Local implementation of a pathway to manage malnourished COPD patients in the community

Background: Malnourished COPD patients have higher healthcare use and poorer outcomes than those not at risk. NICE (CG101, CG32) and the national “COPD pathway” (www.malnutritionpathway.co.uk/copd) highlight the importance of managing malnutrition in COPD but evaluations of the impact locally need investigation. Aim: To investigate the effect of locally implementing the “COPD pathway” on the nutritional status, well-being and health care use of malnourished COPD patients in the community. Methods: 19 patients (75±9.4y) identified at high risk of malnutrition (BMI 18.3±3.1kg/m2) were initiated on the pathway and received dietary advice plus low volume, high protein oral nutritional supplements (600kcal, 36g protein) and followed up at 6 and 12 weeks. Malnutrition risk, health care use, health rating (bad – great, 0-10 scale), COPD assessment test (CAT) (0-40 scale), compliance and satisfaction were recorded for 12 weeks before and after implementation. Results: Implementation of the pathway led to a significant reduction in malnutrition risk (19 high risk to 10 high, 4 medium, 5 low) (p Conclusion: This local pilot suggests appropriate management of malnourished COPD patients in the community improves nutritional status, health and CAT rating with associated reductions in health care use. A larger project to explore the clinical and economic effects is required.