Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Moderating role of live microbe between chronic inflammatory airway disease and depressive symptoms

Purpose

Our study aims to investigate the impact of dietary live microbe on the relationship between chronic inflammatory airway diseases (CIAD) and depressive symptoms.

Methods

We selected data from the NHANES database from 2007 to 2020. First, we explored the relationship between CIAD and depressive symptoms using logistic regression analysis. And subgroup analyses were conducted to demonstrate the relationship and whether there was an interaction effect between the two in each subgroup. Then, we further analyzed the effect of live microbe on depressive symptoms in CIAD patients. And subgroup analyses were conducted to assess whether the effect of dietary viable microbial levels on depressive symptoms held true in each subgroup and whether there was an interaction effect.

Results

A study included 23,072 participants, of whom 5,111 were diagnosed with CIAD, and 5,110 had live microbial information available. Multivariate logistic regression analysis revealed that, compared to those without CIAD, individuals with CIAD had an increased risk of depressive symptoms. Subgroup analysis indicated that, except for educational level and smoking status, all other subgroups demonstrated that CIAD increased the risk of depressive symptoms. Additionally, within the CIAD population, a higher level of live microbe was associated with a reduced risk of depressive symptoms. It is implied that live microbe can negatively modulate the relationship between CIAD and depressive symptoms. Subgroup analysis further showed no significant interaction effects across subgroups (p > 0.05).

Conclusion

Chronic inflammatory airway diseases can increase the risk of developing depressive symptoms. Dietary live microbe negatively modulate the relationship between CIAD and depressive symptoms. High levels of dietary live microbe significantly reduced the risk of depressive symptoms in patients with CIAD.

Association Between Neutrophil Percentage to Serum Albumin Ratio and in-Hospital Mortality of Patients with Chronic Obstructive Pulmonary Disease in Intensive Care Unit: A Retrospective Cohort Study

Objective

This study aimed to investigate the potential correlation between the neutrophil percentage to serum albumin ratio(NPAR) and in-hospital mortality in critically ill patients with Chronic Obstructive Pulmonary Disease (COPD).

Patients and Methods

This study employed a retrospective cohort design. A total of 599 COPD patients were included in this research. Clinical data from the MIMIC-IV (Medical Information Mart for Intensive Care IV) database were utilized. To determine whether a correlation exists between NPAR and in-hospital mortality, a multivariable logistic regression analysis was conducted. Subgroup analyses were performed, taking into account factors such as age, sex, diabetes, congestive heart failure, and ventilator use.

Results

Among the 599 patients studied, 114 (19.0%) experienced in-hospital mortality. In the multivariable logistic regression model, NPAR was positively correlated with in-hospital mortality; for each unit increase in NPAR, the in-hospital mortality rate increased by 5% (Odds Ratio [OR] = 1.05; 95% Confidence Interval [95% CI] = 1.02-1.09). Compared to the lowest NPAR group, the highest NPAR group had a significantly greater risk of in-hospital mortality (OR [95% CI] = 2.15 [1.11-4.17]). Furthermore, the results of the subgroup analyses were consistent across all groups.

Conclusion

Our study reveals a correlation between NPAR levels and mortality in COPD patients. Further research is warranted to validate these findings.

Association of Life's Essential 8 with the prevalence and mortality of chronic obstructive pulmonary disease

Objective

To study the correlation between Life's Essential 8 (LE8) and the occurrence of chronic obstructive pulmonary disease (COPD) among US adults, as well as the association between LE8 and all-cause and cardiovascular disease (CVD) mortality among individuals with COPD.

Methods

Data from National Health and Nutrition Examination Survey (2005-2018 year) were analyzed. The correlation between LE8 scores and the prevalence of COPD was evaluated using logistic regression models. Additionally, the Cox proportional hazards model was applied to investigate how LE8 scores relate to the risk of mortality from all causes and cardiovascular diseases. To ensure the robustness of the findings, sensitivity analyses and subgroup analyses were performed.

Results

In the overall population, an inverse relationship was observed between a 10-point increase in LE8 score and the risk of COPD [OR = 0.78, 95%CI (0.75 ~ 0.82), p < 0.001]. Those diagnosed with COPD experienced a 65% increased rate of all-cause mortality and 5% higher rate of mortality due to cardiovascular diseases compared to the non-COPD group. Within the COPD patient cohort, an inverse relationship was similarly observed between a 10-point increase in the LE8 score and the risk of all-cause mortality [HR = 0.87, 95%CI (0.8 ~ 0.95), p = 0.002]. However, no significant association was found between the LE8 score and CVD mortality [HR = 0.83, 95%CI (0.68 ~ 1.02), p = 0.073]. In further exploration through subgroup analysis, no statistically significant interactions were found, suggesting consistency across different demographic or clinical subgroups.

Conclusion

Higher LE8 adherence is linked to lower COPD prevalence and all-cause mortality, yet no clear link to CVD mortality was found. This highlights the need for more extensive research to clarify LE8's role in CVD outcomes.

Burden of non-communicable diseases in South Asia: a decomposition analysis

BACKGROUND

This study examines the incidence, prevalence, deaths, and disability-adjusted life years (DALYs) related to non-communicable diseases (NCDs) in South Asia, exploring the environmental, metabolic, and behavioural risk factors, and exploring changes in deaths and DALYs driven by population growth, aging, and mortality rates.

METHODS

Using data from the Global Burden of Disease (GBD) study 2021, we estimated age-standardized incidence, prevalence, deaths, and DALYs for four major NCDs: cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases from 2010 to 2021. Gender and age-specific estimations were conducted across all NCDs, with 95% uncertainty intervals and a decomposition analysis was employed to estimate change in death and DALYs attributable to NCDs.

FINDINGS

The burden of NCDs in South Asia increased by 3.00% in incidence from 2010 to 2021, while overall prevalence decreased by 1.00%, yet the age-standardized prevalence rate remains above the global rate (91,570 per 100,000 population). Incidences of cardiovascular and respiratory diseases declined by 3.00% and 13.00%, respectively, whereas diabetes and cancer rose by 21.00% and 13.00% in South Asia. Nepal faced the highest environmental impact (23.4% of DALYs), Bangladesh the greatest metabolic impact (25.62%), and India the highest from behavioural factors (23.95%). Population growth and aging were primary drivers of changes in deaths and DALYs across the region.

CONCLUSION

This finding emphasizes the need for targeted public health interventions addressing environmental, metabolic, and behavioral risks for NCDs in South Asia, alongside strategies to support healthy aging and effective disease management across diverse demographic groups.

Decoding the causal association between immune cells and three chronic respiratory diseases: Insights from a bi-directional Mendelian randomization study

BACKGROUND

Numerous studies have indicated the correlations of immune traits and chronic respiratory diseases (CRDs). Whereas, causality is still implicative. Hence, our study was designed to investigate the causal relations utilizing bidirectional Mendelian randomization (MR) and to identify the immune traits of potential significance.

METHODS

Using GWAS datasets, we performed Mendelian randomization (MR) analyses to examine 731 immune traits associated with three CRDs: asthma, bronchiectasis and chronic obstructive pulmonary disease (COPD). Six widely applied MR approaches, along with Bayesian weighted Mendelian randomization analysis, were utilized to assess causality. Through extensive sensitivity assessments, heterogeneity and pleiotropy have been examined. For integrity, leave-one-out analysis was implemented as the final step.

RESULTS

Our study reveals 13 immune traits that may have a genetic basis for predicting the occurrence of CRDs, which include two risk traits (CD62L- myeloid dendritic cell (DC) absolute count (AC), CD8 on CD28+ CD45RA- CD8+ T cell) and four protective traits (CD39+ CD8+ %T cell, CD4 on CD39+ activated CD4 regulatory T (Treg) cell, herpes virus entry mediator (HVEM) on Central Memory (CM) CD8+ T cell, CD16 on CD14+ CD16+ monocyte) in COPD, three protective traits (IgD- CD27- %B cell, CD3 on CM CD8+ T cell, CD16 on CD14+ CD16+ monocyte) and one risk trait (CD62L- %DC) in bronchiectasis. Additionally, two risk traits (CD14- CD16- AC monocyte, CD19 on IgD+ CD38+ B cell) and one protective trait (HVEM on CD45RA- CD4+ T cell) were identified in asthma. Sensitivity analyses showed no indications of pleiotropy or signs of heterogeneity. The inverse MR assessment results gave no evidence of reverse causations, ultimately validating the soundness of the findings.

CONCLUSIONS

Our investigation identifies latent correlations of immune traits and three major CRDs, offering novel perspectives on the preventive and therapeutical strategies for CRDs.

Epidemiological trends and risk factors of chronic obstructive pulmonary disease in young individuals based on the 2021 global burden of disease data (1990-2021)

OBJECTIVE

Recent studies have shown that chronic obstructive pulmonary disease (COPD) in young individuals cannot be ignored. This study aims to investigate the burden of COPD and its associated risk factors in individuals aged 15 to 49 years, with a particular focus on health inequities across different levels of socioeconomic development.

METHODS

By analyzing data from the Global Burden of Disease (GBD) 2021, we utilized statistical methods such as Joinpoint regression, frontier analysis, and health inequality analysis to evaluate the changes in the age-standardized disability-adjusted life year (DALY) rates (ASDR) and incidence rates (ASIR) of COPD among the global population aged 15-49 years from 1990 to 2021. We specifically examined the disparities in health across countries and regions with varying levels of socioeconomic development. Key risk factors, including particulate matter pollution, smoking, and occupational exposure, were analyzed.

RESULTS

The number of COPD cases among young people globally has significantly increased.While the global ASDR and ASIR of COPD in the 15-49 age group showed an overall declining trend, the burden of COPD remained high in low Sociodemographic Index (SDI) regions and there were significant health inequalities between countries. Particulate matter pollution (41.79%), smoking (19.81%), and occupational exposure (11.73%) were identified as the primary contributors to the burden of COPD in younger individuals. In low SDI regions, particulate matter pollution had a particularly significant impact, accounting for 58.65% of attributable proportion of DALYs, and remained at a persistently high level. Smoking continued to contribute significantly to the burden of COPD in high-income regions, notably in North America, where smoking accounted for 34.26% of DALYs in 2021.

