Principles of nutrition in suppurative lung diseases. Therapeutic nutrition in chronic suppurative lung diseases. Animal Products

Diseases of the respiratory system are the second most common after diseases of the digestive tract. This group of ailments includes lesions of the nose, larynx and lungs.

These pathologies significantly worsen the condition of the animal, and in some cases pose a serious danger to its life.

If any signs of a respiratory inflammatory process appear, treatment should be started as soon as possible in order to increase the chances of a complete recovery of the pet.

Most often, pets develop the following diseases of the respiratory system:

• rhinitis is an inflammatory process of the mucous membrane of the nasal cavity. There are catarrhal, follicular, diphtheria and croupous types of rhinitis. The specified disease is more common in dogs, horses, rabbits and pigs;
• laryngitis - inflammation of the larynx. Often associated with tracheitis. It is accompanied by a cough, an increase in the submandibular lymph nodes, and sometimes an increase in body temperature;
• tracheitis - often develops as a complication of inflammation of the throat or bronchi. Diagnosed in cats and dogs;
• bronchitis - can occur as a result of hypothermia of a pet, inhalation of dusty air or due to the development of pathogenic bacteria (mainly streptococci). You can suspect the development of this ailment by symptoms such as coughing and wheezing;
• pneumonia (catarrhal, focal or bronchopneumonia) - can occur as a complication of bronchitis. Accompanied by shortness of breath, cough reflex, high fever, weakness;
• pleurisy - may appear after pneumonia or as an independent process.

In addition, veterinarians record a number of other respiratory diseases, but they are somewhat less common.

The reasons

The defeat of the respiratory system occurs under the influence of the following factors:

• hypothermia, prolonged exposure to the cold;
• drafts;
• inhalation of dust and various impurities, for example, when treating a room with aerosols;
• exposure to pathogens (bacteria, viruses);
• weakening of the immune system.

Symptoms

The above diseases are accompanied by the following symptoms:

• mucous copious discharge from the nose;
• cough, wheezing;
• elevated temperature;
• weakness and inactivity of a pet;
• swollen lymph nodes in the neck.

Diagnostics

Diagnostics is carried out using the following methods:

• examination of the animal;
• laryngoscopy - instrumental examination of the larynx;
• fluoroscopy of the lungs;
• blood test - allows you to identify changes in the body that occur during the development of the pathological process. Analyzes can be taken here http://www.vetdrug.com.ua/

Treatment

Treatment of the respiratory system consists in the following activities:

• irrigation of the nasal cavity with rhinitis with a solution of novocaine containing antibiotics, as well as solutions of tannin, boric acid, zinc sulfate and other substances;
• the imposition of warm compresses on the neck with laryngitis;
• treatment of the throat with furacilin, chloramine, iodinol and other drugs;
• the use of expectorants;
• use of antibiotics;
• the appointment of drugs that contribute to the expansion of the lumen of the bronchi;
• carrying out inhalations with disinfectant solutions;
• additional intake of vitamins;
• the use of thermal physiotherapy procedures: irradiation with a Minin lamp, solux, etc.

Prevention

In order to prevent damage to the respiratory system, it is recommended:

• prevent hypothermia of the animal's body;
• avoid staying a pet in a draft;
• do not spray aerosols and powder-like substances in the air;
• provide a complete feeding with sufficient protein, vitamins and minerals in the diet.

Approximate one-day menu for acute pneumonia (1680 kcal)

Therapeutic nutrition for suppurative lung diseases

Approximate one-day menu for chronic suppurative lung diseases (2900 kcal)

The lungs perform the function of breathing. With the help of this organ, all tissues are enriched with oxygen and released from carbon dioxide. Man cannot live without air. To keep your lungs healthy for many years, you need to eat right. Many useful products for the lungs improve the regenerative capacity of the respiratory tissue. Favorably affect the restorative function of the lungs vegetables, fruits, dairy products, fish, meat. To ensure the drainage function of the lungs, you need to drink at least 2 liters of water per day.

Vegetables play an important role in human nutrition. They contain a large amount of fiber, vitamins, trace elements necessary for the normal functioning of all body systems.

Eating raw carrots rich in beta-carotene is very beneficial for lung recovery. This substance is necessary to strengthen the tissues of the lungs. Other orange, yellow, red foods are also very useful: tomato, pumpkin, turnip, sweet pepper, radish, radish. Beetroot improves sputum discharge, and also provides blood supply to the lung tissue.

Do not ignore green vegetables: peppers, tomatoes, cucumbers, herbs (parsley, dill, spinach, leeks, green onions), lettuce, radish tops, carrots, beets. Greens contain a lot of beta-carotene, as well as magnesium. It prevents the occurrence of a hyperreactive state of the bronchi, reduces the likelihood of bronchospasm in bronchial asthma.

Berries and fruits

Berries that positively affect the functioning of the lungs and bronchi include: cranberries, raspberries, strawberries, grapes, blackberries, blueberries, currants. They are rich in vitamin C, which is a powerful antioxidant that helps fight infectious agents that affect the bronchial tree. The record holder for the content of ascorbic acid is rose hips.

