Pulmonary Predictors of Incident Diabetes in Smokers

Evaluating the Role of Glycemic Control in Modulating Pulmonary Function Among Smokers With Diabetes Mellitus: A Systematic Review

BACKGROUND

Diabetes mellitus (DM) impacts multiple body systems, including lung function, and this impact can be further complicated by smoking. The connection between blood sugar control and lung health in individuals with diabetes who smoke has been extensively studied, but findings have been varied. This systematic review sought to compile and assess the research on how blood sugar control influences lung function in smokers with diabetes.

METHODS

We searched several databases, including PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, CINAHL, PsycINFO, and Google Scholar, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included studies that looked at lung function tests in smokers with diabetes and examined the relationship with blood sugar control, as indicated by hemoglobin A1c (HbA1c) levels. We conducted thorough quality assessments, data extraction, and analysis.

RESULTS

We identified five relevant studies. The data from these studies indicated a clear trend: smokers with diabetes who had higher HbA1c levels typically showed worse lung function than those with better blood sugar control. Decreases in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were the most frequently observed issues. Some studies also pointed to a complex relationship between HbA1c levels and lung function, particularly when HbA1c was below 7.0%.

CONCLUSION

Our review indicates that smokers with DM who have poor blood sugar control tend to have worse lung function. These findings highlight the importance of managing blood sugar to help maintain lung health in these individuals. Further long-term research is needed to clarify the exact relationship and whether improving blood sugar control can reverse lung problems.

Targeting Lung-Gut Axis for Regulating Pollution Particle-Mediated Inflammation and Metabolic Disorders

Cigarette smoking (CS) or ambient particulate matter (PM) exposure is a risk factor for metabolic disorders, such as insulin resistance (IR), increased plasma triglycerides, hyperglycemia, and diabetes mellitus (DM); it can also cause gut microbiota dysbiosis. In smokers with metabolic disorders, CS cessation decreases the risks of serious pulmonary events, inflammation, and metabolic disorder. This review included recent studies examining the mechanisms underlying the effects of CS and PM on gut microbiota dysbiosis and metabolic disorder development; one of the potential mechanisms is the disruption of the lung-gut axis, leading to gut microbiota dysbiosis, intestinal dysfunction, systemic inflammation, and metabolic disease. Short-chain fatty acids (SCFAs) are the primary metabolites of gut bacteria, which are derived from the fermentation of dietary fibers. They activate G-protein-coupled receptor (GPCR) signaling, suppress histone deacetylase (HDAC) activity, and inhibit inflammation, facilitating the maintenance of gut health and biofunction. The aforementioned gut microbiota dysbiosis reduces SCFA levels. Treatment targeting SCFA/GPCR signaling may alleviate air pollution-associated inflammation and metabolic disorders, which involve lung-gut axis disruption.

Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA): health assessment protocol, participant profile and patterns of participation

BACKGROUND

The Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) is a prospective, longitudinal study of a representative cohort of older adults living in Northern Ireland, United Kingdom. Its aim is to explore the social, behavioural, economic and biological factors of ageing and how these factors change as people age. The study has been designed to maximize comparability with other international studies of ageing thereby facilitating cross-country comparisons. This paper provides an overview of the design and methodology of the health assessment which was carried out as part of Wave 1.

METHODS

Three thousand, six hundred and fifty five community dwelling adults, aged 50 years and over participated in the health assessment as part of Wave 1 of NICOLA. The health assessment included a battery of measurements across various domains that addressed key indicators of ageing namely: physical function, vision and hearing, cognitive function, and cardiovascular health. This manuscript describes the scientific rationale for the choice of assessments, provides an overview of the core objective measures carried out in the health assessment and describes the differences in characteristics of participants who took part in the health assessment compared to those who did not take part.

RESULTS

The manuscript highlights the importance of incorporating objective measures of health in population based studies as a means of complementing subjective measures and as a way to advance our understanding of the ageing process. The findings contextualize NICOLA as a data resource within Dementias Platform UK (DPUK), the Gateway to Global Ageing (G2G) and other existing networks of population based longitudinal studies of ageing.

CONCLUSION

This manuscript can help inform design considerations for other population based studies of ageing and facilitate cross-country comparative analysis of key life-course factors affecting healthy ageing such as educational attainment, diet, the accumulation of chronic conditions (including Alzheimer's disease, dementia and cardiovascular disease) as well as welfare and retirement policies.

The Impact of Lifetime Work and Non-work Physical Activity on Physical Fitness Among White – and Blue – Collar Retirees: A Cross-Sectional Study

Objective: The literature offers significant amount of data on the effects of occupational activity on health, with a distinct link between retirement and health among the most frequently tackled topics. Studies on the relationship between past occupational activity and physical fitness among older retirees remain scarce. The aim of the study was to assess the effects of physical activity on physical fitness in white- and blue-collar retirees.

Methods: A total of 200 participants (aged ≥60) were included in the study. Lifetime physical activity was assessed using the Lifetime Physical Activity Questionnaire. Mean MET/week/year values of total Physical Activity and for each domain separately (occupational, sports, household) were calculated. Participants were stratified to blue- or white- collar group. Physical performance, hand-grip strength (HGS) and pulmonary function were assessed.

Results: Mean total MET/week/year values for the blue- and the white-collar workers were 140.48 ± 55.13 and 100.75 ± 35.98, respectively. No statistically significant differences in physical performance scores were found between the white- and blue- collar groups. Adjustment for age, sex weight and height revealed a statistically significant association between work-related PA FEV*1 in the blue-collar group. White – collar workers presented higher odds ratio for membership in highest quartile in regard to short physical performance battery test score.

