Chronic obstructive pulmonary disease (COPD) is an irreversible airflow blockage that progressively occurs in the patients. 1This condition is caused by the chronic inflammatory response of noxious stimuli that could also be partly reversible. According to the statistic, this condition is mostly found in 9-10% adults aged above 40 years old, and has been reported to be the 4th leading cause of death in the world. 2-4
COPD commonly occurs in lean, malnourished or undernourished patients and usually referred as “pulmonary cachexia syndrome”. Patients with COPD are characterized by loss of fat-free body mass leading to muscle wasting. The pathophysiology of PCS is still unclear although there are several contributing factors such as disuse atrophy, metabolism change and caloric intake, tissue hypoxia, aging, oxidative stress, inflammation, and medications (glucocorticoids) and malnutrition. Muscle wasting is one of the major determinants of mortality in COPD, besides the airflow obstruction.5-7
The poor nutrition in COPD patients leads to many complications in breathing relating to lung function, such as increased gas trapping, lower diffusing and exercise capacities. Loss of respiratory muscles as a result of loss of body cell mas can be also found in malnourished COPD patients. Some clinical sequel such as hypercapnic respiratory failure, dependence in mechanical ventilation, and nosocomial lung infections are some of the effects that might occur in the patients. 8
Nutritional treatment with supplement therapy has been maintained in COPD management and for a long time has shown promising results. Supplement therapy has been strongly advised in patients with body weight loss and muscle wasting, as these two conditions have been associated with increased morbidity and mortality in the patients.
Screening for malnutrition
The nutritional status of the patients is screened every 6-12 months or at the time of routine visits. The assessments include the measurement of BMI (<= 20) and the ideal body weight (<90% is advised). The goals of this assessment are to determine the lung function and the efficacy of nutritional therapy. The patients can be advised to exerciseregularly as this can stimulate appetite and result in more effective nutritional therapy. 9
The nutritional management in COPD patients aims to increase pulmonary function, maintain muscle strength and exercise tolerance, preserve micronutrients and macro nutrition, and relief inflammation . There are several types of food to consume for these patients.
High fat low carbohydrate
It has been proposed from previous research that patients with COPD demonstrate significant improvements in pulmonary function by high fat low carbohydrate diet compared to traditional high carbohydrate diet.1
Omega-3 Polyunsaturated Fatty acids (PUFA)
PUFA has been proven to relief inflammation with its anti-inflammatory effects, which is found to be beneficial in chronic inflammatory disease such as COPD dan malnourished patients. 11
Vitamin D has immune modulatory effects and helps to decrease myopathy/muscle weakness. A vitamin D deficiency has been correlated with early progression/developments of COPD. 12
Fruits and Vegetable
The antioxidants effect, minerals, vitamins, flavonoids, phytochemicals, and fibers in fruits and vegetablesare found to play important role in the relief of chronic and acute respiratory condition
Other recommendations to improve nutritional management of COPD patients are with frequent small feeding, resting before meals, and taking daily dose of multivitamins. Researches have found that nutritional supplementation encourage significant nutritional improvements in the patients.9
● The nutritional management in COPD patients aims to increase pulmonary function, maintain muscle strength and exercise tolerance, preserve micronutrients and macro nutrition, and relief inflammation.
● Supplement therapy has been strongly advised in patients with body weight loss and muscle wasting, as these two conditions have been associated with increased morbidity and mortality in the patients.
1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: Revised 2015. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Available at: www. goldcopd.org. Last accessed on November 2, 2015.
2. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006; 28:523–32.
3. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet 2007; 370: 765–73.
4. Decramer M, Janssens W, Miravitlles Chronic obstructive pulmonary disease. Lancet 2012; 379: 1341–51.
5. Vestbo J, Prescott E, Almdal T, Dahl M, Nordestgaard BG, Andersen T, et al. Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am J Respir Crit Care Med 2006;173:79–83.
6. Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr 2005; 82:53–9.
7. Collins PF, Stratton RJ, Elia M. Nutritional support in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Am J Clin Nutr 2012; 95: 1385–95.
8. Ezzel L. Jensen GL. Malnutrition in Chronic Obstructive Pulmonary Disease. Am J Clin Nutr 2000;72:1415–6.
9. Rawal G. Yadav S. Nutrition in Chronic Pulmonary Obstructive Disease. Journal of Translational Internal Medicine. 2015;3(4).
10. Cai B, Zhu Y, Ma Yi, Xu Z, Zao Yi, Wang J, et al. Comer G.M. Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients. Nutrition 2003; 19: 229–32.
11. Rawal G, Yadav S, Shokeen P, Nagayach S. Medical nutrition therapy for the critically ill. Int J Health Sci Res 2015; 5: 384-93.
12. Persson LJ, Aanerud M, Hiemstra PS, Hardie JA, Bakke PS, Eagan TM. Chronic obstructive pulmonary disease is associated with low levels of vitamin D. PLoS One 2012; 7: e38934.
13. Persson LJP, Aanerud M, Hiemstra PS, Hardie JA, Bakke PS, et al. (2012) Chronic Obstructive Pulmonary Disease Is Associated with Low Levels of Vitamin D. PLoS ONE 7(6): e38934. doi:10.1371/journal.pone.0038934.
14. Shaheen SO, Jameson KA, Syddall HE, Aihie Sayer A, Dennison EM, Cooper C, et al. The relationship of dietary patterns with adult lung function and COPD. Eur Respir J 2010; 36: 277–84.