Rationale for anabolic therapy to facilitate rehabilitation in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) afflicts millions of people and is severely disabling. Exercise intolerance is usually the chief complaint. There are few effective therapies. Pulmonary rehabilitation seeks to return the patient to the highest possible level of function but cannot reverse the underlying pulmonary abnormalities. Several lines of evidence have recently pointed to abnormalities of the muscles of ambulation as a remediable source of exercise intolerance in COPD. Possible mechanisms of the muscle abnormalities include deconditioning, malnutrition, low levels of anabolic hormones and, perhaps, a specific myopathy. To date, most reports of attempts to reverse muscle dysfunction in COPD have focused on exercise training. However, abnormalities in the level of circulating anabolic hormones have recently been described, suggesting that anabolic hormone supplementation may be rational therapy for these patients. Accumulating evidence that anabolic steroids increase muscle mass and improve strength in older men is encouraging trials of anabolic steroids in men with COPD.