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Chronic Obstructive Pulmonary Disease

COPD: Executive Summary of Recommendations (2008)

Executive Summary of Recommendations

Below are the major recommendations and ratings for the Academy of Nutrition and Dietetics Chronic Obstructive Pulmonary Disease (COPD) Evidence-Based Nutrition Practice Guideline. More detail (including the evidence analysis supporting these recommendations) is available on this website to Academy members and EAL subscribers by clicking Major Recommendations from the menu bar on the left..

To see a description of the Academy Recommendation Rating Scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), and an explanation of the type of Recommendation (Imperative, Conditional), click here.

The COPD Recommendations are listed below. (Note: If you mouseover underlined acronyms and terms, a definition will pop-up.)

  • Screening and Referral
    COPD: Medical Nutrition Therapy
    Registered dietitians should provide Medical Nutrition Therapy (MNT) for individuals with chronic obstructive pulmonary disease (COPD). MNT should focus on prevention and treatment of weight loss and other comorbidities.
    Consensus
    Imperative
  • Nutrition Assessment
    COPD: Assessment of Quality of Life
    Registered dietitians should assess the quality of life of individuals with COPD, especially as it relates to their ability to obtain, prepare and consume food to meet nutritional needs. Research indicates that individuals with COPD may have more impairment with activities of daily living and those who are malnourished (as defined by BMI) may also have lower lung function measurements, more dyspnea and lower nutritional intakes.
    Fair
    Imperative
    COPD: Assessment of Weight Status
    Registered dietitians should use BMI and weight change to assess weight status in individuals with COPD. Studies report that in individuals with COPD, the prevalence of lower BMI (under 20kg/m2) may be as high as 30% and the risk of COPD-related death doubles with weight loss.
    Fair
    Imperative
    COPD: Measurement of Body Composition
    In individuals with stable COPD, registered dietitians should evaluate body composition. Studies report that even for those with BMI greater than 20kg/m2, body composition differs from healthy controls in that fat-free mass index and bone mineral density are lower in individuals with COPD.
    Fair
    Conditional
    COPD: Determination of Energy Needs
    Registered dietitians should assess energy needs of individuals with COPD, based on indirect calorimetry measurements, since resting energy expenditure (REE) based on measurement is more accurate than estimation using predictive equations. Studies report that the total daily energy needs of individuals with COPD are highly variable.
    Weak
    Imperative
    COPD: Energy Needs in Stable COPD
    When using predictive equations to assess energy needs of individuals with stable COPD, registered dietitians should account for the presence of inflammation and level of physical activity. Studies report that the presence of inflammation increases resting energy expenditure and that the level of physical activity has varying effects on total daily energy needs.
    Weak
    Conditional
    COPD: Energy Needs During Exacerbation
    When using predictive equations to assess energy needs of individuals with COPD during an exacerbation, registered dietitians should account for the presence of inflammation. Studies report that the presence of inflammation increases resting energy expenditure.
    Weak
    Conditional
    COPD: Bone Density Screening
    Registered dietitians should recommend bone density screening for individuals with COPD. Research indicates that individuals with COPD are at increased risk for osteoporosis and vertebral fractures. 
    Fair
    Imperative
  • Nutrition Intervention
    COPD: Macronutrient Composition of Medical Food Supplements
    Registered dietitians should advise that the selection of medical food supplements for individuals with COPD should be influenced more by patient preference than the percentage of fat or carbohydrate.There is limited evidence to support consumption of a particular macronutrient composition of medical food supplementation.
    Fair
    Conditional
    COPD: Frequent Small Amounts of Medical Food Supplements
    Registered dietitians should recommend frequent small amounts of medical food supplements for individuals with COPD. Studies report that frequent small amounts of medical food supplements are preferred to avoid post-prandial dyspnea and satiety and to improve compliance.
    Fair
    Conditional
    COPD: Medical Food Supplements for Inpatients