CONCLUSION

Although there is a global downward trend in the burden of COPD among young people, significant health inequities persist in low SDI regions. The findings emphasize the need for more effective public health activities targeting younger populations and low SDI countries and regions, particularly in improving air quality, reducing smoking, and mitigating occupational exposures.

CLINICAL TRIAL NUMBER

Not applicable.

To quit or not to quit? estimating the causal effects of Türkiye's indoor smoking ban on the intentions to quit smoking

BACKGROUND

Smoking bans aim to reduce tobacco use, but their long-term effectiveness remains uncertain. This study investigates short- and long-term causal effects of Türkiye's indoor smoking ban policy on the intentions to quit smoking among adults.

METHODS

Using three waves of data (2008, 2012, and 2016) from the Global Adult Tobacco Survey (GATS), we analyse the changes in intentions to quit smoking before and after the implementation of indoor smoking ban policy in July 2009. The analysis includes data from 2008 as the pre-policy period, 2012 as the short post-policy period, and 2016 as a long post-policy period, to observe both initial and sustained effects.

RESULTS

Results indicate a modest positive effect shortly after the ban's implementation, with a 2% increase in the log odds of intention to quit smoking in 2012 among the individuals exposed to the ban. However, by 2016, the effect appears to vanish, with a 11% decrease in the log odds of intention to quit smoking among those exposed to the ban over a prolonged period.

CONCLUSIONS

Overall, the study suggests that while the smoking ban initially encouraged quitting intentions, its effect did not sustain over time, emphasizing the need for the controls of society compliance and of policy implementations.

Predicting PD-L1 status in NSCLC patients using deep learning radiomics based on CT images

Radiomics refers to the utilization of automated or semi-automated techniques to extract and analyze numerous quantitative features from medical images, such as computerized tomography (CT) or magnetic resonance imaging (MRI) scans. This study aims to develop a deep learning radiomics (DLR)-based approach for predicting programmed death-ligand 1 (PD-L1) expression in patients with non-small cell lung cancer (NSCLC). Data from 352 NSCLC patients with known PD-L1 expression were collected, of which 48.29% (170/352) were tested positive for PD-L1 expression. Tumor regions of interest (ROI) were semi-automatically segmented based on CT images, and DL features were extracted using Residual Network 50. The least absolute shrinkage and selection operator (LASSO) algorithm was used for feature selection and dimensionality reduction. Seven algorithms were used to build models, and the most optimal ones were identified. A combined model integrating DLR with clinical data was also developed. The predictive performance of each model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve analysis. The DLR model, based on CT images, demonstrated an AUC of 0.85 (95% confidence interval (CI), 0.82-0.88), sensitivity of 0.80 (0.74-0.85), and specificity of 0.73 (0.70-0.77) for predicting PD-L1 status. The integrated model exhibited superior performance, with an AUC of 0.91 (0.87-0.95), sensitivity of 0.85 (0.82-0.89), and specificity of 0.75 (0.72-0.80). Our findings indicate that the DLR model holds promise as a valuable tool for predicting the PD-L1 status in patients with NSCLC, which can greatly assist in clinical decision-making and the selection of personalized treatment strategies.

Ambient air pollution and depressed mood in the National Longitudinal Study of Adolescent to Adult Health (Add Health) wave 4

Depression is a major contributor to the global burden of disease. There is limited understanding of how environmental exposures may contribute to depression etiology. We used wave 4 of the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine associations between low-level ambient air pollution exposure and depressed mood in a generally healthy population of over 10 000 24-32 year olds. Annual mean PM2.5 levels in the 2008-2009 study were close to the current US standard. In fully adjusted quasibinomial logistic regression models, there were no meaningful associations between IQR increases in air pollutant and change in depressed mood status regardless of specific pollutant or moving average lags. In interaction effects models, an IQR increase in lag day 0-30 PM2.5 resulted in 1.20 (95% CI, 1.02-1.41) times higher likelihood of having depressed mood but only for persons with chronic lung disease (interaction P = .04); the association was null for participants without chronic lung disease (OR, 0.98; 95% CI, 0.91-1.05). Our findings suggest that among persons with a lifetime history of chronic lung disease, greater exposure to even low-level PM2.5, PM10, and sulfate may be associated with modest increases in the likelihood of having depressed mood. This article is part of a Special Collection on Environmental Epidemiology.

Global trends and burdens of neglected tropical diseases and malaria from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

Neglected tropical diseases and malaria (NTDm) afflict the most disadvantaged communities, causing chronic and devastating illnesses. The purpose of this study was to investigate the epidemiological features of NTDm from 1990 to 2021 to provide essential information for policy choices to reduce the incidence of NTDm.

METHODS

The Global Burden of Disease Study 2021 provided information on the incidence, mortality, prevalence, and disability-adjusted life-year (DALY) rates of NTDs and malaria from 1990 to 2021. Prevalence and trends were analysed globally as well as by region, sex, and age. The estimated annual percentage change (EAPC) was used to evaluate illness trends, and the connection between sociodemographic indicators (SDIs) and disease burden was investigated. To further examine the patterns and forecasts, the age-period-cohort (APC) and Bayesian age‒period‒cohort (BAPC) models were used. On the basis of the results of the analysis, the main risk factors affecting NTDm were explored in depth.

RESULTS

In 2021, the global NTDm age-standardized incidence rate increased by 24.12 (95% UI: -158.97-206.77) from 1990. The burden was highest in West and Central Sub-Saharan Africa, with dengue, malaria and rabies being particularly prominent. The incidence rates standardized by age, prevalence rates, mortality rates, and rates of disability-adjusted life years (DALYs) were primarily observed in children younger than five years and in regions with low SDIs. Analyses considering age, period, and cohort indicated that the burden of disease has diminished in populations born later. Forecasts suggest a minor rise in age-standardized incidence rates (ASIRs) from 2022 to 2035, whereas age-standardized prevalence rates (ASPRs), age-standardized mortality rates (ASMRs), and age-standardized disability-adjusted life year rates (ASDRs) are anticipated to decline. Major risk factors for NTDm include child and maternal malnutrition, child growth failure, child stunting and child underweight.

CONCLUSIONS

The burden of NTDm varies by region, age and sex. This is particularly the case in low-SDI regions. To reduce the global burden of NTDm, specific strategies such as strengthening health systems, fostering cross-sector collaboration, and enhancing community participation are essential. Integrated management requires a multisectoral approach that combines policy, health care, education, research, and community involvement to support sustainable development goals.

Periodontal status of the patients presenting with pulmonary disease in a tertiary health care facility in eastern Nepal

BACKGROUND

Periodontitis and pulmonary disease both are common diseases of humans worldwide and are interconnected to each other. Pulmonary disease is one of the leading causes of morbidity and mortality globally. Poor periodontal health has been attributed to enhance multiple systemic diseases including respiratory disease. Therefore, the study was carried out to determine the periodontal status of patients presenting with pulmonary disease and also to assess the association of periodontitis with pulmonary disease along with their oral health behavior.

METHODS

A cross-sectional study was conducted among 103 patients (> 18 years) diagnosed primarily with pulmonary disease in pulmonology/internal medicine ward of a tertiary health care facility in eastern Nepal. A pretested structured questionnaire (WHO-2013 oral health questionnaire for adults/ Global adult tobacco survey questionnaire) was used to assess oral health behavior of participants. Plaque index, gingival index, pocket depth and attachment loss were recorded to assess periodontal condition. Chi square test, t-test and ANOVA were used based on nature of variables. The level of significance was set at p < 0.05.

RESULTS

The mean age of participants was 63.57 (± 16.42) ranging from 19 - 89 years. Male participants were higher (60.2%) compared to female (39.8%). Most of the participants were former smokers (79.6%) and former smokeless tobacco users (62.1%). Majority of the participants had fair plaque control (75.6%) and moderate form of gingivitis (92.2%). Of the total (n = 103) participants, 36.9% (n = 38) were diagnosed with COPD, 23.3% (n = 24) with pneumonia, 18.4% (n = 19) with pulmonary tuberculosis and 21.4% (n = 22) with lung malignancy. Overall, 85.5% of participants had periodontitis. More than two-thirds (73.3%) had moderate periodontitis, followed by severe periodontitis (11.1%). Out of all forms of pulmonary disease periodontitis was found to be higher in COPD group (33.8%). No association was observed between periodontitis and pulmonary disease (p = 0.05) whereas former smokers, former smokeless tobacco users and gingival index score was found to be associated (p < 0.05).

CONCLUSION

More than two-third of the participants diagnosed primarily with pulmonary disease had periodontitis. No association was observed between periodontitis and pulmonary disease. However, gingival index score, habit of smoking and smokeless tobacco was associated with periodontitis.

Optimizing Pulmonary Rehabilitation in Saudi Arabia: Current Practices, Challenges, and Future Directions

Chronic respiratory diseases (CRDs) are a significantly major cause of mortality in Saudi Arabia, with their progression frequently involving comorbidities and exacerbations that extend beyond the lungs. This review considers the current state of pulmonary rehabilitation (PR) in Saudi Arabia, this being a well-known non-pharmacological intervention to help control and reduce the burden of CRDs, highlighting the intervention's availability, multidisciplinary approach, and integration within the healthcare system, as well as examining the diseases' contribution to overall symptom severity, impairing daily activities and significantly worsening the patient's quality of life. Although PR is strongly recommended for managing CRDs, its utilization in Saudi Arabia remains limited or unavailable in many regions. Key barriers to PR access include inadequate awareness among healthcare providers and patients, logistical challenges, and an insufficient number of specialized facilities and trained professionals. Expanding PR programs in Saudi Arabia requires addressing geographical barriers, ensuring adequate space, resources, and trained personnel, and raising awareness among healthcare providers through education and training. Integrating PR principles into medical education and offering incentives for specialization can help overcome personnel shortages. Additionally, promoting telerehabilitation can enhance patient compliance and ensure the long-term success of PR programs. These initiatives aim to optimize PR services and improve patient outcomes across the nation.

