RESPIRATORY DISEASES

Chronic Obstructive Pulmonary Disease (COPD)

Adults

Best time to refer to the dietician:

• following diagnosis of COPD, in combination with at least one of the following:

• BMI ≤ 21 kg/m2
• unwanted weight loss of more than 5% within a 1-month period or more than 10% within a 6-month period
• fat-free mass index (FFMI) ≤ 16 kg/m2 (men) and ≤ 15 kg/m2 (women)
• BMI > 30 kg/m2

Relevant information for the dietician:

• Diagnosis: COPD, any comorbid conditions
• Symptoms: dyspnea, general malaise
• Medications: corticosteroids, antibiotics, theophylline, beta2-sympathomimetic drugs
• Other: height, (changes in) weight, fat-free mass.

Aims of the diet:

• maintain/improve nutritional status and muscle mass.

Characteristics of the diet:

• Energy: caloric intake based on basal metabolism (Harris & Benedict) + extra allowances
• Protein-enriched: 1.5-1.7 g protein per kg of actual body weight
• Calcium: 1000-1200 mg
• Vitamin D: 10-20 μg
• If overweight (BMI > 30 kg/m2): see “Overweight,” with extra attention to increasing physical exercise and adequate consumption of protein and calories, in order to retain muscle mass.

Treatment time:

• Care level 4*, see “Dietician’s working methods.”

Specific remarks:

• Multidisciplinary counseling: Given the complexity, it is best to have a patient with COPD receive multidisciplinary treatment. In the multidisciplinary approach, not only are the pulmonologist and general practitioner involved, but a dietitian, pulmonary nurse specialist and physiotherapist also have active roles in the treatment. Evaluation of peripheral muscle strength and exercise tolerance take place in consultation with the other disciplines. If multidisciplinary treatment is impossible, then it is important that the dietician draw attention to and stimulate not only the diet, but also physical exercise.
• Stabilizing the weight will improve survival rates in COPD patients with moderate or severe COPD and a BMI of more than 25 kg/m2.

References:

CBO. Richtlijn Ketenzorg COPD. Alphen aan de Rijn: Van Zuiden Communications BV; 2005

Schols AMWJ. Voeding bij chronische longziekten. In: Geerts-Van der Wey ACW, Binsbergen JJ van et al, editors. Informatorium voor Voeding en Diëtetiek. Houten: Bohn Stafleu Van Loghum; 1999. p. Dieetleer XXIV.1-XXIV.14

Schmidt K, Froon H. Chronische obstructieve longaandoeningen (COPD). Maarsen: Elsevier Gezondheidszorg; 2010

 Chronic Obstructive Pulmonary Disease (COPD) was written by Heleen Froon, dietician at St. Antonius Ziekenhuis Nieuwegein, also on behalf of the Landelijk Diëtisten Netwerk COPD (LDN-COPD).