Skip to main content

Advertisement

SpringerLink
Log in

Muscle Wasting in the Hospitalised COPD Patients—How Can it Be Prevented and Treated?

  • Pulmonology and Respiratory Care (D Breen, Section Editor)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

COPD exacerbations are widely recognised as a significant cause of mortality and morbidity through their impact on respiratory function but their effect on skeletal muscle function and mass receives less attention. In this article, we review the association of this entity with COPD, the potential contributing factors, and the evidence behind the interventions available to manage this condition with a focus on the elderly population.

Recent Findings

In patients with COPD, there has been a paradigm shift from the focus on body weight and mass index to a more detailed assessment of the loss of muscle mass and function defined as sarcopaenia. Factors that can potentially lead to sarcopaenia has been the subject of multiple basic science and translational research studies. Interventions that have been proven to be associated with clinically significant outcomes in COPD patients include early mobilisation, inpatient exercise programmes, early pulmonary rehabilitation, and nutritional interventions. Prolonged courses of steroids following an acute exacerbation are non-beneficial and can lead to loss of muscle function.

Summary

Multiple factors can potentially contribute to sarcopaenia among patients admitted with COPD exacerbations and should be identified early and treated in a multidisciplinary setting. Nutritional interventions, early mobilisation, and limitation of systemic steroid prescribing are simple and effective interventions that should be utilised.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • Biolo G, Cederholm T, Muscaritoli M. Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of aging and chronic diseases: from sarcopenic obesity to cachexia. Clin Nutr Edinb Scotl. 2014;33(5):737–48. Provides a very detailed yet succinct description of sarcopaenia and its causative factors.

    Article  Google Scholar 

  2. Ståhl E, Lindberg A, Jansson S-A, Rönmark E, Svensson K, Andersson F, et al. Health-related quality of life is related to COPD disease severity. Health Qual Life Outcomes. 2005;3:56.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Akinbami LJ, Liu X. Chronic obstructive pulmonary disease among adults aged 18 and over in the United States, 1998–2009. NCHS Data Brief. 2011;63:1–8.

    Google Scholar 

  4. Maleki-Yazdi MR, Kelly SM, Lam SY, Marin M, Barbeau M, Walker V. The burden of illness in patients with moderate to severe chronic obstructive pulmonary disease in Canada. Can Respir J. 2012;19(5):319–24.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ford ES, Murphy LB, Khavjou O, Giles WH, Holt JB, Croft JB. Total and state-specific medical and absenteeism costs of COPD among adults aged ≥ 18 years in the United States for 2010 and projections through 2020. Chest. 2015;147(1):31–45.

    Article  PubMed  Google Scholar 

  6. Bustacchini S, Chiatti C, Furneri G, Lattanzio F, Mantovani LG. The economic burden of chronic obstructive pulmonary disease in the elderly: results from a systematic review of the literature. Curr Opin Pulm Med. 2011;17(Suppl 1):S35–41.

    Article  PubMed  Google Scholar 

  7. World Health Organization. Chronic Obstructive Pulmonary Disease (COPD). 2018. Available from: http://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd).

  8. Miravitlles M, Ferrer M, Pont A, Zalacain R, Alvarez-Sala JL, Masa F, Verea H, Murio C, Ros F, Vidal R, IMPAC Study Group. Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study. Thorax 2004;59(5):387–395.

  9. Donaldson GC, Wedzicha JA. COPD exacerbations .1: epidemiology. Thorax 2006;61(2):164–168.

  10. Perera PN, Armstrong EP, Sherrill DL, Skrepnek GH. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. COPD. 2012;9(2):131–41.

    Article  PubMed  Google Scholar 

  11. Miravitlles M, García-Polo C, Domenech A, Villegas G, Conget F, de la Roza C. Clinical outcomes and cost analysis of exacerbations in chronic obstructive pulmonary disease. Lung. 2013;191(5):523–30.