Apricots contain antioxidants, as well as substances that prevent bronchospasm, which reduce the likelihood of developing lung cancer. They are useful for patients with bronchial asthma.

Pineapples are indicated for pulmonary tuberculosis, due to the high concentration of the bromelain enzyme in them, which suppresses the division of Koch's bacillus. Pomegranate fights carcinogens that enter the body, which prevent the development of oncology.

Pears and apples for asthma

Scientists conducted a study on the effect of eating apples and pears containing flavonoids (have a bronchodilatory effect) in asthma patients. Doctors selected two groups of patients with bronchial asthma. The doctors did not give apples and pears to the control group. The study group received fruit daily. The results of the work showed that the frequency of asthma attacks decreased in patients in the study group.

Healthy foods containing fats

Fats are essential for the proper functioning of the lungs. Nutritionists advise dressing vegetable salads with olive and linseed oil. They increase the elasticity of the walls of the alveoli, due to the presence of omega-3-amino acids in oils. This promotes good gas exchange in the lungs.

Walnuts contain omega-3 fatty acids and vitamin E. These substances prevent the formation of tumor cells.

Other types of products

Garlic, onion, spices (turmeric, ginger) have substances that prevent the formation of cancer cells in the lungs, have bactericidal properties. Allicin, found in garlic, is necessary to remove mucus from the bronchi. This compound has an antimicrobial effect (for fungi, bacteria and viruses, allicin is toxic). These products are useful for patients with infectious lung diseases.

Legumes, due to the content of phytic acid, contribute to the removal of free radicals from the body, reduce the likelihood of lung cancer.

Seaweed is rich in iodine, facilitates the movement of the cilia of the bronchial epithelium, thereby stimulating sputum discharge.

Honey contains antioxidants and trace elements that strengthen the body's immune system, perform a drainage function in the bronchial tree.

Animal products

What other foods are good for the lungs? For the normal functioning of the respiratory system, milk, meat, fish, seafood (crabs, shellfish, mussels) are important.

Dairy products contain a large amount of calcium, which helps to strengthen the cartilaginous structure of the bronchi, increasing their elasticity. Milk proteins are essential for new cell division in the lungs.

Fish, seafood, and red meat are rich in omega-3s. Due to proteins, metabolic processes in the lungs improve, the surface tension of the alveoli increases. Protein compounds are involved in the processes of cell regeneration, enzyme synthesis, and gas exchange.

Water and other drinks

For the normal functioning of any cell, a sufficient amount of fluid is necessary. A person should drink 1.5 liters of water per day, not counting the liquid contained in soups, teas, fruit drinks, compotes. The lungs need water to thin the sputum. When dehydrated, mucus sticks to the walls of the bronchi, making breathing difficult.

Tea with the addition of cardamom or thyme has mucolytic properties. It is recommended for people who smoke, with stagnation of sputum in the morning, poor coughing. Useful freshly squeezed juices, especially tomato and carrot, as well as fruit and berry drinks.

Nutrition rules for lung diseases

If patients have pulmonary diseases, nutritionists recommend eating right. You need to drink enough liquid. Nutrition should be balanced, contain all the necessary vitamins and minerals. The diet should contain a large number of vegetables, fruits, products containing animal proteins (milk, meat, fish). Avoid overeating, especially at night. This leads to the development of obesity. It is better to eat in small portions, but every 2-3 hours. In this case, a person does not get fat, receives all the necessary nutrients. Patients with lung pathology should exclude semi-finished products, fast foods, a large number of confectionery products, as they have additives that trigger an allergic reaction. Also limit the consumption of coffee and tea. They are diuretic and can cause dehydration. Salty foods should be limited, but it is better to completely abandon them.

Conclusion

A healthy diet has a positive effect on all body systems. For each individual disease, its own diet has been compiled, which helps to cope with the disease. Patients with bronchial asthma need to eat foods that reduce the likelihood of an asthma attack. In the presence of bronchitis or pneumonia, the diet should be aimed at increasing the body's resistance, reducing the inflammatory process. Compliance with the rules of dietary nutrition can reduce the frequency of relapses among patients with pulmonary pathology.

Nutritional support for lung diseases is a relatively new frontier in nutrition, in particular geronto-dietology. It is known that many older patients suffering from chronic lung diseases have protein-energy deficiency, which adversely affects the structure and function of the respiratory muscles, gas exchange, the activity of the cardiovascular and nervous systems, and the nature of the body's immune defenses. Less studied are the adverse effects of malnutrition on the architectonics of the lungs and its recovery after damage, on the production of surfactant, as well as on the possibility of implementing other metabolic processes.

In healthy people and in patients with emphysema, there is a direct correlation between body weight and diaphragm weight. In addition, in patients with protein-energy deficiency, there is a decrease in the strength of the respiratory muscles at the height of maximum inspiratory and respiratory pressure.

A number of studies examining the effect of nutritional status on lung gas exchange and metabolic rate have shown that adequate calorie intake is necessary to maintain normal gas exchange and optimal metabolic rate.

