ABSTRACT
The association between weight loss and severe COPD has long been recognized. Fowler et al. (1) first described the association of weight loss and emphysema in the late nineteenth century. Attempts to describe different COPD classifications found that body weight might be an important determinant (2). This led to the classical description of the pink puffer (emphysematous type) and the blue bloater (bronchitic type). The pink puffing patient is characteristically thin, breathless, with marked hyperinflation of the chest. The blue and bloated patient may not be particularly breathless, at least when at rest, but has severe central cyanosis. In the 1960s several studies reported that a low body weight and weigh loss are negatively associated with survival in COPD (3). Nevertheless, therapeutic management of weight loss and muscle wasting in patients with COPD has gained interest only recently since it was generally considered as a terminal progression in the disease process and therefore inevitable and irreversible. Furthermore, it was even suggested that weight loss is an adaptive mechanism to decrease oxygen consumption. Recent studies have challenged this attitude and showed that weight loss and a low body weight are associated with poor prognosis independent of, or at least not closely correlated with, the degree of lung function impairment (4,5). Moreover, weight gain after nutritional support was associated with decreased mortality (6).
