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Nutrition and

Respiratory Diseases
FN 125
2
nd
semester AY 2012-13

Objectives
1. Review the respiratory system parts and
functions
2. Describe the common respiratory diseases
asthma, bronchitis, COPD, pneumonia, and
PTB
3. Explain the principles behind the nutritional
management of the diseases mentioned
The Respiratory Tract
Bronchi, Bronchioles, & Alveoli
Functional basic unit
Gas exchange
The Respiratory System
Responsible for the exchange of gases between the body and
the external environment.
Cells need a supply of O
2
and to

eliminate CO
2
3 basic processes
Breathing
External respiration
Internal respiration

Two systems supply O
2
& eliminate CO
2

Respiratory system
Cardiovascular system
The Respiratory Tract
Upper respiratory system
Superior to the larynx
Functions intake, moistening, filtering,
sensing
Lower respiratory system
Larynx and below
Functions sound production, transport
of air, gas exchange

The Alveoli
Site of gas exchange with the blood
Closely associated with capillaries
Wall of the alveolus + wall of capillary
Respiratory membrane
Gas exchange occurs by diffusion
Diseases of the heart 20.0 %
Cerebrovascular diseases 11.1 %
Malignant neoplasm 10.0 %
Pneumonia 8.0 %
Tuberculosis 5.4 %
Chronic lower respiratory diseases 4.8 %
Diabetes mellitus 4.8 %
Assault 2.8 %
Perinatal-period illnesses 2.8 %
Nephritis, nephrotic syndrome and neprosis 2.8 %
Top 10 causes of death in the Philippines
(Phil National Statistics, 2007)
Diagnosis of
Respiratory Diseases
Diagnostics
1. Medical History
Dyspnea (SOB)
Chest pain
Respiratory rate
Breathing pattern
2. Patients History
Occupation
Genetics
Smoking
Diagnostics
3. Laboratory Test
Arterial Blood gas
analysis
pCO
2
= 35-45 mmHg
pO
2
= 80-100 mmHg
HCO
3
= 22-26 mEQ/L
O
2
saturation = >95%
pH = 7.35-7.45
Pulmonary function - ?
4. Anthropometrics
Body weight
Asthma
Etiology
Pathophysiology
Manifestations
Nutritional Therapy
Description
A disease of bronchial hyperresponsiveness
and airway inflammation from allergic and
non-allergic causes, leading to airflow
obstruction
Types:
1. Allergic
2. Non-allergic
Etiology of Asthma
The underlying cause of asthma is still
unclear. However, nutritional factors
(maternal diet during pregnancy, diet during
infancy & toddlerhood, and obesity in adults)
have been associated with it.
Interaction of Complex factors:
1. Genes
2. Immune system: T lymphocytes
3. Environment
Pathophysiology of Asthma
Genetic factors Immunologic
factors
Environmental
factors
T Lymphocytes
release cytokines
Release IgE
Airway edema
Airway cells direct inflammatory changes
in airway
Airway inflammation
Intermittent Airway obstruction
Bronchial Hyperresponsiveness
Manifestations of asthma
1. Persistent mouth breathing
2. Decreased breathing sounds
3. Wheezing
4. Paroxysmal dyspnea may be noted secondary
to airway obstruction
Objectives of drug and nutritional
management
1. Ease out difficulty of breathing
2. Promote adequate hydration
3. Promote improved resistance against
diseases
4. For allergic type: identify and control
allergens in the environment
5. Encourage a health-maintenance & asthma
management program

Dietary Strategies
Strategy Rationale
1. Provide balanced, small
meals that are nutrient-
dense
To reduce risk of infections &
poor state of health; to aid in
breathing
2. Highlight foods rich in
vitamins A, C, B6, Zn
To prevent airway tissues
from oxidative stress
3. Increase fluid intake (2-
3L)
To liquefy secretions
4. Include sources of n-3
and n-6 fatty acids
To reduce bronchial
inflammation
Dietary Strategies
Strategy Rationale
5. Include sources of Mg Act as smooth muscle
relaxant & anti-inflammatory
agent
6. Include methylxanthines Acts as bronchodilator
7. For allergic asthma, omit
allergens
To prevent asthma attacks
8. Sodium restriction for
patients with pulmonary
edema
To avoid water retention
Bronchitis
Description
Etiology
Pathophysiology
Manifestations
Nutritional Management
Description
Acute inflammation of the airway structures

