Global burden of chronic respiratory diseases and risk factors, 1990-2019: an update from the Global Burden of Disease Study 2019

Loneliness and social isolation, mediating lifestyle factors, and incidence of COPD: A prospective cohort study

BACKGROUND

Limited information exists regarding the associations and pathways of loneliness and social isolation with chronic obstructive pulmonary disease (COPD). Our goal was to investigate the associations of loneliness and social isolation with COPD, as well as to analyze how lifestyle factors may play a role in mediating these effects.

METHODS

In the UK Biobank, 293,864 participants were included in this study. The study assessed five lifestyle factors: physical activity, eating habits, smoking, alcohol consumption, and body mass index (BMI). Incident COPD was detected through algorithms based on electronic health records. We used Cox proportional models to explore the association. Cause mediation analyses were applied to estimate the effect of various lifestyle factors.

RESULTS

In the fully adjusted model, the lonely participants had a greater risk of developing COPD (HR: 1.31; 95 % CI: 1.20-1.43) compared with those participants without loneliness. Similarly, the HR of social isolation on incident COPD was 1.39 (95 % CI: 1.30-1.48) after adjusting for potential confounders. Current smokers (21.9 %), unhealthy dietary characteristics (4.8 %), BMI (4.0 %), unhealthy drinking habits (1.4 %), and physical activity (0.7 %) explained 32.8 % of the association between loneliness and COPD. Likewise, current smokers, physical activity, and unhealthy drinking habit mediated 46.1 %, 4.7 %, and 4.2 % of the effect of social isolation on incident COPD.

LIMITATIONS

Despite extensive adjustment for potential confounders and several sensitivity analyses, residual confounding and reverse causality could not be ruled out.

CONCLUSION

Individuals with loneliness or social isolation have a higher risk of COPD, partly mediated through lifestyle factors.

Adherence to asthma and COPD inhaled therapies in low- and middle-income countries: a narrative review

INTRODUCTION

In low-income and middle-income countries (LIMCs), defined based on the World Bank classification, non-adherence to respiratory therapies contributes to increasing mortality and morbidity due to chronic respiratory diseases. To address this issue, it is essential to identify and tackle underlying factors such as cultural beliefs, socioeconomic disparities, and limited access to healthcare resources and infrastructures. The absence of strategies that integrate community involvement, healthcare professional's training, economic policies, and educational programs exacerbates the disproportionate burden of chronic respiratory diseases in LIMCs.

AREAS COVERED

This review is based on a structured literature search across PubMed, Scopus, and Google Scholar (2000-2023) using terms relevant to asthma, COPD, adherence, and LMICs. The review examines key factors that hinder patients' adherence to Asthma and COPD medications in LIMCs, providing some insights into the issue and proposing concrete solutions.

EXPERT OPINION

Addressing non-adherence requires a multifaceted approach involving community engagement, educational initiatives, and improved healthcare infrastructure. Future research should focus on tailored interventions to enhance adherence and ultimately improve health outcomes for patients with chronic respiratory diseases in LMICs.

Incidence and prevalence of asthma, chronic obstructive pulmonary disease and interstitial lung disease between 2004 and 2023: harmonised analyses of longitudinal cohorts across England, Wales, South-East Scotland and Northern Ireland

BACKGROUND

We describe the epidemiology of asthma, chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) from 2004 to 2023 in England, Wales, Scotland and Northern Ireland (NI) using a harmonised approach.

METHODS

Data from the National Health Service England (NHSE), Clinical Practice Research Datalink Aurum in England, Secure Anonymised Information Linkage Databank in Wales, DataLoch in South-East Scotland and the Honest Broker Service in NI were used. A harmonised approach to COPD, asthma and ILD case definitions, study designs and study populations across the four nations was performed. Age-sex-standardised incidence rates and point prevalence were calculated between 2004 and 2023 depending on data availability. Logistic and negative binomial regression compared incidence and prevalence rates between the start and end of each study period. Linear extrapolation projected incidence rates between 2020 and 2023 to illustrate how observed and projected rates differed.

RESULTS

Incidence rates were lower in 2019 versus 2005 for asthma (England: incidence rate ratio 0.89, 95% CI 0.88 to 0.90; Wales: 0.66, 0.65 to 0.68; Scotland: 0.67, 0.64 to 0.71; NI: 0.84, 0.81 to 0.86), COPD (England: 0.83, 0.82 to 0.85; Wales: 0.67, 0.65 to 0.69) and higher for ILD (England: 3.27, 3.05 to 3.50; Wales: 1.39, 1.27 to 1.53; Scotland: 1.63, 1.36 to 1.95; NI: 3.03, 2.47 to 3.72). In NHSE, the incidence of asthma was similar in June 2023 versus November 2019, but lower for COPD and higher for ILD. Prevalence of asthma in 2019 in England, Wales, Scotland and NI was 9.7%, 15.9%, 13.2% and 7.0%, respectively, for COPD 4.5%, 5.1%, 4.4% and 3.0%, and for ILD 0.4%, 0.5%, 0.6% and 0.3%. Projected incidence rates were 2.8, 3.4 and 1.8 times lower for asthma, COPD and ILD compared with observed rates at the height of the pandemic.

INTERPRETATION

Asthma, COPD and ILD affect over 10 million people across the four nations, and a substantial number of diagnoses were missed during the pandemic.

Adverse Outcomes Associated With Short-Acting Beta-Agonist Overuse in Asthma: A Systematic Review and Meta-Analysis

INTRODUCTION

The 2019 Global Initiative for Asthma (GINA) report no longer recommended short-acting beta-agonists (SABA) monotherapy due to associated complications and a lack of anti-inflammatory properties. This systematic review and meta-analysis aimed to evaluate adverse outcomes associated with SABA overuse in patients with asthma.

METHODS

PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched for studies on SABA overuse (≥ 3 SABA canisters/year) in patients with asthma, from 1981 to November 2023. Randomized controlled trials (RCTs), cohort studies, and cross-sectional studies were included. Pooled risk ratios (RRs) were calculated for dichotomous measures of all-cause mortality and acute exacerbations using random-effects models and Mantel-Haenszel weighting. Subgroup analyses were conducted based on study design.

RESULTS

Out of 626 records, 27 studies (2 RCTs, 1 prospective cohort study, 12 retrospective cohort studies, and 12 cross-sectional studies) were included. SABA overuse (≥ 3 SABA canisters/year) was associated with significantly higher mortality (2743 of 130,629 in the overuse group versus 3534 of 300,451 in controls; RR = 2.04, 95% confidence interval, CI = 1.37-3.04; p < 0.001) and a significantly higher rate of acute exacerbations (60,320 of 165,271 in the overuse group versus 84,439 of 376,845 in controls; RR = 1.93, 95% CI = 1.24-3.03; p < 0.001). An increased risk of acute exacerbations was observed in retrospective cohort studies (RR = 1.88, 95% CI = 1.43-2.47; p < 0.001) and cross-sectional studies (RR = 2.23, 95% CI = 1.04-4.77; p < 0.001).

CONCLUSIONS

SABA overuse was associated with increased rates of mortality and acute exacerbations in patients with asthma, supporting guidelines that advise against SABA monotherapy in asthma management.

The Indirect Impact of COVID-19 Pandemic on Mortality, Complications, and Healthcare Utilization Among Patients With Chronic Respiratory Diseases in Hong Kong: An Interrupted Time Series Analysis

PURPOSE

This study aimed to investigate COVID-19's indirect influence on chronic respiratory disease (CRD) patients for two years since the COVID-19 pandemic began.

METHODS

Using population-based data in Hong Kong, we included CRD patients diagnosed from January 2011 to December 2021. Interrupted Time Series Analysis were applied to assess mortality, complications, and healthcare utilization rates during the "pre-COVID-19 pandemic" (January 2012-January 2020), "initial COVID-19 pandemic" (February 2020-February 2021), and "post-initial COVID-19 pandemic" (March 2021-December 2021) periods.