Plasma IgG Glycosylation Profiling Reveals the Biological Features of Early Chronic Obstructive Pulmonary Disease

Chronic inflammatory and immune dysregulation are critical drivers of the development and progression of chronic obstructive pulmonary disease (COPD). Posttranslational modifications, such as glycosylation of Immunoglobulin G (IgG), are crucial in modulating systemic inflammatory homeostasis. This study aims to profile plasma IgG glycopeptides (IgGPs) in COPD patients to uncover new insights into their pathogenesis and to identify novel biomarkers. An integrated platform that combines Fe3O4@PDA@DETA nanospheres enrichment with high-resolution mass spectrometry measurement was employed to analyze plasma IgG N-glycopeptides from 90 COPD patients, 45 clinically defined early COPD (CECOPD) patients, and 90 healthy individuals. To explore the underlying mechanism of COPD progression, correlations between IgG N-glycoforms and clinical parameters were assessed. Disease-specific IgGPs were identified in both the ECOPD and COPD cohorts. Notably, it was the IgG glycopattern, rather than the IgG levels themselves, that underwent changes as the disease progressed. In early COPD patients, there was a decrease in bisection, accompanied by an increase in site-specific afucosylated galactosylation and fucosylation of IgG, indicating an anti-inflammatory state. Conversely, in COPD patients, an increase in inflammation was observed, which was characterized by reduced galactosylation and sialylation. Interestingly, a subset of healthy controls displayed IgGP patterns similar to those of early COPD, possibly reflecting the impact of smoking and the associated immune responses. We finally identified 6 anti-inflammatory and 2 pro-inflammatory IgGPs as ECOPD-specific IgGP indicators. Collectively, these findings suggest that plasma IgG glycosylation holds great potential as a biomarker for early COPD diagnosis, providing valuable insights into the immune system changes during disease progression. The raw data files are publicly accessible via the ProteomeXchange Consortium with the identifier PXD056374.

The safety and efficacy of non-typeable Haemophilus influenzae and Moraxella catarrhalis vaccine in chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials

Background

Non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat) are major pathogens implicated in bacterial exacerbations of chronic obstructive pulmonary disease (COPD). Their involvement contributes to antibiotic resistance and poses significant immune challenges, underscoring the need for targeted vaccine strategies. This systematic review and meta-analysis assessed the safety and efficacy of NTHi-Mcat/NTHi vaccines in COPD patients.

Research design and methods

Randomized controlled trials (RCTs) assessing the safety and efficacy of NTHi-Mcat/NTHi vaccines for COPD were systematically searched across four databases (PubMed, CENTRAL, Embase, and Medline) from inception to October 2024. Meta-analyses were conducted using random-effects or fixed-effects models, with subgroup analyses to investigate possible sources of heterogeneity.

Results

This analysis included eight RCTs involving 1,574 participants, primarily conducted in Europe (n = 3) and Australia (n = 2), with interventions administered orally or intramuscularly at varying frequencies (twice or three times). The Meta-analyses revealed that the NTHi-Mcat/NTHi vaccine did not affect the incidence of acute exacerbations of COPD (relative risk (RR): 1.02, 95% confidence interval (CI): 0.76 to 1.36), all-cause mortality (RR: 0.91, 95% CI: 0.38 to 2.21), and hospitalization rate (RR: 0.50, 95% CI: 0.09 to 2.77). Regarding safety, the NTHi-Mcat/NTHi vaccine did not significantly increase the risk of serious adverse events (RR: 1.00, 95% CI: 0.84 to 1.19) or grade 3 serious events (RR: 1.20, 95% CI: 0.93 to 1.53). However, it was associated with a higher risk of local and systemic reactions, including pain (RR: 5.33, 95% CI: 1.98 to 14.33), swelling (RR: 12.15, 95% CI: 4.67 to 31.67), redness (first dose: RR: 12.74, 95% CI: 3.48 to 46.59; second dose: RR: 11.55, 95% CI: 3.90 to 34.22), headaches (RR: 1.20, 95% CI: 1.00 to 1.43), erythema (RR: 15.38, 95% CI: 5.64 to 41.92), and fever (after the second dose: RR: 2.33, 95% CI: 1.24 to 4.38).

Conclusion

Although the NTHi-Mcat/NTHi vaccines were well-tolerated in COPD patients, they did not significantly reduce the risk of exacerbations or mortality. These findings suggest that further research is needed to validate these results and identify potential subgroups that may derive clinical benefit.

Systematic review registration

The study was registered in PROSPERO (ID: CRD42023381488).

Impact of Tele-Pulmonary Rehabilitation in Patients with Chronic Obstructive Disease: A Systematic Review and Network Meta-Analysis

Introduction: Pulmonary rehabilitation (PR) is essential for long-term management of chronic obstructive pulmonary disease (COPD). However, evidence regarding the effectiveness of various PR delivered via telemedicine (tele-pulmonary rehabilitation [tele-PR]) is lacking. This study aims to assess the comparative effects of different tele-PR types on clinical outcomes in patients with COPD. Methods: The following databases were searched: PubMed, EMBASE, CENTRAL, CINAHL, and EBSCO Open Dissertations from inception to May 2023. We included randomized controlled trials, quasi-experimental, and cohort studies investigating the effects of tele-PR on exercise capacity. The Cochrane Effective Practice and Organization of Care Group risk of bias was used to assess the quality of included studies. Data were analyzed using STATA 17.0 with a random-effects model. Tele-PR comparisons were ranked using surface under the cumulative ranking (SUCRA). Results: Seven studies (n = 815) encompassing five tele-PR types were included in the network meta-analysis. Two studies were justified as having a high risk of bias. There were no significant differences among different types of tele-PR and face-to-face PR, in terms of improving the 6-minute walk test. However, the hierarchy estimation suggested that tele-coaching by virtual agents more often than three sessions per week is more likely to be better than other tele-PRs (SUCRA 95.4%). Discussion: While uncertainty persists regarding the optimal tele-PR delivery model, our study suggests that tele-PR was not different from face-to-face PR. However, limited studies and evidence of low-quality underscore the need for well-designed clinical trials to yield more robust comparative evidence.

Integrated network pharmacological analysis and multi-omics techniques to reveal the mechanism of polydatin in the treatment of silicosis via gut-lung axis

Silicosis is a pulmonary disease characterized by inflammation and progressive fibrosis. Previous studies have shown that polydatin (PD) has potential biological activity in key signaling pathways regulating inflammation and apoptosis. To investigate the effect of PD on rats with silicosis, this study used network pharmacology and molecular docking methods to determine the target of PD treatment for silicosis. The therapeutic effect of PD on silicosis was confirmed by measuring the lung injury score, hydroxyproline content, and mRNA expression levels of key targets. In addition, metagenomic sequencing and gas chromatography-mass spectrometry were used to determine the gut microbiota composition and targeted metabolomics analysis, respectively. The results showed that PD could inhibit the expression of inflammation-related indexes and apoptosis-related indexes at protein and mRNA levels. PD also regulates the diversity of the intestinal flora and the content of short-chain fatty acids. In conclusion, the current data suggest that PD has a protective effect against silica-induced lung injury and plays a protective role in regulating intestinal flora diversity and short-chain fatty acid levels through the gut-lung axis.

A combination of alveolar type 2-specific p38α activation with a high-fat diet increases inflammatory markers in mouse lungs

Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease afflict millions of individuals globally and are significant sources of disease mortality. While the molecular mechanisms underlying such diseases are unclear, environmental and social factors, such as cigarette smoke and obesity, increase the risk of disease development. Yet, not all smokers or obese individuals will develop chronic respiratory diseases. The mitogen-activated protein kinase p38α is abnormally active in such maladies, but its contribution, if any, to disease etiology is unknown. To assess whether p38α activation per se in the lung could impose disease symptoms, we generated a transgenic mouse model allowing controllable expression of an intrinsically active variant, p38αD176A+F327S, specifically in lung alveolar type 2 pneumocytes. Sustained expression of p38αD176A+F327S did not appear to induce obvious pathological outcomes or to exacerbate inflammatory outcomes in mice challenged with common respiratory disease triggers. However, mice expressing p38αD176A+F327S in alveolar type 2 cells and fed with a high-fat diet exhibited increased numbers of airway eosinophils and lymphocytes, upregulated levels of proinflammatory cytokines and chemokines including interleukin-1β and eotaxin, as well as a reduction in levels of leptin and adiponectin within the lung. Neither high-fat diet nor p38αD176A+F327S alone induced such outcomes. Perhaps in obese individuals with associated respiratory diseases, elevated p38α activity which happens to occur is the factor that promotes their development.

Associations of Maternal Smoking During Pregnancy and Genetic Susceptibility with Incident Asthma from a Cohort Study

Maternal smoking during pregnancy exhibited an adverse influence on asthma, but its joint effect with genetic factors remained elusive. Moreover, whether there existed a moderating role of genetic susceptibility in this effect on childhood/adolescent-onset asthma (COA) and adult-out asthma (AOA) was unknown. We employed the UK Biobank cohort to estimate the effect of maternal smoking during pregnancy on the risk of offspring asthma (41,828 AOA and 15,120 COA). We investigated genetic influence on asthma and assessed the moderating role of genetic susceptibility in this effect by incorporating polygenetic risk score (PRS) and performing a stratified analysis in distinct genetic risk populations. Hazard ratio (HR) and 95% confidence intervals (CIs) were reported. We found that participants whose mother smoked during pregnancy were more likely to occur asthma (HR = 1.14, 95%CIs 1.12 ~ 1.16), with similar effects for AOA and COA. Additionally, we observed a significant association between genetic factors and asthma (HR = 1.70, 95%CIs 1.66 ~ 1.74), with a higher genetic influence on COA (HR = 2.16, 95%CIs 2.09 ~ 2.23) compared to AOA (HR = 1.84, 95%CIs 1.76 ~ 1.93). Furthermore, we revealed that genetic factors could modify the effect of maternal smoking during pregnancy on asthma especially among childhood and adolescents, with participants having high genetic risk versus low genetic risk (HR = 1.13 vs. 1.02, P = 0.035). We provided supportive evidence that maternal smoking during pregnancy and the genetic factors increased the risk of offspring asthma in whole population. We further revealed that genetic susceptibility exerted more pronounced influence on COA compared to AOA, and played a moderating role in this effect.

MHR as a promising predictor for coronary artery disease in COPD patients: Insights from a retrospective nomogram study

BACKGROUND AND OBJECTIVE

Chronic obstructive pulmonary disease (COPD) frequently co-occurs with coronary artery disease (CAD), adversely affecting patients morbidity and mortality. Identifying new risk factors for CAD in COPD patients is essential for improving clinical management and patients outcomes.