Maybe serious in debilitated patient & those
with chronic lung heart disease

Pneumonia is a critical complication
Etiology of Bronchitis
1. Acute Infections
Bronchitis
Mycoplasmic
pneumoniae and
Chlamydia
Exposure to air
pollutant
2. Acute Irritative
Bronchitis
Mineral & vegetable
dusts
Fumes from strong
acids
Tobacco or other
smoke
Volatile organic
solvents
Pathophysiology of Bronchitis
Hyperemia of mucous membranes
Edema, leukocytic infiltration, mucous
production
Cilia is disturbed
Cough occurs
Bacteria invades
bronchi
Airway obstruction and spasm of
bronchial muscles
Manifestations of Bronchitis
1. Cough is initially dry and nonproductive
2. Occurrence of fever to 38.3 to 38.8
o
C and
may be present for up to 3-5 days.
3. Dyspnea may be noted secondary to the
airways obstruction
Objectives of Nutrition Therapy
1. Normalize body temperature if fever is
present
2. Replenish nutrients
3. Prevent dehydration
4. Allow ample of rest before & after feedings
5. Relieve discomfort
6. Avoid further infections
Dietary strategies
Strategy Rationale
1. Provide a high-calorie
diet (40-55% CHO, 15-
20% CHON, 30-40%
fats)
To prevent weight loss
2. Limit intake of milk For some individuals,
milk thickens mucus
3. Increase fluid intake (2-
3 L)
To liquefy secretions
Dietary strategies
Strategy Rationale
4. Provide adequate
vitamin C
To protect airway from
oxidative stress
5. Provide potassium To maintain fluid
balance
6. Include sources of n-3 &
n-6 fatty acids
To reduce bronchial
inflammation
7. Provide probiotics To replenish the GI
bacteria lost thru
antibiotics
Chronic Obstructive
Pulmonary Disease (COPD)
Description
Etiology
Pathophysiology
Nutritional Management
COPD
A process characterized by the presence of
emphysema or chronic bronchitis, or both,
leading to obstruction of the airways

Two categories:
1. Emphysema (Type 1)
2. Chronic bronchitis (Type 2)
COPD: Emphysema
Weakened & collapsed air sacs with excess
mucus
Pink puffer
Characteristics:
1. Thin and older
2. Presence of dyspnea
3. Mild hypoxemia but normal hematocrit values
4. Cor pulmonale develops late in the course of
the disease enlargement of RV
COPD: Chronic bronchitis
A chronic productive cough with
inflammation of one or more of the bronchi
& secondary changes in the lung tissue
Also called chronic mucous hypersecretion
syndrome
Blue bloater
Characteristics:
1. Normal or overweight
2. Hypoxemia is prominent
3. Increased hematocrit values
4. Cor pulmonale develops early
Etiology of COPD
1. Tobacco smoking
2. Environmental air pollution
3. Genetic susceptibility (alpha1-antitrypsin
deficiency)
Pathophysiology of COPD
Smoking or air pollution
Chronic release of leukocytic
proteolytic enzyme
Mucosal edema Mucosal hypersecretion
Airway obstruction
Decline in lung function
Pathophysiology of COPD
Alpha1-antitrypsin deficiency
Neutrophils release cytotoxic
proteinase
Lung elastin destruction Mucosal hypersecretion
Airway obstruction
Decline in lung function
Manifestations of COPD
1. Chronic or recurring cough
2. Mucus production
3. Dyspnea
4. Presence of hypoxemia and hypercapnia

