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Gerlich J, Ohlander J, Kromhout H, Vermeulen R, Söhler S, Radon K, Nowak D, Karrasch S, Adaskina N, Vogelmeier C, Ochmann U, Jörres RA. Cumulative occupational exposure to gases and fumes is associated with impairment in lung function and disease-related quality of life in a German COPD patient cohort. Occup Environ Med 2023; 81:oemed-2023-108908. [PMID: 38160050 PMCID: PMC10850675 DOI: 10.1136/oemed-2023-108908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The impact of occupational exposures on lung function impairments and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) was analysed and compared with that of smoking. METHODS Data from 1283 men and 759 women (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1-4 or former grade 0, without alpha-1-antitrypsin deficiency) of the COPD and Systemic Consequences Comorbidities Network cohort were analysed. Cumulative exposure to gases/fumes, biological dust, mineral dust or the combination vapours/gases/dusts/fumes was assessed using the ALOHA job exposure matrix. The effect of both occupational and smoking exposure on lung function and disease-specific QoL (St George's Respiratory Questionnaire) was analysed using linear regression analysis adjusting for age, body mass index, diabetes, hypertension and coronary artery disease, stratified by sex. RESULTS In men, exposure to gases/fumes showed the strongest effects among occupational exposures, being significantly associated with all lung function parameters and QoL; the effects were partially stronger than of smoking. Smoking had a larger effect than occupational exposure on lung diffusing capacity (transfer factor for carbon monoxide) but not on air trapping (residual volume/total lung capacity). In women, occupational exposures were not significantly associated with QoL or lung function, while the relationships between lung function parameters and smoking were comparable to men. CONCLUSIONS In patients with COPD, cumulative occupational exposure, particularly to gases/fumes, showed effects on airway obstruction, air trapping, gas uptake capacity and disease-related QoL, some of which were larger than those of smoking. These findings suggest that lung air trapping and QoL should be considered as outcomes of occupational exposure to gases and fumes in patients with COPD. TRIAL REGISTRATION NUMBER NCT01245933.
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Affiliation(s)
- Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Johan Ohlander
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Sandra Söhler
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research (DZL), Philipps-Universität Marburg, Marburg, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
| | | | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research (DZL), Philipps-Universität Marburg, Marburg, Germany
| | - Uta Ochmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Rudolf A Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Kahnert K, A. Jörres R, Behr J, Welte T. The Diagnosis and Treatment of COPD and Its Comorbidities. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:434-444. [PMID: 36794439 PMCID: PMC10478768 DOI: 10.3238/arztebl.m2023.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/12/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third most common cause of death around the world. The affected patients suffer not only from impaired lung function, but also from a wide variety of comorbidities. Their cardiac comorbidities, in particular, lead to increased mortality. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, including guidelines from Germany and abroad. RESULTS The usual diagnostic criteria for COPD are a post-bronchodilator FEV1/FVC quotient below the fixed threshold of 0.7, or, preferably, below the lower limit of normal (LLN) according to the GLI reference values for the avoidance of over- and underdiagnosis. The overall prognosis is markedly affected by comorbidities of the lung itself and those that involve other organs; in particular, many persons with COPD die of heart disease. The potential presence of heart disease must be borne in mind in the evaluation of patients with COPD, as lung disease can impair the detection of heart disease. CONCLUSION As patients with COPD are often multimorbid, the early diagnosis and adequate treatment not only of their lung disease, but also of their extrapulmonary comorbidities are very important. Well-established diagnostic instruments and well-tested treatments are available and are described in detail in the guidelines concerning the comorbidities. Preliminary observations suggest that more attention should be paid to the potential positive effects of treating comorbidities on the lung disease itself, and vice versa.
