Deterioration of limb muscle function during acute exacerbation of chronic obstructive pulmonary disease

Raolat M. Abdulai, Tina Jellesmark Jensen, Naimish R. Patel, Michael I. Polkey, Paul Jansson, Bartolomé R. Celli, Stephen I. Rennard

Research output: Contribution to journalReview articlepeer-review

49 Scopus citations


Important features of both stable and acute exacerbation of chronic obstructive pulmonary disease (COPD) are skeletal muscle weakness and wasting. Limb muscle dysfunction during an exacerbation has been linked to various adverse outcomes, including prolonged hospitalization, readmission, and mortality. The contributing factors leading to muscle dysfunction are similar to those seen in stable COPD: disuse, nutrition/energy balance, hypercapnia, hypoxemia, electrolyte derangements, inflammation, and drugs (i.e., glucocorticoids). These factors may be the trigger for a downstream cascade of local inflammatory changes, pathway process alterations, and structural degradation. Ultimately, the clinical effects can be wide ranging and include reduced limb muscle strength. Current therapies, such as pulmonary/physical rehabilitation, have limited impact because of low participation rates. Recently, novel drugs have been developed in similar disorders, and learnings from these studies can be used as a foundation to facilitate discovery in patients hospitalized with a COPD exacerbation. Nevertheless, investigators should approach this patient population with knowledge of the limitations of each intervention. In this Concise Clinical Review, we provide an overview of acute muscle dysfunction in patients hospitalized with acute exacerbation of COPD and a strategic approach to drug development in this setting.

Original languageEnglish (US)
Pages (from-to)433-449
Number of pages17
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number4
StatePublished - Feb 15 2018


  • COPD
  • Drug development
  • Exacerbations
  • Pharmacological interventions
  • Skeletal muscle

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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