Reduced respiratory muscle strength and endurance in type 2 diabetes mellitus.

BACKGROUND: A restrictive lung function pattern is frequently observed in patients with diabetes mellitus (DM) and has been related to respiratory muscle dysfunction in type 1 DM or in mixed population. We aimed to verify whether such a relationship applies also to type 2 DM patients. METHODS: The respiratory muscle function was explored in 75 non-smoking patients with type 2 DM without pulmonary or cardiac diseases and compared with that of 40 healthy non-smoking control subjects matched by age and sex. Maximal inspiratory and expiratory pressures (MIP, MEP) and maximum voluntary ventilation (MVV), which reflect respiratory muscle strength and endurance, respectively, were measured, and a complete respiratory function assessment was recorded. RESULTS: Patients were in stable metabolic conditions and had, on average, normal total lung capacity and diffusing lung capacity for carbon monoxide. However, MIP and MVV were significantly reduced in comparison with those of control subjects. Both MIP/MEP and MVV significantly correlated with lung volumes and diffusing lung capacity for carbon monoxide. The multiple regression analysis identified age (beta coefficient = -0.238, p = 0.046), glycated haemoglobin (beta coefficient = -0.245, p = 0.047) and total lung capacity (beta coefficient = 0.430, p = 0.016) as independent correlates of MIP, whereas male sex (beta coefficient = 0.423, p = 0.004) and diabetic complications (beta coefficient = -0.248, p = 0.044) were independent correlates of MVV. CONCLUSIONS: In type 2 DM, respiratory muscle strength was reduced and significantly related to lung volumes and quality of metabolic control, whereas impaired endurance of respiratory muscles prevailed in patients with microvascular complications.

Respiratory symptoms/diseases and environmental tobacco smoke (ETS) in never smoker Italian women.

AIM: To study the relationship between respiratory/allergic disorders and chronic environmental tobacco smoke (ETS) exposure to husband or at workplace among non-smoking women of a general population in Italy. METHODS: Analyses regard 2195 married or employed women. Information was collected through a self-administered questionnaire. ETS exposure was validated by salivary cotinine. RESULTS: Exposure both to husband and at work resulted a significant risk factor for current dyspnoea (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.20-2.16), any shortness of breath at rest (OR 2.81, 95% CI 1.83-4.30), recent wheeze (OR 1.71, 95% CI 1.04-2.82), recent attacks of shortness of breath with wheeze (OR 1.85, 95% CI 1.05-3.26), asthma diagnosis/symptoms (OR 1.50, 95% CI 1.09-2.08), diagnosis of asthma or bronchitis/emphysema (obstructive lung diseases (OLD)) (OR 2.24, 95% CI 1.40-3.58), current cough/phlegm (OR 1.52, 95% CI 1.07-2.15), and rhino-conjunctivitis (OR 1.48, 95% CI 1.13-1.94). Exposure only at work yielded higher adjusted odds ratios for all health conditions, except for rhino-conjunctivitis. Overall, about 24% of shortness of breath at rest, 16% of dyspnoea, 17% of rhino-conjunctivitis, 12% of OLD, and 10% of asthma diagnosis/symptoms are attributable to the effect of exposures to both husband and at work. Twelve percent of shortness of breath at rest and 10% of rhino-conjunctivitis cases might be avoided by eliminating exposure only at work and only to husband, respectively. CONCLUSIONS: Lifetime ETS exposure, especially at work, is associated with respiratory symptoms/diseases, and it accounts for a sizeable proportion of such disorders. The combined effect of both exposures is higher than the separate effects.

Decline of neuroadrenergic bronchial innervation and respiratory function in type 1 diabetes mellitus: a longitudinal study.

BACKGROUND AND AIM: Type 1 diabetes mellitus complicated by autonomic neuropathy (AN) is characterized by depressed cholinergic bronchomotor tone and neuroadrenergic denervation of the lung. We explored the effects of AN on the rate of decline of pulmonary sympathetic innervation and respiratory function during a 5-year follow-up. METHODS: Twenty diabetic patients, 11 with AN, were enrolled in 1998 and then followed-up until 2003. During follow-up, glycosylated haemoglobin (HbA1c) was measured every 3 months. In 1998 and 2003 the patients underwent respiratory function tests and a ventilatory scintigraphic study of neuroadrenergic bronchial innervation using 123I-MIBG. RESULTS: During follow-up 4 patients, all with AN, were lost, and 1 developed AN. Forced vital capacity (FVC), and diffusing capacity of the lung for carbon monoxide (DLCO) showed comparable rates of decrease in patients with and without AN. The yearly decline of forced expiratory volume in 1 s (FEV1) was about double the physiologic rate, in both AN and AN-free patients. The MIBG clearance significantly increased both in patients with AN (T1/2: 118.88 +/- 30.14 min at baseline and 92.10 +/- 24.52 min at the end of follow-up) and without AN (135.14 +/- 17.09 min and 92.68 +/- 13.52 min, respectively), indicating a rapidly progressive neuroadrenergic denervation. The rate of the neuroadrenergic denervation was inversely related to the severity of autonomic dysfunction at baseline (Spearman's rho - 0.62, p = 0.017). Neither respiratory function indexes nor MIBG clearance changes correlated with the overall HbA1c values. CONCLUSIONS: Neuroadrenergic denervation of the lung parallels the decline of respiratory function indexes in diabetic patients both with and without AN and seems to be independent from the quality of glycemic control.

Plasma, salivary and urinary cotinine in non-smoker Italian women exposed and unexposed to environmental tobacco smoking (SEASD study).

