Amy Attaway, MD, is a pulmonologist at the Cleveland Clinic.

Amy Attaway, MD

Overcoming Diagnostic, Management Challenges for Sarcopenia in COPD, with Amy Attaway, MD

Sarcopenia, or skeletal muscle loss, is a major yet often overlooked complication in patients with 

chronic obstructive pulmonary disease (COPD)

. Despite being estimated to affect 20-40% of people with COPD and significantly contribute to adverse clinical outcomes, routine screening and treatment are not common.

the American Thoracic Society (ATS) International Conference 2025

, Amy Attaway, MD, a pulmonologist at Cleveland Clinic, suggest the potential value of a subspecialty clinic for overcoming current diagnostic and management challenges.

Data presented at ATS included 85 COPD patients with concern for sarcopenia who were referred to a subspecialty clinic between April 2023-September 2024. As a part of routine care in the clinic, all COPD patients underwent spirometry to quantify FEV1% predicted, handgrip strength (HGS) in kg, CT-scans for clinical indications and to measure pectoralis muscle mass, and six-minute walk distance (6MWD). Overall muscle mass (FFMI) was quantified from pectoralis muscle in kg/m2.

If COPD patients met criteria for low FFMI or low HGS, investigators classified them as “sarcopenia.” If COPD patients met criteria for both low FFMI and low HGS, they were classified as “severe sarcopenia.”

Interventions in the clinic included medical optimization, nutrition interventions (i.e. appetite stimulants, protein supplementation, or nutrition consult), and physical activity interventions (i.e. physical activity, or pulmonary rehabilitation).

Of the COPD patients referred, 58.8% met criteria for sarcopenia and 15.3% met criteria for severe sarcopenia. Investigators noted sarcopenia was more commonly diagnosed by FFMI than HGS (74% vs 52%; 

= .023). COPD patients with sarcopenia had lower FEV1% predicted (35.4

“I think one of the benefits of having this large organization was we were able to really focus on this subset, this phenotype of COPD, which is not always seen in everyone, although it's very common,” Attaway explained to 

. “We were getting these internal referrals from pulmonologists and primary care who thought their patient had sarcopenia, and we found that around 60% of patients referred had actually met criteria for sarcopenia. That was exciting to see because it highlights how prevalent it is.”

Of note, there was no significant difference in 6MWD for those with and without sarcopenia (240.7

= .72). There was also no difference in severity of COPD, with the majority classified as Group E in both cohorts (72% with sarcopenia, 71.4% without sarcopenia; 

= .95). For those diagnosed with sarcopenia, more interventions were prescribed overall (2.4

= .035). While physical activity interventions were recommended in the majority of both cohorts, nutrition interventions were more commonly prescribed for patients with sarcopenia (88% vs 14%; 

“I'm really excited to continue the clinic and continue to look at the research, continue to look at our outcomes and how we're addressing these gaps in the literature,” Attaway said.

Editors’ note: Attaway has no relevant disclosures.

Attaway A. COPD and Skeletal Muscle Mass: Discovering New Possibilities. March 8, 2023. Accessed May 23, 2025. 

https://consultqd.clevelandclinic.org/copd-and-skeletal-muscle-mass-discovering-new-possibilities

Attaway A, Hatipoglu US, Connolly J, et al. Implementation of a Subspecialty Clinic to Diagnose and Treat Skeletal Muscle Loss Due to COPD [abstract]. 

https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A7300

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Attaway reviews data demonstrating the potential benefit of a subspecialty clinic for overcoming current diagnostic and treatment-related challenges for sarcopenia in COPD.

Recognizing the Burden of Sarcopenia in COPD, with Amy Attaway, MD

 based on research she’s presenting at 

, Amy Attaway, MD, a pulmonologist at Cleveland Clinic, explains how part of the underdiagnosis of sarcopenia is attributable to its symptoms—such as fatigue and breathlessness—which mimic those of worsening pulmonary disease.

Highlighting the need for improved diagnostic clarity, Attaway shares a practical example from her clinical experience in which she asks patients if they get out of breath when they walk across a room. For those who said yes, she would inquire further about whether it was their breathing or their legs that made them feel like they had to stop walking to help determine whether it was attributable to their COPD or if they might have sarcopenia.

“I do molecular basic science research on sarcopenia, but I felt like there’s a really big gap clinically,” Attaway said. “When you see these patients clinically as a doctor, it kind of helps drive you to recognize the gaps, and then it goes back into what we need to focus on for research.”

Seeking to address some of these gaps, she and a group of colleagues created a subspecialty clinic for patients with COPD and suspected sarcopenia at Cleveland Clinic. One of the goals of this clinic, Attaway says, is to focus on testing patients for sarcopenia earlier and implementing evidence-based protocols from the literature into a single setting.

Looking at clinical gaps in treatment, Attaway says this process is complicated by the lack of a clear answer as to what causes sarcopenia. Specifically, she calls attention to shortcomings in nutrition counseling in these patients, citing the importance of adequate protein intake for building muscle.

“Everything we're doing is evidence-based, but never kind of put together into one clinic,” Attaway explained. “That was why that was something I thought was really important to do.”

Attaway A. COPD and Skeletal Muscle Mass: Discovering New Possibilities. March 8, 2023. Accessed May 20, 2025. 

Attaway describes the importance of screening for and treating sarcopenia in patients with COPD and clinical gaps that complicate this process.

Amy Attaway, MD

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