Anorexia in chronic obstructive pulmonary disease — Association to cachexia and hormonal derangement
Introduction
Chronic obstructive pulmonary disease (COPD) is an inflammatory disease. In the chronic course of the disease, the pathogenesis and clinical manifestations of COPD are not restricted to pulmonary structural and functional impairment but rather have multi-systemic implications including metabolic, hormonal and organ dysfunction such as in skeletal muscle, heart, brain and skeleton [1]. Weight loss due to tissue wasting is frequent in COPD and may ultimately lead to cachexia as a serious co-morbidity in advanced disease state. Cachexia in COPD – as in other chronic diseases – is associated with a greater susceptibility to exacerbation of clinical symptoms, with severely impaired functional capacity [2], poor health status and quality of life [3], [4]. The loss of skeletal muscle tissue and, in particular, of respiratory muscle is associated with a loss of power and endurance leading to a further mechanical impairment of lung function with consecutive hypoxia and hypercapnia [5]. This may contribute to progression of the disease. Accordingly, increasing evidence suggests that weight loss and cachexia are independent prognostic factors in COPD [6], [7].
Weight loss in COPD is a consequence of increased energy expenditure due to mechanic and metabolic inefficiency that is not balanced by adequately increased energy supply. Inflammatory activation and hormonal derangements may further add to a hypermetabolic state and an overall catabolic/anabolic imbalance leading to depletion of endogenous energy storages and eventually to structural tissue degradation.
The regulation of energy expenditure in association to inflammatory activation and hormonal derangement in COPD patients has widely been studied [8], [9], [10], [11], [12]. Anorexia may importantly contribute to weight loss in COPD. The therapeutic concept, however, of nutritional supplementation failed to show significant effects on anthropometric measures and functional capacity in these patients [13] and mechanisms of non-response to nutritional therapy have been discussed [14]. In this context, the significance of alteration in appetite as a central regulator of food intake has not been studied in detail.
In the current study we prospectively assessed in a cohort of COPD patients with and without weight loss the extent of anorexia in relationship to alteration in body weight. The specific association to hormonal and inflammatory parameters in order to identify potential factors that may influence appetite in COPD is taken into account.
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Patient population
We recruited 103 consecutive patients (age 59.8 ± 1.3 years, 36 female [35%]) diagnosed with COPD by history, physical examination and pulmonary function test, according to the guidelines of the American Thoracic Society [15]. All patients showed a FEV1 reversibility of less than 15% in response to inhaled bronchodilators. At time of investigation, all patients were clinically stable without signs of acute exacerbation. No patient had required hospital admission or treatment change during the
Patient characteristics
The main clinical characteristics of the study population are presented in Table 1. COPD Patients and control subjects were similar for age and global parameters of body composition but patients had impaired respiratory function parameters. Comparing patient subgroups of cachectic and non-cachectic patients, COPD patients with cachexia showed further decreased respiratory (FEV1, FVC, and FEV1/FVC; all p < 0.05). Age, height and drug therapy were similar between subgroups (p > 0.2).
Analysis of anorexia
The analysis of
Discussion
This study demonstrates a significant prevalence of cachexia occurring in COPD and shows that anorexia is frequently present in patients with COPD and cachexia. The degree of appetite in COPD patients is related to body mass index, inflammation and catabolic/anabolic imbalance.
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
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