Pulmonary Disease

Categories of Pulmonary System Disease

a. Primary - tuberculosis (PTB), bronchial asthma, cancer of the lung
b. Secondary those associated with cardiovascular disease, obesity, acquired immunodeficiency syndrome (AIDS),
sickle cell disease, and scoliosis

Signs and symptoms of Pulmonary Disease: cough, early satiety, anorexia, weight loss, dyspnea, (shortness of breath)
during preparing of food and eating, and fatigue

Adverse effects of lung disease on nutritional status
Increased energy expenditure
Increased work of breathing
Chronic infection
Medical treatments (e.g.
bronchodilators, chest physical
therapy)
Reduced intake
Fluid restriction
Shortness of breath
Decreased oxygen saturation when
eating
Anorexia due to chronic disease
Gastrointestinal distress and vomiting
Additional limitations
Difficulty preparing food due to
fatigue
Lack of financial resources
Impaired feeding skills (infants and
children)
Altered metabolism

Asthma a condition of hypersensitive airways from allergic and non-allergic causes, generated by immunologic responses
*a disease of bronchial hyper-responsiveness and airway inflammation, leading to airflow destruction

Diet
1. Avoid salt intake
2. Avoid alcoholic beverages since congeners in alcohol can cause asthmatic symptoms in sensitive patients

Bronchitis acute or chronic inflammation of the membrane lining the bronchial tubes

I. Types
a. Acute may be due to an extension of infection from the upper respiratory tract
b. Chronic may be caused by irritants in polluted air, particularly smoke or gas fumes

II. Diet
a. High kilocalories and protein to help reduce infection
b. Small frequent feedings and allow frequent rest periods while eating when there is difficulty in breathing
c. Avoid milk if it tends to produce mucus

Chronic Obstructive Pulmonary Disease (COPD) a process characterized by the presence of chronic bronchitis,
emphysema, or both, leading to the development of airway obstruction
-it is characterized by slowly progressive obstruction of the airways
-cigarette smoking is the most important risk factor

Two categories:
1. Emphysema (Type I)
-patients are genereally thin, often cathetic; they are older and have mild hypoxemia but normal haematocrit values
-cor pulmonale (a heart condition characterized by right ventricular enlargement and failure that results from
resistance to the passage of blood through the lungs) develops late in the course of the disease
2. Chronic bronchitis (Type II)
-patients have normal weights and often overweight; have hypoxemia; haematocrit values are increased
-cor pulmonale develops early

Consequences of COPD: lungs gradually lose their functional surface area and strength so that it is difficult to deliver
oxygen to the blood and remove carbon dioxide. This results in pulmonary infections, respiratory failure, and heart failure

Progressive Respiratory Failure failure of the pulmonary gas exchange of oxygen and carbon dioxide

I. Symptoms
A. Hypoxemia - deficient oxygenation of the blood
B. Hypercapnia excess carbon dioxide in the blood
C. Nutritional wasting low body weight and triceps skinfold measurements
D. Weakness

II. Nutritional Care
Objective: maintenance of an acceptable weight for height; management of drug-nutrient interactions and fluid
balance

Diet
1. Energy requirements vary; if underweight, may give 150% of REE
-25-35 kcal/day for maintenance based on weight
-45 kcal/kg/day for anabolism to restore lean body mass
2. Fat is the preferred source of energy due to its low respiratory quotient (RQ) value (RQ=0.7); 40% of total
kilocalories
3. Carbohydrate should provide 50% of non-protein kilocalories; large amounts will increase oxygen
consumption and carbon dioxide production and retention (RQ=1.0)
4. Protein is high if underweight to counteract the catabolic effect of illness but not over 15% of total
kilocalories; high biologic value; too much may increase ventilator value drive (RQ=0.8)
5. Give five to six small feedings of easily digested food
6. Monitor fluid intake due to tendency to retain water
7. Sodium restriction (2-3g/day with edema)
8. Supplemental vitamins and minerals
9. Enteral/parenteral feeding if needed. Appropriate commercial formulas based on recommended nutrient
ratios are available

Emphysema and Pulmonary Tuberculosis
*refer to Febrile Conditions, Infections, and Communicable Diseases