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

Trends and regional variations in chronic ischemic heart disease and lung cancer-related mortality among American adults: Insights from retrospective CDC wonder analysis

Introduction

Lung cancer remains the leading cause of cancer-related mortality in the United States and shares cardiovascular risk factors with chronic ischemic heart disease (CIHD). However, the cumulative mortality burden of these comorbid conditions is underexplored. This study aims to retrospectively assess mortality trends among American adults with concurrent lung cancer and CIHD.

Methods

We utilized death certificate data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, encompassing ICD-10 codes for individuals aged ≥45 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 population, annual percentage change (APC), and corresponding 95 % confidence intervals (CIs) were calculated. Data were further stratified by year, sex, race, and geographic region (state, rural-urban, and census regions).

Results

A total of 214,785 deaths were identified in adults aged ≥45 years with comorbid lung cancer and CIHD. The overall AAMR between 1999 and 2020 was 8.4 per 100,000 (95 % CI: 8.3 to 8.4). AAMRs remained relatively stable from 1999 to 2005 (APC: -0.84 %; 95 % CI: -1.91 to 1.54), followed by a significant decline from 2005 to 2010 (APC: -2.37 %; 95 % CI: -5.58 to -0.61) and from 2010 to 2017 (APC: -4.72 %; 95 % CI: -7.61 to -3.60). A subsequent period of stability was noted between 2017 and 2020 (APC: 0.86 %; 95 % CI: -2.17 to 5.22). In 1999, men had a threefold higher mortality rate compared to women (AAMR: 17.8 vs. 5.7), with a non-significant decline by 2020 (AAMR: 10 vs. 4). Stratification by race/ethnicity revealed that non-Hispanic (NH) Whites exhibited the highest AAMR at 9.3, followed by NH American Indian or Alaska Natives (7.3), NH Blacks (6.8), Hispanic/Latinos (3.3), and NH Asians or Pacific Islanders (3.2). Geographically, AAMRs were highest in the Midwest (9.6), followed by the Northeast (8.8), South (8.4), and West (6.8). Non-metropolitan regions exhibited higher AAMRs compared to metropolitan areas (10.3 vs. 8.0). States in the top 90th percentile, such as West Virginia, Kentucky, Vermont, Ohio, and Rhode Island, had nearly triple the AAMRs compared to states in the lower 10th percentile, including Utah, Nevada, Arizona, New Mexico, and Hawaii.

Conclusions

From 1999 to 2020, mortality rates for adults aged ≥45 years with concurrent lung cancer and CIHD declined. The highest AAMRs were observed among men, NH Whites, individuals residing in the Midwest, and non-metropolitan populations. This highlights the need for a more comprehensive and tailored approach to managing these patients moving forward.

The role of digital health in respiratory diseases management: a narrative review of recent literature

This review provides a detailed overview of how digital health can be utilized in the management of Interstitial Lung Disease (ILD), and Chronic Obstructive Pulmonary Disease (COPD). ILD encompasses a diverse range of lung disorders characterized by inflammation and scarring of lung tissue, leading to restrictive lung physiology and impaired gas exchange, with symptoms including progressive dyspnoea, cough, and hypoxia. COPD which ranks as the third leading cause of death globally, is characterized by chronic lung inflammation causing irreversible airflow obstruction, recurrent exacerbations. While recent advances in digital health have shown promise, predicting disease progression in patients with ILD and exacerbation in patients with COPD remains challenging. This review explores the role of digital health in managing ILD and COPD, particularly focusing on telehealth and digital health technologies. Telehealth, defined broadly as the use of electronic information and telecommunications technologies in healthcare, has become increasingly relevant, especially during the COVID-19 pandemic. This review examines the role of digital health technologies in the management of ILD and COPD, with particular focus on telemedicine, and digital health tools. Remote monitoring technologies, including home spirometry and wearable devices, have demonstrated feasibility in managing respiratory diseases. However, challenges such as evidence, data reliability, varying adherence, education, and the high costs of data collection and lack of qualified clinicians present barriers for many national health systems.

Associations of Serum Legumain with Severity and Prognosis Among Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients

Background

A number of studies have demonstrated that legumain is engaged in the pulmonary diseases. Nevertheless, the role of legumain is indistinct in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The aim is to identify the correlation of serum legumain with AECOPD patients through a prospective cohort study.

Methods

All 202 patients with AECOPD were enrolled. Fasting venous blood was collected. Serum legumain was detected by ELISA.

Results

On admission, serum legumain concentration was gradually elevated in line with AECOPD severity scores. Additionally, serum legumain was closely associated with clinical characteristics. Linear regression analysis confirmed the positive relationships of serum legumain with COPD severity scores. Moreover, the poor prognoses were tracked in patients of AECOPD. Serum higher legumain at admission increased the risks of death and acute exacerbation during hospitalization.

Conclusion

Serum legumain at admission was positively correlated with the severity and adverse prognosis in AECOPD patients, indicating that legumain plays a vital role in the initiation and development of AECOPD. As a result, serum legumain can become a biomarker in the disease assessment and prognosis prediction for AECOPD.

The treatment responses among different inhalation therapies for GOLD group E patients with chronic obstructive pulmonary disease

Background

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 revised the combined chronic obstructive pulmonary disease (COPD) assessment, merging groups C and D into group E, and revised the initial inhalation therapy recommendation. We aimed to evaluate the treatment responses among different inhalation therapies in GOLD group E patients stratified by the COPD assessment test (CAT) scores and forced expiratory volume in one-second percentage of predicted (FEV1%pred).

Methods

In this retrospective cohort study, we included patients with COPD registered in the Real World Research of Diagnosis and Treatment of COPD (RealDTC) study between January 2017 and June 2023. According to the GOLD 2023 report, we enrolled patients assigned to GOLD group E based on exacerbations in the past year (≥2 exacerbations or ≥1 hospitalisation) in this study. We classified them into the FEV1%pred <50% and FEV1%pred ≥50% groups, or CAT<10 and CAT≥10 groups. Subsequently, we divided all groups into four subgroups: long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA, and LABA + LAMA + ICS. All patients finished one year of follow-up, during which we collected data on exacerbations, frequent exacerbations, hospitalisations, and all-cause mortality. We defined frequent exacerbations as ≥2 exacerbations per year.

Results

We enrolled a total of 3173 patients in this study. During one year of follow-up, there were no significant differences in exacerbations, frequent exacerbations, hospitalisations, and all-cause mortality among LAMA, LABA + LAMA, LABA + ICS, and LABA + LAMA + ICS in the FEV1%pred ≥50% and CAT<10 groups. However, the patients treated with LABA + LAMA or LABA + LAMA + ICS had a lower incidence of exacerbations and frequent exacerbations compared with the patients treated with LAMA or LABA + ICS in the FEV1%pred <50% and CAT≥10 groups (P < 0.05).

Conclusions

Patients with COPD in GOLD group E should be further stratified to determine the appropriate initial inhalation therapy. This approach may provide more precise treatment for GOLD group E patients.

Cold storage of human precision-cut lung slices in TiProtec preserves cellular composition and transcriptional responses and enables on-demand mechanistic studies

BACKGROUND

Human precision-cut lung slices (hPCLS) are a unique platform for functional, mechanistic, and drug discovery studies in the field of respiratory research. However, tissue availability, generation, and cultivation time represent important challenges for their usage. Therefore, the present study evaluated the efficacy of a specifically designed tissue preservation solution, TiProtec, complete or in absence (-) of iron chelators, for long-term cold storage of hPCLS.

METHODS

hPCLS were generated from peritumor control tissues and stored in DMEM/F-12, TiProtec, or TiProtec (-) for up to 28 days. Viability, metabolic activity, and tissue structure were determined. Moreover, bulk-RNA sequencing was used to study transcriptional changes, regulated signaling pathways, and cellular composition after cold storage. Induction of cold storage-associated senescence was determined by transcriptomics and immunofluorescence (IF). Finally, cold-stored hPCLS were exposed to a fibrotic cocktail and early fibrotic changes were assessed by RT-qPCR and IF.

RESULTS

Here, we found that TiProtec preserves the viability, metabolic activity, transcriptional profile, as well as cellular composition of hPCLS for up to 14 days. Cold storage did not significantly induce cellular senescence in hPCLS. Moreover, TiProtec downregulated pathways associated with cell death, inflammation, and hypoxia while activating pathways protective against oxidative stress. Cold-stored hPCLS remained responsive to fibrotic stimuli and upregulated extracellular matrix-related genes such as fibronectin and collagen 1 as well as alpha-smooth muscle actin, a marker for myofibroblasts.

CONCLUSIONS

Optimized long-term cold storage of hPCLS preserves their viability, metabolic activity, transcriptional profile, and cellular composition for up to 14 days, specifically in TiProtec. Finally, our study demonstrated that cold-stored hPCLS can be used for on-demand mechanistic studies relevant for respiratory research.

[Research progress on N6-methyladenosine and ferroptosis in childhood combined allergic rhinitis and asthma syndrome]

Combined allergic rhinitis and asthma syndrome (CARAS) is one of the common chronic airway inflammatory diseases in children. With the development of epigenetics, research on CARAS has gradually extended from protein levels to molecular levels, such as transcription and post-transcriptional regulation. N6-methyladenosine (m6A) methylation and ferroptosis have emerged as promising research hotspots in recent years, playing crucial roles in tumors, growth and development, and allergic diseases. This paper aims to summarize the characteristics of m6A and ferroptosis, along with their roles in the onset and progression of CARAS in children, thereby providing new insights and strategies for the diagnosis and treatment of childhood CARAS.