Experiments on old animals have shown that an insufficient amount of proteins and calories leads to a decrease in the T-lymphocyte-dependent function of alveolar macrophages, despite their continuing neutrophil-dependent function. Thus, along with a general susceptibility to infectious diseases, malnourished patients may develop disorders of local immunity of the lung mucosa.

Experimental data also indicate that adequate nutrition may play an important role in the production of surfactant and the restoration of normal lung architectonics after lung injury, but the clinical significance of these observations is not yet fully understood.

Depending on the nature of the pathological process, all lung diseases are divided into acute and chronic. This accounts for differences in nutritional care (its potential benefits, adverse effects, and clinical priorities).

PART 1. CHRONIC LUNG DISEASES

Most chronic lung diseases are pathophysiologically represented by the formation of obstructive or restrictive damage in the mechanics of external respiration (singly or in combination).

In the structure of chronic lung diseases, the most common are chronic obstructive pulmonary diseases (COPD), which occur in more than 14% of men and 8% of older women. The term COPD includes: emphysema, chronic bronchitis and bronchial asthma.

Protein-energy malnutrition among patients with chronic lung diseases

Protein-energy malnutrition is extremely common among patients with chronic obstructive pulmonary disease. According to various studies, this syndrome is observed in 19-25% of patients, which negatively affects the survival of these patients. With progressive weight loss in this group of patients, mortality is significantly (2 times) higher compared to those patients who did not have weight loss.

In a retrospective analysis, it was reasonably shown that older patients who had less than 90% of ideal body weight at the beginning of the study, in general, had a greater mortality within 5 years, even after the elimination of complications associated with lung dysfunction. This effect was observed in patients with moderate obstruction (forced expiratory volume greater than 46% required) and those with severe obstruction (forced expiratory volume less than 35% required), and therefore did not depend on lung function. Thus, progress in the treatment of COPD did not change the poor prognosis in these patients with concomitant protein-energy malnutrition. Interestingly, patients with chronic obstructive pulmonary disease and protein-energy malnutrition have more severe respiratory failure and no classic symptoms of chronic bronchitis.

Possible pathophysiological mechanisms of protein-energy malnutrition in patients with chronic lung disease:

• deterioration of the functions of the gastrointestinal tract;
• inadequate nutrition;
• impaired adaptive mechanism for lowering oxygen consumption (in the interests of reducing the work of the respiratory muscles);
• altered pulmonary and cardiovascular hemodynamics, limiting the supply of nutrients to other tissues;
• antioxidant disorders;
• a state of increased metabolism.

Malnutrition, protein deficiency in the diet in patients with chronic obstructive pulmonary disease is explained by a decrease in food intake and an increase in energy expenditure, secondary to high respiratory expenditure, which increases the resistive load and reduces the efficiency of the respiratory muscles. Along with this, insufficient intake of calories and protein can occur during stress, surgery, or infection when the need for energy increases. Thus, there may be a stepwise progressive deterioration in lung function and nutritional status.

Research results have shown that the actual energy requirement in patients with chronic obstructive pulmonary disease with and without weight loss significantly exceeds the value calculated using the Harris-Benedict equation. Although these patients have an increased metabolism, they do not have the increased catabolism that occurs in a state of stress with a predominance of fat oxidation. The increase in energy requirements may be due to increased oxygen consumption by the respiratory muscles. The higher level of energy consumption by the respiratory muscles in patients with COPD compared with healthy people may maintain a state of hypermetabolism and lead to progressive weight loss if calorie expenditure exceeds caloric intake.

Most of the studies demonstrate adequate calorie intake, the requirement for which in patients with COPD has been calculated or measured for the resting state. However, they did not take into account the required amount of calories and protein for vigorous physical activity or intercurrent illness in order to assess their real adequacy for a given patient.

Attempting to increase calorie and protein intake above habitual (baseline) levels may be difficult in these patients due to respiratory and gastrointestinal disturbances (eg, anorexia, early satiety, dyspnea, weakness, bloating, constipation, dental problems). Some of these symptoms (bloating, early satiety, anorexia) may be related to the flattening of the diaphragmatic muscle and thereby affecting the abdominal cavity. In patients with COPD who are in a state of hypoxia, dyspnea may increase during meals, which further limits the amount of food taken. Smaller and more frequent meals may alleviate some of these conditions to some extent.

Studies in which patients with malnutrition and COPD were prescribed a therapeutic diet enriched with a specialized food product with a mixture of protein composite dry (SBCS) "Diso®" "Nutrinor", containing 40 g of protein per 100 g of the product, showed the effectiveness of this method of enriching dietary meals with protein and increasing the nutritional value of diets without increasing the amount of food consumed.

It has been shown that patients with COPD and low body weight have the same energy requirement as patients with normal body weight. But in the first group, there is a lower intake of calories relative to their measured energy needs.

Therapeutic nutrition for COPD

In COPD, the emphasis is on maintaining the strength of the respiratory muscles, especially the diaphragm, their mass, as well as the ability to optimize the overall functioning of the patient's body.

A number of studies have shown that the intake of additional calories and protein for more than 16 days leads to a significant increase in body weight and improvement in maximum respiratory pressure, compared with people of the same age without lung disease.

