Submitted by Jezica Jeeva, SRT, Conestoga College
According to the World Health Organization (WHO, 2017), the prevalence of chronic obstructive pulmonary disease (COPD) is currently on the rise and is anticipated to be one of the leading causes of death in the world by the year 2030.
The WHO (2017) defines COPD as, “an umbrella term used to describe chronic lung diseases that cause limitations in lung airflow.”
Although COPD may be genetically predisposed, there are effective preventative strategies people can take to decrease their susceptibility, such as the cessation of cigarette use, promotion of vaccinations, prevention of infections and avoidance of environmental pollutants (Ambrosino & Bertalla, 2018). One modifiable lifestyle change that is typically overlooked for prevention is nutrition. Patients with COPD are commonly malnourished with a low body weight and inadequate levels of vitamins. Schols (2000) suggests that weight loss is a consequence of insufficient caloric intake to meet increased energy needs. Although weight loss is prevalent in people with COPD, it is a variable that may co-exist with other diseases. Malnutrition may lead to harmful effects on every component of the respiratory system, including respiratory drive, respiratory muscles and pulmonary parenchyma (Laaban, 1991). This may weaken the muscles and their ability to perform adequately, which is associated with a poor prognosis. COPD patients are at a higher risk of vitamin D deficiency due to diminished dietary intake and insufficient ultraviolet B exposure (Walker, 2019). Vitamin D plays a vital role in the body as it is necessary for strong bones, and it also has anti-inflammatory and anti-infectious properties (Gatera et al., 2018). Therefore, it is crucial to be aware of malnourishment and make the appropriate changes where possible to avoid potential harm.
Patients are encouraged to work closely with their interdisciplinary healthcare team to formulate a realistic dietary plan, with suggestions from a qualified dietitian. A nutrient-dense diet, focusing on energy and protein-rich foods is important in weight loss prevention. If the recommended caloric intake cannot be met strictly through diet, oral nutritional supplements (ONS) are advised, particularly for patients who exhibit a “low body mass index (less than 18.5kg/m2)” (Walker, 2019, p. 61-64). A study conducted by Ferreira et al. (2012) found that ONS coupled with exercise improved body weight and muscle strength in malnourished COPD patients. To ensure COPD patients consume enough dietary calories through food, they are encouraged to have meals earlier in the day when they are more energized, and also to have smaller, nutrient-dense meals with minimal preparation requirement to minimize fatigue (Walker, 2019). Patients with COPD experience distressing respiratory symptoms, such as an exacerbation, may find it difficult to consume the same amount and type of foods as when they aren’t experiencing that hardship (Hodson, 2016). Therefore, it is wise to meal-plan in order to prepare for those occurrences.
Moving forward, it is crucial to explain the influence nutrition has on disease development to COPD patients and continuously assess them for malnutrition. Nutritional interventions are recommended for COPD patients as it provides both supportive care and direct intervention, specifically improvement in respiratory and peripheral skeletal muscle function (Schols, 2000). More research needs to be conducted on this topic to further explore potential advantages and consequences. While the preventative measures may prove challenging for some, they could offer significant reductions in the likelihood of development or progression of disease.
Ambrosino, N., & Bertalla, E. (2018).
Lifestyle Interventions in Pervention and Comprehensive Management of COPD. Breathe, 14(3), 186-194.
Ferreira, I. M., Brooks, D., White, J., & Goldstein, R. (2012).
Nutritional Supplementation for Stable Chronic Obstructive Pulmonary Disease. Cochrane Database of Systematic Reviews, (12).
Gatera, V. A., Abdulah, R., Musfiroh, I., Judistiani, R. T. D., & Setiabudiawan, B. (2018).
Updates on the Status of Vitamin D as a Risk Factor for Respiratory Distress Syndrome. Advances in Pharmacological Sciences, 1-6.
Hodson, M. (2016).
Integrating Nutrition Into Pathways for Patients with COPD. British Journal of Community Nursing, 21(11), 548–552.
Laaban, J. P. (1991).
Nutrition and Chronic Obstructive Pulmonary Disease. Revue de Pneumologie Clinique, 47(6), 235-250.
Retrieved September 20, 2019 from https://europepmc.org/abstract/med/1805343
Schols, A. M. W . J. (2000).
Nutrition in Chronic Obstructive Pulmonary Disease. Current Opionion in Pulmonary Medicine, 6(2), 110-115.
Retrieved September 20, 2019 from https://journals.lww.com/co-pulmonarymedicine/Abstract/2000/03000/Nutrition_in_chronic_obstructive_pulmonary_disease.5.aspx
Walker, J. (2019).
Enabling good nutritional care for patients with COPD. Journal of Community Nursing, 33(4), 61–64. Retrieved September 20, 2019, from CINAHL Complete database.
Available from https://www.jcn.co.uk/journal/08-2019/respiratory/2124-enabling-good-nutritional-care-for-patients-with-copd/
World Health Organization. (2017).
Chronic Obstructive Pulmonary Disease (COPD) [Fact sheet].
Retrieved September 20, 2019, from https://www.who.int/en/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)