7: Pulmonary Flashcards
Asthma Pathophys
genetic susceptibility
immune sensitization-allergens, resp ifxns, pollutants
GERD, obesity
induce Th2–excess cytokines, adhesion molecule production: eosinophils, basophils, monocytes
Th2 induces IgE, causing mast cell degranulation/bronchospasm
Asthma Nutritional Tx
Elimination Diet to ID food allergies
(caution anaphylactic rxns- if at home have rescue meds avail)
in children: no single food should be eliminated for >4 weeks because can result in loss of immune tolerance/nutritional def
Asthma (Possible) Food Triggers
sulfites: dried fruits, wine, fruit juice, molasses, dried potatoes)
tartrazine (Yellow 5): fake cheeses
Sodium benzoate: preservative for acidic foods
MSG (?)
Aspartame (?)
Asthma and breastfeeding
4 mos exclusive breastfeeding to exert protective effect
Asthma and vegan diet
no grains, coffee, tea, choc, sugar, Cl water
92% better after 1 year.
Is is the veganism or the no grains and sugar…
Asthma: Antiox
vit E and vit C protective against ozone-induced rxns
low vit C and a-caroteine assoc with asthma risk
Vit C: reduces oxidative stress, improves FEV1 and FEF60; antihistamine effect
Asthma: B6
prevents mass cell degranulation
often low in asthmatics
decreased by theophylline
add Mg (to balance increased need)
Asthma: Mg
often low in asthmatics
anti-inflamm and anti-histamine
depleted by asthma meds
Asthma: fish oil
?
Asthma: Vit D
def in children assoc with exacerbations, severity, glucocorticoid use
COPD
oxidative stress -> hyperactivation of neutrophils, macrophages, flibroblasts, mucus
COPD prevention
min exposure
dietary anti ox
Vit C
EPA, DHA
COPD: NAC
high dose to reduce number of exacerbations
maybe
COPD: FA therapy
ALA, EPA, DHA, GLA improved exercise capacity
COPD: L-Carnitine
improved inspiratory muscle strength and walking tolerance
COPD: Resveratrol
may reduce inflammatory mediators but not effect vasc endothelial GF
Idiopathic Pulm Fibrosis
rare interstitial lung dz
type 1 aveolar cell destruction (gas exchange) with hyperplasia of type 2 (surfactant prxn) with collagen deposition
IPF Risk Factors
Smoking FHx occipational inhalants GERD DMII
IPF: Nutrition
higher fruit intake?
Elimination Diet?
NAC
Pulmonary Arterial HTN
chronic elevation in pulm a P (in absence of elevated L sided P)
arterial obstxn/constrxn
R ventricular hypertrophy/failure
Secondary PAH: CT dz, L sided CV dz, COPD, chronic thromboembolic, multifactorial
PAH Pathophys
metalloprotease upreg-degradation of adventitia
early endothel cell apoptosis
tunica media SM proliferation
activation of hypoxia TFs under normoxic conditions
PAH: Support the mitochondria!
Mg Genistein (soy protein): reduce endothelin, increase NO FA: EPA + DHA: increase mitochondrial membrane integrity L Arginine: increase NO, decrease endothelin
Bronchiectasis
permanent dilation of bronchus/bronchi with thickening of bronchial wall
caused by recurrent infxn, CF, primary ciliary dyskinesia
impaired mucociliary clearance
Bronchiectasis Tx: reduce mucus viscosity
proteolytic enzymes: trypsin + chymotrypsin
NAC
Vit D
allergy elimination diet
Acute Resp Distress Syndrome Causes
Sepsis
Severe Pneumonia
Trauma
Aspiration/Inhalation
ARDS Risk Factors
multiple transfusions
advanced age
cigarette smoking
drug overdose
ARDS Phases
Acute: rapid exudative process with vascular hyperpermeability, compromises surfactant, depletes GSH
Fibroproliferative: 5-10 days after onset, lasts weeks
Resolution: several months - year; decreased exercise capacity after 5 years
ARDS Nutritional Tx Inpatient
enteral feeding (fish oil, vit E, taurine) NAC
ARDS Nutritional Tx Outpatient
anti-inflamm diet FA: EPA + DHA Curcumin Boswellia NAC
Recurrent Resp Papillomatosis
benign viral neoplastic dz casued by HPV
limited to larynx
Routes: maternal transmission during birth, oral-genital, iatrogenic
sxs: difficulty speaking, change in voice
Recurrent Resp Papillomatosis
Indole 3 carbinol (brassicas)
Vit D upregulated AMP
Pulmonary Hemosiderosis
Rare interstitial lung dz: recurrent hemorrhage with subsequent accumulation of hemosiderin-rich macrophages
sxs: hemoptysis, iron def anemia, pulmonary infiltrates
Pulmonary Hemosiderosis Nutritional Tx
Eliminate milk
Eliminate gluten (Celiac)
Elimination Diet
Sarcoidosis
paradoxical immune status:
Hyperactive: macrophage aggregation in granulomas
Hypo: depressed tuberculin response and opportunistic infxn
Sarcoidosis Nutritional Tx
melatonin- resolution of hilar adenopathy flaxseed oil low dose fish oil Curcumin low Ca diet- if hypercalcemic
Sarcoidosis: Vit D
granulomatous tissue over produces 1a-hydroxylase
may need to restrict sun time
Sarcoidosis: Therapeutic goals
- Bone Mineral Density preservation with corticosteroid tx
- decreased dz activity
- decreased opportunistic infxn