Conclusion: Only minimal association of type of occupation on physical fitness were found despite statistically significant differences between mean intensity and duration of sports- and work-related lifetime physical activity. These findings may indicate that the type of past work is not an independent factor influencing the state of a person in old age. Large-scale investigations with physically fit and unfit participants, are necessary.

Co-Morbidity Patterns Identified Using Latent Class Analysis of Medications Predict All-Cause Mortality Independent of Other Known Risk Factors: The COPDGene® Study

PURPOSE

Medication patterns include all medications in an individual's clinical profile. We aimed to identify chronic co-morbidity treatment patterns through medication use among COPDGene participants and determine whether these patterns were associated with mortality, acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and quality of life.

MATERIALS AND METHODS

Participants analyzed here completed Phase 1 (P1) and/or Phase 2 (P2) of COPDGene. Latent class analysis (LCA) was used to identify medication patterns and assign individuals into unobserved LCA classes. Mortality, AECOPD, and the St. George's Respiratory Questionnaire (SGRQ) health status were compared in different LCA classes through survival analysis, logistic regression, and Kruskal-Wallis test, respectively.

RESULTS

LCA identified 8 medication patterns from 32 classes of chronic comorbid medications. A total of 8110 out of 10,127 participants with complete covariate information were included. Survival analysis adjusted for covariates showed, compared to a low medication use class, mortality was highest in participants with hypertension+diabetes+statin+antiplatelet medication group. Participants in hypertension+SSRI+statin medication group had the highest odds of AECOPD and the highest SGRQ score at both P1 and P2.

CONCLUSION

Medication pattern can serve as a good indicator of an individual's comorbidities profile and improves models predicting clinical outcomes.

Chronic obstructive pulmonary disease, lung function and risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies

Background

The association between chronic obstructive pulmonary disease (COPD), lung function and risk of type 2 diabetes mellitus (T2DM) remains controversial. We performed a meta-analysis to clarify this issue.

Methods

The PubMed and EMBASE databases were searched. Cohort studies on COPD, lung function and risk of T2DM in adults were included. A random effects model was adopted to calculate the summary risk ratio (RR) and 95% confidence interval (CI). Dose-response analysis was conducted where possible.

Results

A total of 13 eligible cohort studies involving 307,335 incident T2DM cases and 7,683,784 individuals were included. The risk of T2DM was significantly higher in patients with COPD than those without COPD (RR = 1.25, 95% CI 1.16–1.34). Compared to the highest category of percentage forced vital capacity (FVC%), the lowest category of FVC% was associated with a higher risk of T2DM (RR = 1.43, 95% CI 1.33–1.53). Similarly, the summary RR of T2DM for the lowest versus highest category of percentage forced expiratory volume in 1 s (FEV1%) was 1.49 (95% CI 1.39–1.60). Significant linear associations of FVC% and FEV1% with risk of T2DM were found (P_{non-linearity} > 0.05); the RR of T2DM was 0.88 (95% CI 0.82–0.95) and 0.87 (95% CI 0.81–0.94) per 10% increase in FVC% and FEV1%, respectively. There was a non-significant relationship between the FEV1/FVC ratio and the risk of T2DM.

Conclusions

Both COPD and impaired lung function, especially restricted ventilation dysfunction, could increase the risk of T2DM. However, these findings should be interpreted with caution due to the limited number of studies, and need to be validated by future studies.

Clinical Epidemiology of COPD: Insights From 10 Years of the COPDGene Study

The Genetic Epidemiology of COPD (COPDGene) study is a noninterventional, multicenter, longitudinal analysis of > 10,000 subjects, including smokers with a ≥ 10 pack-year history with and without COPD and healthy never smokers. The goal was to characterize disease-related phenotypes and explore associations with susceptibility genes. The subjects were extensively phenotyped with the use of comprehensive symptom and comorbidity questionnaires, spirometry, CT scans of the chest, and genetic and biomarker profiling. The objective of this review was to summarize the major advances in the clinical epidemiology of COPD from the first 10 years of the COPDGene study. We highlight the influence of age, sex, and race on the natural history of COPD, and the impact of comorbid conditions, chronic bronchitis, exacerbations, and asthma/COPD overlap.

The outcome and the influencing factors of the age of onset in post-mortem of chronic bronchitis patients: a retrospective study

Purpose

Chronic bronchitis is thought to occur in elderly patients, and smoking seems to be an important risk factor. The outcomes related to the age of onset in patients with chronic bronchitis are still unclear.

Patients and methods

A retrospective study was conducted on deceased patients whose diagnosis included bronchitis from 2010 to 2016. Patients were separated into two groups according to the age of onset (Group I, age ≤50 years old; Group II, age >50 years old). Information regarding disease course, smoking history, death age, number of admissions per year, Hugh Jones Index, and self-reported comorbidities of the patients was recorded.

Results

The courses of chronic cough and sputum were 33.38±7.73 years and 14.44±8.60 years in Group I and Group II, respectively (p<0.05). The death ages of Group I and Group II were 77.65±7.87 years and 84.69±6.67 years, respectively (p<0.05). There was a significant negative correlation between the number of hospital admissions per year and the age of onset. The age of onset was negatively associated with daily smoking count (r=−0.210) and total smoking count (r=−0.146). In Group I, there were fewer cases of coronary heart disease (OR =0.41 [0.24–0.71]), neurological diseases (OR =0.48 [0.24–0.97]), and total comorbidities (OR =0.67 [0.54–0.85]) than in Group II.

Conclusion

Patients with early onset chronic bronchitis had a longer history, younger death age, poorer health status, and lower incidence of comorbidities.