Chronic obstructive pulmonary disease COPD

Amanda FoxBenedictine Dietetic Intern

What is COPD?

• A lung disease affecting airflow of the lungs– The airflow becomes damaged trapping air– The main conditions are asthma, emphysema, and

chronic bronchitis– Major cause is smoking

• 4th leading cause of death in the United States

Signs and Symptoms

Emphysema

• Shortness of breath• Wheezing• Weight loss• Chest tightness

COPD Exacerbation

Chronic Bronchitis• Excess mucous production• Chronic cough > 3 months• Shortness of breath• Frequent respiratory

infections

Medications

• Bronchodilators– Side effects include dry

mouth, nausea, and restlessness

• Corticosteroids– Increase blood sugar,

fluid retention, loss of calcium long term

• Mucolytic Agents• Antibiotics– Soft stools or diarrhea,

upset stomach

How does COPD affect Nutrition?

• Weight Loss• Malnutrition • Tissue Wasting

Assessment

• Individualized• Quality of Life• Check Lab Values– Supplementation?

• Weight Status– Malnourished? BMI?

• Energy Needs

Indicators for Nutritional Risk

• Decreased oral intake• Nausea/Vomiting• Diarrhea• Constipation• Weight Loss

Diagnosis

• Inpatient– Involuntary weight loss…– Increased nutrient

needs…– Inadequate

vitamin/mineral intake…– Inadequate energy

intake…

• Outpatient– Impaired ability to

prepare meals

• Could be related to– Shortness of breath– Decreased appetite– Patient lethargy– Poor appetite– Fatigue during food prep– Decreased food intake

Intervention

• Overcome anorexia or malnutrition– High protein/ high calorie diet

• Frequent small meals– High calorie dense foods– 5-6 meals/day

• Low sodium diet• MVI

– + calcium• Fluids

– Consume inbetween meals and snacks to avoid discomfort and fullness

Education

• Adding calories to a meal– Use of fats• Butter, creams, salad dressing

– Sweets• Use jelly or honey

– Snacks• Nuts, dried fruit, buttered popcorn, or cheese

– Beverages• Milk shakes, ice cream, coffee with cream

Education cont.

• Eat foods that are not too hot or cold– Prevents coughing

• May want to limit foods that produce gas– broccoli, cauliflower, beans, and carbonated

beverages• Choose easy to prepare meals– To conserve energy

• Encourage the patient to rest before meals

ADA Evidenced Analysis Library

• Assessment– RD’s should use BMI and weight change to assess

weight status for individuals with COPD. Studies report individuals with COPD, the prevalence of lower BMI (<20 kg/m2) may be as high as 30% and the risk of COPD related death doubles with weight loss

• Fair Imperative

EAL cont.

• Intervention• For inpatient COPD who have low BMI (<20

kg/m2, unintentional wt. loss, reduced oral intake, RD’s should initiate medical food supplementation. Studies have shown medical food supplementation for 7-12 days results in increased energy intake in the inpatient setting.

• Fair Conditional

EAL cont.

• For individuals with COPD who have osteopenia or osteoporosis, RD’s should encourage consumption of adequate amounts of Ca and vitamin D, as well as avoidance of tobacco smoking and excessive alcohol intake, as determined by national treatment guidelines for osteoporosis. Osteopenia or osteoporosis guidelines specific to COPD have not yet been determined.

• Consensus Conditional

EAL cont.• Monitoring– RD’s should monitor and evaluate the quality of life

of individuals with COPD especially as it relates to their ability to obtain, prepare, and consume food to meet nutritional needs. Research indicates that individuals with COPD may have more impairment of activities with daily living and those with lower BMI may also have lower lung function measurements, more dyspnea, and lower nutritional intakes.

• Fair Imperative

Questions?

References• American Dietetic Association. Nutrition Care Manual. Accessed 26.Feb.2011

http://nutritioncaremanual.org• "COPD Executive Summary of Recommendations." ADA Evidence Library. Web. 24

Feb. 2011. http://www.adaevidencelibrary.com

• U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. What is COPD?. Accessed 26.Feb.2011<http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html>