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COPD:
Nutritional Management
Contributed by Jamie McGinn, RD, LDN
Updated by Nutrition411.com staff
Review Date 4/14
G-1368
What Is COPD?
• The two main types of chronic obstructive
pulmonary disease (COPD) are emphysema and
chronic bronchitis
• COPD is the slow, advancing blockage of the
airways in the lungs
Side Effects of COPD?
• Reduced respiratory muscle strength and
endurance
• Breathing muscles fatigue easier
• Increased risk of infections
• Malnutrition
COPD and Nutrition
• Malnutrition is either too many nutrients, not
enough nutrients, or an imbalance of nutrients
• Up to 60% of COPD patients are malnourished
• Malnutrition in emphysema usually is caused by
not getting enough nutrients
• Many factors cause malnutrition in emphysema
patients
• Foods may taste bland
COPD and Malnutrition:
Causes
• Patients with COPD are hypermetabolic,
meaning they need more calories
• Difficulty in breathing causes difficulty in eating
• Medications have gastrointestinal (GI)
side effects
• Oxygen to the GI tract is decreased
• Too much carbon dioxide can cause early
morning headaches and confusion
Limit Carbohydrate
Intake
• Some studies indicate limiting carbohydrate in
the diet
• Follow a high-protein diet with moderate
carbohydrates
• Reduce carbohydrates consumed
• Start by limiting these foods:
̶ Cake and desserts
̶ Candy
̶ Soda
̶ Sweet tea
Limit Salt Intake
• Follow a low-sodium or no-added-salt diet
• Reduce sodium (or salt) consumed by limiting
these foods:
̶ Canned foods
̶ Snack foods, such as chips, pretzels, crackers, and
popcorn
̶ Packaged starchy foods, such as stuffing and rice mixes
̶ Cured/luncheon meats and cheeses
̶ Condiments, such as ketchup, barbecue sauce, and soy
sauce
̶ Salt and any seasoning with the word “salt” in it
Flavor Foods Without
Salt
• Here are some ways to season foods without
salt:
̶ Add lemon juice, lime juice, or vinegar for a tart
flavor
̶ Add peppers or 1 to 2 drops of hot sauce for a hot
flavor
̶ Add onions or season with herbs and spices, such
as garlic and salt-free seasonings, including Mrs.
Dash® (comes in more than 15 varieties)
Increase Protein Intake
• Protein needs are increased up to
1.2-1.7 grams (g)/day
• To calculate how much protein is needed:
̶ Take the weight of the patient and divide by 2.2
̶ Take that number and multiply it by 1.2 and 1.7
̶ This will give you the range of protein needed
̶ Example: 150 pounds ÷ 2.2=68
681.2=82
681.7=116
Protein needs are 81-116 g/day
How to Meet Protein
Needs
1 egg
1 oz nuts
6 oz yogurt
½ C cottage cheese
3 oz canned tuna
6 oz steak
4 oz hamburger
3 oz chicken breast
C=cup, g=gram, oz=ounce
6 g protein
2-4 g protein
6 g protein
14 g protein
25 g protein
42 g protein
28 g protein
26 g protein
Increase Dietary Fats
• Increase calories to compensate for reduced
carbohydrates by increasing dietary fats
• For good health, choose liquid fats over solid
fats:
̶ Olive oil
̶ Peanut oil
̶ Canola oil
̶ Etc
Have Adequate Fluid
Intake
• Drink 8 C of fluids/day
• May need to reduce milk consumption
• Take fluids between meals
Get Enough Vitamins
and Minerals
• Increased need for vitamin C for smokers:
̶ Smokers need double the dose of vitamin C
• Consume adequate amounts of all vitamins
and minerals
• A multivitamin with minerals is appropriate,
especially if intake is poor
• Calcium and vitamin D supplements
sometimes are needed if osteoporosis or
osteopenia is present
Reduce Use of GasForming Foods
• Gas-forming foods can cause bloating and
displacement of the diaphragm
• If this occurs, determine which foods cause the
problem
Reduce Use of GasForming Foods (cont’d)
• Some gas-forming foods include:
̶ Asparagus
̶ Broccoli
̶ Cabbage
̶ Carbonated beverages
̶ Dried beans and peas
̶ Leeks
̶ Onions
Tips for Comfortable
Eating
•
•
•
•
•
•
•
•
•
•
Avoid overfeeding
Have frequent small meals
Choose nutrient-dense foods
Rest before meals
Eat slowly
Wear oxygen during meals
Eat soft, easy-to-chew foods
Remain upright for 1 hour after meals
Drink beverages between meals
Eat main meal with your family or others
Tips for Comfortable
Eating (cont’d)
• Try to avoid constipation and straining to pass
hard stools
• Increase fiber
• Increase antioxidants
• Try milk shakes
• Reduce caffeinated beverages
• Eat chicken soup to clear the respiratory tract
What to Discuss With
Your Doctor, RD, or RDN
• Regular review of lab results
• Need for a nutritional supplement
• If oral intake is not meeting needs, discuss
other options, such as a tube feeding
How to Get in Touch
With an RD or RDN
• Call the hospital where you were admitted and
ask to speak to a RD or RDN
• Ask to speak with the RD or RDN at your
nursing home
• Contact your insurance company and ask for
help in finding an RD or RDN
• Visit www.eatright.org and click on FIND A
REGISTERED DIETITIAN to locate an RD or
RDN in your area
References
Academy of Nutrition and Dietetics. Evidence Analysis Library® Web site.
http://andevidencelibrary.com/default.cfm. Accessed April 14, 2014.
Academy of Nutrition and Dietetics. Nutrition Care Manual Web site [by
subscription]. http://www.nutritioncaremanual.org/. Accessed April 11,
2014.
Mueller DH. Medical nutrition therapy for pulmonary disease. In: Mahan
LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care
Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:782-798.
Patel N, Johnson MM. Nutrition in respiratory diseases. In: Ross AC,
Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in
Health and Disease. 11th ed. Baltimore, MD: Lippincott, Williams, and
Wilkins; 2014:1385-1395.