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FIG.\t33.7\nThe\toverlap\tof\tasthma,\tchronic\tbronchitis,\tand\temphysema\tmaking\tup\tchronic\tobstructive\tpulmonary\ndisease\t(COPD).\nPatients\twith\tprimary\temphysema\tsuffer\tfrom\tgreater\tdyspnea\tand\tcachexia.\tOn\tthe\tother\thand\npatients\twith\tbronchitis\thave\thypoxia,\t\nhypercapnia\n\t(increased\tamount\tof\tCO\n2\n),\tand\tcomplications | [
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hypercapnia\n\t(increased\tamount\tof\tCO\n2\n),\tand\tcomplications\nsuch\tas\tpulmonary\thypertension\tand\tright\theart\tfailure\t(\nPapaioannou\tet\tal,\t2013\n).\nAlpha-1\tantitrypsin\tdeficiency\tis\tpresent\tin\t1%\tto\t2%\tof\tCOPD\tpatients\tand\tis\tlikely\nunderrecognized.\tCOPD\texacerbations\tcan\tbe\tcaused\tby\t\nHaemophilus\tinfluenzae\n,\t\nMoraxella\ncatarrhalis\n, | [
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Haemophilus\tinfluenzae\n,\t\nMoraxella\ncatarrhalis\n,\t\nStreptococcus\tpneumonia\n,\trhinovirus,\tcoronavirus,\tand\tto\ta\tlesser\tdegree,\torganisms\nsuch\tas\t\nP.\taeruginosa\n,\t\nS.\taureus\n,\tMycoplasma\tspp.,\tand\t\nChlamydia\tpneumoniae\n.\tAllergies,\tsmoking,\ncongestive\theart\tfailure,\tpulmonary\n\tembolism,\tpneumonia,\tand\tsystemic\tinfections\tare\tthe\treason\tfor | [
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embolism,\tpneumonia,\tand\tsystemic\tinfections\tare\tthe\treason\tfor\n20%\tto\t40%\tof\tCOPD\texacerbations\t(\nNakawah\tet\tal,\t2013\n).\nProlonged\ttobacco\tuse\tis\tassociated\twith\tan\tincreased\trisk\tof\thaving\tCOPD\tbesides\tother\nrespiratory\tdisorders\t(\nLiu\tet\tal,\t2015\n).\tOsteoporosis\tin\tCOPD\tpatients\tnot\tonly\tpredisposes\tpatients | [
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inflammation.\tThis\tleads\tto\tbone\tloss\tby\tinhibiting\tbone\tmetabolism.\tLack\tof\tsun\texposure\tand\nphysical\tactivity\twith\tCOPD\tleads\tto\ta\tlack\tof\t25-hydroxy\tvitamin\tD\t(25[OH]D),\twhich\tregulates\tbone\nmetabolism\tby\tpromoting\tthe\tabsorption\tof\tcalcium\t(\nXiaomei\tet\tal,\t2014\n).\nFactors\tthat\tinfluence | [
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Xiaomei\tet\tal,\t2014\n).\nFactors\tthat\tinfluence\n\tthe\tprognosis\tof\tCOPD\tare\tthe\tseverity\tof\tdisease,\tgenetic\tpredisposition,\nnutritional\tstatus,\tenvironmental\texposures,\tand\tacute\texacerbations.\nMedical\tmanagement\nIn\tgeneral,\tCOPD\ttherapies\thave\ta\tlimited\teffect\tcompared\twith\ttherapies\tfor\tasthma.\tWith\tthe | [
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exception\tof\tsmoking\tcessation,\tno\tdisease-modifying\tmedications\texist\tthat\tcan\tchange\tthe\nprogression\tof\tairway\tobstruction\tin\tCOPD.\n\tThe\tairflow\tobstruction\tin\tCOPD\tis\tirreversible.\nInhaled\tbronchodilators\tremain\tthe\tmainstay\tof\ttreatment\tfor\tCOPD\tpatients.\tUsually\tthese\tare | [
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] |
given\tby\tmetered\tdose\tinhalers\t(MDI),\tbut\tfor\tsevere\tdyspnea\tor\tthose\tunable\tto\tuse\tinhalers\t(i.e.,\narthritis,\tcognitive\tdysfunction),\tthey\tmay\tbe\tadministered\tin\ta\tnebulized\tform.\tAnticholinergic\nmedications\tsuch\tas\tipratropium\tbromide\tor\tSpiriva\t(tiotropium\n\tbromide),\ta\tlong-acting | [