METHODS

This retrospective case-control study analyzed 406 COPD patients who underwent coronary artery computed tomography angiography (CCTA). Patients were categorized into co-CAD and non-CAD groups based on CCTA findings. Demographic and laboratory data were assessed to determine independent risk factors for CAD in COPD patients using univariate and multivariate logistic regression analyses.

RESULTS

The co-CAD group was significantly older, had a higher prevalence of males, and included a higher proportion of individuals with hypertension, diabetes, cardiovascular diseases, as well as cerebrovascular diseases, exhibiting lower FEV1 values (P < 0.05). This group also exhibited higher levels of HbA1c, IL-6, monocyte count, and MHR (P < 0.05). Multivariate logistic regression identified age, hypertension, and MHR as independent predictors of CAD. A nomogram incorporating these predictors demonstrated robust predictive accuracy with an area under the ROC curve of 0.758 (95 % CI: 0.704-0.814), effectively stratifying patients into high and low risk for CAD.

CONCLUSION

The identification of MHR as an independent predictor of CAD in COPD patients opens new avenues for understanding cardiovascular comorbidities. The nomogram's integration of MHR with age and hypertension provides an effective tool for early CAD detection and management, promising to enhance clinical outcomes and decrease mortality rates in COPD patients. These insights may inform future preventative strategies against CAD in COPD.

Association Between Life's Essential 8 and Frailty in Adults with Asthma

Objectives

To investigate the correlation between Life's Essential 8 (LE8) and frailty in adults with asthma using data from National Health and Nutrition Examination Survey (NHANES).

Methods

We conducted a cross-sectional study by NHANES data (2001-2018) to assess the relationship between LE8 and frailty in asthma patients. Multiple logistic regression, restricted cubic spline (RCS) analysis, and subgroup analyses were performed to evaluate potential associations.

Results

Among the 3, 238 of 91 351 participants, 1066 asthma patients demonstrated frailty and 2172 asthma patients not. When comparing the groups with moderate and high LE8 scores to the group with low LE8 scores, the odds ratios (ORs) (95% confidence intervals) for frailty in asthma were 0.39 (0.27, 0.56) and 0.15 (0.08, 0.27),respectively. Every 10-point increment of LE8 scores was negatively correlated with frailty in asthma. Similar trends were observed for health behavior and health factor scores. ORs for frailty in asthma were 0.54 (0.41, 0.72) and 0.41(0.27, 0.64) when comparing the groups with moderate and high health behavior scores to the group with low health behavior scores. ORs for frailty in asthma were 0.68 (0.48, 0.98) and 0.50 (0.28, 0.88) when comparing the groups with moderate and high health factor scores to the group with low health factor scores. ORs for frailty in asthma were 0.78 (0.72, 0.84) both in the every 10-point increment of health behavior and health factor scores.

Conclusions

Higher LE8 scores, along with health behavior and health factor scores, were linearly and inversely associated with the prevalence frailty in adults with asthma, suggesting that improved LE8 may reduce frailty risk in asthma population.

Association Between the Non-High-Density Lipoprotein Cholesterol-to-High-Density Lipoprotein Cholesterol Ratio (NHHR) and Mortality in Patients with COPD: Evidence From the NHANES 1999-2018

Purpose

The non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (NHHR) is a new composite blood lipid index. We aimed to investigate the relationships of the NHHR with mortality from all-causes, cardiovascular disease (CVD), and chronic lower respiratory disease (CLRD) in US patients with COPD.

Methods

We assessed the association between the NHHR and mortality via weighted multivariate Cox proportional hazards regression models with restricted cubic splines (RCSs). Between-group survival rates at specific time points were compared via Kaplan‒Meier (KM) curves and Log rank tests. Receiver operating characteristic (ROC) curves were constructed to evaluate the efficiency of the NHHR for predicting mortality risk in COPD patients.

Results

After adjusting for confounding factors, weighted multivariate Cox proportional hazards regression model showed that higher NHHR was not significantly associated with all-cause mortality (HRs = 1.74), CVD mortality (HRs = 1.19), and CLRD-related mortality (HRs = 0.65), but HRs tended to increase as NHHR increased. RCS revealed U-shaped associations between the NHHR and all-cause mortality. KM survival analysis revealed a significantly lower survival rate for patients in the high-NHHR group (Log rank test P<0.001). In addition, the NHHR had superior performance in predicting mortality, with AUC values of 0.85 and 0.883 for all-cause mortality, 0.769 and 0.815 for CVD mortality, and 0.765 and 0.815 for CLRD-related mortality at 5 and 10 years, respectively.

Conclusion

The higher the NHHR is, the greater the risk of all-cause mortality in COPD patients. The NHHR was significantly superior to other haematological biomarkers in predicting mortality.

Biological pathways and mechanisms linking COPD and cardiovascular disease

Cardiovascular disease (CVD) still poses a significant risk for morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). For a long time, among functional parameters, only the forced expiratory volume in 1 s (FEV1) has been considered as predictive of cardiovascular (CV) mortality especially in elderly patients in fact, there is evidence that reductions in lung function indices can increase the risk of ischaemic heart diseases and cerebrovascular diseases, independently from other risk factors. Now, there is considerable evidence suggesting that hypoxemia, systemic inflammation, oxidative stress and hyperinflation may lead to an early sub-clinical CV involvement in patients affected by COPD. Ageing in itself impacts specific aspects of the CV system, including reduced beta-adrenergic responsiveness, increased vagal tone and myocardial and vascular stiffness, endothelial dysfunction, diminished arterial baroreflex and compromised diastolic function. The complex involved interactions include ageing mechanisms as well as multiple known and unknown (e.g. genetic) risk factors. CVDs are leading causes of mortality in individuals with impaired lung function and the two entities commonly coexist with poor outcomes in patients experiencing both conditions. However, the precise mechanisms responsible for this association remain largely unknown. In this narrative review, we summarize current knowledge regarding the co-occurrence of COPD and CVD focusing on the shared biological pathways and biological mechanisms involved in these conditions.

Global and regional burden of pneumoconiosis, 1990-2021: an analysis of data from the global burden of disease study 2021

Background

Pneumoconiosis remains a widespread occupational disease globally. This study provides an updated overview of the global burden of pneumoconiosis, examining incidence and mortality from 1990 to 2021.

Methods

The study assessed the incidence and mortality of pneumoconiosis using GBD data from 1990 to 2021, presenting findings as point estimates with 95% uncertainty intervals.

Results

In 2021, there were 62,866 new pneumoconiosis cases and 18,323 deaths worldwide, with age-standardized incidence (ASIR) and age-standardized mortality rates (ASMR) of 0.736 and 0.219 per 100,000 population, respectively, showing decreases of 28.5 and 52.8% since 1990. The highest ASIR and ASMR of pneumoconiosis were found in middle and high-middle SDI quintiles in 2021, with East Asia having the highest ASIRs. ASIR and ASMR generally declined but rose in Australasia and Oceania from 1990 to 2021. Globally, the number of incidences peaked at 65-69 years in 1990 and 2021, with death peaks at 65-69 years in 1990 and 80-84 years in 2021. A correlation analysis revealed that ASIR and ASMR either decreased or remained stable in the majority of countries and territories as SDI increased. Decomposition analysis shows that population growth and aging drove the global number increase in most regions, while epidemiological changes had a negative impact.

Conclusion

Despite an overall decline in global pneumoconiosis burden from 1990 to 2021, particularly in the middle and high-middle SDI quintiles, and in East Asia. The future looks promising, but pneumoconiosis remains a public health concern. The implementation of prevention strategies and improving the quality of life of current patients should be a priority.

Call to action for primary care symptom management in end-stage lung disease

End-stage lung disease is characterised by high symptom burden. We discuss two patients with end-stage lung disease who established with outpatient palliative care and were started on oral opioids for dyspnoea with marked improvement in their shortness of breath and functional status. We review barriers to outpatient opioid prescribing for dyspnoea and suggest that this symptom management is safe and appropriate for primary care providers.

Chronic obstructive pulmonary disease across three decades: trends, inequalities, and projections from the Global Burden of Disease Study 2021

Objective

To assess the global burden of chronic obstructive pulmonary disease (COPD) and cross-country inequalities from 1990 to 2021 and project changes until 2045.

Methods

Data on prevalence, mortality, and disability-adjusted life-years (DALYs) for COPD were extracted from the Global Burden of Disease Study 2021 (https://vizhub.healthdata.org/gbd-results/). Trends were analyzed globally, regionally, and nationally, considering population growth, aging, and epidemiological changes. Inequalities were quantified using the World Health Organization's health equity framework. Future projections were estimated to 2045.

Results

From 1990 to 2021, global age-standardized rates of COPD prevalence, mortality, and DALYs declined annually by -0.04, -1.75%, and -1.71%, respectively. However, absolute cases, deaths, and DALYs increased by 112.23, 49.06, and 40.23%, driven by population growth and aging. Men consistently showed higher age-standardized rates. East Asia reported the highest absolute cases and deaths, while South Asia had the largest DALYs. High-income North America and Oceania had the highest age-standardized rates, while Australasia and Eastern Europe saw the steepest declines in prevalence and mortality, respectively. Disparities in COPD burden across sociodemographic index levels widened over time. By 2045, absolute numbers of COPD cases, deaths, and DALYs are projected to rise despite declining age-standardized rates.

Conclusion

While global age-standardized rates of COPD prevalence, mortality, and DALYs have declined, the absolute burden has increased due to demographic shifts. Persistent disparities in COPD burden, particularly in low- and middle-sociodemographic index regions, underscore the need for targeted prevention and management strategies.

Causal effect of life-course adiposity on the risk of respiratory diseases: a Mendelian randomization study

BACKGROUND

There is limited evidence on the causal associations of life-course adiposity with the risk of respiratory diseases. This study aimed to elucidate these associations.

METHODS

Two-sample Mendelian randomization was conducted using genetic instruments of life-course adiposity (including birth weight, childhood BMI, and adulthood adiposity) to estimate their causal effect on respiratory diseases in participants of European ancestry from the UK Biobank, the FinnGen consortium, and other large consortia.

