الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease, is characterized by persistent air flow limitation that is usually progressive and associated with enhanced chronic inflammatory response in the airway and the lung to noxious particles and gases. Exacerbations and comorbidities contribute to the overall severity in individual patients (1).
Ghrelin is a 28-amino acid peptide hormone. Ghrelin is a potent stimulator of growth hormone (GH) secretion from the anterior pituitary gland. Ghrelin receptors are expressed in a wide variety of tissues, including the pituitary, stomach, intestine, kidney, pancreas, thymus, gonads, thyroid, and heart. Ghrelin has various physiological functions, such as the stimulation of growth hormone release and of appetite, and fat accumulation (198).
Cachexia is a syndrome of wasting and anorexia that worsens the prognosis of many chronic diseases including cancer, chronic kidney disease, chronic heart disease and COPD. Pulmonary cachexia is associated with increased mortality and loss of peripheral and respiratory muscle function. Properties of the orexigenic hormone ghrelin-including appetite-stimulation, weight-gain production and increased cardiac output make it a logical treatment for cachexia (183).
While endogenous ghrelin levels are increased in the setting of cachexia, treatment with exogenous ghrelin and other GHSR-1a agonists in animal models of cachexia and in humans with cachexia has demonstrated consistent effects of increased appetite and improved weight gain. These positive effects occur in multiple underlying diseases associated with cachexia. The mechanism of action in producing these.