**7. Conclusion**

We think that we should estimate the risk of diabetes in a COPD patient and *vice versa,* given the frequent simultaneity of both conditions and the confluence of common related factors.

Definitely, prospective population-based and experimental evidence is needed to elucidate the crucial pathways between chronic hypoxemic status, insulin resistance and their contributing factors, mainly tabaquism, adiposity and disordered sleep. Of note, the architecture of sleep is of growing importance in DM. Understanding the clustering of these disorders and its cardiovascular prognosis may have an epidemiological impact on the tandem increase of COPD, DM and related conditions. Probably, lifestyle interventions on tobacco, diet and sleep habits are the key to keep the individual's health and long term well-being.

Chronic Obstructive Pulmonary Disease and Diabetes *Mellitus* 253

Falk, JA.; Kadiev, S.; Criner, GJ.; Schof, SM.; Minai, OA. & Diaz P. (2008). Cardiac disease in

Faul, JL.; Tormey, W.; Tormey, V. & Burke, C. (1998). High dose inhaled costicosteroid and

Faul, JL.; Wilson, S.; Chu, J.; Canfield, J. & Kuschner, W. (2009). The effect of an inhaled

Festa, A.; D'Agostino, RJ.; Tracy, RP. & Haffner, SM. (2002). Elevated levels of acute-phase

Ford, ES. & Mannino, DM. (2004). Prospective association between lung function and the

Survey Epidemiologic Follo-up Study. *Diabetes Care*, Vol.27, pp.2966-2970 Garcia-Rio, F.; Lores, V.; Mediano, O., Rojo, B.; Herranz, A.; López-Collazo, E. & Alvarez-

*Journal of Respiratory and Critical Care Medicine*, Vol. 80, No.6, pp.506-512 García-Rio, F.; Romero, D.; Lores, V.; Casitas, R.; Herranz, A.; Galera, R.; et.al. (2011).

Greenburg, DL.; Lettieri, CJ. & Eliasson, AH. (2009). Effects of surgical weight loss on

Gudmundsson, G.; Gislason, T.; Lindberg, E.; Hallin, R.; Suplí, C.; Brondum, E.; et al. (2006).

Heindl, S.; Lehnert, M.; Criée, CP.; Hasenfuss, G. & Andreas S. (2001). Marked sympathetic

Hu, G.; Qjao, Q.; Toumilehto, J.; Balkau, B.; Borch-Johnsen, K. & Pyorala, K. (2004).

Kim, HJ.; Lee, JY.; Jung, HS.; Kim, DK.; Lee, SM.; Yim, JJ.; et al.(2010). The impact of insulin

Knutson, KL.; Ryden, AM., Mander, BA.& Van Cauter, E. (2006). Role of sleep duration and

Knutson, K., Spiegel, K.; Penev, P.& Van Cauter, E. (2007). The metabolic consequences of

sleep deprivation. *Sleep Medicine Review* ,Vol.11, No.3, pp.163-178

*Respiratory and Critical Care Medicine*, Vol.164, No. 4, pp.597-601

COPD patients. *Chest* (Epub ahead of print)

morbidity. *Respiratory Research,* Vol. 7, pp. 109-117

*Archives of Internal Medicine*, Vol. 164, pp.1066-1076

*Medicine*, Vol.166, No. 16 , pp.1768-1774

*Medicine,* Vol. 122, pp. 535-542

Vol. 5, No: 4 , pp. 543-548

pp.1491

1131-1137

pp. 362-367

No.1-2 ,pp.14-20

chronic obstructive pulmonary disease. *Proceedings of The American Thoracic Society,* 

dose dependent loss of diabetic control. *British Medical Journal* , Vol. 317, No. 7171,

corticoid on glucose control in type 2 diabetes. *Clinical Medicine & Reserch,* Vol. 7,

proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes: the Insulin Resitance Atherosclerosis Study. *Diabetes,*Vol. 51, No. 4, pp.

