C.O.P.D.

A process characterized by the presence of chronic bronchitis, emphysema, or both, leading to the development of airway obstruction.

CAUSES
Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. Other risk factors for COPD are:
Exposure to certain gases or fumes in the workplace Exposure to heavy amounts of secondhand smoke and pollution Frequent use of cooking fire without proper ventilation

SYMPTOMS
Cough, with or without mucus Fatigue Many respiratory infections Shortness of breath that gets worse with mild activity Trouble catching one's breath Wheezing Because the symptoms of COPD develop slowly, some people may not know that they are sick.

PROGNOSIS
COPD is a long-term (chronic) illness. The disease will get worse more quickly if you do not stop smoking. Patients with severe COPD will be short of breath with most activities and will be admitted to the hospital more often. These patients should talk with their doctor about breathing machines and end-of-life care.

POSSIBLE COMPLICATIONS
Irregular heartbeat (arrhythmia) Need for breathing machine and oxygen therapy Right-sided heart failure or cor pulmonale (heart swelling andheart failure due to chronic lung disease) Pneumonia Pneumothorax Severe weight loss and malnutrition Thinning of the bones (osteoporosis)

ADVERSE EFFECTS OF LUNG DISEASE ON NUTRITION STATUS

Increased energy espenditure
Increased work of breathing Chronic infection Medical treatments

ADVERSE EFFECTS OF LUNG DISEASE ON NUTRITION STATUS

Reduced Intake
Fluid restriction Shortness of breath Decreased osygen saturation when eating Anorexia resulting from chronic disease Gastrointestinal distress and vomiting

ADVERSE EFFECTS OF LUNG DISEASE ON NUTRITION STATUS Additional Limitations

Difficulty preparing food becasue of fatigue Lack of financial resources Impaired feeding skills Altered metabolism

FOUR COMPONENTS OF EFFECTIVE MANAGEMENT

Assess and monitor disease Reduce risk factos Manage stable COPD Manage exacerbations

CASE
MN, 65 year old, Female diagnosed with COPD with a height of 53 and ABW of 45 kg.

COMPUTATION/S
TER: 45 kg x 35 kcal= 1575 kcal TPR: 45 kg x 1.5 g= 67.5 g of CHON

270 kcal CHON NPcal: 1575-270= 1306 NPcal CHO: 1305 NPcal x.40=522 kcal/4=131 g CHO FAT: 1305 NPcal x.60=788 kcal/9= 87 g FAT
=

DIET PRESCRIPTION

1575 Kcal131g CHO68 g CHON87 g FAT

FEL
FOOD GRP. Veg. A Veg. B Fruit Rice Milk Meat (HF) Meat (MF) Fat EXCHAN GE 2 1 3 3 2 3 2 5 CHO 6 3 30 69 24 131 g CHON 2 1 6 16 24 16 65 g FAT 20 30 12 25 87 g KCAL 32 16 120 300 340 366 172 225 1571 kcal

TOTAL

MENU

BREAKFAST Banana Egg Lugaw (Thick Consistency) Milk (Whole)

A.M. SNACK Pan Amerikano (1 slice) Peanut Butter

LUNCH Vienna Sausage Cream of Mushroom Soup Boiled Rice Pear

P.M. SNACK

Hotdog with Mayonnaise Carrot Juice

DINNER
Embutido Ginisang Ampalaya Rice Ripe Papaya

MIDNIGHT SNACK

Milk (Whole)

MEDICAL NUTRITION THERAPY

Each person with COPD must be assessed individually on a continuous basis After assessing fluid balance and requirement, energy is the next requirement. Decreased food intake is common morning headache and confusion from hypercapnia
(excessive carbon dioxide in the blood) must be indentified because these symptoms may intere with food preparation.

MEDICAL NUTRITION THERAPY

On the other side of the equation, energy expenditure usually is elevated. related to pulmonary complications such as degree of
airflow obstruction, thus increasing the energy needs resulting from increased work of breathing.

Nutritional depletion may be evidenced clinically by low body weight for height and reduced tricpes fatfold measurement. The medication profile should be assessed for food and nutrient interaction.

