Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease

Welcome to the Chronic Obstructive Pulmonary Disease Project

Chronic obstructive pulmonary disease (COPD) is a slowly progressive lung disease that is characterized by airflow obstruction. While the disease is treatable, it is not fully reversible.

The focus of this project is on medical nutrition therapy (MNT) for adults with COPD. The primary goals for people with COPD are to maintain appropriate body weight and body composition, maximize pulmonary status, reduce mortality and improve the quality of life (QOL). For the systematic review, the workgroup focused on the following subtopics:

  • Medical Nutrition Therapy
  • Methods to Estimate Energy Requirements (Predictive Equations)
  • Methods to Estimate Protein Requirements
  • Energy and Macronutrient Intake
  • Macronutrient Composition (% Distribution)
  • Body Weight and Body Composition
  • Micronutrients (Vitamin D)

Systematic Review Key Findings:

The systematic review found Grade I Good/Strong and Grade II, Fair evidence that in adults with COPD:

  • The lowest body mass index (BMI) groups had higher mortality rates when compared to higher BMI groups. A BMI of approximately 25.0-29.99kg/m2 appeared to lower the risk of mortality when compared to both higher and lower BMI classifications. (Grade I). 
  • As part of a multidisciplinary team, MNT intervention provided by an RDN (or international equivalent) improved BW, QOL and exercise capacity outcomes (Grade I) and improved body composition and lung function outcomes. (Grade II) 
  • There was improvement in dyspnea scores with higher energy intakes. (Grade II)
  • Vitamin D supplementation improved exacerbation outcomes in those with serum 25(OH)D levels 10ng per ml or lower. (Grade II) 
  • Evidence from 60% of studies reviewed, found positive associations between serum 25(OH)D and lung function measures. (Grade II)
  • In unadjusted results, a positive association was found between BMI and forced expiratory volume in 1 minute % predicted (FEV1 % predicted). An increasing BMI was also shown to reduce the longitudinal decline in FEV1 % predicted over time. (Grade II)

Only Grade III, Limited Weak evidence was found for predictive equations to estimate resting metabolic rate (RMR) and total energy expenditure (TEE), the effectiveness of MNT alone, macronutrient composition, macronutrient intake and effect of body composition on outcomes.

Guideline: The 2019 guideline recommendations are based on the findings of the systematic review and includes: 

  • MNT
  • Energy Intake
  • Body Weight
  • Estimating energy Needs (for RMR and TEE)
  • Energy Prescription (Energy Intake, Body Weight and Energy Needs)
  • Macronutrient Composition (% Distribution)
  • Vitamin D Supplementation
  • Serum 25(OH)D Status

The 2019 COPD guideline complements the 2008 COPD guideline. Download the COPD Guideline Comparison Table to see changes between the 2019 and 2008 guideline. Since not all of the 2008 recommendations were updated/reviewed, the results of the 2008 systematic review and guideline remain an accessible resource.

Use the left navigation to view the COPD systematic review. Expand the section below titled Project Team and Disclosures for a listing of individuals who contributed to the development of the project, disclosures and project funding information.

 

Learn More at FNCE 2019
Session 20: Take a Deep Breath: COPD Systematic Review EAL Update
Monday, October 28, 2019
1:30 PM-3:00 PM

 

 

 

  • Project Team and Disclosures (2019)

    The following individuals contributed their valuable time and expertise to this project:

    Workgroup Members

    • Corrine Hanson, PhD, RD, Chair
      Assistant Professor, University of Nebraska Medical Center, Omaha, NE, USA
    • Katie Braun, MS RDN, LD, CNSC (as of December 2016)
      Clinical Dietitian, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
    • Fritha Dinwiddle, MS, RD, CSG, LD
    • Janice A. James, MS, RDN, LDN, CDE (as of December 2016)
      Dietitian Educator, MedStar Harbor Hospital, Baltimore, MD, USA
    • Margaret W. Lange, MNS, RDN, LDN
      Retired, Frederick, MD, USA
    • Susan H. Meyer, MS, RDN-AP, LD, CNSC
      Dietitian, Cleveland Clinic, Cleveland, OH, USA

    Former Workgroup Members

    • Heather Cunningham, MS, RD, CNSC (resigned September 2016)
    • Wendy Castle, MPH, RD, LD (resigned September 2016)

    Patient Advocates

    • Edna Fiore, MT (ASCP)
      eNEwsletter Editor, Colorado Lung Health Connection, Little, CO, USA
    • Todd Pierce (resigned 2016)

    External Expert on Predictive Equations

    • David Frankenfield, MS, RD
      Dietitian, Penn State Health Milton S. Hersey Medical Center, Hershey, PA, USA

