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

COPDGene and ECLIPSE Investigators

Research output: Contribution to journalArticle

33 Citations (Scopus)

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.

Original languageEnglish (US)
Article number164
JournalBMC Pulmonary Medicine
Volume14
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

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Chronic Obstructive Pulmonary Disease
Diabetes Mellitus
Emphysema
Thorax
Tomography
Tetraodontiformes
Molecular Epidemiology
Hyperlipidemias
Quality of Life
Exercise
Hypertension

Keywords

  • Airway disease
  • CT scan
  • Diabetes mellitus
  • Emphysema
  • Spirometry

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Non-emphysematous chronic obstructive pulmonary disease is associated with diabetes mellitus. / COPDGene and ECLIPSE Investigators.

In: BMC Pulmonary Medicine, Vol. 14, No. 1, 164, 2014.

Research output: Contribution to journalArticle

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title = "Non-emphysematous chronic obstructive pulmonary disease is associated with diabetes mellitus",
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.",
keywords = "Airway disease, CT scan, Diabetes mellitus, Emphysema, Spirometry",
author = "{COPDGene and ECLIPSE Investigators} and Hersh, {Craig P.} and Make, {Barry J.} and Lynch, {David A.} and Barr, {R. Graham} and Bowler, {Russell P.} and Calverley, {Peter M.A.} and Castaldi, {Peter J.} and Cho, {Michael H.} and Coxson, {Harvey O.} and DeMeo, {Dawn L.} and Foreman, {Marilyn G.} and Han, {Mei Lan K.} and Harshfield, {Benjamin J.} and Hokanson, {John E.} and Sharon Lutz and Ramsdell, {Joe W.} and Regan, {Elizabeth A.} and Rennard, {Stephen I.} and Schroeder, {Joyce D.} and Sciurba, {Frank C.} and Steiner, {Robert M.} and Ruth Tal-Singer and {van Beek}, {Edwin J.R.} and Silverman, {Edwin K.} and Crapo, {James D.} and Rochelle Lantz and Lori Stepp and Sandra Melanson and Terri Beaty and Nan Laird and Christoph Lange and Stephanie Santorico and Nadia Hansel and McDonald, {Merry Lynn} and Jin Zhou and Manuel Mattheisen and Emily Wan and Megan Hardin and Jacqueline Hetmanski and Margaret Parker and Tanda Murray and John Newell and John Reilly and Philip Judy and Eric Hoffman and Estepar, {Raul San Jose} and James Ross and {Al Qaisi}, Mustafa and Jordan Zach and Alex Kluiber",
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T1 - Non-emphysematous chronic obstructive pulmonary disease is associated with diabetes mellitus

AU - COPDGene and ECLIPSE Investigators

AU - Hersh, Craig P.

AU - Make, Barry J.

AU - Lynch, David A.

AU - Barr, R. Graham

AU - Bowler, Russell P.

AU - Calverley, Peter M.A.

AU - Castaldi, Peter J.

AU - Cho, Michael H.

AU - Coxson, Harvey O.

AU - DeMeo, Dawn L.

AU - Foreman, Marilyn G.

AU - Han, Mei Lan K.

AU - Harshfield, Benjamin J.

AU - Hokanson, John E.

AU - Lutz, Sharon

AU - Ramsdell, Joe W.

AU - Regan, Elizabeth A.

AU - Rennard, Stephen I.

AU - Schroeder, Joyce D.

AU - Sciurba, Frank C.

AU - Steiner, Robert M.

AU - Tal-Singer, Ruth

AU - van Beek, Edwin J.R.

AU - Silverman, Edwin K.

AU - Crapo, James D.

AU - Lantz, Rochelle

AU - Stepp, Lori

AU - Melanson, Sandra

AU - Beaty, Terri

AU - Laird, Nan

AU - Lange, Christoph

AU - Santorico, Stephanie

AU - Hansel, Nadia

AU - McDonald, Merry Lynn

AU - Zhou, Jin

AU - Mattheisen, Manuel

AU - Wan, Emily

AU - Hardin, Megan

AU - Hetmanski, Jacqueline

AU - Parker, Margaret

AU - Murray, Tanda

AU - Newell, John

AU - Reilly, John

AU - Judy, Philip

AU - Hoffman, Eric

AU - Estepar, Raul San Jose

AU - Ross, James

AU - Al Qaisi, Mustafa

AU - Zach, Jordan

AU - Kluiber, Alex

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

KW - Airway disease

KW - CT scan

KW - Diabetes mellitus

KW - Emphysema

KW - Spirometry

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