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readmission\tfor\tCOPD\thas\tbecome\ta\thealth\tcare\tpolicy\tgoal.\tIdentifying\treasons\tfor\treadmissions\tare\nimportant.\tSome\tof\tthese\treasons\tinclude\tdepression,\tsmoking,\tanxiety,\tGERD,\treduced\tfunctional\nstatus,\tunwillingness\tto\tuse\n\toxygen,\tand\tmalnutrition.\nPulmonary\thypertension\tis\ta\trisk\tfactor\tthat\tshortens\tlife\texpectancy\tand\tis\tcommon\tin\tadvanced | [
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COPD.\tThe\tfirst\tstep\tin\ttreating\tpulmonary\thypertension\tin\tpatients\twith\tCOPD\tis\tappropriate\nmedical\tmanagement\tof\ttheir\tobstructive\tlung\tdisease,\tas\tmentioned\tearlier.\nPatients\twith\tlow\toxygen\tlevels\t(hypoxemic)\tneed\tsupplemental\toxygen.\tPulmonary\trehabilitation\nmay\tbe\thelpful | [
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] |
may\tbe\thelpful\n\tin\tadvanced\tCOPD.\tPatients\twith\tsevere\tCOPD\tmay\tsuffer\trespiratory\tfailure\trelated\nto\tcomplications\tsuch\tas\tpneumothorax,\tpneumonia,\tand\tcongestive\theart\tfailure,\tor\tdue\tto\nuncontrolled\tadministration\tof\thigh-dose\toxygen\tor\tnarcotic\tsedatives.\tThe\tpatients\tin\trespiratory\nfailure\tneed\tmechanical\tventilation\t(\nFig.\t33.8\n). | [
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FIG.\t33.8\nAn\tintensive\tcare\tunit\t(ICU)\tpatient\ton\tventilator.\nIn\taddition\tto\tfacing\tmajor\tphysical\timpairment\tand\tchronic\tdyspnea,\tCOPD\tpatients\tare\tat\tan\nincreased\trisk\tof\tdeveloping\tdepression\tthat\tshould\tbe\tidentified\tand\ttreated.\nMedical\tnutrition\ttherapy | [
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with\tCOPD\t(\nHill\tet\tal,\t2013\n).\tInfection\twith\tfever\tincreases\tmetabolic\trate\teven\tfurther\t(see\t\nChapter\n2\n).\tMalnourished\tpatients,\tidentified\tas\tthose\thaving\tdecreased\tbody\tweight,\treduced\tfat-free\tbody\nmass,\tor\ta\tBMI\t≤20\tkg/m\n2\n,\tare\tlikely\n\tto\thave\tmore\tCOPD\texacerbations\tand\ta\tshorter\tsurvival\ttime\nthan\tthose\twho\tare\twell-nourished\t( | [
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malnutrition.\tA\tcombination\tof\tnutritional\tcounseling\tand\tnicotine\treplacement\tseems\tto\toptimize\nsuccess\t(\nHill\tet\tal,\t2013\n).\nStudies\thave\tshown\tan\tinverse\trelationship\tbetween\tdietary\tiron\tand\tcalcium\tintake\tand\tCOPD\nrisk.\tIron\tdeficiency\tanemia\tis\tseen\tin\t10%\tto\t30%\tof\tpatients\twith\tCOPD\t(\nSilverberg\tet\tal,\t2014\n).\tIt | [
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Silverberg\tet\tal,\t2014\n).\tIt\nhas\tbeen\tseen\tthat\tcorrecting\tthe\tanemia\tand\tiron\tdeficiency\tby\teither\tblood\ttransfusions\tor\nintravenous\tiron\ttherapy\timproves\tdyspnea\t(shortness\tof\tbreath)\tin\tCOPD\tpatients\t(\nSilverberg\tet\tal,\n2014\n).\tCOPD\tpatients\tare\talso\tat\thigher\trisk\tof\tdeveloping\tosteoporosis\tresulting\tfrom\tsteroid\tusage, | [
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smoking,\tand\tvitamin\tD\tdepletion.\tMaintaining\tadequate\tlevels\tof\t25(OH)D\tis\timportant\tfor\tCOPD\npatients\t(\nLee\tet\tal,\t2013\n;\tsee\t\nAppendix\t38\n).\nThe\tprimary\tgoals\tof\tnutrition\tcare\tfor\tpatients\twith\tCOPD\tare\tto\tfacilitate\tnutritional\twell-being,\nmaintain\tan\tappropriate\tratio\tof\tLBM\tto\tadipose\ttissue,\tcorrect\n\tfluid\timbalance,\tmanage\tdrug- | [
