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

COPDGene and ECLIPSE Investigators

doi:10.1186/1471-2466-14-164

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

COPDGene and ECLIPSE Investigators

Research output: Contribution to journal › Article › peer-review

42 Scopus citations

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 language	English (US)
Article number	164
Journal	BMC Pulmonary Medicine
Volume	14
Issue number	1
DOIs	https://doi.org/10.1186/1471-2466-14-164
State	Published - 2014
Externally published	Yes

Keywords

Airway disease
CT scan
Diabetes mellitus
Emphysema
Spirometry

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine

Access to Document

10.1186/1471-2466-14-164

Cite this

@article{2e33bfb710be427c9b0986eee6f2815f,

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",

note = "Funding Information: Supported by U.S. National Institutes of Health grants R01HL094635 (CPH), R01NR013377 (CPH), R01HL089856 (EKS), R01HL089897 (JDC), P01HL105339 (EKS). COPDGene is also supported by the COPD Foundation through contributions made to an Industry Advisory Board comprised of AstraZeneca, Pfizer, Novartis, Boehringer-Ingelheim, Siemens, Sunovion, and GlaxoSmithKline. ECLIPSE is supported by GlaxoSmithKline. The sponsors had no role in study design; collection, analysis, and interpretation of the data; preparation of the manuscript; and decision to submit the manuscript for publication. COPDGene{\textregistered} Investigators - Core Units Administrative Core: James Crapo, MD (PI), Edwin Silverman, MD, PhD (PI), Barry Make, MD, Elizabeth Regan, MD, Rochelle Lantz, Lori Stepp, Sandra Melanson Genetic Analysis Core: Terri Beaty, PhD, Nan Laird, PhD, Christoph Lange, PhD, Michael Cho, MD, Stephanie Santorico, PhD, John Hokanson, MPH, PhD, Dawn DeMeo, MD, MPH, Nadia Hansel, MD, MPH, Craig Hersh, MD, MPH, Peter Castaldi, MD, MSc, Merry-Lynn McDonald, PhD, Jin Zhou, PhD, Manuel Mattheisen, MD, Emily Wan, MD, Megan Hardin, MD, Jacqueline Hetmanski, MS, Margaret Parker, MS, Tanda Murray, MS Imaging Core: David Lynch, MB, Joyce Schroeder, MD, John Newell, Jr., MD, John Reilly, MD, Harvey Coxson, PhD, Philip Judy, PhD, Eric Hoffman, PhD, George Washko, MD, Raul San Jose Estepar, PhD, James Ross, MSc, Mustafa Al Qaisi, MD, Jordan Zach, Alex Kluiber, Jered Sieren, Tanya Mann, Deanna Richert, Alexander McKenzie, Jaleh Akhavan, Douglas Stinson PFT QA Core, National Jewish Health: Robert Jensen, PhD Biological Repository, Johns Hopkins University, Baltimore, MD: Homayoon Farzadegan, PhD, Stacey Meyerer, Shivam Chandan, Samantha Bragan Data Coordinating Center and Biostatistics, National Jewish Health, Denver, CO: Douglas Everett, PhD, Andre Williams, PhD, Carla Wilson, MS, Anna Forssen, MS, Amber Powell, Joe Piccoli Epidemiology Core, University of Colorado School of Public Health, Denver, CO: John Hokanson, MPH, PhD, Marci Sontag, PhD, Jennifer Black-Shinn, MPH, Gregory Kinney, MPH, PhDc, Sharon Lutz, MPH, PhD COPDGene{\textregistered} Investigators: Clinical Centers Ann Arbor VA: Jeffrey Curtis, MD, Ella Kazerooni, MD Baylor College of Medicine, Houston, TX: Nicola Hanania, MD, MS, Philip Alapat, MD, Venkata Bandi, MD, Kalpalatha Guntupalli, MD, Elizabeth Guy, MD, Antara Mallampalli, MD, Charles Trinh, MD, Mustafa Atik, MD, Hasan Al-Azzawi, MD, Marc Willis, DO, Susan Pinero, MD, Linda Fahr, MD, Arun Nachiappan, MD, Collin Bray, MD, L. Alexander Frigini, MD, Carlos Farinas, MD, David Katz, MD, Jose Freytes, MD, Anne Marie Marciel, MD Brigham and Women{\textquoteright}s Hospital, Boston, MA: Dawn DeMeo, MD, MPH, Craig Hersh, MD, MPH, George Washko, MD, Francine Jacobson, MD, MPH, Hiroto Hatabu, MD, PhD, Peter Clarke, MD, Ritu Gill, MD, Andetta Hunsaker, MD, Beatrice Trotman-Dickenson, MBBS, Rachna Madan, MD Columbia University, New York, NY: R. Graham Barr, MD, DrPH, Byron Thomashow, MD, John Austin, MD, Belinda D{\textquoteright}Souza, MD Duke University Medical Center, Durham, NC: Neil MacIntyre, Jr., MD, Lacey Washington, MD, H Page McAdams, MD Funding Information: Dr. Hersh