Malnutrition in Patients with COPD (Chronic Obstructive Pulmonary Disease)

Malnutrition is a common and serious complication of chronic obstructive pulmonary disease (COPD), affecting up to 74% of patients.¹ Symptoms like labored breathing and loss of appetite can make it difficult to consume adequate nutrition. Over time, this may weaken respiratory muscles, reduce lung function and increase infection risk. With targeted nutrition support and rehabilitation, patients can improve strength, endurance and quality of life.

People with COPD face high malnutrition risk

COPD is a progressive lung disease that includes chronic bronchitis and emphysema, caused by chronic inflammation and damage to the respiratory system. This damage results in restricted airflow, causing²:

• Chronic cough
• Shortness of breath while doing everyday activities (dyspnea)
• Coughing up sputum (also called phlegm or mucus)
• Wheezing or chest tightness
• Fatigue or tiredness
• Unable to take a deep breath

COPD can affect overall quality of life, putting patients at risk for falls, social isolation and depression.¹ It also increases the risk of malnutrition, which is strongly associated with the progression of the disease.¹ 

How common is COPD and malnutrition?

Malnutrition is common among patients with COPD. Up to 74% of patients with COPD show signs of malnutrition.¹ This is a significant number considering that 4.6% of adults in the United States report a diagnosis of COPD, chronic bronchitis or emphysema. In geriatric populations, rates may be as high as 10%.³

Why do people with COPD have increased nutrition requirements?

Those with COPD have higher resting energy expenditure (REE) due to a state of hypermetabolism caused by labor-intensive breathing.⁴ Over time, this can lead to weight loss as the body expends more energy trying to maintain resting respiratory function.¹

Why are COPD patients at risk for malnutrition?

Increased nutritional requirements, anorexia (loss of appetite) and socioenvironmental factors are the three main drivers of malnutrition in patients with COPD. When left untreated, malnutrition decreases quality of life and increases the risk of death in those with COPD.¹ Other risk factors for malnutrition include gastrointestinal issues, long-term antibiotic use, mental health and socioeconomic factors.

Gastrointestinal issues

Up to 85% of patients with COPD suffer from at least one gastrointestinal symptom a week, including⁵:

• Early satiety
• Abdominal bloating
• Acid reflux (gastroesophageal reflux disease)
• Diarrhea
• Nausea
• Vomiting
• Constipation

These unpleasant symptoms may cause a change in appetite, and patients may avoid eating to prevent gastrointestinal upset.

Long-term antibiotic use

Medications, particularly antibiotics used to treat chronic or recurring infections, can disrupt gut flora, leading to antibiotic-associated diarrhea (AAD), gastrointestinal upset and disruption of the gut microbiome that can affect nutrient absorption or cause loss of appetite.

Long-term use of antibiotics can also increase susceptibility to infections such as Clostridium difficile (“C. diff.”), a bacterium that causes severe diarrhea and intestinal inflammation.

Depression and anxiety

Those with COPD report higher levels of anxiety and depression, which can affect their eating habits.⁶ About 50% of patients with major depression experience a decrease in appetite, and roughly one-third of these patients have depression-related weight loss.⁷

Anxiety suppresses appetite through several mechanisms. First, stress triggers the release of hormones (adrenaline, corticotropin-releasing hormone) that can reduce appetite. The gastrointestinal system can also be affected by disorders of gut-brain interaction, such as functional dyspepsia.⁸

Socioenvironmental factors

Patients may suffer from malnutrition due to a variety of socioenvironmental factors such as⁹:

• Low socioeconomic status
• Substandard living conditions
• Lack of access to grocery stores
• Social isolation
• Lack of practical support

Financial constraints and environmental factors, such as low income, living far from a grocery store and limited cooking facilities, can make it more difficult to access or prepare nutritious food. Shortness of breath can also make meal preparation and grocery shopping physically difficult.

Social isolation is also common among patients with COPD. Patients may live alone or lack a support system, which can lead to skipping meals.

How does malnutrition affect individuals with COPD?

Malnutrition and chronic illness affect more than energy levels. They can also weaken muscles and impact the immune system. Over time, this may reduce lung function and make the body more vulnerable to infection.

Reduced lung function

The hypermetabolic state of patients with COPD can cause muscle breakdown for energy, including the diaphragm and intercostal muscles (the muscles between the rib bones). This reduces lung function, including^10,11:

• Decreased exercise performance
• Reduced ventilatory drive
• Reduced ventilatory capacity
• Diminished respiratory muscle strength

Muscle atrophy

Reduced lung function can lead to avoidance of exercise or strenuous activity, and eventually to avoidance of some activities of daily living, which can lead to muscle atrophy. This starts a cycle of reduced activity, atrophy and further deconditioning, which continues to make activity more difficult.¹²

Compromised immune system

Malnutrition can also impact the immune system by reducing T-cell immunity, decreasing the ability of lymphocytes to destroy infected cells and lowering overall lymphocyte numbers.^11,13

Managing nutrition in COPD

Restoring proper nutrition leads to improved strength, lung function and overall health. Nutritional rehabilitation and other supportive therapies help to rebuild muscle, increase endurance and improve quality of life.

Nutritional rehabilitation

Nutritional rehabilitation can help address malnutrition acutely. Supplemental oral nutrition can result in significant increases in the following, likely due to improvement of intracellular electrolytes^11,14:

• Respiratory muscle strength
• Limb muscle strength
• Improved muscle contractility
• Improved endurance

Long-term oral nutritional supplementation (ONS) can help patients in an outpatient setting improve¹:

• Food intake
• Nutritional status
• Weight gain
• Lung function, capacity and strength
• Quality of life

Pulmonary rehabilitation for COPD

Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote long-term adherence to health-enhancing behaviors. Patient-tailored therapies include, but are not limited to¹⁵:

• Exercise training
• Education
• Behavior change

Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease and has been shown to improve^15,16:

• Shortness of breath
• Health status
• Exercise tolerance
• Exercise capacity
• Health-related quality of life

H3: Physical therapy and exercise training

Physical therapy and exercise training can help address sarcopenia by improving strength and muscle mass. Upper extremity exercise training has been found to improve arm strength, arm endurance and functional capacity of the upper extremity activity.¹⁵

H3: Occupational therapy

Occupational therapy for patients with COPD and co-occurring malnutrition primarily focuses on patient education, breathing coordination retraining and energy conservation techniques to reduce dyspnea and fatigue.¹⁷

H2: Get help for COPD and malnutrition

If you or a loved one is struggling with malnutrition from chronic bronchitis or emphysema, you’re not alone. Specialized medical care can address nutrient deficiencies, support healing and improve long-term outcomes. Don’t wait to get the support you need.

Start with a free assessment.

Sources

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