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Nutritional status and COPD

Nutritional status and COPD. Ninian Hewitt. Spirometry Male BMI 32. Patient. % Predicted. Normal range. BASELINE FEV 1 VC FEV 1 /VC ratio. 1.90 2.70 70%. 65% 68%. 2.10 – 3.80 3.00 – 5.00 61 - 84. 2.5 mg salbutamol FEV 1 VC. 1.95 2.80. 67% 70%. 0.25 mg ipratropium FEV 1

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Nutritional status and COPD

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  1. Nutritional status and COPD Ninian Hewitt

  2. SpirometryMale BMI 32 Patient % Predicted Normal range BASELINE FEV1 VC FEV1/VC ratio 1.90 2.70 70% 65% 68% 2.10 – 3.80 3.00 – 5.00 61 - 84 2.5 mg salbutamol FEV1 VC 1.95 2.80 67% 70% 0.25 mg ipratropium FEV1 VC 1.90 2.90 65% 73%

  3. Obesity • Definition BMI > 30 • Reasons for association with COPD not clear • Europe 10%- 20% affected • GOLD 1& 2 (16% & 24%) • GOLD 4 (8%) • USA 30%-50% affected • Overall no excess obesity in the COPD population

  4. Obesity • Comorbidities • Sleep apnoea • Hypoventialtion syndrome • Metabolic syndrome • COPD and Obesity may be independent health problems but with link through reduced exercise/ steroids

  5. Effects of obesity • Reduced exercise • Increase SOB • FEV/FVC ratio tends to be preserved • Spirometry results not corrected for obesity • Reduced exp reserve volume and functional residual capacity • Reduced small airways function but O2 uptake normal

  6. Cachexia case • Woman • Aged 63 • BMI 19 • Ex smoke 5 years • FEV 1.7 (74%) • VC 2.71 (99%) Ratio 63 • No response bronchodilation • Alone at home • MRC 3-4

  7. Cachexia • Definition BMI < 21 • FFMI (free fat mass index) <15 • Overall 27% of patients affected • Women more affected than men • One survey 18% low BMI &40% low FFMI

  8. Muscle wasting • Correlates with better low FFMI than BMI • Lack of use • Inflamatory markers (eg TNF / cytokines) • Affects quality and quantity of muscle

  9. Muscle wasting • Affect women > men • GOLD 1&2 28% • MRC dyspnoea 1&2 26% • GOLD 4 38% • MRC 4 OR 5 43%

  10. Muscle wasting • Prevalence of quadriceps weakness by severity in COPD • Seymour et al

  11. Muscle wasting • Prevalence of quads wasting by MRC scale

  12. Paradoxes • Low BMI is not related to severity • Low BMI is related to increase in mortality • No correlation between Low FFMI and mortality • High BMI lower mortality in GOLD 3and 4 • High BMI higher mortality in GOLD 1and 2

  13. Nutrition • Aims • Maintain body weigh • Reduce fatigue eat often. snacks etc • Satiety increased by limiting fluid with meals • Reduce caffeine • Prevent dehydration • Nutritional supplements ref to dietician

  14. Rehabilitation • Early to stop muscle wasting • Immediate post exacerbation • Nutritional status significant impact on performance and well being

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