M Decramer, LM Lacquet, R Fagard and P Rogiers
Respiratory Muscle Research Unit, Laboratory of Pneumology, University Hospitals, Katholieke Universiteit Leuven, Belgium.

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.

This article has been cited by other articles:

				F. Pitta, T. Troosters, V. S. Probst, D. Langer, M. Decramer, and R. Gosselink Are Patients With COPD More Active After Pulmonary Rehabilitation? Chest, August 1, 2008; 134(2): 273 - 280. [Abstract] [Full Text] [PDF]

				J. A. Falk, O. A. Minai, and Z. Mosenifar Inhaled and Systemic Corticosteroids in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, May 1, 2008; 5(4): 506 - 512. [Abstract] [Full Text] [PDF]

				M. D. Eisner, C. Iribarren, E. H. Yelin, S. Sidney, P. P. Katz, L. Ackerson, P. Lathon, I. Tolstykh, T. Omachi, N. Byl, et al. Pulmonary Function and the Risk of Functional Limitation in Chronic Obstructive Pulmonary Disease Am. J. Epidemiol., May 1, 2008; 167(9): 1090 - 1101. [Abstract] [Full Text] [PDF]

				O Schakman, H Gilson, and J P Thissen Mechanisms of glucocorticoid-induced myopathy J. Endocrinol., April 1, 2008; 197(1): 1 - 10. [Abstract] [Full Text] [PDF]

				K. F. Rabe, S. Hurd, A. Anzueto, P. J. Barnes, S. A. Buist, P. Calverley, Y. Fukuchi, C. Jenkins, R. Rodriguez-Roisin, C. van Weel, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary Am. J. Respir. Crit. Care Med., September 15, 2007; 176(6): 532 - 555. [Abstract] [Full Text] [PDF]

				S. Jelic and T. H. Le Jemtel Diagnostic Usefulness of B-Type Natriuretic Peptide and Functional Consequences of Muscle Alterations in COPD and Chronic Heart Failure. Chest, October 1, 2006; 130(4): 1220 - 1230. [Abstract] [Full Text] [PDF]

				F. Pitta, T. Troosters, V. S. Probst, M. A. Spruit, M. Decramer, and R. Gosselink Physical Activity and Hospitalization for Exacerbation of COPD Chest, March 1, 2006; 129(3): 536 - 544. [Abstract] [Full Text] [PDF]

				M. A. Spruit, R. Gosselink, T. Troosters, A. Kasran, M. Van Vliet, and M. Decramer Low-Grade Systemic Inflammation and the Response to Exercise Training in Patients With Advanced COPD Chest, November 1, 2005; 128(5): 3183 - 3190. [Abstract] [Full Text] [PDF]

				M. Van Vliet, M. A. Spruit, G. Verleden, A. Kasran, E. Van Herck, F. Pitta, R. Bouillon, and M. Decramer Hypogonadism, Quadriceps Weakness, and Exercise Intolerance in Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., November 1, 2005; 172(9): 1105 - 1111. [Abstract] [Full Text] [PDF]

				A. Couillard and C. Prefaut From muscle disuse to myopathy in COPD: potential contribution of oxidative stress Eur. Respir. J., October 1, 2005; 26(4): 703 - 719. [Abstract] [Full Text] [PDF]

				A. C. White, N. Terrin, K. B. Miller, and H. F. Ryan Impaired Respiratory and Skeletal Muscle Strength in Patients Prior to Hematopoietic Stem-Cell Transplantation Chest, July 1, 2005; 128(1): 145 - 152. [Abstract] [Full Text] [PDF]

				T. Troosters, R. Casaburi, R. Gosselink, and M. Decramer Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., July 1, 2005; 172(1): 19 - 38. [Full Text] [PDF]

				F. Pitta, T. Troosters, M. A. Spruit, V. S. Probst, M. Decramer, and R. Gosselink Characteristics of Physical Activities in Daily Life in Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., May 1, 2005; 171(9): 972 - 977. [Abstract] [Full Text] [PDF]

				C. Newall, S. Schinke, C. O. Savage, S. Hill, and L. Harper Impairment of lung function, health status and functional capacity in patients with ANCA-associated vasculitis Rheumatology, May 1, 2005; 44(5): 623 - 628. [Abstract] [Full Text] [PDF]

				F. J. Meyer, D. Lossnitzer, A. V. Kristen, A. M. Schoene, W. Kubler, H. A. Katus, and M. M. Borst Respiratory muscle dysfunction in idiopathic pulmonary arterial hypertension Eur. Respir. J., January 1, 2005; 25(1): 125 - 130. [Abstract] [Full Text] [PDF]

				S. Mathur, W D. Reid, and R. D Levy Exercise Limitation in Recipients of Lung Transplants Physical Therapy, December 1, 2004; 84(12): 1178 - 1187. [Full Text] [PDF]

