Corticosteroids contribute to muscle weakness in chronic airflow obstruction.

Twenty-one patients with chronic obstructive pulmonary disease (COPD) or asthma, admitted to our division because of exacerbation of their conditions and requiring intensified treatment with corticosteroids, underwent pulmonary function tests, tests of respiratory muscle function, measurement of quadricep strength, and a variety of anthropometric and biochemical measurements. All tests were performed the 10th day after admission. As expected, muscle strength and pulmonary function were interrelated. Surprisingly, the average daily dose of steroids taken in the previous 6 mo, which ranged from 1.4 to 21.3 mg (average 4.3 mg), was significantly related to inspiratory muscle strength (PImax) and a similar tendency was present for expiratory muscle strength (PEmax). Multiple regression analysis of the relationship between PImax and quadriceps force (QF) and steroid dose revealed that the average daily dose independently explained 32% of the variance in PImax and up to 51% of the variance in QF. These relationships were independent of the degree of bronchial obstruction estimated by percentage predicted FEV1. Other significant determinants were age, sex, and COPD for PImax and age, sex, and body weight for QF. The present study demonstrates that in patients with COPD or asthma, respiratory and peripheral muscle strength and steroid treatment are interrelated despite the relatively low doses administered. This observation imposes further limitations on the prolonged treatment of chronic airflow obstruction with systemic corticosteroids.

[1]  M. Decramer,et al.  Triamcinolone and prednisolone affect contractile properties and histopathology of rat diaphragm differently. , 1993, The Journal of clinical investigation.

[2]  S. Powers,et al.  Exercise and glucocorticoid-induced diaphragmatic myopathy. , 1993, Journal of applied physiology.

[3]  P. Macklem,et al.  Assessment of diaphragm function using mouth pressure twitches in chronic obstructive pulmonary disease patients. , 1993, The American review of respiratory disease.

[4]  N. Jones,et al.  Exercise capacity and ventilatory, circulatory, and symptom limitation in patients with chronic airflow limitation. , 1992, The American review of respiratory disease.

[5]  C. Gallagher,et al.  Inspiratory muscle weakness and dyspnea in chronic heart failure. , 1992, The American review of respiratory disease.

[6]  P. Macklem,et al.  Evaluation of human diaphragm contractility using mouth pressure twitches. , 1992, The American review of respiratory disease.

[7]  M. Weiner,et al.  Impaired skeletal muscle function in patients with congestive heart failure. Relationship to systemic exercise performance. , 1991, The Journal of clinical investigation.

[8]  C. Gallagher,et al.  Corticosteroid therapy and respiratory muscle function in humans. , 1991, The American review of respiratory disease.

[9]  A. Schols.  Nutritional depletion and physical impairment in patients with chronic obstructive pulmonary disease : implications for therapy , 1991 .

[10]  Josep Maria Salanova Grau,et al.  Respiratory and skeletal muscle function in steroid-dependent bronchial asthma. , 1990, The American review of respiratory disease.

[11]  M. Reid,et al.  Diaphragm atrophy and weakness in cortisone-treated rats. , 1989, Journal of applied physiology.

[12]  J. Martin,et al.  Effect of nutritional status on exercise performance in patients with chronic obstructive pulmonary disease. , 1989, The American review of respiratory disease.

[13]  N. Secher,et al.  Histochemical characteristics of human expiratory and inspiratory intercostal muscles. , 1989, Journal of applied physiology.

[14]  R. Rogers,et al.  Oxygen consumption of the respiratory muscles in normal and in malnourished patients with chronic obstructive pulmonary disease. , 1989, The American review of respiratory disease.

[15]  M. Decramer.  Effects of hyperinflation on the respiratory muscles. , 1989, The European respiratory journal.

[16]  G. Hill,et al.  Risk Factors for Postoperative Pneumonia: The Importance of Protein Depletion , 1988, Annals of surgery.

[17]  C. Branger,et al.  Effects of sepsis on diaphragmatic function in rats. , 1988, The American review of respiratory disease.

[18]  M. Green,et al.  Respiratory muscle weakness during upper respiratory tract infections. , 1988, The American review of respiratory disease.

[19]  N. Jones,et al.  Respiratory muscles and dyspnea. , 1988, Clinics in chest medicine.

[20]  M. Tobin,et al.  Respiratory muscles in disease. , 1988, Clinics in chest medicine.

[21]  Buist As.  Standardization of spirometry. , 1987 .

[22]  Mahler Da.  Dyspnea: diagnosis and management. , 1987 .

[23]  S. Gandevia,et al.  Strength and endurance of inspiratory, expiratory, and limb muscles in asthma. , 1986, The American review of respiratory disease.

[24]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[25]  D. F. Rochester,et al.  Determinants of maximal inspiratory pressure in chronic obstructive pulmonary disease. , 2015, The American review of respiratory disease.

[26]  M. Aubier,et al.  Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure. , 1985, The New England journal of medicine.

[27]  S. Bowyer,et al.  Steroid myopathy: incidence and detection in a population with asthma. , 1985, The Journal of allergy and clinical immunology.

[28]  M. Aubier,et al.  Bilateral phrenic stimulation: a simple technique to assess diaphragmatic fatigue in humans. , 1985, Journal of applied physiology.

[29]  B. Bigland-ritchie,et al.  Assessment of human diaphragm strength and activation using phrenic nerve stimulation. , 1984, Respiration physiology.

[30]  Sharp Jt.  The respiratory muscles in emphysema. , 1983 .

[31]  D. F. Rochester,et al.  Respiratory muscle failure. , 1983, The Medical clinics of North America.

[32]  D. F. Rochester,et al.  Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. , 2015, The American review of respiratory disease.

[33]  S B Heymsfield,et al.  Anthropometric measurement of muscle mass: revised equations for calculating bone-free arm muscle area. , 1982, The American journal of clinical nutrition.

[34]  W. F. Scott.  Build Study 1979. , 1982 .

[35]  G. Borg.  Psychophysical bases of perceived exertion. , 1982, Medicine and science in sports and exercise.

[36]  J. Reading,et al.  Risk factors for postoperative pneumonia. , 1981, The American journal of medicine.

[37]  N. Scrimshaw,et al.  Therapeutic index of nutritional depletion in hospitalized patients. , 1975, Surgery, gynecology & obstetrics.

[38]  L. F. Black,et al.  Maximal respiratory pressures: normal values and relationship to age and sex. , 2015 .

[39]  P. Vignos,et al.  Experimental corticosteroid myopathy. , 1969, Arthritis and rheumatism.

[40]  F. H. Tyler,et al.  Studies in disorders of muscle. XII. Myopathy due to the administration of therapeutic amounts of 17-hydroxycorticosteroids. , 1959, The American journal of medicine.