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Affiliation(s)
- Kathrin Kahnert
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL)
| | - Rudolf A. Jörres
- Institute of Occupational, Social and Environmental Medicine,Ludwig Maximilians University LMU, Comprehensive Pneumology Center Munich, Munich
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL)
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Center of Lung Research (DZL), Hannover
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3
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Alter P, Kahnert K, Trudzinski FC, Bals R, Watz H, Speicher T, Söhler S, Welte T, Rabe KF, Wouters EFM, Vogelmeier CF, Jörres RA. Clinical factors linked to the type of respiratory medication in COPD: results from the COSYCONET cohort. Ther Adv Respir Dis 2023; 17:17534666231208584. [PMID: 37936408 PMCID: PMC10631320 DOI: 10.1177/17534666231208584] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The use of maintenance medication in patients with chronic obstructive pulmonary disease (COPD) in real life is known to deviate from recommendations in guidelines, which are largely based on randomized controlled trials and selected populations. OBJECTIVES We used the COSYCONET (COPD and Systemic Consequences - Comorbidities Network) cohort to analyze factors linked to the use of COPD drugs under non-interventional circumstances. DESIGN COSYCONET is an ongoing, multi-center, non-interventional cohort of patients with COPD. METHODS Patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 0-4 participating in visits 1-5 were included. Data covered the period from 2010 to 2018. Generalized linear models were used to examine the relation of COPD characteristics to different types of respiratory medication. RESULTS A total of 1043 patients were included. The duration of observation was 4.5 years. Use of respiratory medication depended on GOLD grades 0-4 and groups A-D. Long-acting muscarinic antagonist therapy increased over time, and was associated with low carbon monoxide (CO) diffusing capacity, while inhaled corticosteroid (ICS) use decreased. Active smoking was associated with less maintenance therapy in general, and female sex with less ICS use. From the eight items of the COPD Assessment Test, only hill and stair climbing were consistently linked to treatment. CONCLUSION Using data from a large, close to real-life observational cohort, we identified factors linked to the use of various types of respiratory COPD medication. Overall, use was consistent with GOLD recommendations. Beyond this, we identified other correlates of medication use that may help us to understand and improve therapy decisions in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT01245933.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), Baldingerstrasse 1, Marburg 35033, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Kathrin Kahnert
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, German Center for Lung Research (DZL), Munich, Germany
- MediCenterGermering, Germering, Germany
| | - Franziska C. Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Center for Lung Research (DZL), Heidelberg, Germany
| | - Robert Bals
- Department of Internal Medicine V – Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tim Speicher
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Sandra Söhler
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F. Rabe
- LungenClinic Grosshansdorf and Department of Medicine, Christian-Albrechts University, Kiel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Emiel F. M. Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands and Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A. Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
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4
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Kahnert K, Jörres RA, Kauczor HU, Alter P, Trudzinski FC, Herth F, Jobst B, Weinheimer O, Nauck S, Mertsch P, Kauffmann-Guerrero D, Behr J, Bals R, Watz H, Rabe KF, Welte T, Vogelmeier CF, Biederer J. Standardized airway wall thickness Pi10 from routine CT scans of COPD patients as imaging biomarker for disease severity, lung function decline, and mortality. Ther Adv Respir Dis 2023; 17:17534666221148663. [PMID: 36718763 PMCID: PMC9896094 DOI: 10.1177/17534666221148663] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Chest computed tomography (CT) is increasingly used for phenotyping and monitoring of patients with COPD. The aim of this work was to evaluate the association of Pi10 as a measure of standardized airway wall thickness on CT with exacerbations, mortality, and response to triple therapy. METHODS Patients of GOLD grades 1-4 of the COSYCONET cohort with prospective CT scans were included. Pi10 was automatically computed and analyzed for its relationship to COPD severity, comorbidities, lung function, respiratory therapy, and mortality over a 6-year period, using univariate and multivariate comparisons. RESULTS We included n = 433 patients (61%male). Pi10 was dependent on both GOLD grades 1-4 (p = 0.009) and GOLD groups A-D (p = 0.008); it was particularly elevated in group D, and ROC analysis yielded a cut-off of 0.26 cm. Higher Pi10 was associated to lower FEV1 % predicted and higher RV/TLC, moreover the annual changes of lung function parameters (p < 0.05), as well as to an airway-dominated phenotype and a history of myocardial infarction (p = 0.001). These associations were confirmed in multivariate analyses. Pi10 was lower in patients receiving triple therapy, in particular in patients of GOLD groups C and D. Pi10 was also a significant predictor for mortality (p = 0.006), even after including multiple other predictors. CONCLUSION In summary, Pi10 was found to be predictive for the course of the disease in COPD, in particular mortality. The fact that Pi10 was lower in patients with severe COPD receiving triple therapy might hint toward additional effects of this functional therapy on airway remodeling. REGISTRATION ClinicalTrials.gov, Identifier: NCT01245933.
