Pulmonary, Lung Disease, COPD

A well functioning pulmonary system enables the body to obtain the oxygen needed to meet its cellular demands for energy from nutrients and to remove carbon dioxide. Malnutrition adversely affects lung structure, elasticity and function, respiratory muscle mass, strength, endurance, and lung immune defence mechanisms.    For example protein and iron deficiencies result in low haemoglobin levels that diminish the oxygen-carrying capacity of the blood.

When treating asthma, the dietitian addresses dietary triggers, corrects energy and nutrient deficiencies or excesses in the diet, educates the patient on a personalised diet that provides optimal levels of nutrients, monitors growth in children, and watches for food-drug interactions.

Chronic obstructive pulmonary disease (COPD) is the 3^rd most common cause of death in the world. Malnutrition is a common problem due to the extra energy required by the ‘work’ of breathing. Inadequate food intake and poor appetite are common concerns. Nutritionally dense, smaller, frequent meals, which are easy to prepare, are recommended. Studies have shown an inverse relationship between dietary iron and calcium intake and COPD risk. Smokers require 35mg / day more vit C than non smokers.

Malnutrition, weight loss and cachexia is common in patients with active pulmonary Tuberculosis (TB). Recurrent infections lead to worsening of nutrition status and loss of body nitrogen, and lower the effectiveness of anti-TB drug regime. Sufficient protein is vital in preventing muscle wasting.

 Chylothorax is a rare cause of pleural effusion.  Disruption or obstruction of the thoracic duct results in the leakage of chyle (lymphatic fluid of intestinal origin)  into the pleural space.  In lower volume chylous drainage ( < 1litre / day) the goal of Medical Nutrition Therapy is to reduce the flow of chyle by providing a high protein, very low fat diet to the patient. Less fat will be absorbed in the gut, therefore reducing  the chyle production.  Surgical repair therefore may be avoided.  It may take 7-10 days for the chylous drainage to clear. Essential fatty acid, and fat soluble vitamin deficiencies need to be corrected and Medium Chain Triglycerides added to the regime by the dietitian.

An inflammatory condition of the lungs, causing chest pain, fever, cough, and dyspnea, is called pneumonia, which may also lead to aspiration. Dysphagia may develop which impairs oral intake.

Dietetic support for patients with lung cancer is essential, as progressive weight loss and malnutrition impairs the contractility of the respiratory muscles, and may worsen fatigue.