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Chronic Obstructive Pulmonary Disease (COPD) and Treatment of COPD-Related Cachexia

  • Emiel R. M. Wouters

Abstract

The association between weight loss and severe chronic obstructive pulmonary disease (COPD) has long been recognised. Fowler and Godlee [1] first described the association of weight loss and emphysema in the late nineteenth century. Attempts to establish different COPD classifications led to the realisation that body weight might be an important disease determinant [2]. This led to the classical description of the pink puffer (emphysematous type) and the blue bloater (bronchitic type). The pink puffing patient is characteristically thin, breathless, and with marked hyperinflation of the chest. The blue and bloated patient may not be particularly breathless, at least when at rest, but has severe central cyanosis. In the 1960s, several studies reported that low body weight and weight loss are negatively associated with survival in COPD [3]. Nevertheless, therapeutic management of weight loss and muscle wasting in patients with COPD has become of interest only recently, since these features were generally considered as terminal progression in the disease process and therefore inevitable and irreversible.

Keywords

Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient Respir Crit Severe Chronic Obstructive Pulmonary Disease Rest Energy Expenditure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Fowler JS, Volkow ND, Wang GJ et al (1996) Inhibition of monoamine oxidase B in the brains of smokers. Nature 379:733–736PubMedCrossRefGoogle Scholar
  2. 2.
    Filley GF, Beckwitt HJ, Reever JT, Mitchelli RS (1968) Chronic obstructive bronchopulmonary disease. 2. oxygen transport in two clinical types. Am J Med 44:26–38PubMedCrossRefGoogle Scholar
  3. 3.
    Vandenbergh E, van der Woestijne KP, Gyselen A (1967) Weight changes in the terminal stages of chronic obstructive pulmonary disease. Am Rev Respir Dis 95:556–566PubMedGoogle Scholar
  4. 4.
    Wilson DO, Rogers RM, Wright EC, Anthonisen NR (1989) Body weight in chronic obstructive pulmonary disease. The National Institutes of Health Intermittent Positive-Pressure Breathing Trial. Am Rev Respir Dis 139:1435–1438PubMedGoogle Scholar
  5. 5.
    Gray Donald K, Gibbons L, Shapiro SH et al (1996) Nutritional status and mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 153:961–966PubMedGoogle Scholar
  6. 6.
    Schols A, Slangen J, Volovics L, Wouters EFM (1998) Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Resp Crit Care Med 157:1791–1797PubMedGoogle Scholar
  7. 7.
    Schols AM, Wouters EF, Soeters PB, Westerterp KR (1991) Body composition by bioelectrical-impedance analysis compared with deuterium dilution and skinfold anthropometry in patients with chronic obstructive pulmonary disease. Am J Clin Nutr 53:421–424PubMedGoogle Scholar
  8. 8.
    Engelen MP, Schols AM, Baken WC et al (1994) Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in out-patients with COPD. Eur Respir J 7:1793–1797PubMedCrossRefGoogle Scholar
  9. 9.
    Bissonnette DJ, Madapallimatam A, Jeejeebhoy KN (1997) Effect of hypoenergetic feeding and high-carbohydrate refeeding on muscle tetanic tension, relaxation rate, and fatigue in slowand fast-twitch muscles in rats. Am J Clin Nutr 66:293–303PubMedGoogle Scholar
  10. 10.
    Fiaccadori E, Del Canale S, Coffrini E et al (1988) Hypercapnic-hypoxemic chronic obstructive pulmonary disease (COPD): influence of severity of COPD on nutritional status. Am J Clin Nutr 48:680–685PubMedGoogle Scholar
  11. 11.
    Anonymous (1999) Skeletal muscle dysfunction in chronic obstructive pulmonary disease. A statement of the American Thoracic Society and European Respiratory Society. Am J Respir Crit Care Med 159:S1–S4OGoogle Scholar
