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Dietary considerations for better breathing A healthy diet for older adults with chronic obstructive pulmonary disease (COPD) can lead to better breathing and possibly facilitate weaning from mechanical ventilation by providing the calories necessary to meet metabolic needs. Author: Ilaria St. Florian, MS, RD A New Zealand Health survey conducted suggests that despite a growing awareness of COPD, only 64 per cent of respondents had ever heard of it. Yet, according to NZHIS Mortality Data, COPD is the third leading cause of chronic morbidity and mortality and over 610,000 are affected. COPD is a progressive lung disease that makes breathing difficult due to partially obstructed air flow into and out of the lungs. It results from an inflammatory and destructive process in the lungs stimulated by exposure to toxins, primarily due to a history of smoking cigarettes. Healthy older adults’ bronchial tubes and alveoli are elastic, thus, when they breathe in and out the lungs inflate and deflate much like a balloon. In contrast, patients with COPD experience limited airflow through their airways, due to either a loss of elasticity and/or inflamed, damaged or mucous-clogged airways. Because the airways are partially blocked, breathing becomes difficult and the lungs begin to lose their ability to effectively take up oxygen and remove carbon dioxide. Symptoms of COPD include chronic cough, often referred to as smoker’s cough; excessive mucous production; wheezing; shortness of breath; tightness in the chest; and a decrease in exercise capacity. The leading cause of COPD is cigarette smoking; in fact, most patients with COPD are either current smokers or have a history of smoking. According to the New Zealand Lung Foundation, an estimated 80 to 90 percent of COPD deaths are attributed to smoking, and smoking cessation is the most effective means of disease prevention. Other causes include long-term exposure to indoor and outdoor air pollutants, occupational chemicals, fumes, dust, and second-hand smoking. In rare cases, a genetic component may increase susceptibility.  COPD is an umbrella term that includes both emphysema and chronic bronchitis. Patients with emphysema are referred to as pink puffers and experience shortness of breath to a loss of elasticity and eventual damage to the air sacs, leading to impaired exhalation and a build-up of gas in their lungs. These patients are typically thin, often exhibiting significant weight loss due to the increased energy requirements associated with laboured breathing. In contrast, patients with chronic bronchitis are referred to blue bloaters and are typically normal weight or overweight and oedematous and experience persistent cough, increased mucous production, and shortness of breath due to inflammation, scarring, and eventual narrowing of the airways. The term COPD is used to refer to these two conditions because patients often exhibit features of both. As the disease progresses, an individual’s ability to breathe worsens, and some patients may require supplemental oxygen or mechanical ventilation. Although COPD is largely preventable, it is not curable and lung damage is irreversible. Therefore, treatment focuses on smoking cessation, symptom management, improved conditioning and increasing a patient’s ability to lead an active life. Maintaining a healthy weight is vital For most people breathing is unconscious and perceived as effortless. Yet, for many adults with COPD, breathing requires a conscious effort. Because of this added effort, patients can increase their resting energy expenditure (REE) by 10 to 15 percent. As a result, if they do not compensate for their increased energy needs used by adding more calories to their diet, they will lose weight. In addition to increased REE, patients lose weight due to decreased dietary intake because of an inherent inability to eat rather than a lack of appetite. Reasons for poor nutritional intake include the following:
The purpose of nutrition care for this population is to provide adequate energy to minimise the risk of unwanted weight loss, avoid loss of fat-free mass (FFM), prevent malnutrition, and improve pulmonary status. Research shows that COPD is a disease that not only affects the lungs but can also have systemic consequences, as well as result in severe weight loss and FFM depletion. Combined, loss of weight and FFM can adversely affect breathing by reducing the strength and function of respiratory and skeletal muscles. The risk of malnutrition is a common concern among patients with COPD who lose an excessive amount of weight and FFM. Malnutrition can impair pulmonary function, increase susceptibility to infection, lower exercise capacity, and increase the risk for mortality and morbidity.  