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nutrient\tinteractions\t(see\t\nAppendix\t13\n),\tand\tprevent\tosteoporosis.\nNutritional\tdepletion\tmay\tbe\tevidenced\tclinically\tby\tlow\tbody\tweight\tfor\theight\tand\tdecreased\tgrip\nstrength.\tCalculation\tof\tBMI\tmay\tbe\tinsufficient\tto\tdetect\tchanges\tin\tfat\tand\tmuscle\tmass.\tInstead, | [
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determination\tof\tbody\tcomposition\thelps\tto\tdifferentiate\tlean\tmuscle\tmass\tfrom\tadipose\ttissue\tand\noverhydration\n\tfrom\tdehydration.\tIn\tpatients\twith\t\ncor\tpulmonale\n\t(increased\tblood\tpressure\tthat\nleads\tto\tenlargement\tand\tfailure\tof\tthe\tright\tventricle\tof\tthe\theart)\tand\tthe\tresultant\tfluid\tretention, | [
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weight\tmaintenance,\tor\tgain\tfrom\tfluid\tmay\tcamouflage\tactual\twasting\tof\tLBM.\tThus\tfor\tpatients\nretaining\tfluids,\tcareful\tinterpretation\tof\tanthropometric\tmeasurements,\tbiochemical\tindicators,\tand\nfunctional\tmeasures\n\tof\tnutrition\tstatus\tare\tnecessary\t(see\t\nChapter\t5\n\tand\t\nAppendices\t11\n\tand\t\n12\n). | [
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] |
Chapter\t5\n\tand\t\nAppendices\t11\n\tand\t\n12\n).\nA\tcombination\tof\tprotein\trich\tsupplements\tand\tanabolic\tsteroids\tcan\tincrease\tmuscle\tmass\tand\nreverse\tany\tnegative\teffects\tof\tweight\tloss.\tExercise\ttolerance\thas\tbeen\tshown\tto\timprove\twith\ta\ndietary\tsupplement\tthat\tcontains\tomega-3\tPUFA,\twhich\thas\tantiinflammatory\teffects\t(\nBerman,\t2011\n)\n(see\t\nChapter\t7\n). | [
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] |
Berman,\t2011\n)\n(see\t\nChapter\t7\n).\nAdipokines\tis\n\ta\tgeneric\tterm\tfor\tthe\tbioactive\tproteins\tthat\tare\tsecreted\tby\tadipocytes.\tThey\ninclude\tadiponectin,\tleptin,\tIL-6,\tand\tTNF-α.\tThey\tplay\ta\tvital\trole\tin\tinfluencing\tthe\tnutritional\nstatus\tand\tregulating\tthe\tappetite.\t\nLeptin\n\t(satiety\thormone)\tis\tsecreted\tpromptly\tin\tresponse\tto\tfood | [
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Leptin\n\t(satiety\thormone)\tis\tsecreted\tpromptly\tin\tresponse\tto\tfood\nintake\tand\tplays\ta\trole\tin\tsuppressing\tappetite\tand\tenhancing\tenergy\texpenditure.\tIt\thas\tbeen\nsuggested\tthat\tmeasuring\n\tlevels\tof\tleptin\tin\tthe\tsputum\tcan\tbe\tuseful\tin\tdetermining\tthe\tseverity\tof\nlung\tdisease\tbecause\tit\thas\tbeen\tshown\tto\tincrease\tduring\tacute\texacerbations\t( | [
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Itoh\tet\tal,\t2013\n).\nAdiponectin\n\t(a\tprotein\tinvolved\tin\tfatty\tacid\tbreakdown\tand\tglucose\tregulation),\tlike\tleptin,\tis\nsecreted\tfrom\tadipocytes,\tbut\thas\tan\topposite\teffect.\tAdiponectin\tenhances\tappetite\tand\thas\tan\nantiinflammatory,\tantidiabetic,\n\tand\tantiatherosclerotic\teffect\tand\tis\tconsidered\tbeneficial.\t\nResistin\n, | [
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Resistin\n,\nanother\tadipokine,\tinduces\tinflammation\tand\tinsulin\tresistance.\tIn\taddition\tto\tbeing\tan\tappetite\nstimulant,\t\nghrelin\n\talso\tstimulates\tgrowth\thormone\tsecretion,\twith\tantagonistic\teffects\tto\tleptin.\nTable\t33.2\n\tsummarizes\tthe\tfunctions\tand\tchange\tin\tthe\tblood\tlevels\tof\tthese\tadipokines\tin\tCOPD\npatients,\tand\thow\tthey\tcan\tinfluence | [
