New Guidance Launched to Help Combat Malnutrition in Patients with COPD

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 British Dietetic Association (BDA), The British Association For Parenteral And

Enteral Nutrition (BAPEN), the Association of Respiratory Nurse Specialists (ARNS), the British Lung

Foundation (BLF), the Royal College of Nursing (RCN) 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).

“Patients with COPD who experience weight loss and are of a low body weight will have a poorer

prognosis and an increased risk of mortality. Malnourished patients have an increased risk of acute

exacerbations, hospital readmission and poor quality of life” says Dr Elizabeth Weekes, Consultant

Dietitian and NIHR Clinical Lecturer and the British Dietetic Association’s Parenteral and Enteral

Nutrition Group (PENG) representative on the ‘Managing Malnutrition in COPD’ expert panel. “It is

common for stable COPD patients to consume close to recommended daily amounts for both energy

and protein while at home however their nutritional intake is often compromised during acute

exacerbations. Dietary advice to optimise oral intake is vital for these patients and for those with a low

BMI NICE recommends that the diet is supplemented with oral nutritional supplements (ONS). This

guidance helps healthcare professionals to identify individuals at risk of malnutrition and assists them in

implementing an appropriate nutritional care plan. The pathway emphasises the importance of regular

monitoring by healthcare professionals once a care plan is in place to ensure patients meet their

nutritional goals.”

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 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

- ends - For further information please contact: Hilary Franklin Hilary Franklin Healthcare Communications Email: hilary@franklincoms.co.uk Tel: 020 8398 8551 Mobile: 07958 607898 References 1. Collins PF et al., Prevalence of malnutrition in outpatients with chronic obstructive pulmonary disease. Proc

Nut Soc. 2010; 69(Issue OCE2): E148 2. 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 3. Ezzell L and Jensen GL. Malnutrition in chronic obstructive pulmonary disease. Am J Clin Nut.

2000;72(6):1415-16 4. 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 5. Collins PF et al., ‘MUST’ predicts 1-year survival in outpatients with chronic obstructive pulmonary disease.

Clin Nutr. 2010;5(2): 17. 6. 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) 7. 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. 8. 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.

9. 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

10. 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)

11. Managing Adult Malnutrition in the Community. Holdoway A. (panel chair). 2012. United Kingdom. www.malnutritionpathway.co.uk Accessed 04.07.2016