Loss of appetite in patients with chronic obstructive pulmonary disease - a mixed methods study

Loss of appetite in patients with COPD can lead to malnutrition, which is associated with an increased risk of morbidity and mortality.

To identify factors associated with loss of appetite among COPD patients and explore their' experiences regarding appetite and eating.

A questionnaire on demographics, medical history and containing the Council on Nutrition Appetite Questionnaire (CNAQ) was posted in a COPD-specific online forum. CNAQ is validated to examine loss of appetite in older adults. The questionnaire contains 8 questions with five ordinal answer options. Ten patients who answered the questionnaire were randomly recruited for semi-structured phone interviews.

Eighty-seven patients responded to the questionnaire. 61% had loss of appetite. Patients with loss of appetite had a lower FEV1% predicted (31% vs. 42%, p = 0.03), higher CAT-score, (23 vs. 18, p = 0.002), and a higher proportion lived alone, (68% vs. 32%, p = 0.02), and got all daily meals delivered (19% vs. 0%, p = 0.009). Among the interviewed patients, the following factors influenced their appetite: Lack of daily routine, insufficient knowledge on nutrition, lack of social contact, bodily limitations, inadequate help and support, limited physical activity and lack of acceptance of life situation.

Patients with loss of appetite are characterized by a low BMI, impaired lung function, more symptoms and live alone. Improvement in social contact and support, nutritional support, and acceptance of their current life situation will help address these challenges.