La nutrición como parte del manejo integral del paciente con enfermedad pulmonar obstructiva crónica: revisión narrativa
DOI:
https://doi.org/10.56050/01205498.2231Resumen
La enfermedad pulmonar obstructiva crónica (EPOC) es una patología de expresión multisistémica, producto de la exposición del pulmón a partículas o gases nocivos, e influenciada por múltiples factores del huésped. Su diagnóstico requiere de la presencia de obstrucción en una espirometría post B2, y con frecuencia se asocia con enfermedades en otros sistemas que incrementan la carga de la enfermedad y que pueden ser considerados rasgos tratables al ser potenciales blancos terapéuticos evaluables con biomarcadores.
Un adecuado interrogatorio y el apoyo de estudios de baja complejidad que evalúen la composición corporal y la función muscular, resultan importantes para establecer los rasgos tratables nutricionales, que serán la base para iniciar y monitorizar el tratamiento nutricional del paciente con EPOC.
Aunque la mayoría de los rasgos nutricionales descritos implican pérdida de tejido adiposo o muscular (presarcopenia, sarcopenia, caquexia), el sobrepeso, la obesidad, la obesidad mórbida y la obesidad sarcopénica son también condiciones prevalentes y de importancia clínica. Estos rasgos nutricionales, que se han asociado con grados variables de inflamación, modificación de la respuesta inmune y de oxidación sistémica, se relacionan con incremento de la carga de la enfermedad y con la mortalidad. El tratamiento para estos rasgos debe darse en el plano de la individualización, teniendo en cuenta el potencial origen de la anormalidad y los objetivos de la intervención.
A pesar de que una buena parte de los estudios disponibles no hacen una evaluación completa del estado nutricional, e intervienen a la población con terapias estándar, el apoyo nutricional ha mostrado impacto positivo sobre desenlaces de interés clínico como peso, fuerza, capacidad funcional y mortalidad. Aunque estos hallazgos resultan promisorios, muestran la necesidad de generar investigación más precisa y con blancos terapéuticos mejor definidos.
Biografía del autor/a
Carlos Eduardo Aguirre Franco, Fundación Neumológica Colombiana
Medicina interna-neumología. Fundación Neumológica Colombiana.
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