Observational studyThorax2021
Respiratory exacerbations are associated with muscle loss in current and former smokers.
Observational study in Thorax, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Computed tomography-based body composition measures in COPD and their association with clinical outcomes: A systematic review.Chronic respiratory diseasePooled it
- Significant Spirometric Transitions and Preserved Ratio Impaired Spirometry Among Ever Smokers.Chest · 2022Trial
- Association of Airway Mucus Plugs and Physical Activity, Exercise Tolerance, Sarcopenia, and Frailty in Patients With COPD and Pre-COPD.Respirology (Carlton, Vic.) · 2026Observational
- Automated 3D chest CT muscle segmentation-derived model development and explanation in discrimination of normal, preserved ratio impaired spirometry, and COPD: a multicenter study.Insights into imaging · 2026Article
- Implementing acute exacerbations of COPD care bundles: evidence, effectiveness and future directions.European respiratory review : an official journal of the European Respiratory Society · 2026Review
- Sarcopenia and Frailty in COPD: Mechanisms, Relationship with Malnutrition and Potential Therapeutic Interventions.Nutrients · 2026Review
- Bidirectional Clinical Interactions among Exacerbations and Comorbidities in COPD: A Narrative Review.Seminars in respiratory and critical care medicine · 2026Review
- Immune system benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease.Experimental physiology · 2026Review
- Identifying key diaphragm ultrasound predictors for early screening of respiratory sarcopenia.Scientific reports · 2026Article
- CT-Derived Pectoralis Muscle Measurements and All-Cause Mortality in COPD.Diagnostics (Basel, Switzerland) · 2026Article
- Thoracic myosteatosis and adipose tissue in COPD: associations of muscle quality and CT biomarkers with GOLD classification.BMC pulmonary medicine · 2026Observational
- Psychological Distress in COPD Assessed by DASS-21-R: Multivariable Regression and Bayesian Analysis Across GOLD Stages.Medical sciences (Basel, Switzerland) · 2026Observational
- The lung-muscle axis in COPD: a conceptual framework integrating evidence, mechanisms, and therapeutic perspectives.Frontiers in immunology · 2026Review
- Medical nutrition therapy in chronic obstructive pulmonary disease: A narrative review.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2025Review
- Role of ultrasonography in assessing respiratory muscle loss: insights from a cross-sectional study on neurological patients with long-term bed rest with and without tracheostomy.BMC pulmonary medicine · 2025Article
- The Cross-Sectional Area of Erector Spinae Muscles Obtained from Chest CT Is an Independent Predictor of Death in COPD.International journal of chronic obstructive pulmonary disease · 2025Article
- An enhanced machine learning-based prognostic prediction model for patients with AECOPD on invasive mechanical ventilation.iScience · 2024Article
- Definition of sinonasal and otological exacerbation in patients with primary ciliary dyskinesia: an expert consensus.ERJ open research · 2024Article
- Proteomics and machine learning in the prediction and explanation of low pectoralis muscle area.Scientific reports · 2024Article
- Prediction model and assessment of malnutrition in patients with stable chronic obstructive pulmonary disease.Scientific reports · 2024Article
Corrections and comments
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Authors and funding
21 authors at 7 institutions in 1 country.
Funding
Abstract
objectivesMuscle wasting is a recognised extra-pulmonary complication in chronic obstructive pulmonary disease and has been associated with increased risk of death. Acute respiratory exacerbations are associated with reduction of muscle function, but there is a paucity of data on their long-term effect. This study explores the relationship between acute respiratory exacerbations and long-term muscle loss using serial measurements of CT derived pectoralis muscle area (PMA). DESIGN AND
settingParticipants were included from two prospective, longitudinal, observational, multicentre cohorts of ever-smokers with at least 10 pack-year history.
participantsThe primary analysis included 1332 (of 2501) participants from Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and 4384 (of 10 198) participants from Genetic Epidemiology of COPD (COPDGene) who had complete data from their baseline and follow-up visits.
interventionsPMA was measured on chest CT scans at two timepoints. Self-reported exacerbation data were collected from participants in both studies through the use of periodic longitudinal surveys.
main outcome measuresAge-related and excess muscle loss over time.
resultsAge, sex, race and body mass index were associated with baseline PMA. Participants experienced age-related decline at the upper end of reported normal ranges. In ECLIPSE, the exacerbation rate over time was associated with an excess muscle area loss of 1.3% (95% CI 0.6 to 1.9, p<0.001) over 3 years and in COPDGene with an excess muscle area loss of 2.1% (95% CI 1.2 to 2.8, p<0.001) over 5 years. Excess muscle area decline was absent in 273 individuals who participated in pulmonary rehabilitation.
conclusionsExacerbations are associated with accelerated skeletal muscle loss. Each annual exacerbation was associated with the equivalent of 6 months of age-expected decline in muscle mass. Ameliorating exacerbation-associated muscle loss represents an important therapeutic target.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.