  12. 12.
    Engelen MP, Schols AM, Lamers RJ, Wouters EF (1999) Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease. Clin Nutr 18:275–280PubMedCrossRefGoogle Scholar
  13. 13.
    Bernard S, LeBlanc P, Whittom F et al (1998) Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 158:629–634PubMedGoogle Scholar
  14. 14.
    Palange P, Forte S, Felli A et al (1995) Nutritional state and exercise tolerance in patients with COPD. Chest 107:1206–1212PubMedGoogle Scholar
  15. 15.
    Palange P, Forte S, Onorati P et al (1998) Effect of reduced body weight on muscle aerobic capacity in patients with COPD. Chest 114:12–18PubMedGoogle Scholar
  16. 16.
    Baarends EM, Schols AM, Mostert R, Wouters EF (1997) Peak exercise response in relation to tissue depletion in patients with chronic obstructive pulmonary disease. Eur Respir J 10:2807–2813PubMedCrossRefGoogle Scholar
  17. 17.
    Russell DM, Walker PM, Leiter LA et al (1984) Metabolic and structural changes in skeletal muscle during hypocaloric dieting. Am J Clin Nutr 39:503–513PubMedGoogle Scholar
  18. 18.
    Layman DK, Merdian Bender M, Hegarty PV, Swan PB (1981) Changes in aerobic and anaerobic metabolism in rat cardiac and skeletal muscles after total or partial dietary restrictions. J Nutr 111:994–1000PubMedGoogle Scholar
  19. 19.
    Pichard C, Vaughan C, Struk R et al (1988) Effect of dietary manipulations (fasting, hypocaloric feeding, and subsequent refeeding) on rat muscle energetics as assessed by nuclear magnetic resonance spectroscopy. J Clin Invest 82:895–901PubMedGoogle Scholar
  20. 20.
    Shoup R, Dalsky G, Warner S et al (1997) Body composition and health-related quality of life in patients with obstructive airways disease. Eur Respir J 10:1576–1580PubMedCrossRefGoogle Scholar
  21. 21.
    Schols AM, Soeters PB, Dingemans AM et al (1993) Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation. Am Rev Respir Dis 147:1151–1156PubMedGoogle Scholar
  22. 22.
    Pouw E, Ten Velde G, Croonen B et al (2000) Early nonelective readmission for chronic obstructive pulmonary disease is associated with weight loss. Clin Nutr 19:95–99PubMedCrossRefGoogle Scholar
  23. 23.
    Vitacca M, Clini E, Porta R et al (1996) Acute exacerbations in patients with COPD: predictors of need for mechanical ventilation. Eur Respir J 9:1487–1493PubMedCrossRefGoogle Scholar
  24. 24.
    Beck AM, Ovesen L (1998) At which body mass index and degree of weight loss should hospitalized elderly patients be considered at nutritional risk? Clin Nutr 17:195–198PubMedCrossRefGoogle Scholar
  25. 25.
    Schols AM, Fredrix EW, Soeters PB et al (1991) Resting energy expenditure in patients with chronic obstructive pulmonary disease. Am J Clin Nutr 54:983–987PubMedGoogle Scholar
  26. 26.
    Hugli O, Schutz Y, Fitting JW (1995) The cost of breathing in stable chronic obstructive pulmonary disease. Clin Sci (Lond) 89:625–632Google Scholar
  27. 27.
    Sridhar MK, Carter R, Lean MEJ, Banham SW ( 1994) Resting energy expenditure and nutritional state of patients with increased oxygen cost of breathing due to emphysema, scoliosis and thoracoplasty. Thorax 49:781–785PubMedGoogle Scholar
  28. 28.
    Hofford JM. Milakofsky L, Vogel WH et al (1990) The nutritional status in advanced emphysema associated with chronic bronchitis. A study of amino acid and catecholamine levels. Am Rev Respir Dis 141:902–908PubMedGoogle Scholar
  29. 29.
    Wilson SR, Amoroso P, Moxham J, Ponte J (1993) Modification of the thermogenic effect of acutely inhaled salbutamol by chronic inhalation in normal subjects. Thorax 48:886–889PubMedGoogle Scholar
  30. 30.
    Amoroso P, Wilson SR, Moxham J, Ponte J (1993) Acute effects of inhaled salbutamol on the metabolic rate of normal subjects. Thorax 48:882–885PubMedGoogle Scholar