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Affiliation(s)
- Kathrin Kahnert
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 5, Munich 80336, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Franziska C Trudzinski
- Thoraxklinik-Heidelberg gGmbH, Translational Lung Research Centre.,Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Felix Herth
- Thoraxklinik-Heidelberg gGmbH, Translational Lung Research Centre.,Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Bertram Jobst
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Sebastian Nauck
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Pontus Mertsch
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Homburg, Germany.,Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, Saarbrücken, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Klaus F Rabe
- Lung Clinic Grosshansdorf, Airway Research Center (ARCN), Grosshansdorf, German.,Faculty of Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Hannover, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Jürgen Biederer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany.,Faculty of Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany.,University of Latvia, Faculty of Medicine, Raina bulvaris 19, Riga, LV-1586 Latvia
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5
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Alter P, Lucke T, Watz H, Andreas S, Kahnert K, Trudzinski FC, Speicher T, Söhler S, Bals R, Waschki B, Welte T, Rabe KF, Vestbo J, Wouters EFM, Vogelmeier CF, Jörres RA. Cardiovascular predictors of mortality and exacerbations in patients with COPD. Sci Rep 2022; 12:21882. [PMID: 36536050 PMCID: PMC9763357 DOI: 10.1038/s41598-022-25938-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
In chronic obstructive pulmonary disease (COPD), comorbidities and worse functional status predict worse outcomes, but how these predictors compare with regard to different outcomes is not well studied. We thus compared the role of cardiovascular comorbidities for mortality and exacerbations. Data from baseline and up to four follow-up visits of the COSYCONET cohort were used. Cox or Poisson regression was employed to determine the relationship of predictors to mortality or mean annual exacerbation rate, respectively. Predictors comprised major comorbidities (including cardiovascular disease), lung function (forced expiratory volume in 1 s [FEV1], diffusion capacity for carbon monoxide [TLCO]) and their changes over time, baseline symptoms, exacerbations, physical activity, and cardiovascular medication. Overall, 1817 patients were included. Chronic coronary artery disease (p = 0.005), hypertension (p = 0.044) and the annual decline in TLCO (p = 0.001), but not FEV1 decline, were predictors of mortality. In contrast, the annual decline of FEV1 (p = 0.019) but not that of TLCO or cardiovascular comorbidities were linked to annual exacerbation rate. In conclusion, the presence of chronic coronary artery disease and hypertension were predictors of increased mortality in COPD, but not of increased exacerbation risk. This emphasizes the need for broad diagnostic workup in COPD, including the assessment of cardiovascular comorbidity.Clinical Trials: NCT01245933.
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Affiliation(s)
- Peter Alter
- grid.10253.350000 0004 1936 9756Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Baldingerstrasse 1, 35033 Marburg, Germany
| | - Tanja Lucke
- grid.411095.80000 0004 0477 2585Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Henrik Watz
- grid.414769.90000 0004 0493 3289Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Stefan Andreas
- grid.411984.10000 0001 0482 5331LungClinic Immenhausen and Department of Cardiology and Pneumology, University Medical Center Göttingen, Member of the German Center for Lung Research (DZL), Göttingen, Germany
| | - Kathrin Kahnert
- grid.411095.80000 0004 0477 2585Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Franziska C. Trudzinski
- grid.7700.00000 0001 2190 4373Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Tim Speicher
- grid.10253.350000 0004 1936 9756Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Baldingerstrasse 1, 35033 Marburg, Germany
| | - Sandra Söhler
- grid.10253.350000 0004 1936 9756Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Baldingerstrasse 1, 35033 Marburg, Germany
| | - Robert Bals
- grid.411937.9Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Benjamin Waschki
- grid.414769.90000 0004 0493 3289Department of Pneumology, Hospital Itzehoe, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), LungenClinic Grosshansdorf, Grosshansdorf, Germany ,grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Tobias Welte
- grid.452624.3Clinic for Pneumology, Hannover Medical School, Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F. Rabe
- grid.9764.c0000 0001 2153 9986LungenClinic Grosshansdorf and Department of Medicine, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Christian-Albrechts University, Kiel, Kiel/Grosshansdorf, Germany
| | - Jørgen Vestbo
- grid.5379.80000000121662407Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Emiel F. M. Wouters
- grid.412966.e0000 0004 0480 1382Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands ,grid.476478.e0000 0004 9342 5701Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Claus F. Vogelmeier
- grid.10253.350000 0004 1936 9756Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Baldingerstrasse 1, 35033 Marburg, Germany
| | - Rudolf A. Jörres