RESULTS

Among 587,049 patients with CRD, all-cause mortality had an increasing trend during the post-initial COVID-19 pandemic period (incidence rate ratio (95% CI): 1.019 (1.005, 1.034); p = 0.007), compared with pre-COVID-19 pandemic period. Nonrespiratory mortality had an increasing trend in the initial COVID-19 pandemic period (1.020 (1.006, 1.033); p = 0.004) and was higher than the pre-pandemic level in the post-initial COVID-19 pandemic. We observed abrupt declines in the incidence rates of asthma exacerbation, acute exacerbation of chronic obstructive pulmonary disease, pneumonia, and acute respiratory failure in the first month of initial COVID-19 pandemic period, remaining below pre-COVID-19 pandemic levels throughout the initial pandemic period.

CONCLUSION

The disruption of usual healthcare impacts mortality rates among patients with CRD without COVID-19, particularly nonrespiratory mortality. Contingency plans on continuing follow-up and monitoring of CRD patients are needed, for example, teleconsultations, shared primary care, and tele-reminders on red-flag symptoms for patients with CRD, when healthcare services may be disrupted during public health crises.

Type 2 gene expression signature in severe asthma associates with more advanced airway remodeling

BACKGROUND

Asthma is a heterogeneous disease with various inflammatory subtypes, including the type-2 (T2) endotype associated with airway eosinophilia. Severe asthma is linked to reduced ventilatory function due to airway structural changes. This study compared the extent of airway remodeling in different immunological endotypes of asthma.

METHODS

Severe asthma patients (n = 30) were stratified based on bronchial expression of T2 (e.g., CST1) and T3 (e.g., IL17A) immunity genes as T2-high, T3-high, or low-inflammatory. We analyzed airway wall thickness using endobronchial ultrasound (EBUS), bronchial biopsy morphometry, and mRNA expression of remodeling genes. Bronchial epithelial cell cultures were used to assess cytokine responses.

RESULTS

T2-high asthma patients showed lower predicted FEV1 (59 vs. 74 % in low-inflammatory variant, p = 0.049) and increased submucosa layer (L2) in EBUS (0.203 vs. 0.189 mm, p = 0.018). T2-high asthma patients also had increased airway smooth muscle (ASM) mass (∼2-fold, p = 0.018) and marginally thicker reticular basement membrane. T3-high asthma showed only a trend toward thicker L2 (p = 0.055). Only patients with an eosinophilic signature in endobronchial biopsy demonstrated increased expression of remodeling genes, including TGFB1. A profibrotic profile was also induced in bronchial epithelium stimulated in vitro with IL-13.

CONCLUSION

These data suggest that T2-signature in severe asthma is associated with increased ASM mass and more pronounced airway obstruction. Overexpression of remodeling genes primarily occurred in patients with signs of eosinophilic infiltration in the bronchial mucosa, suggesting that remodeling may progress with uncontrolled airway inflammation.

Improving Care for People with Chronic Respiratory Diseases: Taking a Policy Lens

Chronic respiratory diseases (CRDs) affect almost 470 million people worldwide, and this number is growing. CRDs take a significant toll on the capacity of health systems and economies, and their effect on people's lives can be devastating. Despite high rates of prevalence and mortality, CRDs are underprioritised by policymakers and governments. Tackling these conditions will require a holistic, multisectoral approach, including government-led strategies for prevention, diagnosis, management and investment in research. In this article, we provide a clear rationale for prioritising CRDs to advance population health. Proactive steps in countries of all income levels must be taken promptly to limit the growing prevalence and impact of CRDs both now and in the future.

Longitudinal analysis of coal workers' pneumoconiosis using enhanced resolution-computed tomography images: unveiling patterns in lung structure, function, and clinical correlations

Rationale

Pneumoconiosis, caused by prolonged exposure to mineral dust, leads to progressive structural and functional lung alterations. Quantitative computed tomography (qCT) has emerged as a critical tool for assessing these changes, yet there is limited research on the longitudinal patterns in pneumoconiosis patients.

Methods

This study examined a cohort of 31 former coal workers with pneumoconiosis over a 1-year period. Inspiratory qCT images were enhanced using a deep learning-based super-resolution model and then processed to extract lung functional and airway structural metrics. A non-rigid image registration process was performed with baseline images as fixed and follow-up images as moving. Registration-derived metrics, including anisotropic deformation index (ADI), slab rod index (SRI), and Jacobian (J), were extracted to quantify regional deformation longitudinally. Pulmonary function tests, including forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), were recorded at both time points to assess functional decline.

Results

The study identified significant airway changes in angles, diameters, and geometry, with a decrease in normal lung tissue in the right upper lobe. Blood vessel volumes declined, indicating vascular remodeling. Registration metrics revealed regional heterogeneity, with higher ADI and SRI values and localized volume loss (J) in the lower lobes. FEV1/FVC progression correlated positively with tracheal angle, emphysema, and consolidation but negatively with normal lung tissue, semi-consolidation, and fibrosis. ADI, SRI, and J were associated with structural deformation, airway remodeling, and parenchymal loss, linking these changes to lung function decline.

Conclusion

qCT imaging and registration metrics effectively monitor structural and functional lung changes in pneumoconiosis. Registering baseline and follow-up inspiration images offers additionally valuable insights into disease progression.

Inequalities and age-period-cohort effects of global and regional burden for interstitial lung disease and pulmonary sarcoidosis: based on Global Burden of Disease study 2021

Background

Interstitial lung disease (ILD) and pulmonary sarcoidosis pose significant disease burdens on a global scale.

Methods

The underlying data was derived from the Global Burden of Disease (GBD) 2021 database. The disease burden was quantified through age-standardized rates (ASRs) and numbers of disability-adjusted life years (DALYs), prevalence, and incidence. The indicators' dynamic trends are captured through Joinpoint analysis and its average annual percentage change (AAPC). Concentration Index (CI) and Slope Index (SI) were employed to characterize the imbalances in the global disease burden. The age-period-cohort model was utilized to elucidate temporal trends in sociobiological factors on the disease burden.

Results

Between 1992 and 2021, the ASRs of ILD and pulmonary sarcoidosis have increased globally. For another, the imbalanced distribution of disease burden increased, with more pronounced in high socio-demographic index (SDI) regions. Besides, age-standardized DALY rates (ASDRs) for ILD and pulmonary sarcoidosis were positively associated with age and period effects worldwide and complexly associated with cohort effects, increasing between 1882 and 1928 birthed cohorts and reducing after 1982. However, the distinct period-effect and cohort-effect curves observed in Africa which illustrate a negative correlation trend are noteworthy.

Conclusion

Between 1992 and 2021, the global burden of ILD and pulmonary sarcoidosis increased, which were higher in high SDI countries and among the elderly. Furthermore, the disease burden increased with age and period and decreased for those born after 1982. However, the risk ratios of disease in Africa were negative with period-effect and cohort-effects, deserving effective interventions.

PEBP1 and 15-LO-1 in Asthma: Biomarker Potential for Diagnosis and Severity Stratification

Background: Ferroptosis, a regulated form of cell death characterized by iron-dependent lipid peroxidation, has been implicated in the pathogenesis of asthma. The ferroptosis markers PEBP1 and 15-LO-1 are increasingly recognized as potential biomarkers for asthma. This study investigates the association of these markers with asthma and its severity to evaluate their diagnostic potential. Methods: This cross-sectional study included 45 asthmatic patients and 45 healthy controls. Serum phosphatidylethanolamine-binding protein 1 (PEBP1) and 15-lipoxygenase-1 (15-LO-1) levels were measured using ELISA. Spirometric parameters (FEV1, FEV1/FVC ratio, and PEFR) were recorded. A multivariate regression assessed associations between ferroptosis markers and asthma severity. A generalized linear model (GLM) analyzed the relationship between biomarkers (PEBP1 and 15-LO-1) and lung function parameters. A receiver operating characteristic (ROC) analysis evaluated the discriminative capacity of PEBP1 and 15-LO-1. Results: PEBP1 and 15-LO-1 levels were significantly associated with asthma. The multivariate analysis revealed that low PEBP1 levels were strongly associated with asthma and severe asthma (p < 0.001). While elevated 15-LO-1 levels were associated with asthma (p < 0.001), they did not correlate with severity. The ROC analysis demonstrated excellent discriminative capacity for PEBP1 (AUC 0.962, cutoff 1509.8 pg/mL) and 15-LO-1 (AUC 0.895, cutoff 144.8 pg/mL). Lower PEBP1 and higher 15-LO-1 levels were associated with reduced lung function, and lower FEV1, FEV1/FVC, and PEF. Older age and female gender were associated with severe asthma. Conclusions: PEBP1 and 15-LO-1 are promising biomarkers for asthma, with PEBP1 showing strong correlations with asthma severity. These findings highlight the potential role of ferroptosis markers in asthma and underscore the need for further longitudinal studies to explore these markers' clinical utility in personalized asthma management.

