International Journal of Diabetes Mellitus (2015) 3 , 7071

Diabetes Science International

International Journal of Diabetes Mellitus

www.elsevier.com/locate/ijdm
www.sciencedirect.com

CLINICAL QUIZ

Signicance of spirometry in a diabetic patient with

chronic cough
Sultan Ayoub Meo

Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
Received 12 January 2011; accepted 17 January 2011

KEYWORDS
Chronic cough;
Spirometry;
Lung function;
Diabetes

Abstract Diabetes mellitus (DM) is a group of metabolic disease of all age groups especially the
middle age and aged people. Diabetes can cause serious complications that involve multiple organs
and physiological functions. The chronic hyperglycemia of diabetes is associated with long-term
damage, dysfunction, and failure of various organs and systems. Spirometry is a powerful tool used
to detect, differentiate, follow and manage the patients with pulmonary disorders. Diabetic patients
with a clinical history of respiratory complaints and any occupational and industrial exposure, in
that condition, spirometry is more important to assess the risk and early diagnosis of lung disease.
 2011 International Journal of Diabetes Mellitus. Published by Elsevier Ltd. All rights reserved.

1. Clinical presentation
A 48-year-old patient, a known case of type 2 diabetes mellitus, presented with a productive cough for the last 2 months.
Detailed clinical history revealed that the patient was smoking
810 cigarette/day for the last 3 years. The patient was working in the cement industry. On clinical examination, tempera-

ture was 98.4 F, blood pressure 120/80 mmHg, pulse rate
78 min 1 and respiratory rate 16 min 1. Spirometry was advised to assess lung functions for COPD (see Fig. 1).

* Address: Department of Physiology [29], College of Medicine, King

Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia. Tel.:
+966 1 4671604; fax: +966 1 4672567.
E-mail addresses: smeo@ksu.edu.sa, sultanmeo@hotmail.com
1877-5934  2011 International Journal of Diabetes Mellitus. Published
by Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijdm.2011.01.009

Production and hosting by Elsevier

Figure 1

Spirogram.

S.A. Meo
2. Questions
1. Identify the pattern of lung function impairment?
2. The forced vital capacity was 3.46 l and forced expiratory
volume in rst second was 2.30 l. What will be the forced
expiratory ratio?
3. Enumerate the clinical signicance of spirometry?

3. Discussion
Spirometry is a widely used pulmonary function test, ideally
suited to describe the effects of obstruction or restriction on
lung function. It is a powerful diagnostic tool that plays a signicant role in the early diagnosis of lung damage and its associated structures in diabetic patients [2,3]. Spirometry is
frequently performed to assess the risk of anaesthetic procedures before surgery, and to evaluate disability or impairment,
and is important in conrming the diagnosis and assessing the
severity of disease [4].
Chronic obstructive pulmonary disease (COPD) is manifested by chronic cough, sputum production, wheezing and,
in later stages, dyspnea and poor exercise tolerance. Symptomatic COPD affects more than 5% of the adult population, and
is the fourth leading cause of death, as well as the twelfth leading cause of morbidity in the United States. Co-existence of
diabetes mellitus and COPD increases the rate complicates
by factors. In more than 80% of cases, cigarette smoking is
causally linked to the development of COPD. Subjects with
COPD cannot breathe out as quickly as a healthy person because of obstructed airow through their airways. Most recently, airow obstruction has been dened as a forced
expiratory volume in 1 s (FEV1) value of less than 80% of predicted, in association with an FEV1 to forced vital capacity ratio (FEV1/FVC%) of less than 70%. Both the FEV1 and FVC
values are usually reduced in patients dened as having airow
limitation. Because FEV1 is affected more than the FVC, the
ratio of the FEV1 to FVC (FEV1/FVC%) also decreases. Spi-

71
rometry, in addition to clinical examination, improves chronic
obstructive pulmonary disease [COPD] diagnostic accuracy, as
compared to clinical examination alone, and it is a useful diagnostic tool in individuals with symptoms suggestive of possible
COPD [5].
4. Answers

1. Mild chronic obstructive pulmonary disease.

2. The forced vital capacity was 3.46 l and forced expiratory
volume in rst second was 2.30 l, hence the forced expiratory ratio is: 2.30/3.46 100 = 66.47%.
3. Spirometry is essential to evaluate dyspnea, wheezing,
cough, phlegm production, diminished breath sounds,
abnormal chest radiographs and for individuals in occupations with exposure to various pollutant substances. Spirometry is also vital to assess preoperative risk and
prognosis, as well as health status, before enrollment in
strenuous physical activity programs and validation of subjective complaints in occupational/environmental settings
[1].

References
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spirometry. Am J Respir Crit Care Med 1995;152:110736.
[2] Meo SA. Signicance of spirometry in diabetic patients. Int J
Diabetes Mellitus 2001;2(1):4750.
[3] Meo SA, Al-Drees AM, Arif M, Al-Rubean K. Lung function
in type 2 Saudi diabetic patients. Saudi Med J 2006;27(3):
33843.
[4] Ruppel GL. Pulmonary function testing. Trends and techniques.
Resp Care Clin North Am 1997;3:15581.
[5] Wilt TJ, Niewoehner D, Kim C, Kane RL, Linabery A, Tacklind J,
et al. Use of spirometry for case nding, diagnosis, and management of chronic obstructive pulmonary disease (COPD). Evid Rep
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