As their life expectancy has been prolonged with improved medical care, patients with chronic obstructive pulmonary disease (COPD) frequently develop systemic complications of their disease. These complications include osteoporosis, depression, and peripheral muscle dysfunction<sup>2 American Thoracic Society/European Respiratory Society Skeletal muscle dysfunction in chronic obstructive pulmonary disease: A statement of the American Thoracic Society and European Respiratory Society Am J Respir Crit Care Med 1999 ;  159 (suppl) : 1

Cliccare qui per andare alla sezione Riferimenti</sup> characterized by atrophy, weakness, and low oxidative capacity. These muscle changes have been associated with exercise intolerance,<sup>44 Gosselink R., Troosters T., Decramer M. Peripheral muscle weakness contributes to exercise limitation in COPD Am J Respir Crit Care Med 1996 ;  153 : 976

Cliccare qui per andare alla sezione Riferimenti</sup> poor quality of life<sup>115 Simpson K., Killian K., McCartney N. , e al. Randomised controlled trial of weightlifting exercise in patients with chronic airflow limitation Thorax 1992 ;  47 : 70  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> and reduced survival,<sup>108 Schols A.M.W.J., Slangen J., Volovics L. , e al. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease Am J Respir Crit Care Med 1998 ;  157 : 1791

Cliccare qui per andare alla sezione Riferimenti, 127 Wilson D.O., Rogers R.M., Wright E.C. , e al. Body weight in chronic obstructive pulmonary disease: The National Institutes of Health Intermittent Positive-Pressure Breathing Trial Am Rev Respir Dis 1989 ;  139 : 1435

Cliccare qui per andare alla sezione Riferimenti</sup> which occur independently of the impairment in lung function. Physicians dealing with patients with advanced COPD face the challenge of finding innovative ways to improve their patients' level of function despite the irreversible impairment of the primarily diseased organ. In this article, the evidence for peripheral muscle dysfunction in patients with COPD and the possible clinical implications of this problem are discussed. The available therapeutic options for improving peripheral muscle function are also considered.