Chronic Obstructive Pulmonary Disease

Micca Henry & Rachel Turley

Learning Objective

• At the end of the lecture students will be able to…

• Recognize the signs and symptoms of COPD

• Gain an understanding of the nutrition care process in patients with COPD

What is COPD?

• Chronic Obstructive Pulmonary Disease• Slow, progressive obstruction of the airways

• Two subcategories of COPD include…• Emphysema• Chronic bronchitis

Chronic Bronchitis

• Inflammatory response scarring the lining of the bronchial tubes

• Signs & Symptoms…• Productive cough• Restricted airflow• Hyperplastic mucus

production

Emphysema

•Abnormal, permanent enlargement •And destruction of the alveoli

•Symptoms• Breathlessness• Wheezing• Chest tightness and pain

•Signs• Lips and fingernails turn

blue• Tachycardia• Lack of mental allertness

Staging of Disease Severity

Disease Severity GOLD

Stage 0: at risk Normal: Chronic symptoms (cough, sputum production)

Stage I: mild ≥80% FEV1 with or without chronic symptoms

Stage II: moderate 50%-79% FEV1 with or without chronic symptoms

Stage III: severe 30%-49% FEV1with or without chronic symptoms

Stage IV: very severe <30% FEV1

Global Initiative for Chronic Obstructive Lung Disease (GOLD)

Epidemiology

• 23.6 million men and women in US with COPD

• 52 million globally

• Studies estimate prevalence of stage-II or higher COPD at 10.1% with prevalence in men greater (11.8%) than women (8.5%)

• Age adjustment is important COPD in people aged <45 yrs is low prevalence is highest in patients aged >65

Epidemiology

• In 1995, 553,000 treated for COPD ~ 2/3 >65

• Prevalence of COPD in those >65 4X greater than 45 -65

• 2007 estimated direct health care costs in US were $23.6 billion and overall cost burden was estimated at more than $42 billion

Etiology

• Primary etiology suggests smoking and 2nd hand smoke

• Certain environmental toxins may play a role in small numbers of cases diagnosed where smoking is not evidenced

Pathophysiology

Pathophysiology

Research

• Nutritional supplementation & exercise

• 32 moderate to severe malnourished COPD patients

• Randomly divided into Nutr supplementation with Ex and control

• Measures taken both before and after 12 week trial

• BW and FFM increased significantly in treatment group

• In addition major decrease in inflammatory response was noted

Reasearch

• Antioxidants, oxidative stress & pulmonary function

• Cross sectional study of both COPD & asthma measuring association between antioxidant nutrients & markers of oxidative stress

• FEV1 and FVC both measured

• 218 subjects from 2 counties in New York State

• Diet tracked for 12 mo period as well as serum levels

• Study showed better results for those with greater intake, but pointed to more research needed

Patient

• Mrs. Bernhardt

• Age 62, female

• Stage 1 COPD (emphysema) 5 yrs ago

• Smoked for 46 yrs quit 1 yr ago

• Family Hx of cancer, mother & 2 aunts died from lung cancer

Patient cont.

•Symptoms• Shortness of breath

• Dark brownish-green phlegm

• Early satiety

• Confusion in the morning

• Bacterial pneumonia Dx

Nutrition hx

• Fills up quickly, meal prep exhausting, loose dentures

• 24-hr recall ~600-700 kcals

• High in empty CHO!!!!!!!

• Very low Pro as well

Recommended intake

• Mifflin St. Jeor for Women W 1.5 AF for COPD

• ~ 1600 kcals/day

• Pro 1.2g/kg for COPD so 65 g Pro/day

• Some recommendation of nutrient balance 30% CHO, 50% lipid, 20% Pro in order to reduce CO2 production

PES # 1

Inadequate energy intake RT early satiety and fatigue secondary to COPD AEB reported energy intake of 600 to 700 kcals which is 900 to a 1000 kcals under predicted energy needs of ~ 1600 kcals

PES # 2

Inadequate vitamin and mineral intake RT food and nutrition knowledge deficit AEB 24 hr recall analysis and lack of supplementation

intervention

• Address PES #1

• Establish an ideal diet plan that will gradually increase kcals and introduce the concept of nutrient dense foods ie fruit and vegetables

• Establish a rapport and increase Mrs. B’s knowledge base

• Discuss with MD introducing vitamin & mineral supplement.

??Any Questions??

References

Juvelekian G, Stoller J. Chronic obstructive Pulmonary Disease[Internet]. Cleveland(OH):The Cleveland Clinic Foundation; 2012 Oct 1 [cited 2013 Feb 17]. Available from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/chronic-obstructive-pulmonary-disease/

Nelms M, Sucher K, Lacey K, Roth S. Nutrition therapy & pathophysiology. 2nd ed. Belmont: Wadsworth; 2011. 839 p.

Ochs-Balcom H, Grant B, Muti P, Semps C, Freudenheim J, Browne R, McCann S, Trevisan M, Cassano P, Iacoviello L, Schunemann H. Antioxidants, oxidative stress, and pulmonary function in individuals diagnosed with asthma or COPD. Eu J CN. 2006;60:991-99

Sugawara K, Takahashi H, Kasai C, Kiyokawa N, Watanabe T, Fujii S, Kashiwagura T, Honma M, Satake M, Shioya T. Effects of nutritional supplementation combined with low-intensity exercise in malnourished patients with COPD. J Rmed. 2010;104:1883-89