With a longer follow-up of patients with COPD, after 3 months of following a diet with an increased amount of protein (including 36 g of a dry composite protein mixture in the treatment diet), there was an increase in their body weight and other anthropometric data, an increase in the strength of the respiratory muscles, an improvement in overall well-being and tolerance of 6-minute walking distances, as well as a decrease in the degree of dyspnea. With a longer duration of adherence to a high-protein diet, along with an increase in the muscle mass of the patients, there was a further improvement in the functions of the respiratory muscles.

Interestingly, patients with initially lower body weight and lower calorie intake benefit more from the protein composite dry formula food, especially if it is continued for a long time, while they experience significant weight gain. Therefore, the likelihood of improved respiratory muscle function may be related to the degree of weight gain and possibly the severity of the initial deficits.

The problem of sufficient calorie intake in this category of patients may be due to diet-induced thermogenesis: patients with reduced nutrition in combination with COPD have been shown to have a greater increase in resting oxygen consumption after a meal than patients without this disease.

There are no long-term studies looking at nutritional support as a criterion for improving overall prognosis in elderly patients with COPD. If survival is associated with weight gain and this is an independent variable, and the inclusion of a dry protein composite mixture in the therapeutic diet can improve and maintain body weight, then it is expected that survival is associated with the optimization of nutrition in this group of patients. It is not clear what its potential effect on respiratory function would lead to an improvement in clinical outcomes: immunocompetent, improved gas exchange, effects on reparative processes in the lung, or surfactant production. Despite mixed results from short-term studies, there is now a clear clinical rationale for the use of specialized SBCS foods in patients with COPD.

Diet vector

Because COPD patients have a limited respiratory reserve, it is likely that a high carbohydrate diet would be undesirable for the respiratory system. A diet high in fat is more beneficial. The study showed that a 5-day low-carbohydrate diet in patients with COPD and hypercapnia (calories from carbohydrates was 28%, from fat 55%) resulted in significantly lower CO2 production and arterial CO2 partial pressure than a 5-day diet. high-carbohydrate diet (74% calories from carbohydrates, 9.4% from fats). A significant functional parameter (12-minute walk) was assessed and high carbohydrate intake was found to reduce walking distance in COPD patients compared with placebo.

Violation of the metabolism of macro- and microelements

Electrolyte deficiency such as hypophosphatemia, hypokalemia and hypocalcemia can adversely affect respiratory muscle function. It has been shown to improve the contractile function of the diaphragm after replenishing the deficiency of phosphorus in patients with acute respiratory failure and hypophosphatemia. This observation is particularly pertinent in elderly patients with COPD who require mechanical ventilation, as they usually experience intracellular shifts after correction of respiratory acidosis. Clinical manifestations of hypophosphatemia arise from the depletion of intracellular phosphorus, which, as a rule, accompanies chronic hypophosphatemia.

It has been reported that a sharp decrease in serum calcium levels can also reduce the maximum contraction of the diaphragm.

A case of hypokalemic respiratory arrest is described, i.e., there was a hypokalemic paralysis of the respiratory muscles.

Magnesium is of great interest to researchers. It has been established that it activates adenylate cyclase, which catalyzes the formation of cAMP, inhibits mast cell degranulation and provides relaxation of bronchial smooth muscles. Patients with hypomagnesemia were found to have obstructive respiratory dysfunction and bronchial hyperreactivity to histamine, which were fully or partially corrected by prescribing magnesium preparations. Magnesium salts after intravenous administration have a bronchodilator effect, stopping asthma attacks, as well as asthmatic status, increase the force of contraction of the respiratory muscles and reduce pulmonary hypertension in patients with bronchial asthma and other obstructive pulmonary diseases. Thus, clinical and experimental observations indicate the participation of magnesium ions in the regulation of bronchial patency, pressure in the pulmonary artery, and contractility of the respiratory muscles. Electrolyte replenishment may ultimately be more important than protein anabolism and lead to dramatic improvements in respiratory muscle strength.

The role of trace elements and vitamins

There has been increased attention to the relationship between micronutrients, vitamins and respiratory diseases. The dependence of respiratory symptoms of bronchitis with the level of vitamin C, zinc, copper, nicotinic acid in the blood serum was found.

Vitamin C is an antioxidant, and copper is an important cofactor for the enzyme lysyl oxidase, which is involved in the synthesis of elastic fibers and glycosaminoglycans that make up the structural component of the framework (basal tone) of the bronchi. Severe copper deficiency can lead to a decrease in bronchial elasticity.

Under artificially induced copper deficiency conditions in mammals, the development of primary emphysema was observed as a result of a sharp decrease in elastin in the lungs. The cause of an irreversible lung tissue defect is the inactivation of the copper-containing enzyme lysyl oxidase, the depression of superoxide dismutase and the associated intensification of lipid peroxidation.

Selective zinc deficiency results in thymic hypoplasia, reduced thyroid hormone activity, and promotes T-cell lymphocytosis. It is believed that the change in the microelement composition of the blood is one of the reasons for the formation of secondary immunodeficiency states in diseases of the respiratory system.

