I. Malnutrition and chronic obstructive pulmonary disease
1, chronic obstructive pulmonary disease patients why is often accompanied by malnutrition?
Foreign research shows that 30%-70% of patients with chronic obstructive pulmonary disease have different degrees of malnutrition, and the degree of malnutrition is more prominent with the aggravation of the disease, which is clinically called “pulmonary cachexia syndrome” in serious cases. Many scholars use nutritional status as an indicator to evaluate the prognosis of patients with chronic obstructive pulmonary disease. The necessary nutritional support for malnourished and normal patients can help the recovery of the disease. Reason: Qiu Xiaojian, Department of Respiratory Medicine, Beijing Tiantan Hospital
Increased energy consumption of the body: The daily energy consumption for breathing in patients with chronic obstructive pulmonary disease is greatly increased due to factors such as increased airway resistance, decreased compliance of the chest and lung, and decreased efficiency of diaphragm contraction due to lung overinflation.
Increased catabolism of the body: Infection, hypoxia and other pathophysiological abnormalities, and even anxiety, fear and other psychological factors put the body in a state of severe stress and high catabolism, resulting in a significant increase in energy expenditure and urea nitrogen excretion.
Reduced nutrient intake: Due to long-term hypoxia, hypercapnia, cardiac insufficiency and gastrointestinal stasis, the patient’s appetite is low and the digestion and absorption of the gastrointestinal tract are affected, resulting in insufficient nutrient intake in patients with chronic obstructive pulmonary disease.
Drug factors: In the process of clinical treatment, the use of corticosteroids and other drugs inhibits the synthesis of proteins and promotes the catabolism of proteins.
2.What is the effect of malnutrition on patients with chronic obstructive pulmonary disease?
First of all, long-term malnutrition can lead to muscle protein decomposition and muscle fiber atrophy, which will inevitably weaken the muscle contraction force. As the respiratory muscle needs to work continuously for a long time, thus prone to respiratory muscle fatigue, respiratory muscle effort. Secondly, when chronic obstructive pulmonary disease is accompanied by malnutrition, it can cause lung tissue damage and affect the repair of damaged muscle tissue. When patients have hypoproteinemia, the immune defense function of the body is reduced, and bronchopulmonary bacterial infections are likely to occur, which aggravates the condition of patients with slow obstructive pulmonary disease. This is manifested in the following ways.
Impaired lung function: In malnourished patients, due to the lack of necessary energy and nutritional support, the respiratory muscle, the power source of normal ventilation, lacks sufficient contraction and endurance, which inevitably affects the already deteriorated lung function, which is highlighted by the significant decrease in maximum inspiratory pressure, maximum expiratory pressure, maximum ventilation, and lung volume in patients with chronic obstructive pulmonary disease. Malnutrition also affects the respiratory center’s ability to respond to hypoxia and reduces the ventilatory drive, resulting in severely impaired ventilatory function in those patients with respiratory failure who rely on hypoxic stimulation to maintain ventilation.
Impaired organism and lung immunity: malnutrition can seriously impair the immune and defense functions of the body and lungs: 1. decreased cellular immune function of the body, especially T lymphocytes 2. decreased humoral immune function of the body and decreased serum immunoglobulin levels 3. decreased activity of the complement system 4. affected regeneration and repair of alveolar and bronchial epithelial cells 5. decreased bronchial cilia motility 6. in the airways Low level of secretory IgA.
3.How do we evaluate the nutritional status of patients with chronic obstructive pulmonary disease?
The nutritional status of a patient should be correctly determined before nutritional treatment and formulation of a reasonable nutritional support program for clinical patients. Clinically, experienced doctors judge the degree of malnutrition based on the patient’s medical history, diet and weight change, limb edema, etc. However, an accurate and detailed evaluation of the patient’s nutritional status is performed by a series of objective indicators.
Body morphological measurements: including body weight, triceps skinfold thickness, upper arm muscle circumference, etc.
Weight: the most direct parameter reflecting the nutritional status. By calculating the ideal weight percentage and the recent weight change rate, the nutritional status of the patient can be initially assessed. It is generally believed that patients with weight less than 90% of ideal weight have a higher 5-year mortality rate.
