NUTRITIONAL SUPPORT IN ADVANCED LUNG-DISEASE - THE PULMONARY CACHEXIASYNDROME

Patients with advanced lung disease (ALD) demonstrate changes in body composition characteristically manifested by a progressive loss of bod y weight. This ''pulmonary cachexia'' is associated with a decline in clinical status and predicts accelerated mortality.(102) Careful asses sment of body composition can demonstrate evidence of this wasting syn drome in obese as well as normal and undernourished patients. The rela tionship between ALD and cachexia has prompted enthusiasm for nutritio nal support as a major therapeutic initiative in both stable and unsta ble (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 th e underlying disease state and indices of nutritional state may serve simply as markers of disease severity. This review addresses current k nowledge regarding the relationship between nutrition and ALD. The maj ority of investigative effort has been directed to the patient with ch ronic obstructive pulmonary disease (COPD) and that disorder therefore provides the focus of discussion. Treatment guidelines are outlined b ased upon our current understanding of the pulmonary cachexia syndrome .