Clinical Briefs
August 30, 2015 4 minutes read
Oral Nutritional Supplementation for Hospitalized COPD Patients Pays Off
SOURCE: Snider JT, et al. Effect of hospital use of oral nutritional supplementation on length of stay, hospital cost, and 30-day readmissions among Medicare patients with COPD. Chest 2015;147:1477-1484.
In contrast to many of the other top 10 causes of death in the United States, chronic obstructive pulmonary disease (COPD) deaths are increasing, such that COPD is now the third most common cause of death. Although a variety of pharmacologic interventions are available to improve symptoms and decrease exacerbations, none has been shown to reduce mortality.
COPD is associated with increased risk for malnutrition, which may lead to further respiratory function compromise and immune dysfunction. Might nutritional supplementation of patients admitted for COPD improve outcomes?
Snider et al utilized the Premier Research Database, which contains hospitalization information from 460 U.S. hospitals and 46 million hospitalizations. The authors compared outcomes in persons > 65 years of age admitted for COPD (n = 378,419) who received oral nutritional supplementation (n = 10,322) vs those who did not. Outcomes of interest were length of hospital stay, hospitalization costs, and readmission rates.
Oral nutritional supplementation was associated with numerous favorable results: Length of stay was reduced by 21.5%, readmission rate was reduced by 7%, and even the cost of hospitalization was reduced by 12.5%. Overall, the results suggested that for every dollar spent on oral nutritional supplementation, the hospital saved $18.
It is clear oral nutritional supplementation has been employed in a small minority of COPD admissions (10,322 out of 378,419 admissions). These favorable results should prompt reconsideration of the value — health wise and economic — of oral nutritional supplementation in patients admitted for COPD.
An Unrecognized Relationship Between Asthma and Obesity
SOURCE: Pakhale S, et al. Effects of weight loss on airway responsiveness in obese adults with asthma: Does weight loss lead to reversibility of asthma? Chest 2015;147:1582-1590.
The prevalence of asthma is increasing, although the reasons behind this are not entirely clear. There may be an important link between asthma and obesity.
For instance, incident asthma is almost 50% more common in obese persons. Each increment of three units in body mass index (BMI) is associated with a 35% increase in asthma. Even the degree of airway hyperreactivity — the hallmark of asthma — is directly related: For each one-unit increase in BMI (e.g., a BMI change from 30 to 31 kg/m2), there is a 3% increase in airway hyperreactivity.
Whether treatment of obesity might benefit patients with asthma has received little attention in the literature. Pakhale et al performed a prospective controlled trial in obese adults (mean BMI = 45 kg/m2) with asthma to compare metrics of pulmonary function and airway hyperreactivity in subjects who participated in a weight loss program vs control. The intervention group received lifestyle intervention to enhance dietary weight loss and exercise.
The metric for airway hyperreactivity was the PC20 — the amount of methacholine necessary to produce a bronchoconstrictive effect large enough to reduce FEV1 by 20% (the more methacholine it takes, the less hyperreactive your airways are).
At the end of the 3-month trial, the intervention group had lost a mean of approximately 17 kg, but the control group had a gain of approximately 1 kg. The intervention group enjoyed improvements in pulmonary function (improved FEV1), asthma quality of life, and PC20. Weight reduction may be an overlooked tool for asthma management.
Sound Stimulation in Alzheimer’s Patients
SOURCE: Clements-Cortes A, Bartel L. Sound stimulation in patients with Alzheimer’s disease. Annals Long-Term Care 2015;23:10-16.
Music therapy can be a helpful and pleasurable experience for patients with Alzheimer’s disease (AD). Although clinical trials on the subject are not large or plentiful, the favorable results obtained appear promising. For instance, one clinical trial looked at the impact of music therapy among persons with agitation and AD. A 45-minute session of music therapy reduced agitated and disruptive behaviors (like swearing or yelling). Whether music therapy provides long-term benefits has not been well studied.
For most, if not all of us, music has deep-rooted emotional links. Background music has been shown to improve cognitive performance throughout the adult lifespan, including college students, older adults, and patients with AD. Interestingly, those brain areas responsible for processing music are commonly preserved in patients with AD, despite their loss of other cognitive functions. At a less macroscopic level, exposure to music has been shown to increase levels of IgA and decrease cortisol.
Whether clinicians want to consider supporting the use of recreational environmental music (simple background music for patients) or the formal structure of music therapy provided by a trained therapist, music may provide meaningful clinical improvements in AD patients, as well as an enhanced quality of life.
In this section: Reconsidering the value of oral nutritional supplementation in patients admitted for COPD; recognizing a relationship between asthma and obesity; and weighing the benefits of sound stimulation in Alzheimer's patients.
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