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

Chronic obstructive pulmonary disease (COPD) afflicts millions of people an d is severely disabling. Exercise intolerance is usually the chief complain t. There are few effective therapies, Pulmonary rehabilitation seeks to ret urn the patient to the highest possible level of function but cannot revers e the underlying pulmonary abnormalities. Several lines of evidence have re cently pointed to abnormalities of the muscles of ambulation as a remediabl e 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 attem pts 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 anab olic steroids increase muscle mass and improve strength in older men is enc ouraging trials of anabolic steroids in men with COPD.