Patients with chronic obstructive pulmonary disease (COPD) are often malnourished manifesting as unintentional weight loss. Consequently, they are more prone to disease exacerbations with adverse clinical outcomes. To explore factors that could be predictive of unintentional weight loss in patients with COPD, JW Chiles from the Dept. of Pulmonary, Allergy, and Critical Care Medicine at the University of Alabama in Birmingham, Alabama, USA and co-researchers enrolled 971 participants, who had been a part of the COPDGene study.¹ Unintentional weight loss was evaluated at the 2nd visit, which happened 5 years after their recruitment for the study. A total of 842 did not report unintentional weight loss at the 3rd visit, which occurred 10 years after recruitment, while 129 reported that they had.

A smoking history was also elicited and the results showed that patients who had unintentional weight loss had on average 6 more pack-years of cigarette smoking (54.7 vs 48.2). The FEV1/FVC ratio was also lower by 3% in this group (lower (57% vs 60%). Those who had unintended weight loss at the 3rd visit reported major loss of initial body weight between the second and the third visits compared to those who did not report weight loss (9.13% vs 1.86%).

The score on the St Georges Respiratory Questionnaire (SGRQ), which measures the disease-related quality of life was 8 points higher among participants with UWL at the third visit (32.5 vs 24.3). They had higher mMRC (Modified Medical Research Council) Dyspnea Scale) score indicative of greater severity of dyspnea in these patients (1.81 vs 1.21). The 6MWD was also shorter at the second visit (1203 ft vs 1341 ft). More patients with UWL had a positive history of gastric ulcers at the third visit compared to those who did not have UWL; 16% vs 7%, respectively. However, the rates of incident and pre-existing cancers were comparable between the two groups.

This study published in the American Journal of Respiratory and Critical Care Medicine shows that “increased symptoms, worse functional status and specific comorbid risk factors” are predictive of unintended weight loss in patients with COPD. Notably, these factors were evident at least five years before the commencement of the weight loss. Unintentional weight loss is a known risk factor for mortality in COPD patients. Patients with COPD should therefore be closely watched for the presence of these risk factors as markers for new-onset unintended weight loss later on in life.

Reference

Chiles JW, et al. Abstract 410. Clinical risk factors for unintentional weight loss in participants with COPD are present five years before its onset. Am J Respir Crit Care Med. 2023;207:A1138. https://www.atsjournals.org/doi/pdf/10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A1138