Vy Doan

CSUSB ISPP Dietetic Intern

Presents:

COPD & Nutrition:

Practical
 Objectives
What is COPD?
What are the nutritional complications of
COPD?

How do we approach quality care of COPD

at IEHP?

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 COPD: Overview

r u c tive er ize
Obs t a c t
ro n i c i s o r der Char pnea
Ch a ry D d y s
o n
Pulm a chronic ition
, d by e s s of
t n
is
e c o nd
es
(shor h),
r e s siv
prog lowly da the m ag breat
m
s
that issues of sputu n,
the t lungs ro d u ctio
p o n ic
c h r
and .
co u g h
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COPD Symptoms and Impact on ADL

https://youtu.be/lenKSGQKScU

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 Look at the numbers
6.3% of the US
population have COPD,
affecting 30 million
Americans. (COPD foundation,
2013).

Heart Disease
Cancer

COPD
591 614 147
3/31/17
K K
Source: CDC, 2016
K
 Patient Education
It is important to educate the patient
with COPD about the disease and to
encourage his or her active
participation in therapy.
Emphasize about prevention and
managing symptoms before they go
into distress.

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 Primary Goals
To achieve and
maintain weight and
improve quality of life
Preserve optimal lung
function
Improve symptoms
Prevent the recurrence
of exacerbations

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 Nutrition & COPD
Individuals with COPD face many nutritional
issues daily, so it is important to address
diet and nutrition in order to
improve the quality of life for our
members.

Also, note that medications for their

pulmonary issues also react with some
nutrients. Members should consult with their
doctor or dietitian about these interactions.

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Nutrition: Its All Connected!
Assist in
dietary issues
Malnutriti
on through ADL
Increase
caloric intake

Nutrition management
of:
Co- Heart Disease
morbidities
Osteoporosis
Diabetes
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 Malnutrition Goals

Assist in Increase
dietary intake caloric intake

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Assist in dietary issues: Improving
ADL

Evidence to suggest that the challenge

of performing tasks had a greater
impact on patients than the
symptoms themselves.
Physicians are unlikely to discuss with
patients how their ability to perform tasks
might be improved.
This is where we, the educators come in
to help manage self-care.
Global Initiative for Chronic Obstructive Lung Disease (GOLD)
3/31/17 Report 2017
 Improving ADL + Nutrition
10-15 minutes
longer for
activities
20-30 minutes
longer for
strenuous
Traveling to supermarket
activities
took
28 additional minutes
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Global Initiative for Chronic Obstructive Lung Disease (GOLD)
Report 2017
 Assist in Dietary Issues
COPD members are at risk of weight
loss and nutritional deficiencies
ener
Eating and digestingrequires
gy

For COPD members, energy is mostly

used for breathing and requires more
work.

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 Tips to make mornings
easier

Set
dish
a k
M F es Ge
eB the he t
s fr lp
ea nigh
y& t m o
sim lo
e ak

be f o d ve
ple
M

re on
BF

s e
ni e
th
ht g
or f
be
e

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 Tips for Dyspnea
Eat 6 small meals instead of 3 large
meals; allows lungs to fill with air in
and empty out more easily.

Eat slowly and chew foods

thoroughly to avoid swallowing air

Drink small sips of water to thin out

the built up mucus in your lungs
which could be the cause of the
breathing problems.

Use your nasal cannula during

meals if on continuous oxygen.

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 Referrals
If member has asthma, they may
qualify for the IEHP Health Education
Breathe and Family Asthma programs
or Local Meals On Wheels program.

Community Action Partnership of San

1-800-440-IEHP (4347) or 1-800-718-
4347 for TTY users. The Family
Asthma Program is offered in English
or Spanish and is FREE for IEHP
Members.
Bernardino County: 909-723-1500
http://www.capsbc.org/
For more locations:
www.mealsonwheelsamerica.org

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 Malnutrition Goals

Assist in Increase
dietary intake caloric intake

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 Why Increase Calories?
Unintentional weight loss due to increased
resting expenditure (energy used from breathing)
and loss of appetite
More energy used in breathing and digesting
Symptoms such as dyspnea and fatigue causes
lower calorie intake
It is important to manage these underlying
causes to improve nutritional status

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 How do we increase caloric
intake?
Seek help from family/friends/caregiver
Nutrition supplements
Use calorie boosters
Recommend for Member to consult with PCP on
possible referral to see a RD
RD may recommend: nutrition supplements and
nutrition therapy to treat conflicting complications
(COPD with diabetes and/or CKD)