incidence of diabetes. Findings from the National Health and Nutrition Examination

Sala, R. (2009). Daily physical activity in patients with chronic obstructive pulmonary disease is mainly associated with dynamic hyperinflation. *American* 

Dynamic hyperinflation, arterial blood oxygen and airway oxidative stress in stable

measures of obstructive sleep apnea: a meta-analysis. *The American Journal of* 

Mortality in COPD patients ischarged from hospital: the role of treatment and co-

activation in patients with chronic respiratory failure. *American Journal of* 

DECODE study Group. Prevalence of the metabolic syndrome and its relation to all cause and cardiovascular mortality in non diabetic European men and women.

sensitisers on lung function in patients with chronic obstructive pulmonary disease and diabetes. *The International Journal of Tuberculosis and Lung Disease* , Vol. 14, No.3,

quality in the risk and severity of type 2 diabetes *mellitus*. *Archives of Internal* 

#### **8. References**


Ashley, C.; Burton, D.; Sverrisdottir, YB.; Sander, M.; McKenzie, DK.& Macefield, VG.(2010).

Alcolea, S.; Villamar, J. & Alvarez-Sala R. (2007). Nutricional status in COPD. *Archivos de* 

Álvarez- Sala, R. Chronic obstructive pulmonary disease: beyond the lungs. (2010). *Revista* 

Archer, JR. & Baker, EH.(2009). Diabetes and metabolic dysfunction in COPD. COPD

Ayas, NT.; White, DP.; Al-Delaimy, WK., Manson, JE.; Stampfer, MJ.; Speizer, FE.; et

Bergman RN. (2005). Minimal model: perspective from. *Hormone Research*, Vol. 64, pp.8-15 Botros, N., Concato, J.; Mohsenin, V.; Selim, B.; Doctor, K. & Yaggi, HK. (2009). Obstructive

Braghiroli, A & Alvarez-Sala, R. (2002). Sleep disordered breathing and COPD. *Sleep Breath*,

Chatila, WC.; Thomashow, BM.; Minai, OA.; Criner, GJ. & Make, BJ. (2008). Comorbidities in

Chen, K.; Li, F.; Li, J.; Cai, H.; Strom, S.; Bisello, A.; et al. (2006). Induction of leptine

Chillón, MJ.; De Miguel, J.; Ferreira, A. & Sánchez, G. (2009). COPD and endocrine and metabolic alterations. *Archivos de Bronconeumología,* Vol. 45, No. 4 , pp. 42-46 Chin, K.; Shimizu, K.; Nakamura, T.; Narai, N.; Masuzaki, H.; Ogawa, Y. et al. (1999).

Davis, WA.; Knuitman, M.; Kendall, P.; Grange, V. & Davis, TM. (2004). Glycemic exposure

De Miguel, J.; Cabello, J.; Sánchez-Alarcos, JM.; Alvarez-Sala, R.; Espinós, D. & Alvarez-Sala,

Ehrlich, SF.; Quesenberry, CP.; Van, SK.; Shan, J. & Ferrara, A. (2010). Patients diagnosed

Dalquen, P. The lung in diabetes *mellitus*. (1999). *Respiration,* Vol. 66, No.1 , pp. 12-13

al.(2003). A prospective study of self-reported sleep duration and incident diabetes

sleep apnea as a risk factor for type 2 diabetes. *The American Journal of Medicine*, Vol.

chronic obstructive pulmonary disease. *Proceedings of The American Thoracic Society*,

resistance through direct interaction of C-reactive protein with leptin. *Nature* 

Changes in intra-abdominal visceral fat and serum leptin levels in patients with intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway pressure

is associated with reduced pulmonary function in type 2 diabetes: the Fremantle

JL. (2002). Long-term effects of treatment with nasal continuous positive airway pressure on lung function in patients with overlap syndrome. *Sleep Breath*, Vol. 6,

with diabetes are at increased risk for asthma, chronic obstructive pulmonary diseae, pulmonary fibrosis, and pneumonia but not lung cancer. *Diabetes Care* 2,

