International Journal of Diabetes Mellitus (2011) xxx, xxx–xxx
Diabetes Science International
International Journal of Diabetes Mellitus www.elsevier.com/locate/ijdm www.sciencedirect.com
CLINICAL QUIZ
Significance of spirometry in a diabetic patient with chronic cough Sultan Ayoub Meo
*
Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia Received 12 January 2011; accepted 17 January 2011
KEYWORDS Chronic cough; Spirometry; Lung function; Diabetes
Abstract Diabetes mellitus (DM) is a group of metabolic disease of all age groups especially the middle age and aged people. Diabetes can cause serious complications that involve multiple organs and physiological functions. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs and systems. Spirometry is a powerful tool used to detect, differentiate, follow and manage the patients with pulmonary disorders. Diabetic patients with a clinical history of respiratory complaints and any occupational and industrial exposure, in that condition, spirometry is more important to assess the risk and early diagnosis of lung disease. 2011 International Journal of Diabetes Mellitus. Published by Elsevier Ltd. All rights reserved.
1. Clinical presentation A 48-year-old patient, a known case of type 2 diabetes mellitus, presented with a productive cough for the last 2 months. Detailed clinical history revealed that the patient was smoking 8–10 cigarette/day for the last 3 years. The patient was working in the cement industry. On clinical examination, tempera-
ture was 98.4 F, blood pressure 120/80 mmHg, pulse rate 78 min 1 and respiratory rate 16 min 1. Spirometry was advised to assess lung functions for COPD (see Fig. 1).
* Address: Department of Physiology [29], College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia. Tel.: +966 1 4671604; fax: +966 1 4672567. E-mail addresses:
[email protected],
[email protected] 1877-5934 2011 International Journal of Diabetes Mellitus. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ijdm.2011.01.009
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Figure 1
Spirogram.
Please cite this article in press as: Meo SA, Significance of spirometry in a diabetic patient with chronic cough, Int J Diab Mellitus (2011), doi:10.1016/j.ijdm.2011.01.009
2 2. Questions 1. Identify the pattern of lung function impairment? 2. The forced vital capacity was 3.46 l and forced expiratory volume in first second was 2.30 l. What will be the forced expiratory ratio? 3. Enumerate the clinical significance of spirometry?
3. Discussion Spirometry is a widely used pulmonary function test, ideally suited to describe the effects of obstruction or restriction on lung function. It is a powerful diagnostic tool that plays a significant role in the early diagnosis of lung damage and its associated structures in diabetic patients [2,3]. Spirometry is frequently performed to assess the risk of anaesthetic procedures before surgery, and to evaluate disability or impairment, and is important in confirming the diagnosis and assessing the severity of disease [4]. Chronic obstructive pulmonary disease (COPD) is manifested by chronic cough, sputum production, wheezing and, in later stages, dyspnea and poor exercise tolerance. Symptomatic COPD affects more than 5% of the adult population, and is the fourth leading cause of death, as well as the twelfth leading cause of morbidity in the United States. Co-existence of diabetes mellitus and COPD increases the rate complicates by factors. In more than 80% of cases, cigarette smoking is causally linked to the development of COPD. Subjects with COPD cannot breathe out as quickly as a healthy person because of obstructed airflow through their airways. Most recently, airflow obstruction has been defined as a forced expiratory volume in 1 s (FEV1) value of less than 80% of predicted, in association with an FEV1 to forced vital capacity ratio (FEV1/FVC%) of less than 70%. Both the FEV1 and FVC values are usually reduced in patients defined as having airflow limitation. Because FEV1 is affected more than the FVC, the ratio of the FEV1 to FVC (FEV1/FVC%) also decreases. Spi-
S.A. Meo rometry, in addition to clinical examination, improves chronic obstructive pulmonary disease [COPD] diagnostic accuracy, as compared to clinical examination alone, and it is a useful diagnostic tool in individuals with symptoms suggestive of possible COPD [5]. 4. Answers
1. Mild chronic obstructive pulmonary disease. 2. The forced vital capacity was 3.46 l and forced expiratory volume in first second was 2.30 l, hence the forced expiratory ratio is: 2.30/3.46 · 100 = 66.47%. 3. Spirometry is essential to evaluate dyspnea, wheezing, cough, phlegm production, diminished breath sounds, abnormal chest radiographs and for individuals in occupations with exposure to various pollutant substances. Spirometry is also vital to assess preoperative risk and prognosis, as well as health status, before enrollment in strenuous physical activity programs and validation of subjective complaints in occupational/environmental settings [1].
References [1] American Thoracic Society. Statement on standardization of spirometry. Am J Respir Crit Care Med 1995;152:1107–36. [2] Meo SA. Significance of spirometry in diabetic patients. Int J Diabetes Mellitus 2001;2(1):47–50. [3] Meo SA, Al-Drees AM, Arif M, Al-Rubean K. Lung function in type 2 Saudi diabetic patients. Saudi Med J 2006;27(3): 338–43. [4] Ruppel GL. Pulmonary function testing. Trends and techniques. Resp Care Clin North Am 1997;3:155–81. [5] Wilt TJ, Niewoehner D, Kim C, Kane RL, Linabery A, Tacklind J, et al. Use of spirometry for case finding, diagnosis, and management of chronic obstructive pulmonary disease (COPD). Evid Rep Technol Assess 2005;121:1–7.
Please cite this article in press as: Meo SA, Significance of spirometry in a diabetic patient with chronic cough, Int J Diab Mellitus (2011), doi:10.1016/j.ijdm.2011.01.009
