Case Report: Malnutrition in an Adult Patient with Chronic Obstructive Pulmonary Disease

  • Agatha Nadya Lianto General Practitioner, Husada Hospital, Indonesia
  • Imelda Wiradarma Clinical Nutrition Specialist, Husada Hospital, Indonesia
Keywords: Chronic Obstructive, Pulmonary Disease, Malnutrition, Nutritional Intervention

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disorder characterized by persistent airflow obstruction and is frequently accompanied by multiple comorbidities. One of the most common complications among patients with COPD is malnutrition, with approximately 20% of patients experiencing weight loss that contributes to reductions in skeletal muscle mass, respiratory function, and overall quality of life. Case Presentation: A 49-year-old male presented with complaints of dyspnea, cough, epigastric pain, fever, and decreased appetite. The patient had a medical history of COPD and pulmonary tuberculosis, for which treatment had been successfully completed in September 2024. Nutritional screening revealed that the patient appeared markedly underweight, with a body weight of 42 kg, a height of 185 cm, a body mass index (BMI) of 12.27 kg/m², and a mid-upper arm circumference (MUAC) of 18 cm, indicating severe malnutrition. Nutritional intervention was subsequently initiated, consisting of an energy intake of 1,500 kcal/day (38 kcal/kg body weight/day), protein intake of 70 g/day (1.7 g/kg body weight/day), a soft rice-based diet with finely minced high-carbohydrate, high-protein (TKTP) side dishes, supplementation with three eggs daily, and zinc tablets administered at a dosage of one tablet twice daily. Discussion: The provision of high-energy and high-protein nutritional therapy was intended to meet the patient's nutritional requirements, improve nutritional status, and facilitate the restoration of lost muscle mass. The use of a soft diet was expected to reduce postprandial dyspnea, prevent early satiety, and enhance dietary adherence. This case highlights that early nutritional screening and timely nutritional intervention constitute essential components of the comprehensive management of patients with COPD complicated by malnutrition. Long-term monitoring of body weight, nutritional status, and dietary tolerance is necessary to support successful patient rehabilitation and improve clinical outcomes.

References

Adeloye, D., Song, P., Zhu, Y., Campbell, H., Sheikh, A., & Rudan, I. (2022). Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. The Lancet Respiratory Medicine, 10(5), 447-458. https://doi.org/10.1016/s2213-2600(21)00511-7

Agreta, S. M. N., Rayasari, F., & Kamil, A. R. (2023). Penerapan Intervensi Pursed-Lips Breathing Meningkatkan Arus Puncak Ekspirasi pada Pasien Penyakit Paru Obstruksi Kronik. Jurnal Keperawatan Silampari, 6(2), 1078–1092. https://doi.org/10.31539/jks.v6i2.4955

Bae, J., Lee, H. J., Choi, K. Y., Lee, J. K., Park, T. Y., Heo, E. Y., ... & Lee, H. W. (2024). Risk factors of acute exacerbation and disease progression in young patients with COPD. BMJ Open Respiratory Research, 11(1), e001740. https://doi.org/10.1136/bmjresp-2023-001740

Boers, E., Barrett, M., Su, J. G., Benjafield, A. V., Sinha, S., Kaye, L., ... & Malhotra, A. (2023). Global burden of chronic obstructive pulmonary disease through 2050. JAMA network open, 6(12), e2346598. https://doi.org/10.1001/jamanetworkopen.2023.46598

Celli, B. R., Fabbri, L. M., Aaron, S. D., Agusti, A., Brook, R. D., Criner, G. J., ... & Wedzicha, J. A. (2023). Differential diagnosis of suspected chronic obstructive pulmonary disease exacerbations in the acute care setting: best practice. American journal of respiratory and critical care medicine, 207(9), 1134-1144. https://doi.org/10.1164/rccm.202209-1795ci

Collins, P. F., Elia, M., & Stratton, R. J. (2013). Nutritional Support and Functional Capacity in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta‐Analysis. Respirology, 18(4), 616–629. https://doi.org/10.1111/resp.12070

Conway, V., Hukins, C., Sharp, S., & Collins, P. F. (2024). Nutritional Support in Malnourished Outpatients with Chronic Obstructive Pulmonary Disease (COPD): A Randomized Controlled Pilot Study. Nutrients, 16(11), 1696. https://doi.org/10.3390/nu16111696

De Sire, A., Lippi, L., Aprile, V., Calafiore, D., Folli, A., D’Abrosca, F., ... & Invernizzi, M. (2022). Pharmacological, nutritional, and rehabilitative interventions to improve the complex management of osteoporosis in patients with chronic obstructive pulmonary disease: a narrative review. Journal of Personalized Medicine, 12(10), 1626. https://doi.org/10.3390/jpm12101626

