EPOC y alteraciones endocrinometabólicas

Martín, María Jesús Chillón; Díez, Javier de Miguel; Moreno, Alicia Ferreira; Muñoz, Gema Sánchez

doi:10.1016/S0300-2896(09)72863-7

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La evolución clínica y el manejo terapéutico de la enfermedad pulmonar obstructiva crónica (EPOC) pueden verse afectados por la presencia de alguna comorbilidad, lo que además suele contribuir a empeorar el pronóstico. Entre las alteraciones endocrinometabólicas que pueden asociarse a la EPOC, se encuentran la diabetes mellitus, la osteoporosis, el síndrome metabólico o la malnutrición. Son diversos los posibles mecanismos etiopatogénicos que intervienen en la asociación entre EPOC y diferentes trastornos endocrinometabólicos, como el tabaco y la respuesta inflamatoria sistémica con intervención de diferentes citocinas, entre otros. Por otro lado, los glucocorticoides sistémicos a dosis altas utilizados en el tratamiento de la EPOC grave y de las agudizaciones, supone un factor importante en el riesgo de desarrollar ciertas alteraciones metabólicas, como la diabetes mellitus y la osteoporosis.

En el estudio del paciente con EPOC, es importante identificar los posibles trastornos endocrinometabólicos coexistentes, para aplicar medidas de corrección y de prevención. Por lo general, los pacientes se beneficiarán de la inclusión en un programa de rehabilitación respiratoria con ejercicio físico y una dieta equilibrada, además del tratamiento farmacológico oportuno en cada caso. También resultan fundamentales ciertas medidas, como evitar el tabaquismo, el sedentarismo, y realizar el tratamiento correcto de la EPOC.

Palabras clave:

Enfermedad pulmonar obstructiva crónica

Diabetes mellitus

Síndrome metabólico

Osteoporosis

Malnutrición

Dislipemia

Alteraciones endocrinometabólicas

Abstract

The clinical course and therapeutic management of chronic obstructive pulmonary disease (COPD) may be affected by the presence of comorbid diseases, which also usually worsen prognosis. Among the endocrinological and metabolic alterations that can be associated with COPD are diabetes mellitus, osteoporosis, metabolic syndrome and malnutrition. There are several possible etiopathogenic mechanisms that intervene in the association between COPD and distinct endocrine and metabolic disorders, such as smoking and systemic inflammation, influenced by distinct cytokines among other factors. The high-dose glucocorticosteroids used in the treatment of severe COPD and exacerbations are a major risk factor for the development of some metabolic alterations such as diabetes and osteoporosis.

Study of patients with COPD should identify the possible coexisting endocrinological and metabolic alterations in order to apply preventive measures and treatment. In general, patients benefit from being included in a respiratory rehabilitation program with physical exercise and a balanced diet, in addition to appropriate drug treatment in each case. Certain measures such as avoiding smoking and sedentariness are also essential in the correct treatment of COPD

Keywords:

Chronic obstructive pulmonary disease

Diabetes mellitus

Metabolic syndrome

Osteoporosis

Malnutrition

Dyslipidemia

Endocrine and metabolic alterations

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Bibliografía

[1.]

R. Horton.

The neglected epidemic of chronic disease.

Lancet, 366 (2005), pp. 1514

http://dx.doi.org/10.1016/S0140-6736(05)67454-5 | Medline

[2.]

V. Sobradillo, M. Miravitlles, C.A. Jiménez, R. Gabriel, J.L. Viejo, J.F. Masa, et al.

Estudio IBERCOP en España: prevalencia de síntomas respiratorios habituales y de limitación crónica al flujo aéreo.

Arch Bronconeumol, 35 (1999), pp. 159-166

Medline

[3.]

W.M. Chatila, B.M. Thomashow, O.A. Minai, G.J. Criner, B.J. Make.

Comorbidities in chronic obstructive pulmonary disease.

Proc Am Thorac Soc, 5 (2008), pp. 549-555

http://dx.doi.org/10.1513/pats.200709-148ET | Medline

[4.]

J. De Miguel Díez, M. Méndez Bailón.

Comorbilidad en la EPOC. Impliocaciones diagnósticas y terapéuticas.

