A service review of dietetic input for chronic obstructive pulmonary disease patients on long-term oral nutritional support



Background:  Patients with chronic obstructive pulmonary disease (COPD) often require long-term oral nutritional support and concomitant dietetic input, secondary to commonly associated weight loss and malnutrition (Batres, 2007). There are approximately 100 000 people in Scotland living with COPD(NHS QIS, 2009). Due to current demands on dietetic services, this retrospective case review looked to explore the number of dietetic reviews provided and the consequent change in nutritional status in a group of COPD patients.

Methods:  A retrospective case review of the 26 COPD patients known to the community dietetic department at the time of the study was carried out (12 females, 14 males). The patient's ranged in age from 44 to 73 with the mean (SD) age of 64 (7.5) years. Their reported heights were recorded and each patient had their weight measured on Tanita scales at each contact. Initial BMI and current BMI were then calculated, together with the number of dietetic reviews that had been provided. The results were then analysed using SPSS statistics software. Recorded BMI data was parametric therefore a paired sample T-Test was used.

Results:  The median number of dietetic reviews was 6 (IQR 3, 10). From this, two patient groups were formed, those receiving six or less dietetic reviews and those with over 6. The T-Test indicated a significant increase between the initial BMI and current BMI for the group receiving six or less reviews (P = <0.005). This was not significant for the group who received over six reviews.

Table 1.   Mean (SD) body mass index (BMI) according to number of dietetic reviews
 BMI on referral (kg m-2)Current BMI (kg m-2)P value
Six or less dietetic reviews (n = 14)18.1 ± 3.319.6 ± 3.4≤0.005
Over six dietetic reviews (n = 12)18.5 ± 1.918.2 ± 2.30.424

Discussion:  This review supports previous research that dietary counseling and food fortification has a positive impact on the nutritional status of COPD patients (Weekes, 2009). It indicates that dietetic input is valuable, however, due to current demands on dietetic services, it is not beneficial to continually review this patient group long-term, once nutritional stability has been established, e.g. <5% weight loss in 3–6 months (BAPEN, 2004). Due to the clinical nature of the study, the limitations included the variable timescales for dietetic reviews.

Conclusion:  Dietetic input has a positive effect on BMI status in COPD patients however more efficient dietetic practices need to be implemented for long-term oral nutritional support patients.

References:  BAPEN (2004) Malnutrition Universal Screening Tool (online) Available at http://www.bapen.org.uk/must_tool.html. [Accessed online June 2010].

Batres et al. (2007) Nutritional status in COPD. Arch Bronconeumol. 43, 283–288.

NHS Quality Improvement Scotland. (2009) Chronic Obstructive Pulmonary Disease (COPD) Services. http://www.nhshealthquality.org/nhsqis/files/COPD_STANF_MAR10.pdf [Accessed on 9 November 2010].

Weekes, C.E., Emery, P.W. & Elia, M. (2009) Dietary Counselling and Food Fortification in stable COPD:a randomised trial. Thorax 64, 326–31.