Insights from Real-World Evidence on the Use of Inhalers in Clinical Practice

Background: Despite the ongoing innovations and the availability of numerous effective inhaled treatment options, achieving optimal disease control in most patients frequently remains disappointing. Unfortunately, although inhaled therapy is the cornerstone of respiratory disease management, the selection of the most appropriate inhaler is still overlooked or underestimated by some healthcare professionals, and inhaler misuse remains a significant challenge in managing chronic respiratory diseases which directly influences patients' quality of life, clinical outcomes, and risk of disease progression. Materials and Methods: This is a unicentric, observational, cross-sectional study designed to evaluate the inhaled therapy prescribed in hospitalized patients and to analyze device changes after hospitalization, as well as the factors associated with these changes. A single face-to-face visit was performed during the patient's hospitalization, where the inhaled therapy used prior to hospitalization was evaluated: technique (critical errors), compliance (TAI questionnaire), maximum peak inspiratory flow [PIF (L/min)], and level of inhaler handling-related knowledge. A binary logistic regression model was used to explore the association between changing device at discharge and the other independent variables Results: The inhaler most used during hospitalization was the metered-dose inhaler (MDI) with a chamber (51.9% of patients), with the dry powdered inhalers (DPI) being the inhalers used in 43% of maintenance inhaled therapies in the community setting prior to hospitalization. In addition, 90% of patients showed a maximum PIF ≥ 30 L/min, and 35.6% performed critical inhaler errors. These patients had statistically significantly lower maximum PIF values (52.1 L/min in patients with critical inhaler errors vs. 60.8 L/min without critical inhaler errors; p > 0.001) and were more likely to exhibit poor inhaler compliance compared to those without critical errors (50.5% vs. 31.0%, respectively). More than half of the patients who used MDI with spacer chamber made critical inhaler errors; 69.9% showed regular or poor treatment adherence, although 75.6% demonstrated good knowledge about inhaler handling. Only in 27% of the patients did the healthcare professional change the type of inhaler after hospitalization within clinical practice. The medical and nursing staff responsible for the patient's hospitalization were not informed of the assessment carried out in the study. The probability of not performing a device change at discharge was lower in patients with previous at-home treatment with combined inhaled therapy with LABA + ICS (OR 0.3 [0.18-0.83], p = 0.016) and in patients under triple inhaled therapy (OR 0.3 [0.17-0.76], p = 0.007). No significant differences were observed in inhaler changes when considering the frequency of critical inhaler errors, inhaler handling-related knowledge or maximum PIF values. Conclusions: Our study highlights the urgent need for a more personalized inhaler selection and consistent monitoring by healthcare professionals to minimize inhaler misuse, increase treatment compliance and adherence, and improve disease management outcomes. It is essential to provide training and promote the role of nursing in the evaluation and education of inhaled therapy. Additionally, the use of standardized approaches and tools, such as the CHECK DIAL, is crucial to facilitate the adaptation of devices to patients' needs.

The Mediation of Circulating Inflammatory Proteins in the Causal Pathway from Immune Cells to COPD

Objective

Observational studies have indicated that immune cells and circulating inflammatory proteins may play a dual role in the progression of COPD; however, the precise mechanisms remain uncertain. The objective of this study was to ascertain the causal relationship between immune cells and COPD and to quantify the potential role of circulating inflammatory proteins as mediators.

Methods

A two-sample Mendelian randomisation analysis was conducted involving 731 immune cells, 91 inflammatory proteins and COPD, utilising summary-level data from genome-wide association studies. The causal relationships between immune cells, inflammatory proteins and COPD were sequentially analysed by multivariate Mendelian randomisation and validated using Bayesian weighted Mendelian randomisation. Subsequently, sensitivity analyses were conducted, employing Cochran's Q test to assess heterogeneity, MR-PRESSO and MR-Egger tests to assess pleiotropy, and reverse MR and Steiger directionality tests to rule out reverse causality. Lastly, a two-step approach was employed to ascertain the proportion of inflammatory proteins that mediate immune cell-mediated effects in COPD.

Results

The combination of the inverse variance weighting method and the Bayesian weighting algorithm identified 30 immune cells that were found to be causally associated with COPD, as well as eight inflammatory proteins that were associated with COPD. By two-step analysis, six inflammatory proteins were found to mediate the effects of eight immune cell phenotypes on COPD, with CXCL10 having the highest percentage of mediation at 14.49%, followed by IL20RA at 11.47%.

Conclusion

This study provides a comprehensive investigation of the causal relationship between immune cells and COPD, as well as an estimation of the proportion of the effect of inflammatory proteins as mediators. These findings facilitate the identification of individuals at high risk of COPD and offer novel insights for early prevention and clinical intervention.

The global burden of chronic respiratory diseases attributable to tobacco from 1990 to 2021: a global burden of disease study 2021

BACKGROUND

Tobacco is a major risk factor for chronic respiratory diseases (CRDs), yet the global distribution and trends of tobacco-related CRD burdens remain inadequately explored.

METHODS

This study extracted data on mortality, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) related to tobacco-attributable CRDs from the 2021 Global Burden of Disease (GBD) study. Joinpoint regression was used to identify temporal trends in age-standardized rates (ASR), while autoregressive integrated moving average (ARIMA) forecasting was applied to project future trends in ASMR and ASDR for tobacco-related CRDs.

RESULTS

In 2021, global tobacco-related CRD deaths and DALYs reached 1,545,686 (95% UI: 1,144,476-1,942,541) and 33,014,429 (95% UI: 24,275,462 - 40,930,821), representing increases of 25.43% and 15.64%, respectively, since 1990. Elderly individuals and males showed a higher disease burden. Between 1990 and 2021, ASMR [average annual percentage change (AAPC) = -2.009 (95% CI: -1.8915 to -2.1263)] and ASDR [AAPC = -2.1057 (95% CI: -2.0123 to -2.199)] for tobacco-related CRDs showed a declining trend globally, with autoregressive integrated moving average forecasting suggesting continued declines in ASMR and ASDR in the future. Regionally, South Asia, East Asia, and Oceania had the highest CRD burdens, while country-specific data indicated that Nepal, Myanmar, Papua New Guinea, Kiribati, and the Democratic People's Republic of Korea bore significant burdens. The ASMR and ASDR of tobacco-related CRDs were highest in regions and countries with Socio-Demographic Index values between 0.4 and 0.5.

CONCLUSION

Although global tobacco-related CRD deaths and DALYs have continued to increase, ASMR and ASDR are on the decline, with variations across geographic regions. Prevention and control strategies tailored to country-specific disease prevalence are essential to mitigate these burdens.

Resources and Readmission for COPD Exacerbation in Pneumology Units in Spain: The COPD Observatory Project

Chronic obstructive pulmonary disease (COPD) represents one of the most frequent causes of hospital readmissions and in-hospital mortality. One in five patients requires readmission within 30 days of discharge following an admission for exacerbation. These 'early readmissions' increase morbidity and mortality, as patients often do not recover their baseline lung function. The identification of factors associated with increased risk has been a major focus of research in recent years. Studies describe patient-related predictors, although some studies also suggest that better-resourced centres provide superior care. Objective: To describe resources, performance, and care provided in pneumology units in Spain, assessing their association with 30-day readmission for COPD and in-hospital mortality. Methods: This survey was conducted in 116 hospitals responsible for the COPD pathway in pneumology units/departments from November 2022 to March 2023. Results: Of the 116 participating hospitals, 56% had a pneumology department while 25.9% had a pneumology section. The vast majority were public and university hospitals. The number of beds allocated to pneumology/100,000 inhabitants was 6.6 (3.1-9.2) and pulmonologist staffing was 3.3 (2.6-4.1) per 100,000 inhabitants. There was an intermediate respiratory care unit (IMCU) dependent on the pneumology department in 31.9% of units and a respiratory team for 24 h emergency care in 30% of units, while only 9.5% had interventional pneumology units for bronchoscopic procedures. COPD rehabilitation programmes were offered in 58.6% of pneumology units. The average rate of patients on ventilatory support in acute failure was 13.8 (9.2-25) per 100 discharges, with a 30-day COPD readmission rate of 14.9%, with significant differences according to the level of complexity (p = 0.041), with a mean length of stay of 8.72 (1.26) days. The overall in-hospital mortality in pneumology units was 4.10 (1.18) per 100 admissions. In the adjusted model, having a discharge support programme and interventions performed during admission (number of patients with ventilatory support) were predictors of a favourable outcome. Hospital stay was also maintained as a predictor of an unfavourable outcome. Conclusions: There is significant variability in resources and the organisation of care in pneumology units in Spain. The availability of a discharge support programme and greater use of ventilatory support at discharge are factors associated with a lower 30-day COPD readmission rate in the pneumology unit. This information is relevant to improve the care of patients with COPD and as a future line of research.

Prevalence and clinical correlates of chronic obstructive pulmonary disease in heart failure patients: a cross-sectional study in China

Background

Despite chronic obstructive pulmonary disease's (COPD)'s prevalence in the general populace, its incidence in heart failure (HF) patients is understudied. This study aimed to assess COPD prevalence and clinical associations in Chinese HF patients.

Methods

From the Chinese Heart Failure Study, demographic and clinical details of 2008 HF patients were analyzed. Divided into 233 COPD cases and 1775 non-COPD controls, a multivariable logistic regression identified factors linked to COPD onset in HF, with thorough examination of intergroup clinical differences.

Results

The incidence of COPD in HF individuals was 11.60% (233/2008). The COPD subgroup featured a higher ratio of individuals over 60 and males, alongside lower systolic blood pressure (SBP), body mass index (BMI), higher Charlson Comorbidity Index (CCI) scores, and increased PaCO₂ levels (p < 0.05). Type II respiratory failure and right ventricular dysfunction (RVD) were more prevalent in the COPD subgroup (p < 0.001). Binary logistic regression, after adjustments, indicated positive associations between COPD and age over 60 (OR = 3.831, 95%CI: 1.085-13.526, p = 0.037), male sex (OR = 1.587, 95%CI: 1.032-2.441, p = 0.036), higher CCI (OR = 2.214, 95%CI: 1.796-2.729, p < 0.001), elevated PaCO2 (OR = 1.035, 95%CI: 1.015-1.055, p < 0.001), and RVD (OR = 0.605, 95%CI: 0.119-3.063, p = 0.544). Inversely, higher SBP (OR = 0.990, 95%CI: 0.982-0.998, p = 0.020) and log (triglycerides) (OR = 0.183, 95%CI: 0.064-0.552, p = 0.002) were negatively correlated with COPD in HF patients.

Conclusion

In a large cohort of Chinese Heart Failure (HF) patients, our study revealed a notable COPD prevalence. Key risk factors included age, sex, elevated PaCO2, CCI score, and right heart failure, while higher SBP and triglyceride levels offered protection. These insights lay groundwork for probing disease mechanisms and therapeutic approaches.

Ultrasensitive 129Xe Magnetic Resonance Imaging: From Clinical Monitoring to Molecular Sensing

Magnetic resonance imaging (MRI) is a cornerstone technology in clinical diagnostics and in vivo research, offering unparalleled visualization capabilities. Despite significant advancements in the past century, traditional 1H MRI still faces sensitivity limitations that hinder its further development. To overcome this challenge, hyperpolarization methods have been introduced, disrupting the thermal equilibrium of nuclear spins and leading to an increased proportion of hyperpolarized spins, thereby enhancing sensitivity by hundreds to tens of thousands of times. Among these methods, hyperpolarized (HP) 129Xe MRI, also known as ultrasensitive 129Xe MRI, stands out for achieving the highest polarization enhancement and has recently received clinical approval. It effectively tackles the challenge of weak MRI signals from low proton density in the lungs. HP 129Xe MRI is valuable for assessing structural and functional changes in lung physiology during pulmonary disease progression, tracking cells, and detecting target molecules at pico-molar concentrations. This review summarizes recent developments in HP 129Xe MRI, including its physical principles, manufacturing methods, in vivo characteristics, and diverse applications in biomedical, chemical, and material sciences. In addition, it carefully discusses potential technical improvements and future prospects for enhancing its utility in these fields, further establishing HP 129Xe MRI's importance in advancing medical imaging and research.

