Sarcopenia as a treatable trait in COPD: From mechanisms to management

Sarcopenia is common in COPD, with prevalence ranging from 14 % to 67 % depending on setting, age, disease severity, and nutritional status, highlighting its clinical relevance and the need for standardized diagnostic criteria and routine screening, especially in older or more severe cases. It results from a complex interplay of systemic inflammation, oxidative stress, mitochondrial dysfunction, physical inactivity, hypoxia, malnutrition, hormonal imbalances, and structural muscle remodeling, all contributing to muscle catabolism and impaired regeneration. These factors form a vicious cycle that worsens functional decline, highlighting the need for multifaceted, integrated therapeutic approaches. Sarcopenia in COPD is a measurable, modifiable, and treatable trait linked to worse lung function, physical performance, and outcomes. Early detection using the EWGSOP2 algorithm, starting with SARC-F screening, muscle strength testing, and confirmation via imaging and targeted interventions, can enable timely, effective interventions to improve outcomes. Targeted sarcopenia treatment in COPD includes pulmonary rehabilitation, nutritional support, and behavioral strategies. Exercise and high-protein, vitamin D-rich diets improve muscle strength and function. Pharmacological options remain experimental. Multidisciplinary care involving pulmonologists, physiotherapists, dietitians, and primary care providers ensures early detection, individualized treatment, and better outcomes through integrated interventions that address both respiratory impairment and muscle loss. Despite promising advances, key research gaps remain in sarcopenia as a treatable trait in COPD, including the need for standardized diagnostic criteria, longitudinal studies, optimal intervention strategies, and integration of functional outcomes. Future research should prioritize equity, mechanistic insights, and implementation science to refine personalized care and improve clinical outcomes in COPD.