EC Pulmonology and Respiratory Medicine

Since 2020, several papers have reported favorable effects of SGLT2 inhibitors on respiratory function in the field of respiratory medicine, but not yet in the field of HF.

We report a case (90-year-old man) of worsening obstructive pulmonary disease complicated by heart failure (HF) in which an SGLT2 inhibitor improved respiratory function. On admission, he had wheezing and elevated BNP level (401 pg/mL). Arterial blood gas analysis on room-air showed pH 7.33, PaCO₂ 55 mmHg, PaO₂ 58 mmHg, HCO₃ 28 mmol, and O₂ saturation 87%. After starting the SGLT2 inhibitor empagliflozin at 10 mg/day, BNP level decreased to 99 pg/dL, and arterial blood gas results indicated marked improvement in his hypercapnia and hypoxemia (pH 7.38, PaCO₂ 38.4 mmHg, PaO₂ 66 mmHg, HCO₃ 22.3 mmol, and O₂ saturation 93.7%).

This case of obstructive pulmonary disease complicated by HF suggests that SGLT2 inhibitors can improve not only cardiovascular function but also respiratory function.

 Keywords: Heart Failure; Respiratory Function; SGLT2 Inhibitor; Hypercapnia; Hypoxia

1. Seferović PM., et al. “European Society of Cardiology/Heart Failure Association position paper on the role and safety of new glucose-lowering drugs in patients with heart failure”. European Journal of Heart Failure 2 (2020): 196-213.
2. Aso Y., et al. “Diverse Clinical Effects of SGLT2 Inhibitor: case presentation and literature mini-review”. Iryo Yakugaku ((Japanese Journal of Pharmaceutical Health Care and Sciences) 49 (2023): 321-330.
3. Kataoka H. “Favorable effect of sodium-glucose cotransporter-2 inhibitor on respiratory function in type 2 diabetic patients”. Journal of Endocrine Disorders and Therapy 1 (2020): 5-9.
4. McDonagh TA., et al. “2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure”. European Heart Journal 37 (2023): 3627-3639.
5. Fried P., et al. “Effect of ketosis on respiratory sensitivity to carbon dioxide in obesity”. New England Journal of Medicine 20 (1976) 1081-1086.
6. Kataoka H. “Treatment of hypochloremia with acetazolamide (“Diamox”) in an advanced heart failure patient and importance of monitoring urinary electrolytes”. Journal of Cardiology Cases 3 (2018): 80-84.
7. Rennke HG and Denker BM. “Renal pathophysiology”. 4^th Philadelphia: Lippincott Williams & Wilkins (2014).
8. Kataoka H and Yoshida Y. “Enhancement of the serum chloride concentration by administration of sodium–glucose cotransporter-2 inhibitor and its mechanisms and clinical significance in type 2 diabetic patients: a pilot study”. Diabetology and Metabolic Syndrome 12 (2020): 5.
9. Kataoka H. “Proposal for new classification and practical use of diuretics according to their effects on the serum chloride concentration: rationale based on the ‘chloride theory’”. Cardiology and Therapy 2 (2020): 227-244.
10. Qiu M., et al. “Use of SGLT2 inhibitors and occurrence of noninfectious respiratory disorders: a meta-analysis of large randomized trials of SGLT2 inhibitors”. Endocrine1 (2021): 31-36.
11. Pradhan R., et al. “Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbation among patients with type 2 diabetes: population-based cohort study”. British Medical Journal 379 (2022): e071380.
12. Kimura Y., et al. “Association of novel antihyperglycemic drugs versus metformin with a decrease in asthma exacerbations”. Journal of Allergy and Clinical Immunology: In Practice 8 (2024): 2035-2044.
13. Neeland IJ., et al. “The impact of empagliflozin on obstructive sleep apnea and cardiovascular and renal outcomes: an exploratory analysis of the EMPA-REG OUTCOME Trial”. Diabetes Care12 (2020): 3007-3015.
14. Heffernan A., et al. “Metabolic crossroads: unveiling the complex interactions between obstructive sleep apnea and metabolic syndrome”. International Journal of Molecular Sciences 6 (2024): 3243.
15. Brikman S and Dori G. “Sodium glucose cotransporter2 inhibitor: possible treatment for patients with diabetes, pulmonary disease and CO₂ retention”. Medical Hypotheses 139 (2020): 109631.