Association between asthma and IgG levels specific for rhinovirus and respiratory syncytial virus antigens in children and adults

Background

Viral infections in childhood, especially to rhinovirus (RV) and respiratory syncytial virus (RSV), are associated with asthma inception and exacerbation. However, little is known about the role of RV- and RSV-specific antibodies in childhood versus adult asthma.

Objective

We sought to investigate associations between RV- and RSV-specific IgG levels and asthma phenotypes in children and adults.

Methods

The analysis included 1771 samples from participants of the Epidemiological Study on the Genetics and Environment of Asthma (530 children; age [mean ± SD], 11.1 ± 2.8, and 1241 adults; age [mean ± SD], 43.4 ± 16.7, among whom 274 and 498 had ever asthma, respectively). RSV- and RV-specific IgG levels were determined using microarrayed virus-derived antigens and peptides. Cross-sectional associations between standardized RSV- and RV-specific IgG levels and asthma phenotypes were estimated by multiple regression models.

Results

In children, ever asthma was associated with higher IgG levels specific to RV, especially to RV-A and RV-C, and to RSV (adjusted odds ratios [95% CI] for a 1 - SD increase in IgG levels were 1.52 [1.16-1.99], 1.42 [1.10-1.83], and 1.24 [0.99-1.54], respectively). These associations were stronger for moderate to severe asthma than for mild asthma. Conversely in adults, ever asthma was associated with lower RV-A, RV-B, and RV-C IgG levels (adjusted odds ratios [95% CI] were 0.86 [0.74-0.99], 0.83 [0.73-0.95], and 0.85 [0.73-0.99], respectively).

Conclusions

Our results suggest that the association between respiratory virus-specific antibody levels and asthma varies during life, with asthma associated with higher levels of IgG to RSV, RV-A, and RV-C in children and lower levels of IgG responses to RV-A/B/C in adults.

Respiratory Benefits of Multisetting Air Purification in Children: A Cluster Randomized Crossover Trial

Importance

Particulate matter exposure has been linked to impaired respiratory health in children, but the respiratory benefits of air purification have not been fully elucidated.

Objectives

To assess the respiratory health outcomes among children exposed to multisetting air purification vs sham purification.

Design, Setting, and Participants

This cluster randomized, double-blind, crossover trial was conducted among healthy school-aged children (10-12 years) in China from April to December 2021. Data were analyzed from December 2021 to July 2024.

Interventions

A multisetting (both in classrooms and bedrooms) air purification intervention compared with sham purification in a 2-stage intervention with more than 2 months (76 days) for each period and a washout period (88 days) to estimate the respiratory benefits of air purification.

Main Outcomes and Measures

The primary outcomes were pulmonary function, airway inflammation markers, and metabolites in exhaled breath condensate (EBC) before and after the air purification intervention. Linear mixed-effects models were used to estimate the respiratory benefits of children related to air purification. Differential metabolites in EBC were identified using metabolomics analysis to explore their possible mediation roles.

Results

A total of 79 children (38 male [48%]; mean [SD] age, 10.3 [0.5] years) were included in the statistical analyses. During the study period, the mean (SD) concentration of outdoor fine particulate matter (PM2.5) at the school site was 32.53 (24.06) μg/m3. The time-weighted personal PM2.5 concentration decreased by 45.14% during the true air purification period (mean [SD], 21.49 [8.72] μg/m3) compared with the sham air purification period (mean [SD], 39.17 [14.25] μg/m3). Air purification improved forced expiratory volume in 1 second by 8.04% (95% CI, 2.15%-13.93%), peak expiratory flow by 16.52% (95% CI, 2.76%-30.28%), forced vital capacity (FVC) by 5.73% (95% CI, 0.48%-10.98%), forced expiratory flow at 25% to 75% of FVC by 17.22% (95% CI, 3.78%-30.67%), maximal expiratory flow at 75% of FVC by 14.60% (95% CI, 0.35%-28.85%), maximal expiratory flow at 50% of FVC by 17.86% (95% CI, 3.65%-32.06%), and maximal expiratory flow at 25% of FVC by 18.22% (95% CI, 1.73%-34.70%). Fractional exhaled nitric oxide in the true air purification group decreased by 22.38% (95% CI, 2.27%-42.48%). Several metabolites in EBC (eg, L-tyrosine and β-alanine) were identified to mediate the effect of air purification on respiratory health.

Conclusions and Relevance

This randomized clinical trial provides robust and holistic evidence that indoor air purification notably improved pulmonary health in children, highlighting the importance of intensified indoor air purification in regions with high air pollution levels.

Trial Registration

ClinicalTrials.gov Identifier: NCT04835337.

Increased Risk of Rheumatoid Arthritis in Patients With Asthma: A Genetic Association Study Using Two-Sample Mendelian Randomization Analysis

OBJECTIVE

Observational studies have explored the association between asthma and some types of arthritis, including rheumatoid arthritis and osteoarthritis, but the results are largely contradictory. We aimed to investigate the causal effects of asthma on arthritis, including osteoarthritis, rheumatoid arthritis, gout, and ankylosing spondylitis.

METHODS

Two-sample Mendelian randomization (MR) analysis was used to investigate the causal effects of asthma on each arthritis. The genetic instruments for asthma were obtained from a large genome-wide association study of asthma. The inverse-variance weighted (IVW) method was used as the main analysis of MR. Bonferroni-adjusted P value threshold was used to account for multiple comparisons.

RESULTS

MR-IVW analysis suggested that adult-onset asthma (AOA) was associated with increased risk of rheumatoid arthritis. The odds ratio for rheumatoid arthritis associated with AOA and childhood-onset asthma (COA) were 1.018 (95% confidence interval [95% CI], 1.011-1.025; P < 0.001) and 1.006 (95% CI 1.001-1.012; P = 0.046), respectively. For osteoarthritis, gout, or ankylosing spondylitis, all the MR analyses showed no significant causal effects of AOA or COA on them. We also performed a reverse MR analysis to explore the causal effects of rheumatoid on all asthma, allergic asthma, or nonallergic asthma and found no significant causal effects on them.

CONCLUSION

Genetically predicted AOA predisposes patients to an increased risk of rheumatoid arthritis but has no causal effects on osteoarthritis, gout, and ankylosing spondylitis. The result of COA on rheumatoid arthritis is suggestive of potential causal relationship but needs to be confirmed in further studies.

Prevalence of chronic respiratory diseases diagnosed by pulmonary function testing: a cross-sectional study

Background

Respiratory diseases are pathological conditions affecting the organs and tissues involved in gas exchange. Pulmonary function tests allow for the classification of the severity of respiratory diseases, their follow-up, and treatment response assessment. The aim was to determine the prevalence of chronic respiratory disease and the risk factors in Khartoum, Sudan.

Methods

A descriptive cross-sectional hospital-based study was conducted in the Respiratory Department from May to October 2021, including the patients who underwent pulmonary function tests. Data were analyzed using Statistical Package for Social Sciences, version 25.0.

Results

Out of the 396 study participants, 214 (54%) were above 40 years of age with similar gender distribution and a male-to-female ratio of 1.1: 1, and almost all were Sudanese. Clinically, 40.4% had normal body mass index (BMI), 24.2% underweight, and 13.6% were obese. Smokers represented 19.4% of the study participants. Moreover, 18.2% reported a positive history of bronchial asthma. Regarding pulmonary function test patterns, 50.8% exhibited normal results, 25.3% displayed restrictive patterns, 19.7% showed obstructive patterns, and 4.3% had mixed patterns. Chi-square cross-tabulation testing revealed a significant association between older ages of participants and the abnormal pulmonary function test results (P < 0.001).

Conclusion

The study revealed that the proportion of respiratory diseases with abnormal lung function test results is considerable and should not be ignored, especially among older patients. Therefore, when indicated, attention should be paid to performing lung function tests widely to accurately identify the prevalence rates of lung diseases and associated risk factors in Sudan.

Adverse Impacts of Corticosteroid Treatment on Osteoporosis/Osteopenia in Adult Asthmatics: A Retrospective ICARUS Cohort Study

BACKGROUND

Inhaled corticosteroid (ICS) and oral corticosteroid (OCS) are often used in asthma management.

OBJECTIVE

To evaluate the long-term effect of ICS/OCS on osteoporosis, osteopenia, fractures, and bone metabolism in adult patients with asthma in real-world clinical practice.

METHODS

This is a retrospective study investigating deidentified electronic health records from Ajou University Medical Center (Korea). Adult patients with asthma receiving maintenance ICS with/without OCS for at least 1 year were enrolled. They were classified into the high/low-dose of ICS or OCS group. Primary outcomes (incidences of osteoporosis, osteopenia, and fractures) and secondary outcomes (drug prescription and laboratory values related to bone metabolism including albumin and alkaline phosphatase) were compared after 5 years of follow-up.

RESULTS

After propensity score matching, both high- and low-dose OCS groups included 468 patients, and high/low-dose ICS groups each comprised 1252 patients. The risk of osteoporosis/major fracture was higher (hazard ratio [95% CI], 2.00 [1.15-3.57]/3.03 [1.04-11.11]) in the high-dose OCS group (especially in females aged ≥50 years) than in the low-dose group, although the ICS groups showed no significant differences. The high-dose ICS group showed a higher risk of osteopenia (1.92 [1.05-3.70]) than the low-dose ICS group. The linear mixed model of laboratory values showed significantly decreased serum albumin and increased alkaline phosphatase in the high-dose OCS group than in the low-dose OCS group.

CONCLUSIONS

The results of this study suggest that long-term use of OCS can increase the risk of osteoporosis and osteoporosis-related fractures, whereas long-term use of ICS may increase the risk of osteopenia in adult patients with asthma.

Implications of Global Lung Function Initiative Spirometry Reference Equations in Northeast Asian Patients With COPD

BACKGROUND

Accurate spirometry interpretation is critical in the diagnosis and management of COPD. With increasing efforts for a unified approach by the Global Lung Function Initiative (GLI), this study evaluated the application of race-specific 2012 GLI and race-neutral 2022 GLI reference equations compared with Choi's reference equations, which are derived and widely used in South Korea, for spirometry interpretation in Northeast Asian patients with COPD.

RESEARCH QUESTION

What are the effects of applying race-specific 2012 GLI, race-neutral 2022 GLI, and Choi's reference equations on the diagnosis, severity grade, and clinical outcome associations of COPD?

STUDY DESIGN AND METHODS

Serial spirometry data from the Korea COPD Subgroup Study (KOCOSS) consisting of 3,477 patients were used for reanalysis using 2012 GLI, 2022 GLI, and Choi's reference equations. The COPD diagnosis and severity categorization, associations with disease manifestations and health outcomes, and longitudinal trajectories of lung function were determined.

