‘Mind the gap’: the importance of managing malnutrition in chronic obstructive pulmonary disease
Malnutrition is linked to poor outcomes in patients with chronic obstructive pulmonary disease (COPD), and reduced fat free mass and low BMI are independent risk factors for increased mortality. However, weight loss is not inevitable and can be prevented or reversed so screening for malnutrition is essential. The latest guidelines for managing malnutrition in COPD recommend first-line nutritional support. In particular, patients with a BMI <20 kg/m2 should be prescribed oral nutritional supplements (ONS), which have been shown to significantly improve outcomes. However, this guidance is often not implemented locally, increasing the likelihood of malnutrition, hospital admission and increased healthcare costs. Ready-prepared, low-volume, high-protein, high-energy drinks can improve compliance with ONS, particularly in people who are unable to tolerate high volumes. ONS therefore play an important role in managing malnutrition in COPD, helping to reduce its physiological and economic effects.
According to the British Lung Foundation, an estimated 1.2 million people are living with diagnosed COPD (BLF, 2017a). In terms of diagnoses, this makes COPD the second most common lung disease in the UK after asthma (BLF, 2017a). Around 2% of the whole population—4.5% of all people aged over 40—live with diagnosed COPD (BLF, 2017a). These numbers are steadily increasing year on year. Moreover, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), COPD is a major cause of chronic morbidity and mortality around the world, and is projected to be the third leading cause of death globally by 2020 (GOLD, 2019).
Malnutrition is a common problem in patients with COPD; it is suggested that 35% of hospitalised patients with the condition (Steer et al, 2010) and 22% of outpatients (Collins et al, 2018) are at risk of developing malnutrition. Inevitably, this will lead to an increase in hospitalisation (Hoong et al, 2017). The direct cost of malnutrition to the NHS is estimated to be £19 billion per year in England alone (Elia, 2015), which equates to £90 million per clinical commissioning group (CCG) (Kominek et al, 2017).
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