Data on the ability of microelements to control the activity of lipid peroxidation and the antioxidant defense system deserve attention. It is known that copper, zinc and manganese are part of superoxide dismutase, selenglutathione peroxidase. These enzymes are components of the intracellular antioxidant system. Ceruloplasmin, one of the main extracellular antioxidants, belongs to the class of copper-containing proteins. Zinc, which forms chemical bonds with sulfhydryl groups of proteins, phosphate residues of phospholipids, and carboxyl groups of sialic acids, has a membrane-stabilizing effect. Deficiency of copper and zinc leads to the accumulation of free radicals in tissues. Excess ionized iron has a pro-oxidant effect.

In recent years, studies have found that elderly patients with COPD, and especially senile people, have a selenium deficiency associated with depression of the intracellular antioxidant glutathione peroxidase. Supplements of sodium selenite in a daily dose of 100 mcg for 14 days increase the activity of this enzyme and significantly reduce the clinical manifestations of bronchial obstruction.

Direction of diet therapy

Chronic lung disease may be associated with free radical damage when the lung's natural antioxidant defense system is suppressed (eg, by smoking, severe vascular disease in old age) or deficient (α-antitrypsin deficiency). Dietary micronutrient deficiency may also contribute to increased susceptibility to free radical damage and be one of the factors that leads to overactivation of lipid peroxidation.

Diet therapy for COPD is aimed at reducing intoxication and increasing the body's defenses, improving the regeneration of the respiratory tract epithelium, and reducing exudation in the bronchi. In addition, the diet provides for the replacement of significant losses of proteins, vitamins and mineral salts, sparing the activity of the cardiovascular system, stimulation of gastric secretion, hematopoiesis.

High Protein Diet (HPD)

Patients with chronic obstructive pulmonary diseases are recommended to prescribe a high-protein diet (HPA) of high energy value (2080-2690 kcal), with a high content of complete proteins - 110-120 g (of which at least 60% of animal origin), a fat quota of 80-90 g and the content of carbohydrates within the physiological norm of 250-350 g (with an exacerbation, the amount of carbohydrates is reduced to 200-250 g).

If a high-protein diet is observed, it is planned to increase foods rich in vitamins A, C, group B (decoctions of wheat bran and rose hips, liver, yeast, fresh fruits and vegetables, their juices), as well as calcium, phosphorus, copper and zinc salts. The inclusion of vegetables, fruits, berries and juices from them, meat and fish broths contributes to the improvement of appetite.

Restriction of table salt to 6 g/day has an anti-inflammatory effect, reduces exudation, fluid retention in the body and thus prevents the development of circulatory failure during the formation of cor pulmonale. The diet provides for the restriction of free fluid, which helps to reduce the amount of sputum discharge and provide a sparing regimen for the cardiovascular system.

In accordance with the norms of therapeutic nutrition, approved by the Order of the Ministry of Health of Russia dated June 21, 2013 No. 395n “On approval of the norms of therapeutic nutrition”, a patient with COPD, while observing a high-protein diet, should receive daily 36 g of a specialized food product of a mixture of protein composite dry. For example, when using SBCS "Diso®" "Nutrinor", the patient's diet is enriched with 14.4 g of high-quality, complete and easily digestible protein.

Diet therapy for bronchial asthma

If there are no indications of intolerance to certain products, patients with bronchial asthma are recommended to have a physiologically complete diet, but with a restriction of strong meat and fish broths, table salt, spicy and salty foods, spices, seasonings and foods containing easily digestible carbohydrates (sugar, honey, chocolate and etc.). It is known that at least some patients with bronchial asthma are sodium-sensitive. Dietary salt supplements lead to a deterioration in bronchial patency and an increase in nonspecific bronchial hyperreactivity.

Since inflammation in the airway mucosa plays a central role in the pathophysiology of asthma, a reduction in bronchial hyperreactivity can be achieved by supplementing the diet with nutritional supplements that contain essential ω-3 fatty acids (eg, eiconol oil, fish oil, cod liver oil), which can have a modulating effect on cytokines.

The effect of fish oil

Numerous trials have demonstrated the anti-inflammatory effects of fish oil in asthma. Studies have shown that in this case there is a significant decrease in the severity of a late allergic reaction due to the replacement of arachidonic acid in cell membranes with ω -3 - polyunsaturated fatty acids, which inhibit the production of lipid inflammatory mediators (5-lipoxygenase and cyclooxygenase) and reduce the tissue response to cytokines. This leads to qualitative changes in the course of the disease: severe asthma attacks occur less often, doses of drugs are reduced.

The increase in the prevalence of asthma over the past two decades is associated with a decrease in the consumption of animal fat and an increase in the use of margarine and vegetable oils containing ω-6-polyunsaturated fatty acids, which can increase the production and activity of pro-inflammatory cytokines such as IL-1, IL-6. The production of IL-1 and IL-6 induced by TNF-α is associated with dietary intake of linoleic acid. In addition, linoleic acid is a precursor of arachidonic acid, which is converted to prostaglandin E2, which in turn affects T-lymphocytes, reducing the production of g-interferon, without affecting the synthesis of interleukin-4 (IL-4). This can lead to the development of allergic sensitization, since IL-4 promotes the synthesis of IgE, while g-interferon produces the opposite effect. The adverse effect of diet may be mediated through an increase in prostaglandin E2 synthesis, which in turn may increase IgE production, while w-3-polyunsaturated fatty acids inhibit the formation of prostaglandin E2.

