Chest
Volume 136, Issue 4, October 2009, Pages 1039-1046
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Original Research
COPD
The Metabolic Syndrome in Patients With Chronic Bronchitis and COPD: Frequency and Associated Consequences for Systemic Inflammation and Physical Inactivity

https://doi.org/10.1378/chest.09-0393Get rights and content

Background

The metabolic syndrome is a condition frequently found among individuals > 60 years of age. It predisposes affected individuals to systemic inflammation and physical inactivity. Systemic inflammation and physical inactivity are relevant extrapulmonary markers of morbidity and mortality in patients with COPD. Here, we studied the following: (1) the frequency of the coexisting metabolic syndrome in patients with chronic bronchitis (CB) and COPD of different severities; and (2) its association with systemic inflammation and physical inactivity.

Methods

In 30 patients with CB (normal spirometry finding) and in 170 patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages I to IV), we measured the characteristics of the metabolic syndrome, systemic inflammation (high-sensitivity C-reactive protein [hs-CRP], interleukin-6, fibrinogen), and the physical activity level.

Results

The frequencies of the metabolic syndrome in patients with CB, GOLD stages I, II, III, and IV, were 53%, 50%, 53%, 37%, and 44%, respectively (average, 47.5%). The levels of hs-CRP and interleukin-6 were significantly increased in patients with the metabolic syndrome, while the physical activity level was significantly decreased. Multivariate linear regression analyses revealed metabolic syndrome, physical activity level, and CB/GOLD stages to be independent predictors of hs-CRP and interleukin-6 levels, and physical activity level to be a predictor of fibrinogen levels.

Conclusions

In our study, almost one-half of the patients with CB/COPD had coexisting metabolic syndrome, with a slightly lower frequency in patients with severe COPD. The coexisting metabolic syndrome is associated with an increase in the levels of some systemic inflammatory markers and physical inactivity, independent of lung function impairment.

Section snippets

Study Population

One hundred seventy stable outpatients with COPD of different levels of severity (128 men and 42 women) and 30 patients with CB (23 men and 7 women) were investigated between February and November 2006 at the Pulmonary Research Institute at Hospital Grosshansdorf, Schleswig-Holstein, Germany. Details of the COPD population and lung function methodology have been published elsewhere.13 Patients with COPD had to be free from exacerbation for at least 2 months. They were classified according to

Results

Characteristics of the patients are given in Table 1, Table 2. The frequencies of the metabolic syndrome in patients with CB, GOLD stages I, II, III, and IV, were 53%, 50%, 53%, 37%, and 44%, respectively (average, 47.5%) [Table 2]. The presence of the metabolic syndrome in patients with CB and COPD was associated with significantly higher levels of hs-CRP and interleukin-6 compared with patients without metabolic syndrome (Fig 1A and B). Fibrinogen levels did not differ between patients with

Discussion

The main finding of our study was that a considerable number of patients with CB and COPD of different severities have a coexisting metabolic syndrome, and that the coexisting metabolic syndrome is associated with an increase in the levels of some systemic inflammatory markers and physical inactivity in these patients, irrespective of lung function impairment.

In our study, at least one-half of the patients with CB, GOLD stage I, and GOLD stage II had a coexisting metabolic syndrome. This

Acknowledgments

Author contributions: Dr. Watz planned this study, collected the data for this study, analyzed the data, and wrote the manuscript. Dr. Waschki collected the data for this study, analyzed the data, and assisted with writing and statistical analysis. Dr. Kirsten analyzed the data, and assisted with writing of the manuscript. Dr. Müller collected the data for this study and assisted with writing of the manuscript. Dr. Kretschmar analyzed the data and assisted with writing of the manuscript. Dr.

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Funding/Support: This study was supported by Deutsche Rentenversicherung Nord, the Dr. Fritz Meyer Struckmann Foundation, and an unrestricted research grant from AstraZeneca.

The work was performed at the Pulmonary Research Institute at Hospital Grosshansdorf, Center for Pneumology and Thoracic Surgery, Grosshansdorf, Germany.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

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