Firing probability and mean firing rates of human muscle vasoconstrictor neurones are elevated during chronic asphyxia. *The Journal of Physiology*, Vol. 588,

**8. References** 

No. 4, pp. 701-711

122, No. 12, pp. 1122-27

Vol. 5, No. 4, pp. 549-555

*Medicine*, Vol.12, No. 4, pp.425-432

therapy. *Circulation,* Vol.100, No. 7, pp. 706-712

Diabetes Study. *Diabetes Care*,Vol.27, No. 3,pp.752-757

Vol.6, No.1, pp. 1-2

No.1, pp.3-10

Vol. 33, No.1, pp.55-60

*Bronconeumología*, Vol.43, No. 5, pp. 283-238

*Clínica Española, V*ol. 210, No. 3, pp. 124-126

uptodate. *Respiratory Medicine,* Vol. 5, pp.67-74

in women. *Diabetes Care ,* Vol.26, No. 2, pp.380-384


Chronic Obstructive Pulmonary Disease and Diabetes *Mellitus* 255

Parappil, A.; Depczynski, B.; Collett, P. & Marks, G.(2010). Effect of comorbid diabetes on

Pauwels, RA.; Buist, AS.;Jenkins, CR. & Hurd, SS. GOLD Scientific Commitee. (2001). Global

Vol. 163, No. 5, pp. 1256-1276. Available from http:// www.goldcopd.org Peces- Barba, G.; Barberá, JA.; Agustí, A.; Casanova, C..; Casas, A.; Izquierdo, JL.; et al.

Pillar, G. & Shehadeh, N. (2008). Abdominal fat and sleep apnea. The chicken or the egg?.

Polotsky, VY.; Li, J.; Punjabi, NM.; Rubin, AE.; Smith, PL.; Schwartz, AR.; et al. (2007).

Popov, V. & Simionescu, M. (1997). Alterations of lung structure in experimental diabetes

Rana, JS.; Mittleman, MA.; Sheikh, J.; Hu, FB.; Manson, JE.; Colditz, GA.; et al. (2004).

Raupach, T.; Bahr, F.; Herrmann, P.; Luethje, L.; Heusser, K.; Hasenfuss, G.; et al. (2008).

Reichmuth, KJ.; Austin, D.; Skatrud, JB. & Young, T. (2005). Association of sleep apnea and

Santiago-Recuerda, A.; Gómez-Terreros, FJ.; Caballero, P.; Martin-Duce, A.; Soleto, MJ.;

Sevenoaks, M. & Stockley, RA. (2006). Chronic obstructive pulmonary disease, inflammation

Sharma, SK.; Kumpawat, S.; Goel, A.; Banga, A.; Ramakrishnan, L.& Chaturvedi, P. (2007).

Slatore, CG.; Bryson, CL. & Au, DH. (2009).The association of inhaled corticosteroid use

COPD. *Respirology,*Vol.15, No. 6, pp. 918-922

*Diabetes Care*, Vol. 31, No. 2, pp. 303-309

*Journal*, Vol.10, No. 8 , pp.1850-1858

*Journal*, Vol. 32, No. 2, pp. 387-392

*Surgery*, Vol.17, No.5, pp.689-97

No.1, pp.70

*Journal of Physiology*, Vol.552, No. 1, pp.253-264

women. *Diabetes Care*, Vol.27, No. 10, pp.2478-2484

*Care of Medicine*, Vol. 172, No. 12, pp. 1590– 1595

*Medicina Interna*, Vol. 24, No. 4, pp.201-203

*Medicine*, Vol.122, No. 5 , pp. 472-478

Vol.5, pp. 271-281

length of stay and risk of death in patients admitted with acute exacerbations of

strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. *The American Journal Critical Care of Medicine,* 

(2008). Diagnosis and management of chronic obstructive pulmonary disease: joint guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Latin American Thoracic Society (ALAT). *Archivos de Bronconeumología*,

