Chronic Obstructive Pulmonary Disease

COPD: Scope of Guideline (2008)

Below, you will find a list of characteristics that describe the Scope of this Guideline.

Guideline Category  

Assessment of Therapeutic Effectiveness, Counseling, Evaluation, Management, Treatment

Clinical Specialty

Allergy and Immunology, Critical Care, Family Practice, Nutrition, Pulmonary Medicine

Intended Users

 Registered Dietitians, Advanced Practice Nurses, Health Care Providers, Nurses, Pharmacists, Physician Assistants, Physicians, Respiratory Care Practitioners, Students

Guideline Objective(s)

  • To provide MNT guidelines for chronic obstructive pulmonary disease to achieve and maintain normal weight and improve quality of life.
Specific Objectives
  • To define evidence-based COPD nutrition recommendations for registered dietitians (RDs) that are carried out in collaboration with other healthcare providers
  • To guide practice decisions that integrate medical, nutritional and behavioral strategies
  • To reduce variations in practice among RDs
  • To provide the RD with data to make recommendations to adjust MNT or recommend other therapies to achieve desired outcomes
  • To enhance the quality of life for the adult with COPD, utilizing customized strategies based on the individual’s preferences, lifestyle and goals
  • To develop guidelines for interventions that have measurable clinical outcomes
  • To define the highest quality of care within cost constraints of the current healthcare environment.

Overall Objective

Target Population

 Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Male, Female

Target Population Description

Adults with COPD.

Interventions and Practices Considered

 

This guideline is based on ADA’s Nutrition Care Process and Model, which involves the following steps:
  • Nutrition Assessment
  • Nutrition Diagnosis
  • Nutrition Intervention
  • Nutrition Monitoring and Evaluation.
This guideline addresses topics that correspond to the following areas of the Nutrition Care Process. Please refer to the Algorithms in this guideline for a more detailed view of the recommendations and their application within the Nutrition Care Process.
 

I.  Referral to a Registered Dietitian
II. Medical Nutrition Therapy

A.     Nutrition Assessment

Below you will find the nutrition assessment terms related to COPD care from International Dietetics & Nutrition Terminology Reference Manual. Standardized Language for the Nutrition Care Process. Third Edition.

1.      Client history
  • Medical/health history
  • Medication and supplement history
  • Social history
  • Personal history
2.      Biochemical data—relevant laboratory values
3.      Anthropometric measurements
  • Height, weight and BMI, waist circumference
  • Weight change rate
4.      Food/nutrition history
  • Food intake
  • Nutrition and health awareness
  • Physical activity and exercise
  • Food availability
  • Psychosocial and economic issues impacting nutrition therapy
  • Consideration of co-morbid conditions and need for additional modifications in nutrition care plan
5.      Physical examination findings

B.     Nutrition Diagnosis

Below you will find the nutrition diagnoses related to COPD care from International Dietetics & Nutrition Terminology Reference Manual. Standardized Language for the Nutrition Care Process. Third Edition.

  • Inadequate energy intake 
  • Excessive energy intake
  • Inadequate oral food/beverage intake
  • Excessive oral food/beverage intake
  • Inadequate intake from enteral/Parenteral nutrition
  • Excessive intake from enteral/Parenteral nutrition
  • Inappropriate infusion of enteral of Parenteral nutrition
  • Inadequate fluid intake
  • Excessive fluid intake
  • Excessive alcohol intake
  • Evident protein-energy malnutrition
  • Inadequate fiber intake
  • Excessive fiber intake
  • Altered GI function
  • Altered nutrition-related laboratory values
  • Underweight
  • Involuntary weight loss 
  • Overweight/obesity
  • Involuntary weight gain
  • Food- and nutrition-related knowledge deficit
  • Swallowing difficulty
  • Biting/Chewing (Masticatory) difficulty
  • Physical inactivity
  • Inability or lack of desire to manage self-care
  • Impaired ability to prepare foods/meals
  • Self-feeding difficulty
  • Limited access to food

C.     Nutrition Intervention (Planning and Implementation)

Individualized prescription based on:
1.      Food/Nutrition Intervention
2.      Physical activity Interventions
3.      Behavioral Interventions
4.      Pharmacotherapy, when indicated

Below you will find the nutrition interventions related to COPD care from International Dietetics & Nutrition Terminology Reference Manual. Standardized Language for the Nutrition Care Process. Third Edition.

Meals and snacks
  • Enteral or Parenteral nutrition
  • Medical Food Supplements
  • Bioactive Substance Supplements
  • Feeding Assistance
  • Feeding Environment
  • Comprehensive nutrition education
  • Nutrition counseling
  • Strategies
  • Coordination of nutrition care
  • Discharge planning and transfer of nutrition care to new setting or provider
D.    Monitoring and Evaluation
The monitoring or progress, measuring of outcomes, and evaluating of outcomes against criteria to determine changes in specific indicators of MNT outcomes.

Below you will find the nutrition monitoring and evaluation terms related to COPD care from International Dietetics & Nutrition Terminology Reference Manual. Standardized Language for the Nutrition Care Process. Third Edition.

Nutrition-related ADLs and IADLs

  • Physical activity
  • Food and nutrient intake outcomes
  • Nutrition-related physical sign/symptoms outcomes
  • Nutrition-related patient/client centered outcomes