Dietary change, nutrition education and chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a prevalent and serious condition. Nutrition might play a role in COPD prevention and is definitely important in COPD management. There are some indications from epidemiological studies that dietary factors such as ample consumption of fruit and fish may decrease COPD risk. The available evidence is, however, not substantial enough to warrant dietary recommendations for primary prevention of COPD. Substantial evidence does point to the conclusion that, regardless of disease severity, weight loss is related to decreased exercise capacity, health status and mortality as well as to increased morbidity among patients with moderate to severe COPD. Current nutritional support strategies have primarily focussed on treatment of severely underweight and disabled patients. In an in-patient setting or when incorporated in a pulmonary rehabilitation programme, nutritional support has proved effective in inducing weight gain and related functional improvements. However, such interventions are only feasible for a selected group of patients and are very laborious. Therefore, opportunities for dietary and nutrition interventions in COPD management should be explored, aiming at early detection, prevention and early treatment of involuntary weight loss. This means expanding the target group to include COPD out-patients and primary care patients before they have become underweight, and putting more emphasis on dietary change than on medically prescribed supplementation. Successful intervention assumes (voluntary) adjustment of dietary behaviour, and health professionals may play an essential role in encouraging patients to make and maintain these changes. Achieving dietary change among COPD patients may require a combination of diet counselling and self-management. A model for such a combination is presented.