Update on the Etiology, Assessment, and Management of COPD Cachexia: Considerations for the Clinician

Abstract

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

Acknowledgments

The authors greatly acknowledge Stacey Tobin for editing and improving the English language of the work.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

Jana De Brandt is funded by the Swedish Heart and Lung Foundation (20200139 and 20210146). Joe Chiles is funded by the NIH NHLBI T32HL105346. Matthew Maddocks is funded by a National Institute for Health and Care Research (NIHR) Career Development Fellowship (CDF-2017-10-009) and NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed in this article are those of the authors and not necessarily those of the NIHR, or the Department of Health and Social Care. Merry-Lynn N. McDonald is funded by the National Institutes for Health (NIH), National Heart, Lung and Blood Institute (NHLBI), R01HL153460. André Nyberg is funded by the Swedish Research Council (2020-01296) and the Swedish Heart and Lung Foundation (20210146).