COPD

Etiology
COPD stands for chronic obstructive
pulmonary disease. COPD is a progressive
disease that causes a limitation in airflow [1].
Chronic obstructive pulmonary disease is a
term that encompasses a number of diseases
that lead to limitation of airflow. These
diseases include emphysema, chronic
bronchitis, and asthma. All three diseases lead
to a limitation of expiratory airflow, but cause
the limitation in different ways. In order to
understand COPD, a brief overview of how the
lungs work is necessary. Bronchioles are tubes
that air goes down when we breath. The
bronchial tubes branch off into smaller
bronchioles, the ends of eh bronchioles have
small air sacs called alveoli. Capillaries run
through the walls of the air sacs and allow
oxygen into the bloodstream. The airways are
elastic and when you breath the air sacs fill up,
when you breath out they deflate. [18] Asthma
causes limited airflow though smooth muscle
contraction with the narrowing of the airway
lumen. Emphysema causes destruction of the
alveolar walls, which leads to a loss in lung
elasticity. The loss of elasticity prevents the
alveoli from functioning, air becomes trap in the
lungs and the alveoli burst. This results in less
oxygen getting into the blood. Chronic
bronchitis is the inflammation of the bronchial
tubes. When the airways become inflamed or
infected less air is allowed to pass to and from
the lungs. The airways eventually thicken and
mucus will stick to the airways making it hard
to breath. [13]

Diagnosis

Sample Menu

Spirometry machines measure how much air you can

breath in and out, they also measure how fast you can
breath out that volume of air. Spirometry gives you a
ratio of the amount of air you can breath out in one
breath over how much of that air that was blew out
came out in the first second. A ratio of less than .07
confirms COPD. [14]

Meal 1- 1 egg, 2 slices toast, cup

orange juice, 2 teaspoon butter

Nutritional Diagnosis
The nutritional diagnosis of COPD is weight loss, fat
free mass loss, and altered metabolism. Weight loss
is caused by increased energy expenditure due to
decreased airway function. [15] The decreased
airway function causes breathing to be harder. [1]
This causes a need for more calories. Not eating
enough additional calories can lead to weight loss.
[15] Patients also loss weight due to the inability to
eat, difficulty swallowing due to dyspnea, fatigue
which leads to not wanting to eat, and chronic mouth
breathing which can alter taste. [17] COPD can lead
to altered metabolism caused by hypoxia,
inflammation, nutritional deprivation, and drug
treatment. COPD can also lead to a loss of fat free
mass. The inflammation can activate protein
breakdown pathways that result in a loss of FFM.

Meal 2- 1 cup milk, 1 cup oatmeal

Meal 3 and Meal 4 (Eat half of meal 3 and
save half for later)- 2 oz hamburger, 1 cup
spaghetti, 1 oz parmesan cheese, cup
tomato sauce, 2 teaspoon butter, 1 apple
Meal 5- 1 oz chicken, 1 baked potato,
cup carrots, 2 teaspoon butter for potato
Meal 6- 1 cup cereal, 1 cup milk, 1 apple
Meal 1 kcal- 419
Meal 2 kcal- 430
Meal 3 and Meal 4 kcal- 798
Meal 5 kcal- 420
Meal 6 kcal- 422
Total kcal- 2489

COPD
Nutritional Treatment
The nutritional treatment of COPD includes
encouraging patients to increase caloric intake to
stop weight loss and wasting. Early intervention
is vital because weight gain is hard to accomplish
once a patient starts to lose weight. [7] Diets
high in fortified foods will help patient get
vitamins into the diet. High carbs and protein
diets are recommended to help with weight gain.
Supplementation of nutrition shakes are
recommended to help with weight gain. COPD
can also lead to low vitamin D. Low vitamin D
intake can cause impaired lung function. Vitamin
D supplementation is recommend to help with
lung function. [17]

Labs
Pulse oximetry is used to assess COPD. Pulse
oximetry works by attaching a probe to the finger
and the probe measures the absorption of
hemoglobin saturation in the blood. The percent
of oxygen in the blood can be used to determine
if patients need oxygen therapy. [12] Atrial blood
gases are also measured to assess COPD. Atrial
blood gases measure how well the body is taking
in oxygen and expelling carbon dioxide. The test
also measures the pressure of carbon dioxide
(PaCO2) and oxygen in the blood (PaO2). Atrial
blood gases also checks to see what percent of
hemoglobin is carrying oxygen (SaO2). The
blood pH can also be determined by atrial blood
gases. Rising PaCO2 and falling PaO2 are an
indicator of COPD. SaO2 of less than 92 % is
another indicator.

