Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease

Welcome to the Chronic Obstructive Pulmonary Disease Project

Chronic obstructive pulmonary disease (COPD) is a slowly progressive lung disease that is characterized by airflow obstruction. While the disease is treatable, it is not fully reversible.

The focus of this project is on medical nutrition therapy (MNT) for adults with COPD. The primary goals for people with COPD are to maintain appropriate body weight and body composition, maximize pulmonary status, reduce mortality and improve the quality of life (QOL). For the systematic review, the workgroup focused on the following subtopics:

• Medical Nutrition Therapy
• Methods to Estimate Energy Requirements (Predictive Equations)
• Methods to Estimate Protein Requirements
• Energy and Macronutrient Intake
• Macronutrient Composition (% Distribution)
• Body Weight and Body Composition
• Micronutrients (Vitamin D)

Systematic Review Key Findings:

The systematic review found Grade I Good/Strong and Grade II, Fair evidence that in adults with COPD:

• The lowest body mass index (BMI) groups had higher mortality rates when compared to higher BMI groups. A BMI of approximately 25.0-29.99kg/m² appeared to lower the risk of mortality when compared to both higher and lower BMI classifications. (Grade I). 
• As part of a multidisciplinary team, MNT intervention provided by an RDN (or international equivalent) improved BW, QOL and exercise capacity outcomes (Grade I) and improved body composition and lung function outcomes. (Grade II) 
• There was improvement in dyspnea scores with higher energy intakes. (Grade II)
• Vitamin D supplementation improved exacerbation outcomes in those with serum 25(OH)D levels 10ng per ml or lower. (Grade II) 
• Evidence from 60% of studies reviewed, found positive associations between serum 25(OH)D and lung function measures. (Grade II)
• In unadjusted results, a positive association was found between BMI and forced expiratory volume in 1 minute % predicted (FEV₁ % predicted). An increasing BMI was also shown to reduce the longitudinal decline in FEV₁ % predicted over time. (Grade II)

Only Grade III, Limited Weak evidence was found for predictive equations to estimate resting metabolic rate (RMR) and total energy expenditure (TEE), the effectiveness of MNT alone, macronutrient composition, macronutrient intake and effect of body composition on outcomes.

Guideline: The 2019 guideline recommendations are based on the findings of the systematic review and includes: 

• MNT
• Energy Intake
• Body Weight
• Estimating energy Needs (for RMR and TEE)
• Energy Prescription (Energy Intake, Body Weight and Energy Needs)
• Macronutrient Composition (% Distribution)
• Vitamin D Supplementation
• Serum 25(OH)D Status

Download the COPD Guideline Comparison Table to see changes between the 2019 and 2008 guidelines. Use the left navigation to view the COPD systematic review. Expand the section below titled Project Team and Disclosures for a listing of individuals who contributed to the development of the project, disclosures and project funding information.

• COPD Resources and Manuscripts

  The following resources are available:

  • Chronic Obstructive Pulmonary Disease: A 2019 Evidence Analysis Center Evidence-Based Practice Guideline. Hanson C, Bowser EK, Frankenfield, DC, Piemonte, TA. J Acad Nutr Diet 2021;121(1):139-165. 
  • Nutrition in COPD: Evidence-Based Nutrition Guidelines Quick Reference Tool - a convenient, practical tool based on the Academy's Evidence Analysis Library guidelines for nutrition therapy for management of COPD. Learn more ... 
• COPD Project Team and Disclosures (2019)

  The following individuals contributed their valuable time and expertise to this project:
  
  Workgroup Members

  • Corrine Hanson, PhD, RD, Chair
    Assistant Professor, University of Nebraska Medical Center, Omaha, NE, USA
  • Katie Braun, MS RDN, LD, CNSC (as of December 2016)
    Clinical Dietitian, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
  • Fritha Dinwiddle, MS, RD, CSG, LD
  • Janice A. James, MS, RDN, LDN, CDE (as of December 2016)
    Dietitian Educator, MedStar Harbor Hospital, Baltimore, MD, USA
  • Margaret W. Lange, MNS, RDN, LDN
    Retired, Frederick, MD, USA
  • Susan H. Meyer, MS, RDN-AP, LD, CNSC
    Dietitian, Cleveland Clinic, Cleveland, OH, USA