RESULTS

Although there was strong concordance in COPD diagnosis comparing 2012 GLI, and 2022 GLI reference equations with Choi's reference equations, a notable portion of patients were reclassified to milder disease severity (17.0% and 23.4% for 2012 GLI and 2022 GLI reference equations, respectively). Relationships between FEV1 % predicted values calculated using 2012 GLI, 2022 GLI, and Choi's equations with clinical outcomes including dyspnea severity, exercise capacity, health-related quality of life, and frequency of exacerbations remain consistently significant. Similar annual decline rates of FEV1 and FVC % predicted were observed among the reference equations used, except for slower annual decline rate of FEV1 in Choi's equation compared with 2022 GLI race-neutral equation.

INTERPRETATION

Application of GLI reference equations for spirometry interpretation in Northeast Asian patients with COPD has potential implications on disease severity grade for clinical management and trial participation, and maintains consistent significant relationships with key disease outcomes.

Sex, Gender, and COPD

Sex and gender have emerged as critical considerations relevant to chronic obstructive pulmonary disease (COPD). Sex differences in lung development and physiologic response to hormones and environmental exposures influence COPD susceptibility, progression, severity, morbidity, and mortality. Gender has been poorly measured in the context of COPD, and gendered exposures further impact biology. The hormonal milieu is critical to study across the life course. Differences in immunity and inflammation likely impact sex- and gender-related features of COPD. Emerging evidence from multiple types of omics data is revealing new genes and pathways to consider as relevant to sex- and gender-divergent features of COPD. Much research to date has focused on autosomes, but the growing awareness of a role for allosomes is highlighting knowledge gaps. Reproductive aging impacts lung function and requires more investigation. Network medicine holds promise as an approach to sex and gender omics to uncover drivers of COPD in men and women.

Immunological Effects of Electronic Cigarette Use: A Review of Current Evidence

Electronic cigarettes (EC) have emerged as a popular alternative to traditional tobacco products, but their impact on immune function has raised significant health concerns. This review explores the immunological effects of EC exposure, focusing on innate and adaptive immune responses. Electronic cigarette aerosol (ECA) induces widespread inflammation. These changes compromise immune cell function, impairing neutrophil chemotaxis, phagocytosis, and oxidative burst while increasing macrophage and dendritic cell recruitment and activation. ECA also disrupts epithelial barriers, increasing susceptibility to bacterial and viral infections. Studies show enhanced biofilm formation in bacteria such as Staphylococcus aureus and Streptococcus pneumoniae and impaired antiviral responses against pathogens like influenza A and SARS-CoV-2. Additionally, EC exposure modulates adaptive immunity, affecting T and B cell function and increasing systemic inflammatory markers. The long-term consequences of these immunological disruptions include heightened risks for chronic inflammatory diseases, respiratory infections, and potentially autoimmune conditions. The widespread adoption of EC, particularly among younger users, poses a growing public health challenge. As the popularity of vaping continues to rise, these immunological disruptions could result in increased healthcare burdens in the future, with higher rates of infections, chronic inflammatory diseases, and immune system-related disorders among those who begin using e-cigarettes at a young age. Understanding the full scope of EC-related health risks is essential for informing public health policies and protecting future generations from the potential long-term effects of vaping.

The use of metagenomic and untargeted metabolomics in the analysis of the effects of the Lycium barbarum glycopeptide on allergic airway inflammation induced by Artemesia annua pollen

ETHNOPHARMACOLOGICAL RELEVANCE

The prevalence of allergic airway inflammation (AAI) worldwide is high. Artemisia annua L. pollen is spread worldwide, and allergic diseases caused by its plant polysaccharides, which are closely related to the intestinal microbiota, have anti-inflammatory effects. Further isolation and purification of Lycium barbarum L. yielded its most effective component Lycium barbarum L. glycopeptide (LbGP), which can inhibit inflammation in animal models. However, its therapeutic effect on AAI and its mechanism of regulating the intestinal flora have not been fully investigated.

AIM OF THE STUDY

To explore LbGP in APE-induced immunological mechanisms of AAI and the interaction mechanism of the intestinal flora and metabolites.

METHODS

A mouse model of AAI generated from Artemisia annua pollen was constructed, and immunological indices related to the disease were examined. A combination of macrogenomic and metabolomic analyses was used to investigate the effects of LbGP on the gut microbial and metabolite profiles of mice with airway inflammation.

RESULTS

LbGP effectively alleviated Artemisia. annua pollen extract (APE)-induced AAI, corrected Th1/Th2 immune dysregulation, decreased Th17 cells, increased Treg cells, and altered the composition and function of the intestinal microbiota. LbGP treatment increased the number of OdoribacterandDuncaniella in the intestines of the mice, but the numble of Alistipes and Ruminococcus decreased. Metabolite pathway enrichment analysis were used to determine the effects of taurine and hypotaurine metabolism, bile acid secretion, and pyrimidine metabolism pathways on disease.

CONCLUSION

Our results revealed significant changes in the macrogenome and metabolome following APE and LbGP intervention, revealed potential correlations between gut microbial species and metabolites, and highlighted the beneficial effects of LbGP on AAI through the modulation of the gut microbiome and host metabolism.

Bone Marrow Mesenchymal Stem Cells-Derived Exosomes Inhibit Apoptosis of Pulmonary Microvascular Endothelial Cells in COPD Mice Through miR-30b/Wnt5a Pathway

Background

Bone marrow mesenchymal stem cells (BMSCs)-derived exosomes are rich in a variety of active substances, including microRNA (miR) and have shown powerful therapeutic effects to ameliorate cell injury and diseases. However, the role of BMSCs-derived exosomes on chronic obstructive pulmonary disease (COPD) has been poorly studied. In addition, pulmonary microvascular endothelial cells (PMVECs) apoptosis contributes to the onset of COPD. Inhibition of PMVECs apoptosis can reverse COPD changes. Therefore, the aim of this study was to explore the role of BMSCs-derived exosomes in the apoptosis of PMVECs in COPD and to investigate the potential mechanisms.

Methods

We isolated and characterized normal mouse BMSCs-derived exosomes and PMVECs. We performed miR sequencing of BMSCs-derived exosomes. We transfected PMVECs with the miR-30b mimic and Wnt5a overexpression plasmid to assess the underlying mechanisms. Cigarette smoke extract (CSE)-induced COPD mice were treated with exosomes and HBLV-mmu-miR-30b via intratracheal instillation. Finally, we determined the expression of miR-30b and Wnt5a in tissues from patients with COPD.

Results

BMSCs-derived exosomes could significantly reduce apoptosis of CSE-induced PMVECs and increase the expression of miR-30b (p<0.05). Based on miR sequencing, miR-30b was highly enriched in BMSCs-derived exosomes. The knockdown of miR-30b in BMSCs-derived exosomes could increase the apoptosis of CSE-induced PMVECs (p<0.05). miR-30b overexpression significantly reduced apoptosis and repressed Wnt5a protein expression in CSE-induced PMVECs (p<0.05). Furthermore, Wnt5a overexpression reversed the anti-apoptotic effect of miR-30b on CSE-induced PMVECs (p<0.05). In addition, compared with the COPD group, treatment with BMSCs-derived exosomes and miR-30b overexpression could alleviate emphysema changes, decrease the mean linear intercept and alveolar destructive index, reduce apoptosis, increase the expression of miR-30b, and decrease the expression of Wnt5a in lung tissue (p<0.05). Finally, miR-30b expression was decreased in patients with COPD, while Wnt5a expression was increased in these patients (p<0.05).

Conclusion

BMSCs-derived exosomes could improve the damage of COPD perhaps by delivering miR-30b. miR-30b could reduce apoptosis of CSE-induced PMVECs by targeting Wnt5a.

Self-critical strategy adjustment based artificial intelligence method in generating diagnostic reports of respiratory diseases

Objective. Humanity faces many health challenges, among which respiratory diseases are one of the leading causes of human death. Existing AI-driven pre-diagnosis approaches can enhance the efficiency of diagnosis but still face challenges. For example, single-modal data suffer from information redundancy or loss, difficulty in learning relationships between features, and revealing the obscure characteristics of complex diseases. Therefore, it is critical to explore a method that can assist clinicians in detecting lesions early and in pre-diagnosing corresponding diseases.Approach.This paper introduces a novel network structure, strong constraint self-critical strategy network (SCSCS-Net), which can effectively extract image features from chest x-ray images and generate medical image descriptions, assist clinicians in analyzing patients' medical imaging information, deeply explore potential disease characteristics, and assist in making pre-diagnostic decisions. The SCSCS-Net consists of a reinforced cross-modal feature representation model and a self-critical cross-modal alignment model, which are responsible for learning the features interdependence between images and reports by using a multi-subspace self-attention structure and guiding the model in learning report generation strategies to improve the professionalism and consistency of medical terms in generated reports, respectively.Main results.We further compare our model with some advanced models on the same dataset, and the results demonstrate that our method achieves better performance. Finally, the CE and NLG metrics further confirm that the proposed method acquires the ability to generate high-quality medical reports with higher clinical consistency in generating medical reports.Significance.Our novel method has the potential to improve the early detection and pre-diagnosis of respiratory diseases. The model proposed in this paper allows to narrow the gap between artificial intelligence technology and clinical medical diagnosis and provides the possibility for in-depth integration.

Short-term effects of combined environmental factors on respiratory disease mortality in Qingdao city: A time-series investigation

BACKGROUND

It is crucial to comprehend the interplay between air pollution and meteorological conditions in relation to population health within the framework of "dual-carbon" targets. The purpose of this study was to investigate the impact of intricate environmental factors, encompassing both meteorological conditions and atmospheric pollutants, on respiratory disease (RD) mortality in Qingdao, a representative coastal city in China.

METHODS

The RD mortality cases were collected from the Chronic Disease Surveillance Monitoring System in Qingdao during Jan 1st, 2014 and Dec 31st, 2020. The distributed-lag nonlinear model and generalized additivity model were used to assess the association between daily mean temperature (DMT), air pollutant exposure and RD mortality. To ascertain the robustness of the model and further investigate this relationship, a stratified analysis and sensitivity analysis were conducted to mitigate potential confounding factors.

