The Body (Weight and Composition) of Evidence in COPD

Noteworthy, it is the trajectory of weight changes during time that has to be carefully considered in these patients, being unintended weight loss an accepted determinant of reduced survival [2] rather than a compensatory mechanism to decrease metabolic rate in the advanced stages of the disease or an unavoidable epiphenomenon of the very end-stage. Indeed, the most severe the disease, the higher the prevalence of underweight patients [1,3]. A similar trend is related to the emphysema extent, where an association with loss of fat and Fat-Free Mass (FFM) has been observed, leading to a decreased BMI [4]. Moreover, Lung Volume Reduction Surgery (LVRS) has been demonstrated to significantly increase BMI and ameliorate health status [5]. Taken together, these evidences suggest a close interaction between body weight and the disease itself: different characteristics of the disease (both clinical severity and pathological and anatomical features) have a strong and significant impact on body weight and composition.