Abstract

Doc number: 164

Abstract

Background: Chronic 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.

Methods: Current 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%).

Results: Out 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.

Conclusions: Non-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 registration: Clinicaltrials.gov identifiers: COPDGene NCT00608764, ECLIPSE NCT00292552.

Details

Title
Non-emphysematous chronic obstructive pulmonary disease is associated with diabetes mellitus
Author
Hersh, Craig P; Make, Barry J; Lynch, David A; Barr, R Graham; Bowler, Russell P; Calverley, Peter MA; Castaldi, Peter J; Cho, Michael H; Coxson, Harvey O; DeMeo, Dawn L; Foreman, Marilyn G; Han, MeiLan K; Harshfield, Benjamin J; Hokanson, John E; Lutz, Sharon; Ramsdell, Joe W; Regan, Elizabeth A; Rennard, Stephen I; Schroeder, Joyce D; Sciurba, Frank C; Steiner, Robert M; Tal-Singer, Ruth; van Beek, Edwin JR; Silverman, Edwin K; Crapo, James D
Pages
164
Publication year
2014
Publication date
2014
Publisher
BioMed Central
e-ISSN
14712466
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/1471-2466-14-164
ProQuest document ID
1617974256
Copyright
© 2014 Hersh et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.