ENERGY
Adjusted energy requirements depend on the intensity and frequency of exercise therapy. Maintatining optimal energy balance is essential to preserving visceral proteins and somatic protein mass. Caloric needs ranging from 94% to 146% of predicted range have been observed. (Thorsdottir and
Gunnarsdottir, 2002)

Health care experts recommend 20 to 35 grams of fiber a day to help maintain bowel function.
(AMERICAN LUNG ASSOCIATION)

MACRONUTRIENTS
Requirements for water, proteins, fat and carbohydrate are determined by the underlying lung diseases, oxygen therapy, medications, weight staus, and any acute fluid fluctuations. Determination of a specific patients macronutrient need is made on an individual basis, with close monitoring outcomes. Sufficient PROTEIN (1.2 to 1.7 g/kg of dry body weight) is necessary to maintain or restore lung and muscle strength.

MACRONUTRIENTS
A balanced ration of PROTEIN (15% to 20% of calories) with FAT (30% to 45 % of calories) is important to preserve a satisfactory RQ from substrate metabolism use. Fat is a rich source of energy. It also produces the least carbon dioxide when it is metabolized.

VITAMINS AND MINERALS

Depend on the underlying lung pathology, other concurrent diseases, medial treatments, weight status and bone mineral density. The role of minerals such as MAGNESIUM and CALCIUM in muscle contraction and relaxation mau be important for people woth COPD. additional vitamins D and K also may be necessary.

VITAMINS AND MINERALS

Some patients with cor pulmonale (failure of the
right side of the heart brought on by long-term high blood pressure in the pulmonary arteries and right ventricle of the heart) and fluid retention require

SODIUM and FLUID RESTRICTION. Depending on the diretics prescribed, increased dietary intake of potassium may be required

FEEDING STRATEGIES
A modified oral diet usually is preferred. When abdominal bloating is a problem, limitation of foods associated with gas formation may be helpful. Some suggestions are resting before meals, eating small proportions of nutrient-dense foods and planning expectorant medication use apart from mealtimes.

FEEDING STRATEGIES
For many patients using oxygen at mealtimes, eating slowly, chewing foods well and engaging in social interaction can enhance food intake. EN supplementation by mouth or feeding tube can increase total caloric and nutrient intake for some patients with COPD.

MEAL PLANNING TIPS

(c) AMERICAN DIETETIC ASSOCATION

Eat whenever you are hungry. Sometimes the first meal in the morning works best. Sometimes late afternoon or early evening is best. Divide your daily foods into 5-6 small meals, or into 5-6 large snacks. Drink enough fluids, including water, throughout the day and evening.

MEAL PLANNING TIPS

(c) AMERICAN DIETETIC ASSOCATION

Drink high-calorie, high-nutrient beverages.

Drink milkshakes, whole milk, fortified milk (powdered nonfat milk added to fluid milk), flavored milk, and commercial nutritional products. Freeze beverages into popsicles or ice cubes. Use nutritional beverages in cooking and baking, and on cereals. Enjoy milk-based, or cream-based, soups.

MEAL PLANNING TIPS

(c) AMERICAN DIETETIC ASSOCATION

Choose foods high in calories.

Add healthy oils, cream cheese, margarine, butter, and nut-butters to foods. Use regular cheeses, salad dressings, dips, sour cream, ice cream, and cold cuts. Select yogurt and cottage cheese made from whole or 2% milk.

MEAL PLANNING TIPS

(c) AMERICAN DIETETIC ASSOCATION

Choose foods high in protein.

Include eggs, milk, cheese, yogurt, meats, poultry, fish, nuts, and beans.

Choose foods with fiber.

Use whole grains, like breads, crackers, pasta, and rice. Eat fruits and vegetables with skins or seeds, like sweet potatoes with skin, tomatoes, grapes, and blueberries.

MEAL PLANNING TIPS

(c) AMERICAN DIETETIC ASSOCIATION

Choose foods with vitamins and minerals.

Use colorful, fresh fruits and vegetables, rather than ones that are overcooked or refined. Use enriched grains and fortified processed foods.

If prescribed, take medical food supplements, and use supplemental oxygen around mealtimes.

CALORIE BOOSTERS
(c) Cleaveland Clinic

REFERENCES
American Deitetic Association Medline Plus (U.S. National Library of Medicine) The Cleaveland Clinic (9500 Euclid Avenue, Cleveland, Ohio) American Lung Association Krauses Food and Nutrition Therapy Textbook Todays Dietitian ( the magazine for nutrition professionals)