Related Articles

Chronic obstructive pulmonary disease and glucose metabolism: a bitter sweet symphony.

Cardiovasc Diabetol. 2012 Oct 27;11(1):132

Authors: Mirrakhimov AE

Abstract
ABSTRACT: Chronic obstructive pulmonary disease, metabolic syndrome and diabetes mellitus are common and underdiagnosed medical conditions. It was predicted that chronic obstructive pulmonary disease will be the third leading cause of death worldwide by 2020. The healthcare burden of this disease is even greater if we consider the significant impact of chronic obstructive pulmonary disease on the cardiovascular morbidity and mortality.Chronic obstructive pulmonary disease may be considered as a novel risk factor for new onset type 2 diabetes mellitus via multiple pathophysiological alterations such as: inflammation and oxidative stress, insulin resistance, weight gain and alterations in metabolism of adipokines.On the other hand, diabetes may act as an independent factor, negatively affecting pulmonary structure and function. Diabetes is associated with an increased risk of pulmonary infections, disease exacerbations and worsened COPD outcomes. On the top of that, coexistent OSA may increase the risk for type 2 DM in some individuals.The current scientific data necessitate a greater outlook on chronic obstructive pulmonary disease and chronic obstructive pulmonary disease may be viewed as a risk factor for the new onset type 2 diabetes mellitus. Conversely, both types of diabetes mellitus should be viewed as strong contributing factors for the development of obstructive lung disease. Such approach can potentially improve the outcomes and medical control for both conditions, and, thus, decrease the healthcare burden of these major medical problems.

PMID: 23101436 [PubMed - as supplied by publisher]

Related Articles

Bronchiolitis is a disease of the small airways accompanied by progressive and often irreversible airflow obstruction. Bronchiolitis can have several causes such as infection, toxic exposure, collagen vascular disease, post lung and stem cell transplant, and idiopathic etiology. Symptoms of cough and sputum production are often mistaken for chronic obstructive pulmonary disease or asthma, leading to a delay in diagnosis. Unfortunately, many types of bronchiolitis do not improve with therapy.

Bronchiolitis following lung and stem cell transplant are the most common types seen in adults, and provide important insights into its pathogenesis.

Related Articles

The objective of this study was to investigate the effect of tiotropium compared with salmeterol on exacerbations in patients with moderate (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage II) chronic obstructive pulmonary disease (COPD) and those naïve to maintenance respiratory therapy in the 1-year Prevention Of Exacerbations with Tiotropium in COPD (POET-COPD(®)) trial (NCT00563381).

Time to first exacerbation (primary endpoint) and rates of exacerbations were analyzed using exploratory Cox and Poisson regression (adjusting for time on treatment). Of 7376 randomized patients, 3614 were GOLD stage II (tiotropium n = 1781; salmeterol n = 1833) and 1343 were maintenance therapy naïve (tiotropium n = 672; salmeterol n = 671). Tiotropium significantly increased time to first exacerbation vs. salmeterol in GOLD stage II patients (hazard ratio [HR], 0.88; 95% confidence interval [CI]: 0.79-0.99; p = 0.028) and maintenance therapy naïve patients (HR, 0.79; 95% CI, 0.65-0.97; p = 0.028). Annual exacerbation rates were also significantly lower with tiotropium in the maintenance naïve subgroup compared with salmeterol (rate ratio [RR], 0.77; 95% CI, 0.63-0.94; p = 0.012). In the GOLD stage II subgroup, the rate of hospitalized exacerbations per year was significantly lower with tiotropium than with salmeterol (RR, 0.70; 95% CI, 0.57-0.85; p < 0.001); tiotropium also significantly prolonged time to first hospitalized exacerbation versus salmeterol in this subgroup (HR, 0.66; 95% CI, 0.48-0.91; p = 0.012).

In conclusion, results from this prespecified subgroup analysis support the selection of tiotropium as first-choice maintenance therapy for patients with GOLD stage II COPD.

Non-invasive ventilation (NIV) is widely used in episodes of acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD) patients. However, there is no evidence on the efficacy of NIV during similar episodes in obesity-hypoventilation syndrome (OHS). We therefore compared the efficacy of NIV in episodes of AHRF due to OHS and COPD.

METHODS: We prospectively assessed 716 consecutive patients (173 with OHS and 543 with COPD) with AHRF (arterial pH <7.35 and PaCO2 >45 mmHg) treated with a similar protocol of NIV. We defined successful NIV as avoidance of intubation and ICU survival at least 24 hours in the ward. Hospital survivors were followed for 1 year to assess hospital readmission and survival.

RESULTS: Both groups had similar (mean±SD) baseline respiratory acidosis (arterial pH, 7.22±0.08; PaCO2, 86±21 mmHg). Patients with OHS were older (74±11 vs. 71±10 years, p<0.001), were more frequently female (134, 77% vs. 66, 12%, p<0.001), had less late NIV failure (12, 7% vs. 67, 13%, p=0.037), lower hospital mortality (10, 6% vs. 96, 18%, p<0.001) and higher one-year survival (odds-ratio 1.83, 95% confidence interval 1.24-2.69, p=0.002). However, survival adjusted for confounders (adjusted odds-ratio 1.41, 95% confidence interval 0.70-2.83, p=0.34), NIV failure (11, 6% vs. 59, 11%, p=0.11), length of stay and hospital readmission were similar in both groups. Among COPD patients, obesity was associated with less late NIV failure and hospital readmission.

CONCLUSION: Patients with OHS can be treated with NIV during an episode of AHRF with similar efficacy and better outcomes than COPD patients.