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      Metabolic Disorders in Chronic Lung Diseases

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          Abstract

          Chronic lung diseases represent complex diseases with gradually increasing incidence, characterized by significant medical and financial burden for both patients and relatives. Their increasing incidence and complexity render a comprehensive, multidisciplinary, and personalized approach critically important. This approach includes the assessment of comorbid conditions including metabolic dysfunctions. Several lines of evidence show that metabolic comorbidities, including diabetes mellitus, dyslipidemia, osteoporosis, vitamin D deficiency, and thyroid dysfunction have a significant impact on symptoms, quality of life, management, economic burden, and disease mortality. Most recently, novel pathogenetic pathways and potential therapeutic targets have been identified through large-scale studies of metabolites, called metabolomics. This review article aims to summarize the current state of knowledge on the prevalence of metabolic comorbidities in chronic lung diseases, highlight their impact on disease clinical course, delineate mechanistic links, and report future perspectives on the role of metabolites as disease modifiers and therapeutic targets.

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          Most cited references109

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          Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999.

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            Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD.

            Chronic obstructive pulmonary disease (COPD) is associated with important chronic comorbid diseases, including cardiovascular disease, diabetes and hypertension. The present study analysed data from 20,296 subjects aged > or =45 yrs at baseline in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS). The sample was stratified based on baseline lung function data, according to modified Global Initiative for Obstructive Lung Disease (GOLD) criteria. Comorbid disease at baseline and death and hospitalisations over a 5-yr follow-up were then searched for. Lung function impairment was found to be associated with more comorbid disease. In logistic regression models adjusting for age, sex, race, smoking, body mass index and education, subjects with GOLD stage 3 or 4 COPD had a higher prevalence of diabetes (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.1-1.9), hypertension (OR 1.6, 95% CI 1.3-1.9) and cardiovascular disease (OR 2.4, 95% CI 1.9-3.0). Comorbid disease was associated with a higher risk of hospitalisation and mortality that was worse in people with impaired lung function. Lung function impairment is associated with a higher risk of comorbid disease, which contributes to a higher risk of adverse outcomes of mortality and hospitalisations.
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              Sarcoidosis.

              Sarcoidosis is a systemic disease of unknown cause that is characterised by the formation of immune granulomas in various organs, mainly the lungs and the lymphatic system. Studies show that sarcoidosis might be the result of an exaggerated granulomatous reaction after exposure to unidentified antigens in individuals who are genetically susceptible. Several new insights have been made, particularly with regards to the diagnosis and care of some important manifestations of sarcoidosis. The indications for endobronchial ultrasound in diagnosis and for PET in the assessment of inflammatory activity are now better specified. Recognition of unexplained persistent disabling symptoms, fatigue, small-fibre neurological impairment, cognitive failure, and changes to health state and quality of life, has improved. Mortality in patients with sarcoidosis is higher than that of the general population, mainly due to pulmonary fibrosis. Predicted advances for the future are finding the cause of sarcoidosis, and the elucidation of relevant biomarkers, reliable endpoints, and new efficient treatments, particularly in patients with refractory sarcoidosis, lung fibrosis, and those with persistent disabling symptoms. Copyright © 2014 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                URI : http://frontiersin.org/people/u/494315
                URI : http://frontiersin.org/people/u/490584
                URI : http://frontiersin.org/people/u/503719
                URI : http://frontiersin.org/people/u/471755
                URI : http://frontiersin.org/people/u/368727
                Journal
                Front Med (Lausanne)
                Front Med (Lausanne)
                Front. Med.
                Frontiers in Medicine
                Frontiers Media S.A.
                2296-858X
                18 January 2018
                2017
                : 4
                : 246
                Affiliations
                [1] 1First Academic Department of Pneumonology, Hospital for Diseases of the Chest “Sotiria”, Medical School, National and Kapodistrian University of Athens , Athens, Greece
                [2] 25th Department of Respiratory Medicine, Hospital for Diseases of the Chest “Sotiria” , Athens, Greece
                [3] 3Department of Internal Medicine, Section of Pulmonary Critical Care and Sleep Medicine, Yale School of Medicine , New Haven, CT, United States
                [4] 4Division of Immunology, Biomedical Sciences Research Center Alexander Fleming , Athens, Greece
                Author notes

                Edited by: Marco Confalonieri, University of Trieste, Italy

                Reviewed by: Eleni Papakonstantinou, Aristotle University of Thessaloniki, Greece; Martin Petrek, Palacký University, Olomouc, Czechia

                *Correspondence: Argyrios Tzouvelekis, argyrios.tzouvelekis@ 123456fleming.gr

                Specialty section: This article was submitted to Pulmonary Medicine, a section of the journal Frontiers in Medicine

                Article
                10.3389/fmed.2017.00246
                5778140
                29404325
                b941299f-49df-487c-bde5-676e46843a21
                Copyright © 2018 Papaioannou, Karampitsakos, Barbayianni, Chrysikos, Xylourgidis, Tzilas, Bouros, Aidinis and Tzouvelekis.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 03 November 2017
                : 18 December 2017
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 133, Pages: 9, Words: 7997
                Categories
                Medicine
                Review

                chronic lung diseases,metabolic disorders,comorbidities,metabolomics,pathogenetic pathways

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