has received lecture fees from Novartis and has been a consultant for CSL Behring. Dr. Make reports advisory board membership for Forest, AstraZeneca, Novartis, Covidien, Breathe, Merck, Sunovion, Boehringer Ingelheim, MedImmune, Ikaria, and Abbot. He has been a consultant for Astellas, Forest, and Boehringer Ingelheim. He has received research grants from AstraZeneca, GlaxoSmithKline, NABI, Boehringer Ingelheim, Sunovion, Forest, and Pfizer. He has received lecture fees from GlaxoSmithKline, Boehringer Ingelheim, Forest, and Pfizer. Dr. Lynch has been a consultant for Perceptive Imaging, Boehringer Ingelheim, Genentech, Gilead, and Intermune. He has received grants from Centocor and Siemens. Dr. Barr has received royalties from UpToDate. Dr. Cho has been a consultant for Merck. Dr. Han has been a consultant for GlaxoSmithKline, Boehringer Ingelheim, Novartis, Genentech, Medimmune, and Forest. She has received lecture fees from GlaxoSmithKline, Boehringer Ingelheim,, Pfizer, Novartis, Grifols, and Forest. She has received royalties from UpToDate. Dr. Ramsdell has received a research grant from Boehringer Ingelheim. Dr. Rennard has received grants from AstraZeneca, Biomarck, Centocor, Mpex, Nabi, Novartis, Otsuka, Boehringer Ingelheim, and Nycomed. He has been a consultant for Able Associates, Adelphi Research, APT Pharma/Britnall, Aradigm, AstraZeneca, Boehringer Ingelheim, Chiesi, CommonHealth, Consult Complete, COPDForum, Data Monitor, Decision Resource, Defined Health, Dey, Dunn Group, Easton Associates, Equinox, Gerson, GlaxoSmithKline, Infomed, KOL Connection, M. Pankove, MedaCorp, MDRX Financial, Mpex, Novartis, Oriel Therapeutics, Otsuka, Pennside, ParmaVentures, Pharmaxis, Price Waterhouse, Propagate, Pulmatrix, Reckner Associates, recruiting Resources, Roche, Schlesinger Medical, Scimed, Sudler and Hennessey, TargeGen, Theravance, UBC, Uptake Medical, VantagePoint Management, Forest, Nycomed, Pearl and Sanyko. He has served on advisory boards for Almirall, Novartis, Nycomed, and Pfizer. He has received lecture fees from AAAAI, American College of Osteopathic Physicians, Asan Medical Center, American Thoracic Society, AstraZeneca, California Society of Allergy, Convergent Health Solutions for Reviews and Trends in COPD, COPD Foundation, Creative Educational Concepts, Dey, Duke University, France Foundation, Information TV, University of Southern California, Network for Continuing Education (CHARM), Novartis, Nycomed, Otsuka, Pfizer, Sarasota Memorial Hospital, Spanish Thoracic Society, University of Washington, University of Alabama Birmingham, University of Pittsburgh, University of British Columbia, University of California Davis, and Sioux Falls VA. Dr. Sciurba has participated in consulting for GSK, AstraZeneca and Pfizer and has received research grant funding from the NIH, GSK, BI, Pfizer, Forest and Actelion. Dr. Steiner reports royalties from Elsevier Publishing and consultancy for Johnson and Johnson. Dr. van Beek is a board member of Quantitative Clinical Trials Imaging Services, Inc. He has been a consultant for Siemens Medical Systems, Synta Pharmaceuticals, and Skolkovo Foundation. He has received speaking fees from Vital Images Inc and Toshiba Medical Systems. Dr. Silverman has been a consultant for GlaxoSmithKline, AstraZeneca, and Merck. He has received research grants from GlaxoSmithKline. He has received speaking fees from GlaxoSmithKline and AstraZeneca. Dr. Calverley reports advisory board membership for AstraZeneca, Merck, Boehringer Ingelheim, GSK and Takeda. He has been a consultant for Boehringer Ingelheim, GSK and Takeda. He has received research grants from GlaxoSmithKline, Boehringer Ingelheim, and Takeda. Dr. Coxson has received consulting fees and research grants from GlaxoSmithKline and a research grant from Spiration. Dr. Tal-Singer is an employee and shareholder of GlaxoSmithKline. Drs. Bowler, Castaldi, DeMeo, Foreman, Hokanson, Lutz, Regan, Schroeder and Crapo and Mr. Harshfield report no disclosures. Publisher Copyright: {\textcopyright} 2014 Hersh et al.",