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patients,\tand\thow\tthey\tcan\tinfluence\n\tmanagement\tand\trecovery\t(\nItoh\tet\tal,\t2013\n).\nTABLE\t33.2\nBlood\tLevels\tof\tHormones\tand\tAdipokines\tin\tPatients\twith\tChronic\tObstructive\tPulmonary\tDisease\t(COPD)\nHormone\nFunction\nChanges\tin\tBlood\tLevels\twith\tCOPD\nLeptin\n•\t\nSuppresses\tappetite\n•\t\nPromotes\tinflammation\n•\t\nRegulates\thematopoiesis, | [
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] |
•\t\nPromotes\tinflammation\n•\t\nRegulates\thematopoiesis,\nangiogenesis,\tand\twound\thealing\nDecreased\tin\tpatients\twith\ta\tlow\tBMI\ncompared\twith\tpatients\twith\n\ta\tnormal\tand\nhigh\tBMI\nGhrelin\nStimulates\tappetite\tand\trelease\tof\ngrowth\thormone\nIncreased\tin\tunderweight\tpatients\ncompared\twith\tnormal\tweight\tpatients\nAdiponectin\n•\t\nStimulates\tfatty\tacid\toxidation | [
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Adiponectin\n•\t\nStimulates\tfatty\tacid\toxidation\n•\t\nIncreases\tinsulin\tsensitivity\tand\ninhibits\tinflammatory\tprocess\nIncreased\tduring\tacute\texacerbation\nDecreased\tlevels\tin\tcurrent\tsmokers\nResistin\nPromotes\tinflammation\tand\tinsulin\nresistance\n\tby\tthe\tproduction\tof\tIL-6\nand\tTNF-α\nInversely\tcorrelated\twith\tpredicted\tFEV\n1\n\t%\nTNF-α | [
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FEV1\n,\tforced\texpiratory\tvolume;\t\nIL-6\n,\tinterleukin-6;\t\nTNF-\nα,\ttumor\tnecrosis\tfactor\n\talpha.\nAdapted\tfrom\tItoh\tM,\tet\tal:\tUndernutrition\tin\tpatients\twith\tCOPD\tand\tits\ttreatment,\t\nNutrients\n\t5:1316,\t2013.\nMacronutrients\nIn\tstable\tCOPD,\trequirements\tfor\twater,\tprotein,\tfat,\tand\tcarbohydrate\tare\tdetermined\tby\tthe | [
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underlying\tlung\tdisease,\toxygen\ttherapy,\tmedications,\tweight\tstatus,\tand\tany\tacute\tfluid\tfluctuations.\nAttention\tto\tthe\tmetabolic\tside\teffects\tof\tmalnutrition\tand\tthe\n\trole\tof\tindividual\tamino\tacids\tis\nnecessary.\tDetermination\tof\ta\tspecific\tpatient’s\tmacronutrient\tneeds\tis\tmade\ton\tan\tindividual\tbasis,\nwith\tclose\tmonitoring\tof\toutcomes.\nEnergy | [
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with\tclose\tmonitoring\tof\toutcomes.\nEnergy\nMeeting\tenergy\tneeds\tcan\tbe\tdifficult.\tFor\tpatients\tparticipating\tin\tpulmonary\trehabilitation\nprograms,\tenergy\trequirements\tdepend\ton\tthe\tintensity\tand\tfrequency\tof\texercise\ttherapy\tand\tcan\nbe\tincreased\tor\tdecreased.\n\tIt\tis\tcrucial\tto\tremember\tthat\tenergy\tbalance\tand\tnitrogen\tbalance\tare | [
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intertwined.\tConsequently,\tmaintaining\toptimal\tenergy\tbalance\tis\tessential\tto\tpreserving\tvisceral\nand\tsomatic\tproteins.\tPreferably,\tindirect\tcalorimetry\tshould\tbe\tused\tto\tdetermine\tenergy\tneeds\tand\nto\tprescribe\tand\tmonitor\tthe\tprovision\tof\tsufficient,\tbut\tnot\texcessive\tcalories.\tWhen\tenergy\nequations\tare\tused\tfor\tprediction\tof | [
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] |
equations\tare\tused\tfor\tprediction\tof\n\tneeds,\tincreases\tfor\tphysiologic\tstress\tmust\tbe\tincluded.\tCaloric\nneeds\tmay\tvary\tsignificantly\tfrom\tone\tperson\tto\tthe\tnext\tand\teven\tin\tthe\tsame\tindividual\tover\ttime\n(see\t\nChapter\t2\n).\nFat\nOmega-3\tand\tomega-6\tare\tPUFAs\tthat\tare\tessential\tfatty\tacids.\tThe\tsimplest\tforms\tof\tthese\tfatty | [