Ideal weight percentage (%) = actual weight / ideal weight × 100%
Recent weight change rate (%) = (usual weight – actual weight) / usual weight × 100%
Note: The ideal weight in the formula is simply calculated as: height (cm) – 105 = ideal weight (kg), which is normal within the range of +-10%.
Biochemical indicators: Albumin, transferrin and vitamin A aldehyde binding protein in blood can reflect the synthesis of protein in the body, but are affected by liver and kidney function; in addition, the determination of lymphocyte count in blood to assess the immune status of the body can assist in determining the nutritional status of the body.
4.How to allocate nutritional elements?
Nutrient composition: The human body relies on sugar, fat and protein as the three major nutrients to supply energy. Sugar is the main functional substance in the body, supplying about 65%-70% of the body’s energy, fat is also an important functional substance, accounting for about 15%-20% of the body’s total energy supply, protein can also be used as a functional substance, its proportion of energy supply is about 10%-15%.
Protein and carbohydrates (sugar and starch) contain 16.7J (4cal) of caloric energy per gram, so for patients with chronic obstructive pulmonary disease who are generally not seriously ill, it is appropriate to supplement such foods. For patients with respiratory failure, it is not advisable to eat foods with too much protein or sugar (starch), otherwise it will aggravate respiratory difficulties, because the respiratory quotient of carbohydrates is higher than that of fats and proteins, and excessive intake of carbohydrates will consume a lot of oxygen and produce a lot of carbon dioxide, which will inevitably increase the burden of ventilation, so too much carbohydrates should not be given to such patients. At the same time, attention should be paid to the supplementation of electrolytes, vitamins and trace elements such as phosphorus, potassium and magnesium. However, if a person is seriously ill and has respiratory distress, eating foods with too much protein will stimulate the respiratory center and increase the symptoms of shortness of breath. At this time, it is better to eat foods containing a high proportion of fat, and fat is as much as 37.6 J (9 kal) per gram of calories, which is beneficial to patients’ caloric supplementation.
Therefore, patients with slow obstructive pulmonary disease not only have increased energy needs, but also have special requirements for the ratio of the three major energy-producing nutrients in the diet. The respiratory quotients of protein, fat and carbohydrate are 0.7, 0.8, and 1.0, respectively, and Rochester et al. suggested that the functional ratios of protein, fat and carbohydrate for patients in remission of slow obstructive pulmonary disease are 15%, 35% and 50%, respectively.
The findings showed that some essential minerals, trace elements and vitamins, such as calcium, zinc, selenium, vitamin A, B1, B2, and C, were also significantly inadequate in the diets of patients in remission from chronic obstructive pulmonary disease, while the intake of iron and vitamin E basically met the RDA standards. Therefore, we should not neglect the supplementation of trace elements and vitamins when guiding patients with chronic obstructive pulmonary disease to adjust their diet.
5.How to choose the nutritional supplementation route?
For patients in remission and mild disease, transgastrointestinal nutrition therapy can be used. Oral supplementation is in line with normal physiological mechanism, which can directly provide nutrients required by intestinal mucosa, maintain the structural integrity of gastrointestinal mucosa, enhance the barrier function of intestinal mucosa, less water and electrolyte disorders, reduce the occurrence of stress ulcers, infections and hyperglycemia, and is easier to perform and less costly. For patients who are critically ill and cannot eat or have poor gastrointestinal function, extra-gastrointestinal nutrition support therapy can be used.
Second, dietary principles
1. Ensure high-quality protein supply. The quality and quantity of protein plays a big role in the prevention and treatment of chronic obstructive pulmonary disease. Daily protein intake should be sufficient to improve the body’s immune function. All kinds of fish, poultry, lean meat, eggs, milk and bean food, should be guaranteed as much as possible. Soybeans and their products contain the high quality protein that people need, which can supplement the loss of tissue protein caused by slow lung disease to the organism. Calories to rice, noodles, grains, according to the usual amount of food adequate supply, so that each meal with meat and vegetables, grain, beans, vegetables mixed food.
