Association of sarcopenia with osteoporosis in patients with chronic obstructive pulmonary disease.

OBJECTIVES: Systemic consequence of Chronic Obstructive Pulmonary Disease (COPD) is associated with progressive loss of muscle mass and function. Preliminary studies showed presence of sarcopenia in COPD leads to reduced pulmonary function and quality of life; studies on whether this condition results in consequent loss of bone mineral density (BMD) is still inconsistent. This study aims to examine the association of sarcopenia in COPD with osteoporosis. METHODS: This is a post-hoc analysis of a study on forty-one (n = 41) participants with COPD seen in a tertiary public hospital in Manila, Philippines who underwent pulmonary function test and dual-energy x-ray absorptiometry. Sarcopenia was defined using a Philippine-based criteria of low fat free mass index (FFMI) and low muscle strength - hand grip strength, and osteoporosis using World Health Organization T-score diagnostic criteria. RESULTS: The prevalence of osteoporosis among COPD is 44%, and 63% in COPD with sarcopenia. There was no statistical difference seen in pulmonary function variables between COPD with and without osteoporosis. Significant positive correlations were observed between Forced Expiratory Volume in 1 s, FFMI, and appendicular lean muscle with total body BMD. Sarcopenia in COPD was associated with significantly increased risk for osteoporosis. CONCLUSIONS: High prevalence rate of osteoporosis, and even higher among sarcopenic Filipino COPD patients should be further studied. The findings also suggest that sarcopenia in COPD is associated with increased risk of osteoporosis, and osteoporosis alone does not seem to affect lung function.

Body Composition of Filipino Chronic Obstructive Pulmonary Disease (COPD) Patients in Relation to Their Lung Function, Exercise Capacity and Quality of Life.

Background and objectives: The loss of muscle or fat free mass (FFM) as a result of systemic inflammation and poor nutrition in Chronic Obstructive Pulmonary Disease (COPD), is recognized as an important factor that influences symptoms and disease-related outcomes. To date, there are no data on body composition among Filipino COPD patients and how it impacts COPD disease severity. This paper examined the relationship of Fat Free Mass Index (FFMI = FFM/height) and sarcopenia with COPD disease severity variables. Methods: This was a cross-sectional analytic study comparing low and normal FFMI, sarcopenic and nonsarcopenic COPD patients, in terms of lung function, exercise capacity, and quality of life score. Filipino COPD patients older than 40 years were included. Patients performed six minute walking distance (6MWD), handgrip strength (HGS), and quality of life status evaluation using Filipino version of COPD Assessment Test (CAT). Body composition was measured using bioelectrical impedance analysis (BIA). Results: A total of 41 patients were included. The mean age was 69.22 years. The prevalence of being underweight and having sarcopenia was 32% and 46%, respectively. Point biserial correlation showed that COPD patients with low FFMI had a statistically significant reduction in peak inspiratory flow (r= -0.5791, P value 0.0002), peak expiratory flow (r= -0.4475, P value 0.0055), and handgrip strength (r= -0.4560, P value 0.0027); and lower CAT score (r= -0.3422, P value 0.0285). Similar findings were observed among sarcopenic COPD patients. Conclusion: The prevalence of being underweight and having sarcopenia was high. Low FFMI results in reduction of lung function and upper limb muscle strength among Filipino COPD patients.

Prevalence, clinical profile, and treatment outcomes of adult patients diagnosed with disseminated tuberculosis seen at University of the Philippines Manila-Philippine General Hospital Tuberculosis Directly Observed Treatment Short Course (TB-DOTS) Clinic

OBJECTIVE: To determine the prevalence, demographic, clinical profile, diagnostic and treatment outcomes of adult patients diagnosed with disseminated tuberculosisMETHODS: This is a cross sectional study of patients referred to the UP-PGH TB DOTS clinic with a diagnosis of disseminated TB from January 2011 to December 2015.RESULTS: The prevalence of disseminated tuberculosis was 1.7 %.Mean age at diagnosis was 33.9 years (range 19-64 years) with a male: female ratio of 1:1. The most common comorbidity was HIV (5.8%). The mean duration of symptoms before initial consult was 281 days (SD 510.7). The most common presenting symptoms were abdominal pain (19%), back pain (13%), and abdominal enlargement (11%). The lungs (86%) are still the most commonly involved site, followed by the gastrointestinal tract (22%) and the vertebra (27%). Majority were started with Category I treatment regimen (54%, 37 patients). Of the 68 patients, only 16% (11 patients) continued follow-up at PGH; all had documented treatment completion.CONCLUSION: Patients with disseminated tuberculosis are young and majority had no comorbid illness. They have long latency of symptoms prior to diagnosis, and usually present with nonpulmonary symptoms despite high evidence of pulmonary involvement. To date, this is the largest local study on disseminated TB known to the authors.