Drugs

, Volume 64, Issue 10, pp 1041–1052 | Cite as

Reversal of Chronic Obstructive Pulmonary Disease-Associated Weight Loss

Are There Pharmacological Treatment Options?
Leading Article

Abstract

Poor nutritional status is associated with an increased incidence of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). While a number of factors have been shown to produce tissue catabolism, no single mechanism has been clearly identified as a primary cause for weight loss in patients with severe COPD. Without a clear understanding of the aetiology of weight loss, therapeutic strategies to reverse this process have historically been unsuccessful. A review of recent studies allows consideration of a model of mechanisms of weight loss. This model includes multiple pathways that may be activated singly or simultaneously to cause loss of weight, specifically lean body mass. These include energy imbalances, elevated levels of cytokines, tissue hypoxia and the effects of cocorticosteroid therapy.

To date, interventional studies that have looked at newer pharmacotherapies such as growth hormone and anabolic steroids in patients with COPD who arelosing weight have not demonstrated reversal of weight loss or improvement in nutritional status. Currently, early identification of patients at risk for weight loss and aggressive nutritional supplementation coupled with an exercise programme has demonstrated the greatest benefit. However, with increasing understanding of the mechanisms that may be implicated, new targets for therapies are being identified.

Of particular research interest are molecules such as leukotrienes, hormones, tumour necrosis factor-α and acute-phase proteins, which are noted to be elevated in some patients with COPD-associated weight loss. Currently, inhibitors to some of these inflammatory substances are used therapeutically in other chronic illnesses such as rheumatoid arthritis and cancer cachexia. Future research may investigate their usefulness in COPD and direct new therapies that target the processes contributing to weight loss in these patients.

Keywords

Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient Lean Body Mass Anabolic Steroid Severe Chronic Obstructive Pulmonary Disease 

Notes

Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  1. 1.College of NursingUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Alexion Brothers Hospital NetworkSchaumbergUSA

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