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

Hersh, CP and Make, BJ and Lynch, DA and Barr, RG and Bowler, RP and Calverley, PMA and Castaldi, PJ and Cho, MH and Coxson, HO and DeMeo, DL and Foreman, MG and Han, MLK and Harshfield, BJ and Hokanson, JE and Lutz, S and Ramsdell, JW and Regan, EA and Rennard, SI and Schroeder, JD and Sciurba, FC and Steiner, RM and Tal-Singer, R and van Beek, EJR and Silverman, EK and Crapo, JD and Lantz, R and Stepp, L and Melanson, S and Beaty, T and Laird, N and Lange, C and Santorico, S and Hansel, N and McDonald, ML and Zhou, J and Mattheisen, M and Wan, E and Hardin, M and Hetmanski, J and Parker, M and Murray, T and Newell, J and Reilly, J and Judy, P and Hoffman, E and Estepar, RSJ and Ross, J and Al Qaisi, M and Zach, J and Kluiber, A and Sieren, J and Mann, T and Richert, D and McKenzie, A and Akhavan, J and Stinson, D and Jensen, R and Farzadegan, H and Meyerer, S and Chandan, S and Bragan, S and Everett, D and Williams, A and Wilson, C and Forssen, A and Powell, A and Piccoli, J and Sontag, M and Black-Shinn, J and Kinney, G and Curtis, J and Kazerooni, E and Hanania, N and Alapat, P and Bandi, V and Guntupalli, K and Guy, E and Mallampalli, A and Trinh, C and Atik, M and Al-Azzawi, H and Willis, M and Pinero, S and Fahr, L and Nachiappan, A and Bray, C and Frigini, LA and Farinas, C and Katz, D and Freytes, J and Marciel, AM and Washko, G and Jacobson, F and Hatabu, H and Clarke, P and Gill, R and Hunsaker, A and Trotman-Dickenson, B and Madan, R and Thomashow, B (2014) Non-emphysematous chronic obstructive pulmonary disease is associated with diabetes mellitus. BMC Pulmonary Medicine, 14 (1).

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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.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Hersh, CP
Make, BJ
Lynch, DA
Barr, RG
Bowler, RP
Calverley, PMA
Castaldi, PJ
Cho, MH
Coxson, HO
DeMeo, DL
Foreman, MG
Han, MLK
Harshfield, BJ
Hokanson, JE
Lutz, S
Ramsdell, JW
Regan, EA
Rennard, SI
Schroeder, JD
Sciurba, FCfcs@pitt.eduFCS
Steiner, RM
Tal-Singer, R
van Beek, EJR
Silverman, EK
Crapo, JD
Lantz, R
Stepp, L
Melanson, S
Beaty, T
Laird, N
Lange, C
Santorico, S
Hansel, N
McDonald, ML
Zhou, J
Mattheisen, M
Wan, E
Hardin, M
Hetmanski, J
Parker, M
Murray, T
Newell, J
Reilly, J
Judy, P
Hoffman, E
Estepar, RSJ
Ross, J
Al Qaisi, M
Zach, J
Kluiber, A
Sieren, J
Mann, T
Richert, D
McKenzie, A
Akhavan, J
Stinson, D
Jensen, R
Farzadegan, H
Meyerer, S
Chandan, S
Bragan, S
Everett, D
Williams, A
Wilson, C
Forssen, A
Powell, A
Piccoli, J
Sontag, M
Black-Shinn, J
Kinney, G
Curtis, J
Kazerooni, E
Hanania, N
Alapat, P
Bandi, V
Guntupalli, K
Guy, E
Mallampalli, A
Trinh, C
Atik, M
Al-Azzawi, H
Willis, M
Pinero, S
Fahr, L
Nachiappan, A
Bray, C
Frigini, LA
Farinas, C
Katz, D
Freytes, J
Marciel, AM
Washko, G
Jacobson, F
Hatabu, H
Clarke, P
Gill, R
Hunsaker, A
Trotman-Dickenson, B
Madan, R
Thomashow, B
Date: 1 January 2014
Date Type: Publication
Journal or Publication Title: BMC Pulmonary Medicine
Volume: 14
Number: 1
DOI or Unique Handle: 10.1186/1471-2466-14-164
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
Date Deposited: 21 Dec 2016 20:45
Last Modified: 22 Jun 2021 13:55


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