2, diet should be light. Fresh vegetables such as cabbage, radish, carrot, spinach, rape, tomatoes, etc., and lamb, beef, dog meat, such as roast, cooked together, have a warming benefit. It is better for those with a cold constitution. Fresh vegetables and fruits are indispensable, especially green leafy vegetables are rich in vitamins and inorganic salts, which have an important role in improving cellular immunity.
3. Encourage the patient to draw more water, which helps to discharge phlegm.
4.When suffering from severe pulmonary heart disease or acute infection that aggravates the condition, a light, easily digestible, low-fat, low-salt diet can be given, and the intake of water should be restricted when accompanied by swelling.
5, choose more neutral food, less cold food, or in the cold food with some ginger, pepper and other hot food, or in the vegetables with some lamb, beef, dog meat and other warm food.
6, avoid greasy hair. The so-called “hairy things”. Generally refers to meat and fishy seafood. The chronic bronchitis patients should use less sea fish, shrimp, crab, as well as milk, fatty meat, etc., one is to prevent moisture and phlegm, the second can avoid allergic reactions.
7, avoid stimulating food. There are many irritating foods, such as chili, raw onion, mustard, etc. have adverse stimulating effects on the respiratory tract, patients with this disease should avoid using, condiments should not be too salty, too sweet, hot and cold should also be moderate. Do not smoke, do not drink alcohol. Drinking alcohol can make the bronchial dilatation, help fire to produce phlegm; smoke dust and mist can destroy the physiological function of the trachea and lungs and defense capabilities.
8, the right amount of food. As we all know, satiety not only makes people feel sick and indigestion, but also can lead to intellectual decline, acute gastric dilatation or acute pancreatitis and other diseases. According to the results of a study by Dr. Glenn, a pharmaceutical assistant at the University of California, San Diego, satiety is even more harmful to patients with lungs and may lead to shortness of breath, breathing difficulties, and even life-threatening cardiac arrest. This is because, when a person eats too much, a full stomach pushes the diaphragm upward, compressing the lungs. Patients with lung disease are already not getting enough oxygen, which will make breathing more difficult and aggravate the development of the disease. On the other hand, when you eat too much, digesting food also requires a lot of oxygen, which affects the normal demand for oxygen from the heart, brain and other vital organs team. Therefore, patients suffering from lung diseases should pay attention to a diet that is seven percent full, especially during celebrations or holidays, and avoid overeating in order to facilitate physical recovery.
9.Common problems during the process of eating and how to deal with them.
A Loss of appetite Provide colorful and flavorful food to increase appetite; provide small and frequent meals, high-calorie, protein diet, snacks, drinks or nutritional supplements; take the best quality and quantity of food when appetite is at its best; use solid food before drinking liquid soup or drinks during meals; use gastric tube to force eating if necessary.
B. Bloating and constipation Avoid gas-producing foods such as onions, peppers, sweet potatoes, beans, etc.; do not open your mouth to breathe and do not talk while eating to avoid inhaling too much air; moderately increase your activity to promote bowel movement; consume appropriate vegetables and fruits to prevent constipation.
C Shortness of breath during feeding Give low-flow oxygen by nasal cannula during feeding; postural drainage, percussion and respiratory therapy exercises should be performed at least 30 minutes before the meal; if breathing difficulty occurs during feeding, rest for a while until you are comfortable before eating.
The first step of diet and nutrition therapy for patients with chronic obstructive pulmonary disease is to arrange a good eating environment. For example, proper rest before eating to reduce oxygen deprivation. In severe cases, oxygen should be administered for 3 to 5 minutes before and after eating. This is because the oxygen consumption increases when eating, and the amount of oxygen needs to be supplemented, but oxygen cannot be inhaled when eating. If eating and oxygen are done at the same time, one is prone to accidental inhalation of food into the airway, and the other is ineffective because the oxygen entering the nasal cavity will be discharged through the mouth with the chewing action. Why do you inhale oxygen after eating? This is because after eating, the stomach contents increase, the abdominal pressure rises, so that the position of the diaphragm moves up, the lung capacity decreases, increasing hypoxia, and oxygen inhalation after eating can relieve the symptoms of hypoxia due to the eating action.
