Chronic Bronchitis
blue bloater |
Hypersecretion of mucus and chronic (3/12+, 2 consecutive years) productive cough |
S/S: inflammation, bronchial oedema, ↑s in size and number of mucous glands, mild dyspnoea, wheezing, Cyanosis (blue discolouration), hyperventilation, stocky build |
Causes: smoking & air pollution |
NIS
Low BMI and low fat-free mass is associated with worse outcomes |
Discomfort when eating – getting breathless easily |
Difficulty chewing and finishing meals as it requires effort |
Hyperinflation of lungs causing pressure on the stomach |
loss of appetite induced by drugs |
Excessive energy expenditure (coughing, inflammation) |
Early satiety, reduced appetite |
Nut Reqs
COPD (exacerbation): 125-145kJ, 1.2-1.5g P(Handbook) |
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Emphysema
pink puffer |
Permanent enlargement of gas exchange airways, and destruction of alveolar walls. |
S/S: : ↑ smooth muscle thickening = narrowing airways, ↓ alveoli elasticity, severe dyspnoea, wheezing, barrel chest, thin build, pursed-lip breathing, weight loss, laboured breathing |
Causes: smoking, air pollution and childhood respiratory infections |
Intervention
Screen malnutrition - MST |
Prevent and treat malnutrition - ONS, HEHP liquids, mid meal snacks etc |
Weight gain in underweight pts |
Prevent muscle wasting: P: 1.2-1.5g/day |
Consider: Oedema/HTN, medications (e.g. diuretics), ability to self-feed, cook and prepare meals, allergies/intolerances etc, swallowing function |
Refer: meals on wheels, social worker |
May have fluid restrictions |
Vit C, E, Zinc & selenium: supp show benefits in quadricep strength & total serum P |
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Strategies
Avoid large meals. 6 or more smaller meals/day or more nutrient-dense meals |
Malnut: HPHE, ONS, enriched milk, fortified foods, mid-meal snacks etc |
Wear oxygen when eating |
Avoid drinking w/ meals |
Use a straw = less effort |
Soft foods that require less chewing |
Stay upright ~20 mins after eating |
Pre-prepared meals, frozen meals, bulk cooking, partner/family cook |
Make sure they can open packets/reach their food |
Avoid non-nutritious drinks: sugar-free drinks, black tea/coffee |
Refer: "The Lung Foundation Australia's Lungs in Action program" |
Rest (15-20 mins) before meal times |
Limit foods that can cause bloating, e.g. beans, onions, cauliflower, soft drinks |
Corticosteroids
Inhaled to ↓ inflammation |
S/E: Sore mouth, cough, altered electrolyte balance, ↑ appetite, weight gain, hyperglycaemia, hyperlipidaemia, poor wound healing |
↓ the intestinal absorption of calcium and ↑ urinary excretion = bone reabsorption |
Example PESS
P |
Malnutrition, inadequate oral intake, inadequate protein energy intake, chronic disease-related malnutrition |
E |
↑ resting energy expenditure secondary to the work of breathing and systemic inflammation |
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tire easily when eating |
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experience dyspnea during eating and drinking |
Guidelines & References
Handbook p134 |
Chronic Obstructive Pulmonary Disease Clinical Care Standard (2024) |
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