Nuances in nutrition

Epidemiological evidence suggests that reduced intake of dietary magnesium is associated with impaired lung function, increased bronchial reactivity, and dyspnea, as discussed earlier in the article. The intake of an increased amount of magnesium with food helps to improve the general condition of a patient with bronchial asthma.

A decrease in dietary intake of vitamin C and manganese is accompanied by a more than fivefold increase in the risk of impaired bronchial reactivity. Thus, an antioxidant diet and dietary supplements (BAA) with an antioxidant effect can have a modulating effect on the incidence of bronchial asthma and the course of the disease.

Unloading and dietary therapy has proven itself well in patients not older than the elderly, which should be carried out in a hospital with the obligatory consent of the patient. The duration of the unloading period usually does not exceed 2-3 weeks. The recovery period in duration corresponds to the unloading period.

Bronchial asthma and food allergies

Among patients with bronchial asthma, a group of patients with endogenous asthma is distinguished, in whom sensitization to food allergens is detected. In particular, 6% of asthmatics reporting isolated food allergies have a true food allergy to one or more foods.

Food and food additive triggers play an important role in approximately 5-8% of all cases of bronchial asthma. The involvement of respiratory symptoms in food allergies reaches 40%. A reliable diagnosis can only be made with a combination of testing methods used for both food allergy and asthma. In the formation of bronchial obstruction, as a rule, immune reactions of the 1st type are involved, with the involvement of IgE antibodies in the pathological process. In the next 1-2 days, the late phase of the allergic reaction develops, in which cellular infiltration by lymphocytes and monocytes dominates, which corresponds to the picture of chronic inflammation.

With the repeated intake of the allergen with food, mononuclear cells secrete a cytokine (histamine-producing factor), which interacts with IgE on the membranes of mast cells and basophils, while increasing their release of inflammatory mediators. Active production of the cytokine thus correlates with increased bronchial reactivity in patients with bronchial asthma.

In therapy, in addition to the usual basic therapy of bronchial asthma, the normalization of the permeability of the intestinal mucosa is of great importance. The use of antihistamines may only be effective in blocking the early phase of the allergic reaction, while late phase manifestations, including cellular infiltration, may be more successfully inhibited by corticosteroids.

Other chronic lung diseases

At present, the effects of nutrition in other chronic lung diseases have not been sufficiently studied. However, since in most of them there is a respiratory load in the respiratory mechanics, those recommendations that are intended to improve the function of the respiratory muscles in COPD should also be relevant.

Therapeutic nutrition for Heiner's syndrome

Heiner's syndrome is a chronic relapsing lung disease characterized by chronic rhinitis, infiltrates in the lungs and the development of pulmonary hemosiderosis, gastrointestinal bleeding, and iron deficiency anemia. This form of pulmonary hemosiderosis most often accompanies acquired intolerance to cow's milk, but it can also accompany intolerance to eggs and pork.

Characteristic manifestations of this disease are peripheral blood eosinophilia and the formation of precipitates in the blood serum to cow's milk. However, the immunological mechanisms have not yet been fully elucidated. This is not an IgE-mediated immune response.

Diet therapy - rejection of the causative allergen (cow's milk, eggs, pork).

PART 2. ACUTE LUNG DISEASES

In acute lung disease accompanied by hypercatabolism, the main goal of nutritional support is to meet the increased needs of the body and prevent protein breakdown.

Acute lung disease can range from localized lung infection (pneumonia) to widespread alveolar damage, such as respiratory distress syndrome seen in the elderly.

Most respiratory diseases are accompanied by such general complaints as lack of appetite, fatigue, and general malaise. When these symptoms are combined with coughing, shortness of breath and/or choking, eating through the mouth becomes impossible in most cases: the patient needs tracheal intubation and mechanical ventilation. It is often difficult to estimate the estimated duration of the reduced intake of food through the mouth. If at the same time a negative nitrogen balance develops, then as a result of it, the strength of contractions of the diaphragm can weaken, the volume of respiratory movements decreases and the state of the immune system changes, which can jeopardize the recovery of the body.

Clinical priorities

In severe lung disease (eg, lobar pneumonia), the degree of metabolic stress and nutrient requirements are similar to those seen in sepsis, multitrauma, severe injury, or burns. Negative nitrogen balance occurs, as a rule, in the phase of hypercatabolism. Changes in carbohydrate metabolism. Hyperglycemia due to increased glucose metabolism may occur. Due to relative insulin resistance, increased hepatic gluconeogenesis, and an excess of contrainsular (catabolic) hormones (glucagon, adrenaline, and cortisol), there is predominant lipid oxidation, which can be the main source of calories in a stressed patient.

