Nutritional support in advanced pulmonary disease.

Advanced pulmonary disease (APD), often secondary to emphysema or chronic bronchitis, is generally a progressive, incurable condition, ultimately leading to death. The condition is associated with significant, distressing symptoms. Most APD patients are underweight, which has numerous implications including accentuation of reduced physical capacity during daily life, increased risk of other secondary diseases, e.g. infections and osteoporosis, and a higher mortality during exacerbations with acute respiratory failure. Consequently, careful nutritional support is crucial both in enhancing physical well-being and function, and in reducing the risk of acute respiratory failure. Knowledge concerning the exact nutritional needs in APD is still very sparse; however, specific actions against malnutrition in APD patients should be mandatory in the treatment of APD. This paper reviews the literature concerning implications of malnutrition and benefits of nutritional support in APD patients, and gives suggestions for the practical, daily-life nutritional management of APD.