COPDCOPDA Nutritional Challenge

Researched bySandy ErhartJanuary, 2009

An Introduction…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….

CChronichronic

OObstructivebstructive

PPulmonaryulmonary

DDiseaseisease

Definition and HistoryDefinition and History

COPD:COPD:PathophysiologyPathophysiology

• Chronic lung inflammation in response to noxious particles, gases

• 3 separate processes, alone or combined Emphysema Chronic bronchitis Asthmatic bronchitis

• Progressive and irreversible

Separate processesSeparate processes

COPD: COPD: Signs and Signs and SymptomsSymptoms

• chronic cough, sputum production

• Taking in less O2

retaining CO2 • shortness of breath

and wheezing• recurrent infections• chest tightness

Emphysema:Emphysema:

““Pink PuffersPink Puffers””

• Retains CO2 (pink)• Shortness of breath• Ineffective cough • Barrel chest yet thin limbs• Significant weight loss• Labored, “pursed lip” breathing• Anxious, short sentences

HealthyHealthy

Emphysema affects Emphysema affects AlveoliAlveoli

DamagedDamaged

• Color dusky to cyanotic (lack of O2)• Persistent

productive cough• Retains CO2 leading to acidosis• Shortness of breath

with exertion• Normal-overweight

Chronic Bronchitis: “Chronic Bronchitis: “Blue Blue BloatersBloaters””

Chronic Bronchitis affects Chronic Bronchitis affects AirwaysAirways

COPD: COPD: Historical AspectHistorical Aspect

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

EMPHYSEMA

René-Théophile-Hyacinthe Laennec

• 1846: Hutchinson invents the spirometer, which measures

vital capacity of lungs.

Lung function Lung function getsgets measuredmeasured

• 1947: Tiffeneau adds “timed” VC.

• 1965: “COPD” term first used and defined.

SpirometrySpirometry::

Vastly underutilized byVastly underutilized byPrimary Care DoctorsPrimary Care Doctors

COPD theories & discoveriesCOPD 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 NutritionAffect on Nutrition

COPD: COPD: AA catabolic catabolic

“wasting”“wasting” diseasedisease

1875-80, from Greek. catabole “a casting down," CATABOLISM

Reasons for Reasons for poorpoor nutrition 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: COPD: CarbohydratesCarbohydrates

• CHO produce themost CO2 during metabolism

• CHO should be 40% of intake

• Complex CHO best

COPD:COPD:Fats and ProteinsFats and Proteins

• Need at least 30% of calories from fat, whole dairy encouraged

• Need 30% from protein

Micronutrients:Micronutrients:Fruits and VegetablesFruits and Vegetables

• Antioxidants

• Vitamin C

• Calcium, Vitamin D

• Phosphorus

Nutrition & Exercise TipsNutrition & Exercise Tips

COPD:COPD: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

Pulmonary RehabilitationPulmonary RehabilitationNever too late!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?Why Should We Care?

Knowing about COPDKnowing about COPD Is Important 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 KEYPrevention Is KEY

• 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

COPD: COPD: Risk FactorsRisk Factors

Meet The SmokersMeet The SmokersBEFORE

Wayne McLaren Maureen Hamilton

20 Years Later…20 Years Later…

Wayne Maureen

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/

ReferencesReferences