Association of heart rate variability index with depressive symptoms and lung function in chronic obstructive pulmonary disease

BACKGROUND

Depression is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD). Research indicates that COPD affects cardiac autonomic control, and heart rate variability (HRV) serves as a simple, non-invasive measure of autonomic nerve activity. However, the relationship between HRV and lung function, as well as the impact of depressive symptoms, remains unclear.

AIM

To investigate the correlation between HRV indicators and depressive symptoms and lung function in patients with COPD.

METHODS

A retrospective cross-sectional study involving 120 COPD patients hospitalized from January 2018 to January 2024 at our institution was conducted. Demographic and clinical characteristics were collected, and depressive symptoms were assessed using the Beck Depression Inventory (BDI). Patients were categorized into a depressed group (BDI ≥ 16) and a non-depressed group (BDI < 16). A control group consisting of 60 healthy volunteers who underwent check-ups at the same institution was also included. Statistical analyses were performed using SPSS 26.0 software. Pearson correlation coefficients were calculated to determine and compare the relationships between HRV parameters, lung function measures, and depressive symptoms across the groups.

RESULTS

Of the 120 patients with COPD, 35.8% (43/120) were diagnosed with depression, compared to 5.0% (3/60) in the control group. The HRV index in COPD patients was significantly lower than that in the control group (P < 0.05), and the value in the depressed group was significantly lower than that in the non-depressed group (P < 0.05). Similarly, the COPD group had a significantly lower pulmonary forced vital capacity (FVC), first-second expiratory volume (FEV1) and FEV1/FVC ratios than the control group (P < 0.05), and the depressed group was significantly lower than that in the non-depressed group (P < 0.05). Pearson correlation analysis revealed that the standard deviation of normal R-R intervals, standard deviation of the mean of 5-minute normal R-R intervals, root mean square of successive differences of normal R-R intervals, percentage of normal R-R intervals greater than 50 ms, high-frequency, and low-frequency indices showed positive correlations with lung function parameters (P < 0.05) and negative correlations with BDI scores (P < 0.05).

CONCLUSION

Compared to patients without COPD, the incidence of depressive symptoms is higher among patients with COPD and is negatively correlated with the patients’ HRV indices. In contrast, HRV indices are positively correlated with the patients’ pulmonary function parameters. Patients and healthcare professionals should enhance their awareness of depression, actively conduct depression assessment screenings, and incorporate HRV indices into disease management. This approach aims to improve the psychological health of patients and ultimately enhance their prognosis and quality of life.

Global, regional, and national trends in peripheral arterial disease among older adults: findings from the global burden of disease study 2021

IMPORTANCE

Lower extremity peripheral arterial disease (PAD) is a significant health concern among older adults globally, affecting both mortality and quality of life.

OBJECTIVE

To evaluate the temporospatial trends and its risk factors in lower extremity PAD-related burden among adults aged 60 years and older from 1990 to 2021.

DESIGN, SETTING, AND PARTICIPANTS

This repeated cross-sectional study utilized data from the Global Burden of Disease Study 2021, encompassing 204 countries and territories. The study population included adults aged 60 years and older.

EXPOSURE

Lower extremity PAD among older adults from January 1990 to December 2021.

MAIN OUTCOMES AND MEASURES

Primary outcomes included age-standardized prevalence rates (ASPR), mortality rates (ASMR), disability-adjusted life-years (DALYs), and average annual percentage changes (AAPCs). Trends were analyzed by age, sex, and sociodemographic index (SDI). Joinpoint regression analysis was used to identify significant trend changes.

RESULTS

From 1990 to 2021, global trends showed decreases in lower extremity PAD-related prevalence, mortality, and DALYs. Significant geographical disparities were observed: high-SDI regions had the highest prevalence (11,171.66 per 100,000 in 2021) but showed declining trends (AAPC, -0.74; 95% CI, -0.80 to -0.68), while low-SDI regions had the lowest prevalence (4,842.40 per 100,000) but demonstrated increasing trends (AAPC, 0.22; 95% CI, 0.21 to 0.24). Regionally, although lower extremity PAD-related prevalence showed a decreasing trend in most regions from 1990 to 2021, there were still some regions with an increasing trend (North Africa and Middle East AAPC, 0.57; 95% CI, 0.55 to 0.59). Temporal analysis showed sex-specific divergent trends in recent years, with males exhibiting an upward trend since 2015 (APC, 0.15; 95% CI, 0.07 to 0.24), while females showed a slowed decline since 2014 (APC, -0.06; 95% CI, -0.12 to -0.01). Decomposition analysis identified population growth as the primary driver of PAD burden increase, with epidemiological changes showing contrasting effects across SDI regions. Among risk factors, high fasting glucose emerged as the leading contributor, while smoking's contribution decreased.

CONCLUSIONS AND RELEVANCE

This study revealed significant disparities in lower extremity PAD burden across different SDI levels and regions, with low-SDI countries facing an increasing burden. The contrasting trends between high- and low-SDI regions, coupled with varying risk factor patterns (particularly the rise in high fasting glucose and decline in smoking), suggest the need for targeted interventions in resource-limited settings to address this growing health challenge among older adults.

Triglyceride-glucose index as an independent predictor of mortality in patients with chronic respiratory diseases

Objective

The consequences of chronic pulmonary illness are known to exacerbate in individuals with metabolic syndrome and insulin resistance. However, the relationship between triglyceride-glucose (TyG) index, a reliable alternative biomarker of metabolic dysfunction, and chronic respiratory diseases (CRDs) are inconclusive.

Research design and methods

Our research involved a total of 7,819 adult individuals diagnosed with CRDs who participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018. To assess the correlation between the TyG index and survival rates, we employed multivariable weighted Cox regression analysis, smoothing curve fitting, survival curve analysis and subgroup analysis to investigate the relationship.

Results

Higher TyG index among CRDs shown a substantial positive correlation with all-cause mortality after controlling for relevant confounders. The restricted cubic spline analysis showed a nonlinear relationship between the TyG score and all-cause mortality in CRDs. Patients with higher TyG indexes had a greater risk of all-cause mortality according to Kaplan-Meier survival curves.

Conclusion

The clinical relevance of the TyG index in predicting the life expectancy of individuals with CRDs is highlighted by our research. The TyG index can serve as a substitute biomarker for monitoring the wellbeing of the individuals with CRDs.

Liujunzi Decoction Regulated Intestinal Flora Homeostasis to Relieve Lung-Gut Axis Inflammation in Asthma Flora Disorder Mice: Possibly Related to GATA3/ILC2

OBJECTIVE

To explore the effects and mechanism of Chinese medicine Liujunzi Decoction (LJZD) on regulating microbial flora in mice with asthma flora disorder.

METHODS

Thirty BALB/c female mice were divided into control, model, LJZD [3.5 g/(kg•d), by gavage], dexamethasone [DXMS, 0.7 mg/(kg•d), intraperitoneal injection], and Clostridium butyricum [CB, 230 mg/(kg•d), by gavage] groups according to a random number table, 6 mice in each group. The asthma flora disorder mice model was induced with ovalbumin (OVA). Lung and gut lesions were analyzed by hematoxylin-eosin (HE) and periodic acid-Schiff (PAS) stainings. The secretory immunoglobulin A (sIgA) protein expression in lung and gut tissues was detected by Western blot. Flow cytometry was used to detect the relative counts of GATA binding protein 3 (GATA3)/type 2 innate lymphoid cells (ILC2) in lung and gut. The levels of inflammatory factors in lung and gut tissues were detected by enzyme-linked immunosorbent assay (ELISA). Chao1 and Shannon index were used to compare microbial abundance and diversity in alveolar lavage fluid and cecal contents. The similarity or difference in the composition of mice microbial communities was analyzed through cluster analysis. The serum short-chain fatty acids (SCFAs) content was detected by ultra performance liquid chromatograph mass spectrometer (LC-MS)/MS.