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] |
acids\tare\tthe\tomega-6\tlinoleic\tacid\t(LA)\tand\talpha-linolenic\tacid\t(ALA).\tThe\tbody\tis\tunable\tto | [
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] |
synthesize\tthem,\n\tand\tthey\tmust\tbe\tconsumed\tin\tthe\thuman\tdiet.\tThese\tfatty\tacids\tare\tdesaturated\tto\nform\tlong-chain\tomega-3\tPUFAs\tor\tomega-6\tPUFAs.\tDocosahexaenoic\tacid\t(DHA),\teicosapentaenoic\nacid\t(EPA),\tand\tALA\tare\tthe\tmajor\tomega-3\tPUFAs,\tand\tthe\tmajor\tlong-chain\tomega-6\tfatty\tacids\tare\nLA\tand\tarachidonic\tacid\t(AA).\tSee\t\nAppendix\t26 | [
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LA\tand\tarachidonic\tacid\t(AA).\tSee\t\nAppendix\t26\n\tfor\tthe\tsources\tof\tthese\tfatty\tacids\tin\tthe\tdiet.\tIn\ntheory,\tintake\tof\tlong-chain\n\tomega-3\tPUFAs,\twhich\treduces\tinflammation,\tshould\timprove\tthe\nefficacy\tof\tCOPD\ttreatments.\tPUFA\tsupplementation\tis\tbeneficial\tin\tCOPD,\tbut\tvarious\tfactors\tsuch | [
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as\tsupplement\tadherence,\tcomorbidities,\tand\tduration\tof\tthe\tsupplementation\tplay\tvital\troles\t(\nFulton\net\tal,\t2013\n).\nDietary\tsupplementation\tof\tDHA\tand\tAA\thas\tbeen\tshown\tto\tdelay\tand\treduce\trisk\tof\tupper\nrespiratory\tinfections\tand\tasthma,\n\twith\tlowering\tthe\tincidence\tof\tbronchiolitis\tduring\tthe\tfirst\tyear\nof\tlife\t(\nShek\tet\tal,\t2012 | [
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protein,\tfat,\tand\tcarbohydrate\tprescribed.\nVitamins\tand\tminerals\nAs\twith\tmacronutrients,\tvitamin\tand\tmineral\trequirements\tfor\tindividuals\twith\tstable\tCOPD\tdepend\non\tthe\tunderlying\tpathologic\tconditions\tof\tthe\tlung,\tother\tconcurrent\n\tdiseases,\tmedical\ttreatments, | [
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diseases,\tmedical\ttreatments,\nweight\tstatus,\tand\tbone\tmineral\tdensity.\tFor\tpeople\tcontinuing\tto\tsmoke\ttobacco,\tadditional\tvitamin\nC\tis\tnecessary\t(see\t\nAppendix\t35\n).\tOne\tstudy\tindicated\tthat\tvitamin\tC’s\trole\tas\tan\tantioxidant\nimproved\tplasma\tglutathione\tlevels\t(\nPirabbasi\tet\tal,\t2016\n). | [
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should\tbe\tprovided.\tDepending\ton\tbone\tmineral\tdensity\ttest\tresults,\tcoupled\twith\tfood\tintake\thistory\nand\tglucocorticoid\tmedications\tuse,\tadditional\tvitamins\tD\tand\tK\talso\tmay\tbe\tnecessary\t(see\t\nChapter\n23\n).\nPatients\twith\tcor\tpulmonale\tand\tsubsequent\tfluid\tretention\trequire\tsodium\tand\tfluid\trestriction.\nDepending\ton\tthe | [
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Depending\ton\tthe\n\tdiuretics\tprescribed,\tincreased\tpotassium\tsupplementation\tmay\tbe\trequired\n(\nAppendix\t13\n).\tAnd\tother\twater-soluble\tvitamins,\tparticularly\tthiamin,\tmay\tneed\tto\tbe\tsupplemented.\nPatients\tare\trecommended\tto\tdrink\tadequate\tfluids\tand\tstay\thydrated\tto\thelp\tsputum\tconsistency | [
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and\teasier\texpectoration.\tThe\tParenteral\tand\tEnteral\tNutrition\tGroup\t(PENG)\trecommends\ta\tfluid\nintake\tof\t35\tmL/kg\tbody\tweight\n\tdaily\tfor\tadults\t18\tto\t60\tyears\tand\t30\tmL\tof\tfluid/kg\tbody\tdaily\tfor\nadults\tover\t60\tyears\t(\nPENG,\t2011\n).\nCOPD\tpatients\treport\tdifficulties\twith\teating\tbecause\tof\tlow\tappetite,\tincreased\tbreathlessness | [