Di Raimondo, D., Pirera, E., Pintus, C., De Rosa, R., Profita, M., Musiari, G., ... & Tuttolomondo, A. (2024). The impact of malnutrition on chronic obstructive pulmonary disease (COPD) outcomes: the predictive value of the mini nutritional assessment (MNA) versus acute exacerbations in patients with highly complex COPD and its clinical and prognostic implications. Nutrients, 16(14), 2303. https://doi.org/10.3390/nu16142303

Ferreira, I., Brooks, D., Lacasse, Y., Goldstein, R., & White, J. (2005). Nutritional Supplementation for Stable Chronic Obstructive Pulmonary Disease. In I. Ferreira (Ed.), Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. https://doi.org/10.1002/14651858.CD000998.pub2

Hao, X., & Bu, T. (2025). Clinical Value of Nutritional Assessment Tools in Older Adults with Chronic Obstructive Pulmonary Disease: An Integrative Review. Clinical Interventions in Aging, 20, 2671–2683. https://doi.org/10.2147/CIA.S556215

Hasanah, F. A., & Mayasari, D. (2023). Holistic Management of Elderly Man with Acute Exacerbation of Chronic Obstructive Pulmonary Disease with History of Smoking and Occupation’s Dust Exposure Through A Family Medicine Approach. Medical Profession Journal of Lampung, 13(5), 683–695. https://doi.org/10.53089/MEDULA.V13I5.766

Heefner, A., Simovic, T., Mize, K., & Rodriguez-Miguelez, P. (2024). The Role of Nutrition in the Development and Management of Chronic Obstructive Pulmonary Disease. Nutrients, 16(8), 1136. https://doi.org/10.3390/nu16081136

Huang, H. Y., Chen, C. L., Lin, Y. L., Chen, S. C., Lee, L. C., Dai, H. M., ... & Lan, C. C. (2025). Optimizing treatment for hospitalized patients with COPD: a study on the impact of a LINE app-based multidisciplinary team approach targeting pharmacological treatment, lifestyle changes, and smoking cessation. International Journal of Chronic Obstructive Pulmonary Disease, 1149-1159. https://doi.org/10.2147/COPD.S511869

Huang, W. J., Fan, X. X., Yang, Y. H., Zeng, Y. M., & Ko, C. Y. (2022). A review on the Role of Oral Nutritional Supplements in Chronic Obstructive Pulmonary Disease. The Journal of Nutrition, Health and Aging, 26(7), 723–731. https://doi.org/10.1007/s12603-022-1822-8

Hurst, J. R., Han, M. K., Singh, B., Sharma, S., Kaur, G., de Nigris, E., ... & Siddiqui, M. K. (2022). Prognostic risk factors for moderate-to-severe exacerbations in patients with chronic obstructive pulmonary disease: a systematic literature review. Respiratory research, 23(1), 213. https://doi.org/10.1186/s12931-022-02123-5

Kahnert, K., Jörres, R. A., Behr, J., & Welte, T. (2023). The diagnosis and treatment of COPD and its comorbidities. Deutsches Ärzteblatt International, 120(25), 434. https://doi.org/10.3238/arztebl.m2023.027

Kim, S. H. (2025). Self-management, Patient Education and Multidisciplinary Care in Chronic Pulmonary Disease: An Integrated Approach to Pulmonary Rehabilitation. Annals of CardioPulmonary Rehabilitation, 5(2), 30-37. https://doi.org/10.53476/acpr.2025.5.2.30

Muscaritoli, M., Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., Hütterer, E., Isenring, E., Kaasa, S., Krznaric, Z., Laird, B., Larsson, M., Laviano, A., Mühlebach, S., Oldervoll, L., Ravasco, P., Solheim, T. S., Strasser, F., … Bischoff, S. C. (2021). ESPEN Practical Guideline: Clinical Nutrition in cancer. Clinical Nutrition, 40(5), 2898–2913. https://doi.org/10.1016/j.clnu.2021.02.005

Nguyen, H. T., Pavey, T. G., Collins, P. F., Nguyen, N. V., Pham, T. D., & Gallegos, D. (2020). Effectiveness of Tailored Dietary Counseling in Treating Malnourished Outpatients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Journal of the Academy of Nutrition and Dietetics, 120(5), 778–791. https://doi.org/10.1016/j.jand.2019.09.013

Ouyang, L., Wang, C., & Song, Y. (2025). Impact of Early Enteral Nutrition on The Prognosis of Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study Based on The MIMIC-IV Database. Frontiers in Nutrition, 12. https://doi.org/10.3389/fnut.2025.1620011

Patel, N., Chong, K., & Baydur, A. (2022). Methods and applications in respiratory physiology: respiratory mechanics, drive and muscle function in neuromuscular and chest wall disorders. Frontiers in Physiology, 13, 838414. https://doi.org/10.3389/fphys.2022.838414

