Nutritional status and COPD Ninian Hewitt

Spirometry Male BMI 32 Patient % Predicted Normal range BASELINE FEV1   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 1.95 2.80 67% 0.25 mg ipratropium 2.90 73%

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

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

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

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

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

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

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

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

Muscle wasting Prevalence of quads wasting by MRC scale

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

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

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