Clinical Nutrition
Lesson 22: Chronic obstructive pulmonary disease


Breathlessness which gets progressively worse is mainly due to the loss of elasticity of the aleveoli. The surfactant, which coats the inside of the aleveoli and reduces surface tension as well as prevents collapse of aleveoli, is also reduced.

  • Cough followed by expectoration of a thin mucous.
  • Loss of weight as the disease progresses.

Malnutrition plays a role in the Respiratory Disease Process.

  • Respiratory muscles, especially diaphragm and intercostal muscles, like other somatic muscles are catabolized to meet energy needs. Thus respiratory muscle mass decreases and this has an impact on respiration.
  • Hypoalbuminemia due to malnutrition may contribute to pulmonary edema. This occurs due to reduction in oncotic pressure as well as fluid shifts into interstitial space. Albumin levels <2.0 g/dl increase mortality tenfold.
  • Immune function is compromised due to a decrease in visceral proteins. Infection rate is increased.
  • Decrease in production of the surfactant which could lead to increased surface tension of pulmonary fluids.
  • Deficiency of sulphur containing amino acids, copper, selenium, iron and various vitamins will impair anti oxidant protective mechanisms.

Early treatment is likely to preserve lung function long term.

Symptoms are often unique to each person and the patient should recognize and report symptoms such as –

  • An increase in the quantity of sputum produced as well as thickness of the sputum.
  • Changes in sputum colour.
  • Increase in severity of shortness of breath, cough, wheeze.
  • Ankle swelling
  • Forgetfulness, confusion, slurring of speech.

  • Increased fatigue, lack of energy.
  • Dizziness and restlessness.
Severe respiratory symptoms are a life threatening emergency.

Last modified: Saturday, 5 November 2011, 9:30 AM