RESULTS

The asthma flora disorder model mice showed obvious asthma-related symptoms, but LJZD treatment effectively alleviated these symptoms. LJZD restored alveolar wall thickening, airway inflammatory cell infiltration, gut tissue structure destruction, and inflammatory cell infiltration in asthma flora disorder mice. LJZD downregulated the sIgA protein expression in mice (P<0.05). Moreover, LJZD decreased the activation of GATA3/ILC2s in lung and gut tissue (P<0.01), and reduced the levels of interleukin (IL)-5, IL-33, IL-25, IL-9 and IL-13 (P<0.01). LJZD treatment returned the abundance of microbial species and the microbial community structure of alveolar lavage fluid and cecal content in asthma flora disorder mice to the normal state. The SCFAs content and body metabolism were also improved.

CONCLUSION

LJZD exerted anti-asthmatic effects by improving the microbial balance of lung-gut axis and affecting systemic metabolism, consequently regulating the GATA3/ILC2s axis to impact the lung inflammatory response.

A comparative analysis of the burden, trends and inequalities of tracheal, bronchus, and lung cancer in India from 2000 to 2021: A systematic analysis for the Global Burden of Disease study 2021

BACKGROUND

Understanding the tracheal, bronchus, and lung (TBL) cancer burden caused by tobacco exposure in India can help local governments implement targeted measures for prevention and treatment of the disease.

METHODS

The burden of TBL cancer deaths and disability-adjusted life years (DALYs) attributable to tobacco exposure from 2000 to 2021 were presented by age, sex, and region. A Joinpoint model was used to analyze temporal trends of the disease, while decomposition analysis was conducted to quantify the contributions of population growth, aging, and epidemiological changes. In addition, the age-period-cohort (APC) model was implemented to assess the effects of age, period, and cohort on tobacco-related TBL cancer deaths and DALYs burden. Finally, age-standardized deaths and DALYs rates for TBL cancer attributable to tobacco exposure were projected through 2035.

RESULTS

In 2021, Mizoram recorded the highest age-standardized rates of TBL cancer deaths and DALYs attributable to tobacco exposure, regardless of sex. Uttar Pradesh and West Bengal consistently exhibited the highest number of deaths and DALYs associated with tobacco exposure across the three age groups analyzed. Population growth and aging are the primary drivers behind the increasing burden of TBL cancer. Overall, the risk of tobacco-related lung cancer death increased with age. There are differential period and cohort effects between male and female populations. In the future, the increase in age-standardized rates of deaths and DALYs attributable to secondhand smoke exposure will be more pronounced among males.

CONCLUSION

Despite ongoing efforts to control the tobacco epidemic, the burden of TBL cancer related to tobacco remains high in India. Each state in India should adopt targeted measures based on local conditions to address the health threats posed by tobacco.

Tobacco smoking and sarcoidosis revisited-Evidence, mechanisms, and clinical implications: a narrative review

Sarcoidosis is a multisystem inflammatory disease with unclear etiology, influenced by genetic predisposition and environmental exposures. Smoking has been widely studied for its potential role in sarcoidosis, with conflicting evidence regarding its impact on disease risk, severity, and treatment response. While some epidemiologic studies suggest that smoking is associated with a lower risk of sarcoidosis, others highlight variations based on geography, ethnicity, and smoking history. Assessing the effects of smoking is particularly challenging because of the complex composition of tobacco smoke, which contains thousands of chemicals with diverse biologic effects. Nicotine, a major component of tobacco, has demonstrated both pro- and anti-inflammatory properties, further complicating its role in sarcoidosis. This narrative review explored the complex relationship between smoking and sarcoidosis by examining smoking's effects on immune modulation, disease presentation and prognosis, and response to immunosuppressive therapy. By summarizing current evidence, this paper aimed to clarify the impact of smoking and nicotine on sarcoidosis and identify key areas for future research, particularly in understanding the mechanisms underlying smoking-related immune modulation and treatment outcomes.

The Role of Computed Tomography and Artificial Intelligence in Evaluating the Comorbidities of Chronic Obstructive Pulmonary Disease: A One-Stop CT Scanning for Lung Cancer Screening

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Comorbidities in patients with COPD significantly increase morbidity, mortality, and healthcare costs, posing a significant burden on the management of COPD. Given the complex clinical manifestations and varying severity of COPD comorbidities, accurate diagnosis and evaluation are particularly important in selecting appropriate treatment options. With the development of medical imaging technology, AI-based chest CT, as a noninvasive imaging modality, provides a detailed assessment of COPD comorbidities. Recent studies have shown that certain radiographic features on chest CT can be used as alternative markers of comorbidities in COPD patients. CT-based radiomics features provided incremental predictive value than clinical risk factors only, predicting an AUC of 0.73 for COPD combined with CVD. However, AI has inherent limitations such as lack of interpretability, and further research is needed to improve them. This review evaluates the progress of AI technology combined with chest CT imaging in COPD comorbidities, including lung cancer, cardiovascular disease, osteoporosis, sarcopenia, excess adipose depots, and pulmonary hypertension, with the aim of improving the understanding of imaging and the management of COPD comorbidities for the purpose of improving disease screening, efficacy assessment, and prognostic evaluation.

Physical, Mental, and Health Empowerment Disparities Across Chronic Obstructive Pulmonary Disease, Asthma, and Combined Groups and the Moderating Role of eHealth Literacy: Cross-Sectional Study

BACKGROUND

Nonpharmacological management plays a key role in enhancing the quality of life for individuals with chronic obstructive pulmonary disease (COPD), asthma, or both. However, disparities in their physical, mental, and health empowerment outcomes have not been fully explored, particularly in relation to the moderating effect of eHealth literacy.

OBJECTIVE

This study aims to assess these disparities and examine how eHealth literacy moderates them to guide the development of tailored nonpharmacological strategies.

METHODS

We analyzed data from 2 waves of the nationally representative "Psychology and Behavior Investigation of Chinese Residents" surveys to identify participants who self-reported asthma, COPD, or both. We assessed 5 physical outcomes (quality of life, physical activity, sleep quality, appetite, nicotine dependence), 4 mental outcomes (anxiety, depression, perceived stress, resilience), and 3 health empowerment measures (social support, self-efficacy, eHealth literacy). Multiple regression with Holm-Bonferroni corrections revealed health disparities and the moderation effect of eHealth literacy.

RESULTS

This unfunded study enrolled 1044 participants between June 2022 and August 2023, with data analysis completed within 7 months following data collection. The sample included 254 (24.3%) participants with asthma, 696 (66.7%) participants with COPD, and 95 (9.1%) participants with both conditions. The mean age of the participants was 48.61 (SD 19.70) years, and 536 (51.3%) participants were male. Linear regression showed that individuals with both COPD and asthma had lower health-related quality of life and higher anxiety and depression compared with those with either condition alone (b ranges from -0.15 to 3.35). This group also showed higher nicotine dependence than asthma-only (b=0.88) and lower resilience than COPD-only groups (b=-0.76) (all adjusted P<.05). eHealth literacy significantly moderated the effect of the disease group on all outcomes except physical activity (all adjusted P for interaction <.05). Nine disease pairs showed disparities in both eHealth literacy groups, 4 only in high literacy, and 8 only in low literacy (all P<.05).

CONCLUSIONS

Individuals with both COPD and asthma had poorer quality of life, greater anxiety and depression, higher nicotine dependence, and lower resilience, underscoring the need for integrated psychosocial and behavioral interventions. Although higher eHealth literacy was associated with improved quality of life, sleep quality, and resilience, it also widened disparities in anxiety and depression. Therefore, while enhancing eHealth literacy may help reduce overall health inequities among patients with chronic respiratory diseases, its potential adverse effects on mental well-being warrant careful attention. Moreover, lower eHealth literacy was linked to more pronounced disparities, indicating that outreach efforts and digital resources should be specifically designed to reach and empower vulnerable populations. Overall, our findings advocate for condition-specific, eHealth-enhanced care pathways that not only foster digital literacy but also integrate comprehensive mental health services, thereby mitigating health disparities among individuals with chronic respiratory diseases.

