Patients with chronic obstructive pulmonary disease (COPD) frequently exhibit intestinal leaks and age-related muscle impairment, termed sarcopenia. The sarcopenia-related quality-of-life (SarQoL) is a tool to evaluate the quality of life of sarcopenic patients.

However, the association of intestinal leak with SarQoL in COPD patients remains unknown. We recruited male controls (n=87, age=72.7±6.7 years) and COPD patients (n=81, age=70.9±5.8 years) to validate the Pashto version of SarQoL.

This was followed by an investigation of the sarcopenia indices, including handgrip strength (HGS), skeletal mass index (SMI), and gait speed. We also measured plasma zonulin (a marker of intestinal leak) and lipopolysaccharides binding protein (LBP) (a marker of bacterial load).

We first confirmed the reliability of Pashto SarQoL by demonstrating its internal consistency, test-retest reliability, and absence of a floor-and-ceiling effect. Next, we report that COPD patients had higher plasma zonulin and LBP levels and lower SarQoL, HGS, SMI, and gait speed than controls (all p<0.05).

Plasma zonulin demonstrated inverse correlations with SarQoL domains for locomotion, functionality, activities of daily living, and cumulative SarQoL scores in COPD patients (all p<0.05). Further, higher LBP levels were correlated with lower scores on SarQoL domains for physical and mental health, locomotion, functionality, fear, and cumulative SarQoL scores (all p<0.05).

In conclusion, intestinal leaks and associated bacterial load potentially contribute to reduced SarQoL in COPD patients. Future studies should investigate intestinal mucosal repair as a therapeutic option in COPD patients.