Lung clearance index in CF: a sensitive marker of lung disease severity

agents for soft tissue injury have demonstrated parallel findings.Although nonsteroidal anti-inflammatory drugs can reduce a particular marker of inflammation, their overall benefit towards healing of tendon and muscle injury is questionable.16 Skeletal muscle dysfunction is a major contributor of morbidity and mortality in COPD.Its pathogenesis, although multifactorial, is not clearly defined.The findings of Barreiro and colleagues 7 chal- lenge the prevailing notion that local inflammation contributes to the decline in muscle function.Like any good research, they have made us think outside the box and to approach this growing problem in a new and refreshing way.Only well designed clinical and animal studies in the future can answer the question: is inflammation good, bad or irrelevant for skeletal muscles in COPD?Or perhaps the more pressing question should be: what aspects of the inflammatory response should be adjusted during the various degenerative and regenerative phases of skeletal muscle as this tissue responds to physical activity, exercise and disuse in COPD?Inflammation is a complicated tangled web of intertwining cascades that are carefully controlled by numerous positive and negative feedback and feed-forward mechanisms.Until we develop a better understanding of the influence of inflammation on muscle injury, regeneration and healing in COPD, clinicians should strongly encourage their COPD patients to stop smoking, exercise regularly and engage in pulmonary rehabilitation, which are proven ways to enhance muscle performance in COPD patients.