Lies ter Beek, Hester van der Vaart, Johan B Wempe, Aliaksandra O Dzialendzik, Jan LN Roodenburg, Cees P van der Schans, Heather H Keller, Harriët Jager-Wittenaar

COPD may impact food-related activities, such as grocery shopping, cooking, and eating. Decreased food intake may result in an unhealthy diet, and in malnutrition, which is highly prevalent in patients with COPD. Malnutrition is known to negatively impact clinical outcome and quality of life. In this qualitative study, we aimed to explore strategies used to overcome food-related challenges, ie, dietary resilience, and whether these led to a healthy diet. Furthermore, we aimed to identify the key themes of motivation for dietary resilience in patients with severe COPD. In October 2015 to April 2016, 12 patients with severe COPD starting a pulmonary rehabilitation program were interviewed. Qualitative description and thematic analysis were performed. All participants mentioned the use of strategies to overcome challenges. Key themes of motivation for dietary resilience were identified as "wanting to be as healthy as possible", "staying independent", and "promoting a sense of continuity and duty". Two out of 12 participants met the criteria for a healthy diet. Our study showed a variety of motivational factors and strategies reported by patients with severe COPD to overcome food-related challenges. However, the majority (n=10) of the participants did not meet the criteria for a healthy diet. The identified key themes can be used to develop education to support patients with severe COPD to improve their diet.