Diabetische Pneumopathie

Abstract

Breathlessness or dyspnea is a frequent symptom in patients with diabetes and the first disease which has to be excluded is the coronary heart disease. However, previous epidemiological studies have shown that patients with diabetes mellitus have an increased risk for fibrotic pulmonary diseases, such as the idiopathic pulmonary fibrosis (IPF). Recent studies were able to show that patients with newly diagnosed type 2 diabetes have impaired pulmonary oxygen consumption and over 26 % of patients with long-term type 2 diabetes showed restrictive lung function with fibrotic interstitial lung diseases. Especially patients with type 2 diabetes and nephropathy had an 8-fold higher risk for lung diseases. This is not surprising since the pathomechanisms of pulmonary fibrosis and diabetic complications have much in common: reactive oxygen species induce DNA-damage with consecutive activation of inflammatory cytokines which induce fibrotic remodeling of the tissue. This leads us to the suggestion that patients with diabetes, albuminuria and breathlessness should be examined for interstitial lung disease on regular basis. However, data regarding the natural course of diabetic pneumopathy and therapeutic approaches are still missing. Small intervention studies with IPF-patients could show that sports and physical activity were able to stabilize the disease progression.

Diabetes mellitus ist eine Systemerkrankung, und betroffene Patienten werden regelmäßig auf makro- und mikrovaskuläre Folgeerkrankungen untersucht. Die Lunge als mögliches betroffenes Organ wird dabei nicht beachtet – obwohl mehrere Studien darauf hinweisen, dass sie ein Zielorgan für diabetische Folgeschäden ist. Dieser Beitrag fasst den aktuellen Wissensstand zu Pathogenese, Diagnostik und Therapie der diabetischen Pneumopathie zusammen.

Schlüsselwörter

Diabetes mellitus - interstitielle Lungenerkrankung - Lungenfibrose - diabetische Pneumopathie - Lungenfunktionsprüfung

Key words

diabetes mellitus - interstitial lung disease - pulmonary fibrosis - diabetic pneumopathy - pulmonary function testing

