A new practical guide ‘Managing Malnutrition in COPD’ has been launched to assist healthcare professionals in identifying and managing people with COPD who are at risk of disease-related malnutrition and includes a pathway for the appropriate use of Oral Nutritional Supplements (ONS) to support community healthcare professionals.
It is estimated that around 21% of individuals with COPD (up to 630,000 people in the UK) are at risk of malnutrition1. Malnutrition may develop gradually over several years or might develop or progress following exacerbations. The consequences of malnutrition in COPD are significant and associated with increased healthcare costs, increased mortality, longer hospital stays, more frequent readmissions, reduced muscle strength and reduce respiratory muscle function2-9.
The guide ‘Managing Malnutrition in COPD’ has been developed by a multi-professional panel, with expertise and an interest in malnutrition and COPD, and is endorsed by ten key professional and patient organisations including the Association of Respiratory Nurse Specialists (ARNS), the British Lung Foundation (BLF), the Royal College of Nursing (RCN), the British Dietetic Association (BDA) and the Royal College of General Practitioners (RCGP)10. The document is based on clinical experience and evidence alongside accepted best practice. It also includes a pathway to assist in the appropriate use of oral nutritional supplements (sip feeds). It is complemented by three colour coded patient leaflets which provide practical advice according to risk category (green – low risk, yellow – medium risk, red – high risk).
“Nurses play a key role in the treatment of patients with COPD” says Michaela Bowden, Lead Nurse Quality & Development (Respiratory), Bolton NHS Foundation Trust and the ARNS representative member of the ‘Managing Malnutrition in COPD’ expert panel, “and these guidelines will assist them in assessing the nutritional status of patients, putting appropriate nutritional care plans in place and referring on for dietetic input when required. They also provide advice on frequency of review and follow-up. The colour-coded patient materials will be invaluable as they enable nurses to give targeted nutritional advice according to risk category.”
The guidance is an updated version of the Respiratory Healthcare Professionals Nutritional Guidelines for COPD Patients which were developed in 2011, it has been updated to complement the ‘Managing Adult Malnutrition in the Community’11 guidelines (www.malnutritionpathway.co.uk) which were launched in 2012 and is available to be download for free via the malnutrition pathway website – www.malnutritionpathway.co.uk/copd
“ARNS has been delighted to be involved with the development of these guidelines and is pleased that we have engaged with the multi-professional team to ensure that we are offering continuity of nutritional care for patients” says Dr Matthew Hodson, Chair of the Association of Respiratory Nurse Specialists (ARNS). “It is estimated that around 1 in 5 patients with COPD will be at risk of malnutrition and identifying and managing it are key to better outcomes and quality of life for patients. I think that nurses and other healthcare professionals involved in treatment of patients with COPD will find the management pathway and the pathway for using oral nutritional supplements invaluable in assisting them in identifying and managing this treatable condition.”
‘Managing Malnutrition in COPD’ includes:
- An overview of COPD and malnutrition including its causes and clinical consequences, cost implications and details on prevalence
- Information on the identification and management of malnutrition in patients with COPD according to risk category
- Guidance on optimising oral intake including dietary advice and the appropriate use of oral nutritional supplements
- A practical pathway on the appropriate use of oral nutritional supplements in the management of malnutrition in COPD
“Poor nutritional intake in patients with COPD is common” says Jo Banner, Senior Registered Dietitian with the Community Respiratory Service at Sandwell and West Birmingham Hospitals NHS Trust and a member of the ‘Managing Malnutrition in COPD’ expert panel. “Causes are varied and include not only the physiological effects of the disease such as breathlessness and fatigue but also psychological, social and environmental factors such as depression, social isolation and living conditions. In addition, patients with COPD will have increased energy expenditure due to systemic inflammation and increased requirements during breathing. These guidelines assist healthcare professionals in using a nutrition screening process to help identify and treat those COPD patients who are at increased risk of being malnourished by guiding them down the correct management pathway to optimise their nutritional intake.”
The three complementary colour-coded patient leaflets all contain dietary advice, advice on eating and physical activity and tips on coping with common symptoms of COPD including dry mouth, taste changes and shortness of breath. In addition the red (high risk) leaflet includes advice for patients on incorporating oral nutritional supplements into their diet. The three leaflets are:
- Green Leaflet – ‘Eating Well for Your Lungs’ – for patients at low risk of malnutrition
- Yellow Leaflet – ‘Improving Your Nutrition in COPD’ – for patients at medium risk of malnutrition
- Red Leaflet – ‘Nutrition Support in COPD’ – for patients at high risk of malnutrition
‘Managing Malnutrition in COPD’ and the three complementary patient leaflets can be downloaded for free via www.malnutritionpathway.co.uk/copd
The Guidelines can be downloaded here:
- Collins PF et al., Prevalence of malnutrition in outpatients with chronic obstructive pulmonary disease. Proc Nut Soc. 2010; 69(Issue OCE2): E148
- Collins PF et al., An economic analysis of the costs associated with weight status in chronic obstructive pulmonary disease (COPD). Proc Nut Soc. 2011; 70(OCE5): E324
- Ezzell L and Jensen GL. Malnutrition in chronic obstructive pulmonary disease. Am J Clin Nut. 2000;72(6):1415-16
- Gupta B et al., Nutritional status of chronic obstructive pulmonary disease patients admitted in hospital with acute exacerbation. J Clin Med Res 2010 Mar 20;2(2):68-74
- Collins PF et al., ‘MUST’ predicts 1-year survival in outpatients with chronic obstructive pulmonary disease. Clin Nutr. 2010;5(2): 17.
- Collins PF et al., The impact of malnutrition on hospitalisation and mortality in outpatients with chronic obstructive pulmonary disease. Proc Nutr Soc 2010; 69(OCE2)
- Landbo C et al., Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 160(6):1856-1861.
- Vestbo J et al., Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am J Respir Crit Care Med 2006; 173(1):79-83.
- Vermeeren MA et al., Prevalence of nutritional depletion in a large outpatient population of patients with COPD. Respir Med, 2006 Aug;100(8):1349-55
- The ‘Managing Malnutrition in COPD’ document and supporting patient materials have been supported by 10 key professional and patient associations:
- The Association of Chartered Physiotherapists in Respiratory Care (ACPRC)
- The Association of Respiratory Nurse Specialists (ARNS)
- The British Association For Parenteral And Enteral Nutrition (BAPEN)
- The British Dietetic Association (BDA)
- The British Lung Foundation (BLF)
- Education for Health
- The National Nurses Nutrition Group (NNNG)
- The Primary Care Respiratory Society (PCRS)
- The Royal College Of General Practitioners (RCGP)
- The Royal College Of Nursing (RCN)
- Managing Adult Malnutrition in the Community. Holdoway A. (panel chair). 2012. United Kingdom. www.malnutritionpathway.co.uk Accessed 07.2016