year = "2014",

doi = "10.1186/1471-2466-14-164",

language = "English (US)",

volume = "14",

journal = "BMC Pulmonary Medicine",

issn = "1471-2466",

publisher = "BioMed Central",

number = "1",

}

TY - JOUR

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

N1 - Funding Information: Supported by U.S. National Institutes of Health grants R01HL094635 (CPH), R01NR013377 (CPH), R01HL089856 (EKS), R01HL089897 (JDC), P01HL105339 (EKS). COPDGene is also supported by the COPD Foundation through contributions made to an Industry Advisory Board comprised of AstraZeneca, Pfizer, Novartis, Boehringer-Ingelheim, Siemens, Sunovion, and GlaxoSmithKline. ECLIPSE is supported by GlaxoSmithKline. The sponsors had no role in study design; collection, analysis, and interpretation of the data; preparation of the manuscript; and decision to submit the manuscript for publication. COPDGene® Investigators - Core Units Administrative Core: James Crapo, MD (PI), Edwin Silverman, MD, PhD (PI), Barry Make, MD, Elizabeth Regan, MD, Rochelle Lantz, Lori Stepp, Sandra Melanson Genetic Analysis Core: Terri Beaty, PhD, Nan Laird, PhD, Christoph Lange, PhD, Michael Cho, MD, Stephanie Santorico, PhD, John Hokanson, MPH, PhD, Dawn DeMeo, MD, MPH, Nadia Hansel, MD, MPH, Craig Hersh, MD, MPH, Peter Castaldi, MD, MSc, Merry-Lynn McDonald, PhD, Jin Zhou, PhD, Manuel Mattheisen, MD, Emily Wan, MD, Megan Hardin, MD, Jacqueline Hetmanski, MS, Margaret Parker, MS, Tanda Murray, MS Imaging Core: David Lynch, MB, Joyce Schroeder, MD, John Newell, Jr., MD, John Reilly, MD, Harvey Coxson, PhD, Philip Judy, PhD, Eric Hoffman, PhD, George Washko, MD, Raul San Jose Estepar, PhD, James Ross, MSc, Mustafa Al Qaisi, MD, Jordan Zach, Alex Kluiber, Jered Sieren, Tanya Mann, Deanna Richert, Alexander McKenzie, Jaleh Akhavan, Douglas Stinson PFT QA Core, National Jewish Health: Robert Jensen, PhD Biological Repository, Johns Hopkins University, Baltimore, MD: Homayoon Farzadegan, PhD, Stacey Meyerer, Shivam Chandan, Samantha Bragan Data Coordinating Center and Biostatistics, National Jewish Health, Denver, CO: Douglas Everett, PhD, Andre Williams, PhD, Carla Wilson, MS, Anna Forssen, MS, Amber Powell, Joe Piccoli Epidemiology Core, University of Colorado School of Public Health, Denver, CO: John Hokanson, MPH, PhD, Marci Sontag, PhD, Jennifer Black-Shinn, MPH, Gregory Kinney, MPH, PhDc, Sharon Lutz, MPH, PhD COPDGene® Investigators: Clinical Centers Ann Arbor VA: Jeffrey Curtis, MD, Ella Kazerooni, MD Baylor College of Medicine, Houston, TX: Nicola Hanania, MD, MS, Philip Alapat, MD, Venkata Bandi, MD, Kalpalatha Guntupalli, MD, Elizabeth Guy, MD, Antara Mallampalli, MD, Charles Trinh, MD, Mustafa Atik, MD, Hasan Al-Azzawi, MD, Marc Willis, DO, Susan Pinero, MD, Linda Fahr, MD, Arun Nachiappan, MD, Collin Bray, MD, L. Alexander Frigini, MD, Carlos Farinas, MD, David Katz, MD, Jose Freytes, MD, Anne Marie Marciel, MD Brigham and Women’s Hospital, Boston, MA: Dawn DeMeo, MD, MPH, Craig Hersh, MD, MPH, George Washko, MD, Francine Jacobson, MD, MPH, Hiroto Hatabu, MD, PhD, Peter Clarke, MD, Ritu Gill, MD, Andetta Hunsaker, MD, Beatrice Trotman-Dickenson, MBBS, Rachna Madan, MD Columbia University, New York, NY: R. Graham Barr, MD, DrPH, Byron Thomashow, MD, John Austin, MD, Belinda D’Souza, MD Duke University Medical Center, Durham, NC: Neil MacIntyre, Jr., MD, Lacey Washington, MD, H Page McAdams, MD Funding Information: Dr. Hersh has received lecture fees from Novartis and has been a consultant for CSL Behring. Dr. Make reports advisory board membership for Forest, AstraZeneca, Novartis, Covidien, Breathe, Merck, Sunovion, Boehringer Ingelheim, MedImmune, Ikaria, and Abbot. He has been a consultant for Astellas, Forest, and Boehringer Ingelheim. He has received research grants from AstraZeneca, GlaxoSmithKline, NABI, Boehringer Ingelheim, Sunovion, Forest, and Pfizer. He has received lecture fees from GlaxoSmithKline, Boehringer Ingelheim, Forest, and Pfizer. Dr. Lynch has been a consultant