BACKGROUND: The aim of this study was to compare cotinine determinations in three biological fluids for assessing environmental tobacco smoke (ETS) exposure in female non-smokers (n=1605) in Italy. METHODS: Information about ETS exposure at home, in the workplace, and in other places within the previous week was collected via questionnaire. Plasma, salivary and urinary cotinine levels were measured. Cotinine levels of > or =0.1 ng/mL for plasma, > or =0.2 ng/mL for saliva, and > or =0.5 ng/mL for urine were used to determine biochemical exposure. RESULTS: Median cotinine levels were significantly higher in exposed than in unexposed women (0.21 vs. 0.05 ng/mL in plasma, 0.80 vs. 0.41 ng/mL in saliva, and 9.74 vs. 5.30 ng/mL in urine). Self-reported ETS exposure was significantly related to biochemical exposure [odds ratio 2.99, (95% CI 2.40-3.72) for plasma; 1.90 (1.51-2.39) for saliva; and 2.67 (2.14-3.34) for urine]. Cotinine significantly increased with increasing exposure level, regardless of the exposure source. Among self-reported exposed subjects, higher percentages of cotinine level above the cut-off, i.e., indicating exposure, were found in saliva (76%) and urine (75%) than in plasma (52%). CONCLUSIONS: In general, women correctly reported their ETS exposure status. Both non-invasive salivary and urinary cotinine determinations seem preferable in epidemiological studies, in view of their higher sensitivity, when compared to plasma cotinine.

Cognitive impairment in chronic obstructive pulmonary disease--a neuropsychological and spect study.

Some analogy exists between cognitive impairment in hypoxemic patients with chronic obstructive pulmonary disease (COPD) and Alzheimer's disease (AD). We purposed to verify whether the analogy extends to the cerebral perfusion pattern. Ten normal subjects, 15 COPD patients with and 18 without hypoxemia, and 15 patients with mild AD matched for age and educational level underwent brain perfusion single photon emission computed tomography (SPECT) and neuropsychological assessment. Normal subjects and non hypoxemic COPD patients had comparable perfusion patterns. The average perfusion decreased from non hypoxemic to hypoxemic COPD and, then, to AD patients. Hypoperfusion of associative areas was the hallmark of AD, whereas the average perfusion of anterior cortical and subcortical regions did not distinguish AD and hypoxemic COPD patients. Both COPD groups scored higher than AD patients (p

Effects of formoterol inhaled dry powder on exercise performance in chronic obstructive pulmonary disease: a single-center, randomized, double-blind, placebo-controlled, crossover study.

BACKGROUND: Inhaled bronchodilators commonly are used to reduce the work of breathing in patients with chronic obstructive pulmonary disease (COPD). The effects of bronchodilators are assessed in terms of symptom relief and/or improvements in spirometric indices. However, disability in COPD patients also is related to determinants such as exercise tolerance, which cannot be predicted on the basis of respiratory function. The effect of bronchodilators, such as inhaled beta2-agonists, on exercise performance of COPD patients needs to be tested. OBJECTIVE: This study investigated the effects of formoterol inhaled dry powder on exercise performance assessed using the shuttle walking test (SWT) in patients with mild to moderate COPD. METHODS: Patients having COPD with mild to moderate airway obstruction performed a pulmonary function test and an SWT before and after inhalation, on 2 consecutive days, of formoterol 12 µg or placebo, given by dry powder inhaler, according to a double-blind, placebo-controlled, crossover study design. Breathlessness was measured using the Borg scale (BS) and a visual analog scale at baseline and after an SWT. RESULTS: Twenty patients (15 men, 5 women; mean [SD] age, 65.95 [8.32] years) were included in the study. Forced expiratory volume in 1 second (FEV1) (P = 0.009), forced mid-expiratory flow (FEF25-75) (P = 0.011), and SWT (P = 0.005) improved significantly more with formoterol than placebo. Breathlessness decreased with formoterol, but the difference compared with placebo was statistically significant only when measured using the BS (P = 0.023). In the pooled placebo and formoterol tests, changes in the SWT were unrelated to changes in FEV1 (r = 0.18) and in FEF25-75 (r = 0.31). CONCLUSIONS: The results of this study showed that formoterol inhaled dry powder significantly improved exercise performance in patients with COPD and that this effect was at least partially independent of achieved bronchodilation. A larger cohort of patients should be studied and a more comprehensive protocol performed to verify whether the increase in exercise tolerance after administration of formoterol is related to a decrease in expiratory flow limitation during exercise and/or to systemic effects of the drug. Another issue to be clarified is whether the improvement in exercise capacity can significantly decrease disability in patients with severe COPD.

[Air pollution and cardiac and respiratory function in three groups of patients]. / Inquinamento atmosferico e funzionalità cardiaca e respiratoria in tre gruppi di pazienti.

The association between exposure to urban air pollution and cardiac or respiratory impairments in susceptible subjects was evaluated in a panel study including 11 patients with chronic obstructive pulmonary disease (COPD), 7 with ischemic heart disease (IHD), and 11 asthmatics resident in Rome (Italy). Patients underwent repeated 24 h Holter EKG monitoring, 12 h pulse oximetry at night and spirometry examinations during 1999 summer and winter. Multiple linear regression models for repeated individual measures (fixed-effect) were used to analyse the relationship between average daily concentrations of pollutants (PM10-2.5, PM2.5 NO2 and O3) and outcome variables, controlling for meteorological conditions, survey period, and week-ends. In the BPCO panel, increasing ambient PM2.5 levels were associated with increased heart rate and decreased respiratory function. In the asthmatic panel, inverse associations between pulmonary function and both NO2 and PM10-2.5 concentrations were observed, as well as direct association between ambient NO2 concentrations and NO in exhaled breath. In the IHD panel an increase of hearth rate variability associated with increasing concentration of PM2.5 was observed.