Chronic Obstructive Pulmonary Disease

By: Elizabeth Brock and Taylor Romano

COPD - Description

Umbrella term used to describe progressive lung diseases.

1. Chronic bronchitis 2. Emphysema 3. Refractory (non-reversible) asthma 4. Some forms of bronchiectasis

COPD is characterized by the worsening of symptoms that involve wheezing/coughing/difficulty to breath (dyspnea) – these episodes are called acute exacerbations and occur 1.5-2 times a year.(5)

COPD – Statistics

COPD affects over 24 million Americans – The Behavior Risk Surveillance Survey conducted by the CDC collects data via telephone.(1)

Causes of COPD(Mainly lifestyle and environmental)

• Smoking - 90% of those diagnosed with COPD have smoked or still do.

• Environmental - long-term contact with harmful pollutants (dust/fumes/certain chemicals).

• Genetic Factors - Alpha-1 Antitrypsin Deficiency (AATD) is the most commonly known genetic risk factor for emphysema.

Picture from: http://publichealthresources.blogspot.com/

5Chronic Bronchitis

• Inflammation of the lining of the airways.

• Increased mucus and phlegm production and a constant cough.

• Ideal breeding ground for infection.

• Diagnosis• A person with chronic

bronchitis has a mucus-producing cough most days of the month, three months of a year for two years in a row without other underlying disease to explain the cough.(7)

Picture from: www.healthtap.com

Comparing normal lungs with lungs

with COPD (above) and the affects of smoking on alveoli

(left).

Both pictures from: www.ecigarettedirect.co.uk

7Emphysema

• Usually grouped with chronic bronchitis to define COPD.

• Destruction of the lungs overtime – usually leading to breathlessness.

• 3 morphological types

• Centriacinar

• Panacinar

• Paraseptal

Diagnosis Tests and Treatments Spirometry – quickest and easiest test. Testing how well

you breath in and out - COPD is defined by FEV1/FVC ratio<0.7. (1)

Bronchodilator reversibility – recommended at least once to those facing respiratory problems. Helps exclude asthma, determine best lung function and further prognosis.(1)

Chest Radiography – not essential, does help eliminate the possibility of other diseases such as pneumonia, cancer, and congestive heart failure.(1)

Alpha – 1 Antitrypsin Deficiency Testing – WHO, along with many other foundations, provide testing for anyone who may have COPD.(1)

Computed Tomography – If all above show unclear results, CT scanning is recommened.(1)

9

COPD – And how it affects nutrition

status

Malnutrition is commonly associated with COPD because of the chronic inflammatory process which also ties into muscle atrophy and weight loss.(2)

Lipids – primary energy source Calories

Adequate protein (1.5 g/kg body weight/day) Carbohydrates – lessen carbon dioxide production in body.(2)

Vitamin A, C, E and Omega – 3 Fatty acids (anti- inflammatory)

Fiber – 20-35 g/day – helps with digestion/breathing.(2)

Enteral nutrition in the chronicobstructive pulmonary disease(COPD) patient

Chronic obstructive pulmonary disease: role of bacteria and guide to antibacterial selection in the older patient

This study looked at different antibacterial agents and compared their effects as to whether they had a positive effect on lessening the exacerbations COPD patients faced…

•Whether bacterial infection is an important cause of acute exacerbation continues to be debated.(5)

•One study showed a statistically significant benefit for antibacterial over placebo in patients with severe exacerbation, but no clear benefit for patients with mild or moderate exacerbations.(5)

•In another study the meta-analysis indicated a small but statistically significant improvement due to antibacterial therapy.(5)

•Still testing not entirely recommended. Overuse and unneeded use of antibacterial may cause resistance and damage of gut flora

11

A recent study from 2013 – new possible

classifications for COPD

• Used questionnaires to determine the severity of disease and then separate COPD patients into different classifications

• Used both CAT questionnaire and mMRC questionnaire and compared the results.

• Use these to assess symptoms but not classify into groups.(6)

Differences in classification of COPD group using COPD assessment test (CAT) or modified Medical Research Council (mMRC) dyspnea scores: a cross-sectional analyses

Charts from (6)

Case Study

• 76 yr old female residing in Stuart, Florida.

