CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Polyunsaturated fatty acids improve exercise capacity in chronic obstructive pulmonary disease

R Broekhuizen¹, E F M Wouters¹, E C Creutzberg², C A P M Weling-Scheepers², A M W J Schols¹

¹ Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands
² Asthma Center Hornerheide, Horn, The Netherlands

Correspondence to:
Correspondence to:
Dr R Broekhuizen
Department of Respiratory Medicine, University Hospital Maastricht, P O Box 5800, 6202 AZ Maastricht, The Netherlands; r.broekhuizen{at}pul.unimaas.nl

Background: Muscle wasting and decreased muscle oxidative capacity commonly occur in patients with chronic obstructive pulmonary disease (COPD). Polyunsaturated fatty acids (PUFA) have been shown to mediate several inflammatory and metabolic pathways which may be involved in the pathogenesis of muscle impairment in COPD. The aim of this study was to investigate the effect of PUFA modulation on systemic inflammation, reversal of muscle wasting, and functional status in COPD.

Methods: Eighty patients with COPD (57 men) with forced expiratory volume in 1 second (FEV₁) 37.3 (13.8)% predicted received 9 g PUFA or placebo daily in a double blind randomised fashion during an 8 week rehabilitation programme. Body composition (bioelectrical impedance), functional capacity (lung function, incremental cycle ergometry test, submaximal cycle test, isokinetic quadriceps strength) and inflammatory markers (C-reactive protein (CRP), interleukin (IL)-6 and tumour necrosis factor (TNF)-) were assessed at baseline and after 8 weeks.

Results: Both groups had similar increases in weight, fat-free mass (FFM), and muscle strength. The peak load of the incremental exercise test increased more in the PUFA group than in the placebo group (difference in increase 9.7 W (95% CI 2.5 to 17.0), p = 0.009) even after adjustment for FFM. The duration of the constant work rate test also increased more in patients receiving PUFA (difference in increase 4.3 min (95% CI 0.6 to 7.9), p = 0.023). The positive effects of PUFA could not be attributed to a decrease in systemic levels of CRP, IL-6 and TNF-.

Conclusions: This is the first study to show beneficial effects of PUFA on exercise capacity in patients with COPD.

Abbreviations: BMI, body mass index; CRP, C-reactive protein; FEV₁, forced expiratory volume in 1 second; FFM, fat-free mass; FFMI, fat-free mass index; FM, fat mass; FVC, forced expiratory vital capacity; IL-6, interleukin 6; ITGV, intrathoracic gas volume; IVC, inspiratory vital capacity; PaO₂, arterial oxygen pressure; PaCO₂, arterial carbon dioxide pressure; PPAR, peroxisome proliferator activated receptor; PUFA, polyunsaturated fatty acids; RER, respiratory exchange ratio; RV, residual volume; TLCO, carbon monoxide transfer factor; TNF-, tumour necrosis factor ; V^·CO₂, peak carbon dioxide production; V^·E, peak ventilation; V^·O₂, peak oxygen consumption

Keywords: chronic obstructive pulmonary disease; exercise capacity; diet; polyunsaturated fatty acids; omega-3

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