Metabolic Syndrome, Diabetes and Chronic Obstructive Pulmonary Disease: Pathogenetic and Clinical Aspects

Author: Boyan Lozanov

Abstract:

Many studies in the last years demonstrate a high co-morbidity and similar pathogenetic characteristics between Metabolic syndrome (MS) and Diabetes mellitus type 2 (DM-2) on one hand, and Chronic obstructive pulmonary disease (COPD) on the other. The frequency of each increases over the age achieving epidemic levels in the population over 60 years. About 50% of the patients with COPD reveal data corresponding to the criteria for MS which is a point of discussion for their causal relationships. It was established recently that a chronic systemic inflammation appears as their common pathological characteristic. It is not restricted only to pulmonary inflammation and airway remodeling but includes also a chronic systemic inflammatory process in the visceral adipose tissue the abdominal area with insulin resistance and high level of proinflammatory cytokines as TNF-alpha, Interleucines (IL-6,IL-8), hormones (Leptin, Adiponectin) and other metabolically active molecules secreated by adipocytes. The local adipose tissue hypoxia and central (pulmonary onset) hypoxia in addition have a key role in the activation of inflammatory pathways which are considered a hallmark of COPD and the increased rate of co-morbidities, including cardiovascular complications. In this respect many environmental factors such as oxidative stress, smoking, bacterial or virus infections may contribute to the manifestations and clinical course of the disease. The crucial requirement for successful treatment is to apply effective methods against systemic inflammation and to increase the insulin sensitivity in order to overcome obesity.