- grid.411095.80000 0004 0477 2585Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Kahnert K, Fischer C, Alter P, Trudzinski F, Welte T, Behr J, Herth F, Kauczor HU, Bals R, Watz H, Rabe K, Söhler S, Kokot I, Vogelmeier C, Jörres R. [What have we learned from the German COPD cohort COSYCONET and where do we go from here?]. Pneumologie 2022; 77:81-93. [PMID: 36526266 PMCID: PMC9931494 DOI: 10.1055/a-1966-0848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
COSYCONET 1 is the only German COPD cohort which is large enough to be internationally comparable. The recruitment, which started in 2010 and ended in December 2013, comprised 2741 patients with the diagnosis of COPD who were subsequently investigated in regular follow-up visits. All visits included a comprehensive functional and clinical characterisation. On the basis of this detailed data set, it was possible to address a large number of clinical questions. These questions ranged from the prescription of medication, the detailed analysis of comorbidities, in particular cardiovascular disease, and biomarker assessment to radiological and health-economic aspects. Currently, more than 60 publications of COSYCONET data are internationally available. The present overview provides a description of all the results that were obtained, focussing on the relationship between different clinical and functional aspects as well as their potential practical consequences. In addition, information on the follow-up study COSYCONET 2 is given.
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Affiliation(s)
- Kathrin Kahnert
- 27192Medizinische Klinik und Poliklinik V, Klinikum der Universitat München LMU, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), München, Deutschland,Korrespondenzadresse PD Dr. med. Kathrin Kahnert Klinikum der Universität München LMU, Medizinische Klinik VZiemssenstr. 180336 MünchenDeutschland
| | - Carolina Fischer
- 27192Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Peter Alter
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Franziska Trudzinski
- 14996Thoraxklinik-Heidelberg gGmbH, Translational Lung
Research Centre Heidelberg (TLRC), Member of the German Center for Lung
Research, Heidelberg, Deutschland
| | - Tobias Welte
- 9177Klinik für Pneumologie, Medizinische Hochschule Hannover, Member of the German Center of Lung Research (DZL), Hannover, Deutschland
| | - Jürgen Behr
- 27192Medizinische Klinik und Poliklinik V, Klinikum der Universitat München LMU, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), München, Deutschland
| | - Felix Herth
- 14996Thoraxklinik-Heidelberg gGmbH, Translational Lung
Research Centre Heidelberg (TLRC), Member of the German Center for Lung
Research, Heidelberg, Deutschland
| | - Hans-Ulrich Kauczor
- 27178Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Deutschland
| | - Robert Bals
- 39072Innere Medizin V – Pulmonologie, Allergologie, Beatmungs-und Umweltmedizin, Universitätsklinikum des Saarlandes, Associated member of the Germen Center of Lung Research (DZL), Homburg, Deutschland,9377Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, Saarbrücken, Deutschland
| | - Henrik Watz
- 9213Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Deutschland
| | - Klaus Rabe
- 9213Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Deutschland,98594Medizinische Fakultät, Christian-Albrechts Universität zu Kiel, Kiel, Deutschland
| | - Sandra Söhler
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Inge Kokot
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Claus Vogelmeier
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Rudolf Jörres
- 27192Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
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Kahnert K, Andreas S, Kellerer C, Lutter JI, Lucke T, Yildirim Ö, Lehmann M, Seissler J, Behr J, Frankenberger M, Bals R, Watz H, Welte T, Trudzinski FC, Vogelmeier CF, Alter P, Jörres RA. Reduced decline of lung diffusing capacity in COPD patients with diabetes and metformin treatment. Sci Rep 2022; 12:1435. [PMID: 35082306 PMCID: PMC8792053 DOI: 10.1038/s41598-022-05276-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/16/2021] [Indexed: 01/11/2023] Open
Abstract
We studied whether in patients with COPD the use of metformin for diabetes treatment was linked to a pattern of lung function decline consistent with the hypothesis of anti-aging effects of metformin. Patients of GOLD grades 1–4 of the COSYCONET cohort with follow-up data of up to 4.5 y were included. The annual decline in lung function (FEV1, FVC) and CO diffusing capacity (KCO, TLCO) in %predicted at baseline was evaluated for associations with age, sex, BMI, pack-years, smoking status, baseline lung function, exacerbation risk, respiratory symptoms, cardiac disease, as well as metformin-containing therapy compared to patients without diabetes and metformin. Among 2741 patients, 1541 (mean age 64.4 y, 601 female) fulfilled the inclusion criteria. In the group with metformin treatment vs. non-diabetes the mean annual decline in KCO and TLCO was significantly lower (0.2 vs 2.3, 0.8 vs. 2.8%predicted, respectively; p < 0.05 each), but not the decline of FEV1 and FVC. These results were confirmed using multiple regression and propensity score analyses. Our findings demonstrate an association between the annual decline of lung diffusing capacity and the intake of metformin in patients with COPD consistent with the hypothesis of anti-aging effects of metformin as reflected in a surrogate marker of emphysema.