Signs and Symptoms

Chronic Cough

Sputum Production

Shortness of Breath

Wheezing

Annotated Bibliography
1.

Burge, S., & Wedzicha, J. (2003). COPD

Exacerbations: Definitions And
Classifications. European Respiratory
Journal, 21(41), 46S-53s.

2. Caszo, B., & D'Souza, G. (2006). COPD and

Nutrition. Lung India, 78-78.

3. Celli, B., MacNee, W., Fein, A., Heffner, J.,

Lareau, S., Meek, P., ... Fahy, B. (2004).
Standards for the diagnosis and treatment
of patients with COPD: A summery of the

Medication
Medications include long term and short term
bronchodilators. Bronchodilators are inhalers that
result in airway smooth muscle relaxation. Short term
bronchodilators are used during periods of shortness
of breath, they begin to work in 15-20 minutes. Long
term bronchodilators are used for all day relief of
shortness of breath. Some typical short term
bronchodilators are albuterol, levalbuterol, pirbuterol,
and ipratropium. Some long term bronchodilators are
tiotropium and indacaterol. Glucocorticoids can also
be used to reduce inflammation.

ATS/ERS paper. European Respiratory

Journal, 23(6), 932-946.

4. Rennard, S. (1998). COPD: Overview Of

Definitions, Epidemiology, And Factors
Influencing Its Development. Chest, 113,
235S-241S.

5. Stepherd, A. (2010). The nutritional management

of COPD: An overview. British Journal of
Nursing, 9(19), 559-562.

Annotated Bibliography
1. Burge, S., & Wedzicha, J. (2003). COPD Exacerbations: Definitions And Classifications. European Respiratory Journal, 46S-53s.

This article discusses exacerbations in chronic obstructive pulmonary disease , assessing the severity of exacerbation, and prevention. Exacerbation
are defined as sustained worsening of the patient's condition, from a stable state and beyond normal day to day variations that is acute in onset and may
warrant additional treatment. They can also be defined as worsening of respiratory symptoms that require treatment with corticosteroids or antibiotics, or
both. Patients with moderate to severe COPD can have three or more exacerbations a year that require hospitalization. The main cause of
exacerbation are bacterial infection, viral infection, pollution events, cold weather, and interruption of regular treatment. The most common symptom of
an exacerbation is dyspnea. The severity of the exacerbation is related to the severity of the COPD. Exacerbations can be broken down into mild,
moderate, severe, very severe, and life threatening. Mild exacerbations are treated with antibiotics and moderate is treated with corticosteroids with or
without antibiotics. Severe is type one respiratory failure with hypoxemia but no carbon dioxide retention and no acidosis. Very severe is type two
respiratory failure compensated with hypoxia, carbon dioxide retention, but no acidosis. Life threatening is type two respiratory failure decompensated
with acidosis and carbon dioxide retention. The length of exacerbations can be defined as the date of first healthcare contact to the return of pre
exacerbation health. Exacerbation frequency is seasonal and is related to influenza. Exacerbations can be prevented with regular inhaled corticosteroid
prescription, mucolytics, exacerbations antibiotic therapy, smoking cessation, and pulmonary rehabilitation.

2. Caszo, B., & D'Souza, G. (2006). COPD and Nutrition. Lung India, 78-78.

The authors of this article look at the mechanism of malnutrition in COPD, how to measure nutritional status, and nutritional intervention. Weight loss in
chronic obstructive pulmonary disease patients is due to an energy deficit caused by a hypermetabolic state. The hypermetabolic state is due to an
increased energy expenditure caused by the resistance to airflow. The resistance to airflow causes patients to have to work harder to breath. Weight
loss is also due to pulmonary inflammation and tissue hypoxia. Patients also lose fat free muscle mass, this can be contributed to an increase in
cytokines and interleukins. The article states that simple measures of nutritional status such as body weight and BMI are preferable for assessing
nutritional status. A drawback to these measures are changes in body composition cannot be assessed. In COPD patients BMI and weight can be
influenced by water retention. A patient's fat free mass can be measured by using a skinfold thickness measurement. This method of measuring fat free
mass involves using calipers to measure skinfold thickness and then comparing the results to a reference number. A advantage of this method is it is
quick, easy, and non invasive. A disadvantage of this method is that the procedure lacks a convenient and accurate reference method. The article
discusses nutritional intervention. The article specifically talks about nutritional supplementation. Short term test show that supplementation increases
exercise tolerance, quality of life, and lung function test. In conclusion COPD patients should have nutritional assessment and nutritional treatment.