Residential greenness and chronic obstructive pulmonary disease in a large cohort in southern China: Potential causal links, risk trajectories, and mediation pathways

INTRODUCTION

Residential greenness may influence COPD mortality, but the causal links, risk trajectories, and mediation pathways between them remain poorly understood.

OBJECTIVES

We aim to comprehensively identify the potential causal links, characterize the dynamic progression of hospitalization or posthospital risk, and quantify mediation effects between greenness and COPD.

METHODS

This study was conducted using a community-based cohort enrolling individuals aged ≥ 18 years in southern China from January 1, 2009 to December 31, 2015. Greenness was characterized by normalized difference vegetation index (NDVI) around participants' residential addresses. We applied doubly robust Cox proportional hazards model, multi-state model, and multiple mediation method, to investigate the potential causal links, risk trajectories among baseline, COPD hospitalization, first readmission due to COPD or COPD-related complications, and all-cause death, as well as the multiple mediation pathways (particulate matter [PM], temperature, body mass index [BMI] and physical activity) connecting greenness exposure to COPD mortality.

RESULTS

Our final analysis included 581,785 participants (52.52% female; average age: 48.36 [Standard Deviation (SD): 17.56]). Each interquartile range (IQR: 0.06) increase in NDVI was associated with a reduced COPD mortality risk, yielding a hazard ratio (HR) of 0.88 (95 % CI: 0.81, 0.96). Furthermore, we observed per IQR (0.04) increase in NDVI was inversely associated with the risk of multiple transitions (baseline - COPD hospitalization, baseline - death, and readmission - death risks), especially a declined risk of all-cause death after readmission (HR = 0.66 [95 %CI: 0.44, 0.99]). Within the observed association between greenness and COPD mortality, three mediators were identified, namely PM, temperature, and BMI (HR for the total indirect effect: 0.773 [95 % CI: 0.703, 0.851]), with PM showing the highest mediating effect.

CONCLUSIONS

Our findings revealed greenness may be a beneficial factor for COPD morbidity, prognosis, and mortality. This protective effect is primarily attributed to the reduction in PM concentration.

The Phase-Amplitude Coupling Changes Induced by Smoking Cue After 12-H Abstinence in Young Smokers

Tobacco use causes more than 8 million deaths globally each year, and the number of younger smokers is growing. It is of great practical importance to explore the underlying neural mechanisms behind the behaviour of young smokers. During cue-induced craving, reward system in the brain generates neural oscillations at specific frequencies. The phase-amplitude coupling (PAC) can capture interactions between these frequencies and may be a more sensitive quantitative indicator for characterizing abnormal neural oscillations in smokers. We monitored the electroencephalography (EEG) data of 30 young smokers during a cue task after 12 h of abstinence, dividing the data into the neutral and smoking-related groups based on different experimental stimuli to analyse the relationship between PAC and craving. In addition, we computed the functional connectivity (FC) under the PAC mechanism. The results showed that the young smokers exposed to smoking-related cues under short-term abstinence conditions had significantly lower PAC values and reduced FC strength in the right prefrontal cortex. In contrast, there was a significant increase in PAC values in the parietal cortex and enhanced FC strength. The correlation analysis showed significant correlations between PAC values and craving. These findings demonstrate for the first time that PAC abnormalities in young smokers exposed to smoking-related cues under short-term abstinence conditions may be related to craving and inhibitory control.

Predicting Respiratory Disease Mortality Risk Using Open-Source AI on Chest Radiographs in an Asian Health Screening Population

Purpose To assess the prognostic value of an open-source deep learning-based chest radiographs algorithm, CXR-Lung-Risk, for stratifying respiratory disease mortality risk among an Asian health screening population using baseline and follow-up chest radiographs. Materials and Methods This single-center, retrospective study analyzed chest radiographs from individuals who underwent health screenings between January 2004 and June 2018. The CXR-Lung-Risk scores from baseline chest radiographs were externally tested for predicting mortality due to lung disease or lung cancer, using competing risk analysis, with adjustments made for clinical factors. The additional value of these risk scores beyond clinical factors was evaluated using the likelihood ratio test. An exploratory analysis was conducted on the CXR-Lung-Risk trajectory over a 3-year follow-up period for individuals in the highest quartile of baseline respiratory disease mortality risk, using a time-series clustering algorithm. Results Among 36 924 individuals (median age, 58 years [IQR, 53-62 years]; 22 352 male), 264 individuals (0.7%) died of respiratory illness, over a median follow-up period of 11.0 years (IQR, 7.8-12.7 years). CXR-Lung-Risk predicted respiratory disease mortality (adjusted hazard ratio [HR] per 5 years: 2.01; 95% CI: 1.76, 2.39; P < .001), offering a prognostic improvement over clinical factors (P < .001). The trajectory analysis identified a subgroup with a continuous increase in CXR-Lung-Risk score, which was associated with poorer outcomes (adjusted HR for respiratory disease mortality: 3.26; 95% CI: 1.20, 8.81; P = .02) compared with the subgroup with a continuous decrease in CXR-Lung-Risk score. Conclusion The open-source CXR-Lung-Risk model predicted respiratory disease mortality in an Asian cohort, enabling a two-layer risk stratification approach through an exploratory longitudinal analysis of baseline and follow-up chest radiographs. Keywords: Conventional Radiography, Thorax, Lung, Mediastinum, Heart, Outcomes Analysis Supplemental material is available for this article. © RSNA, 2025 See also commentary by Júdice de Mattos Farina and Kuriki in this issue.

Longitudinal trajectories of tobacco and alcohol use following first or consecutive admissions for respiratory diseases

BACKGROUND

Smoking and alcohol use worsen Chronic Respiratory Diseases (CRD). Smoking cessation is a cornerstone of treatment. We aim to describe the trajectories of alcohol and tobacco use in patients admitted due to first (FE) or consecutive episodes (CE) of CRD.

METHODS

This prospective study assessed tobacco and alcohol use in 219 patients upon admission for CRD and one year later. Generalized multilevel mixed-effect models analyzed changes within and between groups.

RESULTS

Significant differences between groups were observed in tobacco use prevalence (p = 0.001) and quantity (p = 0.009). Although overall tobacco use prevalence remained stable over time (p = 0.08) and no significant group-by-time interaction was found, weekly cigarette consumption decreased over time (from 32.1 to 19.7 in FE, 15.5 to 4.9 in CE) (p = 0.009). Alcohol use prevalence remained at approximately 50% in both groups and time points. The number of standard drink units per week (SDU)/week showed significant group effects (p = 0.03).

CONCLUSIONS

Admission for a respiratory event alone is not sufficient to induce smoking cessation in many patients. Alcohol use prevalence remains high without significant changes. This gap could be reversed by implementing integrated brief interventions based on motivational interviewing for these patients.

Association between serum cystatin C and chronic lung disease in middle-aged and elderly Chinese: a CHARLS cross-sectional study

The dose-response relationship between cystatin C (CysC) levels and chronic lung disease (CLD) development remains unclear and warrants further investigation. A more in-depth study of the relationship between serum CysC levels and CLD prevalence based on data from the China Health and Retirement Longitudinal Study (CHARLS). A cross-sectional analysis of 10,275 middle-aged and older adults aged 45 years and older was conducted using 2015 CHARLS data. Binary logistic regression models, restricted cubic spline curves (RCS), and threshold effects analyses were used to explore the association between different CysC levels and CLD prevalence in the middle-aged and older population, and subgroup analyses were performed to verify the robustness of the findings. When CysC was used as a categorical variable, the risk of CLD was increased by 38% in the T3 group compared with T1 (P < 0.001), and when CysC was used as a continuous variable, the risk of CLD was increased by 96% for each unit increase in CysC level (P < 0.001). In addition, there was a nonlinear relationship between CysC levels and the risk of CLD prevalence (P for non-linearity < 0.012), and the risk of CLD prevalence increased significantly with increasing CysC levels when CysC levels ≥ 0.754 mg/L. When CysC ≥ 0.754 mg/L, we need to be highly concerned about the risk of developing chronic lung disease in middle-aged and older populations, and those aged 45-64 years should be the focus of screening.

