Mass of intercostal muscles associates with risk of multiple exacerbations in COPD

Güerri, Roberto; Gayete, Ángel; Balcells, Eva; Ramírez-Sarmiento, Alba; Vollmer, Iván; Garcia‐Aymerich, Judith; Gea, Joaquim; Orozco-Levi, Mauricio

doi:10.1016/j.rmed.2009.10.015

Cited by 39 publications

(45 citation statements)

References 43 publications

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“…Our findings dovetail with previous well-established reports that quantitative assessments of both the intercostal muscles and quadriceps are associated with exacerbations and mortality in COPD (11,12). The uniqueness of our study lies in the ease and practicality of obtaining additional clinically relevant information pertaining to skeletal muscle size from readily available CT scans of the chest.…”

Section: Original Researchsupporting

confidence: 86%

“…Although many of these investigations have focused on the airway and parenchymal manifestations of this process, use of the additional imaging data available external to the lungs to assess muscle wasting has been more limited. Güerri and colleagues reported that smaller cross-sectional area of the intercostal and abdominal muscles was associated with a history of more frequent acute exacerbations of COPD (AECOPD) (11). In a larger cohort, Marquis and colleagues demonstrated that mid-thigh cross-sectional area was independently predictive of death in 142 smokers (12).…”

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confidence: 99%

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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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Section: Original Researchsupporting

confidence: 86%

mentioning

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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“…In fact, patients with history of multiple hospital admissions for COPD exacerbation have greater expiratory muscle strength than more stable patients. 7,8 Regarding quadriceps peak torque, we observed no difference between the 3 assessment days, similar to Troosters et al 18 Two other studies, 5,6 however, found a decrease of 5% of predicted in quadriceps peak torque during the hospitalization period. Besides the study of Troosters et al, 18 which found no decrease in this variable, Spruit et al 6 found that 48% of their subjects had no change or an increase in quadriceps peak torque.…”

Section: Discussionsupporting

confidence: 88%

“…Two recent cross-sectional studies found that respiratory muscle dysfunction is associated with an increased risk of hospital admission for exacerbation. 7,8 Two other prospective studies identified inspiratory muscle overload as a risk factor for hospitalization for exacerbation. 9,10 Surprisingly, the respiratory muscle function during and after COPD exacerbation seems to have been poorly investigated.…”

Section: Introductionmentioning

confidence: 99%

Respiratory Muscle Strength During and After Hospitalization for COPD Exacerbation

et al. 2013

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BACKGROUND: A more profound investigation of respiratory muscle strength during COPD exacerbation was needed, so we investigated respiratory muscle strength and related factors in patients with COPD during and after hospitalization for COPD exacerbation. METHODS: In 19 subjects hospitalized for COPD exacerbation (12 males, mean age 67 ؎ 11 y, median percent-ofpredicted FEV 1 26% [IQR 19 -32%]) we measured lung function and respiratory and quadriceps muscle strength at admission (day 1), at discharge, and 1 month after discharge. RESULTS: At admission, 68% of the subjects had inspiratory muscle dysfunction (maximum inspiratory pressure < 70% of predicted O], P ‫؍‬ .001). Inspiratory capacity increased between discharge (1.59 ؎ 0.44 L) and 1 month after discharge (1.99 ؎ 0.54 L, P ‫؍‬ .02). There was no significant change in other lung function variables or quadriceps strength. At admission the inspiratory muscle dysfunction and reduction in inspiratory capacity (< 80% of predicted) correlated linearly (phi coefficient 0.62, P ‫؍‬ .03), whereas the expiratory muscle strength correlated inversely with FEV 1 (Spearman rho ؊0.61, P ‫؍‬ .005) and inspiratory capacity (Spearman rho ؊0.54, P ‫؍‬ .02). CONCLUSIONS: There was a high prevalence of inspiratory muscle dysfunction in patients hospitalized for COPD exacerbation. Inspiratory and expiratory muscle strength increased markedly during and after hospitalization. The degree of air-flow obstruction and hyperinflation were related to inspiratory and expiratory muscle strength.

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“…In COPD, CT imaging of muscle groups, including intercostal muscles and mid-thigh area, has been used to assess low muscle mass and to predict adverse clinical outcomes[14, 15]. In patients with cancer, axial CT from the third lumbar vertebra (L3) region of the spine has been used to calculate FFMI[16–18].…”

Section: Introductionmentioning

confidence: 99%

Chest computed tomography-derived low fat-free mass index and mortality in COPD

McDonald

Díaz

Rutten³

et al. 2017

Eur Respir J

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Low fat free mass index (FFMI) is an independent risk factor for mortality in Chronic Obstructive Pulmonary Disease (COPD) not typically measured during routine care. In the current study, we aimed to derive FFMPMA from the pectoralis muscle area (PMA) and assess whether low FFMIPMA is associated with all-cause mortality in COPD cases. To achieve our objectives, we used data from two independent COPD cohorts, ECLIPSE and COPDGene. Two equal sized groups of COPD cases (N=759) from the ECLIPSE Study were used to derive and validate an equation to calculate the FFMPMA measured using bioelectrical impedance from PMA. Then in COPDGene, we applied the equation in COPD cases (n=3121) and assessed survival. Low FFMIPMA was defined using the Schols classification (FFMI<16 in men, FFMI<15 in women) and the 5th percentile normative values of FFMI from the UK Biobank. The final regression model included PMA, weight, sex and height and had an adjusted R2 of 0.92 with FFM as the outcome. In the test group, the correlation between FFMPMA with FFM remained high (Pearson correlation=0.97). In COPDGene, COPD cases with low FFMIPMA had increased risk of death (HR:1.6, P<0.001). We demonstrated COPD cases with low FFMIPMA have increased risk of death.

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Mass of intercostal muscles associates with risk of multiple exacerbations in COPD

Abstract: This study shows that the risk for multiple admissions due to a COPD exacerbation associates with a marked decrease in the CSA of the intercostal muscle compartment.

Cited by 39 publications

References 43 publications

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

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

Respiratory Muscle Strength During and After Hospitalization for COPD Exacerbation

Chest computed tomography-derived low fat-free mass index and mortality in COPD

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