Respiratory Diseases

Question 1

What is COPD?

Answer 1

COPD is a common preventable and treatable disease, characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response. Episodes of acute worsening of these symptoms are referred to as
exacerbations and are often of infective nature.

Question 2

What are the Nutritional Impact Symptoms of COPD?

Answer 2

Anorexia
Weight Loss
Recurrent infections
Malnutrition
Early satiety

Question 3

What factors affect energy requirements in

patients with COPD?

Answer 3

Basal requirements:
Age
Sex
Weight

Body composition:
Disease effects
Metabolic state
Disease severity
Inflammatory response

Goals of treatment:
Diagnosis
Prognosis
Duration of nutritional
support

Activity:
Mobility status
Level of consciousness
Neuro-muscular function

Question 4

What is Cardiopulmonary Cachexia?

Answer 4

Cachexia is a complex metabolic syndrome:

• Distinct from starvation and age-related loss of muscle
• Infrequently identified and treated, particularly outside of oncology
• Will impact on the body’s ability to utilise nutrition support
• Associated with prognosis

Question 5

What are the Factors for Cachexia Diagnosis?

Answer 5

Weight loss of at least 5% in the last 12 months and
3 of the 5:

decreased muscle strength
fatigue
anorexia
low-fat mass index
abnormal biochemistry

Question 6

What are the 4 faces of malnutrition?

Answer 6

Undernutrition/Anorexia

Frailty

Sarcopenia

Cachexia

Question 7

what is the Nutrition Requirements in COPD?

Answer 7

Classified as moderately hypermetabolic during IECOPD (NEMO 2012)
125-145 kJ/kg/day; 1.2 – 1.5 g protein/kg/day

Fluids shifts (ICF à ECF) are common and makes nutritional assessment difficult (pedal
oedema)

Question 8

What is the nutrition support for inpatients?

Answer 8

Significantly increases energy and protein intakes associated with improvements in weight.

Secondary care is an opportune time to diagnose
malnutrition, start nutrition support and coordinate
nutritional care post-discharge

Question 9

What are the Body compositional changes in COPD Patients

Answer 9

Muscle wasting in clinically stable COPD patients is 20-35%.

This muscle wastage is due to chronic inactivity, underlying systemic inflammation (IL-6, TNF-alpha), medications (corticosteroids) and low
growth factors (testosterone and IGF)

Question 10

Best Interventions for patients with COPD

Answer 10

ONS (Sustagen, Resource Fruit, Ensure, Fortisip compact)

Encourage selection of mid meals

Prioritise protein portions 1st (meat), followed by starch (potato, rice, pasta) and lastly free vegetables.

If at risk of refeeding syndrome: Thiamine 300mg/OD + Multivitamin OD - Monitor electrolytes DAILY

Diet Disease relationship education and why weight stability is important for recovery and QoL.

Question 11

Best way to Monitor and Evaluate COPD patients

Answer 11

Review in 2/7 to assess nutritional adequacy, tolerance of ONS, electrolytes (refeeding risk), nutritional impact symptoms

Determine need for scripting of ONS or recommend purchasing from local supermarket/pharmacy

Recommend follow up via GP 1/52 post-discharge for monitoring of electrolytes

Refer to community outpatient Dietitian if required