However, in a state of shock and multisystem organ failure, there may be poor utilization of lipids, which leads to their accumulation in the body. In order to maintain a constant supply of glucose to the brain and other glucose-dependent tissues, gluconeogenesis is intensified, muscle proteolysis develops (muscle proteins are the source of amino acids for gluconeogenesis), which leads to a negative nitrogen balance.

In this case, energy requirements can be measured using indirect calorimetry at the patient's bedside or estimated using the Harris-Benedict equation.

Demand control

Accurate assessment of energy requirements in patients with acute lung disease is especially important. Excessive parenteral and enteral nutrition can lead to fluid overload, impaired glucose tolerance, and fatty liver. Excessive enteral nutrition can cause diarrhea. On the other hand, underestimation of caloric requirements leads to malnutrition and negative nitrogen balance with a decrease in muscle mass. At the same time, a negative effect on pulmonary mechanics is observed, the volume of respiratory movements decreases, the function of the diaphragm and the immune mechanisms of lung protection are impaired, thus increasing the need for artificial ventilation of the lungs.

Adequate nutritional support is important when mechanical ventilation is discontinued in patients with respiratory failure. Its goal should be to achieve a balance of metabolic processes in acute lung diseases, and not just increase body weight.

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artificial nutrition

Despite clinical doubts, several strategies have been developed to provide artificial nutrition for patients with acute lung injury. The main problems are the choice of substrates corresponding to the clinical conditions of the patient and the optimal method of their administration.

Artificial nutrition can be carried out using proteins, carbohydrates or fats. Let us consider the advantages of these substrates from the position of their relationship with lung diseases.

Most patients with acute respiratory failure who require mechanical ventilation are in a state of hypercatabolism with endogenous protein breakdown. In addition, under conditions of limited glucose supply, the demand of glucose-dependent tissues (brain, erythrocytes, and healing wounds) is met through gluconeogenesis from amino acids. Suppression of gluconeogenesis in order to save protein in fasting patients is carried out by the appointment of 100 g of glucose per day.

Patients with multitrauma or sepsis may theoretically require 600 g or more of glucose per day. Intravenous fat emulsions will save protein when used with carbohydrates (at least 500 kcal/day from carbohydrates). The intake of proteins from outside can also restore their endogenous reserves. Being a substrate for gluconeogenesis, it will limit proteolysis. Given the priority role of proteins in the normal physiology and functions of cells, saving it is an integral part of recovery from any damage.

However, it must be remembered that protein supplementation can increase oxygen consumption (thermic effect of proteins), minute ventilation of the lungs and hypoxemia. Clinically, a high-protein diet could lead to increased dyspnea in patients with already increased respiratory capacity and/or limited respiratory reserve.

Glucose control

The appropriate mixture of delivered substrates (proteins, carbohydrates or fats) depends on the clinical condition and goals to be achieved. In patients with acute or chronic respiratory failure, with a limited respiratory reserve, carbohydrates present about Greater demands on the respiratory system than other substrates due to the relatively greater production of carbon dioxide during their oxidation. For every molecule of oxidizable glucose, one molecule of carbon dioxide is produced, making the respiratory quotient 1.

When carbohydrates are oxidized, more than when fats or proteins are oxidized, CO2 is produced, which is secreted by the lungs. If VCO2 increases, alveolar gas exchange also increases in order to maintain normal PaCO2 in the blood. An increase in alveolar ventilation can occur due to an increase in the frequency of respiratory movements or minute ventilation of the lungs, which, in turn, increase the work of the respiratory system. Thus, respiratory failure may be exacerbated by b about larger amounts of glucose in patients with reduced lung function.

Increasing the fat quota

In an attempt to provide total parenteral nutrition to patients by adding first fat emulsions and then glucose, totaling 50% of non-protein calories, it was noted that after switching from a fat-rich source to a high-glucose source, CO2 production increased by 20%, and minute ventilation - by 26-71%. In patients with hypermetabolism, minute ventilation of the lungs can increase by 121%. This result can be explained by the amount of CO2 released during the production of triglycerides from glucose, which is 30 times greater than the amount of CO2 produced during the conversion of dietary fats to endogenous triglycerides.

Thus, for those patients who have marginal respiratory reserve and risk of respiratory failure, it seems more appropriate to prescribe a diet with a higher quota of fats than carbohydrates (more than 50% of non-protein calories from lipids) and to refrain from overfeeding these patients. Thus, it is possible to avoid an increase in acute respiratory failure or (with the abolition of artificial ventilation of the lungs) to facilitate their transition to independent breathing.

In terms of micronutrients (vitamins, minerals), most pre-mixes provide or can be supplemented to meet their recommended dietary allowances. These mixtures may also be adjusted to address existing fluid and electrolyte deficiencies or excesses and/or other clinical conditions (hepatic, renal, enteral, cardiac or pulmonary insufficiency).

The route of administration of artificial nutrition may be parenteral or enteral. If the patient is capable of self-feeding, oral supplementation is the preferred method. If the patient is unable to eat, then the choice lies between the enteral and parenteral routes.