Intermittent hypoxia increases insulin resistance in genetically obese mice. *The* 

and diabetes associated with hyperlipidemia in hamsters*. The European Respiratory* 

Chronic obstructive pulmonary disease, asthma, and risk of type 2 diabetes in

Slow breathing reduces sympathoexcitation in COPD. *The European Respiratory* 

type II diabetes: a population-based study. *The American Journal Respiratory Critical* 

Vesperinas, G.; et.al. (2007). Relationship between the upper airway and obstructive sleep apnea-hypopnea syndrome in morbidly obese women. *Obesity* 

and co-morbidity – a common inflammatory phenotype?*Respiratory Research*, Vol.7,

Obesity, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleep-disordered breathing. *Sleep Med*, Vol.8, No. 1, pp.12-17 Sicras, A.; Navarro, R. & González, P. (2007). Influencia de la diabetes *mellitus* en los sujetos

con enfermedad pulmonar obstructiva crónica en un ámbito ambulatorio. *Anales de* 

with serum glucose concentration in a large cohort. *The American Journal of* 


Kono, M.; Tatsumi, K.; Saibara, T.; Nakamura, A.; Tanabe, N.; Takiguchi, Y.; et al. (2007).

Kornum, JB.; Thomsen, RW.; Riis, A.; Lervang, HH.; Schonheyder, HC. & Sorensen, HT.

Lavi, S.; Prasad, A.; Yang, EH.; Mathew, V.; Simari, RD.; Rihal, CS.; et al. (2007). Smoking is

Makarevich, AE.; Valevich, VE. & Pochtavtsev, AU. (2007). Evaluation of pulmonary

Makino, S.; Handa, H.; Suzukawa, K.; Fujiwata, M.; Nakamura, M.; Muraoka, S.; et al.(2006).

Mallon, L.; Broman, JE.& Hetta, J. (2005). High incidente of diabetes in men with sleep

Mannino, DM.; Thorn, D.; Swensen, A. & Holguin, F. (2008). Prevalence and outcomes of

Marin, JM.; Soriano, JB.; Carrizo, SJ.; Boldova, A. & Celli, BR. (2010). Outcomes in patients

Mathers, CD. (2008). The global burden of disease: 2004 uptodate. World Health

McArdle, N.; Hillman, D.; Beilin, L.& Watts, G. (2007). Metabolic risk factors for vascular

McNicholas, WT. (2009). Chronic obstructive pulmonary disease and obstructive sleep apnea. *The American Journal Critical Care of Medicine,* Vol*.*180, pp.692-700 Moussas, G.; Tselebis, A.; Karkanias, A.; Stamouli, D.; Ilias, I.; Bratis, D. & Vassila-Demi, K.

Pai, JK.; Pischon, T.; Ma, J.; Manson, JE.; Hankinson, SE.; Joshipura, K.; et al. (2004).

Inflammatory markers and the risk of coronary heart disease in men and women.

hospital of chest diseases. *Annals of General Psychiatry*, Vol. 7, pp. 1-4 Oudijk, EJ.; Lammers, JW. & Koenderman, L. (2003). Systemic inflammation in chronic obstructive pulmonary disease. European Respiriratory Journal, Vo. 46, pp.5-13 Owens, RL.; Malhotra, A. (2010). Sleep-disordered breathing and COPD: the overlap

