Optimum nutrition is crucial as part of the overall treatment plan for patients with bronchiectasis. Nourishing foods and fluids provide the body with macronutrients (protein, fat and carbohydrate) and micronutrients (vitamins and minerals) the body needs for all its needs including the increased work of breathing associated with the condition.
Ideally, all patients with bronchiectasis should receive individualised nutritional education and counselling as part of their overall therapy to maintain or achieve a normal nutritional state. This may be through the optimisation of their diet and assessing the need for oral nutritional supplementation or enteral nutrition if energy and protein deficits are apparent, and cannot be met by diet or food fortification especially during times of exacerbations.
An Accredited Practicing Dietitian (APD) assesses the patient’s global nutrition status by firstly assessing their weight and Body Mass Index (BMI). As defined by the World Health Organisation, a normal BMI is between the range 18.5kg/m2 to 24.99kg/m2.
The International Classification of adult underweight, overweight and obesity according to BMI
|Principal cut-off points||Additional cut-off points|
|Moderate thinness||16.00 – 16.99|
|Mild thinness||17.00 – 18.49|
|Normal range||18.50 – 24.99||18.50 – 22.99|
|23.00 – 24.99|
|Pre-obese||25.00 – 29.99||25.00 – 27.49|
|27.50 – 29.99|
|Obese class I||30.00 – 34.99||30.00 – 32.49|
|32.50 – 34.99|
|Obese class II||35.00 – 39.99||35.00 – 37.49|
|37.50 – 39.99|
|Obese class III||≥40.00||≥40.00|
Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004.
Patients with bronchiectasis may present undernourished and with malnutrition, which impacts on lung function and overall strength capacity. Energy requirements are increased in people with bronchiectasis due to an increased work of breathing, chronic inflammation and infection. Coupled with a loss of appetite, breathlessness and general fatigue increases the risk of weight loss and malnutrition. Malnutrition leads to a loss of lean muscle mass which in turn affects lung function and overall health and well-being. It is advised that the individual with bronchiectasis who is underweight eats small frequent nutrient dense (high energy, high protein) meals and snacks.
The administration of oral nutrition supplements should be considered in patients with a BMI <20kg/m2 or those with a BMI >20kg/m2 who have recently lost weight or are not meeting their nutritional requirements, especially during times of infections or exacerbations.
Being overweight or obese increases the pressure on the patient’s heart and lungs to supply oxygen. Being overweight also increases the risk of developing diabetes, heart disease and some cancers and can impair mobility. Losing weight through a healthy diet and exercise may reduce the increased work of breathing linked to an increased BMI. In the presence of obesity or increased BMI, a weight loss goal should be set (see healthy weight chart). Weight loss can be achieved through calorie restriction and an emphasis on healthy eating and an increase in energy expenditure within the patient’s limits.
Healthy Weight Chart
Other Nutritional Considerations
Adequate micro-nutrient status in people with bronchiectasis is important for the functioning of all organs. This can be achieved by enjoying a wide variety of nutritious foods from the five food groups outlined in the Australian Guide to Healthy Eating. The five food groups are:
Bread, Cereal, Rice, Pasta, Noodles
Milk, Yoghurt, Cheese
Meat, Fish, Poultry, Eggs, Nuts, Legumes
Adequate fluid intake is important for people with bronchiectasis to ensure secretions in the lungs are easy to expectorate. Thick and sticky secretions are often associated with dehydration and increase the risk of infection.
It is recommended to have at least 8 cups of fluid (non-alcoholic and non-caffeinated) per day e.g. water, milk, juice.
A dietitian can discuss any nutritional concerns and give more detailed advice.