Nutrition and Chronic Obstructive Pulmonary Disease

This assignment requires a close examination of various research papers focusing on the impact of nutrition and smoking cessation strategies on individuals with Chronic Obstructive Pulmonary Disease (COPD). The provided list of articles delves into aspects like nutritional support, the effectiveness of interventions for quitting smoking in Indigenous populations, the reasons why COPD patients continue smoking despite diagnosis, the role of nutritional supplementation, and the broader socio-economic factors influencing COPD hospitalizations and mortality.

Running head: CHRONIC ILLNESS MANAGEMENT 1
Chronic Illness Management
Student’s Name
University Affiliation

CHRONIC ILLNESS MANAGEMENT 2
Contents
Introduction......................................................................................................................................2
Overview of the chosen client’s chronic condition.........................................................................2
Potential health concerns.................................................................................................................3
Excessive smoking.......................................................................................................................3
Low body weight.........................................................................................................................4
Appropriate topics for the client education.....................................................................................5
Smoking cessation........................................................................................................................5
Nutrition.......................................................................................................................................5
Specific, appropriate client education strategies.............................................................................6
Diet modification.........................................................................................................................6
Smoking cessation........................................................................................................................7
Justification for my choice of education strategies..........................................................................8
Diet modification.........................................................................................................................8
Smoking cessation........................................................................................................................9
Conclusion.......................................................................................................................................9
References......................................................................................................................................10

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CHRONIC ILLNESS MANAGEMENT 4
Chronic Illness Management
Introduction
Chronic obstructive pulmonary disease (COPD) is a severe lung disease characterised by
chronic obstruction of lung airflow that affects normal breathing. Cigarette smoking and
exposure to air pollutants are the major causes of COPD. This paper is based on the case study of
Mr George Polaris who has been diagnosed with COPD. Low body weight and excessive
smoking are the two potential health concerns for the client. According to the case study, the
client has lost several kilograms and has been smoking 20 cigarettes daily since he was 14 years
old. The paper aims to develop personalised smoking cessation and nutritional education guide
for Mr Polaris.
Overview of the chosen client’s chronic condition
The client Mr George Polaris presented to the local GP clinic with chronic pulmonary
disease (COPD). COPD is a collective term used to elucidated progressive lung diseases such as
chronic bronchitis, emphysema, and refractory asthma. The most common symptoms of COPD
are increased shortness of breath, wheezing and chronic cough. In most cases, the patient with
COPD presents with a productive cough. Mr Polaris presented with shortness of breath,
productive cough and fever, which are clear symptoms of COPD. COPD is fast becoming a
global public health burden. WHO estimates that 80 million people around the world have
experienced moderate to severe COPD. In 2005, approximately three million individuals died of
COPD (Laniado-Laborín, 2009). Recent studies indicate that the global mortality due to COPD
is decreasing. In 2010, the number of deaths attributable to COPD declined to 2.8 million

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(Burney, Patel, Newson, Minelli, & Naghavi, 2015). Even with the increase in the prevalence of
COPD globally, most people remain undiagnosed.
The prevalence of COPD in Australia tends to fluctuate. The hospitalisation due to COPD
in Australia between 2010 and 2011 was 317 individuals per 100,000 people. The rate of
hospitalisation in the country is thus higher than the OCED average (Ore & Ireland, 2015). The
incidences of COPD in Australia reduced in males between 1998 and 2003 but rose in females.
The mortality linked to COPD is high in Australia. Between 1991 and 2004, the mortality rate
was 3.6%. The same study further indicates that the mortality rate between 1997 and 2004 was
4.4% (Laniado-Laborín, 2009). This analysis indicates that the chronic condition of the client is a
significant burden in Australia.
Potential health concerns
Excessive smoking
According to the case study, the client is a smoker and has smoked 20 cigarettes a day
since he was 14 years old. Smoking is the main cause of COPD. In fact, most people develop
COPD because of smoking. About 50 percent of smokers experience this disease at a certain
stage in their life (Eklund, Nilsson, Hedman, & Lindberg, 2012). In this case, smoking includes
inhaling smoke from cigarettes, pipes and cigars. Second-hand smoking, which happens when a
person is exposed to tobacco smoke, might also cause COPD. Tobacco smoke has many
chemical components including carcinogens and toxins (Talhout, Schulz, Florek, Van Benthem,
Wester, & Opperhuizen, 2011). These components of tobacco smoke can potentially injure the
lungs.