for Perceptive Imaging, Boehringer Ingelheim, Genentech, Gilead, and Intermune. He has received grants from Centocor and Siemens. Dr. Barr has received royalties from UpToDate. Dr. Cho has been a consultant for Merck. Dr. Han has been a consultant for GlaxoSmithKline, Boehringer Ingelheim, Novartis, Genentech, Medimmune, and Forest. She has received lecture fees from GlaxoSmithKline, Boehringer Ingelheim,, Pfizer, Novartis, Grifols, and Forest. She has received royalties from UpToDate. Dr. Ramsdell has received a research grant from Boehringer Ingelheim. Dr. Rennard has received grants from AstraZeneca, Biomarck, Centocor, Mpex, Nabi, Novartis, Otsuka, Boehringer Ingelheim, and Nycomed. He has been a consultant for Able Associates, Adelphi Research, APT Pharma/Britnall, Aradigm, AstraZeneca, Boehringer Ingelheim, Chiesi, CommonHealth, Consult Complete, COPDForum, Data Monitor, Decision Resource, Defined Health, Dey, Dunn Group, Easton Associates, Equinox, Gerson, GlaxoSmithKline, Infomed, KOL Connection, M. Pankove, MedaCorp, MDRX Financial, Mpex, Novartis, Oriel Therapeutics, Otsuka, Pennside, ParmaVentures, Pharmaxis, Price Waterhouse, Propagate, Pulmatrix, Reckner Associates, recruiting Resources, Roche, Schlesinger Medical, Scimed, Sudler and Hennessey, TargeGen, Theravance, UBC, Uptake Medical, VantagePoint Management, Forest, Nycomed, Pearl and Sanyko. He has served on advisory boards for Almirall, Novartis, Nycomed, and Pfizer. He has received lecture fees from AAAAI, American College of Osteopathic Physicians, Asan Medical Center, American Thoracic Society, AstraZeneca, California Society of Allergy, Convergent Health Solutions for Reviews and Trends in COPD, COPD Foundation, Creative Educational Concepts, Dey, Duke University, France Foundation, Information TV, University of Southern California, Network for Continuing Education (CHARM), Novartis, Nycomed, Otsuka, Pfizer, Sarasota Memorial Hospital, Spanish Thoracic Society, University of Washington, University of Alabama Birmingham, University of Pittsburgh, University of British Columbia, University of California Davis, and Sioux Falls VA. Dr. Sciurba has participated in consulting for GSK, AstraZeneca and Pfizer and has received research grant funding from the NIH, GSK, BI, Pfizer, Forest and Actelion. Dr. Steiner reports royalties from Elsevier Publishing and consultancy for Johnson and Johnson. Dr. van Beek is a board member of Quantitative Clinical Trials Imaging Services, Inc. He has been a consultant for Siemens Medical Systems, Synta Pharmaceuticals, and Skolkovo Foundation. He has received speaking fees from Vital Images Inc and Toshiba Medical Systems. Dr. Silverman has been a consultant for GlaxoSmithKline, AstraZeneca, and Merck. He has received research grants from GlaxoSmithKline. He has received speaking fees from GlaxoSmithKline and AstraZeneca. Dr. Calverley reports advisory board membership for AstraZeneca, Merck, Boehringer Ingelheim, GSK and Takeda. He has been a consultant for Boehringer Ingelheim, GSK and Takeda. He has received research grants from GlaxoSmithKline, Boehringer Ingelheim, and Takeda. Dr. Coxson has received consulting fees and research grants from GlaxoSmithKline and a research grant from Spiration. Dr. Tal-Singer is an employee and shareholder of GlaxoSmithKline. Drs. Bowler, Castaldi, DeMeo, Foreman, Hokanson, Lutz, Regan, Schroeder and Crapo and Mr. Harshfield report no disclosures. Publisher Copyright: © 2014 Hersh et al.

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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UR - http://www.scopus.com/inward/citedby.url?scp=84971450008&partnerID=8YFLogxK

U2 - 10.1186/1471-2466-14-164

DO - 10.1186/1471-2466-14-164

M3 - Article

C2 - 25341556

AN - SCOPUS:84971450008

VL - 14

JO - BMC Pulmonary Medicine

JF - BMC Pulmonary Medicine

SN - 1471-2466

IS - 1

M1 - 164

ER -

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

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