Nutritional support in advanced lung disease - The pulmonary cachexia syndrome

Patients with advanced lung disease (ALD) demonstrate changes in body composition characteristically manifested by a progressive loss of body weight. This ''pulmonary cachexia'' is associated with a decline in clinical status and predicts accelerated mortality.(102) Careful assessment of body composition can demonstrate evidence of this wasting syndrome in obese as well as normal and undernourished patients. The relationship between ALD and cachexia has prompted enthusiasm for nutritional support as a major therapeutic initiative in both stable and unstable (intensive care unit) patients. A relationship, however, does not assure that treatment will alter the prognosis in a favorable manner. In most medical conditions, nutritional status is tightly linked to the underlying disease state and indices of nutritional state may serve simply as markers of disease severity. This review addresses current knowledge regarding the relationship between nutrition and ALD. The majority of investigative effort has been directed to the patient with chronic obstructive pulmonary disease (COPD) and that disorder therefore provides the focus of discussion. Treatment guidelines are outlined based upon our current understanding of the pulmonary cachexia syndrome.