Successfully reported this slideshow.
Your SlideShare is downloading. ×

Supporting Nutrition in COPD: Sam Blamires. PLAN Summer meeting

Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Upcoming SlideShare
Supporting guide
Supporting guide
Loading in …3
×

Check these out next

1 of 29 Ad

Supporting Nutrition in COPD: Sam Blamires. PLAN Summer meeting

Presentation by Sam Blamires, registered dietician and Senior Medical Affairs Advisor at Nutricia. Part of the PLAN Summer meeting 2016. A review of the latest evidence and guidelines on supporting nutrition in COPD, including the causes and consequences of malnutrition in COPD, the use of screening tools, the NICE guidelines on supplementation, and putting theory into practice.

Presentation by Sam Blamires, registered dietician and Senior Medical Affairs Advisor at Nutricia. Part of the PLAN Summer meeting 2016. A review of the latest evidence and guidelines on supporting nutrition in COPD, including the causes and consequences of malnutrition in COPD, the use of screening tools, the NICE guidelines on supplementation, and putting theory into practice.

Advertisement
Advertisement

More Related Content

Slideshows for you (20)

Advertisement

Similar to Supporting Nutrition in COPD: Sam Blamires. PLAN Summer meeting (20)

More from Pan London Airways Network (11)

Advertisement

Recently uploaded (20)