				J. F. Donohue and J. A. Ohar Effects of Corticosteroids on Lung Function in Asthma and Chronic Obstructive Pulmonary Disease Proceedings of the ATS, November 1, 2004; 1(3): 152 - 160. [Abstract] [Full Text] [PDF]

				C Pinet, P Scillia, M Cassart, M Lamotte, C Knoop, C Melot, and M Estenne Preferential reduction of quadriceps over respiratory muscle strength and bulk after lung transplantation for cystic fibrosis Thorax, September 1, 2004; 59(9): 783 - 789. [Abstract] [Full Text] [PDF]

				N. J. M. Cano, C. Pichard, H. Roth, I. Court-Fortune, L. Cynober, M. Gerard-Boncompain, A. Cuvelier, J.-P. Laaban, J.-C. Melchior, J.-C. Raphael, et al. C-Reactive Protein and Body Mass Index Predict Outcome in End-Stage Respiratory Failure Chest, August 1, 2004; 126(2): 540 - 546. [Abstract] [Full Text] [PDF]

				C. Coronell, M. Orozco-Levi, R. Mendez, A. Ramirez-Sarmiento, J.B. Galdiz, and J. Gea Relevance of assessing quadriceps endurance in patients with COPD Eur. Respir. J., July 1, 2004; 24(1): 129 - 136. [Abstract] [Full Text] [PDF]

				N.S. Hopkinson, W.D-C. Man, M.J. Dayer, E.T. Ross, A.H. Nickol, N. Hart, J. Moxham, and M.I. Polkey Acute effect of oral steroids on muscle function in chronic obstructive pulmonary disease Eur. Respir. J., July 1, 2004; 24(1): 137 - 142. [Abstract] [Full Text] [PDF]

				M. A. Spruit, R. Gosselink, F. Pitta, T. Troosters, M. Decramer, and E. Zanotti Peripheral Muscle Strength Training in Patients With COPD Chest, April 1, 2004; 125(4): 1589 - 1590. [Full Text] [PDF]

				R.T. Jagoe and M.P.K.J. Engelen Muscle wasting and changes in muscle protein metabolism in chronic obstructive pulmonary disease Eur. Respir. J., November 2, 2003; 22(46_suppl): 52s - 63s. [Abstract] [Full Text] [PDF]

				E.C. Creutzberg and R. Casaburi Endocrinological disturbances in chronic obstructive pulmonary disease Eur. Respir. J., November 2, 2003; 22(46_suppl): 76s - 80s. [Abstract] [Full Text] [PDF]

				E. C. Creutzberg, E. F. M. Wouters, R. Mostert, R. J. Pluymers, and A. M. W. J. Schols A Role for Anabolic Steroids in the Rehabilitation of Patients With COPD?: A Double-Blind, Placebo-Controlled, Randomized Trial Chest, November 1, 2003; 124(5): 1733 - 1742. [Abstract] [Full Text] [PDF]

				S. C. Barry and C. G. Gallagher Corticosteroids and skeletal muscle function in cystic fibrosis J Appl Physiol, October 1, 2003; 95(4): 1379 - 1384. [Abstract] [Full Text] [PDF]

				M I Polkey Peripheral muscle weakness in COPD: where does it come from? Thorax, September 1, 2003; 58(9): 741 - 742. [Full Text] [PDF]

				M A Spruit, R Gosselink, T Troosters, A Kasran, G Gayan-Ramirez, P Bogaerts, R Bouillon, and M Decramer Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I Thorax, September 1, 2003; 58(9): 752 - 756. [Abstract] [Full Text] [PDF]

				K. H. Groenewegen, A. M.W.J. Schols, and E. F.M. Wouters Mortality and Mortality-Related Factors After Hospitalization for Acute Exacerbation of COPD Chest, August 1, 2003; 124(2): 459 - 467. [Abstract] [Full Text] [PDF]

				F. Laghi and M. J. Tobin Disorders of the Respiratory Muscles Am. J. Respir. Crit. Care Med., July 1, 2003; 168(1): 10 - 48. [Abstract] [Full Text] [PDF]

				M. Fournier, Z.-S. Huang, H. Li, X. Da, B. Cercek, and M. I. Lewis Insulin-like growth factor I prevents corticosteroid-induced diaphragm muscle atrophy in emphysematous hamsters Am J Physiol Regulatory Integrative Comp Physiol, July 1, 2003; 285(1): R34 - R43. [Abstract] [Full Text] [PDF]

				D. J. Bihari, F. S.S. Leijten, M. A. Spruit, B. Nemery, M. Decramer, M. S. Herridge, and the Toronto ARDS Outcomes Group Survivors of the Acute Respiratory Distress Syndrome N. Engl. J. Med., May 22, 2003; 348(21): 2149 - 2150. [Full Text] [PDF]

