Objectives: To perform a review of the mechanisms involved in the origin of malnutrition in patients with chronic obstructive pulmonary disease (COPD) and a systematic review of randomized controlled studies to clarify the contribution of nutritional supplementation in patients with stable COPD. Methods: Systematic review of article published in this subject, in all languages from several sources, including Medline, Embase, Cinahl and Cochrane Registry in COPD, as well as studies presented in American and European. Results: Studies with nutritional supplementation longer than two weeks showed that the effect was not big and did not reach statistical significance. A study with linear regression showed that old age, relative anorexia, and high inflammatory response are associated with non-response to nutritional therapy. Conclusion: Currently, there is no evidence of the efficacy of nutritional supplementation in patients with COPD. Factors related to lack of response suggest a relationship with the degree of inflammation, including high levels of TNF alpha. Measuring inflammation markers may be useful to determine prognostic and adequate therapy. Treatment with anti-inflammatory cytokines or cytokine inhibitors are promising for the future.

Objective: To establish clinical and functional baseline characteristics related to aerobic improvement (AI) after supervised training, in COPD patients submitted to a comprehensive pulmonary rehabilitation program (PR). Material and methods: Before and after PR was performed in 36 male COPD patients (25 with mild to moderate disease): clinical and anthropometric evaluation, 6-minute walking test, spirometry, arterial blood gas analysis, maximum inspiratory and expiratory pressure measurement, and a symptom-limited incremental cardiopulmonary exercise testing (MGC-CPX System). Supervised training intensity was targeted at the heart rate (HR) corresponding to anaerobic threshold (AT) or at 90% of the maximum HR attained. Results: Initial maximum oxygen consumption (VO2max) was negatively correlated with age and positively with the body mass index (BMI), the maximum inspiratory pressure (MIP) and the forced expiratory volume in one second (FEV1 ) - p < 0.05. After PR, an increment on submaximal exercise tolerance was found in 29 patients (80.5%); however, AI was only found in 15 individuals (41.6%). AI was associated to the following baseline variables: age < 65 years, AT < 40% of VO2max pred, BMI > 18.5, FEV1 > 60% pre and MIP > 60% pred (p < 0.05). Improvement in MIP and BMI and decrease in the maximum dyspnea score were found only in patients with AI (p < 0.05). Conclusion: Supervised pulmonary rehabilitation in a group of COPD patients was able to increase the submaximal exercise tolerance in most of them. Aerobic improvement was more prevalent in the younger, eutrophic, detrained and least obstructed patient; it was associated with an increment in BMI and MIP and decrease in the maximal dyspnea score after training.

Keywords: COPD. Pulmonary rehabilitation. Exercise training. COPD. Pulmonary rehabilitation. Exercise training.