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COPD: A Nutritional Challenge

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Discussing the history of COPD and strategies in meeting the nutritional needs of this patient.

Discussing the history of COPD and strategies in meeting the nutritional needs of this patient.

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    COPD: A Nutritional Challenge COPD: A Nutritional Challenge Presentation Transcript

    • COPD A Nutritional Challenge Researched by Sandy Erhart January, 2009
    • An Introduction… A client comes for nutritional counseling. She is 64, thin and short of breath with audible wheezing. As she sits, she pulls out and uses her rescue inhaler.
    • Then she begins to cough, a deep, productive cough that she must expectorate into a tissue. This client has COPD….
    • Chronic Obstructive Pulmonary Disease
    • Definition and History
    • COPD: Pathophysiology • Chronic lung inflammation in response to noxious particles, gases • 3 separate processes, alone or combined Emphysema Chronic bronchitis Asthmatic bronchitis • Progressive and irreversible
    • Separate processes
    • COPD: Signs and Symptoms • chronic cough, sputum production • Taking in less O2 retaining CO2 • shortness of breath and wheezing • recurrent infections • chest tightness
    • Emphysema: “Pink Puffers” • Retains CO2 (pink) • Shortness of breath • Ineffective cough • Barrel chest yet thin limbs • Significant weight loss • Labored, “pursed lip” breathing • Anxious, short sentences
    • Emphysema affects Alveoli Healthy Damaged
    • Chronic Bronchitis: “Blue Bloaters” • Color dusky to cyanotic (lack of O2) • Persistent productive cough • Retains CO2 leading to acidosis • Shortness of breath with exertion • Normal-overweight
    • Chronic Bronchitis affects Airways
    • COPD: Historical Aspect EMPHYSEMA 1661, from Greek. emphysema "swelling," from emphysan "inflate." René-Théophile-Hyacinthe Laennec
    • Lung function gets measured • 1846: Hutchinson invents the spirometer, which measures vital capacity of lungs. • 1947: Tiffeneau adds “timed” VC. • 1965: “COPD” term first used and defined.
    • Spirometry: Vastly underutilized by Primary Care Doctors
    • COPD theories & discoveries • 1966: scientists induce emphysema in lab animals with pancreatic enzymes. • 1968: a rare genetic marker, deficiency of alpha-one-antitrypsin discovered. • 2006: hypothesis that COPD is an autoimmune disease. • 2008: systemic inflammation shown to raise plasma leptin levels.
    • Affect on Nutrition
    • COPD: A catabolic “wasting” disease CATABOLISM 1875-80, from Greek. catabole “a casting down,"
    • Reasons for poor nutrition • Dyspnea and coughing interfere with adequate dietary intake • Fatigue interferes with buying and preparing foods • Chronic mouth breathing alters the taste of food • Headaches, mental status changes occur because of hypercapnia (excess blood level of CO2)
    • COPD: Carbohydrates • CHO produce the most CO2 during metabolism • CHO should be 40% of intake • Complex CHO best
    • COPD: Fats and Proteins • Need at least 30% of calories from fat, whole dairy encouraged • Need 30% from protein
    • Micronutrients: Fruits and Vegetables • Antioxidants • Vitamin C • Calcium, Vitamin D • Phosphorus
    • Nutrition & Exercise Tips
    • COPD: Help Eating Succeed  Prepare meals early  Rest and medicate before eating  Oral care before meal  Stimulate the appetite  Liquefy foods to reduce chewing  Eat small, frequent meals  Adequate water intake daily
    • Pulmonary Rehabilitation Never too late! • Even mild to moderate helps • Improves strength and endurance • Reduces dyspnea and fatigue • Improves cardiovascular function • Contributes to stronger, improved breathing
    • Why Should We Care?
    • Knowing about COPD Is Important • Fastest growing chronic disease, half not even diagnosed • Disease not apparent until damage is done and irreversible • Costs $39 billion yearly in health care and hospitalizations in the U.S.; $150 billion worldwide • There is no cure
    • Prevention Is KEY
    • COPD: Risk Factors • Long-term exposure to tobacco smoke • Occupational exposure to dusts and chemicals, air pollution • Age over 40 years • Very rarely caused by alpha-1-antitrypsin deficiency, genetic disorder
    • Meet The Smokers BEFORE Wayne McLaren Maureen Hamilton
    • 20 Years Later… Wayne Maureen
    • References http://www.medscape.com http://www. nlhep.org/ (National Lung Health Education Program) http://my.clevelandclinic.org/health/default.aspx http://www.upmc.com/HealthAtoZ/ http://www.who.int/respiratory/asthma/en/ http://www.thoracic.org/