• Literatur

• 1 Berliner D, Schneider N, Welte T. et al. The differential diagnosis of dyspnea. Dtsch Arztebl Int 2016; 113: 834-845
• 2 Frese T, Sobeck C, Herrmann K. et al. Dyspnea as the reason for encounter in general practice. J Clin Med Res 2011; 3: 239-246
• 3 Quanjer PH, Stanojevic S, Cole TJ. et al. Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. Eur Respir J 2012; 40: 1324-1343
• 4 Robinson PD, Latzin P, Verbanck S. et al. Consensus statement for inert gas washout measurement using multiple- and single- breath tests. Eur Respir J 2013; 41: 507-522
• 5 Adeloye D, Chua S, Lee C. et al. Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. J Glob Health 2015; 5: 020415
• 6 Salvi S. Tobacco smoking and environmental risk factors for chronic obstructive pulmonary disease. Clin Chest Med 2014; 35: 17-27
• 7 Bokov P, Delclaux C. Interpretation and use of routine pulmonary function tests: Spirometry, static lung volumes, lung diffusion, arterial blood gas, methacholine challenge test and 6-minute walk test. Rev Med Interne 2016; 37: 100-110
• 8 Scarlata S, Costanzo L, Giua R. et al. Diagnosis and prognostic value of restrictive ventilatory disorders in the elderly: a systematic review of the literature. Exp Gerontol 2012; 47: 281-289
• 9 Hyldgaard C, Hilberg O, Muller A. et al. A cohort study of interstitial lung diseases in central Denmark. Respir Med 2014; 108: 793-799
• 10 Olson AL, Swigris JJ. Idiopathic pulmonary fibrosis: diagnosis and epidemiology. Clin Chest Med 2012; 33: 41-50
• 11 King Jr TE, Pardo A, Selman M. Idiopathic pulmonary fibrosis. Lancet 2011; 378: 1949-1961
• 12 Raghu G, Collard HR, Egan JJ. et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011; 183: 788-824
• 13 Kim YJ, Park JW, Kyung SY. et al. Clinical characteristics of idiopathic pulmonary fibrosis patients with diabetes mellitus: the national survey in Korea from 2003 to 2007. J Korean Med Sci 2012; 27: 756-760
• 14 Enomoto T, Usuki J, Azuma A. et al. Diabetes mellitus may increase risk for idiopathic pulmonary fibrosis. Chest 2003; 123: 2007-2011
• 15 Vracko R, Thorning D, Huang TW. Basal lamina of alveolar epithelium and capillaries: quantitative changes with aging and in diabetes mellitus. Am Rev Respir Dis 1979; 120: 973-983
• 16 Sandler M. Is the lung a “target organ” in diabetes mellitus?. Arch Intern Med 1990; 150: 1385-1388
• 17 Klein OL, Krishnan JA, Glick S. et al. Systematic review of the association between lung function and Type 2 diabetes mellitus. Diabet Med 2010; 27: 977-987
• 18 van den Borst B, Gosker HR, Zeegers MP. et al. Pulmonary function in diabetes: a metaanalysis. Chest 2010; 138: 393-406
• 19 Caughey GE, Preiss AK, Vitry AI. et al. Comorbid diabetes and COPD: impact of corticosteroid use on diabetes complications. Diabetes Care 2013; 36: 3009-3014
• 20 Maher TM, Wells AU, Laurent GJ. Idiopathic pulmonary fibrosis: multiple causes and multiple mechanisms?. Eur Respir J 2007; 30: 835-839
• 21 Richeldi L, Collard HR, Jones MG. Idiopathic pulmonary fibrosis. Lancet 2017; 389: 1941-1952
• 22 Kreuter M, Ehlers-Tenenbaum S, Palmowski K. et al. Impact of comorbidities on mortality in patients with idiopathic pulmonary fibrosis. PLoS One 2016; 11: e0151425
• 23 Röhling M, Pesta D, Markgraf DF. et al. Metabolic determinants of impaired pulmonary function in patients with newly diagnosed type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes 2018; 126: 584-589
• 24 Kopf S, Groener JB, Kender Z. et al. Breathlessness and restrictive lung disease: an important diabetes-related feature in patients with type 2 diabetes. Respiration 2018; 96: 29-40
• 25 Selman M, King TE, Pardo A. et al. Idiopathic pulmonary fibrosis: prevailing and evolving hypotheses about its pathogenesis and implications for therapy. Ann Intern Med 2001; 134: 136-151
• 26 Cheresh P, Kim SJ, Tulasiram S. et al. Oxidative stress and pulmonary fibrosis. Biochim Biophys Acta 2013; 1832: 1028-1040
• 27 Groener JB, Oikonomou D, Cheko R. et al. Methylglyoxal and advanced glycation end products in patients with diabetes – what we know so far and the missing links. Exp Clin Endocrinol Diabetes 2019; 127: 497-504
• 28 Jagadapillai R, Rane MJ, Lin X. et al. Diabetic microvascular disease and pulmonary fibrosis: the contribution of platelets and systemic inflammation. Int J Mol Sci 2016; 17: pii: E1853
• 29 Lipinski B. Pathophysiology of oxidative stress in diabetes mellitus. J Diabetes Complications 2001; 15: 203-210
• 30 Lehrke M, Marx N. Diabetes mellitus and heart failure. Am J Med 2017; 130: S40-S50
• 31 Nersisson R, Noel MM. Heart sound and lung sound separation algorithms: a review. J Med Eng Technol 2017; 41: 13-21
• 32 Padilla-Ortiz AL, Ibarra D. Lung and heart sounds analysis: state-of-the-art and future trends. Crit Rev Biomed Eng 2018; 46: 33-52
• 33 Bestall JC, Paul EA, Garrod R. et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999; 54: 581-586
• 34 Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998; 158: 1384-1387
• 35 Wilson RC, Jones PW. A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise. Clin Sci 1989; 76: 277-282
• 36 Stanojevic S. Standardisation of lung function test interpretation: Global Lung Function Initiative. Lancet Respir Med 2018; 6: 10-12
• 37 Travis WD, Costabel U, Hansell DM. et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2013; 188: 733-748
• 38 Oh IH, Park JH, Lee CH. et al. The association of normal range glycated hemoglobin with restrictive lung pattern in the general population. PLoS One 2015; 10: e0117725
• 39 Spagnolo P, Kreuter M, Maher TM. et al. Metformin does not affect clinically relevant outcomes in patients with idiopathic pulmonary fibrosis. Respiration 2018; 96: 314-322
• 40 Gaunaurd IA, Gómez-Marín OW, Ramos CF. et al. Physical activity and quality of life improvements of patients with idiopathic pulmonary fibrosis completing a pulmonary rehabilitation program. Respir Care 2014; 59: 1872-1879
• 41 Vainshelboim B. Exercise training in idiopathic pulmonary fibrosis: is it of benefit?. Breathe 2016; 12: 130-138