COPD: COPD: Nutritional Nutritional

ManagementManagement

Provided Courtesy of Nutrition411.com

Review Date 4/14G-1368

Contributed by Jamie McGinn, RD, LDNUpdated by Nutrition411.com staff

What Is COPD?

• The two main types of chronic obstructive pulmonary disease (COPD) are emphysema and chronic bronchitis

• COPD is the slow, advancing blockage of the airways in the lungs

• Reduced respiratory muscle strength and endurance

• Breathing muscles fatigue easier• Increased risk of infections• Malnutrition

Side Effects of COPD?

• Malnutrition is either too many nutrients, not enough nutrients, or an imbalance of nutrients

• Up to 60% of COPD patients are malnourished

• Malnutrition in emphysema usually is caused by not getting enough nutrients

• Many factors cause malnutrition in emphysema patients

• Foods may taste bland

COPD and Nutrition

• Patients with COPD are hypermetabolic, meaning they need more calories

• Difficulty in breathing causes difficulty in eating

• Medications have gastrointestinal (GI) side effects

• Oxygen to the GI tract is decreased• Too much carbon dioxide can cause early

morning headaches and confusion

COPD and Malnutrition: Causes

• Some studies indicate limiting carbohydrate in the diet

• Follow a high-protein diet with moderate carbohydrates

• Reduce carbohydrates consumed• Start by limiting these foods:

6̶Cake and desserts6̶Candy6̶Soda6̶Sweet tea

Limit Carbohydrate Intake

• Follow a low-sodium or no-added-salt diet • Reduce sodium (or salt) consumed by

limiting these foods:6̶Canned foods6̶Snack foods, such as chips, pretzels, crackers, and popcorn6̶Packaged starchy foods, such as stuffing and rice mixes6̶Cured/luncheon meats and cheeses6̶Condiments, such as ketchup, barbecue sauce, and soy sauce6̶Salt and any seasoning with the word “salt” in it

Limit Salt Intake

• Here are some ways to season foods without salt:

6̶Add lemon juice, lime juice, or vinegar for a tart flavor6̶Add peppers or 1 to 2 drops of hot sauce for a hot flavor6̶Add onions or season with herbs and spices, such as garlic and salt-free seasonings, including Mrs. Dash® (comes in more than 15 varieties)

Flavor Foods Without Salt

• Protein needs are increased up to 1.2-1.7 grams (g)/day

• To calculate how much protein is needed:

6̶Take the weight of the patient and divide by 2.26̶Take that number and multiply it by 1.2 and 1.76̶This will give you the range of protein needed6̶Example: 150 pounds ÷ 2.2=68

681.2=82681.7=116

Protein needs are 81-116 g/day

Increase Protein Intake

1 egg 6 g protein

1 oz nuts 2-4 g protein

6 oz yogurt 6 g protein

½ C cottage cheese

14 g protein

3 oz canned tuna 25 g protein

6 oz steak 42 g protein

4 oz hamburger 28 g protein

3 oz chicken breast 26 g protein

How to Meet Protein Needs

C=cup, g=gram, oz=ounce

• Increase calories to compensate for reduced carbohydrates by increasing dietary fats

• For good health, choose liquid fats over solid fats:

6̶Olive oil6̶Peanut oil6̶Canola oil6̶Etc

Increase Dietary Fats

• Drink 8 C of fluids/day• May need to reduce milk consumption• Take fluids between meals

Have Adequate Fluid Intake

• Increased need for vitamin C for smokers:

6̶Smokers need double the dose of vitamin C• Consume adequate amounts of all

vitamins and minerals• A multivitamin with minerals is

appropriate, especially if intake is poor• Calcium and vitamin D supplements

sometimes are needed if osteoporosis or osteopenia is present

Get Enough Vitamins and Minerals

• Gas-forming foods can cause bloating and displacement of the diaphragm

• If this occurs, determine which foods cause the problem

Reduce Use of Gas-Forming Foods

• Some gas-forming foods include:6̶Asparagus6̶Broccoli6̶Cabbage6̶Carbonated beverages6̶Dried beans and peas6̶Leeks6̶Onions

Reduce Use of Gas-Forming Foods (cont’d)

Tips for Comfortable Eating

• Avoid overfeeding• Have frequent small meals• Choose nutrient-dense foods • Rest before meals• Eat slowly• Wear oxygen during meals• Eat soft, easy-to-chew foods• Remain upright for 1 hour after meals• Drink beverages between meals• Eat main meal with your family or others

• Try to avoid constipation and straining to pass hard stools

• Increase fiber• Increase antioxidants• Try milk shakes• Reduce caffeinated beverages• Eat chicken soup to clear the respiratory

tract

Tips for Comfortable Eating (cont’d)

• Regular review of lab results• Need for a nutritional supplement • If oral intake is not meeting needs,

discuss other options, such as a tube feeding

What to Discuss With Your Doctor, RD, or RDN

• Call the hospital where you were admitted and ask to speak to a RD or RDN

• Ask to speak with the RD or RDN at your nursing home

• Contact your insurance company and ask for help in finding an RD or RDN

• Visit www.eatright.org and click on FIND A REGISTERED DIETITIAN to locate an RD or RDN in your area

How to Get in Touch With an RD or RDN

References

Academy of Nutrition and Dietetics. Evidence Analysis Library® Web site. http://andevidencelibrary.com/default.cfm. Accessed April 14, 2014.

Academy of Nutrition and Dietetics. Nutrition Care Manual Web site [by subscription]. http://www.nutritioncaremanual.org/. Accessed April 11, 2014.

Mueller DH. Medical nutrition therapy for pulmonary disease. In: Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:782-798.

Patel N, Johnson MM. Nutrition in respiratory diseases. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th ed. Baltimore, MD: Lippincott, Williams, and Wilkins; 2014:1385-1395.