Antioxidant, vitamin and mineral considerations Research indicates that cigarette smoke contains free radicals and other oxidants that can lead to oxidative stress, subsequent inflammation, and reduced airflow to the lungs. For this reason, antioxidant therapy has been proposed for its ability to minimise free radical damage and reduce inflammation. In fact studies have shown that patients who continue to smoke have low concentrations of serum vitamin C. According to findings from the National Health and Nutrition Examination Survey, a positive relationship exists between an increased dietary intake of vitamin C and pulmonary function. Researchers have found that smokers, as well as patients experiencing acute exacerbations, had lower plasma levels of certain antioxidants (eg ascorbic acid, vitamin E, beta-carotene selenium) and that this imbalance between oxidants and antioxidants leads to oxidative stress and inflammation and could be a significant contributing factor to the systemic effects characterised by the disease. Although the research is not sufficient to conclude that anti-oxidant therapy can slow COPD’s rate of progression, findings indicate that the consumption of fresh fruits and vegetables is positively associated with improved pulmonary function, fewer symptoms, and possibly reduced oxidative stress. Keeping in mind that elders may develop vitamin and mineral deficiencies due to reduced dietary intake is also important. Many patients with COPD are prescribed glucocorticoids to help reduce airway inflammation and improve breathing. However, one of the side effects of glucocorticoid use is bone mass loss and eventual osteoporosis, leading to an increased risk of fractures. Several risk factors can cause osteoporosis, and patients with COPD typically have many of them, such as the use of glucocorticoids, smoking, vitamin D deficiency, low BMI, malnutrition, and decreased mobility. According to a recent that examined the impact of COPD on osteoporosis development, 36 to 60 per cent of patients with COPD eventually develop osteoporosis. For this reason, patients who are starting a long-term inhaled or oral glucocorticoid therapy are encouraged to supplement it with calcium and vitamin D since bone loss occurs rapidly upon initiating treatment.  The importance of proper nutrition
Proper nutrition can help reduce carbon dioxide levels and improve breathing. Specifically, it is important to focus on the percentages of total carbohydrate, fat, and protein that patients consume to see how their diet composition impacts their respiratory quotient (RQ), defined as the ratio of carbon dioxide produced to oxygen consumed. To put it simply, following metabolism, in the presence of oxygen carbohydrate, fat and protein are all converted to carbon dioxide and water. However, the ratio of carbon dioxide produced to oxygen consumed differs per macronutrient; the RQ for carbohydrate is 1 fat is 0.7, and protein is 0.8. From a nutritional stand point, this means that eating carbohydrates will yield the most carbon dioxide, while eating fats will yield the least carbon dioxide. Hence, prescribing a high-fat, low carbohydrate diet would reduce patient RQ levels and carbon dioxide production. In fact, patients who have difficulty increasing ventilation following a carbohydrate load or patients with severe dyspnoea or hypercapnia may benefit from ahigh-fat diet. Protein needs should be assessed on an individual basis. Intake should be high enough to stimulate protein synthesis, prevent muscle atrophy, and maintain lung strength but should not contribute excess calories to the diet. The general rule of thumb is about 1.2 to 1.7 g/kg of protein daily, or approximately 20 per cent of total caloric intake. As for fluids, patients who are not on a fluid-restricted diet should be encouraged to drink liquids (2 to 3 litres per day) to keep mucous thin and help clear the airways. There is still debate as to the effectiveness of nutrition therapy in improving anthropometric measurements, lung function, and exercise capacity in patients with COPD. According to the Global Initiative for Chronic Obstructive Lung Disease, nutrition supplementation coupled with exercise may increase efficacy. Although exercise is probably the last thing most patients with breathing problems want to think about, engaging in regular exercise has been shown to improve overall strength and endurance, reduce symptoms of dyspnoea and fatigue, improve cardiovascular function, and breathing. In addition, well-conditioned muscles use less energy, which can help stabalise REE levels. Authors: Ilaria St. Florian, MS, RD From Aged Care NZ Issue 02 2021 Comments are closed.
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AuthorShonagh O'Hagan Archives
March 2025
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