Malnutrition occurs in many patient with moderate to severe COPD.

the incidence of
malnutrition depends on the severity of the disease. malnutrition due to COPD can weaken respiratory
muscles, resulting in altered ventilation, poor msucle strength, and impaired immune function.

a complete nutrition assesment in necessary to identify patients who are at nutritional risk. as
indicated in table 21.5, this assesment should include an evaluation of anthropometric measurements
and food/nutrition-related history, including a detailed nutrient intake evaluation, medication and
herbal supplement use, and physical activity and function measuring loss of fat-free body mass may be a
better prognostic indicator of mortality than weight loss or BMI in malnourished patients. based on this
assesment, nutrition problems can be identified and goals for the individual patient can then be
established.

Anthropometric measurements weight loss and low BMI have been associated with increased
mortality in patients with COPD, regardless of disease severity. weight loss occurs frequently, particulary
in individuals with emmphysema, and is associated with increased resting energy expenditure secondary
to the work of breathing, reduced nutrient intake, and inefficient fuel metabolism. ind contrast,
individuals with bronchitis frequently have normal or above-normal BMI. losses of lean body mass
(LBM), however, have been seen in both conditions. in a study examining body composition of
individuals with COPD, Engelen et al,. found depletion in LBM in 37% of individuals with emphysema
and 12% of those with chronic bronchitis. even in individuals with normal body weight, depletion of LBM
was found in 16% of those with emphysema and 8% of those with chronic bronchitis.

excessive weight gain, particularly excessive body fat, may be deleterious by increasing the
workload of an already compromised respiratory system. individuals who are morbidly obese have
difficulty breathing caused by restrictions on the chest wall due to the accumulation of fat in and
around the throacic cage, diaphragm, and abdomen. this results in reduced lung volume accompanied
by poor oxygen and carbon dioxide exchange.

patients who are more than 40% above IBW should be evaluated individually to determine the
most appropiate intervention that will provide long-term benefits. the primary goal should be to prevent
further weight gain and promote moderate weight loss, if appropriate, for patients who have a history
of weight or appetite fluctuations