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Empirical evidence suggests that smoking causes progressive lung diseases. Emphysema
develops when cigarette smoke damages the walls of air sacs over time (Tuder & Petrache,
2012). This condition might also occur when a person is exposed to air pollutants like fumes or
dust. Mr Polaris works in a construction industry where there are high chances of being exposed
to air pollutants. Just like emphysema, chronic bronchitis develops when a person is exposed to
continuous cigarette smoke or air pollutants.
Low body weight
When the client visited the clinic, it was clear that he had lost several kilograms. His
current weight was 65 kilograms with a height of 178 centimetres. According to the Australian
Bureau of Statistics (ABS), the average height and weight of an Australian man are 175.6
centimetres and 85.9 kilograms (ABS, 2012). There is a conclusion that Mr Polaris was
underweight. Most of the patients with COPD are lean and experience a condition known as
pulmonary cachexia syndrome (PCS). PCS is characterised by loss of fat-free body mass
resulting in muscle wasting. Studies estimate that about 25 percent to 40 percent of patients with
COPD experience PCS. PCS manifests through decreased body weight. Reduction of body
weight in patients with COPD occurs due to disuse atrophy, hypoxia, oxidative stress,
inflammation and caloric intake (Rawal & Yadav, 2015). Progressive muscle wasting reduces the
patient's ability to exercise and may also lead to mortality.
Appropriate topics for the client education
Smoking cessation
The first suitable topic for Mr Polaris education is smoking cessation. Since smoking is
the primary cause of COPD, smoking quitting is one of the most effective techniques of halting

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or delaying the progression of COPD. Smoking is very addictive, and a patient might not quit
smoking on their own. In fact, most clients with COPD continue to smoke a cigarette even after
being encouraged to adopt behavioural change. Approximately, 30.4 percent to 43.0 percent
continue to smoke (Tashkin & Murray, 2009). Given that most patients with COPD continue to
smoke even after being exposed to smoking cessation programs, there is a need to address the
unmet needs of such patients. An evidence-based and well-structured smoking cessation program
will help Mr Polaris to reduce the number of cigarettes he smokes daily and eventually stops to
smoke. Through this topic, the client will understand the impacts of cigarette smoking, especially
with the ongoing condition. Besides, he will understand the benefits of quitting. One study
indicated that patients with COPD require support from care providers to help them decide to
quit smoking (Eklund, Nilsson, Hedman, & Lindberg, 2012). Among the benefits of tobacco
cessation is to improve the quality of life. It is evident that smoking cessation is an effective
technique of harm reduction in patients with COPD.
Nutrition
Nutrition is the second appropriate topic for client education because he has low BMI. Mr
Polaris needs to be educated on diet modification to improve his condition. Evidence suggests
that COPD patients with low BMI tend to experience adverse health outcomes. There is higher
mortality for patients with low BMI compared to those with normal body weight (King,
Cordova, & Scharf, 2008). For patients with severe COPD, low body weight is a substantial
independent predictor of mortality. Nevertheless, for patients with mild to moderate COPD, the
relationship between low BMI and mortality might be statistically insignificant. Education on
nutrition will be fundamental for the client to prevent excessive weight loss. The client will be in
a position to embrace a proper diet to halt the progression of PCS.

