title: Hyperglycaemia during exacerbations of asthma and chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Hyperglycaemia is a well-known phenomenon among patients with an exacerbation of asthma or chronic obstructive pulmonary disease (COPD). It may be associated with increased risks of death and complications.
  
  
  OBJECTIVE
  To define the prevalence and determinants of hyperglycaemia in patients with an exacerbation of asthma or COPD.
  
  
  METHODS
  This was a prospective, cross-sectional study including 153 hospitalised patients with an exacerbation of asthma or COPD. All received inhaled beta-2-adrenergic bronchodilators and oral glucocorticoids in internationally recommend doses. Plasma glucose was measured seven times during the first day. Hyperglycaemia was defined as fasting glucose >6.9 mmol/L or postprandial glucose >11.1 mmol/L. In addition, the family history for diabetes and the Karnofsky performance score were assessed. Height, weight, waist circumference, oxygen saturation, blood pressure, temperature and heart rate were measured. Glycosylated haemoglobin A1c (gHbA1c), C-reactive protein, leucocytes, urea and arterial blood gas values were analysed.
  
  
  RESULTS
  Eighty-two per cent of the patients demonstrated hyperglycaemia, with similar prevalence between asthma and COPD. Of the 130 patients without a previous diagnosis of diabetes, 79% showed hyperglycaemia. In binary logistic regression analysis, high gHbA1c, high C-reactive protein and Karnofsky score less than 80% associated with the presence of fasting hyperglycaemia. High gHbA1c and current smoking associated with postprandial hyperglycaemia.
  
  
  CONCLUSIONS
  Hyperglycaemia is very common among hospitalised patients with an exacerbation of asthma or COPD. It is probably triggered by the medication and the patient's metabolic predisposition mainly determines its presence. Current smoking is the main treatable contributor to hyperglycaemia.
authors.affiliation: Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Heikki O
authors.initials: HO
authors.lastname: Koskela
authors.forename: Päivi H
authors.initials: PH
authors.lastname: Salonen
authors.forename: Leo
authors.initials: L
authors.lastname: Niskanen
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000453:epidemiology* / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology* / Q000378:metabolism; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000378:metabolism; D012307:Risk Factors; D013312:Stress, Physiological / Q000502:physiology*; D014508:Urea / Q000097:blood
chemical_list: D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D014508:Urea; C517652:hemoglobin A1c protein, human
keywords: COPD; asthma; diabetes; glucose metabolism; hyperglycaemia; stress hyperglycaemia