• Past smoker – has not smoked for 28 yrs

• Diagnosed with COPD at 48 and quit smoking

• Goes on walks, plays golf, occasionally swims

• Diagnosed from spirometry test

• Living in a warmer climate and moderate exercise has decreased occurrences of exacerbations.

• Height – 5’0” = 154 cm• Weight – 112 lbs = 51 kg• BMI – 21.9 (normal)• IBW – 100 lbs, %IBW – 112%

3-day Average:•Kcal = 1245 kcal/day•Protein = 73 g/day•Fluid = 1200 cc/day

•Tends to forget to eat breakfast•Eats a generally well-balanced diet with a lot of fish (good!)•Rarely eats starches unless it’s whole wheat pasta or rice•Does not like bread at all•Continues to cook or go to friends’ houses that cook•Still drinks 1 – 2 glasses of vodka with water

13Some Suggestions:

Kcal = 1304 kcal/dayProtein = 76.5 g/dayFluids = 1530 cc/day

•Eat more starchy plant based dishes to obtain more fiber

•Continue to eat fresh fish to obtain omega-3’s.

•Implement more fruits to increase antioxidant intake

•Consume low-fat dairy and continue to lessen carbohydrate intake

•Drink more fluids to help with coughing

14

3 day food record Calories - 1385 kcal/day

Protein - 90 g/day Fluid - 1,500cc/day

Eats balanced diet and still enjoys many foods like fish and fruits

Has cut back on junk food Sometimes skips meals Eats a lot of starch Cooks at home with husband Drinks mostly pop but has

been cutting back Still drinks alcohol- usually a

drink at night of rum and coke

Case Study #2

65 female lives in Livonia Mi Current Smoker-28 years Been trying to quite and

actively cutting back for 1 1/2 years

Diagnosed 5 years ago Diagnosed using spirometry Likes to walk dog, garden

outside, jogs when possible

Ht- 5’2- 157cm Wt - 120 54kg BMI - 21( normal) IBW 100 %IBW- 83%

15

Recommendations

Calories - 1,035 kcal/day protein - 54g/day Fluid- 1,620 cc/day

Continue to eat a balanced diet Continue to walk and jog Quit smoking Cut back on strachy foods and switch to whole

grain Eat smaller meals and more often to prevent

over eating Drink more fluids

Resources1. COPD Foundation [Internet]. Washington DC: COPD Foundation; 2004 [cited 2014 March 24]. Available from www.copdfoundation.org.2. DeBellis HF, Fetterman JW. Enteral nutrition in the chronic obstructive pulmonary disease (COPD) patient. J Pharm Pract [Internet]. 2012 [cited 2014 March 29]; 25(6): 583-585. Available from SAGE: http://jpp.sagepub.com3. Demrijian BG. Emphysema [Internet]. Medscape; 2012 [cited 2014 March 30]. Available from http://emedicine.medscape.com/article/298283-overview.4. Edelman NH, Cohen AB, Kleinhenz ME, Speizer FE. Chronic obstructive pulmonary disease. CHEST [Internet]. 1992 Sept [cited 2014 Match 28]; 102(3): 243-56. Available from American College of Chest Physicians: http://journal.publications.chestnet.org/article.aspx?articleid=1065405.5. Murphy TF, Sethi S. Chronic obstructive pulmonary disease: role of bacteria and guide to antibacterial selection in the older patient. Drugs Aging [Internet]. 2002 Oct [cited 2014 March 28]; 19(10): 761-775. Available from Springer Link: http://link.springer.com/article/10.2165/00002512-200219100-00005#.6. Sunmin K, Jisun O, Yu-ll K, Hee-Jung B, Yong-Soo K, In-Jae O, Kyu-Sik K, Young-Chul K, Sung-Chul L. Differences in classification of COPD group using COPD assessment test (CAT) or modified Medical Research Council (mMRC) dyspnea scores: a cross –sectional analyses. BMC Pulm Med [Internet]. 2013 [cited 2014 March 29]; 13(35): 1-5. Available from BioMed Central: http://www.biomedcentral.com7. Understanding Chronic Bronchitis [Internet]. Chicago, IL: American Lung Association; 2014 [cited 2014 March 24]. Available from http://www.lung.org/lung-disease/bronchitis-chronic/understanding-chronic-bronchitis.html.