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Specific, appropriate client education strategies
Diet modification
Mr Polaris will be educated on diet change to help him prevent progressive weight loss.
The nutrition education program will consist of several specific elements that have been
developed to ensure success. The dietary knowledge of the client will be assessed. First, the
client will be asked to provide their dietary information. This information includes the foods and
snacks they consume daily and the proportions. Mr Polaris can get these details by recording the
kind foods he consumes, quantity and ingredients. A comprehensive food journal of the client
will provide an evidence based approach to improve his condition.
The second element in the nutrition program would entail actual education. The client
should create a plan of what he eats to manage his health. A healthy eating plan would require
the client to change his current eating habits. Mr Polaris’ wife will be requested to come to the
clinic to be a participant in the nutrition education. Thus, the participants of the education will be
the client, his wife and the provider. The setting will be in the clinic. A combination of tools will
be used to improve efficiency. A diet flyer will be the primary tool for educating the client. The
flyer will consist of a guide on the right foods, proportions and time for eating. Another tool will
be a personalised diet guide for the client based on the information he provided in the food
journal.
The education will consider several facts about COPD. The patients have high resting
energy expenditure (REE) leading to high-calorie requirement. The client will be advised to
increase calorie intake to compensate energy loss. Mr Polaris can increase calorie intake through
a high-fat diet. Increasing omega-3 fatty acids will also be beneficial for the client (Hsieh, Yang,

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& Tsai, 2016). The follow-up action plan will aim to monitor the weight of the client. The diet
will be modified according to the client’s response and its efficacy.
Smoking cessation
The smoking cessation education will take part in the clinic and will involve the client
and provider. The program will be divided into two specific parts, and each part will use
different tools and approaches. In the first part, the client will be educated on the benefits of
smoking cessation. He will be informed that smoking cessation can prevent the progression of
the disease. Smoking cessation will also help the client to prevent hospitalisation as well as save
the costs of treatment. Case studies of patients who have successfully quit smoking will be used
as tools to encourage Mr Polaris to stop smoking.
The second part will entail education on specific, appropriate method for the client to quit
smoking. Based on the history of the client, he has developed a nicotine addiction. Due to this
fact, he will be educated on nicotine replacement therapy (NRP). This therapy aims to withdraw
nicotine addiction slowly. The client will be educated on the various options available such as
nicotine patch, lozenge, mouth spray, gum and inhalator (Wadgave & Nagesh, 2016). Mr Polaris
can choose any of these options to help him quit smoking.
This information might not be sufficient to quit smoking especially for Mr Polaris who
has smoked since he was 14 years old. He will further be advised on the importance of calling
quitline within his LGA. Quitline will offer the client further assistance in case he is unable to
stop smoking on his own.

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Justification for my choice of education strategies
Diet modification
There is vast literature that supports nutrition education for patients with COPD.
Additionally, studies indicate that patients with COPD have successfully gained healthy body
weight through nutrition guide. Ferreira and colleagues analysed 17 studies to determine the
impact of nutritional guide on weight gain, muscle strength and quality of life. They found that
nutritional support resulted in weight gain in malnourished patients with COPD. Underweight
patients with COPD can also experience an increase in FFM and fat mass with nutritional
support (Ferreira, Brooks, White, & Goldstein, 2012).
Another study analyzed the impact of nutritional support in twelve randomized controlled
trials. The study found that nutritional support substantially enhanced muscle strength, weight
gain and quality of life. In fact, this study found that the participants gained two kilograms or
more (Collins, Elia, & Stratton, Nutritional support and functional capacity in chronic
obstructive pulmonary disease: A systematic review and meta‐analysis, 2013). Collins and
colleagues also did a meta-analysis of controlled trials of nutritional counselling, nutritional
supplements to determine the effect on malnourished patients with COPD. The subjects
experienced a substantial increase in body weight as well as handgrip strength (Collins, Stratton,
& Elia, 2012). The findings of these meta-analysis studies show that nutritional advice is
fundamental in increasing the body weight of patients with COPD.
Smoking cessation
Face to case counselling and quitline, which have been proposed for the client, are
effective in smoking cessation. One study found that face to face counselling and phone

