Peripheral Neuropathy in Chronic Obstructive Pulmonary Disease: A Case Controlled Cross-Sectional Study

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Background: Chronic Obstructive pulmonary disease (COPD) is not merely lung disease, it is considered as a multi system disorder with significant extrapulmonary manifestations. Peripheral neuropathy (PNP) is increasingly recognized as one of these manifestations, yet potentially under-recognized comorbidity. This study aims to determine the prevalence of PNP in COPD patients using nerve conduction study (NCS) and correlates its association with hypoxemia, smoking history, disease severity and frequent exacerbation of COPD. Methods: One hundred participants were included in this study, divided into two subgroups (50 COPD patients, 50 age- and sex-matched healthy controls). Diagnosis and severity of COPD were based on GOLD 2023 criteria. All participants underwent a full clinical and neurological exam, including a standardized NCS of multiple upper and lower sensor/motor nerves. Results: The prevalence of PNP was 32%. Sixteen of the fifty COPD patients subgroups were found to have varying degrees of PNP, while none in the controlled subgroup (p <0.001). The majority of the affected group were clinically asymptomatic, 75% were having a silent PNP. The neuropathy was predominantly distal, length dependent and axonal, with the Sural nerve being the most affected (100%). Patients with thee abnormally NCS results were significantly older (p =0.004), had higher cumulative smoking exposure (>20 pack-years, p =0.043), more severe advanced GOLD stages (p=0.022), lower oxygen saturation (SpO2 <88%, p=0.026) and a higher frequent exacerbations (p=0.036) compared to COPD patients with normal NCS. Conclusion: Peripheral neuropathy (PNP) is a common, predominantly subclinical and considered as systemic manifestation of COPD. It is largely associated with chronic hypoxemia, severe COPD disease, heavy smoking and frequent exacerbations. Depending on routine clinical assessment for the neuropathy is insufficient. Electrophysiological study is essential for early identification, which may guide a more proper management plan improving the quality of life

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