1. Pulmonary Rehabilitation Dietary Advice
By Stephanie Lee-Barrett
Dietitian
Colchester General Hospital

2. Facts About COPD & Diet
Diet and Nutrition should be an important part of treatment
Breathing requires more energy with COPD
Muscles involved may require 10x more calories than those without COPD
Good nutrition will help reduce hospitalisation from chest infection

3. The eatwell plate Bread, rice, potatoes, pasta Fruit and vegetables
Milk and dairy foods
Meat, fish, eggs, beans
Foods and drinks high in fat and/or sugar

4. General Dietary Advice
Enjoy variety of foods
Limit salt intake
Drink plenty of fluids 6-8 glasses/day
Include high fibre foods e.g. veg, fruit, wholegrain foods, cereal, pasta, rice
Eat several small meals per day

5. Body Mass Index (BMI)
Used to measure if an individual is a healthy weight, underweight or overweight
BMI= Weight (kg)
Height (m²)
Fit into certain categories
16-19 = Underweight
20-25 = Normal weight
26-30 = Overweight
31-40 = Obese

6. Dietary Advice if you are Underweight

7. Underweight Weight loss Loss of respiratory muscle strength
More energy required
to breathe
Increased difficulty breathing and increased risk of infection

8. Poor appetite Have regular meals & snacks Eat anything fancied
Eat from a smaller plate
Avoid filling up on veg, salads, fizzy drinks
Sip nourishing high energy fluids e.g. milk, hot choc, malt drink, milkshake
A short walk before meals may increase appetite
A small amount of alcohol can stimulate appetite

9. Slow Eater Try eating small amounts little & often
Consider a plate warmer & insulated mug
Do not hurry over meals, eat slowly and chew foods well

10. Short of Breath While Eating/ After Meals
Eat more slowly
Choose foods that are easy to chew - softer foods
Try eating 5-6 small meals/day
Try drinking liquids at the end of your meals.
Eat while sitting up to ease pressure on the lungs

11. Too Tired to Eat Later in Day
Choose foods that are easier to prepare
If possible ask family members to help with meal preparation
Freeze extra portions
Rest before eating
Try eating main meal early in the day

12. Feeling of fullness quickly
Eat smaller meals more frequently, rather than one or two big meals
Try not to fill up on fluid whilst eating.

13. Food Fortification
Fortified milk - add 4tbsp skimmed milk powder to 1pint full cream milk
Add butter/margarine/ghee/cream/cheese to mash potatoes, vegetables and sauces
Add cream/ice cream/custard to puddings and fruit
Use sugary foods (unless diabetic) - jam/sugar/syrup/honey added to cereals and puddings

14. Quick Snack Ideas Sandwiches - cheese/egg/meat with pickles/sauces
Toast- cheese/beans/ egg/fish
Toasted crumpets with cheese
Convenience meals
Jacket potato with cheese/beans/tuna mayo
Crackers or digestive biscuits with butter and cheese
Mousse/yoghurt/jelly/ trifle/fromage frais
Fruit loaf/malt loaf with butter

15. Nutritional Supplements
If the discussed ideas do not help to improve your intake, nutritional supplements may be used
Complan® and Build-up® are available to buy “over the counter”.
Others are available on prescription from your GP.
Variety of flavours (sweet and savoury).
Often preferred chilled
Can be incorporated into recipes e.g. milk pudding, ice cream, custard, milkshakes, mousses.

16. Dietary Advice if you are Overweight

17. Overweight Consequence of :
high energy intake from food
reduced exercise tolerance
steroid use
Extra weight increases workload of heart and lungs to supply oxygen around body
Excess fat in abdominal area makes it difficult for the lungs to expand fully

18. Starchy Foods Include at each meal Main source of energy
Starchy foods are filling
Choose wholemeal + wholewheat varieties
Myth that starchy foods are ‘fattening’

19. Fruit and Vegetables Rich in vitamins and minerals
Help protect against infection
Aim for 5 portions per day
Fresh, frozen, canned or dried

20. Meat, Fish and Alternatives
Provides protein, vitamins + minerals
Recommend 2 servings/day
Avoid roasting or frying in large amounts of oil/fat
Try healthier cooking methods
Choose lean meat
Remove visible fat & skins from meat and poultry.

21. Milk and Dairy Products
Provides protein and calcium
Recommend 3 servings/day
Use semi-skimmed milk instead of full cream milk
Use low fat cheeses e.g. Cottage cheese, edam, half fat cheddar
Try low fat yoghurts
If on long term steroids - it is important you have enough calcium.

22. Fatty and sugary foods Try using sweeteners
Choose lower calorie sugar free/no added sugar drinks
Keep sweets, puddings, cakes, chocolate, take-aways, pies and pastries as a treat
Try tinned fruit in natural juice rather than syrup.

23. Hints for weight control
Think of the benefits of weight loss
Make healthier changes to your diet
Fill up on fruit and veg
Have regular meals
Avoid foods which are high in fat and sugar. Aim for:
<3g total fat /100g product
<5g added sugar/100g product
Set realistic, achievable target lose (1-2lbs/week).
Do not crash diet. Consider keeping a food diary

24. Alcohol high in calories and should be kept within sensible limits.
Women ≤14 units per week
Men ≤ 21 units per week
Aim for 2-3 alcohol free days.
A unit of alcohol is:
Half a pint of beer, cider or larger (medium strength)
1 small glass of wine (125ml)
1 small glass of sherry
1 measure of spirits

25. Summary…. Good nutrition helps reduce infections
Need energy to help you breathe
If underweight - choose high protein/calorie foods - important have enough energy
If overweight - choose low fat/low sugar foods, eat more fruit/veg
Refer to relevant diet sheets - examples of menu plans and snack ideas