1. Respiratory System KNH 411

2. Respiratory System Nutritional status and pulmonary function are interdependent Macronutrients fueled using oxygen and carbon dioxide Malnutrition can evolve from pulmonary disorders And can contribute to declining pulmonary status

3. Nutrition and Pulmonary Health Protein-energy malnutrition Antioxidants and lung function Protect lungs Vitamin C, E, and beta-carotene Cigarette smokers Vitamin C DRI +35 for smokers Early satiety, anorexia, weight loss, cough, dyspnea during eating Fatigue easily Get weight history, diet history, medications

4. Bronchopulmonary Dysplasia (BPD) Growth failure d/t decreased nutrient intake, increased requirements, hypoxemia, delayed skeletal mineralization and osteopenia Hypoxemia- low breathing Need to add calories (add supplement) Become easily fatigued

5. Bronchopulmonary Dysplasia (BPD) Treatment/Nutrition Therapy Monitor fluids Energy and macronutrient needs: 15-20% higher 120-130 kcal/kg/day or higher Protein 3-4 g/kg/day Vitamins and minerals Key vitamins and minerals- Vitamin A, calcium, phosphorus, magnesium Vitamin A 1500-2800 Ius (supplement) Closely monitor electrolyte balance Sufficient minerals for bone growth

6. Bronchopulmonary Dysplasia (BPD) Treatment/Nutrition Therapy Mechanical ventilation Nutrition support IV nutrition May need fluid and sodium restriction Specialty infant formulas Breast milk preferred Goal is to consume mothers milk 3x per day Education and support to caregivers

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8. Chronic Obstructive Pulmonary Disease COPD – progressive disease which limits airflow through inflammation of bronchial tubes (bronchitis) Can have an obstruction of airflow to the tubes or destruction of aveoli (or both) Primary risk factor – smoking

9. COPD Nutrition Therapy Low dietary intake Altered taste perceptions and appetite Because of mouth breathing Elevated REE (resting energy expenditure) May also have increased inflammation

10. COPD Nutrition Therapy - Interventions Maintain optimal energy balance Maintain body weight 125%-165% of BEE 25-35 kcal per kg of body weight Consume 20% more protein Overfeeding concern with ventilation Glucose >5 mg/kg/min increases CO 2 production Commercial formulas - low CHO (30%) and higher lipid (50%) Pulmacare supplement

11. COPD Nutrition Therapy - Interventions Supplement antioxidants Monitor serum phosphate Phosphate needed for ATP production Often low in patients Monitor status of calcium and vit. D 1200-1500 mg calcium 400 IU vitamin D Identify specific nutrition problems Manage weight Sedentary lifestyle common

13. Cystic Fibrosis Life long, starts early on, genetic condition Progressive disease May need to go on tube feeding to increase calories Nutrition Poor digestion, absorption of vitamins A, D, E and K, malnutrition d/t pancreatic insufficiency Malabsorptiion of calcium, phosphorus, magnesium, vitamins D and K Treat with corticosteriods Abnormal growth Risk for osteopenia (impaired bone growth) and osteoporosis

14. Cystic Fibrosis Diagnose between birth and 1 year Nutrition Assessment National CF Foundation consensus guidelines - nutrition guidelines Special attention to poor growth: During first year after diagnosis Use growth charts – CDC Growth important before puberty Head circum, length (height) Risk greatest between 10%-25% on charts (10% most dangerous) Timeline

15. Cystic Fibrosis Pancreatic enzyme therapy (take before a meal) Given with food and beverages Individualized Adequate kcal for normal growth based on weight gain patterns Higher fat intake (35-45% kcal) MCT (6-12 carbons, shorter than triglycerides, water soluble)- easily absorbed fats Glucose intolerance common Usually convert to diabetic in teen years (type 2)

17. *Cystic Fibrosis Monitor vitamin & mineral status Monitor sodium levels Assess iron and zinc status Recommend breast feeding Developmentally appropriate recommendations Formulas or nutritional supplements Don’t want to fluid overload Want adequate calories and nutrients Make formula more calorie dense

18. Respiratory Failure Patient is on transplant list Nutrition Meet nutrition needs Preserve lean body mass (respiratory muscle) Energy needs vary widely; may be hypermetabolic Protein and fat main source of energy 1.2-1.5g of protein per kg of body weight 25kcal per kg of body weight Avoid overfeeding (especially carbohydrates) Indirect calorimetry preferred method Preserve and restore LBM; respiratory muscle mass

19. Respiratory Failure Nutrition Maintain fluid balance 1.5-2 calories per cc of fluid Facilitate weaning from ventilation Specialty formulas available EPA and GLA can reduce severity of inflammation (fish oils) Supplementation with antioxidants Beta carotene, vitamin C Phosphate supplementation