Nutritional Management

in Respiratory Diseases

Maria Aamir
Introduction
 Respiratory diseases may be caused by infection, by
smoking tobacco, or by breathing in secondhand
tobacco smoke, or other forms of air pollution.

 Respiratory diseases include asthma, chronic

obstructive pulmonary disease (COPD), pulmonary
fibrosis, pneumonia, and lung cancer.
What Is COPD?

The two main types of chronic obstructive

pulmonary disease (COPD) are emphysema
and chronic bronchitis

COPD is the slow, advancing blockage of the

airways in the lungs
Side Effects of COPD

 Reduced respiratory muscle strength and endurance

 Breathing muscles fatigue easier

 Increased risk of infections

 Malnutrition
COPD and Malnutrition
 Malnutrition is either too much, not enough, or an
imbalance of nutrients

 20%-70% of COPD patients are malnourished

 Malnutrition in emphysema usually is because of

not getting enough nutrients

 Many factors cause malnutrition in emphysema

patients
 Foods may taste bland
COPD and Malnutrition:
Causes
 Up to 94 - 146% of energy is needed

 Difficulty in breathing causes difficulty in eating

 Medications have gastrointestinal side effects

 Oxygen to the gastrointestinal tract is decreased

 Too much carbon dioxide can cause early

morning headaches and confusion
Nutritional Advice
 Normal weight: A regular diet with adequate
fluid intake (2-3l/day) is recommended.

 Underweight: High caloric/ high protein diet to

promote repletion/gradual weight gain: adequate
fluid intake (2-3l/day) is recommended.

 Overweight: Energy-restricted diet to promote

gradual weight loss if appropriate; adequate fluid
intake (2-3L/day is recommended.
Nutritional Advice Cont'd
 Patients should encouraged to eat their main meals
when their energy level is the highest. Early in the day
is often the time when fewer disease symptoms are
present and appetite may be the best.

 Some patients may be able to consume more if

frequent, small meals are offered. Because the
diaphragm is often low lying due to hyperinflation of
the lungs, there may be a physical alteration in gastric
space.

 Nutrient density, eating frequency, and timing of fluid

and medication intake should be individualized to
promote an optimal eating pattern.
 Additional Nutritional Advice
 Instruct patients to swallow as little air as possible while eating.
Aerophagia can lead to a feeling of satiety and/ or painful gas,
both of which can decrease food intake
 Modify food consistency if mastication seems to increase
fatigue while eating. Use of commercial supplements and
modular components may be helpful to patients who have
difficulty ingesting the quantity of food necessary for
maintenance or weight gain. Failure to weight gain may
indicate that the supplements are replacing meals instead of
adding calories.
 Individualized fluid requirements based on the patient’s
medications, clinical status and concomitant disease.
 Smokers have a high requirement for vitamin C than do
nonsmokers and should be encouraged to increase their intake
of fruits and vegetables.
Limit Carbohydrate Intake
(40-55%)
 Follow a high-protein diet withmoderate
carbohydrates

 Reduce carbohydrates consumption by limiting these

foods:
Soda
Sweet tea
Candy
Cake and desserts
Starches
Limit Salt Intake
Follow a low-sodium or no-added-salt diet
Reduce sodium (or salt) consumed by limiting
these foods:
Canned foods
Snack foods, such as chips, pretzels, crackers, and popcorn
Packaged starchy foods, such as stuffing and rice mixes,
Cured meats and cheeses
Condiments, such as ketchup, barbecue sauce, and soy
sauce
Salt and any seasoning with the word “salt” in it
Sufficient Protein Intake
 Protein needs dhould be sufficient, up to 1.2-1.7
grams /day is necessary to maintain or retore lung and
muscle strength, as well as to promote immune function

 To calculate how much protein is needed:

 Take the weight of the patient and divide by 2.2
 Take that number and multiply it by 1.2 and 1.7
 This will give you the range of protein needed
 Example: 150 pounds divided by 2.2=68  68
´1.2=82
 68´1.7=116
 Protein needs are 81-116 g/day
How to Meet Protein
Needs  1 egg 6 g protein
 1 ounce (oz) nuts 2-4 g protein

 6 oz yogurt 6 g protein

 ½ cup (C) cottage cheese 14 g protein

 3 oz canned tuna 25 g protein

 6 oz steak 42 g protein
 3 oz chicken breast 26 g protein
Have Adequate Fluid Intake
 Drink 2-3 litres of fluids/day
 • May need to reduce milk consumption
 • Take fluids between meals
Get Enough Vitamins and Minerals
 Increased need vitamin A
for
vitamin C
 Increased need
for

 Smokers need double the dose of vitamin C

 Get adequate calcium, magnesium, and phosphorus

 Increased need for vitamin D and vitamin K if reduced

bone minerals
 A multivitamin with minerals is appropriate
 Reduce Gas-Forming Foods
Gas-forming foods can cause bloating and displacement
of the diaphragm

If this occurs, avoid the following:

 Broccoli
 Cabbage
 Onions
 Leeks
 Asparagus
 Carbonated beverages
 Dried beans and peas
Tips for Comfortable Eating
 Avoid overfeeding
 Have frequent, small meals
 Choose nutrient-dense foods
 Rest before meals
 Eat slowly
 Wear oxygen during meals
 Eat soft, easy-to-chew foods
 Remain upright for 1 hour after meals
 Drink beverages between meals
 Eat main meal with your family or others
Tips for
Comfortable Eating
(cont’d)
 Try to avoid constipation and straining to pass hard
stools
 Increase fiber
 Increase antioxidants
 Try milk shakes
 Reduce caffeinated beverages
 Eat chicken soup to clear respiratory tract
What to Discuss With
Your Doctor/Dietitian
 Regular review of lab results

 Need for a nutritional supplement

 If oral intake is not meeting needs, other options,

such as a tube feeding
Thank you