Respiratory exacerbations are associated with muscle loss in current and former smokers
- 11 February 2021
- Vol. 76 (6), 554-560
- https://doi.org/10.1136/thoraxjnl-2020-215999
Abstract
Objectives Muscle wasting is a recognised extra-pulmonary complication in chronic obstructive pulmonary disease and has been associated with increased risk of death. Acute respiratory exacerbations are associated with reduction of muscle function, but there is a paucity of data on their long-term effect. This study explores the relationship between acute respiratory exacerbations and long-term muscle loss using serial measurements of CT derived pectoralis muscle area (PMA). Design and setting Participants were included from two prospective, longitudinal, observational, multicentre cohorts of ever-smokers with at least 10 pack-year history. Participants The primary analysis included 1332 (of 2501) participants from Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and 4384 (of 10 198) participants from Genetic Epidemiology of COPD (COPDGene) who had complete data from their baseline and follow-up visits. Interventions PMA was measured on chest CT scans at two timepoints. Self-reported exacerbation data were collected from participants in both studies through the use of periodic longitudinal surveys. Main outcome measures Age-related and excess muscle loss over time. Results Age, sex, race and body mass index were associated with baseline PMA. Participants experienced age-related decline at the upper end of reported normal ranges. In ECLIPSE, the exacerbation rate over time was associated with an excess muscle area loss of 1.3% (95% CI 0.6 to 1.9, pConclusions Exacerbations are associated with accelerated skeletal muscle loss. Each annual exacerbation was associated with the equivalent of 6 months of age-expected decline in muscle mass. Ameliorating exacerbation-associated muscle loss represents an important therapeutic target.Keywords
Funding Information
- COPD Foundation
- National Heart, Lung, and Blood Institute (HL089856, HL089897, T32 HL007633)
This publication has 48 references indexed in Scilit:
- Automated Telecommunication to Obtain Longitudinal Follow-up in a Multicenter Cross-sectional COPD StudyCOPD: Journal of Chronic Obstructive Pulmonary Disease, 2012
- Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative reviewFrontiers in Physiology, 2011
- Is age-related decline in lean mass and physical function accelerated by obstructive lung disease or smoking?Thorax, 2011
- Genetic Epidemiology of COPD (COPDGene) Study DesignCOPD: Journal of Chronic Obstructive Pulmonary Disease, 2010
- Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE)European Respiratory Journal, 2008
- Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary DiseaseAmerican Journal of Respiratory and Critical Care Medicine, 2007
- A prospective study of decline in fat free mass and skeletal muscle strength in chronic obstructive pulmonary diseaseRespiratory Research, 2007
- Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary diseaseThorax, 2007
- Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled studyBMJ, 2004
- Midthigh Muscle Cross-Sectional Area Is a Better Predictor of Mortality than Body Mass Index in Patients with Chronic Obstructive Pulmonary DiseaseAmerican Journal of Respiratory and Critical Care Medicine, 2002