Revista de Patología Respiratoria, 11 (2008), pp. 109-116

[5.]

D.D. Sin, N.R. Anthonisen, J.B. Soriano, A.G. Agusti.

Mortality in COPD: Role of comorbidities.

Eur Respir J, 28 (2006), pp. 1245-1257

http://dx.doi.org/10.1183/09031936.00133805 | Medline

[6.]

L.M. Fabbri, R. Ferrari.

Chronic disease in the elderly: back to the future of internal medicine.

Breathe, 3 (2006), pp. 40-49

[7.]

F.G. Sánchez-Lora, F. Amorós Martínez, M.A. García Ordóñez, J. Custardoy Olavarrieta.

EPOC y trastornos endocrinometabólicos.

Rev Clin Esp, 207 (2007), pp. 33-39

[8.]

D.J. Barker, K.M. Godfrey, C. Fall, C. Osmond, P.D. Winter, S.O. Shaheen.

Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease.

BMJ, 303 (1991), pp. 671-675

Medline

[9.]

H.O. Lithell, P.M. McKeigue, L. Berglund, R. Mohsen, U.B. Lithell, D.A. Leon.

Relation of size at birth to non-insulin dependent diabetes and insulin concentrations in men aged 50-60 years.

BMJ, 312 (1996), pp. 406-410

Medline

[10.]

M.J. Sevenoaks, R.A. Stockley.

Chronic obstructive pulmonary disease, inflammation and co-morbidity - a common inflammatory phenotype?.

Respir Res, 7 (2006), pp. 70

http://dx.doi.org/10.1186/1465-9921-7-70 | Medline

[11.]

L.M. Fabbri, F. Luppi, B. Beghé, K.F. Rabe.

Complex chronic comorbidities of COPD.

Eur Respir J, 31 (2008), pp. 204-212

http://dx.doi.org/10.1183/09031936.00114307 | Medline

[12.]

P. Carrasco Garrido, J. De Miguel Díez, J. Rejas Gutiérrez, A. Martín Centeno, E. Gobartt Vázquez, A. Gil de Miguel, et al.

Negative impacto f chronic obstructive pulmonary disease on the Elath-related quality of life of patients. Results of the EPIDEPOC study.

Health and Quality of Life Outcomes, 4 (2006), pp. 31

http://dx.doi.org/10.1186/1477-7525-4-31 | Medline

[13.]

S. Loukides, D. Polyzogopoulos.

The effect of diabetes mellitus on the outcome of patients with chronic obstructive pulmonary disease exacerbated due to respiratory infections.

Respiration, 63 (1996), pp. 170-173

Medline

[14.]

J.C. Will, D.A. Galuska, E.S. Ford, A. Mokdad, E.E. Calle.

Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohorte study.

Int J Epidemiol, 30 (2001), pp. 540-546

Medline

[15.]

E.C. Creutzberg, R. Casaburi.

Endocrinological disturbances in chronic obstructive pulmonary disease.

Eur Respir J, 22 (2004), pp. 76S-80S

[16.]

M. Poulain, M. Doucet, G.C. Major, V. Drapeau, F. Sériès, L.P. Boulet, et al.

The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies.

CMAJ, 174 (2006), pp. 1293-1299

http://dx.doi.org/10.1503/cmaj.051299 | Medline

[17.]

G. Engstrom, L. Janzon.

Risk of developing diabetes is inversely related to lung function: a population-based cohort study.

Diab Med, 19 (2002), pp. 167-170

[18.]

J.S. Rana, M.A. Mittleman, J. Sheihh, F.B. Hu, J.E. Manson, G.A. Colditz, et al.

Chronic obstructive pulmonary disease, asthma, and risk of type 2 diabetes in women.

Diabetes Care, 27 (2004), pp. 2478-2484

Medline

[19.]

N. Takabatake, H. Nakamura, S. Abe, S. Inoue, T. Hino, H. Saito, et al.

The relationship between chronic hypoxemia and activation of the tumor necrosis factor-alpha system in patients with chronic obstructive pulmonary disease.

Am J Respir Crit Care Med, 161 (2000), pp. 1179-1184

http://dx.doi.org/10.1164/ajrccm.161.4.9903022 | Medline

[20.]

