Rationale for the Use of New Methods of Investigation of Metabolic Syndrome in the Diagnosis and Treatment of Patients with Broncho-Obstructive Diseases

The aim of the investigation was to evaluate the need for further research into features of the morbidity and the course of metabolic syndrome among patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD).

Materials and Methods. We examined 235 patients with BA and 103 patients with COPD. To evaluate their nutritional status we identified the body mass index, waist circumference (WC), the index of “waist circumference/height” (WC/height), and the percentages of adipose tissue and of visceral fat. We also studied the biochemical and immunochemical parameters of their metabolism: the levels of fasting blood glucose, postprandial glucose, glycated hemoglobin (HbA1c), immunoreactive insulin, and C-peptide, together with their lipid profiles.

Results. The metabolic changes identified are typical of patients with BA and COPD. Obesity was observed in 45.5% of patients with COPD and 62% of patients with BA. Calculation of the WC/height index, and assessing data obtained using bioelectrical impedance analysis can help optimise the diagnosis of obesity. As patients with BA and COPD are fairly likely to develop dyslipidemia this reveals the need for thorough studies of their lipid profiles that can help in the calculation the levels of apolipoproteins A1 and B. In both groups a high frequency of diabetes mellitus was registered, reaching 33% in the group of patients with BA. The identification and diagnosis of diabetes mellitus or of early disorders of carbohydrate metabolism amongst hospitalised patients with BA and COPD is impossible without testing fasting blood glucose and the dynamics of postprandial glucose in addition to determining the level of HbA1c.

Conclusion. Regular screening for metabolic disorders among patients with BA and COPD will enable optimisation of their treatment and could reduce the severity of the diseases, as well as decreasing the risk of cardiovascular, endocrinal or pulmonary mortality.

