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Celebrate World COPD Day
November 16th was World COPD Day, and what better to celebrate it than by improving our knowledge of this condition, and discussing nutrition management.
Firstly, do we know what it is?
Chronic Obstructive Pulmonary Disease or COPD describes a group of lung conditions, like chronic bronchitis and emphysema, that make it difficult to empty air out of the lungs because the airways have been narrowed.
COPD usually develops because of long-term damage to lungs from breathing in a harmful substance, usually cigarette smoke. Other factors, particularly occupational exposures, may also contribute to the development of COPD. Symptoms include breathlessness, chronic cough, producing more sputum or phlegm and wheezing.
Researchers looking at the prevalence of COPD in care homes have reported figures between 10 and 30%, and the disease accounts for about 1 in 10 of all hospital admissions from care homes.
For people with COPD, maintaining a healthy weight is important. In obese people with COPD, the heart and lungs have to work harder to supply oxygen to the body. Being underweight is also detrimental to clinical outcomes and quality of life. Around 20% of people with COPD are thought to be at risk of malnutrition, and this is associated with more infections, frequent and longer hospital admissions, reduced muscle strength and reduced respiratory muscle function.
Why are people with COPD at risk of malnutrition?
For most people, breathing is effortless. Yet, for many with COPD, breathing requires added effort and this can increase energy expenditure. In addition, weight loss can be exacerbated by poor nutritional intake. Difficulty in breathing is a common COPD symptom, but this can make chewing and swallowing more challenging. Other reasons for lower intake include fatigue, poor appetite and coughing. There are also factors that may lead to taste changes, like chronic mouth breathing and a dry mouth, and the side effects of medication.
The purpose of nutrition care for people with COPD is to provide adequate energy to minimise the risk of unwanted weight loss, avoid loss of muscle mass and improve lung function. The combined loss of weight and muscle can adversely affect breathing by reducing the strength and function of respiratory and skeletal muscles.
What is good nutrition care in service users with COPD at risk of malnutrition?
Dietary advice to maximise nutritional intake in those at risk of malnutrition would be to encourage small frequent meals and snacks, with high energy and protein food and fluids. Foods high in protein (like meat, fish, eggs, dairy tofu, beans, lentils) are important for maintaining muscle (including those that help with breathing). Foods providing starchy carbohydrate (like potatoes, bread, pasta, rice, cereals) are important sources of energy.
As a result of medication and/or being less active, people with COPD are at risk of weaker bones and so should ensure that calcium-rich foods are included in their diet. As well as dairy foods, other sources of calcium include dried figs, kale, almonds, sesame seeds and canned sardines – lots of different foods you can include on your menus - but probably not all at once!
A helpful new practical guide 'Managing Malnutrition in COPD' developed by a multi-professional panel has been launched this year to assist healthcare professionals in identifying and managing people with COPD - who are at risk of disease-related malnutrition. Three complementary colour coded patient leaflets (green - low risk, yellow - medium risk and red - high risk) containing dietary advice, advice on eating and physical activity and tips on coping with common symptoms of COPD have also been developed.
In addition, the red (high risk) leaflet includes advice on incorporating oral nutrition supplements into the diet.
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