Because patients with chronic obstructive pulmonary disease (COPD) are prone to weight loss and a compromised immune system, proper diet and nutrition is important.
Managed Healthcare Executive (MHE) asked Ilaria St. Florian, a registered dietitian at Stamford Hospital in Stamford, Connecticut, to share her thoughts.
MHE: How is breathing connected to food intake in this patient population?
St. Florian: The hallmark of COPD is increased labored breathing due to the lungs’ limited ability to take up oxygen and remove carbon dioxide. Unlike in healthy individuals, for whom breathing is typically passive, in COPD patients airflow resistance requires effort, which increases the amount of energy or calories burned, as the body must work harder to breathe.
This hypermetabolic state means that one must compensate for this increased energy expenditure by taking in additional calories to avoid unwanted weight loss. In fact, decreased body weight can adversely affect COPD progression and prognosis.
MHE: What are some of the nutritional recommendations for COPD patients?
St. Florian: First of all, you want to make sure you are taking in sufficient calories to balance energy burned from labored breathing, but also focus on nutrient dense foods. COPD patients are also at a higher risk for lung infection, so it is particularly important to ensure that they are eating a healthy and varied diet to boost their immune system and reduce the risk of infection.
Secondly, it is important to encourage patients to eat since factors such as fatigue, weakness, and depression all contribute to a decrease in food intake. One way this can be accomplished is for patients to eat when they have the most energy, which tends to be in the morning, because labored breathing causes fatigue. Also, instead of eating three traditional large meals a day, patients should break it up into four or five smaller meals daily to prevent the feeling of fullness and possible shortness of breath.
In addition, patients should stay upright during and after eating to ease pressure on the lungs.
It is also important to maintain hydration, but try to get your fluids between meals, not during meals, so that fluids do not fill up your stomach and cause satiety.
MHE: What are some specific food recommendations?
St. Florian: You want to make every bit count, such as eating nutrient-dense foods that are both high calorie and nutritious to prevent muscle loss and wasting. Pulmonary muscles are needed for respiration, so eating foods such as fruits, vegetables, whole grains, and protein will help keep your muscles strong.
Popular protein foods are chicken, lean meats, eggs, yogurt, fish, nuts, and beans. High-fiber foods and whole grains are also part of the mix. Some patients also require nutritional supplementation, if they are losing too much weight.
Furthermore, some medications can cause bone loss, so it is important to eat foods that contain vitamin D and calcium, as well as antioxidants for their anti-inflammatory properties. Calcium-rich foods like milk are fortified with vitamin D. Nutrients such as phosphorus, magnesium, and potassium are also recommended.
MHE: Any other things that providers and caregivers should keep in mind when caring for patients?
St. Florian: If you are using home oxygen, wear it during eating, if indicated by a physician, because eating and digestion require oxygen. Limit salt, too, because salt retains fluid.
Eat slowly and chew foods thoroughly to avoid swallowing air, which can lead to a feeling of fullness or pain and discourage eating.
Education is a key part to encourage behavior change to improve nutritional status. COPD patients may not think about the fact that they have more energy at a certain time of day or that if they eat fast they are swallowing air. Simple strategies can improve their nutritional well-being and help maintain their weight.