    Article  PubMed  Google Scholar 

  12. Singer JP, Peterson ER, Snyder ME, Katz PP, Golden JA, D’Ovidio F, et al. Body composition and mortality after adult lung transplantation in the United States. Am J Respir Crit Care Med. 2014;190(9):1012–21.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Xue Q-L, Walston JD, Fried LP, Beamer BA. Prediction of risk of falling, physical disability, and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119–21.

    Article  PubMed  Google Scholar 

  14. Dufour AB, Hannan MT, Murabito JM, Kiel DP, McLean RR. Sarcopenia definitions considering body size and fat mass are associated with mobility limitations: the Framingham Study. J Gerontol A Biol Sci Med Sci. 2013;68(2):168–74.

    Article  PubMed  Google Scholar 

  15. Janssen I. Evolution of sarcopenia research. Appl Physiol Nutr Metab Physiol Appl Nutr Metab. 2010;35(5):707–12.

    Article  Google Scholar 

  16. Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Physical activity and hospitalization for exacerbation of COPD. Chest. 2006;129(3):536–44.

    Article  PubMed  Google Scholar 

  17. Garcia-Aymerich J, Farrero E, Félez MA, Izquierdo J, Marrades RM, Antó JM, Estudi del Factors de Risc d’Agudització de la MPOC investigators. Risk factors of readmission to hospital for a COPD exacerbation: a prospective study. Thorax 2003;58(2):100–105.

  18. Cesari M, Pedone C, Chiurco D, Cortese L, Conte ME, Scarlata S, et al. Physical performance, sarcopenia and respiratory function in older patients with chronic obstructive pulmonary disease. Age Ageing. 2012;41(2):237–41.

    Article  PubMed  Google Scholar 

  19. • da Rocha Lemos Costa TM, Costa FM, Moreira CA, Rabelo LM, Boguszewski CL, Borba VZC. Sarcopenia in COPD: relationship with COPD severity and prognosis. J Bras Pneumol Publicacao Of Soc Bras Pneumol E Tisilogia. 2015;41(5):415–21. This paper evaluates the prevalence of sarcopaenia in COPD patients and also confirms that sarcopaenia correlates with a worse prognosis in COPD.

    Google Scholar 

  20. de Morton NA, Keating JL, Jeffs K. Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev. 2007;1:CD005955.

    Google Scholar 

  21. Puhan MA, Gimeno-Santos E, Cates CJ, Troosters T. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. In: The Cochrane Library [Internet]. John Wiley & Sons, Ltd; 2016 [cited 2018 May 12]. Available from: https://doi.org/10.1002/14651858.CD005305.pub4/full

  22. Rodriguez DA, Rodo-Pin A, Guerrero M, Coll R, Huerta A, Soler N, et al. Impact of step exercises as an early intervention during COPD exacerbation. Eur Respir J. 2016;48(suppl 60):PA2061.

    Google Scholar 

  23. Donaldson GC, Seemungal TAR, Patel IS, Bhowmik A, Wilkinson TMA, Hurst JR, et al. Airway and systemic inflammation and decline in lung function in patients with COPD. Chest. 2005;128(4):1995–2004.

    Article  PubMed  Google Scholar 

  24. Di Francia M, Barbier D, Mege JL, Orehek J. Tumor necrosis factor-alpha levels and weight loss in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1994;150(5 Pt 1):1453–5.

    Article  PubMed  Google Scholar 

  25. Byun MK, Cho EN, Chang J, Ahn CM, Kim HJ. Sarcopenia correlates with systemic inflammation in COPD. Int J Chron Obstruct Pulmon Dis. 2017;12:669–75.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Ferrando AA, Stuart CA, Sheffield-Moore M, Wolfe RR. Inactivity amplifies the catabolic response of skeletal muscle to cortisol. J Clin Endocrinol Metab. 1999;84(10):3515–21.

