COPD is a lung disease affecting the airflow of the lungs. The main conditions for COPD are asthma, emphysema, and chronic bronchitis. The major cause is smoking but also there is a nonsmoking causes like pollutants (coal miners or asbestos) . According to the American Lung Association, COPD is the 4th leading cause of death in the United States
There are no true sign and symptoms for COPD, but rather sign and symptoms from conditions that cause COPD like Emphysema and Bronchitis.COPD Exacerbation can occur with worsening symptoms
Weight loss is common for individuals with COPD because of their symptoms may prevent them from eating. For example, if a patient has shortness of breath, they may not have the energy to eat. This will lead to malnutrition and tissue wasting. COPD can lead to cachexia, in which muscle and fat mass are lost in spite of adequate calorie intake.
Each patient will need their own personal assessment because their symptoms differentiate from one another.Look at their quality of life and see what they can tolerate.The labs values will determine if supplementation is necessary.Their weight status will depend on the proper amount of MNT to provide for the patient. Also, what are the energy needs? It will depend on what they can tolerate.
High protein- 1.2-1.5g milk, eggs, cheese, meat, fish, poultry, nuts, and dried beans or peas.High calorie- 30-35 kcal/kg depending on weightFrequent small meals- high calorie dense foods like adding ensure or glucerna between mealsLow sodium diet may be recommended because to much may result with sodium retention or peripheral edema may inhibit breathingLong term use of steroids, will need calcium and vitamin D supplementationFluid intake is usually met by 1 ml/kcal and want to stress fluid intake between meals so the patient does not fill up on liquids. Want to avoid constipation and dehydration
Fair- the workgroup believes that the benefits exceed the harms, but the quality of evidence is not as strongImperative- broadly applicable to the target population without restraints on their pertinence.
Fair-the benefits exceed the harms, but the quality of evidence is not as strong (grade II or III)Conditional- Expert opinion (grade IV) supports the guideline recommendation even though the available scientific evidence did not present consistent results
Consensus- Expert opinion (grade IV) supports the guideline recommendation even though the available scientific evidence did not present consistent resultsConditional- define a specific situation
Fair- the benefits exceed the harms, but the quality of evidence is not as strong (grade II or III)Imperative- broadly applicable to the target population without restraints on their pertinence.
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 SymptomsEmphysema Chronic Bronchitis• Shortness of breath • Excess mucous production• Wheezing • Chronic cough > 3 months• Weight loss • Shortness of breath• Chest tightness • Frequent respiratory infectionsCOPD Exacerbation
Medications• Bronchodilators • Mucolytic Agents – Side effects include dry • Antibiotics mouth, nausea, and – Soft stools or restlessness diarrhea, upset stomach• Corticosteroids – Increase blood sugar, fluid retention, loss of calcium long term
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 • Could be related to – Involuntary weight loss… – Shortness of breath – Increased nutrient – Decreased appetite needs… – Patient lethargy – Inadequate – Poor appetite vitamin/mineral intake… – Fatigue during food prep – Inadequate energy – Decreased food intake intake…• Outpatient – Impaired ability to prepare meals
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
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.ht ml>