    Project Leaders

    • Tami A. Piemonte, MS, RDN, LDN, Project Manager
      Independent Contractor, St. Petersburg, FL, USA
    • Ellen K. Bowser, MS, RDN, LDN, FAND, RN, BSN, Lead Analyst (as of December 2016)
      Consultant, Gainesville, FL, USA
    • Constantina Papoutsakis, PhD, RD, Lead Analyst (resigned September 2016)
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Margaret J. Foster, MS, MPH, AHIP, Medical Librarian
      Texas A&M University, TAMU-Libraries, College Station, TX, USA
    • Deepa Handu, PhD, RDN, Methodologist 
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, US

    Evidence Analysts

    • Margaret Chenault, MS
      Doctoral Fellow, Drexel University, Philadelphia, PA, USA
    • Alana M. Clark, MPH
      Mentor, Mentornet.org, Charlotte, NC, USA
    • Erika M. Carrasquilla, MS, RD, LN
      Clinical Research Coordinator, Rush University Medical Center, Chicago, IL, USA
    • Anne O. Garceau, MS, RDN
      Nutritionist, USDA, Beltsville, MD, USA
    • Amy A. Huang, MPH, RDN
      Marketing Manager, Lonza Ltd, Basel, Switzerland
    • Yi-Hsuan (Lisa) Liu, MS, RD
      Research Assistant, Department of Nutritional Sciences, Pennsylvania State University, State College, PA, USA
    • Courtney T. Luecking, MPH, MS, RDN
      Doctoral Candidate, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    • Telma V. Moreira,  MS, RDN, LD, CNSC
      Clinical Dietitian, MD Anderson Cancer Center, Houston, TX, USA
    • Terrence M. Vance, PhD, RD
      Assistant Professor, Department of Nutrition and Dietetics, SUNY College at Plattsburgh, Plattsburgh, NY, USA

    Guideline Reviewrs

    • Emily Brigham, MD, MHS
      Assistant Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
    • Steven F. Friedman, RRT, MBA
      Director Respiratory Therapy, MedStar Harbor Hospital, Bowie, MD, USA
    • Juliet M. Mancino, MS, RDN, CDE, FAND
      Research Review Analyst, University of Pittsburgh Human Research Protection Office, Cranberry Twp, PA, USA
    • Mark W. Magnus Sr, BSRC, RRT, RPFT, FAARC
      Adjunct Faculty, Alamo Colleges District, St. Philip’s College, San Antonio, TX, USA
    • Veronica Serrano, MS, RD, LDN, CDM
      Assistant Director of Food and Nutrition, Memorial Hospital Pembroke, Miami, FL, USA
    • Jessica C. Shickel, RDN
      Clinical Dietitian, Serge, Mount Crawford, VA, USA
    • Christie Shubert, MS, RD, LDN, CNSC
      Assistant Director, Emory Healthcare, Atlanta, GA, USA
       

    Financial Contributors

    • Academy of Nutrition and Dietetics

     

    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • None of the workgroup members listed above disclosed potential conflicts.
  • Project Team and Disclosures (2008)

    The following individuals contributed their valuable time and resources to this guideline project:

    Workgroup Members

    • Sandra I. Austhof, MS, RD, LD, CNSD, Chair
    • Carrie Gleeksman, MS, RD
    • Ainsley Malone, MS, RD, LD, CNSD
    • Juliet M. Mancino, MS, RD, CDE
    • Donna H. Mueller, PhD, RD, FADA
    • Ann Neussendorfer, RD

    Former Workgroup Members

    • Irma A. Ishkanian, RD
    • Margaret W. Lange, MNS, RD, LD
    • Joanna Steinman, MA, RD, LDN

    Project Manager/Lead Analyst

    • Erica K. Gradwell, MS, RD

    Evidence Analysts

    • Ellen K. Bowser, MS, RD, CSP
    • Erica K. Gradwell, MS, RD
    • Kimberly R. Larson, MS, RD, LN
    • Margaret A. Maher, PhD, RD
    • Ranae Rogerson, MS, RD, LDN

    Guideline Reviewers

    • Karen Basinger, RD
    • Debbie Benner, MA, RD, CSR
    • Jerrilyn Burrowes, PhD, RD, CND
    • Louise Clement, MS, RD, CSR, LD
    • Charles J. Foulks, MD, FACP, FACN
    • Kathy Schiro Harvey, MS, RD, CSR
    • Maria Karalis, MBA, RD, LDN
    • Pamela Kent, RD
    • Elizabeth Kern, MD, MS
    • Nadiya Lakhani, RD, LD
    • Maureen McCarthy, MPH, RD, CSR, LD
    • Sharon R. Schatz, MS, RD, CSR, CDE

    Academy Staff

    • Deborah Cummins, PhD
    • Kari Kren, MPH, RD

    Financial Contributors

    • Academy of Nutrition and Dietetics
    • Commission on Dietetic Registration


    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • Juliet Mancino.is employed at the Univesity of Pittsburgh and participated in grants/research for NIH-NIDDK and sanofiaventis.
    • Margaret Lange is employed by Washington County Hospital and has participated in grants/resarch for Amgen and Quintiles. She also receive honorariums from World Congress and holds membership with MDA, AM Lung Association, and Asthma Coalition.