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

Abstract

BackgroundChronic 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.MethodsCurrent 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%).ResultsOut 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.ConclusionsNon-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 registrationClinicaltrials.gov identifiers: COPDGene NCT00608764, ECLIPSE NCT00292552.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2466-14-164) contains supplementary material, which is available to authorized users.

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“…It may also be noteworthy that several studies described an anti-inflammatory action of simvastatin [30], an improved FEV 1 in patients undergoing this therapy [31] a protective effect against the development of emphysema [32], in accordance with the, on average, better FEV 1 and KCO in our patients (Table 1). Whether hyperlipidemia-related inflammation favours a specific phenotype of COPD is not known; for diabetes CT data indicate a predominant nonemphysematous type of COPD [33]. Although the differences of lung function parameters between both groups were small, they might become relevant in case of exacerbations.…”

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