Obesity and Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disease characterized by chronic respiratory symptoms and persistent airflow limitation. It is the most common chronic respiratory disease in adults and is associated with substantial morbidity and mortality. Although traditionally considered a wasting disease, it is well-recognized that obesity is a common comorbid condition in COPD and contributes to the heterogeneity of the disease. Obese COPD patients are more symptomatic, although they have reduced static lung hyperinflation, irrespective of the severity of airflow limitation. Obesity is associated with decreased tolerance to weight-bearing exercise in COPD while having beneficial effects on dynamic ventilatory mechanics during weight-supported exercise. Although obese COPD patients have higher levels of systemic inflammation and increased risk of metabolic syndrome, it is currently unknown whether and to what extent adipose tissue dysfunction and insulin resistance contribute to increased cardiovascular risk and extrapulmonary manifestations in COPD. In contrast to early-stage COPD, obesity seems to protect against mortality in patients with severe disease and against severe exacerbations. Pulmonary rehabilitation is a comprehensive, individualized intervention with the potential to reduce body weight in obese COPD patients by including dietary therapy, physical activity, and behavioral modification.