COPD: Introduction (2019)
Chronic Obstructive Pulmonary Disease (2019) Evidence-Based Nutrition Practice Guideline
Guideline Narrative Overview
The focus of this guideline is on medical nutrition therapy (MNT) for people with chronic obstructive pulmonary disease (COPD).
COPD is a leading cause of death in both the United States and world-wide.1, 2 COPD is described by the American Thoracic Society as a slowly progressive lung disease that is characterized by airflow limitation and obstruction.3
Although COPD affects the lungs, it also produces significant systemic consequences. Adults who are diagnosed with COPD often have other comorbidities and especially in the elderly are particularly vulnerable to the effects of smoking, poor diet and inactivity.2 COPD may be accompanied by weight loss, nutritional abnormalities and loss of skeletal muscle and/or function.2
The primary goals of MNT for people with COPD are to achieve and maintain appropriate body weight and composition, maximize pulmonary status, reduce mortality, and improve quality of life (QOL).
1Mortality in the United States, 2016. National Center for Health Statistics. Centers for Disease Control and Prevention. NCHS Data Brief No. 293, December 2017. Accessed Jul 1, 2019: https://www.cdc.gov/nchs/products/databriefs/db293.htm
2Global Strategy for the Diagnosis, management and Prevention of Chronic Obstgructive Pulmonary Disease (2019 Report). Global Initiative for Chronic Lung Disease. Accessed Jul 1, 2019: https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf
3Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, Criner G, van der Molen T, Marciniuk DD, Denberg T, Schunemann H, Wedzicha W, MacDonald R, Shekelle P, for the American College of Physicians, the American College of Chest Physicians, the American Thoracic Society, and the European Respiratory Society. Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011; 155: 179-191.
This guideline is intended for use by Registered Dietitian Nutritionists (RDNs) involved in providing MNT to adults with COPD. The recommendations in this guideline were based upon a systematic review of the literature and the work performed by the Academy of Nutrition and Dietetics Expert Work Group on COPD.
To view the guideline development and review process, see Guideline Methods.
The recommendations provide a framework for the RDN to successfully integrate MNT into the overall medical management of adults with COPD.
- Medical nutrition therapy
- Predictive equations for estimating energy requirements
- Macronutrient composition (percent distribution)
- Energy intake
- Vitamin D supplementation
- Serum 25(OH)D levels
- Body weight
Please expand the “Project Team and Disclosures” to see the list of individuals including the expert workgroup members, methodologists and analysts for this project.
Academy guidelines are revisited every five years. A scoping review will be conducted to examine the need for new and revised recommendations based on the available science. The process includes:
- Literature searches and evidence scoping to identify new research published since the previous searches were completed. Updated inclusion/exclusion criteria and search terms may be warranted.
- Council on Research review to determine if the update will inlcude modification to all, some or no recommendations compared to the earlier version(s) of the guideline, or development of new recommendations.
- Creation of a table comparing the new guideline and the older version of the guideline. The document will indicate which recommendations remained unchanged; updated, new; or not reviewed.
Using the Academy's EAL process, an unbiased and transparent systematic review will be completed and the updated guideline published on the EAL. To learn more about the Academy's development process, download "Academy of Nutrition and Dietetics Methodology for Developing Evidence-Based Nutrition Practice Guidelines. J Acad Nutr Diet 2017 May 117; (5):794-804.
Medical Nutrition Therapy and Chronic Obstructive Pulmonary Disease
Scientific evidence supports the effectiveness of MNT to increase effectiveness of therapy for COPD.
Medical Nutrition Therapy and COPD
Scientific evidence supports the importance of the RDN providing MNT to adults with COPD and is integral to the interdisciplinary health care team caring for COPD patients. The RDN designs and implements the optimal nutrition care plan and prescription that complements physical activity and pharmacologic therapy, if needed. Based on the patient’s clinical status, plan for treatment, and comorbidities, the RDN monitors and evaluates the effectiveness of the nutrition care plan in promoting the patient’s nutrition and health outcomes. The RDN adjusts the nutrition care plan as necessary to achieve desired outcomes.
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