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

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

Auteurs : Craig P. Hersh [États-Unis] ; Barry J. Make [États-Unis] ; David A. Lynch [États-Unis] ; R Graham Barr [États-Unis] ; Russell P. Bowler [États-Unis] ; Peter Ma Calverley [Royaume-Uni] ; Peter J. Castaldi [États-Unis] ; Michael H. Cho [États-Unis] ; Harvey O. Coxson [Canada] ; Dawn L. Demeo [États-Unis] ; Marilyn G. Foreman [États-Unis] ; Meilan K. Han [États-Unis] ; Benjamin J. Harshfield [États-Unis] ; John E. Hokanson [États-Unis] ; Sharon Lutz [États-Unis] ; Joe W. Ramsdell [États-Unis] ; Elizabeth A. Regan [États-Unis] ; Stephen I. Rennard [États-Unis] ; Joyce D. Schroeder [États-Unis] ; Frank C. Sciurba [États-Unis] ; Robert M. Steiner [États-Unis] ; Ruth Tal-Singer [États-Unis] ; Edwin Jr Van Beek [Royaume-Uni] ; Edwin K. Silverman [États-Unis] ; James D. Crapo [États-Unis]

Source :

BMC Pulmonary Medicine [ 1471-2466 ] ; 2014.

RBID : PMC:4216374

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.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2466-14-164) contains supplementary material, which is available to authorized users.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216374

