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Handgrip Strength Weakness Associated With Elevated Risk of COPD Exacerbation


Patients with chronic obstructive pulmonary disease (COPD) who experienced handgrip strength (HGS) weakness may be more susceptible to exacerbation, a new study shows.

Patients with chronic obstructive pulmonary disease (COPD) exacerbation who demonstrated weak handgrip strength (HGS) are more likely to experience further exacerbation, according to research published in BMC Pulmonary Medicine.

HGS serves as a good basis of measurement for overall muscle strength and is useful when assessing patients with COPD, as they often experience muscle weakness compared with healthy individuals, the authors notes. HGS also correlates with the strength of other muscles, like the quadriceps and respiratory muscles. Further, HGS weakness is linked to a decline in forced expiratory volume in 1 second percentage of predicted value and COPD Global Initiative for Chronic Obstructive Lung Disease grading.

Although previous research shows that HGS is linked with exacerbation risk in cross-sectional and longitudinal analyses, there is little research regarding the relationship of HGS and further exacerbation risk. The current study examined the relationship between HGS in early stages of admissions for acute exacerbation of COPD (AECOPD) and postdischarge exacerbation risk of the following year.

The study enrolled 43 participants who were admitted for AECOPD between January 2018 and June 2019. Patients with AECOPD were defined as having acute worsening of respiratory symptoms that led to additional therapy. HGS among the study population were measured within 3 days after admission using a dynamometer.

Relationships among demographics, HGS, pulmonary function parameters, and acute exacerbation events were analyzed. The primary end points were acute exacerbations leading to emergency department (ED) visits or readmission within 12 months after admission.

Findings showed:

  • 31 (72.1%) participants (HGSw) had HGS weakness (mean [SD], 22.1 [4.1] kg)
  • 12 (27.9%) participants (non-HGSw) had good HGS (33.7 [3.1] kg)
  • The HGSw group had a significantly higher mean rate of ED visits within 6, 9, and 12 months after the index admission than non-HGSw group, suggesting HGS weakness increased readmission rates of exacerbation:
    • 6 months: 0.81 (1.30) vs 0.08 (0.29) (P = .045)
    • 9 months: 1.26 (1.59) vs 0.17 (0.38) (P = .019)
    • 12 months:1.48 (1.86) vs 0.25 (0.62) (P = .027)
  • There was a trend toward a higher mean admission rate within 9 and 12 months in the HGSw group, compared with the non-HGSw group, which did not achieve statistical significance:
    • 9 months: 0.77 (1.38) vs 0.08 (0.29) (P = .064)
    • 12 months: 0.94 (1.56) vs 0.08 (0.29) (P = .062)

The study’s findings confirms that HGS weakness measured among initial admission of patients with COPD exacerbation was linked to a higher risk of exacerbation in the next year.

Patients with COPD who experience HGS weakness could benefit from upper limb training, which could lead to improved arm function and reduce symptoms associated with COPD, according to the study authors. Using HGS as a surrogate of measurement provides treatment clues to patients with COPD as well as acts as a follow-up parameter for treatment.


Lee C-T, Wang P-H. Handgrip strength during admission for COPD exacerbation: impact on further exacerbation risk. BMC Pulm Med. Published online July 21, 2021. doi:10.1186/s12890-021-01610-7

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