IGF1 and chronic obstructive pulmonary disease: Martinez‐Llorens et al. found an increase in IGF1 mRNA expression in the intercostal muscles of patients with COPD.68 Doucet et al. compared the ratio of quadriceps to diaphragm AKT activation in COPD patients with controls and found a lower ratio in COPD.20 This implicates that the AKT activation is relatively higher in the diaphragm than in the quadriceps.