Peripheral Muscle Dysfunction in Chronic Obstructive Pulmonary Disease
Section snippets
EVIDENCE OF PERIPHERAL MUSCLE DYSFUNCTION
Peripheral muscle abnormalities described in patients with COPD include:
Muscle atrophy109
Weakness44, 46
Morphologic changes
↓proportion of type I fibers48, 54, 79, 124
↑proportion of type IIb fibers48, 124
atrophy of type I and IIa fibers124
↓capillarization124
Altered metabolic capacity
↓intramuscular pH36
↓adenosine triphosphate (ATP) concentration36, 41
↑muscle lactate concentration36, 41
↑iononine monophosphate94
↓mitochondrial enzyme activities55, 78
The quadriceps is the most
CAUSES OF SKELETAL MUSCLE DYSFUNCTION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Several factors have been suggested to explain the occurrence of skeletal muscle dysfunction in COPD:
Chronic inactivity and disuse atrophy
Systemic inflammation
Nutritional imbalance
Systemic corticosteroids
Hypoxemia
Electrolyte disturbances
The relative importance of these factors is likely to vary among patients. Peripheral muscle dysfunction is probably multifactorial in origin and is unlikely to be explained by a unique mechanism in all patients. Chronic inactivity,77 systemic inflammation
Exercise Intolerance
Exercise intolerance is a major consequence of COPD. The mechanisms of exercise intolerance are reviewed in the article by Nici later in this issue. Importantly, several observations have made it clear that exercise intolerance in these individuals cannot be explained solely on the basis of limitations in ventilation and gas exchange. The degree of impairment in lung function is a poor predictor of exercise capacity, for instance.58 Perhaps the most striking clinical observation pointing to a
Exercise Training
As reviewed in the article by Bourjeily and Rochester in this issue, several excellent studies have documented that exercise tolerance can be improved with exercise training in patients with COPD.1, 13, 18, 21, 42, 91, 98, 115, 116 Until the 1990s, however, skeletal muscle adaptation to training was not believed to occur in these individuals.6, 7 It was thought that these patients could not achieve a sufficiently high training intensity for the occurrence of a physiologic training effect. This
SUMMARY
Peripheral muscle dysfunction is a common systemic complication of moderate to severe COPD and may contribute to disability, handicap, and premature mortality. In contrast to the lung impairment, which is largely irreversible, peripheral muscle dysfunction is potentially remediable with exercise training, nutritional intervention, oxygen, and anabolic drugs. Therapeutic success is often incomplete, however, and a better understanding of the mechanisms involved in the development of peripheral
ACKNOWLEDGMENTS
Drs Maltais, LeBlanc, and Jobin wish to thank Marthe Bélanger, Sarah Bernard, Marie-Josée Breton, Richard Debigaré, Jean-François Doyon, and François Whittom for their contribution to their research.
References (128)
Exercise in chronic obstructive pulmonary disease
Clin Chest Med
(1986)Nutritional support in advanced lung disease
Clin Chest Med
(1997)- et al.
Hypophosphatemia in course of chronic obstructive pulmonary disease: Prevalence, mechanisms, and relationships with skeletal muscle phosphorus content
Chest
(1990) - et al.
Skeletal muscle energetics, acid–base equilibrium and lactate metabolism in patients with severe hypercapnia and hypoxia
Chest
(1987) - et al.
Survival in COPD patients with a daytime Pao2 >60 mm Hg with and without nocturnal oxyhemoglobin desaturation
Chest
(1992) - et al.
Randomised controlled trial of respiratory rehabilitation
Lancet
(1994) - et al.
Long-term oxygen therapy may improve skeletal muscle metabolism in advanced chronic obstructive pulmonary disease with chronic hypoxaemia
Respiratory Medicine
(1995) - et al.
Dietary supplementation and respiratory muscle performance in patients with COPD
Chest
(1988) - et al.
