Nutritional status and COPD

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Nutritional status and COPD

• Ninian Hewitt

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SpirometryMale BMI 32
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Obesity

• Definition BMI gt 30
• Reasons for association with COPD not clear
• Europe 10- 20 affected
• GOLD 1 2 (16 24)
• GOLD 4 (8)
• USA 30-50 affected
• Overall no excess obesity in the COPD population

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Obesity

• Comorbidities
• Sleep apnoea
• Hypoventialtion syndrome
• Metabolic syndrome
• COPD and Obesity may be independent health
  problems but with link through reduced exercise/
  steroids

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Effects of obesity

• Reduced exercise
• Increase SOB
• FEV/FVC ratio tends to be preserved
• Spirometry results not corrected for obesity
• Reduced exp reserve volume and functional
  residual capacity
• Reduced small airways function but O2 uptake
  normal

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Cachexia case

• Woman
• Aged 63
• BMI 19
• Ex smoke 5 years
• FEV 1.7 (74)
• VC 2.71 (99) Ratio 63
• No response bronchodilation
• Alone at home
• MRC 3-4

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Cachexia

• Definition BMI lt 21
• FFMI (free fat mass index) lt15
• Overall 27 of patients affected
• Women more affected than men
• One survey 18 low BMI 40 low FFMI

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Muscle wasting

• Correlates with better low FFMI than BMI
• Lack of use
• Inflamatory markers (eg TNF / cytokines)
• Affects quality and quantity of muscle

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Muscle wasting

• Affect women gt men
• GOLD 12 28
• MRC dyspnoea 12 26
• GOLD 4 38
• MRC 4 OR 5 43

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Muscle wasting

• Prevalence of quadriceps weakness by severity in
  COPD
• Seymour et al

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Muscle wasting

• Prevalence of quads wasting by MRC scale

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Paradoxes

• Low BMI is not related to severity
• Low BMI is related to increase in mortality
• No correlation between Low FFMI and mortality
• High BMI lower mortality in GOLD 3and 4
• High BMI higher mortality in GOLD 1and 2

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Nutrition

• Aims
• Maintain body weigh
• Reduce fatigue eat often. snacks etc
• Satiety increased by limiting fluid with meals
• Reduce caffeine
• Prevent dehydration
• Nutritional supplements ref to dietician

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Rehabilitation

• Early to stop muscle wasting
• Immediate post exacerbation
• Nutritional status significant impact on
  performance and well being