*The New England Journal of Medicine,* Vol.351, No.25, pp. 2599-2610

metabolic syndrome. *Chest* , Vol. 131, pp.1387-1392

*European Respiratory Journal*, Vol.20, No. 6, pp.1406-1412

resistance. *Clinical Endocrinology*, Vol.64, No. 1, pp.12-19

population. *Diabetes Care* ,Vol.28, No. 11, pp.2762-2767

*Journal Critical Care of Medicine,* Vol.175, No. 2, pp.190-195

síndrome. *Respiratory Care*, Vol.55, No.10, pp.1333-1344

*Respiratory Journal*, Vol.32, No.4, pp. 962-969

*Circulation,* Vol. 115, No. 20, pp. 2621-2627

pp. 265-272

No. 3, pp.325-331

Organization

Obstructive sleep apnoea syndrome is associated with some components of

(2008). Diabetes, glycemic control and risk of hospitalization with pneumonia: a population-based case-control study. *Diabetes Care*, Vol.31, No. 8, pp. 1541-1545 Lange, P.; Parner, J.; Schnohr, P. & Jensen, G. (2002). Copenhagen City Heart Study:

longitudinal analysis of ventilatory capacity in diabetic and nondiabetic adults. *The* 

associated with epicardial coronary endothelial dysfunction and elevated white blood cell count in patients with chest pain and early coronary artery disease.

hypertension in COPD patients wth diabetes. *Advances in Medical Sciences*, Vol.52,

Obstructive sleep apnoea syndrome, plasma adiponectin levels, and insulin

complaints or short sleep duration: a 12-year follow-up study of a middle-aged

diabetes, hypertension and cardiovascular disease in COPD. *The European* 

with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. *The American Journal Respirtory Critical Care of Medicine,* Vol.182,

disease in obstructive sleep apnea: a matched controlled study. *The American* 

(2008). A comparative study of anxiety and depression in patients with bronchial asthma, chronic obstructive pulmonary disease and tuberculosis in a general


**13** 

*Turkey* 

**Evaluation of Dyspnea and** 

Hatice Tel, Zeynep Bilgiç and Zübeyde Zorlu *Cumhuriyet University, Health Sciences Faculty,* 

*Department of Nursing, Sivas* 

**Fatigue Among the COPD Patients** 

Chronic diseases are diseases of long duration and generally slow progression. Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in the world, representing 63% of all deaths (World Health Organization(WHO), 2010a). Rapid improvements in health and longevity are dramatically changing the burden of illness throughout the world. In developed countries changes in lifestyle and improvements in the treatment of major causes of mortality have aged the population and increased the prevalence of chronic diseases. Poor countries that have achieved gains in life expectancy are also experiencing an increase in chronic disease (Davis et al.,1999). According to Centers for Disease Control and Prevention (CDC) more than 1.7 million Americans die of a chronic disease in 2005. Chronic disabling conditions cause major limitations in activity for more than one of every 10 Americans, or 25 million people (CDC, 2005). In Turkey, chronic diseases accounted for 79% of all deaths in 2002(WHO, 2010b). Notification to national reports, 305.467 dies of total 430.459 was related to chronic diseases in Turkey (Turkey Health Ministry National Burden of Illness Report

 Chronic obstructive pulmonary disease (COPD) is one of the important chronic diseases. COPD is characterized by airflow obstruction with related symptoms such as chronic cough, exertion dyspnea, expectoration, and wheeze. (Edelman et al., 1992; Mannino, 2003). COPD is a highly prevalent, usually progressive illness associated with disability and early death (WHO, 2008). COPD is a major cause of chronic morbidity and mortality throughout the world. It is a growing cause of morbidity and mortality worldwide (Mannino, 2003; Mannino & Braman, 2007; Tatlcoğlu, 2000). According to the World Health Organization, 80 million people worldwide have moderate to severe COPD. More than 3 million people died of COPD in 2005, which is approximately 5% of all deaths worldwide (WHO, 2008). COPD is currently the fifth leading cause of death and disease burden globally (O'Donnell et al., 2008). In the Turkey, COPD is the third leading cause of death. Although there has been significant decrease in other mortality causes; there has been an increase by 163 % in COPD mortality (Turkish Thorasic Society, 2010). COPD will be third leading cause of death globally by 2020(WHO, 2008). COPD is the tenth leading disease burden, expressed in disability-adjusted life-years (DALYs), and causes about 2% of the burden of disease

**1. Introduction** 

2004).

