On the basis of the above findings (ie, release of growth hormone, increased food intake, decreased fat oxidation, beneficial effects on pulmonary vasculature and heart), one could hypothesize that ghrelin might benefit patients with COPD through anabolic and organ protective actions. In this issue of CHEST (see page 1187), Nagaya et al16 evaluated ghrelin treatment in seven cachectic patients with COPD, and assessed the effect of ghrelin on both body mass and muscle function. Although the study was not blinded or controlled, was short term (3 weeks), and the sample size small, the results are provocative. Ghrelin increased growth hormone secretion, food intake, body weight, lean body mass, peripheral and respiratory muscle strength, Karnofsky status score, and walking distance. Ghrelin also attenuated sympathetic nervous system activity assessed with plasma norepinephrine levels. Importantly, results were consistent throughout the study parameters, and all were in beneficial directions. There were no adverse effects on glucose, insulin, and cortisol levels. Ghrelin was administered twice daily IV, and it is unclear whether similar results would also be obtained using subcutaneous injection. This study needs to be repeated in a larger population using appropriate control subjects and over longer time periods. It will also be important to evaluate other routes of ghrelin administration such as the subcutaneous route. However, results to date suggest that ghrelin represents a new and potentially beneficial treatment for patients with both advanced COPD and pulmonary hypertension. Additionally, decreased appetite is an important medical issue in the elderly and in many patients with chronic diseases. Ghrelin may be useful for appetite stimulation in these patients.