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when\teating,\tdifficulty\tshopping\tand\tpreparing\tmeals,\tdry\tmouth,\tearly\tsatiety\tand\tbloating,\tanxiety\nand\tdepression,\tand\tfatigue.\tIn\taddition\tto\tthe\tabove,\tinefficient\tand\toverworking\trespiratory\nmuscles\tlead\tto\tincreased\tnutritional\trequirements\t(\nEvans,\t2012\n).\nPatients\tin\tthe\tadvanced\tstage\tof\tCOPD | [
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Evans,\t2012\n).\nPatients\tin\tthe\tadvanced\tstage\tof\tCOPD\nPatients\twith\tadvanced\tCOPD\tare\tundernourished\tand\tin\ta\tstate\tof\t\npulmonary\tcachexia\n,\twhich\tis\ndefined\tas\ta\tBMI\tof\tless\tthan\t17\tin\tmen\tand\tless\tthan\t14\tin\twomen\t(\nAllen\tet\tal,\t2017\n).\tThe\tcause\tof\ncachexia\tin\tadvanced\tCOPD\tis\tpoorly\tunderstood.\tThe\trole\tfor\tmyostatin\thas\tbeen\tsuggested. | [
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the\tmainstays\tof\tCOPD\ttreatment\tin\tsuch\tpatients\t(\nItoh\tet\tal,\t2013\n).\tSarcopenia\tand\tcachexia\tresult\nfrom\tthe\taccelerated\tloss\tof\tlean\ttissue\t(\nRaguso\tand\tLuthy,\t2011\n).\tThis\tmuscle\twasting\thas\ta\ndetrimental\teffect\ton\tthe\trespiratory\tfunction\t(\nCollins\tet\tal,\t2012\n). | [
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dyspnea.\tSmoking,\tlow\tBMI,\tlow\tskeletal\tmuscle\tmass,\tand\tcorticosteroid\tusage\tcan\tlead\tto\tbone\nloss\talong\twith\n\tlow\tserum\tvitamin\tD\tlevels\t(\nEvans\tand\tMorgan,\t2014\n)\t(\nBox\t33.2\n).\nBOX\t33.2\nPlanning\tthe\tDiet\tfor\tthe\tPatient\twith\tPulmonary\tCachexia\nEnergy\trequirements\tduring\thealing\t=\t30\tkcal/kg\tof\tusual\tbody\tweight\tor\t13.7\tcal/usual\tbody | [
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per\tday\nFluid\trequirements\tare\tincreased\tbecause\tof\tfever,\tchemotherapy\tregimen,\toxygen\tuse,\tand\npresence\tof\tchronic\tobstructive\tpulmonary\tdisease\t(COPD).\tLack\tof\tenergy\tor\tdehydration\nincreases\tfatigue\tand\tconstipation.\tFluid\tdeficits\tof\t1%\tbody\tweight\tlower\tmetabolic\tfunction\tby\n5%.\nLevin\tRM:\t\nNutrition\tin\tthe\tpatient\twith\tlung\tcancer,\tcaring | [
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5%.\nLevin\tRM:\t\nNutrition\tin\tthe\tpatient\twith\tlung\tcancer,\tcaring\n\tambassadors\tlung\tcancer\tchoices\n\t(website).\nhttp://lungcancercap.org/wp-content/uploads/2014/10/Chapter_8_2014.pdf\n,\t2012.\nPulmonary\thypertension\nPulmonary\thypertension\t(PH)\n\tis\tdefined\tas\televated\tpressure\twithin\tthe\tpulmonary\tcirculation | [
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is\tdefined\tas\televated\tpressure\twithin\tthe\tpulmonary\tcirculation\nthat\tincludes\tthe\tpulmonary\tartery,\tcapillaries,\tand\tpulmonary\tveins.\tThe\tpulmonary\tartery\ttakes\ndeoxygenated\tblood\tfrom\tthe\tright\tventricle\tinto\tthe\n\tsmall\tcapillaries,\twhere\tgas\texchange\ttakes\nplace,\tand\toxygenated\tblood\treturns\tvia\tthe\tpulmonary\tvein\tinto\tthe\tleft\tatrium. | [
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Patients\twith\tPH\tusually\tcomplain\tof\tshortness\tof\tbreath,\tmainly\ton\texertion.\tAs\tthe\tdisease\nadvances,\tthe\tshortness\tof\tbreath\tbecomes\tmore\tprominent\teven\tat\trest,\tand\tpatients\thave\nsymptoms\trelated\tto\thypoxia\tsuch\tas\theadache,\tdizziness,\tand\tchest\tpain.\tUpon\tevaluation\n\tby\ta | [
