Abstract
BackgroundPatients with fibrotic interstitial lung disease (ILD) are frequently physically inactive and many ILD subtypes are characterized by risk factors for myopathy; however, the importance of body composition, muscle strength, and physical performance in this population is largely unknown.MethodsPatients were prospectively recruited from a specialized ILD clinic, baseline characteristics were collected from the clinical record, pulmonary function tests were performed per established protocols, and dyspnea was measured using the University of California San Diego Shortness of Breath Questionnaire. Dual-energy X-ray absorptiometry (DXA) was used to assess body composition; handgrip strength to determine muscle strength, and 4-m gait speed to measure physical performance.ResultsOne hundred and fifteen patients with fibrotic ILD including 40 patients with idiopathic pulmonary fibrosis were recruited. The mean age was 69+/− 10 years in men (62% of the cohort), and 66+/− 9 years in women, with mild and moderate reduction in FVC and DLCO, respectively, for both sexes. ILD severity (measured by FVC %-predicted, DLCO %-predicted, or the Composite Physiologic Index in separate models) significantly predicted muscle mass and percent body fat including with adjustment for age, sex, and weight. ILD severity was associated with grip strength and gait speed independent from body composition.ConclusionsILD severity has an important impact on body composition, particularly in men. Future studies are needed to confirm and further explore the possibility of additional pathways through which ILD directly impacts limb muscle function and physical performance.
Highlights
Fibrotic interstitial lung diseases (ILDs) are progressive disorders that have high morbidity and early mortality [1, 2]
idiopathic pulmonary fibrosis (IPF) and non-IPF patients had no differences in their body composition, limb muscle function, and physical performance; all ILDs were pooled for all analyses
We show that ILD severity is associated with upper limb muscle dysfunction and worse physical performance independent of muscle mass or body fat percentage
Summary
Fibrotic interstitial lung diseases (ILDs) are progressive disorders that have high morbidity and early mortality [1, 2]. The morbidity of fibrotic ILD is primarily determined by disabling dyspnea and cough; extrapulmonary symptoms are common (e.g., depression, anxiety, fatigue) [3] Together, these pulmonary and extrapulmonary manifestations reduce physical activity [4, 5], which in turn leads to limb muscle disuse and deconditioning [6, 7]. Many ILD subtypes are characterized by systemic inflammation, oxidative stress, hypoxemia, impaired energy balance, malnutrition, and accelerated biological aging [10,11,12]. These are additional potential risk factors for myopathy and limb muscle dysfunction that have not been adequately studied in fibrotic ILD [13,14,15]. Patients with fibrotic interstitial lung disease (ILD) are frequently physically inactive and many ILD subtypes are characterized by risk factors for myopathy; the importance of body composition, muscle strength, and physical performance in this population is largely unknown
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