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Chronic Obstructive Pulmonary Disease. Micca Henry & Rachel Turley. Learning Objective. At the end of the lecture students will be able to… Recognize the signs and symptoms of COPD Gain an understanding of the nutrition care process in patients with COPD. What is COPD?.

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chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease

Micca Henry & Rachel Turley

learning objective
Learning Objective
  • At the end of the lecture students will be able to…
      • Recognize the signs and symptoms of COPD
      • Gain an understanding of the nutrition care process in patients with COPD
what is copd
What is COPD?
  • Chronic Obstructive Pulmonary Disease
    • Slow, progressive obstruction of the airways
    • Two subcategories of COPD include…
      • Emphysema
      • Chronic bronchitis
chronic bronchitis
Chronic Bronchitis
  • Inflammatory response scarring the lining of the bronchial tubes
  • Signs & Symptoms…
    • Productive cough
    • Restricted airflow
    • Hyperplastic mucus production
emphysema
Emphysema
  • Abnormal, permanent enlargement
  • And destruction of the alveoli
  • Symptoms
    • Breathlessness
    • Wheezing
    • Chest tightness and pain
  • Signs
    • Lips and fingernails turn blue
    • Tachycardia
    • Lack of mental allertness
staging of disease severity
Staging of Disease Severity

Global Initiative for Chronic Obstructive Lung Disease (GOLD)

epidemiology
Epidemiology
  • 23.6 million men and women in US with COPD
  • 52 million globally
  • Studies estimate prevalence of stage-II or higher COPD at 10.1% with prevalence in men greater (11.8%) than women (8.5%)
  • Age adjustment is important COPD in people aged <45 yrs is low prevalence is highest in patients aged >65
epidemiology1
Epidemiology
  • In 1995, 553,000 treated for COPD ~ 2/3 >65
  • Prevalence of COPD in those >65 4X greater than 45 -65
  • 2007 estimated direct health care costs in US were $23.6 billion and overall cost burden was estimated at more than $42 billion
etiology
Etiology
  • Primary etiology suggests smoking and 2nd hand smoke
  • Certain environmental toxins may play a role in small numbers of cases diagnosed where smoking is not evidenced
research
Research
  • Nutritional supplementation & exercise
  • 32 moderate to severe malnourished COPD patients
  • Randomly divided into Nutr supplementation with Ex and control
  • Measures taken both before and after 12 week trial
  • BW and FFM increased significantly in treatment group
  • In addition major decrease in inflammatory response was noted
reasearch
Reasearch
  • Antioxidants, oxidative stress & pulmonary function
  • Cross sectional study of both COPD & asthma measuring association between antioxidant nutrients & markers of oxidative stress
  • FEV1 and FVC both measured
  • 218 subjects from 2 counties in New York State
  • Diet tracked for 12 mo period as well as serum levels
  • Study showed better results for those with greater intake, but pointed to more research needed
patient
Patient
  • Mrs. Bernhardt
  • Age 62, female
  • Stage 1 COPD (emphysema) 5 yrs ago
  • Smoked for 46 yrs quit 1 yr ago
  • Family Hx of cancer, mother & 2 aunts died from lung cancer
patient cont
Patient cont.
  • Symptoms
  • Shortness of breath
  • Dark brownish-green phlegm
  • Early satiety
  • Confusion in the morning
  • Bacterial pneumonia Dx
nutrition hx
Nutrition hx
  • Fills up quickly, meal prep exhausting, loose dentures
  • 24-hr recall ~600-700 kcals
  • High in empty CHO!!!!!!!
  • Very low Pro as well
recommended intake
Recommended intake
  • Mifflin St. Jeor for Women W 1.5 AF for COPD
  • ~ 1600 kcals/day
  • Pro 1.2g/kg for COPD so 65 g Pro/day
  • Some recommendation of nutrient balance 30% CHO, 50% lipid, 20% Pro in order to reduce CO2 production
pes 1
PES # 1

Inadequate energy intake RT early satiety and fatigue secondary to COPD AEB reported energy intake of 600 to 700 kcals which is 900 to a 1000 kcals under predicted energy needs of ~ 1600 kcals

pes 2
PES # 2

Inadequate vitamin and mineral intake RT food and nutrition knowledge deficit AEB 24 hr recall analysis and lack of supplementation

intervention
intervention
  • Address PES #1
  • Establish an ideal diet plan that will gradually increase kcals and introduce the concept of nutrient dense foods ie fruit and vegetables
  • Establish a rapport and increase Mrs. B’s knowledge base
  • Discuss with MD introducing vitamin & mineral supplement.
references
References

Juvelekian G, Stoller J. Chronic obstructive Pulmonary Disease[Internet]. Cleveland(OH):The Cleveland Clinic Foundation; 2012 Oct 1 [cited 2013 Feb 17]. Available from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/chronic-obstructive-pulmonary-disease/

Nelms M, Sucher K, Lacey K, Roth S. Nutrition therapy & pathophysiology. 2nd ed. Belmont: Wadsworth; 2011. 839 p.

Ochs-Balcom H, Grant B, Muti P, Semps C, Freudenheim J, Browne R, McCann S, Trevisan M, Cassano P, Iacoviello L, Schunemann H. Antioxidants, oxidative stress, and pulmonary function in individuals diagnosed with asthma or COPD. Eu J CN. 2006;60:991-99

Sugawara K, Takahashi H, Kasai C, Kiyokawa N, Watanabe T, Fujii S, Kashiwagura T, Honma M, Satake M, Shioya T. Effects of nutritional supplementation combined with low-intensity exercise in malnourished patients with COPD. J Rmed. 2010;104:1883-89