RESULTS

Genetically predicted higher birth weight was associated with decreased risk of acute upper respiratory infections and increased risk of pulmonary embolism, sleep apnea, and lung cancer. Genetically predicted high childhood BMI was associated with increased risk of asthma, COPD, pulmonary embolism, and sleep apnea. However, most of these observed associations were no longer significant after adjusting for adult BMI. Genetically predicted higher adult BMI and WHR were associated with 10 and 4 respiratory diseases, respectively. High adult body fat percentage and visceral adiposity were genetically associated with increased risk of 9 and 11 respiratory diseases, respectively. Consistently, genetically predicted higher whole-body fat mass was associated with increased risk of 8 respiratory diseases.

CONCLUSIONS

This study provides genetic evidence that greater adiposity in childhood and adulthood has a causal effect in increasing the risk of a wide range of respiratory diseases. Furthermore, the effects of childhood obesity on respiratory outcomes may be mediated by adult obesity.

Heat exposure and respiratory diseases health outcomes: An umbrella review

INTRODUCTION

Heat exposure and heatwaves are becoming more frequent and prolonged due to global warming. Heat exposure poses a significant potential risk for respiratory diseases. However, a comprehensive synthesis of existing evidence on the health impacts of heat exposure on respiratory diseases is lacking. This review aims to address this knowledge gap.

METHODS

The PubMed, Scopus, Embase, and Web of Science databases were searched for reviews examining the impact of heat exposure on respiratory-related mortality and morbidity, as well as on respiratory diseases such as asthma, pneumonia, COPD, acute bronchiolitis, and acute respiratory infections. The final search was conducted in July 2024. The quality of evidence for each health outcome category was assessed using a modified GRADE framework.

RESULTS

A total of 28 reviews were included. There is strong evidence linking heat exposure to increased mortality in respiratory diseases. However, the associations between heat exposure and respiratory morbidity are less robust. Asthma is the most studied condition and has the most consistent evidence supporting its association with heat exposure. For other respiratory diseases, the evidence remains inconclusive.

CONCLUSION

This review strengthens the evidence that heat exposure increases the risk of respiratory diseases globally. Future research should focus on low-income countries, specific respiratory diseases, and the integration of multi-dimensional data to develop evidence-based prevention and adaptation strategies.

Current status of pharmacists in community pharmacies in China in the health management of chronic respiratory diseases

BACKGROUND

Effective management of chronic respiratory diseases (CRDs) is critical, and community pharmacists play a key role. This study evaluates pharmacists' knowledge, attitude, technology use and patient education in CRDs management across various regions in China.

METHODS

This cross-sectional study conducted a survey of pharmacists across nine provinces and two municipalities in China from January to September 2024, using a stratified convenience sampling method based on regional GDP. A total of 733 questionnaires were distributed through online platforms and pharmacy networks, yielding 699 valid responses, resulting in a response rate of 95.4%.

RESULTS

61.5% of pharmacists correctly answering 5 or fewer questions on knowledge-related topics. Additionally, 68.1% of the pharmacists demonstrated an accuracy rate of less than 50% in COPD-related questions, and 58.7% had an accuracy rate below 50% in asthma-related questions. Pharmacists in developed regions showed higher scores in knowledge, attitude, and patient education compared to those in underdeveloped areas (P < 0.05). Higher education and professional certifications were associated with better scores (P < 0.05). Frequent CRDs patient management and positive attitudes enhanced technology use, while longer working hours were linked to lower technology use and patient education scores (P < 0.05). Higher knowledge and attitude scores were significantly associated with better patient education (P < 0.05).

CONCLUSION

Community pharmacists display significant knowledge gaps in managing CRDs, particularly COPD and asthma. Developed regions, higher education, certification, and frequent CRDs management correlate with better scores. These findings highlight the need for ongoing education and improved working conditions to strengthen pharmacists' roles in CRDs management, aligning with the Healthy China initiative.

Digital Health Education for Chronic Lung Disease: Scoping Review

BACKGROUND

Chronic lung disease (CLD) is one of the most prevalent noncommunicable diseases globally, significantly burdening patients and increasing health care expenditures. Digital health education (DHE) is increasingly important in chronic disease prevention and management. However, DHE characteristics and impacts in CLD are rarely reported.

OBJECTIVE

This study aimed to provide an overview of the existing literature on DHE for CLD, with a focus on exploring the DHE mediums, content, mechanisms, and reported outcomes in patients with CLD.

METHODS

We searched PubMed, Web of Science, Embase, PsycINFO, and The Cochrane Library with the assistance of a librarian specialist. Articles were screened by the reviewer team with ASReview (Utrecht University) and EndNote X9 (Clarivate Analytics) based on predefined inclusion and exclusion criteria and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Quality assessment was conducted with the Critical Appraisal Skills Program tool. A descriptive analysis was used to summarize the study characteristics, DHE characteristics, and outcomes.

RESULTS

A total of 22 studies were included in this review with medium or high quality. They were published between 2000 and 2022, showing an increasing publication trend with the year, mostly in developed countries (16/22, 73%). Websites and mobile apps (10/22, 45%) were the most widely used DHE medium. Education on self-management skills of CLD was the primary topic (21/22, 95%), 4/22 (18%) of which mentioned DHE mechanisms. The majority of studies reported positive changes in CLD awareness (14/16, 88%), clinical outcomes (3/6, 50%), DHE feasibility, acceptability, and satisfaction (6/8, 75%), lifestyle outcomes (3/3, 100%), and psychosocial outcomes (7/8, 88%). Only 2 studies reported cost-effectiveness (2/22, 9%).

CONCLUSIONS

Despite the heterogeneity of the study situation, some aspects can be concluded. DHE can improve disease awareness and clinical outcomes in patients with chronic lung disease, with good feasibility, acceptability, and satisfaction through different mediums and learning content. There is still relatively little research among people in low- and middle-income countries. Future research should consider the impact on cost-effectiveness, duration, frequency, and theoretical mechanisms of the DHE to maximize the potential impact. It should also be conducted in the context of health services research to better reflect the real world.

The relationship between ferroptosis and respiratory infectious diseases: a novel landscape for therapeutic approach

Respiratory infectious diseases, particularly those caused by respiratory viruses, have the potential to lead to global pandemics, thereby posing significant threats to public and human health. Historically, the primary treatment for respiratory bacterial infections has been antibiotic therapy, while severe cases of respiratory viral infections have predominantly been managed by controlling inflammatory cytokine storms. Ferroptosis is a novel form of programmed cell death that is distinct from apoptosis and autophagy. In recent years, Recent studies have demonstrated that ferroptosis plays a significant regulatory role in various respiratory infectious diseases, indicating that targeting ferroptosis may represent a novel approach for the treatment of these conditions. This article summarized the toxic mechanisms underlying ferroptosis, its relationship with respiratory infectious diseases, the mechanisms of action, and current treatment strategies. Particular attentions were given to the interplay between ferroptosis and Mycobacterium tuberculosis, Epstein-Barr virus, severe acute respiratory syndrome coronavirus-2, Pseudomonas aeruginosa, dengue virus, influenza virus and herpes simplex virus type1infection. A deeper understanding of the regulatory mechanisms of ferroptosis in respiratory infections will not only advance our knowledge of infection-related pathophysiology but also provide a theoretical foundation for the development of novel therapeutic strategies. Targeting ferroptosis pathways represents a promising therapeutic approach for respiratory infections, with significant clinical and translational implications.

Predictive Value of the Neutrophil-to-Lymphocyte Ratio/Serum Albumin for All-Cause Mortality in Critically Ill Patients Suffering from COPD

Background

Among critically ill patients, chronic obstructive pulmonary disease (COPD) is an independent risk factor for death. Recently, biomarkers such as neutrophil-lymphocyte ratio (NLR) and albumin (ALB) have been used to predict the prognosis in patients with COPD. However, the association between NLR/ALB and all-cause mortality in critically ill COPD patients remains unclear. This study aims to explore the association between the NLR/ALB and prognosis in critically ill patients with COPD.

Methods

Data was sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Primary outcome was 28-day all-cause mortality, with secondary outcomes being in-hospital and 90-day all-cause mortality. The area under the receiver operating characteristic curve (AUROC) was calculated to compare prognostic accuracy of NLR, NLR/ALB, PLR, SII and MLR variables. After identifying the most predictive factor, KM survival curves, Cox models and subgroup analyses were used to examine NLR/ALB's relationship with mortality in critically ill COPD patients. Additionally, patients with COPD from the National Health and Nutrition Examination Survey data (1999-2018) was used with Cox regression to investigate NLR/ALB's correlation with all-cause mortality in COPD patients.

Results

1916 critically ill COPD patients from MIMIC IV, divided into quartiles by NLR/ALB levels: Q1 (NLR/ALB<1.108), Q2 (2.095>NLR/ALB≥1.108), Q3 (4.221>NLR/ALB≥2.095), Q4 (NLR/ALB≥4.221). In multivariate Cox regression, Q4 vs Q1: 28-day mortality HR=2.27 (95% CI: 1.63-3.16); 90-day mortality HR=2.06 (95% CI: 1.56-2.71); in-hospital mortality HR=1.93 (95% CI: 1.35-2.77); P<0.001. Subgroup analyses showed that the correlation between NLR/ALB and 28-day mortality was stable Additionally, we recruited 2,003 COPD patients from the NHANES that found NLR/ALB also correlated with all-cause mortality in COPD (In multivariate Cox regression: Q4 vs Q1 hR=1.92 (95% CI: 1.45-2.55, P<0.001)).

Conclusion

Elevated NLR/ALB levels are associated with increased all-cause mortality in critically ill patients with COPD.

Association between allergic rhinitis, nasal polyps, chronic sinusitis and chronic respiratory diseases: a mendelian randomization study

BACKGROUND

Epidemiological investigations provide considerable evidence supporting the coexistence of upper airway ailments with lower airway disorders, but the association between common nasal diseases, such as allergic rhinitis, chronic sinusitis, nasal polyps, and chronic respiratory conditions require further exploration.