G.A. Brooks, G.E. Butterfield, R.R. Wolfe, B.M. Groves, R.S. Mazzeo, J.R. Sutton, et al.

Increased dependence on blood glucose after acclimatization to 4,300 m.

J Appl Physiol, 70 (1991), pp. 919-927

Medline

[21.]

J.L. Azevedo Jr, J.O. Carey, W.J. Pories, P.G. Morris, G.L. Dohm.

Hypoxia stimulates glucosa transport in insulin-resistent human skeletal muscle.

Diabetes, 44 (1995), pp. 695-698

Medline

[22.]

A. Hjalmarsen, U. Aasebo, K. Birkeland, G. Sager, R. Jorde.

Impaired glucose tolerance in patients with chronic hypoxic pulmonary disease.

Diabetes Metab (Paris), 22 (1996), pp. 37-42

[23.]

G.C. Funk, D. Doberer, V. Petrov, L.H. Block.

Hyperglycemia, bronchial artery sclerosis, and lung function.

Am J Respir Crit Care Med, 169 (2004), pp. 3

http://dx.doi.org/10.1164/rccm.2310014 | Medline

[24.]

E.H. Baker, C.H. Janaway, B.J. Philips, A.L. Brennan, D.L. Baines, D.M. Wood, et al.

Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease.

Thorax, 61 (2006), pp. 284-289

http://dx.doi.org/10.1136/thx.2005.051029 | Medline

[25.]

G. Gudmundsson, T. Gislason, E. Lindberg, R. Hallin, C.S. Ulrik, E. Brondum, et al.

Mortality in COPD patients discharged from hospital: the role of treatment ando comorbidity.

Respir Res, 7 (2006), pp. 109

http://dx.doi.org/10.1186/1465-9921-7-109 | Medline

[26.]

D. Blackburn, J. Hux, M. Mamdani.

Quantification of the risk of the corticosteroidinduced diabetes mellitus among the elderly.

J Gen Intern Med, 17 (2002), pp. 717-720

Medline

[27.]

K.F. Rabe, S. Hurd, A. Anzueto, P.J. Barnes, S.A. Buist, P. Calverley, et al.

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

Am J Respir Crit Care Med, 176 (2007), pp. 532-555

http://dx.doi.org/10.1164/rccm.200703-456SO | Medline

[28.]

J.F. Ascaso, P. González-Santos, A. Hernández Mijares, A. Mangas Rojas, L. Massana Marín, J. Millán Núñez-Cortés, et al.

Foro-HDL. Diagnóstico de síndrome metabólico. Adecuación de los criterios diagnósticos en nuestro medio.

Clin Invest Arterioscl, 18 (2006), pp. 244-260

[29.]

G. Hu, Q. Qiao, J. Toumilehto, B. Balkau, K. Borch-Johnsen, K. Pyorala, DECODE Study Group.

Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women.

Arch Intern Med, 164 (2004), pp. 1066-1076

http://dx.doi.org/10.1001/archinte.164.10.1066 | Medline

[30.]

K. Marquis, F. Maltais, V. Duguay, A.M. Bezeau, P. LeBlanc, J. Jobin, et al.

The metabolic syndrome in patients with chronic obstructive pulmonary disease.

J Cardiopulm Rehab, 25 (2005), pp. 226-232

[31.]

S.M. Grundy, J.I. Cleeman, S.R. Daniels, K.A. Donato, R.H. Eckel, B.A. Franklin, et al.

Diagnosis and management of the metabolic syndrome: an American Heart Association/ National Heart, Lung, and Blood Institute Scientific Statement.

Circulation, 112 (2005), pp. 2735-2752

http://dx.doi.org/10.1161/CIRCULATIONAHA.105.169404 | Medline

[32.]

L.M. Entrenas Costa, J. Fernández de Córdoba y Gamero.

Comorbilidad en la EPOC.

EPOC. Inflamación, efectos sistémicos y comorbilidad, Ergon, (2008),

[33.]

N.R. Jorgensen, P. Schwarz, I. Holme, B.M. Henriksen, L.J. Petersen, V. Backer.

The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease-A cross sectional study.