DOI: 10.1186/1471-2466-14-164
PubMed: 25341556
PubMed Central: 4216374

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<author><name sortKey="Han, Meilan K" sort="Han, Meilan K" uniqKey="Han M" first="Meilan K" last="Han">Meilan K. Han</name>
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<author><name sortKey="Hokanson, John E" sort="Hokanson, John E" uniqKey="Hokanson J" first="John E" last="Hokanson">John E. Hokanson</name>
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<author><name sortKey="Lutz, Sharon" sort="Lutz, Sharon" uniqKey="Lutz S" first="Sharon" last="Lutz">Sharon Lutz</name>
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<wicri:cityArea>Department of Biostatistics, Colorado School of Public Health, Aurora</wicri:cityArea>
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<author><name sortKey="Ramsdell, Joe W" sort="Ramsdell, Joe W" uniqKey="Ramsdell J" first="Joe W" last="Ramsdell">Joe W. Ramsdell</name>
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<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>Division of Pulmonary and Critical Care Medicine, University of California, San Diego</wicri:cityArea>
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<author><name sortKey="Regan, Elizabeth A" sort="Regan, Elizabeth A" uniqKey="Regan E" first="Elizabeth A" last="Regan">Elizabeth A. Regan</name>
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<author><name sortKey="Rennard, Stephen I" sort="Rennard, Stephen I" uniqKey="Rennard S" first="Stephen I" last="Rennard">Stephen I. Rennard</name>
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<author><name sortKey="Schroeder, Joyce D" sort="Schroeder, Joyce D" uniqKey="Schroeder J" first="Joyce D" last="Schroeder">Joyce D. Schroeder</name>
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<author><name sortKey="Sciurba, Frank C" sort="Sciurba, Frank C" uniqKey="Sciurba F" first="Frank C" last="Sciurba">Frank C. Sciurba</name>
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</placeName>
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<author><name sortKey="Steiner, Robert M" sort="Steiner, Robert M" uniqKey="Steiner R" first="Robert M" last="Steiner">Robert M. Steiner</name>
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<placeName><region type="state">Pennsylvanie</region>
</placeName>
<wicri:cityArea>Department of Radiology, Temple University, Philadelphia</wicri:cityArea>
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<author><name sortKey="Tal Singer, Ruth" sort="Tal Singer, Ruth" uniqKey="Tal Singer R" first="Ruth" last="Tal-Singer">Ruth Tal-Singer</name>
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<author><name sortKey="Van Beek, Edwin Jr" sort="Van Beek, Edwin Jr" uniqKey="Van Beek E" first="Edwin Jr" last="Van Beek">Edwin Jr Van Beek</name>
<affiliation wicri:level="2"><nlm:aff id="Aff17">Department of Radiology, University of Edinburgh, Edinburgh, Scotland</nlm:aff>
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<placeName><region type="country">Écosse</region>
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<wicri:cityArea>Department of Radiology, University of Edinburgh, Edinburgh</wicri:cityArea>
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<author><name sortKey="Silverman, Edwin K" sort="Silverman, Edwin K" uniqKey="Silverman E" first="Edwin K" last="Silverman">Edwin K. Silverman</name>
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<placeName><region type="state">Massachusetts</region>
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<placeName><region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston</wicri:cityArea>
</affiliation>
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<author><name sortKey="Crapo, James D" sort="Crapo, James D" uniqKey="Crapo J" first="James D" last="Crapo">James D. Crapo</name>
<affiliation wicri:level="2"><nlm:aff id="Aff3">Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Colorado</region>
</placeName>
<wicri:cityArea>Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver</wicri:cityArea>
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<author><name sortKey="Hersh, Craig P" sort="Hersh, Craig P" uniqKey="Hersh C" first="Craig P" last="Hersh">Craig P. Hersh</name>
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<author><name sortKey="Make, Barry J" sort="Make, Barry J" uniqKey="Make B" first="Barry J" last="Make">Barry J. Make</name>
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<author><name sortKey="Lynch, David A" sort="Lynch, David A" uniqKey="Lynch D" first="David A" last="Lynch">David A. Lynch</name>
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<placeName><region type="state">Colorado</region>
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<author><name sortKey="Barr, R Graham" sort="Barr, R Graham" uniqKey="Barr R" first="R Graham" last="Barr">R Graham Barr</name>
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<placeName><region type="state">État de New York</region>
</placeName>
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<author><name sortKey="Bowler, Russell P" sort="Bowler, Russell P" uniqKey="Bowler R" first="Russell P" last="Bowler">Russell P. Bowler</name>
