COPD: A Nutritional Challenge

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

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COPD: A Nutritional Challenge

  1. 1. COPD A Nutritional Challenge Researched by Sandy Erhart January, 2009
  2. 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. 3. Then she begins to cough, a deep, productive cough that she must expectorate into a tissue. This client has COPD….
  4. 4. Chronic Obstructive Pulmonary Disease
  5. 5. Definition and History
  6. 6. 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
  7. 7. Separate processes
  8. 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. 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
  10. 10. Emphysema affects Alveoli Healthy Damaged
  11. 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
  12. 12. Chronic Bronchitis affects Airways
  13. 13. COPD: Historical Aspect EMPHYSEMA 1661, from Greek. emphysema "swelling," from emphysan "inflate." René-Théophile-Hyacinthe Laennec
  14. 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. 15. Spirometry: Vastly underutilized by Primary Care Doctors
  16. 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.
  17. 17. Affect on Nutrition
  18. 18. COPD: A catabolic “wasting” disease CATABOLISM 1875-80, from Greek. catabole “a casting down,"
  19. 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. 20. COPD: Carbohydrates • CHO produce the most CO2 during metabolism • CHO should be 40% of intake • Complex CHO best
  21. 21. COPD: Fats and Proteins • Need at least 30% of calories from fat, whole dairy encouraged • Need 30% from protein
  22. 22. Micronutrients: Fruits and Vegetables • Antioxidants • Vitamin C • Calcium, Vitamin D • Phosphorus
  23. 23. Nutrition & Exercise Tips
  24. 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. 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
  26. 26. Why Should We Care?
  27. 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
  28. 28. Prevention Is KEY
  29. 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. 30. Meet The Smokers BEFORE Wayne McLaren Maureen Hamilton
  31. 31. 20 Years Later… Wayne Maureen
  32. 32. 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/

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