1. Nutritional status and COPD
Ninian Hewitt

2. 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
2.5 mg salbutamol
1.95
2.80
67%
0.25 mg ipratropium
2.90
73%

3. Obesity Definition BMI > 30
Reasons for association with COPD not clear
Europe 10%- 20% affected
GOLD 1& 2 (16% & 24%)
GOLD (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%
MRC 4 OR %

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