RESULTS

A total of 19,905 mortalities from RD were recorded. The minimum mortality temperature (MMT) was determined to be 23.5°C, and DMT and RD mortality showed an N-shaped relationship. At the MMT of 23.5°C, the cumulative relative risk (cumRR) for mortality within a lag period of 0-14 days from the highest temperature (31°C) was estimated at 2.114 (95% confidence interval [CI]: 1.475 ~ 3.028). The effect value of particulate matter (PM) also increased with a longer cumulative lag time. In the single pollutant model, the highest risk of RD mortality was observed on the lag1-day of per 10 μg/m3 increase in PM2.5 exposure, with an excess risk ratio (ER) of 0.847% (95% CI: 0.335% ~ 1.362%). The largest cumulative effect was found at a lag of 8 days, with an ER of 1.546% (95% CI: 0.483% ~ 2.621%). A similar trend was found for PM10. For O3 exposure, the highest risk was observed on the lag1-day of per 10 μg/m3 increase, with an ER of 1.073% (95% CI: 0.502% ~ 1.647%), and the largest cumulative effect occurred at a lag of 2 days with an ER of 1.113% (95%CI: 0.386% ~ 1.844%). Results from the dual-pollutants model demonstrated that the effect of PM on the risk of RD mortality remained significant and slightly increased in magnitude. Moreover, composite pollutants exhibited a higher risk effect, reaching its peak after one week; however, there was a decrease in single-day cumulative effects as more pollutant types were included. Subgroup analysis showed that females, elderly individuals, and those exposed during warm seasons demonstrated greater susceptibility to PM exposure.

CONCLUSION

The present study revealed a significant association between short-term exposure to high temperature, PM2.5, PM10 and O3 and the risk of RD mortality in Qingdao, even in dual- and composite-pollutants models. Furthermore, our findings indicate that females, the elderly population, and warm seasons exhibit heightened sensitivity to PM exposure.

The inclusion and consideration of cultural differences and health inequalities in physical activity behaviour in the UK - the impact of guidelines and initiatives

Despite widespread attempts from governments and leading health organisations worldwide to promote equity in healthy living medicine, the evidence suggests that attempts to curb worsening public health have been almost entirely ineffective. Despite significant advancements in knowledge, medicine, and technology, as well as the promotion of guidelines and the implementation of numerous global initiatives aimed at addressing health disparities and mitigating the progression of non-communicable diseases (NCDs) worldwide, substantial work remains to be undertaken particularly in addressing inequalities in physical activity. Achieving equitable access to health resources and parity in health outcomes remains a critical and unresolved challenge. Whilst it is recognized that the public health paradigm is broad and complex, with many intersecting and interacting parts, the actions and considerations required to address the urgent and escalating scale of the problem appear at a crossroads of now or never. Throughout this narrative review, we describe the effectiveness of landmark physical activity-related guidelines, policies and national interventions that have been implemented since the turn of the century to address physical activity behaviour in the context of health inequalities.

Exploring the Causal Relationship Between Frailty and Chronic Obstructive Pulmonary Disease: Insights From Bidirectional Mendelian Randomization and Mediation Analysis

Background

Observational studies have underscored a robust association between frailty and chronic obstructive pulmonary disease (COPD), yet the causality remains equivocal.

Methods

This study employed bidirectional two-sample Mendelian randomization (MR) analysis. Univariable MR investigated the causal relationship between frailty and COPD. Genetic correlation was assessed using linkage disequilibrium score (LDSC) regression. Multivariable MR and mediation analysis explored the influence of various confounders and their mediating effects. The primary analytic approach was inverse variance weighted (IVW).

Results

LDSC analysis revealed moderate genetic correlations between frailty and Global Biobank Meta-Analysis Initiative (GBMI) COPD (rg = 0.643, P = 6.66×10-62) as well as FinnGen COPD (rg = 0.457, P = 8.20×10-28). IVW analysis demonstrated that frailty was associated with increased risk of COPD in both the GBMI cohort (95% CI, 1.475 to 2.158; P = 2.40×10-9) and the FinnGen database (1.411 to 2.434; 9.02×10-6). Concurrently, COPD was identified as a susceptibility factor for frailty (P < 0.05). These consistent findings persisted after adjustment for potential confounders in MVMR. Additionally, mediation analysis revealed that walking pace mediated 19.11% and 15.40% of the impact of frailty on COPD risk, and 17.58% and 23.26% of the effect of COPD on frailty risk in the GBMI and FinnGen cohorts, respectively.

Conclusion

This study has strengthened the current evidence affirming a reciprocal causal relationship between frailty and COPD, highlighting walking pace as a pivotal mediator.

Oxidative balance score and its association with chronic inflammatory airway diseases and mortality: a population-based study

Objective

The aim of this research was to explore the possible connection between combined Oxidative Balance Score (OBS) and the prevalence of chronic inflammatory airway diseases (CIAD), including asthma, chronic obstructive pulmonary disease (COPD), and chronic bronchitis, along with the mortality rate among individuals with CIAD.

Methods

Data were gathered from the National Health and Nutrition Examination Survey (NHANES) 2013-2018 cycles. The Oxidative Balance Score (OBS) was calculated using 16 different nutrients and 4 different lifestyles, which was then categorized into four groups. The CIAD included individuals with self-reported asthma, chronic bronchitis, or COPD. Mortality data up to December 31, 2019, was obtained from the National Death Index. In cross-sectional studies, the association between OBS and the prevalence of total and specific CIAD was examined using multiple logistic regressions. Dose-response relationships were analyzed through restricted cubic spline regression (RCS). In prospective cohort studies, cumulative survival rates were determined using the Kaplan-Meier method and compared with log-rank tests. Multiple COX regressions were conducted to evaluate the relationship between OBS and all-cause as well as respiratory diseases mortality among participants with CIAD.

Results

A total of 12,458 adults were enrolled in this study. The demographic characteristics of the study population revealed a mean age of 52.25 ± 15.8 years, 47.73% being male, and the majority identified as Non-Hispanic White (66.87%). We found that 20.26% of the participants were suffered from CIAD, followed by asthma (15.41%), chronic bronchitis (6.10%) and COPD (3.80%), respectively. The median OBS levels were 20.98 with a standard deviation of 0.17. After adjusting for all confounders, we found that the highest quartile of OBS was significantly associated with lower prevalence of total CIAD (OR = 0.71, 95% CI 0.64-0.81), asthma (OR = 0.62, 95% CI 0.52-0.73), chronic bronchitis (OR = 0.64, 95% CI 0.44-0.92), and COPD (OR = 0.48, 95% CI 0.31-0.77) compared to the lowest quartile. Additionally, a linear and inverse relationship was found between OBS and the incidence of various respiratory disorders. Kaplan-Meier survival analysis showed that individuals in the highest quartile of OBS had the lowest risk of both all-cause mortality (log-rank test p = 0.017) and respiratory diseases mortality (log-rank test p < 0.001). Furthermore, after adjusting for multiple factors, individuals in the fourth quartile continued to show a significantly reduced risk of all-cause mortality (HR = 0.71, 95% CI 0.55-0.93) and respiratory diseases mortality (HR = 0.53, 95% CI 0.43-0.74) in comparison to those in the lowest quartile of OBS levels.

Conclusion

The findings revealed that a higher OBS was significantly linked to a decreased prevalence of total and specific CIAD, including asthma, chronic bronchitis, and COPD. Higher OBS levels were also associated with reduced mortality from both all causes and respiratory diseases among CIAD patients. These findings offer valuable information on the role of diet and lifestyle in preventing CIAD.

eHealth literacy in the general population: a cross-sectional study in China

BACKGROUND

eHealth literacy (eHL) is positively associated with health-related behaviors and outcomes. Previous eHL studies primarily collected data from online users and seldom focused on the general population in low- and middle-income countries (LMIC). Additionally, knowledge about factors that affect eHL is limited. Chronic lung disease (CLD) has brought a large burden in LMIC, making it a relevant example for studying eHL. This study aims to explore eHL and its associated factors within the general population of China, encompassing sociodemographic characteristics, CLD knowledge, digital access, eHealth use and attitudes towards eHealth.

METHOD

Data were collected from November 2023 to January 2024 via online and hard-copy questionnaires among the general population in China. Descriptive analyses were performed to explore eHL, CLD knowledge, digital access, and attitudes towards eHealth at different sociodemographic levels. Univariable and multivariable regression analyses were performed to identify factors associated with eHL.

RESULTS

439 valid questionnaires were collected. Participants demonstrated a mean eHL of 24.7 ± 8.2 and CLD knowledge of 5.9 ± 3.7, obtained a score of 6.9 ± 1.8 in attitudes towards eHealth. A notable percentage of participants (45/439, 10.3%) reported no digital access, especially those aged 66+, the unemployed, retired, those with a primary school or below degree and earning ≤ 1500 RMB monthly. Multivariable hierarchical regression analysis showed higher eHL was uniquely associated with younger age (b=-0.10, P < .001), higher educational level (b = 2.02, P < .001), higher income (b = 1.10, P < .001), having digital access (b = 6.35, P < .001), more frequent eHealth use (b = 1.14, P < .001), and more positive attitudes towards eHealth (b = 0.47, P = .003).

CONCLUSION

Our sample from the general population in China had a relatively low eHL and CLD knowledge level, but held a positive attitudes towards eHealth. A digital divide was noticed between the elderly, low socioeconomic population and other groups. Younger age, higher educational and income level, having digital access, more frequent eHealth use and more positive attitudes towards eHealth were significantly associated with higher eHL. Efforts at both individual and systematic levels should be made to improve eHL, and promote CLD knowledge and digital access, especially in disadvantaged populations. Moreover, there is a pressing need to develop and refine national and international standards for eHL.

Prevalence and Economic Impact of Acute Respiratory Failure in the Prehospital Emergency Medical Service of the Madrid Community: Retrospective Cohort Study

Background

Chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and acute pulmonary edema (APE) are serious illnesses that often require acute care from prehospital emergency medical services (EMSs). These respiratory diseases that cause acute respiratory failure (ARF) are one of the main reasons for hospitalization and death, generating high health care costs. The prevalence of the main respiratory diseases treated in a prehospital environment in the prepandemic period and during the COVID-19 pandemic in Spain is unknown. The Madrid Community EMS is a public service that serves all types of populations and represents an epidemiological reference for supporting a population of 6.4 million inhabitants. The high volume of patients treated by Madrid's medical advanced life supports (ALSs) allows us to analyze this little-studied problem.

objectives

Our goal was to lay the groundwork for comprehensive data collection and surveillance of respiratory failure, with an emphasis on the most prevalent diseases that cause it, an aspect that has been largely overlooked in previous initiatives. By achieving these objectives, we hope to inform efforts to address respiratory failure and establish a standardized methodology and framework that can facilitate expansion to a continuous community-wide registry in Madrid, driving advances in emergency care and care practices in these pathologies. The aim of this retrospective observational study was to determine the pathologies that have mainly caused respiratory failure in patients and required medicalized ALS and to evaluate the cost of care for these pathologies collected through this pilot registry.

Methods

A multicenter descriptive study was carried out in the Madrid Community EMS. The anonymized medical records of patients treated with medical ALS, who received any of the following medical diagnoses, were extracted: ARF not related to chronic respiratory disease, ARF in chronic respiratory failure, exacerbations of COPD, APE, CHF, and bronchospasm (not from asthma or COPD). The prevalence of each pathology, its evolution from 2014 to 2020, and the economic impact of the Medical ALSs were calculated.