  31. 31.
    Creutzberg EC, Schols AM, Bothmer-Quaedvlieg FC et al (1998) Acute effects of nebulized salbutamol on resting energy expenditure in patients with chronic obstructive pulmonary disease and in healthy subjects. Respiration 65:375–380PubMedCrossRefGoogle Scholar
  32. 32.
    De Godoy I, Donahoe M, Calhoun WJ et al (1996) Elevated TNF-alpha production by peripheral blood monocytes of weight-losing COPD patients. Am J Respir Crit Care Med 153:633–637PubMedGoogle Scholar
  33. 33.
    Di Francia M, Barbier D, Mege JL, Orehek J (1994) Tumor necrosis factor-alpha levels and weight loss in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 150:1453–1455PubMedGoogle Scholar
  34. 34.
    Takabatake N, Nakamura H, Abe S et al (1999) Circulating leptin in patients with chronic obstructive pulmonary disease. Am J Resp CritCare Med 159:1215–1219Google Scholar
  35. 35.
    Schols AM, Buurman WA, Staal van den Brekel AJ et al (1996) Evidence for a relation between metabolic derangements and elevated inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease. Thorax 51:819–824PubMedCrossRefGoogle Scholar
  36. 36.
    Hugli O, Frascarolo P, Schutz Y et al (1993) Dietinduced thermogenesis in chronic obstructive pulmonary disease. Am Rev Respir Dis 148:1479–1483PubMedGoogle Scholar
  37. 37.
    Baarends EM, Schols AM, Pannemans DL et al (1997) Total free living energy expenditure in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 155:549–554PubMedGoogle Scholar
  38. 38.
    Hugli O, Schutz Y, Fitting JW (1996) The daily energy expenditure in stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 153:294–300PubMedGoogle Scholar
  39. 39.
    Baarends EM, Schols AM, Westerterp KR, Wouters EF (1997) Total daily energy expenditure relative to resting energy expenditure in clinically stable patients with COPD. Thorax 52:780–785PubMedGoogle Scholar
  40. 40.
    Baarends EM, Schols A, Akkermans MA, Wouters EF (1997) Decreased mechanical efficiency in clinically stable patients with COPD. Thorax 52:981–986PubMedCrossRefGoogle Scholar
  41. 41.
    Wuyam B, Payen JF, Levy P et al (1992) Metabolism and aerobic capacity of skeletal muscle in chronic respiratory failure related to chronic obstructive pulmonary disease. Eur Respir J 5:157–162PubMedGoogle Scholar
  42. 42.
    Maltais F, Simard AA, Simard C et al (1996) Oxidative capacity of the skeletal muscle and lactic acid kinetics during exercise in normal subjects and in patients with COPD. Am J Respir Crit Care Med 153:288–293PubMedGoogle Scholar
  43. 43.
    Jakobsson P, Jorfeldt L, Henriksson J (1995) Metabolic enzyme activity in the quadriceps femoris muscle in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 151:374–377PubMedGoogle Scholar
  44. 44.
    Sauleda J, Garcia-Palmer F, Wiesner RJ et al (1998) Cytochrome oxidase activity and mitochondrial gene expression in skeletal muscle of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 157:1413–1417PubMedGoogle Scholar
  45. 45.
    Pouw EM, Schols AMWJ, Vusse GJ, Wouters EF (1998) Elevated inosine monophosphate levels in resting muscle of patients with stable COPD. Am J Respir Crit Care Med 157:453–457PubMedGoogle Scholar
  46. 46.
    Pouw EM, Schols AM, Deutz NE, Wouters EF (1998) Plasma and muscle amino acid levels in relation to resting energy expenditure and inflammation in stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 158:797–801PubMedGoogle Scholar
  47. 47.
    Goldstein SA, Thomashow BM, Kvetan V et al (1988) Nitrogen and energy relationships in malnourished patients with emphysema. Am Rev Respir Dis 138:636–644PubMedGoogle Scholar
  48. 48.
    Hjalmarsen A, Aasebo U, Birkeland K et al (1996) Impaired glucose tolerance in patients with chronic hypoxic pulmonary disease. Diab Metab 22:37–42Google Scholar
