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Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease
  1. Elisabeth B Swallow1,
  2. Diana Reyes1,
  3. Nicholas S Hopkinson1,
  4. William D-C Man2,
  5. Raphaël Porcher3,
  6. Edward J Cetti1,
  7. Alastair J Moore1,
  8. John Moxham2,
  9. Michael I Polkey1
  1. 1Respiratory Muscle Laboratory, Royal Brompton Hospital, London, UK
  2. 2Respiratory Muscle Laboratory, King’s College London School of Medicine, Strand, London, UK
  3. 3Department of Biostatistics and Medical Informatics, Hôspital Saint-Louis, Paris, France
  1. Correspondence to:
    Dr E B Swallow
    Respiratory Muscle Laboratory, Royal Brompton Hospital, Fulham Road, London SW3 6NP, UK; e.swallow{at}


Background: Prognosis in chronic obstructive pulmonary disease (COPD) is poorly predicted by indices of air flow obstruction, because other factors that reflect the systemic nature of the disease also influence prognosis.

Objective: To test the hypothesis that a reduction in quadriceps maximal voluntary contraction force (QMVC) is a useful predictor of mortality in patients with COPD.

Methods: A mortality questionnaire was sent to the primary care physician of 184 patients with COPD who had undergone quadriceps strength measurement over the past 5 years. QMVC was expressed as a percentage of the patient’s body mass index. The end point measured was death or lung transplantation, and median (range) follow-up was 38 (1–54) months.

Results: Data were obtained for 162 patients (108 men and 54 women) with a mean (SD) percentage of forced expiratory volume in 1 s (FEV1) predicted of 35.6 (16.2), giving a response rate of 88%. Transplant-free survival of the cohort was 93.5% at 1 year and 87.1% at 2 years. Cox regression models showed that the mortality risk increased with increasing age and with reducing QMVC. Only age (HR 1.72 (95% CI 1.14 to 2.6); p = 0.01) and QMVC (HR 0.91 (95% CI 0.83 to 0.99); p = 0.036) continued to be significant predictors of mortality when controlled for other variables in the multivariate analysis.

Conclusion: QMVC is simple and provides more powerful prognostic information on COPD than that provided by age, body mass index and forced expiratory volume in 1 s.

  • BMI, body mass index
  • BODE, Body Mass Index, Airflow Obstruction, Dyspnoea and Exercise Capacity
  • COPD, chronic obstructive pulmonary disease
  • MTCSACT, mid-thigh cross-sectional area measured by CT scanning
  • FEV1, forced expiratory volume in 1 s
  • FFM, fat free mass
  • FFMI, Fat Free Mass Index
  • GOLD, Global Initiative for Chronic Obstructive Lung Disease
  • QMVC, quadriceps maximum voluntary contraction force
  • TFS, transplant-free survival

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  • Published Online First 7 November 2006

  • Competing interests: None.

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