Predictive modelling methods of hospital readmission risks for patients with chronic obstructive pulmonary disease (COPD): a systematic review protocol

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a significant chronic respiratory condition characterised by persistent airway obstruction, leading to substantial morbidity and mortality worldwide. Patients with COPD frequently experience hospital readmissions shortly after discharge, mainly due to acute exacerbations. This review aims to identify and synthesise the reported performance metrics and methodological limitations of different predictive modelling methods for hospital readmissions in COPD patients.

METHOD AND ANALYSIS

This protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analysis Protocols (PRISMA-P) guidelines. The review will include studies that develop or validate predictive models for hospital readmissions in COPD patients. A comprehensive search will be conducted across PubMed, Embase, Cochrane Library, IEEE Xplore, Web of Science and Google Scholar using predefined keywords. Eligible studies will include those utilising any predictive modelling method, focusing on unplanned readmissions within specified timeframes (30, 60 or 90 days). Two independent reviewers will screen titles, abstracts and full texts, selecting studies based on predefined inclusion criteria.Data extraction will be conducted based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS), and the methodological quality and risk of bias will be assessed using the Prediction Model Risk Of Bias Assessment Tool (PROBAST).The results will be synthesised narratively. A meta-analysis using a random-effects model will be conducted if at least five external validation studies are available for the same prediction model.

ETHICS AND DISSEMINATION

This research is based exclusively on published studies and does not involve the collection of primary data collection from patients. Therefore, ethical approval is not required. Findings will be disseminated through publications in peer-reviewed journals and presentations at national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42024579524.

Risk of fall in middle-aged and older adult patients with chronic lung disease: evidence from the China Health and Retirement Longitudinal Study

Background

Chronic lung disease (CLD) not only manifests with respiratory symptoms but is often associated with various systemic conditions that may elevate the risk of falls. This study aimed to evaluate the independent association between chronic lung disease (CLD) and fall risk among middle-aged and older adult Chinese adults.

Methods

We enrolled participants aged over 45 years from the baseline wave of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011 and divided them into two groups based on the presence of CLD: the CLD group and the non-CLD group. Follow-up assessments were subsequently performed during the 2013, 2015, 2018, and 2020 survey waves to track longitudinal outcomes. The primary endpoint was the incidence of falls (≥1 fall event) during the entire follow-up period (2011-2020). To address potential confounding and strengthen causal inference, we employed a multivariable logistic regression model, conducted propensity score matching, and performed subgroup analyses.

Results

A total of 9,204 participants were included in the study, consisting of 940 patients with CLD and 8,264 individuals in the non-CLD group. The incidence of falls among patients with CKD was 33.5% (315/940), which was higher than the 27.5% (2,275/8264) observed in the non-CLD group (p < 0.001). After adjusting for confounding factors using logistic regression, the incidence of falls in the CLD group was found to be significantly higher compared to the non-CLD group (OR = 1.19, 95% CI: 1.02, 1.38, p = 0.02). Similar results were observed in the propensity score matching analysis and subgroup analyses.

Conclusion

Our study found that the risk of falls is significantly increased in middle-aged and older adult patients with CLD in China, highlighting the importance of fall screening and risk prevention programs for CLD patients.

An Updated Systematic Review on Asthma Exacerbation Risk Prediction Models Between 2017 and 2023: Risk of Bias and Applicability

Background

Accurate risk prediction of exacerbations in asthma patients promotes personalized asthma management.

Objective

This systematic review aimed to provide an update and critically appraise the quality and usability of asthma exacerbation prediction models which were developed since 2017.

Methods

In the Embase and PubMed databases, we performed a systematic search for studies published in English between May 2017 and August 2023, and identified peer-reviewed publications regarding the development of prognostic prediction models for the risk of asthma exacerbations in adult patients with asthma. We then applied the Prediction Risk of Bias Assessment tool (PROBAST) to assess the risk of bias and applicability of the included models.

Results

Of 415 studies screened, 10 met eligibility criteria, comprising 41 prediction models. Among them, 7 (70%) studies used real-world data (RWD) and 3 (30%) were based on trial data to derive the models, 7 (70%) studies applied machine learning algorithms, and 2 (20%) studies included biomarkers like blood eosinophil count and fractional exhaled nitric oxide in the model. PROBAST indicated a generally high risk of bias (80%) in these models, which mainly originated from the sample selection ("Participant" domain, 6 studies) and statistical analysis ("Analysis" domain, 7 studies). Meanwhile, 5 (50%) studies were rated as having a high concern in applicability due to model complexity.

Conclusion

Despite the use of big health data and advanced ML, asthma risk prediction models from 2017-2023 had high risk of bias and limited practical use. Future efforts should enhance generalizability and practicality for real-world implementation.

Association of CALLY index and CLR with COPD risk in middle-aged and older Americans: evidence from NHANES 2017-2020

Background

Chronic obstructive pulmonary disease (COPD) is marked by restrictions on airflow, leading to a gradual and irreversible reduction in lung function. This study assessed the predictive value of hematological inflammatory biomarkers, specifically the C-reactive protein-albumin-lymphocyte (CALLY) index and the C-reactive protein to lymphocyte ratio (CLR), for determining COPD risk in United States adults aged 40 and above.

Methods

Data were sourced from the National Health and Nutrition Examination Survey (NHANES) covering the period from 2017 to March 2020. The relationship between inflammatory markers, including the CALLY index, CLR, and their components, and COPD was assessed using multivariate logistic regression. Subgroup analyses explored the relationship between the CALLY index, CLR, and COPD, while restricted cubic spline (RCS) analyses evaluated potential non-linearity. The predictive performance of these biomarkers for COPD risk was assessed using receiver operating characteristic (ROC) curve analysis.

Results

After controlling for confounders, for every one-unit increase in the CALLY index (converted to natural logarithm), the prevalence of COPD decreased by 19% (OR = 0.81, 95% CI: 0.71-0.92, P = 0.001). Conversely, for every one-unit increase in the CLR (converted to natural logarithm), the prevalence of COPD increased by 23% (OR = 1.23, 95% CI: 1.08-1.40, P < 0.001). The linear negative correlation between the CALLY index and COPD was demonstrated by using RCS curves, while the CLR exhibited a positive association. After being fully adjusted, both the CALLY index and the CLR yielded an adjusted area under the curve (AUC) of 0.831 for predicting the risk of COPD, demonstrating excellent predictive capability.

Conclusion

The study identifies a linear negative relationship between the CALLY index and COPD, unaffected by potential confounders. A higher CLR is linked to an elevated risk of COPD development. Both the CALLY index and CLR were superior in predicting the risk of developing COPD. Our findings emphasize that the CALLY index and CLR may be a new inflammatory early warning biomarker for COPD.

Transforming pulmonary health care: the role of artificial intelligence in diagnosis and treatment

INTRODUCTION

Respiratory diseases like pneumonia, asthma, and COPD are major global health concerns, significantly impacting morbidity and mortality rates worldwide.

AREAS COVERED

A selective search on PubMed, Google Scholar, and ScienceDirect (up to 2024) focused on AI in diagnosing and treating respiratory conditions like asthma, pneumonia, and COPD. Studies were chosen for their relevance to prediction models, AI-driven diagnostics, and personalized treatments. This narrative review highlights technological advancements, clinical applications, and challenges in integrating AI into standard practice, with emphasis on predictive tools, deep learning for imaging, and patient outcomes.

EXPERT OPINION

Despite these advancements, significant challenges remain in fully integrating AI into pulmonary health care. The need for large, diverse datasets to train AI models is critical, and concerns around data privacy, algorithmic transparency, and potential biases must be carefully managed. Regulatory frameworks also need to evolve to address the unique challenges posed by AI in health care. However, with continued research and collaboration between technology developers, clinicians, and policymakers, AI has the potential to revolutionize pulmonary health care, ultimately leading to more effective, efficient, and personalized care for patients.

Tissue-Informed Biomaterial Innovations Advance Pulmonary Regenerative Engineering

Irreversible progressive pulmonary diseases drastically reduce the patient quality of life, while transplantation remains the only definitive cure. Research into lung regeneration pathways holds significant potential to expand and promote the discovery of new treatment options. Polymeric biomaterials designed to replicate key tissue characteristics (i.e., biochemical composition and mechanical cues) show promise for creating environments in which to study chronic lung diseases and initiate lung tissue regeneration. In this Viewpoint, we explore how naturally derived materials can be employed alone or combined with engineered polymer systems to create advanced tissue culture platforms. Pulmonary tissue models have historically leveraged natural materials, including basement membrane extracts and a decellularized extracellular matrix, as platforms for lung regeneration studies. Here, we provide an overview of the progression of pulmonary regenerative engineering, exploring how innovations in the growing field of tissue-informed biomaterials have the potential to advance lung regeneration research by bridging the gap between biological relevance and mechanical precision.

