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Extrathoracic muscle wasting in exacerbations of COPD: no longer outside the region of interest
  1. Neil J Greening1,2,
  2. Michael I Polkey3,
  3. Hamish Joseph Cameron McAuley1,2
  1. 1 Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, UK
  2. 2 Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
  3. 3 Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK
  1. Correspondence to Dr Neil J Greening, Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK; njg27{at}

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While airflow limitation is used to diagnose chronic obstructive pulmonary disease (COPD), it is well established that forced expiratory volume in one second alone relates poorly to mortality1 or health-related quality of life.2 Skeletal muscle dysfunction has been shown to be a better predictor than lung function for both prognosis3 and risk of hospitalisation.4 Moreover, skeletal muscle weakness is increasingly recognised as an important component of both frailty and sarcopaenia. Acute exacerbations of COPD (AECOPD) are a feature of many patients with COPD, with intermittent worsening of symptoms contrasting to many other chronic conditions. The impact of exacerbations is well established, with prevention and treatment an important goal for therapy with COPD.

Therefore, the interaction between exacerbations and skeletal muscle dysfunction is of great interest. A reduction in both exercise capacity and quadriceps strength has been reported in patients admitted with acute exacerbation of COPD5 and to a lesser extent among patients treated as an outpatient6 but the longer-term impact on muscle mass is unknown. Similarly, how therapies such as pulmonary rehabilitation (PR) may impact on future exacerbations risk in the longer term is less clear, although the short-term benefits of this therapy after AECOPD are established.7

In this issue of Thorax, Mason et al 8 report an association between exacerbation frequency and accelerated muscle loss in patients with COPD. …

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  • Contributors All authors wrote and reviewed the manuscript.

  • Funding NJG is funded by a National Institute for Health Research (NIHR) Post-Doctoral Fellowship (pdf-2017-10-052) and supported by the NIHR Leicester Biomedical Research Centre—Respiratory Theme.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the National Health Service and National Institute for Health Research or the Department of Health.

  • Competing interests MIP has received grants from GlaxoSmithKline outside of the submitted work.

  • Provenance and peer review Commissioned; externally peer reviewed.

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