Weight monitoring should be incorporated into national and international COPD guidance, according to the authors of a new study.
The study enrolled 1755 consecutive outpatients with stable COPD from 2 London centres between 2012 and 2017. Patients were stratified according to European Respiratory Society Task Force defined cachexia (unintentional weight loss >5 per cent and low fat-free mass index [FFMI]), pre-cachexia (weight loss >5 per cent but preserved FFMI), or no cachexia. The primary outcome was all-cause mortality.
The prevalence of cachexia was 4.6 per cent (95% CI, 3.6-5.6) and the prevalence of pre-cachexia was 1.6 per cent (95% CI, 1.0-2.2). Prevalence was similar in men and women but increased with worsening Global Initiative for Chronic Obstructive Pulmonary Disease spirometric stage and Medical Research Council dyspnoea score (all P<.001).
There were 313 (17.8%) deaths over a median (interquartile range) follow-up duration 1089 (547-1704) days. Both cachexia (HR, 1.98; 95% CI, 1.31-2.99; P=.002) and pre-cachexia (HR, 2.79; 95% CI, 1.48-5.29; P=.001) were associated with increased mortality.
In multivariable analysis, the unintentional weight loss feature of cachexia was independently associated with mortality (HR, 2.16; 95% CI, 1.51-3.08; P<.001], whereas low FFMI was not (HR, 0.88; 95% CI, 0.64-1.20; P=.402].
Based on the findings, the authors say weight loss should be regularly monitored in practice and may represent an important target in COPD management. They propose the incorporation of weight monitoring into national and international COPD guidance.
