COPD

A Nutritional Challenge

Researched by
Sandy Erhart
January, 2009
 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.
Then she begins to cough, a
deep, productive cough that
she must expectorate into a
tissue. This client has COPD….
Chronic
Obstructive
Pulmonary
Disease
Definition and History
 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
Separate processes
COPD: Signs and Symptoms

• chronic cough,
sputum production
• Taking in less O2
retaining CO2
• shortness of breath
and wheezing
• recurrent infections
• chest tightness
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
Emphysema affects Alveoli

Healthy Damaged
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
Chronic Bronchitis affects Airways
 COPD: Historical Aspect

EMPHYSEMA
1661, from Greek. emphysema "swelling,"
from emphysan "inflate."

René-Théophile-Hyacinthe Laennec
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.
 Spirometry:
Vastly underutilized by
Primary Care Doctors
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.
Affect on Nutrition
 COPD:
A catabolic
“wasting” disease

CATABOLISM
1875-80, from Greek. catabole “a casting down,"
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)
COPD: Carbohydrates

• CHO produce the

most CO2 during
metabolism
• CHO should be
40% of intake
• Complex CHO best
 COPD:
Fats and Proteins

• Need at least 30%

of calories from
fat, whole dairy
encouraged
• Need 30% from
protein
 Micronutrients:
Fruits and Vegetables

• Antioxidants
• Vitamin C
• Calcium, Vitamin D
• Phosphorus
Nutrition & Exercise Tips
 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
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
Why Should We Care?
 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
Prevention Is KEY
 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
 Meet The Smokers
BEFORE

Wayne McLaren Maureen Hamilton

20 Years Later…

Wayne Maureen
 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/