A Randomized, Controlled Study Evaluating Effects of Saccharomyces boulardii in Adult Patients with Asthma

To determine the potential benefit of adding Saccharomyces boulardii (S. boulardii) probiotic supplementation to conventional treatments in asthmatic patients.In this randomized, double-blinded, and placebo-controlled trial 50 asthmatic patients were enrolled. The eligible subjects received either S. boulardii (N=25) or placebo (N=25) added to conventional treatments for three months. Spirometry parameters (FEV1, FVC, FEV1/FVC, and FEF 25-75%) and blood test parameters (CBC, eosinophil percentage, IgE, IL-5, ESR and CRP) were measured and compared at baseline and after treatment completion.The mean age was 39.22±12.55 years. As compared to baseline values, a significant improvement was noted in FEV1 in patients who received S. boulardii (p=0.026). Although the changes in FEV1, FVC, FEV1/FVC, and FEF 25-75% were comparable between the study groups, the differences were not statistically significant (p ˃ 0.05). In addition, patients who received probiotic showed lower levels of IL-5 and IgE in comparison with patients who received placebo.Our findings showed that the addition of S. boulardii to conventional treatments partially improved the pulmonary function and was associated with reductions in IgE and IL-5 levels.

Utilization of Dietary Supplements in People with the Atopic Triad in Korea: A Cross-Sectional Study Using KNHANES (2018-2021)

Background and Objectives: Studies investigating the types of dietary supplements associated with the atopic triad using large-scale data remain limited. We assessed the prevalence of the atopic triad, the types of dietary supplements used, and their associations in Korean adults using a 4-year national survey data. Materials and Methods: This cross-sectional study utilized data from the Korea National Health and Nutrition Examination Survey (2018-2021). Adults aged ≥ 19 years were included. Descriptive statistics were used to summarize participants' overall characteristics and estimate the national prevalence of the atopic triad, defined as a diagnosis of asthma, allergic rhinitis, or atopic dermatitis. Logistic regression analyses were conducted using each atopic condition as a dependent variable, with the types of dietary supplements currently used as independent variables. Covariates included socioeconomic status, lifestyle factors, frailty, and diet. Dietary supplements were categorized as multivitamins/minerals, vitamin C, vitamin D, vitamin A/lutein, propolis, omega-3, probiotics, red ginseng, calcium, or iron. Results: A total of 18,182 adults were analyzed, representing an estimated 52.8 million adults (mean age: 47 years; 50% male). Of these, 21% reported a history of any atopic triad, and 61% were current supplement users. Logistic regression showed significantly higher odds of all three atopic conditions among users of propolis (asthma: OR 1.90, 95% CI 1.04-3.47; allergic rhinitis: OR 1.64, 95% CI 1.25-2.17; atopic dermatitis: OR 2.04, 95% CI: 1.18-3.52), and higher odds of allergic rhinitis among users of probiotics (OR 1.21, 95% CI 1.06-1.38) and vitamin D (OR 1.43, 95% CI 1.16-1.75). Conclusions: A positive association was found between propolis use and all three atopic conditions. Also, a positive association was found between probiotics or vitamin D use and allergic rhinitis. We did not find significant associations with the other supplements. Further research in establishing causal relationships between the dietary supplements and atopic conditions are needed.

The global burden of heart failure attributable to interstitial lung diseases: insights from the global burden of disease study 2021

BACKGROUND

The burden of interstitial lung disease (ILD)-associated heart failure (HF) poses a significant challenge to the prognosis of ILD patients. This study aimed to characterize the disease burden and analyse future trends of ILD-associated HF, offering valuable insights to inform targeted prevention and control strategies.

METHODS

Data on the prevalence and years lived with disability (YLDs) of ILD-associated HF were retrieved from the Global Burden of Disease (GBD) database for the period 1990-2021. Trends in ILD-associated HF were evaluated using average annual percentage change (AAPC) and percentage change analyses. Future prevalence data were projected up to 2050 using predictive modelling.

RESULTS

Globally, the number of patients with ILD-associated HF increased from 20,229 in 1990 to 104,059 in 2021, with the prevalence rising from 0.53 to 1.41 per 100,000 population. Prevalence rates were disproportionately higher in older populations, with individuals over 95 years experiencing a 17.78-fold increase over the study period. Additionally, a positive correlation was observed between higher socioeconomic development index (SDI) levels and ILD-associated HF prevalence. Among 204 countries, 71.1% exhibited an increasing trend in prevalence. However, Bayesian age-period-cohort (BAPC) modelling predicts a declining trend over the next 28 years.

CONCLUSION

Over the past three decades, the global burden of ILD-associated HF has escalated, particularly among individuals aged over 65 and in regions with high SDI levels. These findings underscore the need for region-specific, personalized intervention strategies to mitigate disease progression and enhance the quality of life for ILD patients.

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

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

Association between urinary exposures and the risk of chronic obstructive pulmonary disease in smokers: results from NHANES 2007-2016

Objective

This study aims to shed light on the connection of urinary exposures with risk of chronic obstructive pulmonary disease (COPD) among smokers, thereby providing scientific evidence for the prevention and intervention of COPD.

Methods

Data of the National Health and Nutrition Examination Survey (NHANES) 2007-2016 were utilized, including 3,973 smokers aged 20 or older. We employed the weighted multivariate logistic and weighted quantile sum (WQS) regression models to delve into the link of urinary concentrations of exposures to COPD risk. Additionally, restricted cubic spline regression was utilized to examine the dose-response relationship between biomarker concentrations and COPD risk. The stability of the associations across different participant characteristics was evaluated through subgroup and mediation analyses.

Results

Our study encompassed a total of 3,973 participants, of whom 472 were diagnosed with COPD. Regression analyses revealed the inverse association between urinary concentrations of benzophenone-3 (BP-3) and propyl paraben (PrP) and COPD risk. Higher quartiles of BP-3 and PrP exhibited lower COPD incidence [BP-3: odds ratio (OR) = 0.64, 95% confidence interval (95%CI) (0.47, 0.89), p = 0.007; PrP: OR = 0.56, 95%CI (0.36, 0.86), p = 0.008]. Significant synergistic interactions among urinary exposures were observed [WQS: 0.75, 95%CI (0.65, 0.88), p = 0.026], with BP-3 and PrP contributing 40.31 and 40.01% to the weighted analysis, respectively. Mediation analysis proved that inflammatory markers, such as white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR), significantly mediated the association between BP-3, PrP, and COPD risk (all p-values <0.05).

Conclusion

BP-3 and PrP in environmental exposure in smokers have an inverse correlation with COPD risk, with WBC and NLR partially mediating this association.

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

Background

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

Research design and methods

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

Results

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

Conclusion

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

Systematic review registration

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

Association Between Visceral Adipose Tissue and Chronic Respiratory Diseases: A Two-Sample Multivariable Mendelian Randomization Study in European Population

Background

The relationship between obesity and some respiratory diseases has been well documented. However there have been few studies on the association between visceral adipose tissue (VAT) and chronic respiratory diseases (CRDs), it remains unclear whether VAT is causally associated with CRDs.

Methods

We used two-sample Mendelian randomization (MR) to illuminate the effects of VAT on four CRDs: chronic obstructive pulmonary disease (COPD), allergic asthma, interstitial lung disease (ILD), and sarcoidosis. Inverse variance weighted (IVW) served as the primary assessment method. MR Egger, weighted median, Simple mode and Weighted mode were the supplementary methods for MR analysis. We used multivariate MR analysis to adjust for the effect of body mass index (BMI) on outcomes, Egger intercept, MR-pleiotropy residual sum and outlier, and leave-one-out analysis to confirm the MR results' consistency.

