CMAJ • April 10, 2007; 176 (8). doi:10.1503/cmaj.1060122.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Treatment of chronic respiratory diseases in obese people

Luca Mascitelli* and Francesca Pezzetta{dagger}

Sanitary Service, Comando Brigata alpina Julia, Udine, Italy;* Cardiology Service, Ospedale di San Vito al Tagliamento, San Vito al Tagliamento, Italy{dagger}

Magali Poulain and colleagues do not appear to have considered the action of the renin–angiotensin system in their review of the effect of obesity on chronic respiratory diseases.1 A recent study showed increased activation of the renin–angiotensin system in obese people.2 However, a decrease in angiotensin-converting-enzyme activity may improve the efficiency of peripheral use of oxygen and respiratory muscle function in patients with chronic lung diseases.3 Further, because several studies have shown that inhibition of the renin–angiotensin system may be a useful treatment for secondary erythrocytosis,4–6 such an approach might also have profound benefits in the long-term treatment of erythrocytosis associated with obesity hypoventilation syndrome. Therefore, we suggest that therapy with angiotensin-converting-enzyme inhibitors or angiotensin II type 1 receptor blockers should be considered in the treatment of chronic respiratory diseases in obese people.

REFERENCES

  1. Poulain M, Doucet M, Major GC, et al. The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies. CMAJ 2006;174(9):1293-9.[Abstract/Free Full Text]
  2. Engeli S, Böhnke J, Gorzelniak K, et al. Weight loss and the renin-angiotensin-aldosterone system. Hypertension 2005;45:356-62.[Abstract/Free Full Text]
  3. Forth R, Montgomery H. ACE in COPD: a therapeutic target? Thorax 2003;58:556-8.[Free Full Text]
  4. Gaston RS, Julian BA, Diethelm AG, et al. Effects of enalapril on erythrocytosis after renal transplantion. Ann Intern Med 1991;115:954-5.[Abstract/Free Full Text]
  5. Plata R, Cornejo A, Arratia C, et al. Angiotensin-converting-enzyme inhibition therapy in altitude polycythaemia: a prospective randomised trial. Lancet 2002;359:663-6.[CrossRef][Medline]
  6. Marathias KP, Agroyannis B, Mavromoustakos T, et al. Hematocrit-lowering effect following inactivation of renin-angiotensin system with angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Curr Top Med Chem 2004;4:483-6.[CrossRef][Medline]




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