				A.G.N. Agusti, A. Noguera, J. Sauleda, E. Sala, J. Pons, and X. Busquets Systemic effects of chronic obstructive pulmonary disease Eur. Respir. J., February 1, 2003; 21(2): 347 - 360. [Abstract] [Full Text] [PDF]

				M.A. Spruit, R. Gosselink, T. Troosters, K. De Paepe, and M. Decramer Resistance versus endurance training in patients with COPD and peripheral muscle weakness Eur. Respir. J., June 1, 2002; 19(6): 1072 - 1078. [Abstract] [Full Text] [PDF]

				N. R. MacIntyre Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support : A Collective Task Force Facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine Chest, December 1, 2001; 120(6_suppl): 375S - 396S. [Abstract] [Full Text] [PDF]

				P.M.A. Calverley Modern treatment of chronic obstructive pulmonary disease Eur. Respir. J., July 2, 2001; 18(34_suppl): 60S - 66s. [Abstract] [Full Text] [PDF]

				R. A. PAUWELS, A. S. BUIST, P. M. A. CALVERLEY, C. R. JENKINS, and S. S. HURD Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease . NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop Summary Am. J. Respir. Crit. Care Med., April 1, 2001; 163(5): 1256 - 1276. [Full Text]

				M. I. Polkey and J. Moxham Clinical Aspects of Respiratory Muscle Dysfunction in the Critically Ill Chest, March 1, 2001; 119(3): 926 - 939. [Full Text] [PDF]

				M C Steiner and M D L Morgan Enhancing physical performance in chronic obstructive pulmonary disease Thorax, January 1, 2001; 56(1): 73 - 77. [Full Text]

				L. M A Heunks and P N R. Dekhuijzen Respiratory muscle function and free radicals: from cell to COPD Thorax, August 1, 2000; 55(8): 704 - 716. [Full Text]

				H. R Gosker, E. F. Wouters, G. J van der Vusse, and A. M. Schols Skeletal muscle dysfunction in chronic obstructive pulmonary disease and chronic heart failure: underlying mechanisms and therapy perspectives Am. J. Clinical Nutrition, May 1, 2000; 71(5): 1033 - 1047. [Abstract] [Full Text] [PDF]

				G. H. MILLS, D. KYROUSSIS, P. JENKINS, C.-H. HAMNEGARD, M. I. POLKEY, J. WASS, G. MICHAEL BESSER, J. MOXHAM, and M. GREEN Respiratory Muscle Strength in Cushing's Syndrome Am. J. Respir. Crit. Care Med., November 1, 1999; 160(5): 1762 - 1765. [Abstract] [Full Text]

				J. G. PANTOJA, F. H. ANDRADE, A. E. FROST, W. L. ESCHENBACHER, and M. B. REID Respiratory and Limb Muscle Function in Lung Allograft Recipients Am. J. Respir. Crit. Care Med., October 1, 1999; 160(4): 1205 - 1211. [Abstract] [Full Text]

				M. ESTENNE, M. CASSART, P. PONCELET, and P. A. GEVENOIS Volume of Graft and Native Lung after Single-Lung Transplantation for Emphysema Am. J. Respir. Crit. Care Med., February 1, 1999; 159(2): 641 - 645. [Abstract] [Full Text]

				S Trapani, G Camiciottoli, M Ermini, W Castellani, and F Falcini Pulmonary involvement in juvenile systemic lupus erythematosus: a study on lung function in patients asymptomatic for respiratory disease Lupus, October 1, 1998; 7(8): 545 - 550. [Abstract] [PDF]

				J. E. Beeken, D. Parks, J. Cory, and G. Montopoli The Effectiveness of Neuromuscular Release Massage Therapy in Five Individuals with Chronic Obstructive Lung Disease Clin Nurs Res, August 1, 1998; 7(3): 309 - 325. [Abstract] [PDF]

				R. H. H. Van Balkom, P. N. R. Dekhuijzen, H. T. M. Folgering, J. H. Veerkamp, H. T. Van Moerkerk, J. A. M. Fransen, and C. L. A. Van Herwaarden Anabolic steroids in part reverse glucocorticoid-induced alterations in rat diaphragm J Appl Physiol, May 1, 1998; 84(5): 1492 - 1499. [Abstract] [Full Text] [PDF]

				R. H. H. Van Balkom, W.-Z. Zhan, Y. S. Prakash, P. N. R. Dekhuijzen, and G. C. Sieck Corticosteroid effects on isotonic contractile properties of rat diaphragm muscle J Appl Physiol, October 1, 1997; 83(4): 1062 - 1067. [Abstract] [Full Text] [PDF]

				H. SAUDNY-UNTERBERGER, J. G. MARTIN, and K. GRAY-DONALD Impact of Nutritional Support on Functional Status During an Acute Exacerbation of Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., September 1, 1997; 156(3): 794 - 799. [Abstract] [Full Text] [PDF]