International Journal of COPD (Nov 2022)
Update on the Etiology, Assessment, and Management of COPD Cachexia: Considerations for the Clinician
Abstract
Jana De Brandt,1 Rosanne JHCG Beijers,2 Joe Chiles,3 Matthew Maddocks,4 Merry-Lynn N McDonald,3 Annemie MWJ Schols,2 André Nyberg1 1Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden; 2Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands; 3Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; 4Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UKCorrespondence: Jana De Brandt, Section of Physiotherapy, Department of Community Medicine and Rehabilitation, Faculty of Medicine, Umeå University, Umeå, 901 87, Sweden, Tel +32 477 73 98 11, Email [email protected]: Cachexia is a commonly observed but frequently neglected extra-pulmonary manifestation in patients with chronic obstructive pulmonary disease (COPD). Cachexia is a multifactorial syndrome characterized by severe loss of body weight, muscle, and fat, as well as increased protein catabolism. COPD cachexia places a high burden on patients (eg, increased mortality risk and disease burden, reduced exercise capacity and quality of life) and the healthcare system (eg, increased number, length, and cost of hospitalizations). The etiology of COPD cachexia involves a complex interplay of non-modifiable and modifiable factors (eg, smoking, hypoxemia, hypercapnia, physical inactivity, energy imbalance, and exacerbations). Addressing these modifiable factors is needed to prevent and treat COPD cachexia. Oral nutritional supplementation combined with exercise training should be the primary multimodal treatment approach. Adding a pharmacological agent might be considered in some, but not all, patients with COPD cachexia. Clinicians and researchers should use longitudinal measures (eg, weight loss, muscle mass loss) instead of cross-sectional measures (eg, low body mass index or fat-free mass index) where possible to evaluate patients with COPD cachexia. Lastly, in future research, more detailed phenotyping of cachectic patients to enable a better comparison of included patients between studies, prospective longitudinal studies, and more focus on the impact of exacerbations and the role of biomarkers in COPD cachexia, are highly recommended.Keywords: chronic obstructive pulmonary disease, muscle, weight loss, nutrition, pulmonary rehabilitation
