Respir Investig. 2026 Apr 17;64(3):101432. doi: 10.1016/j.resinv.2026.101432. Online ahead of print.
ABSTRACT
Chronic obstructive pulmonary disease (COPD) and asthma pose health and socioeconomic challenges worldwide. While management strategies mainly target airway and parenchymal pathology, extrapulmonary abnormalities also influence clinical outcomes. Chest computed tomography (CT), which is increasingly used in clinical settings for lung cancer screening, bronchial valve interventions, and differential diagnosis, provides valuable insights not only into airway structure and lung parenchyma but also into skeletal muscles, adipose tissues, coronary arteries, and bone. In patients with COPD, a reduction in the cross-sectional area and density of the erector spinae and pectoralis muscles is linked to physical inactivity, exacerbations, and mortality, independent of lung function and emphysema severity. Abnormalities in adipose tissue, such as elevated intermuscular adipose tissue, are associated with poor prognosis, whereas epicardial adipose tissue indicates cardiovascular risk. Coronary artery calcification and the pulmonary artery-to-aorta ratio predict cardiovascular events and mortality. Reduced vertebral bone mineral density on chest CT is associated with vertebral fractures, exacerbations, and mortality in patients with COPD. In patients with asthma, particularly among females, lower skeletal muscle density is associated with airway wall thickening and small airway dysfunction, independent of body mass index. An increased visceral fat-to-muscle ratio, rather than muscle mass alone, negatively impacts patient-reported outcomes. This narrative review synthesizes established evidence on extrapulmonary CT findings in COPD and emerging insights in asthma, emphasizing their clinical relevance. Recognizing these extrapulmonary characteristics may aid clinicians in developing individualized management strategies, including pulmonary rehabilitation, nutritional support, and metabolic interventions.
PMID:42000480 | DOI:10.1016/j.resinv.2026.101432