COPD & Nutrition

How is COPD and Nutrition Overlapped and Affecting Each Other
How to Solve the Problem as a Part of Pulmonary Rehabilitation
The Presentation is Discussing these items in the form of Problem Solving

1. COPD & NUTRITION
By
Dr. Riham Hazem Raafat
Lecturer of Chest Diseases
Ainshams University

2. •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?

3. 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

5. Consequences of malnutrition in COPD

6. Case 1 Case 2 Case 3
Screening/
Assessment
SGA -HB or IC
Anthropometric
Laboratory
SGA- HB or IC
Anthropometric
Laboratory
MUST
Ireton-jones
HB x1.3-1.5
REE +
Fluids
20-25 Kcal/day
Oral diet
8cup/d30ml//kg
25-30 Kcal/d
ONS bid
Small, Frequent
1
st
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
Decreased
Increased
Up to 2.5g/kg
RQ  decrease
Micro-
nutrients
Vitamins,
Minerals, Trace
Elements
Antioxidants
Omega 3, MCT
(Pulmocare)
Antioxidants
Po4, Vit. D, Ca
Glutamine, O3

9. / Malnutrition Universal Screening Tool

16. 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 <21
10% WEIGHT LOSS IN 6 MONTHS
5% WEIGHT LOSS IN 1 MONTH
LOSS OF FFM
ANTHROPOMETRY
BIOIMPEDANCE
ANALYSIS
DEXA
Lab. Investigations
CALORIC
SUPPLEMENTS
PROTEIN
SUPPLEMENT
STRENGTH
EXERCISE
A
N
A
B
O
L
I
C

S
T
E
R
O
I
D
S
G
R
O
W
T
H

H
O
R
M
O
N
E
INTERVENTIONS

17. 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

19. CarbohydratesCarbohydrates
•CHO produce the
most CO
2
during
metabolism
•CHO should be
40% of intake
•Complex CHO best

20. When Limited Carbohydrate Intake
needed
•Follow a high-protein diet with moderate
carbohydrates
•Reduce carbohydrates consumed
•Start by limiting these foods:
Soda
Sweet tea
Candy
Cake and desserts
Starches
Fruits
Milk

21. Fats and ProteinsFats and Proteins
•Need at least 30%
of calories from
fat, whole dairy
encouraged
•Need 30% from protein
when in malnutrition

22. 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 protein
Oz = 28.35g

23. 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

24. 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

25. Micronutrients:Micronutrients:
Fruits and VegetablesFruits and Vegetables
•Antioxidants
•Vitamin C
(smokers need double dose)
•Calcium, Vitamin D
•Phosphorus

26. Reduce Gas-Forming
Foods
•Gas-forming foods can cause bloating and
displacement of the diaphragm
•If this occurs, avoid the following:
Broccoli
Cabbage
Onions
Leeks
Asparagus
Carbonated beverages
Dried beans and peas

27. 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

28. INTERVENTION WEIGHT
GAIN
FFM GAIN EXERCISE
CAPACITY
CALORIC SUPP. + - -
CALORIC
SUPPLEMENTATION +
EXERCISE TRAINING
++ + +
STRENGTH EXERCISE - + -
ANABOLIC STEROIDS ++ ++ -
ANABOLIC STEROIDS +
EXERCISE
++ +++ ?