Discussing the history of COPD and strategies in meeting the nutritional needs of this patient.

1. COPD
A Nutritional Challenge
Researched by
Sandy Erhart
January, 2009

2. An Introduction…
A client comes for nutritional
counseling. She is 64, thin and
short of breath with
audible wheezing. As
she sits, she pulls out and
uses her rescue inhaler.

3. Then she begins to cough, a
deep, productive cough that
she must expectorate into a
tissue. This client has COPD….

4. Chronic
Obstructive
Pulmonary
Disease

5. Definition and History

6. COPD:
Pathophysiology
• Chronic lung inflammation in response
to noxious particles, gases
• 3 separate processes, alone or combined
Emphysema
Chronic bronchitis
Asthmatic bronchitis
• Progressive and irreversible

7. Separate processes

8. COPD: Signs and Symptoms
• chronic cough,
sputum production
• Taking in less O2
retaining CO2
• shortness of breath
and wheezing
• recurrent infections
• chest tightness

9. Emphysema:
“Pink Puffers”
• Retains CO2 (pink)
• Shortness of breath
• Ineffective cough
• Barrel chest yet thin limbs
• Significant weight loss
• Labored, “pursed lip”
breathing
• Anxious, short sentences

10. Emphysema affects Alveoli
Healthy Damaged

11. Chronic Bronchitis: “Blue Bloaters”
• Color dusky to
cyanotic (lack of O2)
• Persistent
productive cough
• Retains CO2 leading
to acidosis
• Shortness of breath
with exertion
• Normal-overweight

12. Chronic Bronchitis affects Airways

13. COPD: Historical Aspect
EMPHYSEMA
1661, from Greek. emphysema "swelling,"
from emphysan "inflate."
René-Théophile-Hyacinthe Laennec

14. Lung function gets measured
• 1846: Hutchinson invents the
spirometer, which measures
vital capacity of lungs.
• 1947: Tiffeneau
adds “timed” VC.
• 1965: “COPD” term
first used and defined.

15. Spirometry:
Vastly underutilized by
Primary Care Doctors

16. COPD theories & discoveries
• 1966: scientists induce emphysema in lab
animals with pancreatic enzymes.
• 1968: a rare genetic marker, deficiency
of alpha-one-antitrypsin discovered.
• 2006: hypothesis that COPD is an
autoimmune disease.
• 2008: systemic inflammation shown to
raise plasma leptin levels.

17. Affect on Nutrition

18. COPD:
A catabolic
“wasting” disease
CATABOLISM
1875-80, from Greek. catabole “a casting down,"

20. Reasons for poor nutrition
• Dyspnea and coughing interfere
with adequate dietary intake
• Fatigue interferes with buying and
preparing foods
• Chronic mouth breathing alters the
taste of food
• Headaches, mental status changes
occur because of hypercapnia
(excess blood level of CO2)

21. COPD: Carbohydrates
• CHO produce the
most CO2 during
metabolism
• CHO should be
40% of intake
• Complex CHO best

22. COPD:
Fats and Proteins
• Need at least 30%
of calories from
fat, whole dairy
encouraged
• Need 30% from
protein

23. Micronutrients:
Fruits and Vegetables
• Antioxidants
• Vitamin C
• Calcium, Vitamin D
• Phosphorus

24. Nutrition & Exercise Tips

25. COPD:
Help Eating Succeed
 Prepare meals early
 Rest and medicate before eating
 Oral care before meal
 Stimulate the appetite
 Liquefy foods to reduce chewing
 Eat small, frequent meals
 Adequate water intake daily

26. Pulmonary Rehabilitation
Never too late!
• Even mild to moderate helps
• Improves strength and endurance
• Reduces dyspnea and fatigue
• Improves cardiovascular function
• Contributes to stronger, improved
breathing

28. Why Should We Care?

29. Knowing about COPD
Is Important
• Fastest growing chronic disease,
half not even diagnosed
• Disease not apparent until damage is
done and irreversible
• Costs $39 billion yearly in health
care and hospitalizations in the U.S.;
$150 billion worldwide
• There is no cure

30. Prevention Is KEY

31. COPD: Risk Factors
• Long-term exposure to tobacco smoke
• Occupational exposure to dusts and
chemicals, air pollution
• Age over 40 years
• Very rarely caused by
alpha-1-antitrypsin
deficiency, genetic disorder

32. Meet The Smokers
BEFORE
Wayne McLaren Maureen Hamilton

33. 20 Years Later…
Wayne Maureen

34. References
http://www.medscape.com
http://www. nlhep.org/
(National Lung Health Education Program)
http://my.clevelandclinic.org/health/default.aspx
http://www.upmc.com/HealthAtoZ/
http://www.who.int/respiratory/asthma/en/
http://www.thoracic.org/