The incidence of polyneuropthy and its relation with disease parameters in chronic obstructive pulmonary disease

Objective: Chronic Obstructive Pulmonary Disease (COPD) is accompanied by several concomitant conditions due to its systemic effects. Hypoxia and oxidative stress associated with COPD are also believed to contribute to the disease course through the effects of several inflammatory mediators. Major causative agents causing of peripheral neuropathy are age, hypoxia, duration and severity of COPD, hypercapnia and smoking. The present study aimed to investigate the incidence of polyneuropathy and its relation with disease parameters in COPD patients. Methods: Of a total number of 45 patients who had been followed up between January 1, 2015 and December 31, 2016 with a diagnosis of COPD at Ufuk University School of Medicine were enrolled retrospectively. All patients underwent electroneuromyography, arterial blood gas measurements and pulmonary function tests. Patients were divided as those with or without neuropathy, and factors contributing to the development of neuropathy were investigated based on clinical and laboratory findings. Results: Eleven (24.4%) patients were women and 34 (74.6%) were men, and the mean age was 73.2 years. Mean PaO2 was 58.2 mmHg, pCO2 was 41.2 mmHg, and FEV1 was 45.3%. Neuropathy was diagnosed in twenty (44.4%) patients. Significant differences were found in pO2, pCO2, SO2, mMRC, smoking status and number of exacerbations per year (p < 0.05). Conclusions: Patients who experience frequent exacerbations and those with hypoxemia or hypercapnia as demonstrated should be taken into more careful clinical assessments with respect to polyneuropathy. 

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  • [1] Global Initiative for Chronic Obstructive Lung Disease. Pocket guide to COPD diagnosis, management, and prevention. A Guide for Health Care Professionals 2017 edition. 2017.
  • [2] Kazi K, Mehta A, Mulla M. Electrophysiological evaluation of peripheral nerves in patients with chronic obstructive pulmonary disease. Int J Basic Appl Physiol 2012;1:83-7.
  • [3] Sönmezler A, Yoldaş TK, Ünsal İ, Çalık M, Karakaş E. [Who gets the diagnosis of polyneuropathy?] Journal of Harran University Medical Faculty 2012;9:65-7. [Article in Turkish]
  • [4] Pfeiffer G, Kunze K, Brüch M, Kutzner M, Ladurner G, Malin JP, et al. Polyneuropathy associated with chronic hypoxaemia: prevalence in patients with chronic obstructive pulmonary disease. J Neurol 1990;237:230-3.
  • [5] Paramelle B, Vila A, Pollak P, Muller P, Gavelle D, Reymond F, et al. Incidence of polyneuropathies in chronic obstructive bronchopneumopathies. Presse Med 1986;15:563-7.
  • [6] Tuck RR, Schmelzer JD, Low PA. Endoneurial blood flow and oxygen tension in the sciatic nerves of rats with experimental diabetic neuropahty. Brain 1984;107:935-50.
  • [7] Low PA, Schmelzer JD, Ward KK, Yao JK. Experimental chronic hypoxic neuropathy: relevance to diabetic neuropathy. Am J Physiol 1986;250:94-9.
  • [8] Stoebner P, Mezin P, Vila A, Grosse R, Kopp N, Paramelle B. Microangiopathy of endoneurial vessels in hypoxemic chronic obstructive pulmonary disease (COPD). A quantitative ultrastructural study. Acta Neuropathol (Berl) 1989;78:388-95.
  • [9] Jann S, Gatti A, Crespi S, Rolo J, Beretta S. Peripheral neuropathy in chronic respiratory insufficiency. J Peripher Nerv Syst 1998;3:69-74.
  • [10] Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009;33:1165-85.
  • [11] Mantilla CB, Sieck GC. Neuromotor control in chronic obstructive pulmonary disease. J Appl Physiol 2013;114:1246-52.
  • [12] Wright JL, Lawson LM, Pare PD, Wiggs BJ, Kennedy S, Hogg JC. Morphology of peripheral airways in current smokers and ex-smokers. Am Rev Respir Dis 1983;127:474-7.
  • [13] Hunninghake GW, Crystal RG. Cigarette smoking and lung destruction. Accumulation of neutrophils in the lungs of cigarette smokers. Am Rev Respir Dis 1983;128:833-8.
  • [14] Faden A, Mendoza E, Flynn F. Subclinic neuropathy associated with chronic obstructive pulmonary disease. Possible pathologic role of smoking. Arch Neurol 1981;38:639-42.
  • [15] Agrawal D, Vohra R, Gupta PP, Sood S. Subclinical peripheral neuropathy in stable middle-aged patients with chronic obstructive pulmonary disease. Singapore Med J 2007;48:887-94.
  • [16] Kayacan O, Beder S, Deda G, Karnak D. Neurophysiological changes in COPD patients with chronic respiratory insufficiency. Acta Neurol Belg 2001;101:160-5.
  • [17] Ulubay G, Ulasli SS, Bozbas SS, Ozdemirel T, Karatas M. Effects of peripheral neuropathy on exercise capacity and quality of life in patients with chronic obstructive pulmonary diseases. Arch Med Sci 2012;8:296-302.
  • [18] Gupta PP, Agarwal D. Chronic obstructive pulmonary disease and peripheral neuropaty. Lung India 2006;23:25-33.
  • [19] Gasnault J, Moore N, Arnaud F, Rondot P. Peripheral neuropathies during hypoxaemic chronic obstructive airways disease. Bull Eur Physiopathol Respir 1987;11:199-202.
  • [20] Moore N, Lerebours G, Senant J, Ozenne G, David P, Nouvet G. Peripheral neuropathy in chronic obstructive lung disease. Lancet 1985;11:1311.
  • [21] Shah S, Salvi, Kowale A. Peripheral nerves in chronic obstructive pulmonary disease: a review. Int J Adv Physiol Allied Sci 2016;3:78-87.
  • [22] Ozge A, Atis S, Sevim S. Subclinical peripheral neuropathy associated with chronic obstructive pulmonary disease. Electromyogr Clin Neurophysiol 2001;41:185-91.
  • [23] Demir R, Özel L, Özdemir G, Kocatürk İ, Ulvi H. Neurophysiological changes in patients with chronic obstructive pulmonary diseases. Eur J Gen Med 2014;11:153-6.
  • [24] Jarratt JA, Morgan CN, Twomey JA, Abraham R, Sheaff PC, Pilling JB, et al. Neuropathy in chronic obstructive pulmonary disease: a multicentre electrophysiological and clinical study. Eur Respir J 1992; 5:517-24.
  • [25] Çağlar T, Aka MT, Tabakoğlu E, Utku U, Agun K. [Peripheral neuropathy in chronic obstructive pulmonary disease]. Balkan Med J 1994;11:185-91. [Article in Turkish]
  • [26] Oncel C, Baser S, Cam M, Akdağ B, Taspinar B, Evyapan F. Peripheral neuropathy in chronic obstructive pulmonary disease. COPD 2010;7:11-6.