1. Avdeev S.N. Khronicheskaya obstruktivnaya bolezn’ legkikh [Chronic obstructive pulmonary disease]. Moscow: Izdatel’skiy kholding “Atmosfera”; 2010; 160 p.
2. Astaf’eva N.G., Gamova I.V., Udovichenko E.N., Perfilova I.A. Obesity and bronchial asthma. Lechashchiy vrach 2014; 5: 100.
3. Global’naya strategiya diagnostiki, lecheniya i profilaktiki khronicheskoy obstruktivnoy bolezni legkikh (peresmotr 2011 g.) [Global strategy of diagnosis, treatment and prevention of chronic obstructive pulmonary disease (updated 2011)]. Pod red. Belevskogo A.S. [Belevskiy A.S. (editor)]. Moscow: Rossiyskoe respiratornoe obshchestvo; 2012.
4. Popova T.N. Osobennosti kliniko-laboratornykh proyavleniy i nutritivnogo statusa u bol'nykh KhOBL v sochetanii s metabolicheskim sindromom. Avtoref. dis. ... kand. med. nauk [Features of clinical laboratory manifestations and nutritional status in patients with COPD in combination with metabolic syndrome. PhD Thesis]. Tyumen; 2009.
5. Ryazanov A.S., Kireev S.A., Eremenko N.N. Influence of the body mass index on the spirography parameters in patients with COPD in combination with metabolic syndrome. Biomeditsina 2010; 4: 119–121.
6. Sokolova S.Yu. Klinicheskie, immunologicheskie i bakteriologicheskie proyavleniya khronicheskoy obstruktivnoy bolezni legkikh na fone ozhireniya. Dis. ... kand. med. nauk [Clinical, immunological and bacteriological manifestations of chronic obstructive pulmonary disease complicated by obesity. DSc Dissertation]. Samara; 2007.
7. Smetneva N.S., Vikentiev V.V., Zavyalova S.A., Popkova A.M., Malishev I.Y. Role of inflammatory factors in the development of cardiovascular pathology in chronic obstructive pulmonary disease. Fundamentalnie issledovania 2013; 3: 162–166.
8. Chuchalin A.G. Chronic obstructive pulmonary disease and comorbidities. Part I. COPD and diseases of the cardiovascular system. Russkij medicinskij zurnal 2008; 16(2): 58–64.
9. Mannino D.M., Thorn D., Swensen A., Holguin F. Prevalence and outcomes of diabetes, hypertension, and cardiovascular disease in COPD. Eur Respir J 2008; 32(4): 962–969, http://dx.doi.org/10.1183/09031936.00012408.
10. Antonovich Zh.V., Oleynik T.S., Starovoytova S.O., Tsarev V.P. Disorders of lipid metabolism in patients with bronchial asthma and dose maintenance therapy with inhaled glucocorticosteroids. Meditsinskaya panorama 2009; 6: 6–12.
11. Global’naya strategiya lecheniya i profilaktiki bronkhial’noy astmy (peresmotr 2011 g.) [Global strategy for asthma management and prevention (updated 2011)]. Pod red. Belevskogo A.S. [Belevskiy A.S. (editor)]. Moscow: Rossiyskoe respiratornoe obshchestvo; 2012.
12. Ermolova A.V., Budnevskiy A.V., Drobysheva E.S. bronchial asthma and metabolic syndrome: clinical-pathological relations. Molodoy uchenyy 2014; 6: 291–294.
13. Nagornyy A.B. Osobennosti narusheniya uglevodnogo obmena u bol’nykh bronkhial’noy astmoy. Avtoref. dis. … kand. med. nauk [Features of disorders in the carbohydrate metabolism of patients with bronchial asthma. PhD Thesis]. Moscow; 2004.
14. Panfilov U.A., Uryasiev O.M. Clinicofunctional and laboratory features of the course of bronchial asthma among patients with metabolic syndrome. Rossiyskiy mediko-biologicheskiy vestnik im. akademika I.P. Pavlova 2008; 4: 85–99.
15. Uryas’ev O.M., Panfilov Yu.A. Bronchial asthma and metabolic syndrome: some aspects of comorbidity. Mezhdunarodnyy endokrinologicheskiy zhurnal 2008; 3(15): 15–25.
16. Tsibulkina V.N., Tsibulkin N.A. Asthma and obesity: coincidence or pattern? Prakticheskaya meditsina 2011; 6(54): 36–41.
17. Brenner J.S., Kelly C.S., Wenger A.D., Brich S.M., Morrow A.L. Asthma and obesity in adolescents: is there an association? J Asthma 2001; 38(6): 509–515, http://dx.doi.org/10.1081/jas-100105872.
18. Beyther D.A., Sutherland E.R. Over weight, obesity and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Resp Crit Care Med 2007; 175: 661–667, http://dx.doi.org/10.1164/rccm.200611-1717OC.
19. Saint-Pierre P., Bourdin A., Chanez P., Daures J.P., Godard P. Are overweight asthmatics more difficult to control. Allergy 2006; 61(1): 79–84, http://dx.doi.org/10.1111/j.1398-9995.2005.00953.x.
20. Sood A., Qualls C., Li R., Schuyler M., Beckett W.S., Smith L.J., Thyagarajan B., Lewis C.E., Jacobs D.R.; CARDIA Investigators. Lean mass predicts asthma better than fat mass among females. Eur Respir J 2011; 1(37): 65–71, http://dx.doi.org/10.1183/09031936.00193709.
21. Yeh K.H., Skowronski M.E., Coreno A.J., Seitz R.E., Villalba K.D., Dickey-White H., McFadden E.R. Impact of obesity on the severity and therapeutic responsiveness of acute episodes of asthma. J Asthma 2011; 8(6): 546–552, http://dx.doi.org/10.3109/02770903.2011.581733.
22. Yashina L.A., Ishchuk S.G. Bronchial asthma in patients with obesity — a specific phenotype of the disease. Astma ta alergіya 2011; 4: 46–49.
23. Kovaleva O.N. Obesity and the risk of cardiovascular pathology in women. Zdorov’ya Ukraini 2009; 9(26).
24. Proekt rekomendatsiy ekspertov rossiyskogo kardiologicheskogo obshchestva po diagnostike i lecheniyu metabolicheskogo sindroma (3-y peresmotr) [Draft Recommendations of experts from the russian society of cardiology for the diagnostics and treatment of metabolic syndrome (3rd updated)]. Moscow; 2013; 103 p.
25. Likhonosova A.P., Likhonosov N.P., Kuznetsova O.G. Analysis of methods for determining the level of glycosylated hemoglobin as used in health care facilities in Saint Petersburg. Mezhdunarodnyy endokrinologicheskiy zhurnal 2010; 6(30): 23–27.
26. Ametov A.S. Sakharnyy diabet 2 tipa. Problemy i resheniya [Diabetes mellitus type 2. Problems and solutions]. Moscow: GEOTAR-Media; 2011; 704 p.

Vakhlamov V.A., Tyurikova A.V. Rationale for the Use of New Methods of Investigation of Metabolic Syndrome in the Diagnosis and Treatment of Patients with Broncho-Obstructive Diseases. Sovremennye tehnologii v medicine 2015; 7(4): 127, https://doi.org/10.17691/stm2015.7.4.17