GHRL and chronic obstructive pulmonary disease: On the other hand, high levels of adiponectin and ghrelin may have an anti-inflammatory effect, such as have been reported that in male with low BMI with severe-to-very severe COPD-TS; however, when BMI is higher the increment in ghrelin seems not be enough to sustenance an anti-inflammatory state, that might contrarested the proinflammatory effect of insulin [27].