The diabetic lung: Relevance of alveolar microangiopathy for the use of inhaled insulin

Hsia, Connie C. W.; Raskin, Philip

doi:10.1016/j.amjmed.2004.09.019

Cited by 82 publications

(66 citation statements)

References 82 publications

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“…In our patient, fibroblast foci may have been triggered by vasculitis, with neutrophilic degranulation resulting in chemotactic damage, rupture of the alveolar endothelial basement membrane, and alveolar hemorrhage. Damage to the pulmonary microcirculation has been associated with interstitial lung disease in other syndromes, including the inflammatory myopathies (9), scleroderma (22), and even diabetes (23). A broader mechanistic implication of our case report is that since features of leukocytoclastic vasculitis were observed in the background of usual IP, damage to the pulmonary microvasculature may have an underappreciated role in some cases of idiopathic interstitial pneumonia.…”

Section: Discussionmentioning

confidence: 75%

Microscopic polyangiitis presenting as a “pulmonary‐muscle” syndrome: Is subclinical alveolar hemorrhage the mechanism of pulmonary fibrosis?

Birnbaum¹,

Danoff²,

Askin³

et al. 2007

Arthritis & Rheumatism

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Microscopic polyangiitis (MPA) may present with a syndrome that resembles idiopathic pulmonary fibrosis (IPF). We describe an MPA patient with the clinical presentation of a “pulmonary‐muscle” syndrome in which interstitial lung disease antedated the onset of myopathy. Identification of vasculitis on muscle biopsy was instrumental in recognizing clinical, radiographic, and histopathologic features that were more characteristic of MPA than of IPF. Institution of glucocorticoid and cyclophosphamide therapy led to the induction of a complete remission. The histologic findings in this case implicate subclinical episodes of alveolar hemorrhage as the mechanism of interstitial lung disease in MPA.

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Section: Discussionmentioning

confidence: 75%

Microscopic polyangiitis presenting as a “pulmonary‐muscle” syndrome: Is subclinical alveolar hemorrhage the mechanism of pulmonary fibrosis?

Birnbaum¹,

Danoff²,

Askin³

et al. 2007

Arthritis & Rheumatism

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“…The first is whether impaired lung function could result in a reduced effect of such a therapy. It can be assumed that the microangiopathy and the reduced diffusing capacity of the alveolarcapillary membrane may have adverse effects on the efficacy of inhalation therapy [102]. The second issue is whether inhaled insulin could contribute to lung injury, and thus increase the accelerated decline in lung function in diabetic patients.…”

Section: Potential Effects Of Inhaled Insulin On the Respiratory Tractmentioning

confidence: 99%

The Diabetic Lung - A New Target Organ?

Pitocco

Fuso²,

Conte³

et al. 2012

Rev Diabet Stud

133

108

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■ AbstractSeveral abnormalities of the respiratory function have been reported in patients with type 1 and type 2 diabetes. These abnormalities concern lung volume, pulmonary diffusing capacity, control of ventilation, bronchomotor tone, and neuroadrenergic bronchial innervation. Many hypotheses have emerged, and characteristic histological changes have been described in the "diabetic lung", which could explain this abnormal respiratory function. Given the specific abnormalities in diabetic patients, the lung could thus be considered as a target organ in diabetes. Although the practical implications of these functional changes are mild, the presence of an associated acute or chronic pulmonary and/or cardiac disease could determine severe respiratory derangements in diabetic patients. Another clinical consequence of the pulmonary involvement in diabetes is the accelerated decline in respiratory function. The rate of decline in respiratory function in diabetics has been found to be two-to-three times faster than in normal non-smoking subjects, as reported in longitudinal studies. This finding, together with the presence of anatomical and biological changes similar to those described in the aging lung, indicates that the "diabetic lung" could even be considered a model of accelerated aging. This review describes and analyses the current insight into the relationship of diabetes and lung disease, and suggests intensifying research into the lung as a possible target organ in diabetes.

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“…In the present study, poor pulmonary function preceded diabetes and was independent of age, sex, genotype, medical interventions, and other cystic fibrosis-related complications. Individuals with diabetes (but without cystic fibrosis) have lung parenchymal histological changes including thickened basement membrane, fibrosis, and septal obliteration (26), suggesting a direct deleterious effect of hyperglycemia.…”

Section: Risk Factorsmentioning

confidence: 99%

Genetic Determinants and Epidemiology of Cystic Fibrosis–Related Diabetes

et al. 2008

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OBJECTIVE -Longer survival of patients with cystic fibrosis has increased the occurrence of cystic fibrosis-related diabetes (CFRD). In this study we documented the incidence of CFRD and evaluated the association between mutations responsible for cystic fibrosis and incident CFRD, while identifying potential risk factors.RESEARCH DESIGN AND METHODS -This was a population-based longitudinal study of 50 cystic fibrosis speciality clinics in the U.K. Subjects included 8,029 individuals aged 0 -64 years enrolled in the U.K. Cystic Fibrosis Registry during 1996 -2005. Of these, 5,196 with data and without diabetes were included in analyses of incidence, and 3,275 with complete data were included in analyses of risk factors. Diabetes was defined by physician diagnosis, oral glucose tolerance testing, or treatment with hypoglycemic drugs.RESULTS -A total of 526 individuals developed CFRD over 15,010 person-years. The annual incidence was 3.5%. The incidence was higher in female patients and in patients with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene in classes I and II. In a multivariate model of 377 cases of 3,275 patients, CFTR class (relative risk 1.70 [95% CI 1.16 -2.49], class I or II versus others), increasing age, female sex, worse pulmonary function, liver dysfunction, pancreatic insufficiency, and corticosteroid use were independently associated with incident diabetes.CONCLUSIONS -The incidence of CFRD is high in Britain. CFTR class I and II mutations increase the risk of diabetes independent of other risk factors including pancreatic exocrine dysfunction.

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The diabetic lung: Relevance of alveolar microangiopathy for the use of inhaled insulin

Cited by 82 publications

References 82 publications

Microscopic polyangiitis presenting as a “pulmonary‐muscle” syndrome: Is subclinical alveolar hemorrhage the mechanism of pulmonary fibrosis?

Microscopic polyangiitis presenting as a “pulmonary‐muscle” syndrome: Is subclinical alveolar hemorrhage the mechanism of pulmonary fibrosis?

The Diabetic Lung - A New Target Organ?

Genetic Determinants and Epidemiology of Cystic Fibrosis–Related Diabetes

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