Weight Changes in the Terminal Stages of Chronic Obstructive Pulmonary Disease1, 2

Abstract

The occurrence of marked weight loss during the terminal stages of respiratory insufficiency is a frequent clinical finding (1-3). This can lead to cachexia, with the result that suspicion of malignancy arises (3-5). Nevertheless, only limited data are available in the literature on the beginning, the degree, the duration, the causes, and the repercussions on lung function due to this weight loss. In a group of 220 emphysematous patients Wenk (5) mentioned 19 patients admitted to hospital because of marked weight loss or cachexia. Among 199 of these patients he found 130 whose actual weight was at least 10 per cent less than their theoretic body weight, as determined by the index of Broca. Mitchell and Filley (2) observed weight loss in 51 per cent of their group of 150 patients with chronic obstructive disease; in 14 per cent, this weight loss exceeded the predyspnea body weight by 20 per cent. Ziegenspeck and co-workers (6) studied the relation between weight loss and the extent of pulmonary emphysema, evaluated by the ratio residual volumejtotallung capacity (RV /TLC). In a group of 338 emphysematous patients compared with 100 healthy subjects, these investigators found a significant drop in body weight with the degree of emphysema. Sukumalchantra and Williams (7), who followed 44 patients with chronic obstructive pulmonary disease over a five-year period, found a reduction of the maximal midexpiratory flow rate (MMF) and of the diffusing capacity (Dco) in the 12 patients who lost more than 10 per cent of their initial weight. In a group of 32 patients without weight loss followed over a same period of time, these in-