nutrition and respiratory diseases.pdf

Nutrition and Respiratory Diseases

FN 125

2nd 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 O2 and to eliminate CO2 3 basic processes

Breathing

External respiration

Internal respiration Two systems supply O2 & eliminate CO2

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

pCO2 = 35-45 mmHg

pO2 = 80-100 mmHg

HCO3 = 22-26 mEQ/L

O2 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 38.8oC 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


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 O2

and elimination of CO2;

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


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


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 8th 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 2nd semester AY 2006-07

Nutrition and

Respiratory Diseases

nutrition and respiratory diseases.pdf

Documents