A Maltese Study in Determining the Presence of Chronic Obstructive Pulmonary Disease in Metabolic Syndrome

Both Chronic Obstructive Pulmonary Disease (COPD) and Metabolic Syndrome (MetS) are pro-inflammatory states, and while the diagnosis of MetS in COPD has been extensively studied, the diagnosis of COPD in MetS is poorly studied. The study focuses on determining the presence of COPD in persons living with diabetes and MetS in Malta, and aims to identify differences in biomarkers between MetS subjects with and without COPD.

Diabetic MetS subjects at Malta's main general hospital were assessed through St George's Respiratory Questionnaire for COPD (SGRQ-C), modified Medical Research Council scale (mMRC), COPD Assessment Test (CAT), Centre for Epidemiological Studies Depression scale (CES-D), Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue scale, Spirometry, Six Minute Walk Test (6MWT), BODE index (composed of Body Mass Index, Obstruction, Dyspnoea, Exercise capacity) and routine blood tests. They were divided into three groups: the main study group consisted of MetS subjects with COPD, one control group consisted of MetS subjects with a smoking history but not COPD, and the other control group consisted of diabetic MetS subjects with no smoking history.

A total of 67 MetS subjects were included. Those with COPD had significantly worse outcomes in SGRQ-C scores, mMRC, CAT, spirometry, BODE, CES-D and FACIT Fatigue scale than smokers without COPD and non-smokers. 25-hydroxy-vitamin D levels were significantly lower in MetS subjects with COPD compared to smokers without COPD (p=0.030) and non-smokers (p=0.043). C-reactive protein (p=0.036), triglycerides (p=0.023) and total cholesterol (p=0.039) were significantly higher in MetS subjects with COPD compared to smokers without COPD.

Screening for depression and fatigue in subjects with COPD and MetS is recommended. Low vitamin D, high CRP, high triglyceride and high total cholesterol levels are correlated with a COPD diagnosis within the local MetS population, and monitoring these parameters would enable timely management.