Supporting Nutrition in COPD: Sam Blamires. PLAN Summer meeting

  1. 1. Reviewing the latest evidence and guidelines Samantha Blamires 16th June 2016 Supporting Nutrition in COPD
  2. 2. Who Am I? Samantha Blamires Registered Dietitian Senior Medical Affairs Advisor Samantha.blamires@nutricia.com
  3. 3. Outline  Overview of malnutrition in COPD • Prevalence • Causes • Consequences  NICE Clinical Guidelines • CG32 and CG101  Evidence for nutrition support in COPD • A review of the current evidence base  Putting theory into practice • Managing malnutrition in COPD
  4. 4. 1. Overview of malnutrition in COPD
  5. 5. Definition of Malnutrition “A state of nutrition in which a deficiency, excess (or imbalance) of energy, protein, and other nutrients causes measurable adverse effects on tissue / body form (body shape, size and composition) and function, and clinical outcome” (Elia,2000) For the purpose of this session we will focus on malnutrition relating to a deficiency of nutrients, inadequate intake, unintentional weight loss.
  6. 6. Malnutrition is common but is often under- recognised1  In the UK, approximately 1/3 of patients with COPD are at risk of malnutrition2  Depends on severity of disease and method of assessment  More common in severe COPD patients and patients with emphysema  In older patients attention should be paid to changes in weight, particularly if the change is more than 3 kg3 1. Ambrosino, et al. Respiratory Medicine; 2007;101:1613-24. 2. Stratton, et al. Disease-related malnutrition: an evidence-based approach to treatment. Oxford: CABI Publishing, 2003. 3. NICE. https://www.nice.org.uk/guidance/cg101[3.2.2016].
  7. 7. Weight Loss in COPD = Loss of Lean Body Mass  Cross-sectional survey  n = 300 COPD outpatients  38% had lean body mass depletion  Whereas only 17% had low BMI (<20 kg/m2) Cano NJ, et al. Eur Respir J 2002;20:30–7.
  8. 8. Causes of malnutrition in COPD Malnutrition can occur in COPD due to increased nutritional requirements and decreased oral intake1 Within COPD patients there is a spectrum ranging from those who are very underweight to those who are overweight2 Patients with chronic bronchitis are more commonly overweight. Typically emphysematous patients are more commonly underweight. 1. Ezzell, et al. Am J Clin Nutr. 2000;72:1415-6. 2. Ohar, et al. Prim Care Respir J. 2011;20:370-8.
  9. 9. Factors affecting nutritional intake in COPD Gandy. Manual of Dietetic Practice. Wiley-Blackwell, 2014. Pharmacological • Dry mouth • Oral thrush • Taste changes Physical • Dyspnoea • Fatigue • Dysphagia Psychological • Depression • Anxiety • Loneliness Social • Social isolation • Unemployment • Housebound
  10. 10. Consequences of malnutrition in COPD 1. Ezzell L and Jensen GL. Am J Clin Nut 2000;72:1415-1416. 2. Collins PF et al. Clinical Nutrition 2010;5,S2:17 3. Gupta B, Kant S, Mishra R, Verma S. J Clin Med Res, 2010 Mar 20; 2(2): 68-74. 4. Ferreira IM, Brooks D, White J, Goldstein R. Cochrane Database Syst Rev. 2012. 5.Vermeeren MA et al. Respir Med, 2006; 100: 1349- 1355, 6. Collins PF, Stratton RJ, Elia M. Proceedings of the Nutrition Society, 2011; 70 (OCE5): E324.
  11. 11. 1 year mortality according to BMI 0 5 10 15 20 25 BMI classification (kg/ m2 ) <20 20-24.9 25-29.9 >30 p< 0.001 %mortality 1-year mortality is four-fold higher in underweight patients compared to those classified as overweight or obese Collins P. Thorax 2010;65(Suppl.4):A74 underweight 21%, normal weight 15%, overweight 5%, obese 4%; p <0.001
  12. 12. 2. Nutritional Screening
  13. 13. Identifying patients at risk of malnutrition Malnutrition in COPD can present as1: Assessing BMI alone will not pick up all patients who are at risk The ‘Malnutrition Universal Screening Tool’ (‘MUST’) can help identify adults who are underweight and/or at risk of malnutrition2 Reduction in lean body mass and/or unintentional weight loss Low BMI (<20 kg/m2) and/or 1. Managing Malnutrition in COPD. http://malnutritionpathway.co.uk/copd/ 2. BAPEN. http://www.bapen.org.uk/musttoolkit.html[26.2.2016].
  14. 14. 3. NICE Clinical Guidelines
  15. 15. NICE CG32: Nutrition Support in Adults Healthcare professionals should consider oral nutrition support to improve intake for people who can swallow safely and are malnourished or at risk of malnutrition (A GRADE)
  16. 16. NICE CG101  BMI should be calculated in patients with COPD  Normal range is 20-25kg/m2  If the BMI is abnormal, or changing over time refer for dietetic advice  If the BMI is low:  Give ONS to increase total calorific intake  Encourage patient to take exercise to augment the effects of ONS
  17. 17. 4. Evidence for nutritional support in COPD
  18. 18. Evidence for nutritional support in COPD Systematic reviews and meta-analyses show multiple benefits of nutritional support in COPD1–3 1. Collins, et al. Am J Clin Nutr. 2012;95:1385-95. 2. Collins, et al. Respirology. 2013;18:616-29. 3. Ferreira, et al. Cochrane Database Syst Rev. 2012;12:CD000998. Study Number of trials Statistically significant outcomes Collins et al. 20121 13 ↑ Nutritional intake ↑ Weight gain ↑ Hand grip strength Collins et al. 20132 12 ↑ Inspiratory/expiratory muscle strength ↑ Hand grip strength Ferreira et al. 20123 17 ↑ Weight gain ↑ Fat-free mass/fat-free mass index ↑ Fat mass/fat mass index ↑ Exercise capacity ↑ Health-related QoL
  19. 19. NICE CG32 – Evidence Update 46 (2013) - Oral nutritional supplements appear to improve energy and protein intake, body weight, and functional outcomes in malnourished patients with stable COPD - Evidence is consistent with the recommendation in NICE CG101 to give nutritional supplements to patients with COPD and a low BMI - The evidence base now appears to be more robust
  20. 20. European Respiratory Society statement (2014)
  21. 21. Hospital Use of ONS in malnourished COPD patients1 *N.b. A 21.5% reduction in LOS equates to 1.9days (8.8 to 6.9 days) 1. Snider et al. CHEST 2015;147(6):1477 - 1484 • Average length of stay was reduced*21.5% • Total hospital costs were lowered12.5% • Hospital readmissions (within 30 days) were reduced13.1%
  22. 22. 5. Putting theory into practice
  23. 23. The Respiratory Healthcare Professional’s Nutritional Guideline for COPD Patients The original nutritional guideline for COPD patients was launched in 2011 and was supported by ARNS.
  24. 24. Managing Malnutrition in COPD Coming soon at http://www.malnutritionpathway.co.uk/copd/ 1. Managing Malnutrition in COPD. http://malnutritionpathway.co.uk/copd/
  25. 25. A pathway for the appropriate use of ONS in the management of malnutrition in COPD  For ‘high risk’ patients and/or those with a BMI<20kg/m2  Guides you through goal setting and the appropriate use of ONS  When to stop ONS prescription
  26. 26. Management plans according to ‘MUST’ score Re-categorise individuals according to improvement or deterioration Reassess individuals identified at risk as they move through care settings Low risk – score 0 Routine clinical care Provide green leaflet to raise awareness of importance of a healthy diet If BMI>30kg/m2 (obese) treat according to local guidelines Review / re-screen annually Medium risk – score 1 Observe Dietary advice to maximise nutritional intake Provide yellow leaflet to support dietary advice NICE recommends patients with a BMI <20kg/m2 should be prescribed ONS Review progress after 1–3 months High risk – score 2+ Treat as appropriate Dietary advice to maximise nutritional intake Provide red leaflet to support dietary advice Prescribe ONS and monitor Review progress Refer to dietitian if no improvement
  27. 27. What can you do today to improve the nutritional management of your patients? • Recognise that malnutrition is prevalent amongst patients with COPD • Screen your patients! – ‘MUST’ at initial appointment and annually thereafter or more regularly where there is clinical concern • Set nutritional goals with patient/carer • Implement appropriate nutritional care plan • ONS should be provided to patients with a low BMI (NICE CG101) • Review at agreed intervals Make nutrition an integral part of COPD care!
  28. 28. Questions samantha.blamires@nutricia.co m
  29. 29. Thank you

×