Effect of Intravenous Fructose 1,6-Diphosphate Administration in Malnourished Chronic Obstructive Pulmonary Disease Patients with Chronic Respiratory Failure

Background: Weight loss and skeletal muscle wasting are common in patients with chronic obstructive pulmonary disease (COPD) and can influence the course and the prognosis of COPD. Hypophosphatemia is a pathologic status often characterized by muscle weakness and is a frequent laboratory finding in these patients. Objective: The aim of the present study was to evaluate the effect of an organic phosphate (fructose 1,6-diphosphate, FDP) administration on respiratory performance in 45 malnourished COPD patients in stable clinical conditions. Methods: Physiologic evaluation including spirometry, maximal voluntary ventilation (MMV), elevated arm test, maximal mouth pressures (PImax and PEmax), respiratory response to CO 2 , oxygen (PaO 2 ) and carbon dioxide (PaCO 2 ) arterial tension, a visual analogic scale (VAS) to measure dyspnea, and complete blood tests were done at the beginning and again at the end of the study. Results: After FDP administration, there was a significant increase in PImax (43.0 ± 18.3 cm H 2 O before treatment vs. 49.8 ± 14.9 cm H 2 O after treatment; p < 0.005). This did not occur in the placebo group (40.3 ± 17.4 cm H 2 O before treatment vs. 42.6 ± 20.1 cm H 2 O after treatment, nonsignificant). There was also a trend of VAS to decrease and of MVV to increase. Conclusions: These results show that FDP administration may be useful in the management of malnourished COPD patients, especially in increasing their respiratory muscle strength.