COPD: COPD: Nutritional Nutritional

ManagementManagement

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Review Date 8/10 G-1368Contributed by Jamie McGinn, RD, LDN

What Is COPD?

• The two main types of chronic obstructive pulmonary disease (COPD) are emphysema and chronic bronchitis

• COPD is the slow, advancing blockage of the airways in the lungs

Side Effects of COPD

• Reduced respiratory muscle strength and endurance

• Breathing muscles fatigue easier• Increased risk of infections• Malnutrition

COPD and Malnutrition

• Malnutrition is either too much, not enough, or an imbalance of nutrients

• 20%-70% of COPD patients are malnourished

• Malnutrition in emphysema usually is because of not getting enough nutrients

• Many factors cause malnutrition in emphysema patients

• Foods may taste bland

COPD and Malnutrition: Causes

• Up to 140% of energy is needed• Difficulty in breathing causes difficulty in

eating• Medications have gastrointestinal side

effects• Oxygen to the gastrointestinal tract is

decreased• Too much carbon dioxide can cause early

morning headaches and confusion

Limit Carbohydrate Intake

• Follow a high-protein diet with moderate carbohydrates

• Reduce carbohydrates consumed• Start by limiting these foods:

6̶Soda6̶Sweet tea6̶Candy6̶Cake and desserts6̶Starches6̶Fruits6̶Milk

Limit Salt Intake

• Follow a low-sodium or no-added-salt diet • Reduce sodium (or salt) consumed by

limiting these foods:6̶Canned foods6̶Snack foods, such as chips, pretzels, crackers, and popcorn6̶Packaged starchy foods, such as stuffing and rice mixes6̶Cured/luncheon meats and cheeses6̶Condiments, such as ketchup, barbecue sauce, and soy sauce6̶Salt and any seasoning with the word “salt” in it

Flavor Foods Without Salt

• Here are some ways to season food without salt:

6̶For a tart flavor, add lemon juice, lime juice, or vinegar6̶For a hot flavor, add peppers or 1-2 drops of hot sauce6̶Add onions or season with herbs and spices, such as garlic and salt-free seasonings, including Mrs. Dash® (comes in more than 15 varieties)

Increase Protein Intake

• Protein needs are increased up to 1.2-1.7 grams (g)/day

• To calculate how much protein is needed:

6̶Take the weight of the patient and divide by 2.26̶Take that number and multiply it by 1.2 and 1.76̶This will give you the range of protein needed6̶Example: 150 pounds divided by 2.2=68

681.2=82681.7=116

Protein needs are 81-116 g/day

How to Meet Protein Needs

1 egg 6 g protein1 ounce (oz) nuts 2-4 g protein6 oz yogurt 6 g protein½ cup (C) cottage cheese

14 g protein

3 oz canned tuna 25 g protein6 oz steak 42 g protein4 oz hamburger 28 g protein3 oz chicken breast 26 g protein

Increase Dietary Fats

• Increase calories to compensate for reduced carbohydrates by increasing dietary fats

• Increase your intake of omega-3 fatty acids:

6̶Salmon6̶Haddock6̶Mackerel6̶Tuna 6̶Flaxseed6̶Omega-3 fatty acid eggs

Have Adequate Fluid Intake

• Drink 8 C of fluids/day• May need to reduce milk consumption• Take fluids between meals

Get Enough Vitamins and Minerals

• Increased need for vitamin A• Increased need for vitamin C

6̶Smokers need double the dose of vitamin C• Get adequate calcium, magnesium, and

phosphorus• Increased need for vitamin D and

vitamin K if reduced bone minerals• A multivitamin with minerals is

appropriate

Reduce Gas-Forming Foods

• Gas-forming foods can cause bloating and displacement of the diaphragm

• If this occurs, avoid the following:6̶Broccoli6̶Cabbage6̶Onions6̶Leeks6̶Asparagus6̶Carbonated beverages6̶Dried beans and peas

Tips for Comfortable Eating

• Avoid overfeeding• Have frequent, small meals• Choose nutrient-dense foods• Rest before meals• Eat slowly• Wear oxygen during meals• Eat soft, easy-to-chew foods• Remain upright for 1 hour after meals• Drink beverages between meals• Eat main meal with your family or others

Tips for Comfortable Eating (cont’d)

• Try to avoid constipation and straining to pass hard stools

• Increase fiber• Increase antioxidants• Try milk shakes• Reduce caffeinated beverages• Eat chicken soup to clear respiratory

tract

What to Discuss With Your Doctor/Dietitian

• Regular review of lab results• Need for a nutritional supplement • If oral intake is not meeting needs, other

options, such as a tube feeding

How to Get in Touch With a Dietitian

• Call the hospital where you were admitted and ask to speak to a dietitian

• Ask to speak with the dietitian at your nursing home

• Contact your insurance company and ask for help in finding a dietitian

• Visit www.eatright.org and click on FIND A DIETITIAN to locate a dietitian in your area

References

American Dietetic Association. ADA Nutrition Care Manual. Chicago, IL: American Dietetic Association; 2009.

Dorner B. Diet Manual. Akron, OH: Becky Dorner & Associates; 2008.

Escott-Stump S. Nutrition and Diagnosis-Related Care. Philadelphia, PA: Lippincott Williams &Wilkins; 2002.

Mahan LK, Escott-Stump S. Krause’s Food, Nutrition, & Diet Therapy. 11th ed. Philadelphia, PA: WB Saunders; 2004.

Mrs. Dash®. Salt free, flavor-full, no MSG. Available at: www.mrsdash.com. Accessed March 20, 2010.

Niedert KC, Dorner B. Nutrition Care of the Older Adult. Chicago, IL: American Dietetic Association; 2004.

US Dept of Agriculture. MyPyramid.gov: steps to a healthier you. Available at: www.mypyramid.gov. Accessed March 29, 2010.