Changes in Body Composition in Patients with Chronic Obstructive Pulmonary Disease: Do They Influence Patient-Related Outcomes?

Rutten, Erica P.A.; Calverley, Peter M.A.; Casaburi, Richard; Agustí, Àlvar; Bakke, Per; Celli, Bartolomé R.; Coxson, Harvey O.; Crim, Courtney; Lomas, David A.; MacNee, William; Miller, Bruce E.; Rennard, S. I.; Scanlon, Paul D.; Silverman, Edwin K.; Tal‐Singer, Ruth; Vestbo, Jørgen; Watkins, Michael L.; Wouters, Emiel F.M.

doi:10.1159/000353211

Cited by 57 publications

(61 citation statements)

References 31 publications

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“…In the majority of previous studies, dyspnea scores were found to be higher in obese subjects compared to normal-weight subjects (7,8). However, there are studies demonstrating no difference between obese and normal-weight patients in terms of dyspnea (21).…”

Section: Discussionmentioning

confidence: 94%

“…However, obesity might also increase the numbers of obstructed peripheral airways (6). It was determined that dyspnea perception is enhanced, health status is impaired, and quality of life (QOL) is reduced in obese COPD patients compared to non-obese COPD patients (7,8). It has been shown that pulmonary rehabilitation (PR) reduces dyspnea, enhances exercise performance, improves QOL, and decreases psychological symptoms in COPD patients (9).…”

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confidence: 99%

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Does Increased Body Mass Index Effect the Gains of Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease Patients?

Şahin¹,

Naz²,

Varol³

et al. 2017

Eurasian J Pulmonol

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Obesity is one of the most important public health problems, and it is increasing in prevalence worldwide (1,2). Obesity is an inflammatory disease that involves many systems in the body, especially the respiratory system, causing changes in pulmonary functions (2). Chronic obstructive pulmonary disease (COPD) is also an important public health problem usually accompanied by nutritional abnormalities (3, 4). The majority of COPD patients are overweight or obese rather than normal or low-weight (4). Obesity and COPD cause mortality and morbidity all over the world, and this global outbreak is predicted to be much higher in the future (5). Obesity might be the reason for respiratory symptoms alone due to decreased pulmonary compliance, increased work in breathing, and increased need for oxygen, even without airway obstruction. However, obesity might also increase the numbers of obstructed peripheral airways (6). It was determined that dyspnea perception is enhanced, health status is impaired, and quality of life (QOL) is reduced in obese COPD patients compared to non-obese COPD patients (7,8). It has been shown that pulmonary rehabilitation (PR) reduces dyspnea, enhances exercise performance, improves QOL, and decreases psychological symptoms in COPD patients (9). The present study aimed to compare the gains of PR in obese, pre-obese, and normal-weight COPD patients who completed an 8-week outpatient PR program. AbstractObjective: We aimed to compare the gain of pulmonary rehabilitation (PR) in obese, pre-obese, and normal-weight patients with chronic obstructive pulmonary disease (COPD) who underwent a PR program.Methods: COPD patients (n=137) underwent pulmonary and cardiac system examination and pulmonary function tests (PFTs) before PR. Chest X-rays, arterial blood gases, body mass index, quality of life (QOL) questionnaires, anxiety and depression scores, and Modified Medical Research Council dyspnea scale (MMRC) scores were evaluated in all patients. A 6-min walk test was performed to determine the exercise capacity of the patients. All patients underwent an 8-week outpatient PR program. The patients were reevaluated at the end of 8th week in terms of all parameters. Results:The study group consisted of 44 normal-weight, 52 pre-obese, and 41 obese COPD patients. Before PR, there was no significant difference in terms of 6-min walk distance (6MWD), PFT, MMRC, or QOL scores between the groups (p>0.05 for all). After PR, partial arterial oxygen pressure and arterial saturation, MMRC, and QOL scores improved significantly in all three groups (p<0.05 for all). 6MWD and walkwork significantly increased after PR in all three groups (p<0.001 for all), but the gain in 6MWD was significantly lower in obese patients compared to pre-obese and normal-weight patients (p=0.049). Conclusion:Pre-obese and obese patients benefit from PR similarly to the normal-weight patients in terms of gas exchange, dyspnea perception, and QOL. But it seems to be that exercise capacity improves less in obese COPD patients compared to pre-o...

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Does Increased Body Mass Index Effect the Gains of Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease Patients?

Şahin¹,

Naz²,

Varol³

et al. 2017

Eurasian J Pulmonol

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“…We began by examining the association of pectoralis muscle area and measures of fat-free mass at baseline in a subset of 73 subjects enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Study (10). Bioelectrical impedance analysis (BIA) was performed on each subject, using the Bodystat 1500 (Bodystat Ltd, Isle of Man, UK), and the resistance was used to calculate fat-free mass (14) as previously described (15). The goal of this analysis was to establish the correlation between fat-free mass and pectoralis muscle area; therefore we investigated only that subset of the total ECLIPSE population that had pectoralis muscle area, bioimpedance, and CT measures at baseline.…”

Section: Methodsmentioning

confidence: 99%

“…Measurement of fat-free mass by BIA is an indirect method of body composition and is not recommended in the clinical setting (30). However, body composition as assessed by BIA has been related to COPD-related traits and outcomes, including mortality, indicating that the method has use in the research setting (15,18,27,30).…”