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<author><name sortKey="Calverley, Peter Ma" sort="Calverley, Peter Ma" uniqKey="Calverley P" first="Peter Ma" last="Calverley">Peter Ma Calverley</name>
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<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Division of Infection and Immunity Clinical Sciences Centre, University Hospital Aintree, Liverpool</wicri:regionArea>
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<author><name sortKey="Castaldi, Peter J" sort="Castaldi, Peter J" uniqKey="Castaldi P" first="Peter J" last="Castaldi">Peter J. Castaldi</name>
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<placeName><region type="state">Massachusetts</region>
</placeName>
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<author><name sortKey="Cho, Michael H" sort="Cho, Michael H" uniqKey="Cho M" first="Michael H" last="Cho">Michael H. Cho</name>
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<country>États-Unis</country>
<placeName><region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Channing Division of Network Medicine, Boston</wicri:cityArea>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="Aff2">Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Coxson, Harvey O" sort="Coxson, Harvey O" uniqKey="Coxson H" first="Harvey O" last="Coxson">Harvey O. Coxson</name>
<affiliation wicri:level="1"><nlm:aff id="Aff7">Department of Radiology, University of British Columbia, Vancouver, Canada</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>Department of Radiology, University of British Columbia, Vancouver</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Demeo, Dawn L" sort="Demeo, Dawn L" uniqKey="Demeo D" first="Dawn L" last="Demeo">Dawn L. Demeo</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">Channing Division of Network Medicine, Boston, MA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Channing Division of Network Medicine, Boston</wicri:cityArea>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="Aff2">Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Foreman, Marilyn G" sort="Foreman, Marilyn G" uniqKey="Foreman M" first="Marilyn G" last="Foreman">Marilyn G. Foreman</name>
<affiliation wicri:level="2"><nlm:aff id="Aff8">Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Géorgie (États-Unis)</region>
</placeName>
<wicri:cityArea>Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Han, Meilan K" sort="Han, Meilan K" uniqKey="Han M" first="Meilan K" last="Han">Meilan K. Han</name>
<affiliation wicri:level="2"><nlm:aff id="Aff9">Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Michigan</region>
</placeName>
<wicri:cityArea>Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Harshfield, Benjamin J" sort="Harshfield, Benjamin J" uniqKey="Harshfield B" first="Benjamin J" last="Harshfield">Benjamin J. Harshfield</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">Channing Division of Network Medicine, Boston, MA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Channing Division of Network Medicine, Boston</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Hokanson, John E" sort="Hokanson, John E" uniqKey="Hokanson J" first="John E" last="Hokanson">John E. Hokanson</name>
<affiliation wicri:level="2"><nlm:aff id="Aff10">Department of Epidemiology, Colorado School of Public Health, Aurora, CO USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Colorado</region>
</placeName>
<wicri:cityArea>Department of Epidemiology, Colorado School of Public Health, Aurora</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Lutz, Sharon" sort="Lutz, Sharon" uniqKey="Lutz S" first="Sharon" last="Lutz">Sharon Lutz</name>
<affiliation wicri:level="2"><nlm:aff id="Aff11">Department of Biostatistics, Colorado School of Public Health, Aurora, CO USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Colorado</region>
</placeName>
<wicri:cityArea>Department of Biostatistics, Colorado School of Public Health, Aurora</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Ramsdell, Joe W" sort="Ramsdell, Joe W" uniqKey="Ramsdell J" first="Joe W" last="Ramsdell">Joe W. Ramsdell</name>
<affiliation wicri:level="2"><nlm:aff id="Aff12">Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>Division of Pulmonary and Critical Care Medicine, University of California, San Diego</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Regan, Elizabeth A" sort="Regan, Elizabeth A" uniqKey="Regan E" first="Elizabeth A" last="Regan">Elizabeth A. Regan</name>
<affiliation wicri:level="2"><nlm:aff id="Aff3">Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Colorado</region>
</placeName>
<wicri:cityArea>Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Rennard, Stephen I" sort="Rennard, Stephen I" uniqKey="Rennard S" first="Stephen I" last="Rennard">Stephen I. Rennard</name>
<affiliation wicri:level="2"><nlm:aff id="Aff13">Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Omaha, NE USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Nebraska</region>
</placeName>
<wicri:cityArea>Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Omaha</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Schroeder, Joyce D" sort="Schroeder, Joyce D" uniqKey="Schroeder J" first="Joyce D" last="Schroeder">Joyce D. Schroeder</name>
