Non-emphysematous chronic obstructive pulmonary disease is associated with diabetes mellitus

BMC Pulmonary Medicine

James D Crapo^1,13  Edwin K Silverman^1,16  Edwin JR van Beek⁹  Ruth Tal-Singer^1,15  Robert M Steiner⁶  Frank C Sciurba⁵  Joyce D Schroeder^1,17  Stephen I Rennard⁷  Elizabeth A Regan^1,13  Joe W Ramsdell^1,14  Sharon Lutz¹  John E Hokanson²  Benjamin J Harshfield⁴  MeiLan K Han^1,10  Marilyn G Foreman^1,12  Dawn L DeMeo^1,16  Harvey O Coxson^1,11  Michael H Cho^1,16  Peter J Castaldi⁴  Peter MA Calverley⁸  Russell P Bowler^1,13  R Graham Barr³  David A Lynch^1,17  Barry J Make^1,13  Craig P Hersh^1,16 

[1] Department of Biostatistics, Colorado School of Public Health, Aurora, CO, USA;Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA;Department of Medicine, Columbia University, New York, NY, USA;Channing Division of Network Medicine, Boston, MA, USA;Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA;Department of Radiology, Temple University, Philadelphia, PA, USA;Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Omaha, NE, USA;Division of Infection and Immunity Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK;Department of Radiology, University of Edinburgh, Edinburgh, Scotland;Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA;Department of Radiology, University of British Columbia, Vancouver, Canada;Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA;Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA;Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA, USA;GlaxoSmithKline R&D, King of Prussia, PA, USA;Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA;Department of Radiology, National Jewish Health, Denver, CO, USA

关键词: Spirometry;    Emphysema;    Diabetes mellitus;    CT scan;    Airway disease;   

Others  :  1091745
DOI  :  10.1186/1471-2466-14-164

 received in 2014-05-06, accepted in 2014-10-09,  发布年份 2014

【 摘 要 】

Background

Chronic obstructive pulmonary disease (COPD) has been classically divided into blue bloaters and pink puffers. The utility of these clinical subtypes is unclear. However, the broader distinction between airway-predominant and emphysema-predominant COPD may be clinically relevant. The objective was to define clinical features of emphysema-predominant and non-emphysematous COPD patients.

Methods

Current and former smokers from the Genetic Epidemiology of COPD Study (COPDGene) had chest computed tomography (CT) scans with quantitative image analysis. Emphysema-predominant COPD was defined by low attenuation area at -950 Hounsfield Units (LAA_-950) ≥10%. Non-emphysematous COPD was defined by airflow obstruction with minimal to no emphysema (LAA_-950 < 5%).

Results

Out of 4197 COPD subjects, 1687 were classified as emphysema-predominant and 1817 as non-emphysematous; 693 had LAA_-950 between 5–10% and were not categorized. Subjects with emphysema-predominant COPD were older (65.6 vs 60.6 years, p < 0.0001) with more severe COPD based on airflow obstruction (FEV₁ 44.5 vs 68.4%, p < 0.0001), greater exercise limitation (6-minute walk distance 1138 vs 1331 ft, p < 0.0001) and reduced quality of life (St. George’s Respiratory Questionnaire score 43 vs 31, p < 0.0001). Self-reported diabetes was more frequent in non-emphysematous COPD (OR 2.13, p < 0.001), which was also confirmed using a strict definition of diabetes based on medication use. The association between diabetes and non-emphysematous COPD was replicated in the ECLIPSE study.

Conclusions

Non-emphysematous COPD, defined by airflow obstruction with a paucity of emphysema on chest CT scan, is associated with an increased risk of diabetes. COPD patients without emphysema may warrant closer monitoring for diabetes, hypertension, and hyperlipidemia and vice versa.

Trial registration

Clinicaltrials.gov identifiers: COPDGene NCT00608764, ECLIPSE NCT00292552.

【 授权许可】

   
2014 Hersh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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