METHODS

In this study, a two-sample mendelian randomization was employed to explore the potential association between allergic rhinitis, nasal polyps, and chronic sinusitis with various chronic respiratory diseases. For the primary analysis, summary statistics related to chronic respiratory diseases were obtained from the UK Biobank of European ancestry. To externally validate the results, summary statistics related to chronic respiratory diseases were sourced from the FinnGen R10 database. The analysis incorporated various methodologies, including the inverse variance weighted method, the MR Egger method, and the weighted median method. Sensitivity analysis encompassed Cochran 's Q test, MR-Egger intercept tests, leave-one-out analyses, and the construction of funnel plots.

RESULTS

Allergic rhinitis was significantly associated with asthma (UKB database, OR 1.082, 95% CI 1.072-1.0924, P < 0.001; FinnGen database, OR 1.382, 95% CI 1.305-1.462, P < 0.001), COPD (UKB database, OR 1.003, 95% CI 1.001-1.006, P = 0.020; FinnGen database, OR 1.102, 95% CI 1.037-1.172, P = 0.002), ILD (UKB database, OR 1.013, 95% CI 1.010-1.017, P < 0.001; FinnGen database, OR 1.152, 95% CI 1.035-1.283, P = 0.010). Nasal polyps were potentially related to the increased risks of COPD (UKB database, OR 1.003, 95% CI 1.001-1.004, P < 0.001; FinnGen database, OR 1.092, 95% CI 1.050-1.136, P < 0.001) and bronchiectasis (UKB database, OR 1.000, 95% CI 1.000-1.001, P = 0.036; FinnGen database, OR 1.109, 95% CI 1.022-1.203, P = 0.013).

CONCLUSIONS

This study indicates a potential relationship between allergic rhinitis and respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). Additionally, the presence of nasal polyps appears to be correlated with an increased prevalence of COPD and bronchiectasis.

Insights into associations between Life's essential 8 and lung function from NHANES data

The Life's Essential 8 (LE8) is a novel indicator of cardiovascular health proposed by the American Heart Association. While numerous studies have demonstrated its guiding value in chronic diseases, research on its role in lung function remains limited. This study utilized data from the National Health and Nutrition Examination Surveys (NHANES 2007-2012), which included comprehensive measurements of lung function, diet, physical activity, nicotine exposure, sleep patterns, body mass index (BMI), blood glucose, blood pressure, blood lipids, and relevant covariates. We calculated lung function Z-score and LE8 scores, employing multiple linear regression, multivariable logistic regression, and restricted cubic spline models to evaluate their correlations. In this study of 10,400 participants (mean age 44 years; 48.75% male), participants were classified into threeforcedexpiratory volume in one second (FEV1) Z-score groups: Z1 (normal lung function, n = 9,600), Z2 (mild impairment, n = 618), and Z3 (moderate to severe impairment, n = 182). Significant differences in demographic characteristics and health parameters were observed among the groups. Notably, variations in the Healthy Eating Index 2015 (HEI-2015), physical activity, nicotine exposure, and sleep patterns were identified within the LE8 health behavior domain. Higher LE8 scores were found to be positively associated with lung function, even after adjusting for demographic and health factors. Further analysis revealed positive correlations between lung function and favorable dietary habits, higher physical activity levels, reduced nicotine exposure, and improved sleep quality. Conversely, BMI, blood lipids, blood glucose, and blood pressure exhibited variable effects. Subgroup and sensitivity analyses consistently supported findings, confirming a positive correlation between LE8 and lung function. Our study highlights significant associations between LE8 scores and lung function, demonstrating that higher LE8 scores, which reflect better cardiovascular health behaviors, are positively correlated with improved lung function.

Geriatric nutritional risk index as a predictor of mortality in women with chronic inflammatory airway disease: evidence from NHANES 1999-2018

Background

The incidence of Chronic Inflammatory Airway Diseases (CIAD) has been steadily increasing, making it a significant contributor to the global disease burden. Additionally, the risk of airway diseases in elderly women continues to rise each year, with nutritional factors playing a crucial role in the progression of CIAD. The Geriatric Nutritional Risk Index (GNRI) is a novel tool for assessing individual nutritional status. This study aims to assess the relationship between GNRI and the risk of all-cause and cardiovascular mortality in elderly women with CIAD, providing guidance for nutritional interventions to reduce mortality risk.

Methods

Data from elderly female patients and relevant indicators were sourced from the National Health and Nutrition Examination Survey (NHANES) database. Nutritional status was assessed using the GNRI, and patients were divided into four groups based on their GNRI quartiles. Weighted Cox proportional hazards regression models were used to examine the relationship between GNRI and all-cause as well as cardiovascular mortality in elderly women with CIAD. Additionally, restricted cubic spline (RCS) analysis was applied to explore the association between GNRI and different mortality outcomes, and subgroup analysis was conducted to further validate the robustness of the findings.

Results

A total of 1,417 elderly female CIAD patients were included in this study. During a median follow-up of 91 months, 515 deaths from all causes and 157 deaths from cardiovascular causes occurred. Multivariable-adjusted Cox proportional hazards models indicated that compared to the lowest GNRI quartile, the other quartiles showed a general decreasing trend in both all-cause and cardiovascular mortality risk (p < 0.05). In the fully adjusted model, the highest GNRI quartile had the lowest risks of all-cause mortality (HR = 0.40, 95% CI: 0.22-0.72, p < 0.05) and cardiovascular mortality (HR = 0.29, 95% CI: 0.11-0.78, p < 0.05).The RCS analysis demonstrated a nonlinear association between GNRI and both all-cause and cardiovascular mortality (P for nonlinearity <0.001).

Conclusion

In elderly women with CIAD, lower GNRI levels are associated with an increased mortality risk. GNRI may serve as a potential predictive tool for both all-cause and cardiovascular mortality, providing valuable insights for nutritional interventions and clinical decision-making.

Machine learning-based risk assessment for cardiovascular diseases in patients with chronic lung diseases

The association between chronic lung diseases (CLDs) and the risk of cardiovascular diseases (CVDs) has been extensively recognized. Nevertheless, conventional approaches for CVD risk evaluation cannot fully capture the risk factors (RFs) related to CLDs. This research sought to construct a CLD-specific CVD risk prediction model based on machine learning models and evaluate the prediction performance. The cross-sectional study design was adopted with data retrieved from Waves 1 and 3 of the China Health and Retirement Longitudinal Study, including 1357 participants. Multiple RFs were integrated into the models, including conventional RFs for CVDs, pulmonary function indicators, physical features, and measures of quality of life and psychological state. Four machine learning algorithms, including extreme gradient boosting (XGBoost), logistic regression, random forest, and support vector machine, were evaluated for prediction performance. The XGBoost model displayed superior performance to machine learning algorithms for predictive accuracy (area under the receiver operating characteristic curve [AUC]: 0.788, accuracy: 0.716, sensitivity: 0.615, specificity: 0.803). This model pinpointed the top 5 RFs for CLD-specific CVD RFs: body mass index, age, C-reactive protein, uric acid, and grip strength. Moreover, the prediction performance of the random forest model (AUC: 0.709, accuracy: 0.633) was higher relative to the logistic regression (AUC: 0.619, accuracy: 0.584) and support vector machine (AUC: 0.584, accuracy: 0.548) models. Nonetheless, these models performed less favorably compared to the XGBoost model. The XGBoost model presented the most accurate predictions for CLD-specific CVD risk. This multidimensional risk assessment approach offers a promising avenue for the establishment of personalized prevention strategies targeting CVD in patients with CLDs.

Healthcare utilization trends in adults with asthma or COPD during the first year of COVID-19 pandemic in comparison to pre-pandemic: A population-based study

OBJECTIVES

To assess how changes in outpatient services during the first year of the COVID-19 pandemic were related to acute healthcare use (emergency department or hospitalizations) for individuals with asthma or chronic obstructive pulmonary disease (COPD).

METHODS

We conducted an observational study using health administrative data in Ontario (Canada) from January 2016 to March 2021 on all adults with diagnosed asthma or COPD. We used monthly time series auto-regressive integrated moving-average (ARIMA) and pre-pandemic monthly rates (January 2016 to February 2020) to calculate projected rates (i.e., a pandemic had not occurred) during the pandemic (March 2020 to March 2021), and Quasi-Poisson models with two-way interaction to estimate crude and adjusted rate ratios.

RESULTS

In the first pandemic year, in individuals with asthma or COPD, outpatient visit rates started lower than projected (Mar-May 2020), returned to projected in the middle of the year (Jun-Aug 2020) and then rose to higher than projected between Sep 2020 and Mar 2021: observed rates of 80,293 per 100,000 persons vs. projected 74,192 (95% CI: 68,926-79,868) in individuals with asthma, and 92,651 vs. projected 85,871 (95% CI: 79,975-92,207) in individuals with COPD. Acute care rates remained below projected during the first pandemic year. While pulmonary function test (PFT) rates remained below projected during the first pandemic year, in both populations, a decrease in acute care visits during the pandemic, compared to pre-pandemic, was noted during months with the highest PFT rates (interaction p-values < 0.0001).

CONCLUSIONS

Despite asthma and COPD being ambulatory-care sensitive conditions, lower rates of outpatient visits during the beginning of the pandemic were not associated with increased rates of acute care use. Lower PFT rates were associated with higher acute care visit rates, suggesting that access to PFT during pandemic is likely important for individuals with asthma or COPD.

Correlation analysis between the prevalence of common respiratory pathogens and exposure to ambient air pollutants in Central China, 2014-2022

Background

Whether ambient air pollutants affect the transmission of respiratory pathogens in central Wuhan is unknown. So, we conducted a series of statistical analyses to discover the correlation between the two.

Methods

We enrolled a total of 47,668 outpatient and hospitalized patients who underwent IgM antibody tests for nine types of respiratory pathogens, namely, Legionella pneumophila type 1 (LP1), Mycoplasma pneumoniae (MP), Q fever rickettsia (QFR), Chlamydia pneumoniae (CP), adenovirus (ADV), respiratory syncytial virus (RSV), influenza virus A (FluA), influenza virus B (FluB), and parainfluenza virus (PIVs) between January 2014 and December 2022. Monthly measurements were taken for specific air pollutants, including fine particulate matter 2.5 (PM2.5), inhalable particulate matter 10 (PM10), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) at the same periods. The association between different respiratory pathogen infections and major air pollutants was primarily analyzed using Spearman's correlation analysis.

