COPD & NUTRITION

By

Dr. Riham Hazem RaafatLecturer of Chest Diseases

Ainshams University

• Case 1: Stable COPD Grade B patient, BMI 20, no wt loss,

coming for rehab. program, what will be his nutritional program?

• Case 2: COPD patient with acute infective exacerbation, BMI 17,

increased purulence and amount of sputum and needs admission in

hospital, what will change in his nutritional support program?

• Case 3: COPD patient with RF II and mechanically ventilated in

ICU and hypotensive, how will u manage his nutrition?

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

Consequences of malnutrition in COPD

Case 1 Case 2 Case 3

Screening/Assessment

SGA -HB or IC Anthropometric

Laboratory

SGA- HB or ICAnthropometric

Laboratory

MUST Ireton-jonesHB x1.3-1.5

REE + Fluids

20-25 Kcal/dayOral diet

8cup/d30ml//kg

25-30 Kcal/dONS bid

Small, Frequent

1st resuscitate EN in 24-48hrs

25-30 Kcal/d

Macro-nutrients

CHO: 40-50 %Fat: 15-25 %

Protein: 0.8-1.5 g/kg (25 %)

Less CHO, High Fat,

High Protein to 2g/kg

DecreasedIncreased

Up to 2.5g/kgRQ decrease

Micro-nutrients

Vitamins, Minerals, Trace

Elements

AntioxidantsOmega 3, MCT

(Pulmocare)

AntioxidantsPo4, Vit. D, CaGlutamine, O3

/ Malnutrition Universal Screening Tool

Body composition abnormalities:

↑ ACTIVITY RELATED ENERGY EXPENDITURE

HYPERMETABOLIC STATE

DECREASED INTAKE

IMPAIRMENT OF ENERGY BALANCE

IMBALANCE IN PROTEIN SYNTHESIS AND BREAKDOWN

LOSS OF FAT

LOSS OF WEIGHT: BMI <2110% WEIGHT LOSS IN 6 MONTHS5% WEIGHT LOSS IN 1 MONTH

LOSS OF FFMANTHROPOMETRYBIOIMPEDANCE ANALYSISDEXALab. Investigations

CALORIC SUPPLEMENTS

PROTEIN SUPPLEMENT

STRENGTH

EXERCISE

ANABOLIC

STEROIDS

GROWTH

HORMONE

INTERVENTIONS

Help Eating SucceedHelp 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

CarbohydratesCarbohydrates

• CHO produce the

most CO2 during

metabolism

• CHO should be

40% of intake

• Complex CHO best

When Limited Carbohydrate Intake needed

• Follow a high-protein diet with moderate carbohydrates

• Reduce carbohydrates consumed• Start by limiting these foods:

SodaSweet teaCandyCake and dessertsStarchesFruits

Milk

Fats and ProteinsFats and Proteins

• Need at least 30%

of calories from

fat, whole dairy

encouraged

• Need 30% from protein

when in malnutrition

How to Meet Protein Needs

1 egg 6 g protein

1 ounce (oz) nuts 2-4 g protein

6 oz yogurt 6 g protein

½ cup (C) cottage cheese 14 g protein

3 oz canned tuna 25 g protein

6 oz steak 42 g protein

4 oz hamburger 28 g protein

3 oz chicken breast 26 g proteinOz = 28.35g

Increase Dietary Fats

• Increase calories to compensate for reduced

carbohydrates by increasing dietary fats

• Increase your intake of omega-3 fatty acids: Salmon

Haddock

Mackerel

Tuna

Flaxseed

Omega-3 fatty acid eggs

Limit Salt Intake

• Follow a low-sodium or no-added-salt diet

• Reduce sodium (or salt) consumed by limiting these

foods:Canned foods

Snack foods, such as chips, pretzels, crackers, and

popcorn

Packaged starchy foods, such as stuffing and rice mixes

Cured/luncheon meats and cheeses

Condiments, such as ketchup, barbecue sauce, and soy

sauce

Salt and any seasoning with the word “salt” in it

Micronutrients:Micronutrients:Fruits and VegetablesFruits and Vegetables

• Antioxidants

• Vitamin C

(smokers need double dose)

• Calcium, Vitamin D

• Phosphorus

Reduce Gas-Forming Foods

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

• If this occurs, avoid the following:BroccoliCabbageOnionsLeeksAsparagusCarbonated beveragesDried beans and peas

Anabolic steroids

• Anabolic steroids

• Nandrolone decanoate - 50 mg for male; 25 mg

for females; 2 Weekly 4 doses

• Anabolic therapy alone increases muscle mass

but not exercise capacity

INTERVENTION WEIGHT GAIN

FFM GAIN EXERCISE CAPACITY

CALORIC SUPP. + - -

CALORIC SUPPLEMENTATION +EXERCISE TRAINING

++ + +

STRENGTH EXERCISE - + -

ANABOLIC STEROIDS ++ ++ -

ANABOLIC STEROIDS + EXERCISE

++ +++ ?