Objectives of Nutrition Therapy
1. Correct malnutrition
2. Overcome anorexia
3. Improve ventilation before meals
4. Alleviate difficulty in swallowing or chewing
5. Prevent or correct dehydration
6. Avoid constipation
Dietary Strategies
Strategy Rationale
1. A high-protein & kcal diet
(45% CHO, 15% CHON,
40% fat);
Use 1.2-1.5 g/CHON/kg
To balance the need for O
2

and elimination of CO
2
;
replenish nutrients
2. Soft diet

Alleviate chewing and
swallowing
3. Small, frequent feedings To lessen fatigue
4. Increase intake of n-3 To reduce bronchial
inflammation
Dietary Strategies
Strategy Rationale
5. Supplement diet with
vitamin A & C
For tissue healing
6. Include vitamin B-
complex
For proper energy
metabolism
7. Increase fluid intake to
1ml/kcal
To prevent dehydration
8. Restrict sodium but
increased K+
To prevent water retention &
maintain fluid balance
9. Increase fiber gradually To avoid constipation
Pneumonia
Description
Etiology
Pathophysiology
Nutrition Therapy
Pneumonia
A general term used to indicate infection &
inflammation of lung tissue
Any lung condition in which the alveoli
becomes filled with fluid or blood
Classified according to the structural
distribution: whole lungs, lobular,
bronchopneumonia, or interstitial
May be due to bacteria, virus, cigarette
smoking, or alcoholism
Pathophysiology of Pneumonia (Bacteria)
Pneumococci
Upper respiratory tract
Lodge in bronchioles
Inflammation in alveolar
spaces
Congestion
Pathophysiology of Pneumonia (Virus)
Viral
Invade bronchiolar
epithelial
Bronchiolitis
Infection extends to the
pulmonary interstitum &
alveoli
Manifestations of Pneumonia
1. Impaired pulmonary ventilation & diffusion
2. Increased pulse rate & respirations
3. Cyanosis of lips & nail beds
4. Cough
5. Elevated leucocytes
Objectives of Nutrition Therapy
1. Prevent or correct dehydration
2. Relieve breathing difficulty and discomfort
3. Prevent weight loss from hypermetabolic
state
4. Avoid additional infections
5. Avoid constipation
Dietary Strategies
Strategy Rationale
1. Offer 3-3.5 L of fluid
daily
To relieve uncomfortable
dry mouth
2. Progress as tolerated to
a high calorie/soft diet
To restore energy source
3. Provide multivitamin &
mineral supplement
To increase immune
defense
4. Add more fiber To avoid constipation
Pulmonary Tuberculosis
(PTB)
Description
Etiology
Nutrition Therapy
PTB
Caused by Tubercle bacillus
Chronic, recurrent infection most common in
the lungs
Formation of granuloma in the lung tissue
May be acquired thru the air
Manifestations
1. Cough
2. Dyspnea
3. Hemoptysis
4. Chest pain
Objectives of Nutrition Therapy
1. Maintain or prevent weight loss
2. Normalize Ca
++
levels in serum
3. Replace nutrient losses from lung
hemorrhage
4. Promote healing of the cavity
5. Stimulate appetite
6. Prevent dehydration
7. Prevent pleurisy & complications

Dietary Strategies
Strategy Rationale
1. Liberal protein and
adequate kcal
To restore balance due to
hypercatabolism &
hypermetabolism
2. Provide sufficient Ca and
vitamin D
To counteract INH therapy
3. Adequate vitamin B-
complex
For Hgb formation & wound
healing
4. Adequate fluids To counteract INH therapy
Medical Treatment
Medication Rationale
1. Isoniazid (INH) Bactericidal
2. Rifampicin Inhibits RNA synthesis of the
bacteria
References
1. DeBruyne, Pinna, and Whitney. Chapter 24 Energy- and
protein-modified diets for metabolic and respiratory diseases.
Nutrition and Diet Therapy 8
th
ed. 2012.
(Nutrition assessment checklist for people undergoing
metabolic & respiratory stress p.631)

2. Nelms, M, Sucher K, and S Long. Chapter 23 Diseases of the
Respiratory System. Nutrition Therapy and Pathophysiology.
Thomson Wadsworth. 2007.

Parts of the lecture were from the report submitted by
Ms. Frances Bernadette Caramat and Mr. Napoleon Domineng
FN 125 2
nd
semester AY 2006-07
Nutrition and
Respiratory Diseases