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by\ta\npulmonologist\tor\tcardiologist,\tsome\tof\tthe\timportant\tsigns\tto\tlook\tfor\twould\tinclude\tcardiac\tmurmur,\nright-sided\tventricular\theave\t(the\theel\tof\thand\tlifts\toff\tthe\tchest\twith\tevery\tbeat,\tindicating\tan\nenlarged\tright\tventricle),\tloud\theart\tsound,\tand\tan\televated\tjugular\tvein\tpressure.\t\nCyanosis\n\tcan\tbe | [
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artery\tpressure,\tusing\tright\theart\tcatheterization.\nElevated\tpulmonary\tcirculation\tpressure\tcan\toccur\tdue\tto\tprimary\tpulmonary\tartery\tdisease\n(primary\tPH)\tor\tsecondary\tto\tpulmonary\tor\textrapulmonary\tdiseases.\tIn\t2013\tthe\tWorld\tHealth\nOrganization\t(WHO)\tclassified\tPH\tinto\tfive\tcategories\t(\nHopkins\tand\tRubin,\t2018\n). | [
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Hopkins\tand\tRubin,\t2018\n).\nCategory\t1:\tPulmonary\tarterial\thypertension;\tPH\tdue\tto\tautoimmune\tdisorders,\thuman\nimmunodeficiency\tvirus\t(HIV),\ttoxins,\tdrugs,\tsickle\tcell\tdisease;\tporto-PH\nCategory\t2:\tPH\tdue\tto\tleft\theart\tdisease\nCategory\t3:\tPH\tdue\tto\tunderlying\tlung\tdisease\tsuch\tas\tCOPD,\t\ninterstitial\tpulmonary\nfibrosis\n\t(scar\ttissue\tin\tthe\tlungs) | [
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interstitial\tpulmonary\nfibrosis\n\t(scar\ttissue\tin\tthe\tlungs)\nCategory\t4:\tchronic\tthromboembolic\tPH\nCategory\t5:\tmultifactorial\tand\n\tunclear\tmechanisms\tleading\tto\tPH.\tExamples\tinclude\nsarcoidosis\t(a\tcondition\tthat\tcan\tlead\tto\tinflammation\tprimarily\tin\tthe\tlung\tand\tthe\tlymph\nnodes)\nMedical\tmanagement | [
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fatigue.\tIf\tthe\tdisease\n\tadvances,\tpatients\tbecome\thypoxic,\trequiring\toxygen,\tand\tare\tlimited\tin\ttheir\nphysical\tactivity.\tThe\tprognosis\tfor\tthese\tdiseases\tvary\tdue\tto\tthe\tunderlying\tcause\tand\tthe\tresponse\nto\ttreatment.\nIdiopathic\tpulmonary\tfibrosis\t(IPF)\n\tis\tthe\tmost\tcommon\tILD\tand\tis\tassociated\twith\tthe\tworst | [
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is\tthe\tmost\tcommon\tILD\tand\tis\tassociated\twith\tthe\tworst\nprognosis.\tIPF\tis\ta\tchronic\tprogressive\tdisease\tcharacterized\tby\tprogressive\tlung\tscarring.\tThe\nincidence\tof\n\tIPF\tis\t0.22\tto\t8.8/100,000\tin\tthe\tUnited\tStates.\tMen\tare\taffected\tmore\tthan\twomen.\nPatients\twith\tIPF\tcommonly\tpresent\tin\tthe\tsixth\tand\tseventh\tdecades\tof\tlife.\tTypical\tsymptoms\tare | [
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chronic\tshortness\tof\tbreath\tthat\tprogresses\tand\tnonproductive\tcough.\tPulmonary\tfunction\ttests\nshow\trestrictive\tpattern\twith\treduced\tvolumes.\tThe\tdiagnosis\tof\tIPF\tincludes\tthe\tfollowing: | [
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] |
1.\t\nExclusion\tof\tknown\tcauses\n\tof\tILD\tsuch\tas\tmedication,\tenvironmental\texposure,\tor\tsystemic\ndisorders\n2.\t\nSymptoms\tthat\tare\tconsistent\twith\tIPF\tsuch\tas\tchronic\tprogressive\tshortness\tof\tbreath,\nnonproductive\tcough,\tand\thypoxia\n3.\t\nCT\tscan\tconsistent\twith\tIPF\tpattern\n4. | [
