Medical

Nutrition
Therapy
for
Pulmonary
Disease
Patient
Anggun Rindang Cempaka, S.Gz, Dietisien
 Overview Pulmonary System

An Optimal Enables the body to obtain the oxygen needed to

Pulmonary meet its cellular metabolic demands
System

Enables to remove metabolic by-products

Permits the proper growth and development of the

Optimal respiratory anatomy
Nutrition
Supporting structures of the skeleton and muscles;
and related nervous, circulatory, and immunologic
system
Function of Pulmonary System
Gas exchange obtain the
oxygen needed and remove
the carbon dioxide produced
The lungs also function to
filter, warm and humidify
inspired air
Synthesize surfactant
Regulate body acid-base
balance
Synthesize arachidonic acid
Convert angiotensin I to
angiotensin II.
Function of Pulmonary System
Gas exchange obtain the
Main function
oxygen needed and remove
the carbon dioxide produced
The lungs also function to
filter, warm and humidify
inspired air
Synthesize surfactant
Regulate body acid-base
balance
Synthesize arachidonic acid
Convert angiotensin I to
angiotensin II.
 Nutrition & Pulmonary System
Protein
Macro-
Hb carrying O2 levels
Pulmonary edema nutrient
Surfactant
Immune system

Micronutrient
Ca, Mg, P, K respiratory
muscle function
Vit C collagen formation
Water, electrolytes mucus
subtances
 Nutrition & Pulmonary System
Protein
Macro-
Hb carrying O2 levels
Pulmonary edema nutrient
Malnutrition
Surfactant
Hypoproteinemia, Immune system
Anemia

Micronutrient
Ca, Mg, P, K respiratory
muscle function
Vit C collagen formation
Water, electrolytes mucus
subtances
 Adverse
Effects of
Lung
Disease on
Nutrition
Status
 ASTHMA
A disease of bronchial
hyperresponsiveness and
airway chronic inflammation
(primary problem mediated
by Ig-E), leading to airflow
obstruction

Complex interactions among genetic, immunologic,

Etiology and environmental factors (allergen-induce)

Persistent mouth breathing

Signs/ Air flow blockage and disorder due to : Increase
Symptoms mucous secretion, and narrow smooth muscle
Inflammation
 Asthma
Triggers
 Asthma
Triggers

Inflammation

Hypersecretion of mucus
Airway Muscle Constriction
Swelling bronchial membranes

Narrowing Breathing Passage

Wheezing, Cough, SOB, etc.

 NCP for Asthma

Antropometry Height, Weight, BMI

Biochemical Glucose, Albumin, Hemoglobin, Hematokrit,

Serum Fe, Ca, Mg, Leukosit, CRP

Clinical Blood Pressure, Temperature, Spyrometry Test

Dietary Dietary history, usual food intake

 The Objectives of
Nutrition Intervention

Prevent lung infection and

Optimize nutritional inflammation by altered
status immune or antioxidant
activity

Prevent distention of For allergic asthma,

Encourage a health
identify and control
stomach from large allergens in the
maintenance program,
meals including physical activity
environment
 Dietary Intervention
Provide balanced, small meals that are nutrient dense correction of diagnosed energy
and nutrient deficiencies or excesses
Omit food allergens as identified include individual evaluation for environmental or
food triggers and strategies food their avoidance if necessary
Encourage extra fluids unless contraindicated Use less sodium when pulmonary edema
exist
N-3 and n-6 fatty acids in proper ratio: decreasing the production of bronchoconstrictive
leukotrines
Antioxidant nutrient: protecting the airway tissues from oxidative stress

Vitamin D: molecular anti-infective nutrient due to inhaler use

Magnesium: a smooth-muscle relaxant and antiinflamatory agent

Education of the patients, family and community include medication-food-nutrient

interactions
 CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD)

Slowly
tobacco smoking,
Definition progressive Risk Factors
environmental air
obstruction of
pollution, genetic
the airways

Categories

Emphysema (type 1) Chronic Bronchitis (type 2)

Thin, cachexia Normal - Overweight
Mild hypoxemia, Hypoxemia
Normal HMT values HMT values increase
Cor pulmonale develops late Cor pulmonale develops early
NCP for COPD

Nutritional
Assessment
Objectives of Nutrition Interventions
Promote a nutrient-dense food
Prevents excessive weight loss,
choice. Ensure adequate flavor
especially in underweight
patients
of foods because appetite is
often minimized

Improve ventilation before

Prevent respiratory infections/
meals and overall physical
respiratory acidosis. Decrease
conditioning to strengthen
excess CO2 production as well.
respiratory muscles