Three, diet regimen
1, the principles and precautions of eating fruits for patients with chronic obstructive pulmonary disease.
The Dutch National Institute of Public Health and Environment is engaged in the research of flavin protein contained in fruits and other plants. There are thousands of flavin proteins, of which catechins, flavonols and flavonoids are reported to have the effect of preventing the aggravation of COPD. Therefore, with the assistance of 13,651 COPD patients, they investigated the relationship between the content of catechins, flavonols and flavonoids in the foods that patients normally eat and the degree of COPD illness. The results showed that if the patients were divided into five groups according to the amount of flavoprotein consumed, those who consumed the most amount of flavoprotein had 20-30% less cough and breathlessness than those who consumed the least amount. The FEV1 index, which is used to determine the degree of copd, also varies depending on the amount of flavoprotein consumed.
Black tea and apples contain large amounts of catechins, flavonols, and flavonoids. However, it is interesting to note that the relationship between the intake of flavin protein from black tea or from apples and the degree of COPD is different. no correlation was seen between the degree of COPD and the intake of black tea, while the more apples eaten, the less COPD symptoms.
2.Adjustment method.
Snow pear white root juice
Recipe and modulation: wash the snow pear, remove the skin and core, white lotus root, each equal amount of chopped, squeeze the juice, the amount of tea drink frequently.
Effects: Clearing heat and resolving phlegm, cooling blood and stopping bleeding.
Indications and contraindications: for tuberculosis, dry throat, prolonged cough, blood in the sputum.
Almond Honey
Recipe and preparation
Pound 15 grams of almonds repeatedly, add water and strain the juice, then add 1 teaspoon of honey and take with boiling water 2 to 3 times a day.
Effects: Relieving phlegm and cough.
Indications and contraindications: For all kinds of COPD patients.
Sichuan shellfish stewed snow pear
Recipe and modulation: take 1 pear, wash it, cut it crosswise, scoop out the core and incorporate 10 grams of Sichuan mussels, then put the two pears together and fix it with bamboo skewer, put it in a bowl with 20g of rock sugar and water, stew it for 1 hour with water. Eat pears and drink soup, 1 time per night.
Functions: moisten the lung, clear heat, eliminate phlegm, stop cough.
Suitable for coughing for a long time, phlegm sticky and difficult to cough, phlegm with blood in the Yin deficiency dry heat type patients, the cough phlegm clear and white is prohibited this formula.
Silverbeet Snow Pear Soup
Recipe and modulation: 15g of honeysuckle, 12g of Sichuan peppermint, 100g of snow pear, sugar, wash the snow pear, remove the skin, core, cut into slices; Sichuan peppermint broken, with honeysuckle, sugar together into the stew pot, set in a pot of water stewed. Eat the snow pear, drink soup, serve warm.
Uses: resolve phlegm to stop cough, clear heat and produce fluid.
Contraindication: suitable for chronic bronchitis is phlegm-heat congestion type of patients to eat.
Orange stew with rock sugar
Recipe and modulation: 1 fresh orange with skin cut into 4 pieces, add 15 grams of rock sugar, stewed in water for half an hour, eat with skin, 1 each morning and evening.
Functions: moisten the lung to stop coughing, eliminate phlegm and move gas.
Indications and contraindications: suitable for patients with cough and phlegm, abdominal distension and dullness.
Lily steamed pear
Recipe and modulation: 1 northern pear, 10 grams of lily, 15 grams of rock sugar. Remove the skin and core of the pear and slice it, wash the lily and soak it in warm water for 20 minutes, put the pear slices and rock sugar and steam it until it is cooked. Once a day, warm food, and even use 7 days.
Effects: Clearing heat and moistening lung, benefiting qi and resolving phlegm.
Indications and contraindications: Suitable for patients with prolonged cough, sticky phlegm, blood in phlegm and yin deficiency, agitation and heat.