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Affiliation(s)
- Kathrin Kahnert
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstraße 1, 80336, Munich, Germany.
| | - Stefan Andreas
- LungClinic Immenhausen, Member of the German Center for Lung Research (DZL), Immenhausen, Germany
| | - Christina Kellerer
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital of Munich (LMU), Munich, Germany.,School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich (TUM), Munich, Germany
| | - Johanna I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital of Munich (LMU), Munich, Germany
| | - Önder Yildirim
- Institute of Lung Biology and Disease (ILBD), Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Mareike Lehmann
- Institute of Lung Biology and Disease (ILBD), Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jochen Seissler
- Department of Medicine IV, Diabetes Center, University Hospital, LMU Munich, Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstraße 1, 80336, Munich, Germany
| | - Marion Frankenberger
- Institute of Lung Biology and Disease (ILBD), Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Hannover, Germany
| | - Franziska C Trudzinski
- Thoraxklinik Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), University Hospital of Heidelberg, Heidelberg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UMR), Marburg, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UMR), Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital of Munich (LMU), Munich, Germany
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8
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Kahnert K, Jörres RA, Lucke T, Trudzinski FC, Mertsch P, Bickert C, Ficker JH, Behr J, Bals R, Watz H, Welte T, Vogelmeier CF, Alter P. Lower Prevalence of Osteoporosis in Patients with COPD Taking Anti-Inflammatory Compounds for the Treatment of Diabetes: Results from COSYCONET. Int J Chron Obstruct Pulmon Dis 2021; 16:3189-3199. [PMID: 34853511 PMCID: PMC8627854 DOI: 10.2147/copd.s335029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) often have osteoporosis and diabetes as comorbid conditions. Anti-diabetic medication, including metformin, has protective effects on osteoporosis in experimental studies. We therefore studied whether patients with COPD receiving anti-diabetic medication had a lower osteoporosis prevalence in a large COPD cohort, COSYCONET. Methods Assessment of osteoporosis was based on patients’ reports of physician-based diagnoses and the presence of disease-specific medication. The predictive value of physical characteristics, lung function, comorbidities, cardiovascular medication, and the use of anti-inflammatory diabetes medication, including metformin, sulfonylureas, glinides or DPP4I, was evaluated using logistic regression analysis. ClinicalTrials.gov: NCT01245933. Results In total, 2222 patients were eligible for analysis (863 [39%] female, mean age 65 y), 515 of whom had higher symptoms and exacerbations (Global Initiative for Chronic Obstructive Lung Disease group D). Osteoporosis was present in 15.8% of the overall cohort, and in 24.1% of GOLD D patients. Regression analyses identified the following as associated with osteoporosis (p < 0.05): female sex, higher age, lower body-mass index, asthma, higher air trapping, oral steroids, and cardiovascular medication. Although oral anti-diabetic medication was overall not associated with a lower prevalence of osteoporosis (p = 0.131), anti-inflammatory anti-diabetic medication (p = 0.009) and metformin-containing therapy (p = 0.039) were. This was driven by GOLD D patients. Conclusion In a large COPD cohort, anti-inflammatory diabetes therapy, including metformin, was associated with a lower prevalence of osteoporosis, especially in patients with higher symptoms and exacerbations. These findings suggest a protective effect of common anti-diabetic medication on osteoporosis, possibly as a result of attenuated systemic inflammation.