Results

The study included 96,221 patients. The most common pathology was exacerbation of COPD, with a prevalence of 0.07% in 2014; it decreased to 0.03% in 2020. CHF followed at 0.06% in 2014 and 0.03% in 2020. APE had a prevalence of 0.01% in 2014, decreasing to 0.005% in 2020 with the pandemic. The greatest economic impact was on exacerbation of COPD in 2015, with an annual cost of €2,726,893 (which equals to US $2,864,628).

Conclusions

COPD exacerbations had the higher prevalence in the Madrid region among the respiratory diseases studied. With the COVID-19 pandemic, the prevalence and costs of almost all these diseases decreased, except for ARF not related to chronic disease. The cost of these pathologies over 5 years was €58,791,031 (US $61,832,879).

Joint association of systemic immune-inflammation index and phenotypic age acceleration with chronic respiratory disease: a cross-sectional study

BACKGROUND

Chronic respiratory diseases (CRD) represents a series of lung disorders and is posing a global health burden. Systemic inflammation and phenotypic ageing have been respectively reported to associate with certain CRD. However, little is known about the co-exposures and mutual associations of inflammation and ageing with CRD. Here, we aim to systematically elucidate the joint and mutual mediating associations of systemic immune-inflammation index (SII) and phenotypic age acceleration (PhenoAgeAccel) with CRD based on data from National Health and Nutrition Examination Survey (NHANES).

METHODS

Data for this study was obtained from NHANES 2007-2010 and 2015-2018. The single and combined associations of SII and PhenoAgeAccel with CRD were analyzed using multivariable logistic regression models. The dose-response relationship between exposures and outcomes was determined by restricted cubic splines (RCS) regression. Subgroup and mediation analyses were further conducted.

RESULTS

Totally, 15,075 participants were enrolled in this study including 3,587 CRD patients. Compare with controls, CRD patients tended to be older, females and present higher SII and PhenoAgeAccel values. Single-index analysis indicated that either SII or PhenoAgeAccel demonstrated a significantly positive association with CRD via logistic regressions and RCS curves. Furthermore, the joint-indexes analysis revealed that compared to individuals with lower SII and PhenoAgeAccel, those with higher SII and PhenoAgeAccel exhibited remarkably stronger associations with CRD (adjusted OR [aOR], 1.56; 95% CI, 1.31-1.85; P < 0.001), chronic obstructive pulmonary disease (aOR, 1.56; 95% CI, 1.22-2.00; P = 0.001) and asthma (aOR, 1.40; 95% CI, 1.16-1.70; P = 0.001), which were predominant among those aged above 40 years, females and smokers. Eventually, mediation analyses suggested the mutual mediating effects of SII and PhenoAgeAccel on CRD and PhenoAgeAccel mediated SII resulting in CRD more significantly.

CONCLUSION

This study confirmed the coexposure effect and mutual mediation between SII and PhenoAgeAccel on CRD. We recommend that the joint assessment may conduce to the accurate identification for populations susceptible to CRD and early prevention of chronic respiratory diseases.

Trends, seasonal variations and forecasting of chronic respiratory disease morbidity in charcoal producing areas, northwest Ethiopia: time series analysis

Objective

This study analyzed the trend, seasonal variations and forecasting of chronic respiratory disease morbidity in charcoal producing areas, northwest Ethiopia, aiming to provide evidences in planning, designing strategies, and decision-makings for preparedness and resource allocation to prevent CRD and reduce public health burden in the future.

Materials and methods

The trend, seasonal variation, and forecasting for CRD were estimated using data collected from the three zones of Amhara region annual reports of DHIS2 records. Smoothing decomposition analysis was employed to demonstrate the trend and seasonal component of CRD. The ARIMA (2, 1, 2) (0, 0, 0) model was used to forecast CRD morbidity. The model's fitness was checked based on Bayesian information criteria. The stationarity of the data was assessed with a line chart and statistically with the Ljung-Box Q-test. SPSS version 27 was utilized for statistical analysis.

Results

The annual morbidity rate of CRD has shown an increasing trend in both sexes over a seven-year period among people aged 15 years and older. Seasonal variation in CRD morbidity was observed. The smoothing decomposition analysis depicted that the seasonal component was attributed to 44.47% and 19.16% of excess CRD cases in the period between September to November, and June to August, respectively. A substantial difference among the three zones of the Amhara region in CRD morbidity rate was noted, with the highest observed in the Awi zone. Forecasting with the ARIMA model revealed that CRD-related morbidity will continue to increase from 2020 to 2030.

Conclusion

The study revealed that the CRD morbidity rate has shown an increasing trend from 2013 to 2019. Seasonal variation in the CRD morbidity rate was observed, with the highest peak from September to November. The morbidity attributed to CRD will continue to increase for the next ten years (2020-2030). Therefore, this study could potentially play a groundbreaking role. Further study is warranted to understand the risk factors and facility readiness through a further understanding of seasonality and future trends.

Single cell transcriptomics in blood of patients with chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Single-cell RNA sequencing (scRNA-seq) provides gene expression profiles at the single-cell level. Hence, we evaluated gene expression in the peripheral blood of patients with COPD.

METHODS

Peripheral blood samples from seven healthy controls and eight patients with COPD were obtained in this study. The 10X Genomics Chromium Instrument and cDNA synthesis kit were utilized to generate a barcoded cDNA library for single cell RNA-sequencing. We compared the scRNA-seq data between the COPD and control groups using computational analysis. Functional analyses were performed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses.

RESULTS

scRNA-seq was used to analyze the transcriptome of peripheral blood mononuclear cells from seven normal controls and eight patients with COPD. We found an increased number of monocyte/macrophages in the COPD group compared to the normal control group. Among the differentially expressed genes (DEGs) in monocyte/macrophages, we identified 15 upregulated genes (EGR1, NR4A1, CCL3, CXCL8, PTGS2, CD83, BCL2A1, SGK1, IL1B, BTG2, NFKBIZ, DUSP2, MAFB, PLAUR and CCL3L1) and 7 downregulated genes (FOLR3, RPS4Y1, HLA-DRB5, NAMPT, CD52, TMEM176A and TMEM176B) in the COPD group compared to the normal control group.

CONCLUSIONS

Using scRNA-seq, we found differences in cell type distribution, especially in monocyte/ macrophages. Several upregulated and downregulated genes were found in the monocyte/macrophages of the COPD group.

Trends in mortality in Spain, with a special focus on respiratory-related conditions in the midst of the COVID-19 pandemic

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic significantly increased the global burden of respiratory morbidity and mortality. In Spain, 2020 saw a 68.5% surge in deaths from respiratory diseases compared to 2019, largely due to COVID-19. This study aims to describe respiratory disease mortality in Spain from 2019 to 2022, focusing on the intersection of COVID-19, pre-existing respiratory conditions, and specific health determinants.

MATERIALS AND METHODS

We analyzed mortality data from the Spanish National Institute of Statistics (INE), covering 102 causes of death, including tuberculosis, COVID-19, and lung cancer as respiratory-related conditions. The analysis considered absolute death counts and proportions by sex, age, and region, along with percentage changes in proportional mortality. Logistic regression models were used to identify factors potentially associated with COVID-19 and respiratory-specific mortality.

RESULTS

In 2022, Spain reported 98,128 deaths from respiratory diseases, accounting for 21.1% of all deaths and ranking as the second leading cause of death after cardiovascular diseases. Although deaths due to COVID-19 decreased in 2021 and 2022, there was a notable rise in other respiratory causes, indicating a lasting post-pandemic impact. Factors linked to higher mortality included male gender, older age, being divorced, and residing in urban areas, with significant regional variability.

CONCLUSIONS

Despite overall mortality returning to pre-pandemic levels, this study highlights a significant increase in respiratory disease deaths in Spain in 2022 compared to 2019.

Brain Oxygenation During Exercise in Different Types of Chronic Lung Disease: A Narrative Review

Chronic lung diseases such as Chronic Obstructive Pulmonary Disease, Interstitial Lung Disease (ILD), and Pulmonary Hypertension (PH) are characterized by progressive symptoms such as dyspnea, fatigue, and muscle weakness, often leading to physical inactivity, and reduced quality of life. Many patients also experience significantly impaired exercise tolerance. While pulmonary, cardiovascular, respiratory, and peripheral muscle dysfunction contribute to exercise limitations, recent evidence suggests that hypoxia and impairments in cerebral oxygenation may also play a role in exercise intolerance. This narrative review (i) summarizes studies investigating cerebral oxygenation responses during exercise in patients with different types of chronic lung diseases and (ii) discusses possible mechanisms behind the blunted cerebral oxygenation during exercise reported in many of these conditions; however, the extent of cerebral desaturation and the intensity at which it occurs can vary. These differences depend on the specific pathophysiology of the lung disease and the presence of comorbidities. Notably, reduced cerebral oxygenation during exercise in fibrotic-ILD has been linked with the development of dyspnea and early exercise termination. Understanding the effects of chronic lung disease on cerebral oxygenation during exercise may improve our understanding of exercise intolerance mechanisms and help identify therapeutic strategies to enhance brain health and exercise capacity in these patients.

Exploring the association between socioeconomic inequalities in chronic respiratory disease and all-cause mortality in China: findings from the China Health and Retirement Longitudinal Study

Objective

Research on the inequality of chronic respiratory disease (CRD) is limited, and the association between CRD and all-cause mortality is not well-established. Investigating the distribution of CRD and its associated mortality risks is essential for improving CRD conditions and developing targeted intervention measures. This study aimed to explore the relationship between inequalities in CRD and all-cause mortality in China.

Methods

This study utilized nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020, wave 1-wave 5), including a total of 14,743 subjects. The concentration index was employed to measure socioeconomic-related inequality in CRD, and the concentration index decomposition method was used to describe its influencing factors. Cox proportional hazards regression model was employed to examine the association between CRD and all-cause mortality.

Results

The prevalence of CRD was 11.79% (95% CI: 10.98, 12.66) in China. The concentration index for CRD was -0.050 (95% CI: -0.075, -0.026), indicating a certain degree of inequality in its prevalence. Chronic lung disease (concentration index = -0.046, 95% CI: -0.073, -0.019), asthma (concentration index = -0.102, 95% CI: -0.148, -0.056), and asthma-chronic obstructive pulmonary disease overlap syndrome (concentration index = -0.114, 95% CI: -0.173, -0.055) also exhibited a pro-poor distribution. The decomposition analysis of the concentration index for CRD revealed that age, education level, and economic status played substantial roles in contributing to the observed inequality. Additionally, Cox regression analysis showed that participants with CRD had an increased risk of all-cause mortality (HR = 1.49, 95% CI: 1.34, 1.65).

Conclusion

Inequalities exists in CRDs in China, with the prevalence of these diseases primarily concentrated among economically disadvantaged groups. Additionally, CRD increases the risk of all-cause mortality. Addressing the root causes of economic inequalities and enhancing the educational attainment of individuals with low socioeconomic status can help improve the situation.

