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.

New research presented at 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%; P = .023). COPD patients with sarcopenia had lower FEV1% predicted (35.4+15.7 vs 43.4+17.4%; P = .030), HGS (23.8+8.4 vs 30.8+8.0 kg; P = .001), and FFMI (15.4+2.4 vs 18.9+2.8 kg/m2).

“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 HCPLive. “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+86.8 vs 248.5+90.1 meters; P = .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; P = .95). For those diagnosed with sarcopenia, more interventions were prescribed overall (2.4+1.0 vs 1.9+0.9; P = .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%; P <.001).

“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.

References

1. 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

2. Attaway A, Hatipoglu US, Connolly J, et al. Implementation of a Subspecialty Clinic to Diagnose and Treat Skeletal Muscle Loss Due to COPD [abstract]. Am J Respir Crit Care Med 2025;211:A7300. https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A7300