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Nutritional support in advanced lung disease

Lisa M Bellini, MD
Section Editors
Scott Manaker, MD, PhD
Timothy O Lipman, MD
Deputy Editor
Helen Hollingsworth, MD


Patients with advanced lung disease often suffer from changes in body composition manifested by progressive weight loss. Many of these patients have malnutrition, which impairs respiratory muscle contractility and affects both endurance and respiratory mechanics [1].

The pathophysiology and treatment of malnutrition in patients with advanced lung disease is reviewed here. The management of stable COPD, the assessment of nutritional status, and nutritional support in critical illness are discussed separately. (See "Management of stable chronic obstructive pulmonary disease" and "Palliative care: Assessment and management of anorexia and cachexia" and "Nutrition support in critically ill patients: An overview".)

The American Gastroenterological Association (AGA) has published a guideline for enteral nutrition [2]. Other guidelines for enteral and parenteral nutrition can be accessed at American Society for Parenteral and Enteral Nutrition.


Malnutrition associated with advanced lung disease has been termed the "pulmonary cachexia syndrome" and is characterized by loss of fat-free body mass [3]. The pulmonary cachexia syndrome is associated with an accelerated decline in functional status and can affect patients with any type of advanced lung disease, although it is best studied and described in association with chronic obstructive pulmonary disease (COPD) [3,4]. The incidence of undernutrition in patients with COPD depends on disease severity and the methods used to define nutritional status [5]. When cachexia is defined as less than 90 percent of ideal body weight, 20 to 50 percent of patients with COPD are underweight [6]. In the Intermittent Positive-Pressure Breathing (IPPB) Trial, 24 percent of the patients were underweight [7]. In the same study, among patients with an FEV1 of less than 35 percent predicted, 50 percent were undernourished. Thus, the severity of airway obstruction correlates with the risk of undernutrition. Skeletal muscle wasting and dysfunction in advanced lung disease may be under recognized clinically, especially in overweight or obese patients, but may still signal a higher risk for morbidity and mortality.

Definition — The consensus definition of cachexia is: "a complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass. The prominent clinical feature of cachexia is weight loss in adults (corrected for fluid retention)…Anorexia, inflammation, insulin resistance, and increased muscle protein breakdown are frequently associated with cachexia" [5].

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Literature review current through: Nov 2017. | This topic last updated: Aug 26, 2017.
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