    PubMed  CAS  Google Scholar 

  27. Bowyer SL, LaMothe MP, Hollister JR. Steroid myopathy: incidence and detection in a population with asthma. J Allergy Clin Immunol. 1985;76(2 Pt 1):234–42.

    Article  PubMed  CAS  Google Scholar 

  28. Decramer M, Lacquet LM, Fagard R, Rogiers P. Corticosteroids contribute to muscle weakness in chronic airflow obstruction. Am J Respir Crit Care Med. 1994;150(1):11–6.

    Article  PubMed  CAS  Google Scholar 

  29. Leuppi JD, Schuetz P, Bingisser R, Bodmer M, Briel M, Drescher T, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA. 2013;309(21):2223–31.

    Article  PubMed  CAS  Google Scholar 

  30. Vermeeren M a P, Creutzberg EC, Schols AMWJ, Postma DS, Pieters WR, Roldaan AC, et al. Prevalence of nutritional depletion in a large out-patient population of patients with COPD. Respir Med. 2006;100(8):1349–55.

    Article  PubMed  CAS  Google Scholar 

  31. Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157(6 Pt 1):1791–7.

    Article  PubMed  CAS  Google Scholar 

  32. Schols AMWJ, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr. 2005;82(1):53–9.

    Article  PubMed  CAS  Google Scholar 

  33. Prado CMM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629–35.

    Article  PubMed  Google Scholar 

  34. Del Fabbro E, Parsons H, Warneke CL, Pulivarthi K, Litton JK, Dev R, et al. The relationship between body composition and response to neoadjuvant chemotherapy in women with operable breast cancer. Oncologist. 2012;17(10):1240–5.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, Biolo G, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr Edinb Scotl. 2010;29(2):154–9.

    Article  CAS  Google Scholar 

  36. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39(4):412–423.

  37. Woo J, Leung J, Morley JE. Validating the SARC-F: a suitable community screening tool for sarcopenia? J Am Med Dir Assoc. 2014;15(9):630–4.

    Article  PubMed  Google Scholar 

  38. Metter EJ, Conwit R, Tobin J, Fozard JL. Age-associated loss of power and strength in the upper extremities in women and men. J Gerontol A Biol Sci Med Sci. 1997;52(5):B267–76.

    Article  PubMed  CAS  Google Scholar 

  39. Morley JE. Sarcopenia: diagnosis and treatment. J Nutr Health Aging. 2008;12(7):452–6.

    Article  PubMed  CAS  Google Scholar 

  40. Joseph A-M, Adhihetty PJ, Buford TW, Wohlgemuth SE, Lees HA, Nguyen LM-D, et al. The impact of aging on mitochondrial function and biogenesis pathways in skeletal muscle of sedentary high- and low-functioning elderly individuals. Aging Cell. 2012;11(5):801–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  41. Bua EA, McKiernan SH, Wanagat J, McKenzie D, Aiken JM. Mitochondrial abnormalities are more frequent in muscles undergoing sarcopenia. J Appl Physiol Bethesda Md 1985. 2002;92(6):2617–24.

    Google Scholar 

  42. Hepple RT. Mitochondrial involvement and impact in aging skeletal muscle. Front Aging Neurosci. 2014;6:211.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Galway University Hospital, Newcastle Road, Galway, H91 YR71, Ireland

    Tara Cahill

  2. Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland

    Mohammed Ahmed

Authors
  1. Tara Cahill
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammed Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tara Cahill.

Ethics declarations

Conflict of Interest

Tara Cahill and Mohammed Ahmed declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pulmonology and Respiratory Care

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cahill, T., Ahmed, M. Muscle Wasting in the Hospitalised COPD Patients—How Can it Be Prevented and Treated?. Curr Geri Rep 7, 147–153 (2018). https://doi.org/10.1007/s13670-018-0245-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13670-018-0245-1

Keywords

Search

Navigation