Prevent or correct
Alleviate difficulty in chewing
dehydration thickens
or swallowing
muccus

Avoid constipations and Avoid distention from large

straining at stool meals or gaseous food
 Preserves a satisfactory RQ from substrate
utilization
Interventions
Protein: 1,2-1,7 g/kgBW or 15%-20% TE to
Macronutrients maintain or restore lung and muscle strength,
promote immune
Fat: 30 - 45% total energy, increased use of
omega 3 fatty acids
Carbs: 40 - 55% total energy, Fiber should be
RQ? increased gradually
Enrich the diet with antioxidant
Fluid intake should be high, especially when
The ratio of the patients is febrile 1 cc/kcal (8 glasses daily)
amount of CO2 Limit salt intake too much sodium can
produced divided
by the amount of cause fluid retention/peripheral edema
O2 consumed at
the cellular level
Carbs 1; Protein 0.8; Fat 0.7
 Acute inflammation of
PNEUMONIA the alveolar sapces of
the lung

Pneumonia usually occurs as a

nasocomial infections or as a
consequences of aspiration of
food, fluid or secretion (saliva)

The infection causes

deterioration of lung function so
that makes fluid accumulation
and breathing difficulty occurs
 Types of Pneumonia

Hospital-Acquired Pneumonia Community-Acquired

(HAP) Pneumonia (CAP)

Also known as Nasocomial Occurs when infected

Pneumonia or Health-Care person cough or sneeze and
Associated Pneumonia spread the bacteria to
(HCAP) around them
Often affects patients who Streptococcus pneumoniae,
are in the intensive care Pneumococcal pneumonia
unit (ICU) or are on
mechanical ventilator
Signs
&
Symp-
toms
 Nutritional Assessment

Dietary
- Diet history
Clinical
- Food intake
- Temperature
Biochemical (fever, chills)
- WBC - RR, BP
Anthropometry - pCO2, pO2 - Bronchoscopy
- Height - Na,K, Ca, Mg - Productive
- Weight - Albumin cough
- BMI - Transthyretin
- CRP
- serum Fe
- BUN, creatinine
 Intervention - Objectives

Prevent or correct dehydration

Relieve breathing difficulty and discomfort, oxygenate all tissues.

Prevent weight loss from hypermetabolic state

Support diet with adequate antioxidants and nutrients dense food

Avoid additional infections; prevents sepsis and multiple organ dysfunction syndrome

In convalescent stage, avoid constipation

 Nutrients Needs

Energy Increase Protein: 1,5-2 g/

Fat: 30-45%
25-50% kgBW (15-20% TE)

Vit A increase Vit C synthesize

immuno competence,
Carbs: 40-45% anti-inflammation,
collagen, immuno
epithelisation competence

Zinc & Se Na restricted Meal frequency: 5-6

neutralize free radical (edema) x/day + snacks
 Tubercolosis (TB)

Caused by a tubercle Signs & Symptoms

bacillus (Mycobacterium
tuberculosis) which is
invading the lungs and
setting up an inflammatory
process
loss appetite, constant fatigue, tissue
wasting, exhaustion, cough lasting 3
weeks or longer with occasional blood-
tinged sputum, fever or chills, profuse
night sweats and weight loss

The disease is spread from

inhalation of organisms
dispersed as droplets from the
sputum of infected persons (the
bacteria-laden droplets can float
in the air for several hours)
Pathogenesis
 Nutritional Assessment

Anthropometry
Height, Weight, BMI

Biochemical Albumin, transthyretin, CRP, RBC, Fe serum, Na, K,

Ca, Mg, BUN, creatinine

Clinical BP, TB skin test (mantoux), chest x-rays,

temperature, fever, sputum test

Dietary
Dietary history, food intake
 Intervention Objectives
Maintain weight (or pervent losses)
Reduce fever
Replace nutrient losses from lung hemmorhage
Promote healing the cavity
Counteract neuritis from isoniazid (INH) theraphy
Stimulate appetite
Prevent dehydration
Prevent lung inflammation, infections and complications
 Intervention Nutrient Needs

Energy: 35-45 kcal/kg BW
(if weight loss has been
significant)
Fat : 20-25 % TE
Protein: 2,0-2,5 gr/kg BB
Add more omega 3 FA improve
food intake, restore normal eating
Carbs : 55-65% TE
patterns, prevent body weight
loss

Fluids: 35 cc/kgBW or 2 L INH may cause neuritis by

daily
Iron and vit C proper Hb
formation and wound healing
depleting vit B6.
Niacin, Ca, vit B12 are also depleted
which cause nausea, vomiting,
stomach cramping, dry mouth
supplement vit B16, niacin, Ca, B12