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      Sarcopenia correlates with systemic inflammation in COPD

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          Muscle wasting and chronic inflammation are predominant features of patients with COPD. Systemic inflammation is associated with an accelerated decline in lung function. In this study, the prevalence of sarcopenia and the relationships between sarcopenia and systemic inflammations in patients with stable COPD were investigated.

          Materials and methods

          In a cross-sectional design, muscle strength and muscle mass were measured by handgrip strength (HGS) and bioelectrical impedance analysis in 80 patients with stable COPD. Patients (≥40 years old) diagnosed with COPD were recruited from outpatient clinics, and then COPD stages were classified. Sarcopenia was defined as the presence of both low muscle strength (by HGS) and low muscle mass (skeletal muscle mass index [SMMI]). Levels of circulating inflammatory biomarkers (IL-6 and high-sensitivity TNFα [hsTNFα]) were measured.


          Sarcopenia was prevalent in 20 (25%) patients. Patients with sarcopenia were older, had lower body mass index, and a higher percentage of cardiovascular diseases. In addition, they had significantly higher modified Medical Research Council scores and lower 6-minute walk distance than those without sarcopenia. HGS was significantly correlated with age, modified Medical Research Council score, and COPD Assessment Test scores. Both HGS and SMMI had associations with IL-6 and hsTNFα (HGS, r=−0.35, P=0.002; SMMI, r=−0.246, P=0.044) level. In multivariate analysis, old age, lower body mass index, presence of cardiovascular comorbidities, and higher hsTNFα levels were significant determinants for sarcopenia in patients with stable COPD.


          Sarcopenia is very common in patients with stable COPD, and is associated with more severe dyspnea-scale scores and lower exercise tolerance. Systemic inflammation could be an important contributor to sarcopenia in the stable COPD population.

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          Most cited references 18

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          Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis.

          Individuals with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular diseases, osteoporosis, and muscle wasting. Systemic inflammation may be involved in the pathogenesis of these disorders. A study was undertaken to determine whether systemic inflammation is present in stable COPD. A systematic review was conducted of studies which reported on the relationship between COPD, forced expiratory volume in 1 second (FEV(1)) or forced vital capacity (FVC), and levels of various systemic inflammatory markers: C-reactive protein (CRP), fibrinogen, leucocytes, tumour necrosis factor-alpha (TNF-alpha), and interleukins 6 and 8. Where possible the results were pooled together to produce a summary estimate using a random or fixed effects model. Fourteen original studies were identified. Overall, the standardised mean difference in the CRP level between COPD and control subjects was 0.53 units (95% confidence interval (CI) 0.34 to 0.72). The standardised mean difference in the fibrinogen level was 0.47 units (95% CI 0.29 to 0.65). Circulating leucocytes were also higher in COPD than in control subjects (standardised mean difference 0.44 units (95% CI 0.20 to 0.67)), as were serum TNF-alpha levels (standardised mean difference 0.59 units (95% CI 0.29 to 0.89)). Reduced lung function is associated with increased levels of systemic inflammatory markers which may have important pathophysiological and therapeutic implications for subjects with stable COPD.
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            Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society.

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              Pulmonary function is a long-term predictor of mortality in the general population: 29-year follow-up of the Buffalo Health Study.

              Results from several studies have described a relationship between pulmonary function and both all-cause and cause-specific mortality. The purpose of this study was to investigate the predictive value of pulmonary function by gender after 29 years of follow-up. Prospective study with 29-year follow-up of the Buffalo Health Study cohort. Randomly selected sample of 554 men and 641 women, aged 20 to 89 years, from all listed households of the city of Buffalo, NY. Baseline measurements were performed in 1960 to 1961. Pulmonary function was assessed based on FEV(1) expressed as the normal percent predicted (FEV(1)%pred). FEV(1)%pred adjusted by age, body mass index, systolic BP, education, and smoking status was inversely related to all-cause mortality in both men and women (p 25 years, we observed a statistically significant negative association between FEV(1)%pred and all-cause mortality. FEV(1)%pred was also inversely related to ischemic heart disease (IHD) mortality. When participants were divided into quintiles of FEV(1)%pred, participants in the lowest quintile of FEV(1)%pred experienced significantly higher all-cause mortality compared with participants in the highest quintile of FEV(1)%pred. For the entire follow-up period, the adjusted hazard ratios for all-cause mortality were 2.24 (95% confidence interval [CI], 1.60 to 3.13) for men and 1. 81 (95% CI, 1.24 to 2.63) for women, respectively. Hazard ratios for death from IHD in the lowest quintile of FEV(1)%pred were 2.11 (95% CI, 1.20 to 3.71) and 1.96 (95% CI, 0.99 to 3.88) for men and women, respectively. These results suggest that pulmonary function is a long-term predictor for overall survival rates in both genders and could be used as a tool in general health assessment.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                20 February 2017
                : 12
                : 669-675
                [1 ]Division of Pulmonology, Department of Internal Medicine, Gangnam Severance Hospital
                [2 ]Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
                Author notes
                Correspondence: Hyung Jung Kim, Division of Pulmonology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Dogok-dong, Gangnam-gu, Seoul 06273, South Korea, Tel +82 2 2019 3316, Fax +82 2 3463 3882, Email khj57@
                © 2017 Byun et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                Respiratory medicine

                systemic inflammation, copd, handgrip strength, sarcopenia, muscle wasting


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