Chronic Obstructive Pulmonary Disease

COPD: Scope of Guideline (2019)

Guideline Scope Characteristics

Below you will find a list of characteristics that describe the Scope of this Guideline.

Disease/Condition(s)

Populations to Whom This Guideline May Apply

This guideline applies to adults with COPD.

Other Guideline Overview Material

For more details on the guideline components, use the links in the left navigation bar:

  • Scope of Guideline
  • Statement of Intent
  • Guideline Methods
  • Implementation of the Guideline
  • Benefits and Harms of Implementing the Recommendations

Contraindications

This guideline was developed for adults in all stages of COPD, regardless of source of diagnosis and for individuals in all settings, except critical care. While individuals with COPD with and without comorbid conditions were included in the research, careful consideration should be given to the application of these guidelines for patients with significant medical co-morbidities. Clinical judgement is crucial in the application of these guidelines.

This guideline is not intended:

  • For prevention of COPD in individuals without COPD.
  • For individuals with COPD who are on mechanical ventilation.
  • For individuals with other pulmonary diagnoses, such as asthma, pulmonary hypertension,  interstitial lung disease, and Asthma-COPD Overlap Syndrome.
  • For interventions typically within the scope of practice of a certified exercise physiologist or athletic trainer, or other professional, for which, adequate training in physical activity interventions is necessary. 
  • As a replacement for interventions typically within the scope of practice of behavioral or psychological professional, for which adequate training in behavioral therapy is necessary.
  • The reader may explore other EAL Guidelines such as Critical Illness, Diabetes 1 and 2, Adult Weight Management, Hypertension or systematic review projects, such as Adult Nutrition Screening for further information on treatment beyond this guideline.

Guideline Category

Assessment of Therapeutic Effectiveness, Counseling, Evaluation, Management, Treatment

Clinical Specialty

Allergy and Immunology, Cardiology, Family Practice, Geriatrics, Internal Medicine, Nutrition, Pulmonary Medicine, Thoracic Surgery

Intended Users

Registered Dietitians, Advanced Practice Nurses, Health Care Providers, Nurses, Patients, Pharmacists, Physician Assistants, Physicians, Respiratory Care Practitioners, Students

Guideline Objective(s)

Guideline Objective(s)

  • To provide evidence-based MNT recommendations for adults with COPD that assist in achieving and maintaining optimal weight and improved QOL.

Specific Objectives

  • To define evidence-based COPD nutrition recommendations for RDNs that may be carried out in collaboration with other healthcare providers
  • To guide practice decisions that integrate medical, nutritional and lifestyle strategies  
  • To reduce variations in practice among RDNs and other health professionals who may use these guidelines
  • To provide the RDN with data to make recommendations to adjust MNT or recommend other therapies to achieve desired outcomes
  • To enhance the QOL for the adult with COPD, utilizing customized strategies based on the individual’s preferences, lifestyle and goals
  • To develop content for intervention that can be tested for impact on clinical outcomes
  • To define the highest quality of care within cost constraints of the current healthcare environment.

Target Population

Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Advanced Aged (80 years and over), Male, Female

Target Population Description

Adults with COPD.

Interventions and Practices Considered

The COPD Evidence-Based Nutrition Practice Guideline is based on the Academy of Nutrition and Dietetics' Nutrition Care Process and Model, which involves the following steps. Terms relevant to the treatment of adults with COPD come from the Nutrition Terminology Reference Manual (eNCPT, 2018).

  • Nutrition Assessment
  • Nutrition Diagnosis
  • Nutrition Intervention
  • Nutrition Monitoring and Evaluation.

This guideline addresses topics that correspond to the following areas of the Nutrition Care Process.

I. Referral to a Registered Dietitian Nutritionist
II. Medical Nutrition Therapy.

Reference: 
Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. 2018 edition. Accessed June 2, 2019: http://www.ncpro.org

Future Research Needs

The COPD Expert Work Group identified several areas for future research based on their review of the literature and subsequent evidence analysis. Suggestions regarding research methodology were also made. 

Based on this systematic review, additional research is needed for adults with COPD in the following areas:

  • MNT intervention alone (not as part of a multidisciplinary program), including the frequency and duration of visits provided by an RDN (or international equivalent) 
  • Define optimal nutrition interventions to maintain lung function, decrease exacerbations and mortality, and improve QOL. 
  • Further investigation into Vitamin D supplementation, including dosing, timing, delivery routes, and length of intervention. Optimal serum 25(OH)D concentrations in COPD also remain undefined. 
  • The optimal macronutrient distribution in COPD remains undefined. 
  • Determine of most accurate methods to calculate resting metabolic rate (RMR) and total energy expenditures (TEE) 
  • The effect of body composition, and changes in body composition over time, needs further research. 

Research methodology:

  • Additional trials addressing the systemic and heterogeneous nature of COPD are needed. 
  • Few longitudinal studies have been conducted with regard to nutrition and COPD.

The Academy of Nutrition and Dietetics supports and encourages member participation in nutrition research. Contribution to nutrition research is essential to improve the effectiveness of nutrition interventions and thus, patient care.  

The Academy has two main resources for data collection, which is free to Academy members:  

Dietetics Practice Based Research Network (DPBRN) is a network of RDNs who are members of the Academy and are interested in research. DPBRN provides education resources and opportunities for members to participate in research. 

Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII) provides tools for RDNs to collect outcomes. Dietitians can collect outcomes for their own research project and add anonymous data to the national Dietetics Outcomes Registry, contributing to the evidence supporting nutrition practice and helping ensure high-quality patient care.

 

 

 Proceed to Statement of Intent  Return to COPD Home Page