Impact of diabetes mellitus on the risk of severe exacerbation in patients with chronic obstructive pulmonary disease

Exploring the Interrelationship Between Diabetes Mellitus and Chronic Lung Diseases: A Comprehensive Review

Diabetes mellitus (DM) is a chronic metabolic disorder that affects millions of individuals worldwide. With an increasing prevalence, understanding its implications for respiratory health is essential. Chronic lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD), significantly impact morbidity and healthcare costs, with COPD alone accounting for substantial economic burdens. This comprehensive review investigates the intricate relationship between DM and chronic lung diseases. A systematic search across multiple databases yielded 1,078 articles, from which 10 studies were selected for detailed examination. The findings reveal a bidirectional relationship: diabetes increases the risk of developing chronic lung conditions, while chronic lung diseases can exacerbate glycemic control. Shared inflammatory pathways and comorbidities complicate patient outcomes, underscoring the urgent need for integrated treatment approaches. By elucidating the mechanisms linking these conditions, this review provides valuable insights for healthcare professionals, emphasizing the importance of interdisciplinary care to enhance the quality of life for individuals affected by both diabetes and chronic lung diseases. The results highlight the necessity for further research to explore targeted therapies and preventive measures addressing these interconnected health issues.

Potential systemic effects of acquired CFTR dysfunction in COPD

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, respiratory symptoms, inflammation of the airways, and systemic manifestations of the disease. Genetic susceptibility and environmental factors are important in the development of the disease, particularly exposure to cigarette smoke which is the most notable risk factor. Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene are the cause of cystic fibrosis (CF), which shares several pathophysiological pulmonary features with COPD, including airway obstruction, chronic airway inflammation and bacterial colonization; in addition, both diseases also present systemic defects leading to comorbidities such as pancreatic, gastrointestinal, and bone-related diseases. In patients with COPD, systemic CFTR dysfunction can be acquired by cigarette smoking, inflammation, and infection. This dysfunction is, on average, about half of that found in CF. Herein we review the literature focusing on acquired CFTR dysfunction and the potential role in the pathogenesis of comorbidities associated with COPD and chronic bronchitis.

Hyperglycaemia and Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) may coexist with type 2 diabetes mellitus (T2DM). Patients with COPD have an increased risk of developing T2DM compared with a control but, on the other side, hyperglycaemia and DM have been associated with reduced predicted levels of lung function. The mechanistic relationships between these two diseases are complicated, multifaceted, and little understood, yet they can impact treatment strategy. The potential risks and benefits for patients with T2DM treated with pulmonary drugs and the potential pulmonary risks and benefits for patients with COPD when taking antidiabetic drugs should always be considered. The interaction between the presence and/or treatment of COPD, risk of infection, presence and/or treatment of T2DM and risk of acute exacerbations of COPD (AECOPDs) can be represented as a vicious circle; however, several strategies may help to break this circle. The most effective approach to simultaneously treating T2DM and COPD is to interfere with the shared inflammatory substrate, thus targeting both lung inflammation (COPD) and vascular inflammation (DM). In any case, it is always crucial to establish glycaemic management since the reduction in lung function found in people with diabetes might decrease the threshold for clinical manifestations of COPD. In this article, we examine possible connections between COPD and T2DM as well as pharmacological strategies that could focus on these connections.

Epidemiological Characteristics of 101,471 Patients Hospitalized with Chronic Obstructive Pulmonary Disease (COPD) in Poland in 2019: Multimorbidity, Duration of Hospitalization, In-Hospital Mortality

Chronic obstructive pulmonary disease (COPD) is a common lung disease. There is a limited amount of nationwide data on COPD patients in Poland. This study aimed to characterize patients hospitalized with COPD in Poland in 2019 as well as to identify factors associated with the risk of in-hospital death and prolonged hospitalization among patients with COPD. This study is a retrospective database analysis. Data on patients hospitalized with COPD in Poland were obtained from the Nationwide General Hospital Morbidity Dataset. Data on all adults aged ≥40 years with a diagnosis of COPD from a physician (J44 code) were included in the analysis. Data were analyzed separately for patients hospitalized due to COPD (primary diagnosis) and patients with COPD as a comorbidity (secondary diagnosis). Completed medical records were available for 101,471 patients hospitalized with COPD (36.9% were females). Of those, 32% were hospitalized due to COPD. The mean age was 71.4 ± 9.7 years. The mean duration of hospitalization was 9.4 ± 11.4 days (median 7 days). Most of the COPD patients (89.3%) had at least one comorbidity. The in-hospital mortality rate was 6.8%. Older age, presence of cardiovascular diseases, and diseases of the genitourinary system (p < 0.05) were the most important factors associated with the risk of in-hospital death among patients hospitalized due to COPD.