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Affiliation(s)
- Kathrin Kahnert
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Franziska C Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Pontus Mertsch
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Christiane Bickert
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Nürnberg General Hospital, Paracelsus Medical University, Nürnberg, Germany
| | - Jürgen Behr
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
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9
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Wang MT, Lai JH, Huang YL, Kuo FC, Wang YH, Tsai CL, Tu MY. Use of antidiabetic medications and risk of chronic obstructive pulmonary disease exacerbation requiring hospitalization: a disease risk score-matched nested case-control study. Respir Res 2020; 21:319. [PMID: 33267895 PMCID: PMC7709288 DOI: 10.1186/s12931-020-01547-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Exacerbation of chronic obstructive pulmonary disease (COPD) severely impacts the quality of life and causes high mortality and morbidity. COPD is involved with systemic and pulmonary inflammation, which may be attenuated with antidiabetic agents exerting anti-inflammatory effects. Real-world evidence is scant regarding the effects of antidiabetic agents on COPD exacerbation. Accordingly, we conducted a disease risk score (DRS)-matched nested case-control study to systemically assess the association between each class of oral hypoglycemic agents (OHAs) and risk of severe COPD exacerbation in a nationwide COPD population co-diagnosed with diabetes mellitus (DM). METHODS We enrolled 23,875 COPD patients receiving at least one OHA for management of DM by analyzing the Taiwan National Health Insurance claims database between January 1, 2000, and December 31, 2015. Cases of severe exacerbation were defined as those who had the first hospital admission for COPD. Each case was individually matched with four randomly-selected controls by cohort entry date, DRS (the estimated probability of encountering a severe COPD exacerbation), and COPD medication regimens using the incidence density sampling approach. Conditional logistic regressions were performed to estimate odds ratios (OR) of severe COPD exacerbation for each type of OHAs. RESULTS We analyzed 2700 cases of severe COPD exacerbation and 9272 corresponding controls after DRS matching. Current use of metformin versus other OHAs was associated with a 15% (adjusted OR [aOR], 0.85; 95% confidence interval [CI] 0.75-0.95) reduced risk of severe COPD exacerbation, whereas the reduced risk was not observed with other types of antidiabetic agents. When considering the duration of antidiabetic medication therapy, current use of metformin for 91-180 and 181-365 days was associated with a 28% (aOR, 0.72; 95% CI 0.58-0.89) and 37% (aOR, 0.63; 95% CI 0.51-0.77) reduced risk of severe COPD exacerbation, respectively. Similarly, 91-180 days of sulfonylureas therapy led to a 28% (aOR, 0.72; 95% CI 0.58-0.90) lower risk, and longer treatments consistently yielded 24-30% lower risks. Current use of thiazolidinediones for more than 181 days yielded an approximately 40% decreased risk. CONCLUSIONS Duration-dependent beneficial effects of current metformin, sulfonylurea, and thiazolidinedione use on severe COPD exacerbation were observed in patients with COPD and DM.