Facilitators and barriers affecting the implementation of e-health for chronic respiratory diseases in remote settings: a qualitative evidence synthesis

BACKGROUND

Chronic respiratory diseases are important causes of disability and mortality globally. Their incidence may be higher in remote locations where healthcare is limited and risk factors, such as smoking and indoor air pollution, are more prevalent. E-health could overcome some healthcare access obstacles in remote locations, but its utilisation has been limited. An improved understanding of barriers and facilitators to the implementation of e-health in remote locations could aid enhanced application of these approaches.

METHODS

We performed a qualitative evidence synthesis to explore factors affecting the successful implementation of e-health interventions in remote locations for patients with chronic respiratory diseases. We searched PubMed, CINAHL, Embase, Web of Science and PsycINFO databases for qualitative and mixed-methods studies. Studies were assessed by two researchers, and 41 studies were included in the synthesis. Quality was assessed via the CASP-tool. Findings were coded with Atlas.ti software and categorised based on an adapted Digital Health Equity Framework.

RESULTS

Nineteen themes were identified across five levels (individual, interpersonal, community, society and technology), with associated facilitators and barriers for implementation. An important facilitator of e-health was its role as a tool to overcome obstacles of distance and to increase access to care and patients' self-efficacy. Potential barriers included the reduction of in-person interactions and an increased burden of work for healthcare providers. Good quality, usability, adaptability and efficacy of e-health interventions were important for implementation to be successful, as were adaptation to the local setting - including culture and language -and involvement of relevant stakeholders throughout the process.

CONCLUSIONS

Several factors affecting the implementation of e-health in remote and rural locations for patients with chronic respiratory disease were identified. Intervention objectives, target population, geographical location, local culture, and available resources should be carefully considered when designing an e-health intervention. These findings can be used to inform the successful design and implementation of future e-health interventions.

Global, regional, and national burden of chronic obstructive pulmonary disease and its attributable risk factors from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021

BACKGROUND

Chronic obstructive pulmonary disease (COPD) continues to be a significant issue, leading to premature death or reduced quality of life. It's important to assess the current burden of COPD and its risk factors on a geographical basis to guide health policy.

METHODS

Data on the prevalence, deaths, and disability-adjusted life years (DALYs) related to COPD, and risk-attributable burden were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 database. The relationship between COPD DALYs and the sociodemographic index (SDI) was estimated using Smoothing Splines models.

RESULTS

Between 1990 and 2021, the changes were -1.46% (95% uncertainty interval [UI] -3.36% to 0.39%) in age-standardized prevalence, -37.12% (-43.37% to -27.68%) in mortality, and -36.98% (-42.37% to -28.54%) in DALYs rate. In 2021, a total of 213.39 million prevalent cases of COPD were estimated. The age-standardized prevalence of COPD increased with age and was more common in males. The age-standardized COPD DALYs had a reversed U-shaped relationship with SDI at the regional level, with the highest burden at an SDI of about 0.45. At the global level, smoking had the highest influence on COPD DALYs, accounting for 34.8%, followed by ambient particulate matter pollution (22.2%), household air pollution from solid fuels (19.5%), and occupational particulate matter, gases, and fumes (15.8%).

CONCLUSIONS

The overall burden of COPD has been increasing despite improvements in some rates since 1990. It's crucial to focus on interventions such as smoking cessation and addressing environmental and occupational exposures.

Association between chronic respiratory diseases and frailty in Chinese elderly: a population-based longitudinal study

BACKGROUND

Chronic respiratory diseases (CRDs) have been shown to be associated with frailty, but these findings have not yet reached a consensus. The aim of this study was to investigate the association between CRDs and frailty in the elderly using a nationally representative data from China.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) were analysed, including 3309 frailty-free participants followed for three waves from 2011. Frailty was assessed using the physical frailty phenotype scale, and CRDs were conformed by self-reported physician diagnoses. Cox proportional hazard models were used to examine the association between baseline CRDs and subsequent frailty.

RESULTS

Among participants (mean age 67.07 years, 51.53% male), 497 (15.02%) had CRDs. During a mean follow-up of 46 months, 273 (8.25%) participants developed frailty. The incidence rate of frailty was significantly higher in the CRDs group (37.17% per 1000 person-years vs 18.41% per 1000 person-years, p<0.01). Adjusted for covariables, participants with CRDs had a 44% higher risk of developing frailty (HR = 1.44, 95% CI: 1.08 to 1.91). Specifically, asthma only (HR=1.89, 95% CI: 1.07 to 3.33) and asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) (HR=1.79, 95% CI: 1.19 to 2.69) were associated with a higher risk of frailty among the elderly, while COPD only was not (HR=1.11, 95% CI: 0.73 to 1.65).

CONCLUSION

This study shows a significant association between CRDs, particularly asthma only and ACO, and frailty in the elderly. We need to pay attention to the frailty status of CRDs patients and consider routine screening among them in both clinical practice and community settings. Active treatment and control of CRDs are necessary to avoid frailty caused by primary lung disease progression or exacerbation.

One-year epidemiological patterns of respiratory pathogens across age, gender, and seasons in Chengdu during the post-COVID era

Respiratory tract infections caused by various pathogens remain a significant public health concern due to their high prevalence and potential for severe complications. This study systematically analyzed the epidemiological characteristics of six common respiratory pathogens-Chlamydia pneumoniae (CP), Mycoplasma pneumoniae (MP), Adenovirus (AdV), Influenza A virus (FluA), Influenza B virus (FluB), and Respiratory Syncytial Virus (RSV)-in patients from Sichuan Jinxin Xinan Women and Children's Hospital between April 2023 and March 2024. Throat swab samples were collected from a total of 22,717 individuals. Each sample was processed using the AUTOMOLEC 3000 analyzer and the PCR-fluorescent probe method. The results showed that 10,171 (44.8%) individuals tested positive for at least one pathogen. MP had the highest overall positive rate (21.83%), followed by FluA (17.50%) and FluB (14.84%). MP showed the highest mean monthly (average) positive rate (16.84% ± 8.41). Significant differences were found between MP and AdV, CP and RSV in average positive rate (p < 0.05). Co-infection analysis revealed frequent associations between MP and AdV, MP and CP, and FluB with MP. Seasonal analysis indicated distinct peaks: FluA and FluB in winter, RSV in spring, and MP in summer, autumn and winter. Age-stratified analysis showed higher positivity rates of RSV in children aged 0-6 years, MP and CP in the 7-17 years group. Gender-based differences were only observed in RSV positive samples. These findings provide crucial insights into the prevalence and seasonal distribution of respiratory pathogens in Chengdu, offering valuable data to inform public health strategies in the post-COVID era.

Effect of ambient O3 on respiratory mortality and synergies with meteorological factors in Shenyang, China

The impact of O3 on the respiratory system is a significant global problem. Nevertheless, there is insufficient information about its impact on respiratory disorders in northeast China. In this study, we used a generalized additive model (GAM) to determine the correlation between O3 concentrations and respiratory deaths based on the daily meteorological data, pollutant concentrations, and respiratory deaths from 2014 to 2016 in Shenyang, a typical city in northeast China. Single and cumulative lag structures and seasonal modification were considered to investigate the link between O3 exposure and respiratory mortality in Shenyang, northeast China. Synergic effects of O3 and meteorological factors were also evaluated. Results indicated that there was a significant correlation between O3 and the number of deaths caused by respiratory diseases on a daily basis, regardless of the time delay between exposure and the occurrence of the deaths. A 10 µg/m3 rise in O3 concentration was associated with a 0.85% (95% CI 0.18-1.52%) increase in respiratory death at a lag of 1 day and a 1.43% (95% CI 0.40-2.48%) increase at a cumulative lag of 3 days. Stratified analyses revealed that O3 had a greater impact on health under warm conditions compared to cold settings. Additionally, O3 had a more pronounced effect on females than on males. The results for this study could provide some scientific guidance for local environment and health departments.

Climate change, air pollution and chronic respiratory diseases: understanding risk factors and the need for adaptive strategies

Under the background of climate change, the escalating air pollution and extreme weather events have been identified as risk factors for chronic respiratory diseases (CRD), causing serious public health burden worldwide. This review aims to summarize the effects of changed atmospheric environment caused by climate change on CRD. Results indicated an increased risk of CRD (mainly COPD, asthma) associated with environmental factors, such as air pollutants, adverse meteorological conditions, extreme temperatures, sandstorms, wildfire, and atmospheric allergens. Furthermore, this association can be modified by factors such as socioeconomic status, adaptability, individual behavior, medical services. Potential pathophysiological mechanisms linking climate change and increased risk of CRD involved pulmonary inflammation, immune disorders, oxidative stress. Notably, the elderly, children, impoverished groups and people in regions with limited adaptability are more sensitive to respiratory health risks caused by climate change. This review provides a reference for understanding risk factors of CRD in the context of climate change, and calls for the necessity of adaptive strategies. Further interdisciplinary research and global collaboration are needed in the future to enhance adaptability and address climate health inequality.

Wenshen Yiqi Granule Alleviates Chronic Obstructive Pulmonary Disease via the Long Noncoding RNA-XIST/MicroRNA-200c-3p Axis

Chronic obstructive pulmonary disease (COPD) is a major challenge to global public health. Evidence showed that long noncoding RNA (lncRNA)-XIST/microRNA (miRNA)-200c-3p axis regulated apoptosis and inflammation in cigarette smoke extract (CSE)-exposed human bronchial epithelial cells. Wenshen Yiqi granule (WSYQG) is a Traditional Chinese medicine compound prescription and often used for treating COPD. However, the current understanding of the mechanism by which WSYQG improves COPD is still limited, which has somewhat restrained its widespread application. Therefore, this study aims to investigate the effects and biological mechanisms of WSYQG on CSE-exposed type II alveolar epithelial (AEC II) cells with cell transfection and miRNA mimics/inhibitors intervention. Cell counting kit-8, flow cytometry, Transwell, Western blot, real-time quantitative reverse transcription PCR, and fluorescence in situ hybridization assays were used. Results showed that WSYQG intervention increased cell viability and decreased levels of IFN-γ, TNF-α and apoptosis, also preventing cell migration in CSE-exposed ACE II cells. Additionally, expression of epithelial marker (ZO-1), Notch1/4 decreased, and mesenchymal markers (vimentin) and Notch2 expression increased in CSE-exposed ACE II cells, while WSYQG intervention antagonized them and also decreased N-cadherin and increased E-cadherin. Silencing lncRNA-XIST enhanced WSYQG's effects on CSE-exposed ACE II cells, while inhibiting miR-200c-3p reversed silencing lncRNA-XIST's effects. Furthermore, dual-luciferase reporter assay system and RNA immunoprecipitation assay proved that lncRNA-XIST acts as a miR-200c-3p sponge. This study highlights the importance of the lncRNA-XIST/miR-200c-3p axis in WSYQG improving COPD, providing a research basis for WSYQG to improve COPD and expanding the possibility of expanding its clinical application.

