PT - JOURNAL ARTICLE AU - Stefanie Elizabeth Mason AU - Rafael Moreta-Martinez AU - Wassim W Labaki AU - Matthew Strand AU - David Baraghoshi AU - Elizabeth A Regan AU - Jessica Bon AU - Ruben San Jose Estepar AU - Richard Casaburi AU - Merry-Lynn N McDonald AU - Harry Rossiter AU - Barry J Make AU - Mark T Dransfield AU - MeiLan K Han AU - Kendra A Young AU - Greg Kinney AU - John E Hokanson AU - Raul San Jose Estepar AU - George R Washko ED - , TI - Respiratory exacerbations are associated with muscle loss in current and former smokers AID - 10.1136/thoraxjnl-2020-215999 DP - 2021 Jun 01 TA - Thorax PG - 554--560 VI - 76 IP - 6 4099 - http://thorax.bmj.com/content/76/6/554.short 4100 - http://thorax.bmj.com/content/76/6/554.full SO - Thorax2021 Jun 01; 76 AB - Objectives Muscle wasting is a recognised extra-pulmonary complication in chronic obstructive pulmonary disease and has been associated with increased risk of death. Acute respiratory exacerbations are associated with reduction of muscle function, but there is a paucity of data on their long-term effect. This study explores the relationship between acute respiratory exacerbations and long-term muscle loss using serial measurements of CT derived pectoralis muscle area (PMA).Design and setting Participants were included from two prospective, longitudinal, observational, multicentre cohorts of ever-smokers with at least 10 pack-year history.Participants The primary analysis included 1332 (of 2501) participants from Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and 4384 (of 10 198) participants from Genetic Epidemiology of COPD (COPDGene) who had complete data from their baseline and follow-up visits.Interventions PMA was measured on chest CT scans at two timepoints. Self-reported exacerbation data were collected from participants in both studies through the use of periodic longitudinal surveys.Main outcome measures Age-related and excess muscle loss over time.Results Age, sex, race and body mass index were associated with baseline PMA. Participants experienced age-related decline at the upper end of reported normal ranges. In ECLIPSE, the exacerbation rate over time was associated with an excess muscle area loss of 1.3% (95% CI 0.6 to 1.9, p<0.001) over 3 years and in COPDGene with an excess muscle area loss of 2.1% (95% CI 1.2 to 2.8, p<0.001) over 5 years. Excess muscle area decline was absent in 273 individuals who participated in pulmonary rehabilitation.Conclusions Exacerbations are associated with accelerated skeletal muscle loss. Each annual exacerbation was associated with the equivalent of 6 months of age-expected decline in muscle mass. Ameliorating exacerbation-associated muscle loss represents an important therapeutic target.Data may be obtained from a third party and are not publicly available. Investigators can contact the data coordinating centers for each study with data requests. ECLIPSE: https://eclipse-copd.com/COPDGene: http://www.copdgene.org/