<affiliation wicri:level="2"><nlm:aff id="Aff4">Department of Radiology, National Jewish Health, Denver, CO USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Colorado</region>
</placeName>
<wicri:cityArea>Department of Radiology, National Jewish Health, Denver</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Sciurba, Frank C" sort="Sciurba, Frank C" uniqKey="Sciurba F" first="Frank C" last="Sciurba">Frank C. Sciurba</name>
<affiliation wicri:level="2"><nlm:aff id="Aff14">Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Pennsylvanie</region>
</placeName>
<wicri:cityArea>Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Steiner, Robert M" sort="Steiner, Robert M" uniqKey="Steiner R" first="Robert M" last="Steiner">Robert M. Steiner</name>
<affiliation wicri:level="2"><nlm:aff id="Aff15">Department of Radiology, Temple University, Philadelphia, PA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Pennsylvanie</region>
</placeName>
<wicri:cityArea>Department of Radiology, Temple University, Philadelphia</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Tal Singer, Ruth" sort="Tal Singer, Ruth" uniqKey="Tal Singer R" first="Ruth" last="Tal-Singer">Ruth Tal-Singer</name>
<affiliation wicri:level="2"><nlm:aff id="Aff16">GlaxoSmithKline R&D, King of Prussia, PA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Pennsylvanie</region>
</placeName>
<wicri:cityArea>GlaxoSmithKline R&D, King of Prussia</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Van Beek, Edwin Jr" sort="Van Beek, Edwin Jr" uniqKey="Van Beek E" first="Edwin Jr" last="Van Beek">Edwin Jr Van Beek</name>
<affiliation wicri:level="2"><nlm:aff id="Aff17">Department of Radiology, University of Edinburgh, Edinburgh, Scotland</nlm:aff>
<country>Royaume-Uni</country>
<placeName><region type="country">Écosse</region>
</placeName>
<wicri:cityArea>Department of Radiology, University of Edinburgh, Edinburgh</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Silverman, Edwin K" sort="Silverman, Edwin K" uniqKey="Silverman E" first="Edwin K" last="Silverman">Edwin K. Silverman</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">Channing Division of Network Medicine, Boston, MA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Channing Division of Network Medicine, Boston</wicri:cityArea>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="Aff2">Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Crapo, James D" sort="Crapo, James D" uniqKey="Crapo J" first="James D" last="Crapo">James D. Crapo</name>
<affiliation wicri:level="2"><nlm:aff id="Aff3">Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Colorado</region>
</placeName>
<wicri:cityArea>Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver</wicri:cityArea>
</affiliation>
</author>
</analytic>
<series><title level="j">BMC Pulmonary Medicine</title>
<idno type="eISSN">1471-2466</idno>
<imprint><date when="2014">2014</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>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.</p>
</sec>
<sec><title>Methods</title>
<p>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<sub>-950</sub>
) ≥10%. Non-emphysematous COPD was defined by airflow obstruction with minimal to no emphysema (LAA<sub>-950</sub>
 < 5%).</p>
</sec>
<sec><title>Results</title>
<p>Out of 4197 COPD subjects, 1687 were classified as emphysema-predominant and 1817 as non-emphysematous; 693 had LAA<sub>-950</sub>
 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 (FEV<sub>1</sub>
 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.</p>
</sec>
<sec><title>Conclusions</title>
<p>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.</p>
</sec>
<sec><title>Trial registration</title>
<p>Clinicaltrials.gov identifiers: COPDGene <ext-link ext-link-type="uri" xlink:href="http://clinicaltrials.gov/show/NCT00608764">NCT00608764</ext-link>
, ECLIPSE <ext-link ext-link-type="uri" xlink:href="http://clinicaltrials.gov/show/NCT00292552">NCT00292552</ext-link>
.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/1471-2466-14-164) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
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<journal-id journal-id-type="iso-abbrev">BMC Pulm Med</journal-id>
<journal-title-group><journal-title>BMC Pulmonary Medicine</journal-title>
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<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
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<article-id pub-id-type="pmc">4216374</article-id>
<article-id pub-id-type="publisher-id">599</article-id>
<article-id pub-id-type="doi">10.1186/1471-2466-14-164</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
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<given-names>Joyce D</given-names>
</name>
<address><email>schroederj@njhealth.org</email>
</address>
<xref ref-type="aff" rid="Aff4"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sciurba</surname>
<given-names>Frank C</given-names>
</name>
<address><email>sciurbafc@upmc.edu</email>
</address>
<xref ref-type="aff" rid="Aff14"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Steiner</surname>
