Key takeaways:

• In adults hospitalized for diabetic ketoacidosis, odds for CPAP use were elevated among those with asthma or COPD vs. no pulmonary comorbidity.
• Those with asthma or COPD spent fewer days in the hospital.

PHOENIX — In hospitalizations for diabetic ketoacidosis, the odds for in-hospital mortality were decreased among those with asthma or COPD vs. no pulmonary comorbidity, according to data presented at the CHEST Annual Meeting.

In a retrospective case-control study, Anthony Lim, MD, PGY-3 internal medicine resident at The Brooklyn Hospital Center, and colleagues evaluated 2,743,079 adult hospitalizations for diabetic ketoacidosis (DKA) from the National Inpatient Sample (2016 to 2023) to determine if having asthma or COPD impacts the odds for mortality, in-hospital complications, length of stay and charges.

Data derived from Lim A, et al. Clinical outcomes of asthma and COPD in adults hospitalized with diabetic ketoacidosis: A national case-control study. Presented at: CHEST Annual Meeting; Oct. 18-21, 2026; Phoenix.

“In DKA, metabolic acidosis increases minute ventilation to exhale CO2,” Lim said during his presentation. “In theory, underlying lung disease, like asthma or COPD, can restrict this hyperventilation by increasing airway resistance to promote air trapping. This effectively reduces gas exchange.

“Studies have shown how diabetes affects COPD hospitalizations, increasing pneumonia, strokes [and] AKI, but they don’t really show you how COPD affects DKA admissions,” he continued.

The asthma only group included 188,675 patients (mean age, 37.8 years), the COPD only group included 149,635 patients (mean age, 61.4 years) and the group with no pulmonary comorbidity included 2,404,769 patients (mean age, 43.5 years).

In a model adjusted for age, sex, race, insurance, hospital bed size, hospital location and Elixhauser comorbidities, researchers found significantly elevated odds for CPAP use among patients with asthma vs. no pulmonary comorbidity (OR = 1.28; 95% CI, 1.16-1.42) and patients with COPD vs. no pulmonary comorbidity (OR = 2.1; 95% CI, 1.97-2.25).

Compared with the group without pulmonary comorbidity, the group with COPD also had significantly heightened odds for bilevel positive airway pressure (BiPAP) use (OR = 2.54; 95% CI, 1.3-4.97) and acute respiratory failure (OR = 1.07; 95% CI, 1.03-1.11).

“These patients have a higher need for noninvasive respiratory support, so that means we have to be proactive with monitoring respiratory status and be ready for early escalation to CPAP or BiPAP,” Lim said.

In contrast, the odds for in-hospital mortality were significantly lower among those with asthma vs. no pulmonary comorbidity (OR = 0.6; 95% CI, 0.54-0.65) and COPD vs. no pulmonary comorbidity (OR = 0.83; 95% CI, 0.78-0.88).

“There may have been several confounding factors and biases that have led to this result,” Lim said. “Patients with chronic respiratory disease might seek care sooner while having episodes of dyspnea from Kussmaul respirations. If they were to present earlier, this would also lead to DKA being diagnosed at a less severe stage.

“A second reason for this could be DKA in this population may be triggered by more readily treatable causes like pneumonia, and these typically respond really well to empiric antibiotic treatment,” he continued.

Survivor bias may also have contributed to the finding, according to Lim.

“People with DKA and severe asthma or COPD may die before they even get admitted to the hospital,” Lim said.

Researchers also observed significantly decreased odds among those with asthma or COPD vs. no pulmonary comorbidity for mechanical ventilation (asthma, OR = 0.69; 95% CI, 0.65-0.73; COPD, OR = 0.95; 95% CI, 0.91-0.99) and ICU utilization (asthma, OR = 0.75; 95% CI, 0.73-0.78; COPD, OR = 0.9; 95% CI, 0.87-0.93).

Further, hospital length of stay was 0.83 days shorter in the asthma only vs. no pulmonary comorbidity group and 0.52 days shorter in the COPD only vs. no pulmonary comorbidity group per an adjusted linear model.

Total hospital charges were also smaller in the groups with vs. without pulmonary comorbidity (asthma: –$14,097; COPD: –$10,331), according to the presentation.