Tuberc Respir Dis.  2010 Mar;68(3):125-139. 10.4046/trd.2010.68.3.125.

Skeletal Muscle Dysfunction in Patients with Chronic Obstructive Pulmonary Disease

Affiliations
  • 1Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea. yshwang@nongae.gsnu.ac.kr
  • 2Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.

Abstract

Patients with chronic obstructive pulmonary disease (COPD) frequently complain of dyspnea on exertion and reduced exercise capacity, which has been attributed to an increase in the work of breathing and in impaired of gas exchange. Although COPD primarily affects the pulmonary system, patients with COPD exhibit significant systemic manifestations of disease progression. These manifestations include weight loss, nutritional abnormalities, skeletal muscle dysfunction (SMD), cardiovascular problems, and psychosocial complications. It has been documented that SMD significantly contributes to a reduced exercise capacity in patients with COPD. Ventilatory and limb muscle in these patients show structural and functional alteration, which are influenced by several factors, including physical inactivity, hypoxia, smoking, aging, corticosteroid, malnutrition, systemic inflammation, oxidative stress, apoptosis, and ubiquitin-proteasome pathway activation. This article summarizes briefly the evidence and the clinical consequences of SMD in patients with COPD. In addition, it reviews contributing factors and therapeutic strategies.

Keyword

Muscle, Skeletal; Pulmonary Disease, Chronic Obstructive; Exercise Tolerance

MeSH Terms

Aging
Anoxia
Apoptosis
Disease Progression
Dyspnea
Exercise Tolerance
Extremities
Humans
Inflammation
Malnutrition
Muscle, Skeletal
Muscles
Oxidative Stress
Pulmonary Disease, Chronic Obstructive
Smoke
Smoking
Weight Loss
Work of Breathing
Smoke

Figure

  • Figure 1 The strength of the quadriceps, pectoralis major, and latissimus dorsi muscles in normal subjects and in chronic obstructive pulmonary disease (COPD). The strength of each muscle was significantly reduced in COPD patients compared with normal subjects. Values are mean±SD. *p<0.005. Adapted from Bernard S, LeBlanc P, Whittom F, Carrier G, Jobin J, Belleau R, et al. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;158:629-34.

  • Figure 2 Computed tomography finding of quadriceps muscle found in chronic obstructive pulmonary disease (COPD) patient and in control subject. Adapted from Bernard S, LeBlanc P, Whittom F, Carrier G, Jobin J, Belleau R, et al. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;158:629-34.

  • Figure 3 Fiber-type composition of the vastus lateralis muscle found in chronic obstructive pulmonary disease (COPD) patients and in normal subjects. When it compared with normal subjects, a significant reduction in the proportion of type I fiber with a corresponding increase in the proportion of type IIb fiber was observed in COPD patients. Values are mean±SD. *p<0.0005, †p<0.05. Adapted from Whittom F, Jobin J, Simard PM, Leblanc P, Simard C, Bernard S, et al. Histochemical and morphological characteristics of the vastus lateralis muscle in patients with chronic obstructive pulmonary disease. Med Sci Sports Exerc 1998;30:1467-74.

  • Figure 4 Proposed mechanisms of skeletal muscle dysfunction in patients with COPD. COPD: chronic obstructive pulmonary disease; UPP: ubiquitin proteasome pathway.


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