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Affiliation(s)
- Meng-Ting Wang
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Jyun-Heng Lai
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Ling Huang
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.,Department of Pharmacy, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Feng-Chih Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yun-Han Wang
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Chen-Liang Tsai
- Division of Pulmonary and Critical Care, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Min-Yu Tu
- Department of Health Business Administration, Meiho University, Pingtung, Taiwan. .,Aviation Physiology Research Laboratory, Kaohsiung Armed Forces General Hospital Gangshan Branch, No.1, Dayi 2nd Rd., Gangshan Dist., Kaohsiung City, 82050, Taiwan. .,Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan. .,Department of Life Sciences, and Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
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10
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Bidirectional relationship between diabetes and pulmonary function: a systematic review and meta-analysis. DIABETES & METABOLISM 2020; 47:101186. [PMID: 32889114 DOI: 10.1016/j.diabet.2020.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/25/2020] [Accepted: 08/01/2020] [Indexed: 01/29/2023]
Abstract
AIM Evidence of the lungs being a target organ of diabetes-related pathophysiology is increasing, and decreased pulmonary function increases the risk of diabetes after adjusting for demographic and metabolic factors. This systematic review and meta-analysis evaluates the bidirectional relationship between diabetes and pulmonary function. METHODS MEDLINE, Embase, The Cochrane Library and Web of Science databases were searched, and all studies describing this bidirectional relationship were identified. Two reviewers independently extracted study characteristics and assessed the risk of bias. RESULTS A total of 93 studies were included in the meta-analysis. The pooled weighted mean difference (WMD) between diabetes patients and non-diabetic participants for forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were -5.65% and -5.91%, respectively, of predicted values. Diabetes-related microvascular complications and poor glycaemic control were associated with poorer pulmonary function in those with diabetes. In addition, diabetes was associated with a restrictive spirometry pattern (RSP) in both cross-sectional studies [odds ratio (OR): 2.88, 95% confidence interval (CI): 2.18-3.81, I2 = 0.0%] and prospective cohort studies [hazard ratio (HR): 1.57, 95% CI: 1.04-2.36]. In five longitudinal studies, the conclusions were inconsistent as to whether or not diabetes accelerates pulmonary function decline. However, every 10% decrease in baseline predicted FVC value was associated with a 13% higher risk of incident diabetes (HR: 1.13, 95% CI: 1.09-1.17, I2 = 0.0%). CONCLUSION There is a bidirectional relationship between diabetes and pulmonary function. However, further investigations into whether dynamic changes in glycaemic levels before and shortly after diabetes onset mediate the deleterious effects on pulmonary function, or vice versa, are now required.
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11
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Zhang RH, Zhao W, Shu LP, Wang N, Cai YH, Yang JK, Zhou JB, Qi L. Obstructive sleep apnea is associated with coronary microvascular dysfunction: A systematic review from a clinical perspective. J Sleep Res 2020; 29:e13046. [PMID: 32293774 PMCID: PMC7685100 DOI: 10.1111/jsr.13046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 12/15/2022]
Abstract
There is now increasing evidence demonstrating that obstructive sleep apnea (OSA) contributes to microvascular disorder. However, whether OSA is associated with impaired coronary flow reserve is still unclear. Therefore, we conducted this systematic review and meta‐analysis to summarize current evidence. In a systematic review, PubMed, Embase, the Cochrane Library and Web of Science were searched; five observational studies fulfilled the selection criteria and were included in this study. Data were extracted from selected studies and meta‐analysis was performed using random‐effects modelling. In all, 829 OSA patients and 507 non‐OSA subjects were included and assessed for coronary flow reserve (CFR), the clinical indicator of coronary microvascular dysfunction (CMD). For all studies, OSA was significantly associated with reduced CFR. The pooled weighted mean difference (WMD) of CFR was −0.78 (95% confidence interval [CI] −1.25 to −0.32, p < 0.001, I2 = 84.4%). The difference in the apnea–hypopnea index (AHI) between studies can explain 89% of heterogeneity (coef = −0.05, 95% CI −0.12 to 0.02, p = .078) in a meta‐regression, indicating the CFR tended to negatively correlate with severity of OSA. The Egger regression test did not show statistical significance (p = .49). In conclusion, there are plausible biological mechanisms linking OSA and CMD, and the preponderance of evidence from this systematic review suggests that OSA, especially severe OSA, is associated with reduced CFR. Future studies are warranted to further delineate the exact role of OSA in CMD occurrence and development in a prospective setting.