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] |
3.\t\nCT\tscan\tconsistent\twith\tIPF\tpattern\n4.\t\nIf\tdiagnosis\tremains\tuncertain,\tthen\topen\tlung\tbiopsy\tand\thistologic\tconfirmation\tare\nnecessary\nPathophysiology\nMost\tcases\tof\tIPF\tare\tsporadic\talthough\n\tsome\tgenetic\tcomponent\thas\tbeen\tdescribed.\tRisk\tfactors\nfor\tIPF\tinclude\tsmoking\tand\texposures\tto\tmetals\tand\tsome\torganic\tdusts.\tGastroesophageal\treflux | [
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may\tcontribute\tto\tthe\tprogression\tof\tthe\tdisease\t(\nLederer\tand\tMartinez,\t2018\n).\nMedical\tmanagement\nThe\tevaluation\tand\tmanagement\tof\tIPF\trequires\ta\tpulmonologist,\tradiologist,\tand\tpathologist.\nInvestigations\tneed\tto\trule\tout\tother\tdiseases\tthat\n\tcould\tmimic\tIPF\tand\tto\tassess\tthe\tseverity\tof\tthe | [
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nintedanib).\tPirfenidone\tis\tassociated\twith\trash,\tphotosensitivity,\tand\tpossible\tgastrointestinal\ndisturbances\tsuch\tas\tdiarrhea,\tnausea,\tvomiting,\tor\tabdominal\tdiscomfort.\tDose\tadjustment\tmay\nhelp\trelieve\tsome\tof\tthese\n\tsymptoms.\tNintedanib\tis\tassociated\twith\tmore\tgastrointestinal\tside\teffects | [
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increased\toxygen\n\trequirements.\tTheir\tmanagement\tis\tmost\toften\tsupportive\tcare.\tHigh\tdoses\tof\nsteroids\twere\tused\tin\tthe\tpast\twith\tconflicting\tresults\tand\ttherefore\tare\tnot\talways\trecommended.\nPatients\twho\tbecome\tmore\tsymptomatic\tand\tworsen\tquickly\tmight\tbenefit\tfrom\tan\tearly\treferral\tto\ta\nlung\ttransplant\tcenter.\nPulmonary\tdiagnostic\ttests | [
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lung\ttransplant\tcenter.\nPulmonary\tdiagnostic\ttests\nPulmonary\tFunction\tTests\t(PFT):\tincludes\tspirometry,\tmeasuring\tlung\n\tvolumes,\tand\tdiffusion\ncapacity.\tUsed\tto\tdiagnose\tasthma\tand\tCOPD\tand\tto\tassess\tseverity\tof\tlung\tdisease\tsuch\tas\nILD.\nChest\tRadiograph\t(chest\tx-ray) | [
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ILD.\nChest\tRadiograph\t(chest\tx-ray)\nComputed\tTomography\t(CT)\tScan:\tscans\tcross-section\tof\tchest.\tMore\taccurate\tand\thigher\nsensitivity\tand\tspecificity\tcompared\twith\tchest\tx-ray.\tGreater\tradiation\texposure\tthan\tchest\nx-ray.\nBronchoscopy:\tScope\twith\ta\tcamera\tis\tinserted\tin\tthe\tmouth\n\tor\tnose\tand\tgoes\tthrough\tthe | [
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or\tnose\tand\tgoes\tthrough\tthe\nupper\tairways\tand\ttrachea.\tUsed\tfor\tairway\texamination,\tsampling\tfluid\tfor\tinfection\nworkup,\tand\tbiopsies\tto\trule\tout\tmalignancies\tor\tsarcoidosis.\nLung\tBiopsy:\teither\tby\tbronchoscopy\tor\tmore\tinvasive\tapproach\tin\tthe\toperating\troom\tby\nusing\tvideo-assisted\tthoracoscopic\tsurgery\t(VATS)\tand\trequiring\tgeneral\tanesthesia. | [
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may\tbe\tappropriate\tfor\tpatients\twith\tIPF:\n•\t\nsmall\tfrequent\tmeals\n•\t\nconsumption\tof\tmain\tmeal\twhen\tenergy\tlevel\tis\tat\tits\thighest\n•\t\nadequate\tcalories,\tprotein,\tvitamins,\tand\tminerals\tto\tachieve\tappropriate\tweight\n•\t\nuse\tof\tfoods\n\tthat\tare\teasily\tprepared\t(i.e.,\tmicrowave)\n• | [
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