Petnehazy, N., Barnes, H. N., Newman, A. B., Kritchevsky, S. B., Cummings, S. R., Hepple, R. T., & Cawthon, P. M. (2024). Muscle mass, strength, power and physical performance and their association with quality of life in older adults, the Study of Muscle, Mobility and Aging (SOMMA). The Journal of Frailty & Aging, 13(4), 384-390. https://doi.org/10.1101/2023.10.31.23297845

Rakhima, A., Diloramkhan, A., Feruza, T., Chynara, T., Aizat, K., Mamatova, S., ... & Rana, S. (2025). Nutritional status in patients with COPD and its impact on biochemical status: a narrative review. Journal of Advanced Pharmacy Education & Research| Apr–Jun, 15(2). https://doi.org/10.51847/qfEaYyPqMP

Safiri, S., Carson-Chahhoud, K., Noori, M., Nejadghaderi, S. A., Sullman, M. J., Heris, J. A., ... & Kaufman, J. S. (2022). Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019. bmj, 378. https://doi.org/10.1136/bmj-2021-069679

Savino‐Lloreda, P., López‐Daza, D., & Casas‐Herrera, A. (2025). Medical Nutrition Therapy in Chronic Obstructive Pulmonary Disease: A Narrative Review. Nutrition in Clinical Practice, 40(4), 793–804. https://doi.org/10.1002/ncp.11329

Schols, A. M., Ferreira, I. M., Franssen, F. M., Gosker, H. R., Janssens, W., Muscaritoli, M., Pison, C., Rutten-van Mölken, M., Slinde, F., Steiner, M. C., Tkacova, R., & Singh, S. J. (2014). Nutritional Assessment and Therapy in COPD: A European Respiratory Society Statement. European Respiratory Journal, 44(6), 1504–1520. https://doi.org/10.1183/09031936.00070914

Sharma, S., Salibi, G., & Tzenios, N. (2023). Modern approaches of rehabilitation in COPD patients. Special Journal of the Medical Academy and other Life Sciences., 1(6). https://doi.org/10.58676/sjmas.v1i6.39

Simanjuntak, E. G., & Serepina, A. (2020). Perspektif Terkini terhadap Penyakit Paru Obstruktif Kronis: Review Literatur. Jurnal Kedokteran Universitas Palangka Raya, 8(2), 999–1009. https://doi.org/10.37304/jkupr.v8i2.2034

Sundar, K. M., Stark, A., & Morris, M. J. (2024). Laryngeal dysfunction manifesting as chronic refractory cough and dyspnea: laryngeal physiology in respiratory health and disease. Chest, 166(1), 171-186. https://doi.org/10.1016/j.chest.2024.03.026

Tony, S. M., & Abdelrahim, M. E. (2022). Respiratory Tract, Ventilation, and Pulmonary Functions Tests. Journal of Clinical and Nursing Research, 6(3). https://doi.org/10.26689/jcnr.v6i3.3906

Tuna, T., & Samur, G. (2025). The Role of Nutrition and Nutritional Supplements in the Prevention and Treatment of Malnutrition in Chronic Obstructive Pulmonary Disease: Current Approaches in Nutrition Therapy. Current Nutrition Reports, 14(1), 21. https://doi.org/10.1007/s13668-025-00613-8

Utama, O. D., Dewi, D. S., Asmaria, M., & Yessi, H. (2026). Asuhan Keperawatan Pasien dengan Penyakit Paru Obstruksi Kronis (PPOK) Di Ruang Inap Paru RSUD Prof. H. Muhammad Yamin, SH. Jurnal Ilmu Psikologi Dan Kesehatan, 3(1), 1133–1138. https://doi.org/10.62379/JIPK.V3I1.1992

Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., Barnes, P. J., Fabbri, L. M., Martinez, F. J., Nishimura, M., Stockley, R. A., Sin, D. D., & Rodriguez-Roisin, R. (2013). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine, 187(4), 347–365. https://doi.org/10.1164/rccm.201204-0596PP

Wheeldon, A. (2023). The respiratory system and associated disorders. British Journal of Nursing, 32(13), 613-619. https://doi.org/10.12968/bjon.2023.32.13.613

Widjaja, E. H., Pratama, A., & Subroto, H. (2025). Gambaran Anemia pada Pasien Dewasa-Lansia dengan PPOK di Rumah Sakit Immanuel Bandung Periode Oktober - Desember 2023. Sound of Health Journal, 1(1), 67–73. https://doi.org/10.28932/shj.v1i1.11213

Zhang, J.-H. (2025). Effect of Nutritional Management on the Nutritional Status and Quality of Life of Patients with Chronic Obstructive Pulmonary Disease. International Journal of Chronic Obstructive Pulmonary Disease, 20, 487–496. https://doi.org/10.2147/COPD.S494323

Published
2026-08-31
How to Cite
Lianto, A. N., & Wiradarma, I. (2026). Case Report: Malnutrition in an Adult Patient with Chronic Obstructive Pulmonary Disease. Journal La Medihealtico, 7(4), 830-838. https://doi.org/10.37899/journallamedihealtico.v7i4.5082