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Affiliation(s)
- Rui-Heng Zhang
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Zhao
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lin-Ping Shu
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nan Wang
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yao-Hua Cai
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jian-Bo Zhou
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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12
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Kahnert K, Föhrenbach M, Lucke T, Alter P, Trudzinski FT, Bals R, Lutter JI, Timmermann H, Söhler S, Förderreuther S, Nowak D, Watz H, Waschki B, Behr J, Welte T, Vogelmeier CF, Jörres RA. The impact of COPD on polyneuropathy: results from the German COPD cohort COSYCONET. Respir Res 2020; 21:28. [PMID: 31959163 PMCID: PMC6971882 DOI: 10.1186/s12931-020-1293-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral neuropathy is a common comorbidity in COPD. We aimed to investigate associations between alterations commonly found in COPD and peripheral neuropathy, with particular emphasize on the distinction between direct and indirect effects. Methods We used visit 4 data of the COPD cohort COSYCONET, which included indicators of polyneuropathy (repeated tuning fork and monofilament testing), excluding patients with diabetes a/o increased HbA1c. These indicators were analysed for the association with COPD characteristics, including lung function, blood gases, 6-min walk distance (6-MWD), timed-up-and-go-test (TUG), exacerbation risk according to GOLD, C-reactive protein (CRP), and ankle-brachial index (ABI). Based on the results of conventional regression analyses adjusted for age, BMI, packyears and gender, we utilized structural equation modelling (SEM) to quantify the network of direct and indirect relationships between parameters. Results 606 patients were eligible for analysis. The indices of polyneuropathy were highly correlated with each other and related to base excess (BE), ABI and TUG. ABI was linked to neuropathy and 6-MWD, exacerbations depended on FEV1, 6-MWD and CRP. The associations could be summarized into a SEM comprising polyneuropathy as a latent variable (PNP) with three measured indicator variables. Importantly, PNP was directly dependent on ABI and particularly on BE. When also including patients with diabetes and/or elevated values of HbA1c (n = 742) the SEM remained virtually the same. Conclusion We identified BE and ABI as major determinants of peripheral neuropathy in patients with COPD. All other associations, particularly those with lung function and physical capacity, were indirect. These findings underline the importance of alterations of the micromilieu in COPD, in particular the degree of metabolic compensation and vascular status.
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Affiliation(s)
- K Kahnert
- Department of Internal Medicine V - Pulmonology, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), Marchioninisr. 15, 81377 München, and Ziemssenstr. 1, 80336, Munich, Germany.
| | - M Föhrenbach
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - T Lucke
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - P Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany.,Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - F T Trudzinski
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - R Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - J I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstädter Landstr. 1, 85764, Munich, Germany
| | - H Timmermann
- Hamburger Institut für Therapieforschung GmbH, Colonaden 72, 20354, Hamburg, Germany
| | - S Söhler
- ASCONET Study Coordination Office, University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - S Förderreuther
- Department of Neurology, Klinikum Innenstadt, Ludwig Maximilian University of Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - D Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - H Watz
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - B Waschki
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany.,Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - J Behr
- Department of Internal Medicine V - Pulmonology, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), Marchioninisr. 15, 81377 München, and Ziemssenstr. 1, 80336, Munich, Germany
| | - T Welte
- Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - C F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - R A Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
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13
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Marietta von Siemens S, Alter P, Lutter JI, Kauczor HU, Jobst B, Bals R, Trudzinski FC, Söhler S, Behr J, Watz H, Waschki B, Bewig B, Jones PW, Welte T, Vogelmeier CF, Jörres RA, Kahnert K, Stefan A, Robert B, Jürgen B, Kathrin K, Burkhard B, Roland B, Ralf E, Beate S, Ficker JH, Manfred G, Christian G, Rainer H, Matthias H, Berthold J, Markus H, Felix H, Gerd H, Katus Hugo A, Anne-Marie K, Henrik W, Rembert K, Klaus K, Juliane K, Cornelia KS, Christoph L, Peter Z, Michael P, Randerath Winfried J, Werner S, Michael S, Christian T, Helmut T, Hartmut T, Christian VJ, Claus V, Ulrich W, Tobias W, Hubert W, Lehnert D, Struck B, Krabbe L, Arikan B, Tobias J, Speth K, Pieper J, Gleiniger M, Markworth B, Hinz Z, Burmann E, Wons K, Rieber U, Schaufler B, Schwedler K, Michalewski S, Rohweder S, Berger P, Schottel D, Janke V, Untsch R, Graf J, Reichel A, Weiß G, Traugott E, Kietzmann I, Schrade-Illmann M, Polte B, Hübner G. CAT score single item analysis in patients with COPD: Results from COSYCONET. Respir Med 2019; 159:105810. [DOI: 10.1016/j.rmed.2019.105810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/31/2019] [Accepted: 11/02/2019] [Indexed: 12/14/2022]
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