Medical Nutritional Therapy in Infected Bronchiectasis with Impending Respiratory Failure: A CASE REPORT
Dian Wahyuni(a), Devintha Virani(b), Nurpudji Taslim(b), Nurbaya Syam(b)

(a) Clinical Nutrition Specialist Program, Nutrition Departement, School of Medicine, Hasanuddin University Indonesia
(b) Nutrition Departement, School of Medicine, Hasanuddin University Indonesia

Abstract

Objectives
Bronchiectasis is a chronic infective and inflammatory respiratory disease that causes significant morbidity and mortality. Repeated respiratory infections may lead to Infected Bronchiectasis (IB) and acute exacerbations which often require hospital admission, increase risk of malnutrition and impact quality of life and eventually leads to death. Nutritional therapy is needed to modulate inflammation and enhance immunity to reduce severity of exacerbation, overcome malnutrition, as well as to decrease morbidity and mortality.

Case Report
We reported a 59-year-old female patient, diagnosed with IB. The patient had low oral intake due to productive cough and anorexia since 2 weeks before admission. Moreover, she had gradual shortness of breath that caused an impending respiratory failure during hospitalization, supported by continuous positive airway pressure (CPAP). Nutritional assessment was made based on Subjective Global Assessment (SGA) score C. Abnormal laboratory findings seen were increased in neutrophil-to-lymphocyte ratio (NLR) 9.3, moderate depletion of immune system with total lymphocyte count (TLC) 808.4/ul, hypoalbuminemia (3.2 g/dl) and increased in liver enzymes : Aspartate aminotransferase (AST) 206 U/l, Alanine aminotransferase (ALT) 224 U/l. Nutritional therapy was given gradually with target calorie 1400-1900 kcal, protein 0.8-1.5 g/kg IBW/day, carbohydrates 45-50%, and fat 33,3-43% through oral and parenteral nutrition. The patient was given supplementations such as vitamins (A, B complex, C, D), zinc, curcumin and snakehead fish extract high albumin content. After 14 days of treatment, significant clinical and metabolic improvement in NLR, TLC, plasma albumin, liver enzymes (AST/ALT), blood gas analysis, and functional capacity (hand grip strength) were found.

Conclusion
An adequate nutritional therapy with macro and micro-nutrients in IB patient could improve clinical outcome, nutritional status and quality of life.

Keywords: Infected Bronchiectasis; Malnutrition; Nutritional therapy; Respiratory failure.

Topic: Dietetics and nutrition