Digital healthcare services in community pharmacies in Switzerland: Pharmacist and patient acceptability, and pharmacist readiness-the Pneumoscope™ pilot study

Background

The integration of artificial intelligence (AI)-based pharmaceutical services in community pharmacy (CP) settings has the potential to enhance point-of-care services and improve informed patient access to healthcare. The Pneumoscope™, an innovative AI-powered digital stethoscope that analyses lung sounds to detect specific respiratory pathologies, could be a valuable tool for pharmacists in conducting respiratory screening. To understand how this device can be implemented in the healthcare system, this exploratory research aims to assess the acceptability of pharmacists and patients, and the pharmacists' readiness to use the Pneumoscope™ in CPs for respiratory disease management.

Methods

A 2-stage exploratory approach was conducted using mixed methods: 1) a qualitative analysis of pharmacists' acceptability and readiness was developed using semi-structured interviews and focus groups ; 2) followed by a quantitative cross-sectional survey of patients' acceptability of the device in CPs.

Results

Pharmacists were generally positive about the integration of e-health services into their daily clinical practice, recognizing their potential to improve advanced pharmaceutical triage and collaboration with physicians. Most patients were satisfied with the care provided by CPs, and their acceptability to use the Pneumoscope™ was significantly associated with their level of confidence in AI (p = 0.0092) and with the location of their CP (p = 0.0276).

Conclusions

Digital devices such as the Pneumoscope™ have the potential to reinforce the pharmacists' clinical roles within an interprofessional team and improve patient care, but further scientific evaluation and implementation are necessary to support its integration and ensure its reimbursement by health insurers.

Dupilumab Induces Long-Term On-Treatment Clinical Remission in Patients With Type 2 Asthma

BACKGROUND

Remission is proposed as a multicomponent outcome for patients with severe asthma.

OBJECTIVE

This post hoc analysis of QUEST (NCT02414854) and TRAVERSE (NCT02134028) evaluated whether dupilumab treatment leads to clinical asthma remission (≥12 months with no severe exacerbations, zero oral corticosteroid use, stabilized or improved lung function, patient-reported asthma control <1.5) and assessed its durability in patients with uncontrolled, moderate to severe type 2 asthma (blood eosinophils ≥150 cells/μL or fractional exhaled nitric oxide ≥20 ppb at parent-study baseline) who are not receiving maintenance oral corticosteroids.

METHODS

In QUEST, patients (aged ≥12 years) were randomized to dupilumab 200/300 mg or placebo every 2 weeks for 52 weeks. In TRAVERSE, all patients received dupilumab 300 mg every 2 weeks for up to 96 weeks. We assessed the proportion of patients meeting criteria for on-treatment clinical remission up to 48 weeks of TRAVERSE.

RESULTS

At QUEST baseline, 1,040 patients receiving dupilumab and 544 taking placebo had type 2 asthma; of those, 842 (dupilumab/dupilumab) and 437 (placebo/dupilumab) enrolled in TRAVERSE. At QUEST week 52 (year 1), 37.2% of patients receiving dupilumab met clinical remission criteria, compared with 22.2% taking placebo (all P < .001). At week 48 of TRAVERSE (year 2 overall), 42.8% (dupilumab/dupilumab) and 33.4% (placebo/dupilumab) of patients met clinical remission criteria. Overall, 29.5% of patients in the dupilumab/dupilumab group met the criteria at both years 1 and 2.

CONCLUSIONS

Dupilumab treatment enabled approximately one third of patients with type 2 asthma to meet the multicomponent end point for on-treatment clinical asthma remission for up to 2 years.

Does photobiomodulation alter mitochondrial dynamics?

Mitochondrial dysfunction is one of the leading causes of disease development. Dysfunctional mitochondria limit energy production, increase reactive oxygen species generation, and trigger apoptotic signals. Photobiomodulation is a noninvasive, nonthermal technique involving the application of monochromatic light with low energy density, inducing non-thermal photochemical effects at the cellular level, and it has been used due to its therapeutic potential. This review focuses on the mitochondrial dynamic's role in various diseases, evaluating the possible therapeutic role of low-power lasers (LPL) and light-emitting diodes (LED). Studies increasingly support that mitochondrial dysfunction is correlated with severe neurodegenerative diseases such as Parkinson's, Huntington's, Alzheimer's, and Charcot-Marie-Tooth diseases. Furthermore, a disturbance in mitofusin activity is also associated with metabolic disorders, including obesity and type 2 diabetes. The effects of PBM on mitochondrial dynamics have been observed in cells using a human fibroblast cell line and in vivo models of brain injury, diabetes, spinal cord injury, Alzheimer's disease, and skin injury. Thus, new therapies aiming to improve mitochondrial dynamics are clinically relevant. Several studies have demonstrated that LPL and LED can be important therapies to improve health conditions when there is dysfunction in mitochondrial dynamics.

Driving Sustainability in Asthma and COPD Management: Preventative Models and Green Prescribing in a Rural Primary Care Practice in England

BACKGROUND

Asthma and COPD are among the most prevalent chronic respiratory conditions, with inhalers as their primary pharmacological treatment. In the UK, metered-dose inhalers (MDIs) account for 70% of all inhaler prescriptions and contribute significantly to the NHS's carbon footprint, making green prescribing a critical focus. Aligning environmental sustainability with clinical excellence is essential to reducing exacerbations and deaths while minimising carbon emissions.

OBJECTIVE

This initiative aimed to assess the localised impact of a structured quality improvement program designed to enhance respiratory care and integrate sustainable prescribing practices. Specifically, it sought to evaluate prescribing patterns, respiratory review completion rates, and the feasibility of transitioning patients from MDIs to lower-carbon alternatives whilst maintaining clinical outcomes.

METHODS

The initiative, implemented at a UK general practice in January 2020, focussed on staff education, restructuring respiratory consultations, and patient engagement. The "treatable traits" paradigm and best practice frameworks guided the program to optimise individualised care. Prescribing data, in-date respiratory review rates, and estimated carbon emissions were analysed over 4 years (2020-2024) using publicly available sources such as OpenPrescribing.net. While education was a component of the intervention, no formal assessment was conducted on its direct impact on prescribing behaviours.

RESULTS

The practice achieved an in-date respiratory review rate exceeding 90%, rising to over 96% during the most recent QOF period. Over 4 years, the proportion of non-salbutamol MDI prescriptions decreased from 62.9% to 36.2%, aligning with national sustainability goals. Despite growth in the practice population, overall carbon emissions from inhalers were successfully reduced, reflecting a shift towards lower-carbon prescribing.

CONCLUSION

This initiative illustrates the feasibility of integrating sustainable prescribing practices into routine respiratory care, aligning with the goals of the national health system. This work highlights the potential of local-level interventions to contribute to broader sustainability efforts in respiratory medicine. Improvements in prescribing patterns and review rates have been noted, but more research is needed to evaluate the impact of educational interventions on healthcare providers' and patients' decisions. Future initiatives should focus on structured evaluations of long-term adherence and clinical outcomes.

Inherent immunity and adaptive immunity: Mechanism and role in AECOPD

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading cause of hospitalization and mortality in COPD patients. The occurrence of antibiotic resistance and the progression of non-infectious diseases contribute to poor patient outcomes. Thus, a comprehensive understanding of the mechanisms underlying AECOPD is essential for effective prevention. It is widely acknowledged that the immune system plays a fundamental role in pathogen clearance and the development of inflammation. Immune dysregulation, either due to deficiency or hyperactivity, has been implicated in AECOPD pathogenesis. Therefore, the purpose of this review is to investigate the possible mechanisms underlying dysregulated immune function and disease progression in COPD patients, specifically focusing on the innate and adaptive immune responses. The ultimate aim is to provide new insights for clinical prevention and treatment strategies targeting AECOPD.

Safety and efficacy of ensifentrine in COPD: A systemic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) significantly impacts global health due to persistent airflow limitation and inflammation. Despite standard therapies, symptoms persist. Ensifentrine, targeting both bronchoconstriction and inflammation as a dual phosphodiesterase 3 and 4 inhibitor, offers a promising therapeutic advancement for COPD management. This meta-analysis evaluates the safety and efficacy of ensifentrine in improving lung function, dyspnea, and quality of life in COPD patients.

METHODS

We searched PubMed, Embase, and Web of Science through August 2024 for randomized controlled trials evaluating ensifentrine in COPD patients over a minimum of four weeks. Data extraction and screening utilized Knowledge software, and meta-analyses were performed using R v4.4 with a random-effects model.

RESULTS

From 206 studies identified, four met our inclusion criteria. Ensifentrine improved FEV1 significantly at a dose of 3 mg (LS mean difference: 40.90 mL; 95 % CI: 19.65-62.15). It also improved dyspnea as measured by the Transition Dyspnea Index (TDI) (LS mean difference: 0.91; 95 % CI: 0.61-1.21) and quality of life according to the St. George's Respiratory Questionnaire-C (SGRQ-C) scores (LS mean difference: -1.92; 95 % CI: -3.28 to -0.55). Safety profiles were comparable between the ensifentrine and placebo groups, with no significant increase in treatment-emergent adverse events (TEAEs) (RR: 1.02; 95 % CI: 0.94-1.10).

CONCLUSION

Ensifentrine significantly enhances lung function, reduces dyspnea, and improves quality of life in COPD patients, especially at a 3 mg dose. These benefits, coupled with a stable safety profile, support its use as an adjunctive therapy in COPD management.

Current perspectives on the rehabilitation of COPD patients with comorbidities

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by a variety of comorbidities, complicating management and rehabilitation efforts. Understanding this interplay is crucial for optimizing patient outcomes.

AREAS COVERED

This review, based on the MEDLINE, Embase and Cochrane Library databases, summarizes the main research on the rehabilitation of patients with COPD, with an emphasis on relevant comorbidities, such as cardiovascular diseases, pulmonary hypertension, lung cancer, metabolic, musculoskeletal, and gastrointestinal disorders. anxiety/depression and cognitive disorders. The study highlights the importance of pre-participation assessments, ongoing monitoring and personalized rehabilitation programs. A review includes a comprehensive literature search to assess the scientific evidence on these interventions and their impact.

EXPERT OPINION

The integration of cardiorespiratory rehabilitation program is essential for improving physical capacity and quality of life in COPD patients with comorbidities. While existing studies highlight positive outcomes, challenges such as interdisciplinary collaboration and access to rehabilitation services remain. Future strategies must prioritize personalized and integrated approaches programs combining pharmacological optimization and a close monitoring during cardiopulmonary rehabilitation to significantly reduce hospital readmissions and mortality, even in patients with complex multimorbidities. Continued research is necessary to refine rehabilitation protocols and better understand the complexities of managing COPD alongside cardiac conditions.