Why do patients with emphysema lose weight?

doi:10.1016/S0140-6736(95)91984-8

The Lancet

Volume 345, Issue 8959, 13 May 1995, Pages 1190-1191

https://doi.org/10.1016/S0140-6736(95)91984-8 Get rights and content

References (13)

G. Filley et al.
Chronic obstructive pulmonary disease: oxygen transport in two clinical types
Am J Med
(1968)
Jk Fowler et al.
Emphysema of the lungs
Do Wilson et al.
Body weight in chronic obstructive pulmonary disease: the National Institutes of Health Intermittent Positive Pressure Breathing Trial
Am Rev Respir Dis
(1989)
Rm Rogers et al.
Physiological effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease
Am Rev Respir Dis
(1992)
M. Donahoe et al.
Oxygen consumption of the respiratory muscles in normal and in malnourished patients with chronic obstructive pulmonary disease
Am Rev Respir Dis
(1989)
Jh Green et al.
Comparisons between basal metabolic rate and diet induced thermogenesis in different types of chronic obstructive pulmonary disease
Clin Sci
(1992)

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Cited by (33)

Anorexia in chronic obstructive pulmonary disease - Association to cachexia and hormonal derangement
2007, International Journal of Cardiology
Citation Excerpt :
The pathogenesis and clinical manifestations of COPD are not restricted to pulmonary inflammation and airway remodelling [18]. Involuntary weight loss occurs frequently in a significant number of patients, particularly in those suffering from emphysema [19,20], and presents an independent risk factor of impaired prognosis [21]. Several studies have shown that decreased respiratory muscle strength and endurance, decreased diaphragmatic size [22] with increased work of breathing, and predisposition to death due to heart failure play an important role triggering weight loss in COPD.
In patients with chronic obstructive pulmonary disease (COPD) weight loss frequently occurs that may ultimately lead to cachexia as a serious co-morbidity, indicating severely impaired functional capacity, health status and increased mortality. Increased energy expenditure due to mechanic and metabolic inefficiency and systemic inflammation are determinants of a hypermetabolic state that is not balanced by dietary intake. Anorexia may importantly contribute to weight loss in COPD, however, the association between immune and hormonal derangement and altered appetite has not been studied in detail.
The aim of the present study was to investigate whether anorexia in COPD is related to inflammation and hormonal derangement in association to weight loss.
We prospectively enrolled 103 consecutive patients with COPD (age 59.8 ± 1.3 years, 35% female, mean FEV₁ 38.3 ± 1.7%) in comparison to healthy controls of similar age (n = 15).
In 34 patients (33%) cachexia was diagnosed (weight loss > 7.5%, BMI ≤ 24 kg/m²). Cachectic COPD patients had lower BMI (19.0 ± 0.5 vs 25.6 ± 0.7 kg/m²) and impaired lung function (FEV₁ 31 ± 2% vs 42 ± 2%, FVC 51 ± 3 vs 59 ± 3%, both p < 0.001). Inflammatory immune activation (IL-6 and IL-6/IL-10 ratio) was significantly higher in cachectic COPD patients. Analysis of the extent of anorexia (visual analogue scale) revealed that cachectic COPD patients had significantly decreased subjective desire to eat compared to non-cachectic patients (3.5 ± 0.3 vs 6.3 ± 0.2, p < 0.001). Patients with COPD and cachexia showed evidence of acquired GH resistance (decreased IGF-1/GH ratio) and insulin resistance (HOMA). Anorexia showed a direct correlation with the IGF-1/GH ratio (r = 0.34, p < 0.05) and was further related to BMI and % weight loss (both p < 0.001).
In COPD anorexia relates to hormonal derangement and inflammatory immune activation. Anorexia contributes to development of cachexia. The concept of appetite stimulating therapy emerges as a novel therapeutic option in cachectic COPD patients.
Weight loss in chronic obstructive pulmonary disease. Mechanisms and implications
2002, Pulmonary Pharmacology and Therapeutics
Weight loss occurs frequently in patients with chronic obstructive pulmonary disease (COPD). Although the precise cellular mechanisms underlying weight loss in COPD are unclear, this is a clinically relevant phenomenon because it contributes to limit the exercise capacity of these patients and, therefore, it jeopardizes their quality of life. More importantly, it is a negative prognostic factor that is independent of the degree of lung function impairment present. Thus, weight loss in COPD constitutes a new therapeutic target. This article reviews the mechanisms and potential consequences of weight loss in COPD and highlights areas that needed future research. It is hoped that a better understanding of its pathogenesis may eventually contribute to the development of new therapeutic strategies that contribute to improve the well-being and/or long-term prognosis of patients suffering from this devastating disease and, potentially, from others characterized also by unexplained weight loss.
Disfunción muscular esquelética de la EPOC. Mecanismos celulares
2001, Archivos de Bronconeumologia
Papel de los músculos periféricos en la tolerancia al ejercicio de pacientes con enfermedad pulmonar obstructiva crónica
2001, Archivos de Bronconeumologia
Peripheral muscle dysfunction in chronic obstructive pulmonary disease
2000, Clinics in Chest Medicine
Citation Excerpt :
Inflammation may also induce an oxidant/antioxidant imbalance in patients with chronic disorders by providing a continuous source of oxidative stress96 that may contribute to poor muscle performance.64 In patients with COPD, increased levels of TNF-α, IL-8, and acute-phase protein have also been found.23,29,105,117 Accordingly, it is conceivable that a low-grade and chronic systemic inflammatory process may participate in the development of peripheral muscle wasting and dysfunction in COPD.
As their life expectancy has been prolonged with improved medical care, patients with chronic obstructive pulmonary disease (COPD) frequently develop systemic complications of their disease. These complications include osteoporosis, depression, and peripheral muscle dysfunction² characterized by atrophy, weakness, and low oxidative capacity. These muscle changes have been associated with exercise intolerance,⁴⁴ poor quality of life¹¹⁵ and reduced survival,108, 127 which occur independently of the impairment in lung function. Physicians dealing with patients with advanced COPD face the challenge of finding innovative ways to improve their patients' level of function despite the irreversible impairment of the primarily diseased organ. In this article, the evidence for peripheral muscle dysfunction in patients with COPD and the possible clinical implications of this problem are discussed. The available therapeutic options for improving peripheral muscle function are also considered.
Tissue wasting in patients with chronic obstructive pulmonary disease, the acquired immune deficiency syndrome, and congestive heart failure
2000, Neurologic Clinics
Citation Excerpt :
Oxygen administration to hypoxemic patients with COPD causes a shift away from this inefficient metabolic state toward oxidative phosphorylation.70, 89, 91 Additional putative contributors to hypermetabolism in COPD are proinflammatory cytokines which recently have been shown to be elevated in patients with COPD who are experiencing weight loss.21, 22, 103 Forty percent to 50% of patients with COPD are malnourished.

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COMMENTARYWhy do patients with emphysema lose weight?

Am J Med

Emphysema of the lungs

Body weight in chronic obstructive pulmonary disease: the National Institutes of Health Intermittent Positive Pressure Breathing Trial

Am Rev Respir Dis

Physiological effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease

Am Rev Respir Dis

Oxygen consumption of the respiratory muscles in normal and in malnourished patients with chronic obstructive pulmonary disease

Am Rev Respir Dis

Comparisons between basal metabolic rate and diet induced thermogenesis in different types of chronic obstructive pulmonary disease

Clin Sci

COMMENTARY
Why do patients with emphysema lose weight?