Sensitive indices of improvement in a pulmonary rehabilitation program
Chest
(1983) Pulmonary rehabilitation. Joint ACCP/AACVPR evidence-based guidelines
Chest
(1997)
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
Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure
N Engl J Med
Total free living energy expenditure in patients with severe chronic obstructive pulmonary disease
Am J Respir Crit Care Med
Bicarbonate buffering of lactic acid generated during exercise
J Appl Physiol
Exercise training fails to increase skeletal muscle enzymes in patients with chronic obstructive lung disease
Am Rev Respir Dis
Peripheral muscle weakness in patients with chronic obstructive pulmonary disease
Am J Respir Crit Care Med
Aerobic and strength training in patients with COPD
Am J Respir Crit Care Med
The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men
N Engl J Med
Effects of disuse on the structure and function of skeletal muscle
Med Sci Sports Exerc
Administration of growth hormone to underweight patients with chronic obstructive pulmonary disease: A prospective, randomized, controlled study
Am J Respir Crit Care Med
Exercise training in chronic obstructive lung disease
Deconditioning
Rehabilitative exercise training in chronic renal failure
Randomized placebo-controlled trial of growth hormone in severe COPD patients undergoing endurance exercise training
Am J Respir Crit Care Med
Substantial prevalence of low anabolic hormone levels in COPD patients undergoing rehabilitation
Am J Respir Crit Care Med
Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease
Am Rev Respir Dis
Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease
Am J Respir Crit Care Med
Low-intensity peripheral muscle conditioning improves exercise tolerance and breathlessness in COPD
Eur Respir J
Randomised controlled trial of rehabilitation in chronic respiratory disability
Thorax
Effects of detraining on responses to submaximal exercise
J Appl Physiol
Elevated TNF-α production by peripheral blood monocytes of weight-losing COPD patients
Am J Respir Crit Care Med
In vitro contractile functions on vastus lateralis in patients with COPD: A validity study
Am J Respir Crit Care Med
Functional and histologic picture of steroid-induced myopathy in chronic obstructive pulmonary disease
Am J Respir Crit Care Med
Muscle weakness is related to utilization of health care resources in COPD patients
Eur Respir J
Corticosteroids contribute to muscle weakness in chronic airflow obstruction
Am Rev Respir Dis
Triamcinolone and prednisolone affect contractile properties and histopathology of rat diaphragm differently
J Clin Invest
Tumor necrosis factor-α levels and weight loss in chronic obstructive pulmonary disease
Am J Respir Crit Care Med
The effect of an aggressive nutritional support regimen on body composition in patients with severe COPD and weight loss
Am J Respir Crit Care Med
The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease
Am Rev Respir Dis
Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in out-patients with COPD
Eur Respir J
Abnormal skeletal muscle oxidative capacity after lung transplantation by 31P-MRS
Am J Respir Crit Care Med
Exercise hemodynamics and gas exchange in patients with chronic obstructive pulmonary disease, sleep desaturation, and a daytime Pao2 above 60 mm Hg
Am Rev Respir Dis
Strength training and determinants of Vo2max in older men
J Appl Physiol
Biomolecular metabolism in a peripheral skeletal muscle of the upper limbs in COPD patients
Am J Respir Crit Care Med
Muscle metabolism in patients with chronic obstructive lung disease and acute respiratory failure
Clin Sci Mol Med
Nitrogen and energy relationships in malnourished patients with emphysema
Am Rev Respir Dis
Peripheral muscle weakness contributes to exercise limitation in COPD
Am J Respir Crit Care Med
Operation Everest II: Adaptations in human skeletal muscle
J Appl Physiol
Muscle strength, symptom intensity and exercise capacity in patients with cardiorespiratory disorders
Am J Respir Crit Care Med
Anticytokine approaches to the treatment of anorexia and cachexia
Semin Oncol
Cited by (84)
Peak Quadriceps Muscle Torque and Electromyographic Output in Patients With Chronic Respiratory Disorders: Effects of Pulmonary Rehabilitation
2023, Archives of Rehabilitation Research and Clinical TranslationEfficacy of Liuzijue Qigong in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis
2022, Complementary Therapies in MedicineCitation Excerpt :It is a complex multisystem disease that not only impairs lung function, but also leads to systemic manifestations that include peripheral muscle dysfunction, as well as negative effects on physiology and psychology. These factors may eventually affect the daily activities of patients with COPD and contribute to disability, handicap and premature mortality.64–66 Therefore, it is pertinent that future research focuses on ways to effectively manage COPD by slowing down its progression and the deterioration of lung function.
Peripheral Gas Exchange
2021, Encyclopedia of Respiratory Medicine, Second EditionReproducibility of NIRS assessment of muscle oxidative capacity in smokers with and without COPD
2017, Respiratory Physiology and NeurobiologyCitation Excerpt :Chronic obstructive pulmonary disease (COPD) is characterized by dyspnea on exertion, with subsequent reduced exercise tolerance and quality of life. Skeletal muscle dysfunction is a systemic consequence of COPD that also contributes to increased morbidity and mortality in this population (Agustí et al., 2003; Casaburi, 2001; Decramer et al., 2008; Maltais et al., 2000, 2014; Nici, 2000; Vogiatzis and Zakynthinos, 2012; Wouters, 2002). Morphological and structural skeletal muscle alterations in COPD are especially prevalent in the locomotor muscles, and include atrophy and weakness, loss of type I fibers, loss of muscle oxidative capacity and mitochondrial dysfunction, among others (Allaire et al., 2004; Coronell et al., 2004; Couillard and Prefaut, 2005; Engelen et al., 2000; Gosker et al., 2002, 2007; Maltais et al., 2014; Picard et al., 2008; Whittom et al., 1998).
The roles of miRNAs as potential biomarkers in lung diseases
2016, European Journal of Pharmacology
Address reprint requests to François Maltais, MD, Centre de Pneumologie, Hôpital Laval, Institut Universitaire de Cardiologie, et de Pneumologie de l'Université Laval, 2725 Chemin Ste-Foy, Québec, Québec, Canada, G1V 4G5
This work was supported in part by the “Fonds de la recherche en santé du Québec,” Québec, and by “la fondation JD Bégin, Université Laval,” Ste-Foy, Québec, Canada.