Definition;

•    Chronic obstructive pulmonary diseases COPD Chronic obstructive pulmonary disease is a progressive disease that limits airflow through

• Either inflammation of the lining of bronchial tube bronchitis destruction or destruction of alveoli( emphysema ) 

• Chronic bronchitis is is defined using the criteria of a productive cough and shortness of breath that lasts about three month or more each year for two or more years in a row.

• Most cases of emphysema are caused by inflammation of the airways and lungs tissue.

• Frequently, both conditions coexist as part of the disorder 

    Epidemiology:

• The primary risk factors for the development of COPD is smoking.

• Other risk factors includes the air pollution, secondhand smoke, history of childhood infections and occupational exposure to certain industrial pollutants.

• Although normal lung function generally decline with age, individuals who are smokers have a more rapid decline-twice the rate of non smokers.

• Low body weight has also been shown to be a risk factor for the development of COPD.

   Etiology:

• Cigarette smoking is the primary cause; the longer and more heavily a person smokes, the more likely it is that he or she will develop bronchitis.

• Second-hand smoke may also cause bronchitis.

• Chronic bronchitis is seen in people's of all ages but is more common in individual over the age of 45.

• Females are more chances to be diagnosed with chloric bronchitis than males.

• Emphysema develops generally over years, usually as a result of the exposure to cigarette smoke.

    Pathophysiology:

     Chronic bronchitis

• Repeated exposure to cigarette smoke and other pollutants results in generalized inflammatory response.

• The walls of the airways thicken and mucus glands become hyperplastic.

• The damaged cilia are unable to clean mucus from the airways and the patient is unable to increase the work of breathing enough to overcome the signs and symptoms of the disease.

• The thickened and mucus provides and an environment conducive to bacterial growth and chronic respiratory infection are common.

    Clinical manifestation:

    Chronic bronchitis;

Chronic bronchitis is characterized by.

• Decreased air flow rates 

• Dyspnea 

• Hypoxemia (low O2 conc. In blood)

• Hypercapnia (increased CO2 in blood)

• The quality of life for persons diminishes resulting in an inability to work.
• .
• Malnutrition is also common in individual will  COPD.

• As the effort to breathe increases, the intake of the food intake main decreases.

• Often, individuals with COPD eventually require the supplemental oxygen.

• Chronic respiratory disease leads to increase the work of the heart ❤️

   Clinical Manifestations:

      Emphysema;

• Infer schema results in a decreased forced expiratory volume.

• Though inspiration is not impaired, expiration is, because air is trapped within the lungs.

• This inability to expire results in dyspnea and orthopnea and causes the development of a"barrel chest".

• Patients with emphysema do not experience hypoxemia until the last stages of disease, when extreme fatigue and physical exhausted prevent adequate oxygen intake.

Nutrition therapy for chronic obstructive pulmonary disease;

Nutrition assessment and diagnosis; 

• Assessment should include and evolution of:

• Anthropometric measurements

• Food/nutrition-related history

• Medication and herbal supplement use

• Physical activity and function

• Measuring loss of fats-free body mass may be a better prognostic indicator of mortality than weight loss or BMI.

• Based on this assessment, nutrition problems can be identified and goals for the individual patient can be established.

    Anthropometric measurements:

• Weight loss occurs frequently, particularly in individuals with emphysema, and is associated with increased resting energy expenditure due to the work of breathing, reduce nutrient intake, and inefficient fuel metabolism.

• In contrast, individuals with bronchitis frequently have normal or above normal BMI.

• Losses of lean body mass LBM, however ,have been seen in what conditions.

• Obese individuals have difficulty breathing caused by restrictions on the chest wall due to accumulation of fats in and around the thoracic cage, diaphragm and abdomen.

• This results in reduced lung volume accompanied by poor Oxygen and carbon dioxide exchange.

   Food/Nutrition-Related History:

• Low dietary intake, weight loss, and cachexia occur in individuals with moderate to severe COPD. 

• Taste perceptions may be altered with the chronic mouth breathing and appetite may be for the reduced as a result of depression.

• Look for antioxidant, vitamin D, and calcium intake.

     Medication use:

• The use of glucosorticosteroid in the treatment of COPD has been shown to increase the incidence of osteoporosis.

• Glucocorticosteroids decreases the intestinal absorption of the calcium and increase urinary excretion, resulting in an increase in parathyroid hormone levels and bone resorption.

   Physical activity and functions:

• The patient tire easily when eating or experience dyspnea during eating and drinking.

• Fatigue resulting from dyspnea may also interfere with eating.

• Chewing and swallowing may be impaired since both activities change breathing patterns and reduce oxygen uptake.  

• Chronic mouth breathing or certain medication may also cause changes in taste perceptions or xerostomia.

   Nutrition interventions:

    Energy and Nutrients Needs:

• Maintaining optimal energy balance in the individual with COPD is essential in order to preserve body weight, lamb body weight, and general way being.

• It is essential that the individual with COPD receive sufficient kcal and protein.

• Energy intake of one 125% to 156% (average 140%) above basal energy expenditure.

• Protein intake of 1.2 to 1.7 g/ kg body weight (average 1.2g/kg) are adequate to avoid protein losses in patients admitted to hospital.

   Food or nutrients delivery:

• Commercial enteral formulas that have been specifically designed for individuals with respiratory disease contain lower carbohydrate content 30% and higher lipid  content 50%.

• One potential negative side effect of higher-fat meals or supplements is delayed gastric emptying which may result in abdominal discomfort, bloating or early satiety.

• Consuming foods that are not only good sources of both kcal and protein but are also nutrients dense.

• Instruct individuals to rest before meals to avoid fatigue.

• Eating smaller, more frequent meals rather than three larger ones may help to alleviate the feeling of fullness and bloating.

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What are the symptom of (COPD)?

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Pulmonary diseases and nutrition / asthma