Elevated Blood Glucose is Associated with Severe Exacerbation of Chronic Obstructive Pulmonary Disease

Background

Methods

Results

Conclusion

Characteristics of patients referred to Canary Island pneumology outpatient services for chronic obstructive pulmonary disease: the EPOCan study

Objective

Assessing patients with chronic obstructive pulmonary disease (COPD) accounts for 30% of all pneumology outpatient evaluations. COPD is a heterogeneous disease and generates a massive public health problem. Overall morbidity, particularly cardiovascular disease, challenges patient management. This is an observational, multicentre study, performed at four hospitals in the Canary Islands (Spain), aimed at characterising patients with COPD referred to pneumology outpatient services. Demographic variables, lung function, and morbidity were assessed.

Results

Of the 877 included patients, 44.9% were active smokers with a mean (± SD) age of 68.2 ± 10.3 years. The median (IQR) score for the Charlson comorbidity index was 2 (2), and 70.6% of the patients were assigned high risk according to the Spanish Guidelines for COPD (GesEPOC) 2021. The degree of airflow obstruction defined by the GOLD 2021 stages 1, 2, 3, and 4 corresponded to 13.6%, 49%, 31%, and 6.3% of patients, respectively. The most frequently associated morbidities were arterial hypertension (59.5%), dyslipidaemia (54.3%), and type 2 diabetes mellitus (31.2%); 32% of the patients suffered heart disease. There is a high prevalence of active smoking, type 2 diabetes mellitus, and heart disease in patients referred for COPD to Canary Island pneumology outpatient services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-022-05930-7.

Ratio of FEV1/Slow Vital Capacity of < 0.7 Is Associated With Clinical, Functional, and Radiologic Features of Obstructive Lung Disease in Smokers With Preserved Lung Function

BACKGROUND

Mild expiratory flow limitation may not be recognized using traditional spirometric criteria based on the ratio of FEV₁/FVC.

RESEARCH QUESTION

Does slow vital capacity (SVC) instead of FVC increase the sensitivity of spirometry to identify patients with early or mild obstructive lung disease?

STUDY DESIGN AND METHODS

We included 854 current and former smokers from the Subpopulations and Intermediate Outcome Measures in COPD Study cohort with a postbronchodilator FEV₁/FVC ≥ 0.7 and FEV₁ % predicted of ≥ 80% at enrollment. We compared baseline characteristics, chest CT scan features, exacerbations, and progression to COPD (postbronchodilator FEV₁/FVC, < 0.7) during the follow-up period between 734 participants with postbronchodilator FEV₁/SVC of ≥ 0.7 and 120 with postbronchodilator FEV₁/SVC < 0.7 at the enrollment. We performed multivariate linear and logistic regression models and negative binomial and interval-censored proportion hazards regression models adjusted for demographics and smoking exposure to examine the association of FEV₁/SVC < 0.7 with those characteristics and outcomes.

RESULTS

Participants with FEV₁/SVC < 0.7 were older and had lower FEV₁ and more emphysema than those with FEV₁/SVC ≥ 0.7. In adjusted analysis, individuals with postbronchodilator FEV₁/SVC < 0.7 showed a greater percentage of emphysema by 0.45% (95% CI, 0.09%-0.82%), percentage of gas trapping by 2.52% (95% CI, 0.59%-4.44%), and percentage of functional small airways disease based on parametric response mapping by 2.78% (95% CI, 0.72%-4.83%) at baseline than those with FEV₁/SVC ≥ 0.7. During a median follow-up time of 1,500 days, an FEV₁/SVC < 0.7 was not associated with total exacerbations (incident rate ratio [IRR], 1.61; 95% CI, 0.97-2.64), but was associated with severe exacerbations (IRR, 2.60; 95% CI, 1.04-4.89). An FEV₁/SVC < 0.7 was associated with progression to COPD during a 3-year follow-up even after adjustment for demographics and smoking exposure (hazard ratio, 3.93; 95% CI, 2.71-5.72). We found similar results when we examined the association of prebronchodilator FEV₁/SVC < 0.7 or FEV₁/SVC less than the lower limit of normal with chest CT scan features and progression to COPD.

INTERPRETATION

Low FEV₁ to SVC in current and former smokers with normal spirometry results can identify individuals with CT scan features of COPD who are at risk for severe exacerbations and is associated with progression to COPD in the future.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT01969344T4; URL: www.clinicaltrials.gov.