It has now been recognised that nutrition is an important adjunctive therapy in the management of patients with COPD. Although COPD is principally an inflammatory disease involving the lungs it also affects other body tissues (e.g. bones and muscles), these are known as co morbidities. Diet and nutritional intake are important in COPD because they help to combat some of these co morbidities, which fluctuate and progress throughout the course of the disease. A substantial number of patients with COPD are either underweight or overweight and this influences their prognosis. Being short of breath can lead to a reduced nutritional intake leading to weight loss. However breathlessness can also make exercise difficult leading to weight gain.Latest Guidelines
The Respiratory Healthcare Professionals Nutritional COPD Guideline launching this year at the Winter BTS meeting, has been designed to raise the awareness of nutrition with respiratory health professionals and their COPD patients. They provide a simple tool to aid first line nutritional management of this patient group and improve the nutritional status of COPD patients
Nutritional screening in COPD
It is important to regularly monitor the nutritional status of patients with COPD. Ideally this will involve routine screening using a validated nutritional screening tool, such as the ‘Malnutrition Universal Screening Tool’ or ‘MUST’ (www.bapen.org.uk), which is recommended by NICE. ‘MUST’ is a quick and simple tool which has been validated for use in primary care and involves 3 steps: assessment of body mass index (BMI), recent changes in weight and likely nutritional intake over the coming 5 days. Research has shown that ‘MUST’ is able to independently identify those patients with COPD who are likely to go on to have a poor clinical outcome in terms of hospital re-admission rates, length of hospital stay and mortality. Although ‘MUST’ primarily screens for malnutrition it also highlights those patients with an excessive BMI.
Table: Body mass index (BMI) classification and suggested nutritional management.
Obesity and COPD
Obesity is a major risk factor for obstructive sleep apnoea (OSA) and it has been suggested that up to 70% of patients with OSA to be obese. Being obese can lead to a restriction of the airways as well as an increase the mechanical work of breathing which will impact on a patient’s quality of life. Patients classified as obese should be encouraged to lose weight through controlled calorie restriction, ideally under the supervision of a dietitian, in combination with increased physical activity. The target being a reduction in fat mass and preservation of muscle mass.
Malnutrition and COPD
Malnutrition is a significant problem in COPD and often goes undetected and as a result often untreated. Up to 45% of outpatients and 60% of inpatients with COPD have been reported to be at risk of malnutrition. Patients at risk of malnutrition with COPD are more likely to be admitted to hospital, experience increased length of hospital stay, have earlier readmission rates and have a poorer prognosis than those patients not at risk of malnutrition. If you identify a patient as at risk of malnutrition refer to a dietician and/or implement your local nutritional management care pathway.