3. Celli, B., MacNee, W., Fein, A., Heffner, J., Lareau, S., Meek, P., ... Fahy, B. (2004). Standards for the diagnosis and treatment of patients with COPD: A
summer of the ATS/ERS paper. European Respiratory Journal, 23(6), 932-946.

This article is a summary on the position paper of the American Thoracic Society and European Respiratory Society. The paper covers a wide range of
topics regarding chronic obstructive pulmonary disease. Definition, diagnosis, epidemiology, pathophysiology, management, therapy, and treatment
are all covered. The publishers of this authors define COPD as a preventable and treatable disease state characterized by airflow limitation that is not
fully reversible. Chronic obstructive pulmonary disease is typically diagnosed with spirometry. A spirometry test measures forced expiratory volume in
one second over forced vital capacity. This ratio is used to diagnose COPD. The pathophysiology of the disease comprises pathological changes in
the central airways, peripheral airways, lung parenchyma, and pulmonary vasculature. Tobacco smoking is the main risk factor, other inhaled noxious
particles can also be a risk factor. The disease leads to inflammation of the lungs and oxidative stress. It is estimated that 6.9 percent of United
States citizens between the age of 25-75 have mild COPD.

The article goes into detail about bronchodilators and glucocorticoids for treatment of

COPD. There are three types of bronchodilators. All of the bronchodilators work to be airway smooth muscle relaxers and improve lung emptying
during tidal breathing. Glucocorticoids are steroid treatments that work to reduce inflammation. The review paper also goes over management by
using long term oxygen therapy, pulmonary rehabilitation, nutrition, and surgery. Nutrition therapy is vital to reduce weight loss and fat free muscle
wasting.

4. Rennard, S. (1998). COPD: Overview Of Definitions, Epidemiology, And Factors Influencing Its Development. Chest, 235S-241S.

This article gives a basic overview of what chronic obstructive pulmonary disease is and what goes on in patients body. The article states that
COPD is defined by one single physiological feature, that is, limitation of expiratory airflow. COPD embraces emphysema, chronic bronchitis, and
asthma. The article then gives in depth descriptions of the mechanism of airflow obstruction relative to each disease encompassed by COPD.
Emphysema causes destruction of the alveolar walls, which leads to a loss in lung elasticity. The loss of elasticity prevents the alveoli from
functioning and traps air in the lungs. This causes less oxygen to get into the blood and causes airways to collapse. Chronic bronchitis is an
inflammation of the bronchial tubes, when the airways are inflamed less air is allowed to pass to and from the lungs. The airways eventually thicken
and mucus will stick to the airways and make it difficult to breath. The article goes on to discuss risk factors. The major risk factor for COPD is
smoking. Occupational exposures, a1- protease inhibitor deficiency, air pollution, passive smoke exposure, respiratory infection, and age are all risk
factors for COPD. The article gives in depth details regarding smoking and COPD. The article makes it clear that cessation of smoking is a key
factor in improving health in COPD patients.

5. Stepherd, A. (n.d.). The nutritional management of COPD: An overview. British Journal of Nursing, 559-562.

This paper looks at causes, consequences, and management of malnutrition in COPD patients. Malnutrition in COPD patient is caused by a variety of
factors. Increased dyspnoea, altered absorption of nutrients, and an increased resting energy expenditure all lead to malnutrition. COPD patients may
also have less of a sensation of taste, which can lead to weight loss. Malnutrition is also caused by oxidative stress and hypoxemia. There are a
variety of complications that can arise from malnutrition in COPD patients. Some complications include delayed recovery, impaired immunity leading to
sepsis, impaired wound healing, impaired gastrointestinal function, muscle atrophy, impaired cardiac function, and reduced renal function. Malnutrition
can be managed with proper nutrition therapy. When patients are identified as being at risk of malnutrition, a decision needs to be made regarding oral
feeding and nutritional supplementation. Enteral feeding is the first option if tube feeding is necessary. Patients should be advised to consume fortified
foods that are high in protein and are energy dense. COPD patients are also at an increased risk for vitamin D deficiency. Vitamin D status is
associated with lung function, so vitamin D supplementation is recommended. The article also gives some general tips to help patients consume more
calories. Some tips include, maintaining an upright position while eating, rest prior to meals, ensure foods are soft, modify the consistency of foods, eat
slowing, and drink fluids at the end of the meal. The article concludes by stating that nutritional treatment can help delay disease progression and
reduce the risk of early mortality.