Conclusion

MP, LP1, and FluB are correlated with respiratory infections and have been identified as potential causative agents. Elevated levels of O3 were found to augment the incidence of MP infection. We first discovered the positive correlation between SO2 and ADV infection and between CO and LP1 infection. The presence of air pollutants in Wuhan showed a significant correlation with respiratory pathogens, and elevated levels of air pollution facilitated their transmission to individuals.

Vitronectin regulates lung tissue remodeling and emphysema in chronic obstructive pulmonary disease

Vitronectin (VTN) is an important extracellular matrix protein in tissue remodeling, but its role in chronic obstructive pulmonary disease (COPD) is unknown. We show that VTN regulates tissue remodeling through urokinase plasminogen activator (uPA) signaling pathway in COPD. In human COPD airways and bronchoepithelial cells and the airways of mice with cigarette smoke (CS)-induced experimental COPD, VTN protein was not changed, but downstream uPA signaling was altered (increased plasminogen activator inhibitor-1) that induced collagen and airway remodeling. In the parenchyma, VTN levels were decreased, uPA signaling pathway differentially altered and collagen reduced in lung fibroblasts from human and lung parenchyma in experimental COPD. Vtn inhibition with siRNA in mouse fibroblasts altered uPA signaling increased matrix metalloproteinase-12, and reduced collagen, whereas over-expression restored collagen production after CS extract challenge. Vtn-/- and Vtn small interfering RNA-treated mice had exaggerated inflammation, emphysema, and impaired lung function compared with controls with CS-induced COPD. Restoration of VTN in the parenchyma may be a therapeutic option for emphysema and COPD.

Global, regional, and national temporal trends in prevalence, deaths and disability-adjusted life years for chronic pulmonary disease, 1990-2021: an age-period-cohort analysis based on the global burden of disease study 2021

Background

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally, with significant disparities in disease burden across countries and socioeconomic regions. Despite advancements in public health, the global burden of COPD remains substantial, particularly in low- and middle-income countries. This study aims to provide a comprehensive analysis of global, regional, and national trends in COPD-related prevalence, deaths, and disability-adjusted life years (DALYs) from 1990 to 2021 using an age-period-cohort (APC) model.

Methods

Data from the Global Burden of Disease Study 2021 were analyzed for 204 countries and territories, stratified by five Sociodemographic Index (SDI) levels. An APC model was employed to assess the temporal effects of age, time periods, and birth cohorts on COPD burden. Trends in prevalence, deaths, and DALYs were evaluated through metrics such as Net Drift, Local Drift, and risk ratios.

Results

Globally, from 1990 to 2021, the age-standardized rates of COPD demonstrated a decline of -1.46% (95% UI: -3.36 to 0.39%) in prevalence, -37.12% (95% UI: -43.37% to -27.68%) in deaths, and -36.98% (95% UI: -42.37% to -28.54%) in DALYs. After adjusting for age and cohort effects, the annual changes were -0.35% (95% UI: -0.39% to -0.32%) in prevalence, -3.87% (95% UI: -4.00% to -3.74%) in deaths, and - 2.95% (95% UI: -3.02% to -2.89%) in DALYs. Notably, in middle, low-middle, and low SDI regions, the age-standardized prevalence rates in 2021 showed an increase compared to 1990, with respective changes of 4.03% (95% UI: 2.00-5.89%), 0.13% (95% UI: -2.90 to 2.84%), and 6.71% (95% UI: 4.25-8.91%). However, age-standardized deaths and DALYs significantly decreased across all five SDI regions. From an age effect perspective, globally, over 50% of COPD prevalence is concentrated among individuals aged 65 years and older, particularly in middle, low-middle, and high-middle SDI regions. COPD-related deaths and DALYs have shown a declining trend across all age groups. Globally, the period effect indicates that earlier periods were associated with a higher burden of disease, while cohort effects highlight that birth cohorts around 1920 had a particularly pronounced impact on the COPD burden. Both period and cohort effects exhibited notable heterogeneity across different SDI regions and countries.

Conclusion

The prevalence of COPD remains concerning. Compared to 1990, the global prevalence of COPD in 2021 showed a stable or slightly increasing trend, with over half of the countries experiencing an annual increase in prevalence during the 1990-2021 period. Global mortality and DALYs associated with COPD showed a notable decline in 2021 compared to 1990. However, this trend exhibited significant heterogeneity across countries and regions, likely linked to differences in socioeconomic development. Countries in the high-middle and middle SDI regions were found to be more affected by period effects. From an age effect perspective, population aging has undoubtedly exacerbated the COPD burden. Regarding cohort effects, earlier birth cohorts demonstrated a stronger contribution to the increasing disease burden. While Higher levels of socioeconomic development can mitigate the adverse effects associated with earlier birth cohorts.

Optimal spirometry thresholds for the prediction of chronic airflow obstruction: a multinational longitudinal study

Introduction

Chronic airflow obstruction is key for COPD diagnosis, but strategies for its early detection are limited. We aimed to define the optimal z-score thresholds for spirometry parameters to discriminate chronic airflow obstruction incidence.

Methods

The Burden of Obstructive Lung Disease study is a multinational cohort study. Information on respiratory symptoms was collected and pre- and post-bronchodilator spirometry was performed at baseline. 18 study sites were followed-up with repeat measurements after a median of 8.4 years. We converted lung function measurements into z-scores using the Third National Health and Nutrition Survey reference equations. We used the Youden index to calculate the optimal z-score thresholds for discriminating chronic airflow obstruction incidence. We further examined differences by smoking status.

Results

We analysed data from 3057 adults (57% female, mean age: 51 years at baseline). Spirometry parameters were good at discriminating chronic airflow obstruction incidence (area under the curve 0.80-0.84), while respiratory symptoms performed poorly. The optimal z-score threshold was identified for pre-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) <-1.336, equivalent to the 9th percentile (sensitivity: 78%, specificity: 72%). All z-score thresholds associated with a lower post-bronchodilator FEV1/FVC and greater odds of chronic airflow obstruction at follow-up. The risk of chronic airflow obstruction was slightly greater for current smokers and, to some extent, never-smokers with a pre-bronchodilator FEV1/FVC <9th/10th percentiles at baseline, particularly among males.

Conclusions

Spirometry is better than respiratory symptoms at predicting chronic airflow obstruction incidence. A pre-bronchodilator FEV1/FVC <9th/10th percentiles, particularly among current smokers, could suggest early airflow obstruction or pre-COPD.

The in- and outpatient health care use of patients with COPD before and after initiation of home care: a registry study from Norway

OBJECTIVE

Chronic obstructive pulmonary disease (COPD) is a common condition associated with age, multimorbidity and frequently involves the use of health care across levels. Understanding the factors associated with the initiation of long-term care is important when planning the future need for services. We describe healthcare use before and after the reception of any home care. We further studied the associations between healthcare use and first registered home care service and from first registered home care service to nursing home admission or death.

DESIGN AND SUBJECTS

Patients residing in Oslo or Trondheim at the time of first contact with a COPD primary diagnosis, 2009-2018. Patient data were linked across national and municipal registries, covering healthcare and sociodemographics. The sample consisted of 16,738 individuals.

RESULTS

There was a marked increase in inpatient and outpatient hospital contacts in the years prior to and after the reception of any home care. Adjusted for comorbidities and sociodemographics, high numbers of GP consultations, and inpatient and outpatient hospital contacts for respiratory diagnoses were associated with a significantly higher likelihood of receiving home care the next year (hazard odds ratios > 1.3). Following the reception of home care, the type of home care service received (e.g. home nursing or short-term rehabilitation/treatment) was more important than outpatient services in predicting next-year nursing home admission or death.

CONCLUSION

Including data on prior outpatient care when predicting future need for home care is beneficial. A high frequency (top 10%) of yearly GP, in- or outpatient hospital contacts can imply that the patient may be in need of home care in the near future.

Type 2 inflammation: a Portuguese consensus using Web-Delphi and decision conferencing (INFLAT2-PT)

OBJECTIVES

Atopic/allergic diseases impose a growing burden on public health, affecting millions of patients worldwide. The main objective of this study was to develop a national expert consensus on relevant clinical questions related to type 2 inflammation.

METHODS

We conducted: a comprehensive literature review with a qualitative analysis to identify the most repeated themes on the overlap of conditions; a modified 3-round Web-Delphi (or e-Delphi); and a final online decision conference.

RESULTS

We included 51 studies. Following three Web-Delphi rounds, we ended up with 30 statements with a 76% overall full agreement rate, 16% agreement, 2% disagreement, and 0% full disagreement. The decision conference enabled adjustments, and the expert panel agreed unanimously on the final set of statements. The consensus used evidence synthesis, Web-Delphi, and decision conference to produce 30 statements on type 2 inflammation as a driver for multimorbidity in asthma, certain rhinitis phenotypes, atopic dermatitis, chronic rhinosinusitis with nasal polyps, and eosinophilic esophagitis grouped under five domains in underlying pathophysiology, multimorbidity, diagnosis and management, multidisciplinary management, and impact on mental health.

CONCLUSION

We expect the first Portuguese expert consensus INFLAT2-PT to promote understanding of type 2 inflammation diseases, multidisciplinary care, integrated care pathways, future research, and inform health authorities.

Unmasking the veil of PM2.5 pollution: A comprehensive analysis of health effects, economic losses, and environmental implications in North Indian States

This research paper analyses particulate matter (PM2.5) pollution data from five Indian states to assess health impacts, including premature deaths from lung cancer (LC), chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), stroke, and lower respiratory infections (LRI). Intake factors (iF), effect factors (EF), and characterization factors (CF) were used to quantify pollutant inhalation, health impact per unit intake, and potential health impact in Disability-Adjusted Life Years (DALYs), respectively. We found localities like Jahangirpuri in Delhi (DL) (3.25E-04-4.01E-04), Faridabad in Haryana (HR)(1.1E-04-9.59E-05), Bhiwadi in Rajasthan (RJ) (6.76E-05-9.73E-05), Ghaziabad in Uttar Pradesh (UP) (7.49E-05-1.32E-04) and Gobindgarh in Punjab (PB) (4.14E-05-5.16E-05) had much higher iFs than the previously reported pan- India value of 7.60E-06. Ghaziabad of UP recorded the highest EF of 4.02E+ 02 DALYs per kilogram PM2.5 inhalation in 2021. High iF and EF values resulted in alarmingly high CF values across all the monitoring stations of the states. The Jahangirpuri of DL recorded the highest CF of 9.88E+ 01 DALYs per kg of PM2.5. The combined five diseases PM2.5-induced mortality cases for five states were assessed to be 171,551 in 2019, which increased to 175,140 in 2022. UP had the largest share of combined mortality cases in 2022, where mortality cases due to stroke grew highest at 29.48 % during 2019-2022, followed by IHD (27.6 %), COPD (20.85 %), and LC (20.35 %). The study estimated economic loss from PM2.5 mortality for five diseases in five states from 2019 to 2022, ranging from 197,964 million US$ to 276,541 million US$. According to the research, the economic burden would still be worrisome if policy interventions can achieve a targeted 30 % PM2.5 reduction across five states by 2024. The study underscores the imperative need for a time-bound holistic approach to decimate air pollution in north Indian states.