  49. 49.
    Jakobsson P, Jorfeldt L, von Schenck H (1995) Insulin resistance is not exhibited by advanced chronic obstructive pulmonary disease patients. Clin Physiol 15:547–555PubMedGoogle Scholar
  50. 50.
    Schols AM, Soeters PB, Mostert R et al (1991) Energy balance in chronic obstructive pulmonary disease. Am Rev Respir Dis 143:1248–1252PubMedGoogle Scholar
  51. 51.
    Grunfeld C, Zhao C, Fuller J et al (1996) Endotoxin and cytokines induce expression of leptin, the ob gene product, in hamsters. J Clin Invest 97:2152–2157PubMedCrossRefGoogle Scholar
  52. 52.
    Schols A, Creutzberg E, Buurman W et al (1999) Plasma leptin is related to pro-inflammatory status and dietary intake in patients with COPD. Am J Respir Crit Care Med 160:1220–1226PubMedGoogle Scholar
  53. 53.
    Vermeeren MA, Schols AM, Quaedvlieg FC, Wouters EF (1994) The influence of an acute disease exacerbation on the metabolic profile of patients with chronic obstructive pulmonary disease. Clin Nutr 13(suppl. l):38–39CrossRefGoogle Scholar
  54. 54.
    Wilson DO, Rogers RM, Sanders MH et al (1986) Nutritional intervention in malnourished patients with emphysema. Am Rev Respir Dis 134:672–677PubMedGoogle Scholar
  55. 55.
    Whittaker JS, Ryan CF, Buckley PA, Road JD (1990) The effects of refeeding on peripheral and respiratory muscle function in malnourished chronic pulmonary disease patients. Am Rev Respir Dis 142:283–288PubMedGoogle Scholar
  56. 56.
    Russell DM, Prendergast PJ, Darby PL et al (1983) A comparison between muscle function and body composition in anorexia nervosa: the effect of refeeding. Am J Clin Nutr 38:229–237PubMedGoogle Scholar
  57. 57.
    Fuenzalida CE, Petty TL, Jones ML et al (1990) The immune response to short-term nutritional intervention in advanced chronic obstructive pulmonary disease. Am Rev Respir Dis 142:49–56PubMedGoogle Scholar
  58. 58.
    Rogers RM, Donahoe M, Constatino J (1992) Physiologic effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary diseases, a randomized control study. Am Rev Respir Dis 146:1511–1517PubMedGoogle Scholar
  59. 59.
    Efthimiou J, Fleming J, Gomes C, Spiro SG (1988) The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 137:1075–1082PubMedGoogle Scholar
  60. 60.
    Otte KE, Ahlburg P, D’Amore F, Stellfeld M (1989) Nutritional repletion in malnourished patients with emphysema. JPEN J Parenter Enterai Nutr 13:152–156Google Scholar
  61. 61.
    Knowles JB, Fairbarn MS, Wiggs BJ et al (1988) Dietary supplementation and respiratory muscle performance in patients with COPD. Chest 93:977–983PubMedGoogle Scholar
  62. 62.
    Lewis MI, Belman MJ, Dorr Uyemura L (1987) Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 135:1062–1067PubMedGoogle Scholar
  63. 63.
    Schols AM, Soeters PB, Mostert R et al (1995) Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial. Am J Respir Crit Care Med 152:1268–1274PubMedGoogle Scholar
  64. 64.
    Creutzberg EC, Wouters EF, Mostert R et al (2003) Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease. Nutrition 19:120–127PubMedCrossRefGoogle Scholar
  65. 65.
    Creutzberg EC, Wouters EFM, Vanderhoven-Augustin IM et al (2000) Disturbances in leptin metabolism are related to energy imbalance during acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 162:1239–1245PubMedGoogle Scholar
  66. 66.
    Saudny Unterberger H, Martin JG, Gray Donald K (1997) Impact of nutritional support on functional status during an acute exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 156:794–799PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2006

Authors and Affiliations

  • Emiel R. M. Wouters
    • 1
  1. 1.Department of Respiratory MedicineUniversity Hospital MaastrichtMaastrichtThe Netherlands

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