Section: Original Researchmentioning

confidence: 99%

Quantitative Computed Tomography Measures of Pectoralis Muscle Area and Disease Severity in Chronic Obstructive Pulmonary Disease. A Cross-Sectional Study

et al. 2014

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Rationale: Muscle wasting in chronic obstructive pulmonary disease (COPD) is associated with a poor prognosis and is not readily assessed by measures of body mass index (BMI). BMI does not discriminate between relative proportions of adipose tissue and lean muscle and may be insensitive to early pathologic changes in body composition. Computed tomography (CT)-based assessments of the pectoralis muscles may provide insight into the clinical significance of skeletal muscles in smokers.Objectives: We hypothesized that objective assessment of the pectoralis muscle area on chest CT scans provides information that is clinically relevant and independent of BMI.Methods: Data from the ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) Study (n = 73) were used to assess the relationship between pectoralis muscle area and fat-free mass. We then used data in a subset (n = 966) of a larger cohort, the COPDGene (COPD Genetic Epidemiology) Study, to explore the relationship between pectoralis muscle area and COPD-related traits. Measurements and Main Results:We first investigated the correlation between pectoralis muscle area and fat-free mass, using data from a subset of participants in the ECLIPSE Study. We then further investigated pectoralis muscle area in COPDGene Study participants and found that higher pectoralis muscle area values were associated with greater height, male sex, and younger age. On subsequent clinical correlation, compared with BMI, pectoralis muscle area was more significantly associated with COPD-related traits, including spirometric measures, dyspnea, and 6-minute-walk distance (6MWD). For example, on average, each 10-cm 2 increase in pectoralis muscle area was associated with a 0.8-unit decrease in the BODE (Body mass index, Obstruction, Dyspnea, Exercise) index (95% confidence interval, -1.0 to -0.6; P , 0.001). Furthermore, statistically significant associations between pectoralis muscle area and COPD-related traits remained even after adjustment for BMI.Conclusions: CT-derived pectoralis muscle area provides relevant indices of COPD morbidity that may be more predictive of important COPD-related traits than BMI. However, the relationship with clinically relevant outcomes such as hospitalization and death requires additional investigation. Pectoralis muscle area is a convenient measure that can be collected in the clinical setting in addition to BMI.

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“…Spirometry was performed after inhalation of 4 puffs of albuterol 29 ; lung volumes by body plethysmography and diffusing capacity by single breath carbon monoxide uptake (DLCO) (Vmax 229 and Autobox 6200; SensorMedics; Yorba Linda, California) were performed according to American Thoracic Society (ATS)/ European Respiratory Society (ERS) standards.…”

Section: Assessmentsmentioning

confidence: 99%

Effect of Megestrol Acetate and Testosterone on Body Composition and Hormonal Responses in COPD Cachexia

Casaburi¹,

Nakata²,

Bistrong³

et al. 2016

J COPD F

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Background: Underweight chronic obstructive pulmonary disease (COPD) patients with involuntary weight loss have a poor prognosis; no effective therapy is currently available. We conducted the first clinical trial seeking to determine whether combination therapy with an appetite stimulant and an anabolic steroid would have beneficial effects on body composition for patients with COPD cachexia. Methods: We conducted a 12-week pilot study in which 4 men and 5 women (age 64±10 y, forced expiratory volume in 1 second [FEV1] 31±9 %pred., body mass index [BMI] 18±3 kg/m 2 ) with low-normal testosterone levels (average 532±45 ng/dl in men and 12.4±5.3 ng/dl in women) and weight loss ≥10 lbs over the previous year were treated with oral megestrol acetate 800 mg/day plus weekly testosterone enanthate injections, initially 125 mg in men and 40 mg in women, with doses subsequently adjusted targeting circulating nadir testosterone levels of 850 and 300 ng/dl, respectively. Results: On treatment, nadir testosterone level increases averaged 160±250 ng/dl (NS) in men and 322±49 (p<0.001) ng/dl in women. Body weight increased in all individuals, with average end-intervention weight gain of 3.1±2.2 kg (p<0.005). Two women and 2 men had COPD exacerbations and did not complete the 12-week study. In the 5 individuals who completed, dual energy x ray absorptiometry (DEXA) scans revealed an average 2.0±1.5 kg lean mass and 2.3±1.7 kg fat mass increase (each p<0.05). No adverse effects of treatment were detected. Conclusions: Combination therapy reversed the trajectory of involuntary weight loss and increased lean mass in cachectic COPD patients. Though the interventions were apparently well tolerated, participant drop-out rate was high. Larger randomized placebo-controlled long-term studies with functional outcomes are needed. AbstractAbbreviations: chronic obstructive pulmonary disease, COPD; forced expiratory volume in 1 second, FEV 1 ; body mass index, BMI; dual emission x-ray absorptometry, DEXA; prostate specific antigen, PSA; diffusion capacity of the lungs for carbon monoxide, DLCO; American Thoracic Society, ATS; European Respiratory Society, ERS; forced vital capacity, FVC; total lung capacity, TLC; follicle stimulating hormone, FSH; luteinizing hormone, LH; insulin-like growth factor-1, IGF1

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Changes in Body Composition in Patients with Chronic Obstructive Pulmonary Disease: Do They Influence Patient-Related Outcomes?

Cited by 57 publications

References 31 publications

Does Increased Body Mass Index Effect the Gains of Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease Patients?

Does Increased Body Mass Index Effect the Gains of Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease Patients?

Quantitative Computed Tomography Measures of Pectoralis Muscle Area and Disease Severity in Chronic Obstructive Pulmonary Disease. A Cross-Sectional Study

Effect of Megestrol Acetate and Testosterone on Body Composition and Hormonal Responses in COPD Cachexia

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