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1.
COPD
A Nutritional Challenge
Researched by
Sandy Erhart
January, 2009
2.
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.
3.
Then she begins to cough, a
deep, productive cough that
she must expectorate into a
tissue. This client has COPD….
8.
COPD: Signs and Symptoms
• chronic cough,
sputum production
• Taking in less O2
retaining CO2
• shortness of breath
and wheezing
• recurrent infections
• chest tightness
9.
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
11.
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
13.
COPD: Historical Aspect
EMPHYSEMA
1661, from Greek. emphysema "swelling,"
from emphysan "inflate."
René-Théophile-Hyacinthe Laennec
14.
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.
15.
Spirometry:
Vastly underutilized by
Primary Care Doctors
16.
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.
18.
COPD:
A catabolic
“wasting” disease
CATABOLISM
1875-80, from Greek. catabole “a casting down,"
19.
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)
20.
COPD: Carbohydrates
• CHO produce the
most CO2 during
metabolism
• CHO should be
40% of intake
• Complex CHO best
21.
COPD:
Fats and Proteins
• Need at least 30%
of calories from
fat, whole dairy
encouraged
• Need 30% from
protein
22.
Micronutrients:
Fruits and Vegetables
• Antioxidants
• Vitamin C
• Calcium, Vitamin D
• Phosphorus
24.
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
25.
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
27.
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
29.
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
30.
Meet The Smokers
BEFORE
Wayne McLaren Maureen Hamilton