  Former Workgroup Members

  • Heather Cunningham, MS, RD, CNSC (resigned September 2016)
  • Wendy Castle, MPH, RD, LD (resigned September 2016)

  Patient Advocates

  • Edna Fiore, MT (ASCP)
    eNEwsletter Editor, Colorado Lung Health Connection, Little, CO, USA
  • Todd Pierce (resigned 2016)

  External Expert on Predictive Equations

  • David Frankenfield, MS, RD
    Dietitian, Penn State Health Milton S. Hersey Medical Center, Hershey, PA, USA

  Project Leaders

  • Tami A. Piemonte, MS, RDN, LDN, Project Manager
    Independent Contractor, St. Petersburg, FL, USA
  • Ellen K. Bowser, MS, RDN, LDN, FAND, RN, BSN, Lead Analyst (as of December 2016)
    Consultant, Gainesville, FL, USA
  • Constantina Papoutsakis, PhD, RD, Lead Analyst (resigned September 2016)
    Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
  • Margaret J. Foster, MS, MPH, AHIP, Medical Librarian
    Texas A&M University, TAMU-Libraries, College Station, TX, USA
  • Deepa Handu, PhD, RDN, Methodologist 
    Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, US

  Evidence Analysts

  • Margaret Chenault, MS
    Doctoral Fellow, Drexel University, Philadelphia, PA, USA
  • Alana M. Clark, MPH
    Mentor, Mentornet.org, Charlotte, NC, USA
  • Erika M. Carrasquilla, MS, RD, LN
    Clinical Research Coordinator, Rush University Medical Center, Chicago, IL, USA
  • Anne O. Garceau, MS, RDN
    Nutritionist, USDA, Beltsville, MD, USA
  • Amy A. Huang, MPH, RDN
    Marketing Manager, Lonza Ltd, Basel, Switzerland
  • Yi-Hsuan (Lisa) Liu, MS, RD
    Research Assistant, Department of Nutritional Sciences, Pennsylvania State University, State College, PA, USA
  • Courtney T. Luecking, MPH, MS, RDN
    Doctoral Candidate, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  • Telma V. Moreira,  MS, RDN, LD, CNSC
    Clinical Dietitian, MD Anderson Cancer Center, Houston, TX, USA
  • Terrence M. Vance, PhD, RD
    Assistant Professor, Department of Nutrition and Dietetics, SUNY College at Plattsburgh, Plattsburgh, NY, USA

  Guideline Reviewrs

  • Emily Brigham, MD, MHS
    Assistant Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  • Steven F. Friedman, RRT, MBA
    Director Respiratory Therapy, MedStar Harbor Hospital, Bowie, MD, USA
  • Juliet M. Mancino, MS, RDN, CDE, FAND
    Research Review Analyst, University of Pittsburgh Human Research Protection Office, Cranberry Twp, PA, USA
  • Mark W. Magnus Sr, BSRC, RRT, RPFT, FAARC
    Adjunct Faculty, Alamo Colleges District, St. Philip’s College, San Antonio, TX, USA
  • Veronica Serrano, MS, RD, LDN, CDM
    Assistant Director of Food and Nutrition, Memorial Hospital Pembroke, Miami, FL, USA
  • Jessica C. Shickel, RDN
    Clinical Dietitian, Serge, Mount Crawford, VA, USA
  • Christie Shubert, MS, RD, LDN, CNSC
    Assistant Director, Emory Healthcare, Atlanta, GA, USA
     

  Financial Contributors

  • Academy of Nutrition and Dietetics

   

  Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

  • None of the workgroup members listed above disclosed potential conflicts.