they had significantly lower duration after diagnosis of COPD, mMRC score, and BMI.