Food for thought: optimal diet in patients with asthma and chronic obstructive pulmonary disease

PURPOSE OF REVIEW

Nutritional intake plays a major role in the management of lung health. This review provides the latest perspective on how dietary choices can modulate lung function in patients with chronic obstructive pulmonary disease (COPD) and asthma.

RECENT FINDINGS

The pathophysiology of COPD and asthma is driven by oxidative stress and inflammation of the airways, which is exacerbated by modifiable risk factors such as cigarette smoking and diet. Various foods can influence patient symptoms; highly processed foods increase the production of reactive oxygen species that augment airway inflammation, whereas foods rich in antioxidants, fiber and protein combat oxidative stress and muscle wastage. Patients with COPD or asthma are at increased risk of developing metabolic comorbidities, including cachexia and obesity that complicate disease phenotypes, leading to greater symptom severity. While clinical findings suggest a role for antioxidant and macronutrient support of lung function, comprehensive translational and clinical studies are necessary to better understand the mechanisms underlying nutrient interaction and lung structure-function.

SUMMARY

Understanding the nutritional requirements that protect lung health and support weight management in COPD and asthma is imperative to providing personalized dietary recommendations and reducing patient morbidity.

Global, regional, and national burden of asthma from 1990 to 2021: A systematic analysis of the global burden of disease study 2021

Background

Asthma is a prevalent non-communicable disease that affects individuals of all ages and has emerged as a significant global public health concern. This study aims to conduct a comprehensive assessment of the burden of asthma worldwide, as well as at regional and national levels, utilizing the Global Burden of Diseases (GBD) 2021 database for the years 1990 to 2021.

Methods

This study utilized the GBD 2021 database to report the prevalent cases and incident cases of asthma, alongside age-standardized prevalence rates (ASPR), age-standardized incidence rate (ASIR), the number of disability-adjusted life years (DALYs), age-standardized DALY rates (ASDR), the number of deaths, and age-standardized mortality rates (ASMR) at global, regional, and national levels for the year 2021. Additionally, it computed the estimated annual percentage change (EAPC) for these asthma burden indicators from 1990 to 2021. This study further analyzed the levels of the above indicators in different gender and age groups, and investigated the association between asthma ASDR/ASMR levels and socio-demographic index (SDI). It also provided an analysis of the contribution of four risk factors to the overall asthma burden.

Results

From 1990 to 2021, the global EAPC for asthma ASIR was -1.04 (95 % confidence interval [CI]:-1.18 to -0.89), the EAPC for ASPR was -1.59 (95 % CI:-1.74 to -1.43), the EAPC for ASDR was -1.91 (95 % CI:-1.98 to -1.84), and the EAPC for ASMR was -2.03 (95 % CI:-2.09 to -1.98). In 2021, the prevalent cases of asthma remained alarmingly high at 260.48 million (95 % UI: 227.21 million to 297.97 million). Developed countries, exemplified by the United States, exhibited elevated asthma ASPR. However, the burden of asthma-related mortality and DALYs predominantly afflicted low- and middle-income nations. In China, there has been a significant decline in ASIR, ASPR, ASDR and ASMR for asthma. In most age groups, the burden of asthma among women was markedly higher than that among men, particularly evident in prevalence and DALYs. Children and the elderly bore a heavier burden of asthma. In 2021, ASDR and ASMR levels varied across countries, generally exhibiting a negative correlation with SDI levels. A high body-mass index continued to be a primary risk factor for asthma on a global scale. Decomposition analysis reveals that population growth plays a significant role in exacerbating the burden of asthma-related deaths and DALYs.

Conclusions

From 1990 to 2021, the burden of asthma as measured by age-standardized rate (ASR) has shown a declining trend. However, the overall burden of asthma remains significantly high. Moreover, there is a notable inequality in the burden of asthma across different regions and populations worldwide. This highlights the urgent need for countries to prioritize asthma management and control strategies to address these disparities and improve health outcomes for affected individuals.

Effect of Menaquinone-7 (MK-7) Supplementation on Anthropometric Measurements, Glycemic Indices, and Lipid Profiles: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Menaquinone-7 (MK-7) is a type of vitamin K that has a longer half-life and stays in the body for a more extended period compared to other types of vitamin K. Recently, the effects of this vitamin on body weight, glycemic control, and lipid profiles have garnered much attention.

AIM OF THE REVIEW

This systematic review and meta-analysis were performed to evaluate the effects of MK-7 on anthropometric measurements, glycemic indices, and lipid profiles.

METHODS

A systematic search via appropriate keywords was conducted in electronic databases including PubMed, Scopus, Web of Science, and Google Scholar up to October 2023 to obtain relevant original articles. The quality of studies was evaluated using the Cochrane Collaboration tool. Six original articles met our criteria and were included in the analysis.

RESULTS

Statistical analysis showed that MK-7 had a desirable effect on inulin (SMD= -0.56; 95 % CI: -0.77, -0.36; P = 0.000, I2 = 84 %, P = 0.000), HbA1c (SMD=-0.32; 95 % CI: -0.55, -0.09; P = 0.007, I2 = 86.8 %, P = 0.000), and homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (SMD= -0.56; 95 % CI: -0.76, -0.35; P = 0.000, I2 = 84.3 %, P = 0.000). Additionally, subgroup analysis revealed negligible effects of MK-7 on total cholesterol (TC), insulin, HbA1c, and HOMA-IR in both genders of patients who received ≤ 90 mg MK-7 for less than 12 weeks. However, MK-7 didn't have any meaningful effect on other factors.

CONCLUSION

Based on the findings of the present systematic review and meta-analysis, MK-7 may have beneficial effects on glycemic control and TC, although further highly qualified original research is needed for a consistent conclusion.

Household air pollution and respiratory health in Africa: persistent risk and unchanged health burdens

PURPOSE OF REVIEW

Despite evidence emerging from the Global Burden of Disease studies that biomass use and household air pollution are declining globally, with important positive health impacts for households in low- and middle-income countries, these trends have not been equally documented in African countries. This review describes the state of household air pollution exposure and its relationship with respiratory disease in Africa.

RECENT FINDINGS

African studies on this topic are limited, and generally focus on respiratory infections. Most evidence emerge from models based on the Global Burden of Disease data, and from limited individual epidemiological studies across the continent. More than 80% of the African population is exposed to household air pollution. Women and children continue to bear the substantial burden of exposure. Evidence from limited exposure-response studies strongly points to household air pollution being the major driver of acute and chronic respiratory diseases on the continent.

SUMMARY

Respiratory infections, particularly in children, and other chronic respiratory diseases, are strongly attributable to household air pollution. Elimination of such exposures through interventions such as cleaner fuels and preferably, electricity, is critical to improving respiratory health on the continent.

The effect of long-term exposure to a mixture of air pollutants on chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a major global cause of morbidity and mortality; however, evidence on the effects of air pollutant mixtures on COPD remains limited. This study assessed the impact of long-term exposure to multiple pollutants on COPD prevalence and identified vulnerable subgroups. We analyzed Korea National Health and Nutrition Examination Survey (2010-2017) data linked to 5-year moving average concentrations of CO, NO₂, SO₂, O₃, PM₂.₅, and PM₁₀. Bayesian kernel machine regression (BKMR) estimated the combined effects of pollutants on COPD prevalence, with subgroup analyses performed according to sex, smoking status, and airflow limitation. Adjustments included age, sex, BMI, smoking status, and household income. Among 21,804 participants, 3515 had COPD. BKMR analysis showed that long-term exposure to a pollutant mixture was associated with increased COPD prevalence. O₃ and NO₂ were identified as the most influential pollutants (posterior inclusion probabilities > 0.50). Further analysis showed a significant increase in COPD risk with higher NO₂ and O₃ concentrations, particularly when other pollutants were at lower or median levels. Significant interactions were observed, particularly between SO₂ and CO, CO and O₃, and NO₂ and O₃. Subgroup analyses identified vulnerable populations, indicating stronger associations among females and never smokers and more pronounced effects in individuals with GOLD 2-4. These findings suggest that long-term exposure to multiple air pollutants could increase COPD risk, particularly for females, never smokers, and individuals with more severe COPD. Targeted interventions and policy measures are needed to reduce exposure, especially for these at-risk populations.

Global prevalence of fatigue in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis

BACKGROUND

Fatigue is a common symptom in patients with chronic obstructive pulmonary disease (COPD). Published studies of fatigue among patients with COPD have presented diverse findings that may reflect variations in research methods as well as actual population differences.

OBJECTIVE

To estimate the worldwide prevalence of fatigue in patients with COPD and its associated epidemiological characteristics.

METHODS

The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and China Biology Medicine disc (CBM) databases were searched for articles from their inception date through August 2024. The pooled prevalence of fatigue in patients with COPD and 95 % confidence interval (CI) were calculated using a random-effects model with Stata 15.0 software. Agency for Healthcare and Research and Quality (AHRQ) indicators and the Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the included studies.

RESULTS

The 25 included studies involved 6830 patients. The meta-analysis results showed a 59 % (95 % CI: 52%-66 %) pooled prevalence of fatigue in patients with COPD. Subgroup analysis indicated that the prevalence varied significantly by region, setting, assessment tool, and publication year.

CONCLUSIONS

Fatigue is a common symptom among patients with COPD worldwide. To reduce the negative effects of fatigue in these patients, clinicians should actively explore the mechanisms of fatigue occurrence and its risk factors to provide a basis for further research.