Chronic Obstructive

Pulmonary Disease
Emily Sinn
ND 568- Acute Care MNT
Marywood University- Dietetic Intern
What is COPD?
 Refers to a group of lung diseases that block airflow and make it difficult to
breathe

 2 main types are chronic bronchitis and emphysema

 Caused by long-term exposure to substances that irritate and damage the lungs
 I.e. cigarette smoke, air pollution, chemical fumes or dust

 Symptoms begin mildly and become more severe as the disease progresses
 I.e. coughing with a lot of mucus, SOB, wheezing and chest tightness

 Lung function tests, imaging tests and blood tests are used to diagnose

 Treatments are used to alleviate symptoms

 I.e. medicine, oxygen therapy, surgery, lung transplant and quitting smoking
Photo 1- Illustrates the difference between a healthy airway and a blocked airway in a
patient with COPD
Chronic
Bronchitis
 Inflammation of the lungs
 Primarily affects the windpipe
and passageways of the lungs
 Caused by severe irritation or
infection
 I.e. brief illness, chronic
condition, smoking
 Our bodies natural reaction is to
clear the air passages which
results in severe coughing
 Symptoms: SOB, fatigue, fever,
cough, excess mucus, symptoms
come and go often
Emphysema
 Gradual destruction of the sacs
(alveoli) in the lungs
 Alveoli are responsible for
providing oxygen to the
bloodstream
 Most common in individuals who
have a history of smoking
 Emphysema weakens the sacs and
destroys the elasticity of our lungs
 Symptoms: SOB, fatigue,
difficulty performing tasks,
feeling less alert, blue or gray
fingernails
Photo 2- Illustrates the difference between normal lungs versus
those affected by Obstructive chronic bronchitis or Emphysema
Dietary Tips for
Better Breathing
 Eat meals when energy levels are at their highest (morning)
 Eat several small, nutrient-rich meals to avoid feelings of breathlessness
 Eat slowly and chew foods thoroughly to avoid swallowing air
 Choose foods that are easy to chew, modify consistency
 Limit salt, too much can cause the body to retain water and increase difficulty
breathing
 Eat calcium and vitamin D rich foods to support bone health
 Eat while sitting up to ease lung pressure
 Drink liquids at the end of the meal to avoid feeling full while eating
Case Overview
 72-year-old African American female, underweight

 Hx of hypertension (HTN), depression and chronic obstructive pulmonary

disease (COPD)

 Recently experienced fever, loss of appetite, fatigue, chills and dyspnea

 Dx bronchitis and began on a bronchodilator and corticosteroid nebulizer

treatment along with antibiotic

 Increased confusion and shortness of breath (SOB) continued with no

improvement

 Hospitalized via ambulance admitted with pneumonia and started on 2 L of

oxygen via nasal cannula and intravenous antibiotics
Case Study Questions
 What are the main goals of medical nutrition therapy for patients with COPD?
 Prevent and treat weight loss
 O2 therapy, reduce CO2 levels to improve breathing
 Focus on % of total CHO, protein and fat

 What factors interfere with food intake for patients with COPD?
 Patients with COPD expend up to 10-15% more energy therefore, require more
calories during the day
 Patients lose weight due to decreased dietary intake due to their inability to eat rather
than lack of appetite
 Additional reasons for decreased dietary intake includes:
 Dysphagia, chronic mouth breathing which can alter the taste of food, chronic
mucous production, coughing, fatigue, morning headache or confusion due to
hypercapnia, anorexia or depression
Case Study Questions Cont.
 What dietary recommendations might help Mrs. Hernandez get the nutrients
that she needs during her hospitalization
 Encourage high fiber foods, control her sodium intake, monitor calcium and
Vitamin D intake to promote bone health
 If her appetite does not improve and she remains underweight, Mrs. Hernandez
could benefit from beginning a tube feed to ensure she gets the nutrients she needs

 Why should fluids be encouraged?

 COPD causes mucus in our lungs to become thick, sticky and more difficult to clear
by coughing- drinking more fluids helps thin out the consistency therefore making it
easier to cough up in turn, clearing the lungs and making it easier to breathe
 Fluids help COPD patients fight infections- O2 therapy can lead to additional
dryness and irritation that can be prevented by staying hydrated
 Mrs. Hernandez should be advised to avoid caffeine as it may interfere with some of
her medications
 Recommended to drink ~8-12 glasses of fluids each day
Plan of Action PES Statement
 First plan of action would be to adjust  Problem: Inadequate energy
Mrs. Hernandez’s diet to regular but with
soft textures to see if she can tolerate this intake
better for 2-5 days
 Etiology: Related to diagnosis
 If there is no improvement, she could (COPD)
benefit from being placed on a tube feed
to achieve her nutrient needs
 Signs/Symptoms: As
 Fluid requirements for women >70 years evidenced by patients CBW
old = 30 mL/kg UBW underweight and lack of
 Energy requirements for women >70
appetite.
years old = 25-35 kcal/kg

 Protein requirements for women >70

years old = 0.8- 1.0 g/kg UBW

 BMI guidelines for elderly >65 years old

= 24-29
Resources
 COPD | Chronic Obstructive Pulmonary Disease | MedlinePlus. (2017, October 17).
Retrieved January 14, 2018, from https://medlineplus.gov/copd.html

 Diet and Nutrition for Energy with COPD. (2011, December 31). Retrieved January
14, 2018, from https://my.clevelandclinic.org/health/articles/9451-nutritional-
guidelines-for-people-with-copd

 Difference Between Emphysema & Chronic Bronchitis. (2017, July 06). Retrieved
January 14, 2018, from https://lunginstitute.com/blog/difference-between-
emphysema-and-chronic-bronchitis/

 Florian, I. S. (2009, February). Nutrition and COPD - Dietary Considerations for

Better Breathing. Retrieved January 14, 2018, from
http://www.todaysdietitian.com/newarchives/td_020909p54.shtml

 Nicholson, A. (2015, July). Staying Hydrated. Retrieved January 14, 2018, from
https://copd.net/living-with-copd/pulmonary-rehab/weight-management/hydration/