Executive Summary of Recommendations

Below are the major recommendations and ratings for the American Dietetic Association Chronic Obstructive Pulmonary Disease (COPD) Evidence-Based Nutrition Practice Guideline. Click here to view the Guideline Overview. More detail (including the evidence analysis supporting these recommendations) is available on this website to ADA members and EAL subscribers under Major Recommendations.

To see a description of the ADA Recommendation Rating Scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here.

The COPD Recommendations are listed below. (Note: If you mouseover underlined acronyms and terms, a definition will pop-up.)

COPD: Medical Nutrition Therapy

Registered dietitians should provide Medical Nutrition Therapy (MNT) for individuals with chronic obstructive pulmonary disease (COPD). MNT should focus on prevention and treatment of weight loss and other comorbidities.

Consensus
Imperative

COPD: Assessment of Quality of Life

Registered dietitians should assess the quality of life of individuals with COPD, especially as it relates to their ability to obtain, prepare and consume food to meet nutritional needs. Research indicates that individuals with COPD may have more impairment with activities of daily living and those who are malnourished (as defined by BMI) may also have lower lung function measurements, more dyspnea and lower nutritional intakes.

Fair
Imperative

COPD: Assessment of Weight Status

Registered dietitians should use BMI and weight change to assess weight status in individuals with COPD. Studies report that in individuals with COPD, the prevalence of lower BMI (under 20kg/m²) may be as high as 30% and the risk of COPD-related death doubles with weight loss.

Fair
Imperative

COPD: Measurement of Body Composition

In individuals with stable COPD, registered dietitians should evaluate body composition. Studies report that even for those with BMI greater than 20kg/m², body composition differs from healthy controls in that fat-free mass index and bone mineral density are lower in individuals with COPD.

Fair
Conditional

COPD: Determination of Energy Needs

Registered dietitians should assess energy needs of individuals with COPD, based on indirect calorimetry measurements, since resting energy expenditure (REE) based on measurement is more accurate than estimation using predictive equations. Studies report that the total daily energy needs of individuals with COPD are highly variable.

Weak
Imperative

COPD: Energy Needs in Stable COPD

When using predictive equations to assess energy needs of individuals with stable COPD, registered dietitians should account for the presence of inflammation and level of physical activity. Studies report that the presence of inflammation increases resting energy expenditure and that the level of physical activity has varying effects on total daily energy needs.

Weak
Conditional

COPD: Energy Needs During Exacerbation

When using predictive equations to assess energy needs of individuals with COPD during an exacerbation, registered dietitians should account for the presence of inflammation. Studies report that the presence of inflammation increases resting energy expenditure.

Weak
Conditional

COPD: Bone Density Screening

Registered dietitians should recommend bone density screening for individuals with COPD. Research indicates that individuals with COPD are at increased risk for osteoporosis and vertebral fractures.

Fair
Imperative

COPD: Macronutrient Composition of Medical Food Supplements

Registered dietitians should advise that the selection of medical food supplements for individuals with COPD should be influenced more by patient preference than the percentage of fat or carbohydrate.There is limited evidence to support consumption of a particular macronutrient composition of medical food supplementation.

Fair
Conditional

COPD: Frequent Small Amounts of Medical Food Supplements

Registered dietitians should recommend frequent small amounts of medical food supplements for individuals with COPD. Studies report that frequent small amounts of medical food supplements are preferred to avoid post-prandial dyspnea and satiety and to improve compliance.

Fair
Conditional

COPD: Medical Food Supplements for Inpatients

For inpatients with COPD who have low BMI (under 20kg/m²), unintentional weight loss, reduced oral intake or who are at nutritional risk, registered dietitians should initiate provision of medical food supplements. Studies report that medical food supplementation for seven to 12 days results in increased energy intake in the inpatient setting.

Fair
Conditional

COPD: Medical Food Supplements for Outpatients

For outpatients with COPD who have low BMI (less than 20kg/m²), unintentional weight loss, reduced oral intake or who are at nutritional risk, registered dietitians should recommend consumption of medical food supplements. In the outpatient setting, studies report that medical food supplementation results in increased energy intake, with weight gain more likely when combined with exercise.

Fair
Conditional

COPD: Treatment of Osteopenia and Osteoporosis

For individuals with COPD who have osteopenia or osteoporosis, registered dietitians should encourage consumption of adequate amounts of calcium and vitamin D, as well as avoidance of tobacco smoking and excessive alcohol intake, as determined by national treatment guidelines for osteoporosis. Osteopenia and osteoporosis guidelines specific to individuals with COPD have not yet been determined.

Consensus
Conditional

COPD: Antioxidant Vitamins

Registered dietitians should encourage individuals with COPD to consume a diet that meets the Recommended Dietary Allowances (RDA) for vitamin A, vitamin C and vitamin E. Several studies report reduced serum or tissue levels of vitamin A, vitamin C and vitamin E in individuals with COPD, however adequately powered studies have not been conducted to evaluate the effects of intake above the RDA.

Weak
Imperative

COPD: Omega-3 Fatty Acids

Registered Dietitians should encourage individuals with COPD to consume a diet that meets the Adequate Intake (AI) for omega-3 fatty acids. Adequately powered studies have not been conducted to evaluate the effects of intake above the AI.

Weak
Imperative

COPD: Milk Consumption and Mucus Production

Registered dietitians should advise individuals with COPD that the consumption of milk and milk products is unrelated to mucus production. Studies report no significant effect of milk and milk product consumption on mucus production or various lung function parameters, despite individual sensory perception.

Weak
Imperative

COPD: Integrated Care

Registered dietitians should implement Medical Nutrition Therapy (MNT) and coordinate nutrition care with a team of clinical professionals. An interdisciplinary team approach is optimal to integrate MNT, for individuals with COPD, into overall disease management and involves redesigning standard medical care to integrate rehabilitative elements into a system of patient self-management and regular exercise.

Consensus
Imperative

COPD: Oxygen Therapy

Registered dietitians should reinforce the use of supplemental oxygen for individuals with COPD in whom it is prescribed, especially as it relates to their ability to obtain, prepare and consume food to meet nutritional needs. Studies report that supplemental oxygen improves the ability of individuals with COPD to perform activities of daily living and exercise.

Weak
Conditional

COPD: Collaboration on Pharmacotherapy

Registered dietitians should collaborate with other members of the health-care team regarding the use of pharmacotherapy for individuals with COPD, including drug effectiveness and potential nutrition-related side effects. The change in lung function after treatment with any drug does not help in predicting other clinically-related outcomes.

Consensus
Imperative

COPD: Monitor and Evaluate Quality of Life

Registered dietitians should monitor and evaluate the quality of life of individuals with COPD, especially as it relates to their ability to obtain, prepare and consume food to meet nutritional needs. Research indicates that individuals with COPD may have more impairment of activities with daily living and those with lower BMI may also have lower lung function measurements, more dyspnea and lower nutritional intakes.

Fair
Imperative

COPD: Monitor and Evaluate Weight Status

Registered Dietitians should use BMI and weight change to monitor and evaluate weight status in individuals with COPD. Studies report that in individuals with COPD, the prevalence of lower BMI (<20 kg/m²) may be as high as 30%, and the risk of COPD-related death doubles with weight loss.

Fair
Imperative

COPD: Monitor and Evaluate Body Composition

In individuals with stable COPD, Registered Dietitians should monitor and evaluate body composition. Studies report that even for those with BMI greater than 20 kg/m², body composition differs from healthy controls in that fat free mass index and bone mineral density are lower in individuals with COPD.

Fair
Conditional