<given-names>Robert M</given-names>
</name>
<address><email>rsteiner5933@aol.com</email>
</address>
<xref ref-type="aff" rid="Aff15"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tal-Singer</surname>
<given-names>Ruth</given-names>
</name>
<address><email>Ruth.M.Tal-Singer@gsk.com</email>
</address>
<xref ref-type="aff" rid="Aff16"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>van Beek</surname>
<given-names>Edwin JR</given-names>
</name>
<address><email>edwin-vanbeek@ed.ac.uk</email>
</address>
<xref ref-type="aff" rid="Aff17"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Silverman</surname>
<given-names>Edwin K</given-names>
</name>
<address><email>ed.silverman@channing.harvard.edu</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff2"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Crapo</surname>
<given-names>James D</given-names>
</name>
<address><email>crapoj@njhealth.org</email>
</address>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author"><collab>the COPDGene and ECLIPSE Investigators</collab>
</contrib>
<aff id="Aff1"><label></label>
Channing Division of Network Medicine, Boston, MA USA</aff>
<aff id="Aff2"><label></label>
Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA</aff>
<aff id="Aff3"><label></label>
Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO USA</aff>
<aff id="Aff4"><label></label>
Department of Radiology, National Jewish Health, Denver, CO USA</aff>
<aff id="Aff5"><label></label>
Department of Medicine, Columbia University, New York, NY USA</aff>
<aff id="Aff6"><label></label>
Division of Infection and Immunity Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK</aff>
<aff id="Aff7"><label></label>
Department of Radiology, University of British Columbia, Vancouver, Canada</aff>
<aff id="Aff8"><label></label>
Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA USA</aff>
<aff id="Aff9"><label></label>
Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI USA</aff>
<aff id="Aff10"><label></label>
Department of Epidemiology, Colorado School of Public Health, Aurora, CO USA</aff>
<aff id="Aff11"><label></label>
Department of Biostatistics, Colorado School of Public Health, Aurora, CO USA</aff>
<aff id="Aff12"><label></label>
Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA USA</aff>
<aff id="Aff13"><label></label>
Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Omaha, NE USA</aff>
<aff id="Aff14"><label></label>
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA USA</aff>
<aff id="Aff15"><label></label>
Department of Radiology, Temple University, Philadelphia, PA USA</aff>
<aff id="Aff16"><label></label>
GlaxoSmithKline R&D, King of Prussia, PA USA</aff>
<aff id="Aff17"><label></label>
Department of Radiology, University of Edinburgh, Edinburgh, Scotland</aff>
</contrib-group>
<pub-date pub-type="epub"><day>24</day>
<month>10</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>24</day>
<month>10</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="collection"><year>2014</year>
</pub-date>
<volume>14</volume>
<elocation-id>164</elocation-id>
<history><date date-type="received"><day>6</day>
<month>5</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>9</day>
<month>10</month>
<year>2014</year>
</date>
</history>
<permissions><copyright-statement>© Hersh et al.; licensee BioMed Central Ltd. 2014</copyright-statement>
<license license-type="open-access"><license-p>This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>
) applies to the data made available in this article, unless otherwise stated.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p>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.</p>
</sec>
<sec><title>Methods</title>
<p>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<sub>-950</sub>
) ≥10%. Non-emphysematous COPD was defined by airflow obstruction with minimal to no emphysema (LAA<sub>-950</sub>
 < 5%).</p>
</sec>
<sec><title>Results</title>
<p>Out of 4197 COPD subjects, 1687 were classified as emphysema-predominant and 1817 as non-emphysematous; 693 had LAA<sub>-950</sub>
 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 (FEV<sub>1</sub>
 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.</p>
</sec>
<sec><title>Conclusions</title>
<p>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.</p>
</sec>
<sec><title>Trial registration</title>
<p>Clinicaltrials.gov identifiers: COPDGene <ext-link ext-link-type="uri" xlink:href="http://clinicaltrials.gov/show/NCT00608764">NCT00608764</ext-link>
, ECLIPSE <ext-link ext-link-type="uri" xlink:href="http://clinicaltrials.gov/show/NCT00292552">NCT00292552</ext-link>
.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/1471-2466-14-164) contains supplementary material, which is available to authorized users.</p>
</sec>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd>Airway disease</kwd>
<kwd>CT scan</kwd>
<kwd>Diabetes mellitus</kwd>
<kwd>Emphysema</kwd>
<kwd>Spirometry</kwd>
</kwd-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2014</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
</record>

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

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

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