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counselling led to abstinence from smoking. These results can be attributed to the benefits of
quitlines. Smoking quitlines reduce logistical hindrances to treatment and even increases service
use. In case, Mr Polaris requires additional help to stop smoking without visiting the clinic they
can simply call the quitline and re-engage in counselling. Phone counselling is fast, and the
counsellor focuses on getting only the information that will make the session more productive
(DiGiacomo, Davidson, Abbott, Davison, Moore, & Thompson, 2011). Lastly, the proposed
smoking cessation program will allow the counsellor to offer proactive counselling.
Conclusion
The most important concerns for Mr Polaris are to manage the smoking habit and manage
body weight. The smoking cessation education that has been elucidated in this paper will help
the client to quit smoking. Education on benefits of smoking cessation, NRP and quitlines has
been developed for the client. Besides, education on nutrition management and enhancement has
been provided. This education will help the client to improve quality of life in the long-term.

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References
ABS. (2012, 10 29). Profiles of Health, Australia, 2011-13. Retrieved 8 29, 2017, from
http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4338.0main+features212011-13
Burney, P., Patel, J., Newson, R., Minelli, C., & Naghavi, M. (2015). Global and regional trends
in COPD mortality, 1990–2010. European Respiratory Journal , 45 (5), 1239-1247.
Collins, P., Elia, M., & Stratton, R. (2013). Nutritional support and functional capacity in chronic
obstructive pulmonary disease: A systematic review and meta‐analysis. Respirology , 18
(4), 616-629.
Collins, P., Stratton, R., & Elia, M. (2012). Nutritional support in chronic obstructive pulmonary
disease: a systematic review and meta-analysis. The American journal of clinical
nutrition , 96 (5), 1385-1395.
DiGiacomo, M., Davidson, P., Abbott, P., Davison, J., Moore, L., & Thompson, S. (2011).
Smoking cessation in Indigenous populations of Australia, New Zealand, Canada, and the
United States: elements of effective interventions. nternational journal of environmental
research and public health , 8 (2), 388-410.
Eklund, B. M., Nilsson, S., Hedman, L., & Lindberg, I. (2012). Why do smokers diagnosed with
COPD not quit smoking?-a qualitative study. Tobacco induced diseases , 10 (1), 17.

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Ferreira, I., Brooks, D., White, J., & Goldstein, R. (2012). Nutritional supplementation for stable
chronic obstructive pulmonary disease. The Cochrane Library .
Hsieh, M.-J., Yang, T.-M., & Tsai, Y.-H. (2016). Nutritional supplementation in patients with
chronic obstructive pulmonary disease. Journal of the Formosan Medical Association ,
115 (8), 596-601.
King, D., Cordova, F., & Scharf, S. (2008). Nutritional aspects of chronic obstructive pulmonary
disease. Proceedings of the American Thoracic Society , 5 (4), 519-523.
Laniado-Laborín, R. (2009). Smoking and Chronic Obstructive Pulmonary Disease (COPD).
Parallel Epidemics of the 21st Century. International journal of environmental research
and public health , 6 (1), 209-224.
Ore, T., & Ireland, P. (2015). Chronic obstructive pulmonary disease hospitalisations and
mortality in Victoria: analysis of variations by socioeconomic status. Australian and New
Zealand journal of public health , 39 (3), 243-249.
Rawal, G., & Yadav, S. (2015). Nutrition in chronic obstructive pulmonary disease: A review.
Journal of translational internal medicine , 3 (4), 151-154.
Talhout, R., Schulz, T., Florek, E., Van Benthem, J., Wester, P., & Opperhuizen, A. (2011).
Hazardous compounds in tobacco smoke. International journal of environmental
research and public health , 8 (2), 613-628.
Tashkin, D. P., & Murray, R. P. (2009). Smoking cessation in chronic obstructive pulmonary
disease. Respiratory Medicine , 103 (7), 963-974.

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Tuder, R., & Petrache, I. (2012). Pathogenesis of chronic obstructive pulmonary disease. The
Journal of clinical investigation , 122 (8), 2749.
Wadgave, U., & Nagesh, L. (2016). Nicotine Replacement Therapy: An Overview. International
journal of health sciences , 10 (3), 425-435.