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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe impact of obesity on many chronic diseases is well known, but the effect of obesity on clinical outcomes for people with chronic obstructive pulmonary disease (COPD) is less clear. The number of people with COPD who are obese is expected to increase in line with the obesity pandemic, making it essential to gain a better understanding of the effects of obesity on COPD. Although classically considered a wasting disease, a link between COPD and obesity is becoming increasingly recognized, and it may influence clinical diversity in COPD.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPulmonary Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EChronic Obstructive Pulmonary Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPulmonary \u0026amp; Critical Care\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPulmonary Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EChronic Obstructive Pulmonary Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EFeatured Meeting - Specialty page\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe impact of obesity on many chronic diseases is well known, but the effect of obesity on clinical outcomes for people with chronic obstructive pulmonary disease (COPD) is less clear. The number of people with COPD who are obese is expected to increase in line with the obesity pandemic, making it essential to gain a better understanding of the effects of obesity on COPD.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAlthough classically considered a wasting disease, a link between COPD and obesity is becoming increasingly recognized, and it may influence clinical diversity in COPD, said Frits M. E. Franssen, MD, PhD, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands. Data on the prevalence of obesity in COPD have conflicted, with some studies showing a higher prevalence among patients with COPD and others showing a lower prevalence [Vozoris NT, O\u0027Donnell DE. \u003Cem\u003ECan Respir J\u003C\/em\u003E 2012; Montes de Oca M et al. \u003Cem\u003ERespir Med\u003C\/em\u003E 2008; Steuten LM et al. \u003Cem\u003EPrim Care Respir J\u003C\/em\u003E 2006; Eisner MD et al. \u003Cem\u003ERespir Res\u003C\/em\u003E 2007]. Low levels of physical activity have been consistently reported for patients with COPD, and this may contribute to weight gain.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EContrary to expectations, obesity is not necessarily associated with worse patient-related outcomes in COPD, said Prof. Franssen. He pointed to an early study in which the risk of mortality was evaluated in obese and normal-weight patients with COPD [Landbo C et al. \u003Cem\u003EAm J Respir Crit Care Med\u003C\/em\u003E 1999]. The relative risk of all-cause mortality was increased for obese patients with mild or moderate COPD compared with normal-weight patients. However, in contrast to patients with mild and moderate COPD, among patients with severe disease, the risks of all-cause and COPD-related mortality were lowest for obese patients. These findings are referred to as the obesity paradox.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EStudies have also found different effects of obesity on dyspnea. In one study, obese patients with COPD reported increased dyspnea and poorer health-related quality of life than normal-weight patients, even though lung function was better for obese and overweight patients [Cecere LM et al. \u003Cem\u003ECOPD\u003C\/em\u003E 2011]. In another study, researchers found that absolute peak workload increased in obese patients during cycling (compared with normal-weight patients matched for age and degree of airway obstruction), but these patients reported less dyspnea during all levels of ventilation during cycling [Ora J et al. \u003Cem\u003EAm J Respir Crit Care Med\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EObesity appears to be a substantial contributor to systemic inflammation in COPD. Adipose tissue is a source of inflammation in obesity, and obesity (high body mass index [BMI]) has been associated with highly elevated levels of C-reactive protein in patients with COPD; the highest levels have been found in patients with abdominal obesity [Breyer MK et al. \u003Cem\u003EClin Nutr\u003C\/em\u003E 2009]. In addition, persistent inflammation in COPD has been associated with a high BMI but not with the fat-free mass index, which suggests a role for adipose tissue in the inflammatory process [Agusti A et al. \u003Cem\u003EPloS One\u003C\/em\u003E 2012; van den Borst B et al. \u003Cem\u003EAm J Respir Crit Care Med\u003C\/em\u003E 2013]. Prof. Franssen said that increasing evidence suggests a relationship between visceral adipose tissue dysfunction and the pathophysiology of COPD, and he proposed several links between COPD, adipose tissue dysfunction, and systemic inflammation, noting that several questions remain unanswered (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Franssen FME et al. \u003Cem\u003EThorax\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/4\/21\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Obesity and Chronic Obstructive Pulmonary Disease: Unanswered Questions\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1588315504\u0022 data-figure-caption=\u0022Obesity and Chronic Obstructive Pulmonary Disease: Unanswered Questions\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/4\/21\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/4\/21\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/4\/21\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13108\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EObesity and Chronic Obstructive Pulmonary Disease: Unanswered Questions\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced from Franssen FME et al.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EObesity and the Lung: 5 \u2022 Obesity and COPD. \u003Cem\u003EThorax\u003C\/em\u003E 2008;23(12):1110\u20131117. With permission from The BMJ Publishing Group.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/4\/21.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznxq1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznxq1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}