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Muscle fibre type shifting in the vastus lateralis of patients with COPD is associated with disease severity: a systematic review and meta-analysis
  1. Harry R Gosker1,
  2. Maurice P Zeegers2,
  3. Emiel F M Wouters1,
  4. Annemie M W J Schols1
  1. 1
    Department of Respiratory Medicine, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, The Netherlands
  2. 2
    Unit of Genetic Epidemiology, Department of Public Health & Epidemiology, University of Birmingham, UK
  1. Dr H R Gosker, Department of Respiratory Medicine, NUTRIM, Maastricht University, P O Box 616, 6200 MD Maastricht, The Netherlands; h.gosker{at}


Background: Skeletal muscle dysfunction is a common feature in chronic obstructive pulmonary disease (COPD) which is associated with intrinsic muscular abnormalities. One of the most consistently reported alterations is a shift from fibre type I to II in the vastus lateralis of these patients. Surprisingly, the relationship between this shift and the severity and phenotype of COPD remains unclear. A study was conducted to determine whether vastus lateralis muscle fibre type proportions are associated with COPD disease severity and to provide reference values for the proportions of fibre types in the vastus lateralis in COPD.

Methods: A systematic review and a meta-analysis were conducted in which muscle fibre type data and markers of disease severity were collected from the literature.

Results: The forced expiratory volume in 1 s (FEV1), the ratio of FEV1 to forced vital capacity (FVC) and body mass index were positively associated with the proportion of type I fibres in COPD. A proportion of 51% for vastus lateralis fibre type I and 13% for fibre type IIX were calculated from the combined data as normal values for patients with typical GOLD stage 3–4 COPD aged 60–70 years. Based on these reference values, a proportion of fibre type I <27% and of fibre type IIX >29% were defined as pathologically abnormal.

Conclusions: This review sheds new light on the relationship between skeletal muscle abnormalities and important hallmarks of the disease in severe COPD, and identifies absence of data in GOLD stages 1–2. This review also provides reference values on fibre type composition for diagnostic purposes in COPD.

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  • The research of HRG was supported by an award from the Netherlands Asthma Foundation (project number

  • Competing interests: None.

  • Abbreviations:
    body mass index
    chronic obstructive pulmonary disease
    forced expiratory volume in 1 s
    forced vital capacity
    myosin heavy chain
    arterial oxygen tension
    carbon monoxide transfer factor

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