[Global therapeutic approach of muscle dysfunction in COPD].

Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by the presence of chronic obstruction and incomplete airflow reversibility. It is a disease with increasing prevalence and high sociosanitary cost. Hyponutrition and muscle dysfunction are two determinant factors of clinical severity and disease prognosis. The close relationship between weight loss or hyponutrition and mortality has been known for several years. Today we know that muscle mass is better predictor than weight of survival in patients with moderate to severe COPD. Several factors are implicated in the development of hyponutrition and deterioration of muscle structure and function. Slowing "muscle wasting" in COPD patients requires designing new integrated therapeutic strategies. Health care programs for COPD patients include multidisciplinary care of the main areas involved in the course of the disease. The main lines address: cigarette smoking cessation, pharmacotherapy, oxygen therapy, rehabilitation, nutritional support, surgery, travels, intercurrent periods, and palliative care. Pulmonary rehabilitation (PR) should be seen as part of a multidisciplinary program in individualized care of each COPD patient, aiming at optimizing his/her physical and social autonomy. Physical training, psychosocial intervention, patient education, and support groups for patients and relatives and friends, smoking cessation, oxygen therapy, appropriate oral feeding, and nutritional support are part of that therapeutic strategy allowing for an integral approach of muscle dysfunction in COPD patients.