How to improve appetite in an elderly patient with bronchiectasis?

From the Guidelines

To improve appetite in an elderly patient with bronchiectasis, focus on both nutritional strategies and addressing underlying issues, prioritizing small, frequent, nutrient-dense meals and considering medications like megestrol acetate or mirtazapine, as well as ensuring adequate airway clearance and treating acute exacerbations promptly. The management of bronchiectasis aims to reduce exacerbations, reduce symptoms, improve quality of life, and reduce the risk of future complications, as outlined in the European Respiratory Society guidelines for the management of adult bronchiectasis 1.

Key considerations include:

• Starting with small, frequent, nutrient-dense meals rather than three large ones to reduce overwhelm for patients with reduced appetite
• Encouraging consumption of high-calorie, high-protein foods and considering nutritional supplements like Ensure, Boost, or Sustagen between meals
• Medications that may help include megestrol acetate (Megace) 400-800 mg daily, which stimulates appetite through progesterone effects, or mirtazapine 7.5-15 mg at bedtime, which can improve appetite while aiding sleep, as suggested by general medical knowledge and not directly addressed in the provided evidence but relevant to clinical practice
• Ensuring adequate airway clearance with techniques like postural drainage, chest physiotherapy, or devices like flutter valves to reduce sputum burden that may interfere with eating, based on the understanding of bronchiectasis management 1
• Treating any acute exacerbations promptly with appropriate antibiotics and addressing symptoms like nausea with metoclopramide 10 mg before meals or ondansetron 4-8 mg as needed
• Creating a pleasant eating environment, encouraging social meals when possible, and incorporating favorite foods

Underlying appetite suppression may be related to chronic inflammation from bronchiectasis, increased metabolic demands from respiratory effort, or side effects from medications like antibiotics, so addressing these factors is essential for comprehensive management, as implied by the discussion on the pathophysiology of bronchiectasis and its management 1. However, it's crucial to note that the British Thoracic Society guideline for bronchiectasis in adults advises against routinely recommending alternative treatments, including nutritional supplementation, as part of the management of patients with bronchiectasis, emphasizing the need for evidence-based practices 1.

From the FDA Drug Label

Megestrol acetate is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

• Improving appetite in an elderly patient with bronchiectasis may be achieved with megestrol acetate.
• The patient's age (78) and renal function should be considered when selecting a dose, starting at the low end of the dosing range.
• It is essential to monitor renal function and adjust the dose accordingly to minimize the risk of toxic reactions 2.

From the Research

Improving Appetite in Elderly Patients with Bronchiectasis

To improve appetite in an elderly patient with bronchiectasis, several strategies can be considered:

• Managing the underlying condition of bronchiectasis to reduce symptoms and improve quality of life 3, 4, 5
• Using airway clearance techniques and mucoactive therapies to help clear mucus from the airways and reduce inflammation 6
• Considering the use of megestrol acetate, which has been shown to increase appetite and weight gain in patients with cachexia-anorexia syndrome, although its effectiveness in elderly patients with bronchiectasis is not well established 7

Treatment Options for Bronchiectasis

Treatment options for bronchiectasis include:

• Airway clearance techniques, such as chest physiotherapy and positive expiratory pressure therapy 4, 6
• Inhaled antibiotics and macrolides to reduce airway inflammation and prevent exacerbations 3, 5
• Mucoactive agents, such as mucolytics and expectorants, to help thin and clear mucus from the airways 6
• Pulmonary rehabilitation to improve lung function and overall health 6

Appetite Stimulation

Appetite stimulation can be achieved through:

• The use of megestrol acetate, which has been shown to increase appetite and weight gain in patients with cachexia-anorexia syndrome 7
• Ensuring adequate nutrition and hydration to help maintain weight and overall health
• Managing symptoms of bronchiectasis, such as cough and sputum production, to improve overall comfort and appetite