14.4: Treatments and Nutrition
By the end of this section, you should be able to:
- 14.3.1 Identify drug–food interactions for their impact on treatments utilized for pulmonary disorders.
- 14.3.2 Identify treatments and medications that can cause nutritional deficiencies in clients with pulmonary disorders.
Drug–Food Interactions with Treatments for Pulmonary Disorders
Medical interventions for pulmonary disorders may be associated with dietary interactions or adverse effects. Some medications used to treat chronic pulmonary disorders require dietary modifications, while other foods and supplements interact with the prescribed medications. When interactions do occur, harmful side effects can result, or interaction may limit the efficacy of the drug used to treat the illness.
Chronic pulmonary diseases such as asthma, COPD, and pulmonary fibrosis affect millions of people worldwide (NIH, 2022a; NIH, 2022b; NIH, 2022d). Treatment to manage these conditions includes a variety of medications in certain combinations. Bronchodilators, corticosteroids, and immunosuppressants help manage condition symptoms; however, these medications have the potential to interact with certain foods that may alter their absorption ability, limit effectiveness, and jeopardize safety. This section will provide an overview of everyday drug-food interactions associated with standard treatment options for pulmonary diseases.
Health care providers must discuss possible food and drug interactions with their clients to ensure that the medications are being used effectively with maximum results and minimize side effects. The nurse and health care provider should guide clients on the best ways to take prescribed medications and advise on potential dietary restrictions.
Bronchodilators
Bronchodilators are beta-2 adrenergic receptor agonists used as first-line medications to treat asthma and COPD. Foods such as caffeine enhance the efficacy of bronchodilators as a first-line treatment options (Wee et al., 2020), because caffeine shares the same effects in the body as bronchodilators. Side effects include tremors, nervousness, anxiety, and heart palpitations. On the other hand, meals high in dietary fat can prohibit the absorption of the bronchodilator (Santo et al., 2021). When the absorption is delayed, the effect of a beta-2 adrenergic receptor is diminished. So high-fat diets should be avoided in clients with asthma and COPD who use bronchodilators.
Corticosteroids
Corticosteroids are hormone mediators created in the adrenal cortex (Yasir et al., 2022). This medication class decreases airway inflammation in acute and chronic pulmonary conditions. Corticosteroids are used in asthma and exacerbation of COPD. Nurses should advise clients to take corticosteroids with food to prevent stomach irritation. Some foods—grapefruit, for example—may increase corticosteroid volume amounts in the bloodstream and increase the risk for adverse effects (Food and Drug Administration, 2021).
Antibiotics
Antibiotics are commonly used to treat lower RTI and while antibiotics , antivirals, and antifungals are common medical interventions for pneumonia. Levofloxacin is commonly used to treat RTI and pneumonia (DailyMed, 2022). Concurrently using levofloxacin with dairy products or calcium-fortified juices decreases the absorption of the medication and thus should be avoided (DailyMed, 2022).
Fruits and vegetables have antioxidant, antifungal, antibiotic, and antiviral qualities, which support the immune system (Vahid & Rahmani, 2021). These effects help the immune system combat the invader during the use of antibiotics.
Treatments and Medication That Can Cause Nutritional Deficiencies
Certain medications and medical interventions can be lifesaving when discussing pulmonary disorders. However, these life-saving treatment options sometimes unintentionally affect a client’s nutritional condition. These treatment modalities might lead to deficiencies in vital nutrients that maintain, prevent, or improve pulmonary function. It is crucial for health care providers to continuously monitor the clients they treat and educate them about potential nutritional deficiencies and how to treat them. A balanced and nutrient-rich diet may help reduce nutritional deficiencies and support and improve overall respiratory function.
Corticosteroids
As previously mentioned, corticosteroids are commonly used to decrease inflammation in the airways in conditions such as asthma and COPD (Yasir et al., 2022). Long-term use of corticosteroids causes some nutritional deficiencies. These deficiencies include decreased potassium, calcium, and vitamin D, which in turn increase the risk for decreased bone density , fractures , diminished muscle mass , muscle weakness , and osteoporosis .
Oxygen Therapy
Sometimes, chronic pulmonary conditions such as COPD warrant long-term oxygen therapy . Long-term oxygen therapy in COPD clients contributed to deficiencies of vital nutrients in clients already suffering from malnutrition (Mekal et al., 2021). As the energy demand shifts during COPD, hypoxia (low oxygenation to tissues) causes decreased oxygenation and decreased normal intestine function (Zheng et al., 2015). As the body works to oxygenate, the decrease in intestine function causes a loss of nutrients (Zheng et al. 2015). Mekal et al. (2021) noted deficiencies in calcium, vitamins A, C, D, and E, and folates in about 95% of their COPD clients. The lack of vital nutrients impacts the pulmonary system's optimal functional capabilities by decreasing muscle strength and respiratory function. Clients with deficiencies need to be closely monitored and taught about nutrient-rich dietary options to select to minimize these insufficiencies in nutrients.
Mechanical Ventilation
If an acute or chronic respiratory disease exacerbates to the point of life-saving measurement requirements, mechanical ventilation provides a break to the lungs to allow them time to rest (Kalaiselvan et al., 2021). According to Kalaiselvan et al. (2021), clients on mechanical ventilators do not have appropriate dietary intake, anorexia, and malabsorption of vital nutrients. The prolonged use of mechanical ventilation leads to vitamin D and calcium deficiencies. These deficits contribute to respiratory problems secondary to muscle weakness and difficulty weaning from the ventilator.
Antibiotics
Malabsorption of vital nutrients contributes to pulmonary problems, limited immunity, and increased risk for RTI. Antibiotics are often used in the treatment plan for RTI and bacterial pneumonia (Sanivarapu & Gibson, 2023). Long-term use of antibiotics disrupts gut bacteria and prevents nutrient absorption , leading to deficiencies. According to Ramirez et al. (2020), healthy bacteria in the colon helps break down xenobiotics and other compounds that play a role in amino acid and vitamin synthesis within the colon. When antibiotics are used, they remove the healthy bacteria that helps vitamin synthesis in the colon, causing the deficiencies. Nurses should recommend probiotic-rich sources such as kimchi, sauerkraut, kefir, yogurt, and drinks such as kombucha to counter the loss of good bacteria with antibiotic use. These probiotic-rich interventions help combat the side effects of antibiotics that include nausea, vomiting, and diarrhea. When the nurse develops a discharge plan that includes antibiotic use, probiotic-rich foods and drinks should be included in the plan.