    For inpatients with COPD who have low BMI (under 20kg/m2), unintentional weight loss, reduced oral intake or who are at nutritional risk, registered dietitians should initiate provision of medical food supplements. Studies report that medical food supplementation for seven to 12 days results in increased energy intake in the inpatient setting.
    Fair
    Conditional
    COPD: Medical Food Supplements for Outpatients
    For outpatients with COPD who have low BMI (less than 20kg/m2), unintentional weight loss, reduced oral intake or who are at nutritional risk, registered dietitians should recommend consumption of medical food supplements. In the outpatient setting, studies report that medical food supplementation results in increased energy intake, with weight gain more likely when combined with exercise.
    Fair
    Conditional
    COPD: Treatment of Osteopenia and Osteoporosis
    For individuals with COPD who have osteopenia or osteoporosis, registered dietitians should encourage consumption of adequate amounts of calcium and vitamin D, as well as avoidance of tobacco smoking and excessive alcohol intake, as determined by national treatment guidelines for osteoporosis. Osteopenia and osteoporosis guidelines specific to individuals with COPD have not yet been determined.
    Consensus
    Conditional
    COPD: Antioxidant Vitamins
    Registered dietitians should encourage individuals with COPD to consume a diet that meets the Recommended Dietary Allowances (RDA) for vitamin A, vitamin C and vitamin E. Several studies report reduced serum or tissue levels of vitamin A, vitamin C and vitamin E in individuals with COPD, however adequately powered studies have not been conducted to evaluate the effects of intake above the RDA.
    Weak
    Imperative
    COPD: Omega-3 Fatty Acids
    Registered Dietitians should encourage individuals with COPD to consume a diet that meets the Adequate Intake (AI) for omega-3 fatty acids.  Adequately powered studies have not been conducted to evaluate the effects of intake above the AI.
    Weak
    Imperative
    COPD: Milk Consumption and Mucus Production
    Registered dietitians should advise individuals with COPD that the consumption of milk and milk products is unrelated to mucus production. Studies report no significant effect of milk and milk product consumption on mucus production or various lung function parameters, despite individual sensory perception.
    Weak
    Imperative
    COPD: Integrated Care
    Registered dietitians should implement Medical Nutrition Therapy (MNT) and coordinate nutrition care with a team of clinical professionals. An interdisciplinary team approach is optimal to integrate MNT, for individuals with COPD, into overall disease management and involves redesigning standard medical care to integrate rehabilitative elements into a system of patient self-management and regular exercise.
    Consensus
    Imperative
    COPD: Oxygen Therapy
    Registered dietitians should reinforce the use of supplemental oxygen for individuals with COPD in whom it is prescribed, especially as it relates to their ability to obtain, prepare and consume food to meet nutritional needs. Studies report that supplemental oxygen improves the ability of individuals with COPD to perform activities of daily living and exercise.
    Weak
    Conditional
    COPD: Collaboration on Pharmacotherapy
    Registered dietitians should collaborate with other members of the health-care team regarding the use of pharmacotherapy for individuals with COPD, including drug effectiveness and potential nutrition-related side effects. The change in lung function after treatment with any drug does not help in predicting other clinically-related outcomes.
    Consensus
    Imperative
  • Nutrition Monitoring and Evaluation
    COPD: Monitor and Evaluate Quality of Life
    Registered dietitians should monitor and evaluate the quality of life of individuals with COPD, especially as it relates to their ability to obtain, prepare and consume food to meet nutritional needs. Research indicates that individuals with COPD may have more impairment of activities with daily living and those with lower BMI may also have lower lung function measurements, more dyspnea and lower nutritional intakes.
    Fair
    Imperative
    COPD: Monitor and Evaluate Weight Status
    Registered Dietitians should use BMI and weight change to monitor and evaluate weight status in individuals with COPD.  Studies report that in individuals with COPD, the prevalence of lower BMI (<20 kg/m2) may be as high as 30%, and the risk of COPD-related death doubles with weight loss. 
    Fair
    Imperative
    COPD: Monitor and Evaluate Body Composition
    In individuals with stable COPD, Registered Dietitians should monitor and evaluate body composition.  Studies report that even for those with BMI greater than 20 kg/m2, body composition differs from healthy controls in that fat free mass index and bone mineral density are lower in individuals with COPD.
    Fair
    Conditional