Enteral nutrition

This type of supplementary nutrition can be done with a gastric or duodenal tube. Gastric tubes are less difficult to insert but more likely to cause complications such as aspiration and/or nosocomial pneumonia despite tracheal intubation.

Paresis of the stomach is common in elderly patients who are in serious condition, especially those who need mechanical ventilation. The presence of a probe that crosses the lower esophageal sphincter allows regurgitation of gastric contents and pulmonary aspiration. In addition, neutralization of the acidic pH of the stomach by enteral nutrition promotes the overgrowth of bacteria in the stomach and their subsequent colonization of the oropharynx. To minimize microaspiration, the head of the patient's bed should be raised by at least 45°. Unfortunately, it is difficult to maintain this position in an intubated patient, because frequent turning is required in order to toilet the lungs and reduce the risk of pressure ulcers. In connection with these points, it is preferable to place food probes intended for insertion into the duodenum.

parenteral nutrition

Total parenteral nutrition can be performed via a central vein, while allowing the use of high osmolar solutions, or via a peripheral vein.

The peripheral route of administration may require a higher fluid load to match the energy requirements of the central route. Since impaired fluid metabolism is common in acute lung injury, limited fluid administration is preferable. In patients with respiratory failure, it is more beneficial to administer a large quota of fat calories resulting in a lower respiratory quotient. This is especially important when trying to cancel artificial ventilation.

Research suggests that, despite being an excellent, compact source of calories, the possible effects of lipid emulsions on immune system regulation may be important in severe, frequently infected elderly patients with respiratory dysfunction as to raise questions about their appropriateness in this population. patient groups.

Some experimental work has shown that the conversion of linoleic acid to arachidonic acid, a precursor of prostaglandins and leukotrienes, can have a strong influence on the cytokine regulation of the immune response. Linolenic acid may, conversely, reduce the production of prostaglandins and leukotrienes and therefore reduce the inflammatory response. The relationship between diet and inflammatory response in the body of an elderly patient is, if not in the initial, then far from the final stages of research.

Diet therapy for patients with lung abscess and bronchiectasis is built taking into account the distinctive features of the pathological process. These are:

The combination of a purulent inflammatory process with the destruction of lung tissue;

Severe intoxication due to purulent contents;

Loss of a large amount of protein with purulent sputum;

Tendency to develop pulmonary heart disease;

Exhaustion of the body;

Gradual development of amyloidosis.

Medical nutrition of patients is aimed at:

Stimulation of the body's defenses;

Compensation for protein losses;

Detoxification of the body;

Reduction of inflammatory exudation;

activation of reparative processes,

Facilitate the activity of the cardiovascular system.

The main condition for successful treatment is to ensure proper nutrition of the patient. At the same time, it is necessary to ensure sufficient energy value of the daily diet (2550-2960 kcal) by increasing the daily amount of proteins to 130-160 g, a moderate amount of carbohydrates (350-400 g) and a slightly reduced (70-80 g) fat content.

An excess of proteins helps to replenish protein losses, stimulates plastic processes in the lungs, activates the defenses and immune processes in the patient's body, prevents and stops the development of amyloidosis. The menu should contain sufficient quantities of complete proteins of animal origin: meat, fish, cottage cheese, eggs, etc. The content of fatty foods is reduced taking into account their ability to suppress appetite in long-term febrile patients. To reduce inflammatory exudation in the acute phase of the pathological process, it is necessary to reduce the amount of carbohydrates (up to 200-250 g), limit table salt (6-8 g) and introduce an excess amount of calcium salts. Salt deficiency (hypochloride diet) has an anti-inflammatory effect due to the fixation of calcium salts in tissues.

With such nutrition, fluid retention in the body is reduced, which prevents the likelihood of development and progression of circulatory failure.

Limiting free fluid intake to 700-800 ml per day can reduce sputum production and facilitate the activity of the cardiovascular system.

The need of patients in large doses of vitamins is associated with the need to stimulate the protective forces and reparative processes. Ascorbic acid promotes detoxification of the body, positively affects oxidative processes and protein metabolism. Retinol is necessary for the regeneration of the mucous membrane of the respiratory tract. Therefore, it is recommended to use foods rich in vitamins (yeast, rosehip broth, vegetables, fruits).

The inclusion in the diet of foods stimulating gastric secretion (meat and fish broths, kvass, vegetable and fruit juices, strong tea, coffee) improves appetite.

When building a therapeutic diet for patients with chronic suppurative processes in the lungs, diet No. 5 is taken as a basis.

One day menu option:

1st breakfast: butter (10 g), buckwheat porridge (150 g), protein omelet (100 g), tea with milk (180 g).

2nd breakfast: boiled fish, baked with potatoes (250 g), yeast drink with sugar (200 g).

Lunch: borscht with meat broth (250 g), beef stroganoff with mashed potatoes (55/130 g), apple compote (180 g).

Afternoon snack: rosehip broth (200 ml).

Dinner: potato casserole with boiled meat (260 g), cottage cheese (100 g) with milk (25 g), tea with lemon (200 ml).

At night: curdled milk (200 g).

For the whole day: wheat bread (150 g), rye bread (100 g), sugar (30 g).