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 Oral Nutrition Supplement (ONS)
Studies report that ONS
combined with exercise
results in increased
energy intake and weight
gain.
Examples: Ensure, Boost,
Glucerna, Carnation
Breakfast Essentials, etc.
(available in retail stores
such as Walmart)
Ask your doctor or
dietitian aboutEALnutritional
(Evidence Analysis Library)
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supplements (*Do not 2017
use
 Calorie Boosters
Use some calorie boosters to add calories to
favorite foods
1. Egg yolk or whole egg
2. Non-fat powdered milk or undiluted evaporated milk
3. Cream cheese or shredded, melted, sliced, cubed, or
grated cheese
4. Vegetable oils, mayo, butter, margarine, or sour
cream
*Check for
5. Peanut butter (natural) allergies!
6. Nut Dust (ground nuts)
7. Honey/maple syrup (not recommended for members
with diabetes)

3/31/17 Cleveland Clinic 2013

 Co-morbidities: Whats the
Link? DIABETES
Inflammation of
Heart Disease lung + pancreas,
Narrowing of resistance to
resp. blood insulin and weight
vessels gain risk of
risk for DM
cardiac High BG levels
28
cachexia damaged nervous 0
risk of high system
BP in lungs (neuropathy)
(cor weaken
pulmonae) respiratory
Osteoporosi
muscles
High doses of
Smokings
corticosteroid use
Vit D risk of DM-
Sedentary related
Corticosteroid hospitalizations in
SE pts. with COPD and
DM.
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Co-morbidities: How can we help?
DIABETES
Weight
Heart Disease management
Increase fruits
Heart Health and vegetables
Program Consistent CHO
Encourage intake
light cardio
activity (i.e. 28
Refer to Journey 0
walking, light DM Program
hiking, etc.) Refer to PCP or
RD
Osteoporosi
s
Encourage
strength Refer to PCP or
training Pharmacist
Refer to CRC

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 Conclusion
It is clear that the COPD patient will
be best served in the future by a
health system that provides a more
joined up approach to management
and treatment.

Global Initiative for Chronic Obstructive Lung Disease (GOLD)

3/31/17 Report 2017
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 Any
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Questions?
 Resources
1. Caughey, G. E., Preiss, A. K., Vitry, A. I., Gilbert, A. L., & Roughead, E. E. (2013). Comorbid Diabetes
and COPD: Impact of corticosteroid use on diabetes complications. Diabetes Care, 36(10), 3009-
3014. doi:10.2337/dc12-2197
2. Chronic Obstructive Pulmonary Disease. (2017.). Retrieved January 09, 2017, from
http://www.andeal.org/topic.cfm?menu=530
3. Committee, G. S. (2017). Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease. Retrieved
January 10, 2017, from http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-
prevention-copd/
4. COPD Foundation. (2017). Retrieved January 10, 2017, from http://www.copdfoundation.org/What-is-
COPD/Living-with-COPD/Staying-Healthy-and-Avoiding-Exacerbations.aspx
5. Deaths and Mortality. (2016, October 07). Retrieved January 13, 2017, from
https://www.cdc.gov/nchs/fastats/deaths.htm
6. Diet and Nutrition for Energy with COPD. (2013, December 31). Retrieved January 04, 2017, from
http://my.clevelandclinic.org/health/articles/nutritional-guidelines-for-people-with-copd
7. Leader, Deborah, RN. (2016, June 24). The Effects of Diabetes and High Blood Sugar on COPD.
Retrieved January 13, 2017, from https://www.verywell.com/diabetes-and-copd-914931
8. Nutrition. (2016, November 11). Retrieved January 04, 2017, from http://www.lung.org/lung-health-
and-diseases/lung-disease-lookup/copd/living-with-copd/nutrition.html
9. Terry, P. B., M.D., M.A (Ed.). (2015, July 23). COPD and Heart Disease Risk. Retrieved January 11,
2017, from http://www.healthcommunities.com/copd/copd-heart-disease_jhmwp.shtml
10. Understanding COPD: Comorbidities. (2017). Retrieved January 09, 2017, from
http://www.lungchicago.org/understanding-copd-comorbidities/
11. Varrasso, Raphaelle, and Carmago Jr, Carlos. More evidence for the importance of nutritional
factors in chronic obstructive pulmonary disease American Journal of Clinical Nutrition 2012, 95
(2012): 1301-2. Print.
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