Respir Med, 101 (2007), pp. 177-185

http://dx.doi.org/10.1016/j.rmed.2006.03.029 | Medline

[34.]

T.P. Van Staa, H.G. Leufkens, C. Cooper.

The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis.

Osteoporosis Int, 13 (2002), pp. 777-787

[35.]

O. Gluck, G. Colice.

Recognizing and treating glucocorticoid-induced osteoporosis in patients with pulmonary diseases.

Chest, 125 (2004), pp. 1859-1876

Medline

[36.]

M.B. Reid, Y.P. Li.

Tumor necrosis factor-α and muscle wasting: a cellular perspective.

Respir Res, 2 (2001), pp. 269-272

Medline

[37.]

T.J. Chambers.

Regulation of the differentiation and function of osteoclasts.

J Pathol, 192 (2000), pp. 4-13

http://dx.doi.org/10.1002/1096-9896(2000)9999:9999<::AID-PATH645>3.0.CO;2-Q | Medline

[38.]

B.R. Celli, C.G. Cole, J.M. Marin, C. Casanova, M. Montes de Oca, R.A. Mendez, et al.

The body-mass index, airflow obstruction, dyspnea and exercise capacity index in chronic obstructive pulmonary disease.

N Engl J Med, 350 (2004), pp. 1005-1012

http://dx.doi.org/10.1056/NEJMoa021322 | Medline

[39.]

J.J. Soler, L. Sánchez, P. Román, M.A. Martínez, M. Perpiñá.

Prevalencia de la desnutrición en pacientes ambulatorios con enfermedad pulmonar obstructiva estable.

Arch Bronconeumol, 40 (2004), pp. 250-258

Medline

[40.]

K. Marquis, R. Debigaré, Y. Lacasse, P. Leblanc, J. Jobin, G. Carrier, et al.

Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease.

Am J Respir Crit Care Med, 166 (2002), pp. 809-813

http://dx.doi.org/10.1164/rccm.2107031 | Medline

[41.]

R. Broelkhuizen, R.F. Grimble, W.M. Howell, D.J. Shale, E.C. Creutzberg, E.F. Wouters, et al.

Pulmonary cachexia, systemic inflammatory profile, and the interleukin 1-β-511 single nucleotide polymorphism.

Am J Clin Nutr, 82 (2005), pp. 1059-1064

Medline

[42.]

E. Barreiro, B. De la Puente, J. Minguella, J.M. Corominas, S. Serrano, S.N. Hussain, et al.

Oxidative stress and respiratory muscle dysfunction in severe chronic obstructive pulmonary disease.

Am J Respir Crit Care Med, 171 (2005), pp. 1116-1124

http://dx.doi.org/10.1164/rccm.200407-887OC | Medline

[43.]

N.S. Arora, D.F. Rochester.

Respiratory muscle strength and maximal voluntary ventilation in undernourished patients.

Am Rev Respir Dis, 126 (1982), pp. 5-8

http://dx.doi.org/10.1164/arrd.1982.126.1.5 | Medline

[44.]

A.C. Villablanca, J.M. McDonald, J.C. Rutledge.

Smoking and cardiovascular disease.

Clin Chest Med, 21 (2000), pp. 159-172

Medline

[45.]

F. Laghi, A. Antonescu-Turcu, E. Collins, J. Segal, D.E. Tobin, A. Jubran, et al.

Hypogonadism in men with chronic obstructive pulmonary disease: prevalence and quality of life.

Am J Respir Crit Care Med, 171 (2005), pp. 728-733

http://dx.doi.org/10.1164/rccm.200501-037OC | Medline

[46.]

J.A. Walters, E.H. Walters, R. Wood-Baker.

Oral corticosteroids for stable chronic obstructive pulmonary disease.

Cochrane Database Syst Rev, 3 (2005),

http://dx.doi.org/10.1002/14651858.CD009601.pub2 | Medline

[47.]

R.A. Pauwels, C.G. Lofdahl, L.A. Laitinen, J.P. Schouten, D.S. Postma, N.B. Pride, et al.

Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease.

N Engl J Med, 340 (1999), pp. 1948-1953

http://dx.doi.org/10.1056/NEJM199906243402503 | Medline

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