Approaching the Malnourished Patient

Nutritional assessment that involves screening and therapy is an essential component of pulmonary rehabilitation in COPD patients, in whom weight loss, muscle wasting, and altered muscle metabolism are typical findings that are observed as the disease progresses (14). The association between low body weight and increased mortality has been well documented in several retrospective studies (15-17). Therefore, it is essential to address 

Decreased mass, force, contractihty, and endurance of the diaphragm 

Increased bacterial adhesion in the lower respiratory traet 

This process includes dietary, anthropometric, and biochemical aspects. Nutritional assessment begins with a detailed nutritional history that includes clinical, dietary, socioeconomic, and family issues. Areas of interest include present and past illnesses, family illness history, food allergies or intolerance, medications, nutritional supplements, over-the-counter medications, alcohol use, work environment, and education level. A useful standardized protocol is the Prognostic Nutritional Index (PNI), which incorporates serum albumin, serum transferrin, delayed skin hypersensitivity, and triceps skinfold thickness (20,21). The PNI has been shown to correlate with postoperative complications and mortality (22). Whole body functional assessment by examining overall activity, exercise tolerance, grip strength, respiratory function, wound healing, and plasma albumin concentration can also be useful. 

Laboratory measures of albumin, transferrin, and prealbumin are sensitive and cost-effective methods of assessing malnutrition in patients who are critically ill or have a chronic disease. Prealbumin levels are accurate predictors of patient recovery (23,24). 

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