Results

Genetically-predicted VAT was associated with an increased risk of COPD (OR = 1.56; 95% CI: 1.34-1.82; P = 1.16×10-8), allergic asthma (OR = 1.44; 95% CI: 1.20-1.73; P = 8.63×10-5), and ILD (OR = 1.15; 95% CI: 1.04-1.26; P = 4.62×10-3). However, there was limited evidence to support an association between VAT and sarcoidosis. In multivariate MR analysis, VAT's associations with COPD, allergic asthma, and ILD persisted after adjusting for BMI.

Conclusion

This study provides evidence for a potential causal relationship between VAT and COPD, allergic asthma, and ILD; these relationships were independent of the effect of BMI.

Bioinspired 3D-Nanoprinted Optical Sensilla for Bidirectional Respiratory Monitoring

Chronic respiratory diseases (CRDs) are the leading causes of death worldwide. Monitoring both inhalation and exhalation is crucial for lung function assessment and patient outcomes. However, current sensors lack sufficient stability and also lack the ability to differentiate between inhalation and exhalation, limiting clinical effectiveness. Inspired by bat-wing hair structures, we report an all-optical fiber sensilla for bidirectional airflow detection. Optical Merkel cells and microhairs are integrated at the fiber tip through femtosecond laser 3D nanoprinting. Bidirectional airflow interacts with the hair structures, inducing opposing nanoscale deformations of the Merkel cells, which causes spectral drift in different directions. The device enables bidirectional flow detection with sensitivities of 19.16 nm/(L/min) and -24.46 nm/(L/min), a record-high stability over 10,000 cycles. The ultracompact design allows seamless integration into trachea or masks. The device effectively identifies respiratory patterns, distress signals, and apnea signs, providing a noninvasive and precise tool for CRD management and emergency response.

Prevalence of Asthma, Allergic Rhinitis, and Eczema in Schoolchildren From Huambo, Angola: A Cross-Sectional Study

Background and Aims

Asthma is the most common chronic non-communicable disease in children with a higher prevalence in high-income countries, however, the majority of asthma-related deaths occur in low- and middle-income countries, including Angola. Therefore, we aimed to investigate the prevalence of asthma and allergic diseases among schoolchildren in Huambo, Angola's fourth most populous province.

Methods

A cross-sectional study was carried out in April and May 2022 among schoolchildren aged 6-14 using the ISAAC methodology. The questionnaire included questions on asthma, allergic rhinitis, and eczema symptoms, as well as environmental exposure and risk factors. Twenty schools were randomly selected. χ 2 tests and univariate and multivariate logistic regression analyses examined associations between categorical variables. A p-value of < 0.05 was considered significant.

Results

The final sample included 1807 schoolchildren, all of whom lived in an urban area, 52.2% were girls, with a mean age of 11.9 ± 2.92 years, and 21.3% of whose parents were illiterate. Current asthma, allergic rhinitis, and eczema prevalence were 7.7%, 23.7%, and 15.8%, respectively, and none of the schoolchildren with asthma were regularly followed up by a physician or were medicated for asthma. The mother's educational level was positively associated with asthma (p = 0.022) and eczema (p = 0.042) prevalence, while having allergic rhinitis was positively associated with older schoolchildren (p < 0.001). Concerning the risk factors studied, schoolchildren with allergic rhinitis [AOR: 3.88 (95%CI 2.67-5.64); p < 0.001] and eczema [AOR: 2.99 (95%CI 2.02-4.41); p < 0.001] had a significant risk of having asthma.

Conclusion

Our findings indicate a significant burden of asthma, allergic rhinitis, and eczema among the schoolchildren studied, underscoring the need to address this critical public health issue.

Chronic airway inflammatory diseases and e-cigarette use: a review of health risks and mechanisms

Chronic airway inflammatory diseases, which primarily include chronic obstructive pulmonary disease (COPD), asthma, allergic rhinitis, and chronic sinusitis, continue to have a high global prevalence, highlighting their significant public health impact. Concurrently, the use of e-cigarettes (tobacco e-cigarettes) has been rising worldwide, with many users perceiving them as a safer alternative to traditional cigarettes. However, accumulating evidence from international studies suggests that e-cigarettes pose substantial health risks. This review aims to explore recent research on the relationship between e-cigarette use and chronic airway inflammatory diseases. The findings indicate that e-cigarette usage increases the risk of developing these conditions. Specifically, studies have shown that e-cigarettes exacerbate airway inflammatory responses, elevate levels of type 2 inflammatory cytokines such as IL-4, IL-5, and IL-13, increase cellular oxidative stress, and impair lung function. These mechanisms may collectively contribute to an increased risk of chronic airway inflammatory diseases potentially associated with e-cigarette use.

Excess healthcare utilization and costs linked to chronic conditions: a comparative study of nine European countries

The increasing prevalence of chronic conditions is a significant challenge for healthcare systems worldwide, not only from a public health perspective but also for the aggregate cost that these represent. This paper estimates the additional use of healthcare services due to chronic health conditions and their associated costs in nine European countries. We analyzed inpatient and outpatient healthcare utilization using longitudinal data (Survey of Health, Ageing and Retirement in Europe [SHARE]). We implemented a difference-in-differences approach across multiple time periods. Monetary estimates were derived using WHO-CHOICE healthcare service costs. To compare countries, we calculated the healthcare cost burden of chronic conditions as a percentage of total health expenditure. People with chronic conditions require significantly more healthcare services than those without such conditions, averaging three additional outpatient visits and one extra overnight inpatient stay annually. These patterns vary across countries. In Germany, outpatient care usage is particularly high, with an average of four additional visits, while Switzerland leads in inpatient care with two extra overnight stays. The associated costs also differ widely, influenced by variations in healthcare demand, service pricing, and the prevalence of chronic conditions in each country. Chronic conditions significantly increase healthcare utilization, and demographic trends suggest this demand will continue to grow steadily. This rising pressure poses serious challenges for healthcare systems, necessitating a shift toward more efficient service delivery models.

Asthma incidence, prevalence, and mortality in the United States and worldwide, 1990-2019: Findings from the Global Burden of Disease study

INTRODUCTION

Asthma is a serious global health issue, contributing to premature deaths and reduced quality of life.

OBJECTIVE

This study examines trends in the incidence, prevalence, and mortality of asthma in the US and globally from 1990 to 2019.

METHODS

Data from the Global Burden of Disease database were used to calculate age-standardized incidence (ASIR), prevalence (ASPR), and mortality (ASMR) rates per 100,000 individuals, stratified by gender. Joinpoint regression analysis determined annual percent changes (APCs), and average annual percentage changes (AAPCs) were calculated as weighted averages of these trends.

RESULTS

In the US, ASIR increased by 10.2%, rising from 1404.6 in 1990 to 1547.2 in 2019, with an overall AAPC of 0.33. Globally, ASIR decreased by 13%, declining from 580.1 to 504.3, with an overall AAPC of -0.46. ASPR in the US rose from 9374.0 to 10399.3, reflecting a 0.37% annual increase, whereas globally, ASPR dropped by 24.1%, decreasing from 4496.9 to 3415.5 with an overall AAPC of -0.91. Females consistently exhibited higher ASPR rates than males in both settings. US asthma mortality decreased by 50%, with ASMR dropping from 1.66 to 0.87 and an AAPC of -2.15. Globally, ASMR decreased by 51.3%, falling from 11.91 to 5.80, with an overall AAPC of -2.47.

CONCLUSION

Males globally showed higher ASMR, whereas in the US, females had higher rates. While asthma incidence and prevalence increased in the US, global rates declined. Both the US and global populations experienced substantial reductions in asthma-related mortality, highlighting the need for targeted interventions and international collaboration.

Long-term exposure to air pollution and greenness in association with respiratory emergency room visits and hospitalizations: The Life-GAP project

BACKGROUND

Air pollution has been linked to respiratory diseases, while the effects of greenness remain inconclusive.

OBJECTIVE

We investigated the associations between exposure to particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO2), ozone (O3), and greenness (normalized difference vegetation index, NDVI) with respiratory emergency room visits and hospitalizations across seven Northern European centers in the European Community Respiratory Health Survey (ECRHS) study.

METHODS

We used modified mixed-effects Poisson regression to analyze associations of exposure in 1990, 2000 and mean exposure 1990-2000 with respiratory outcomes recorded duing ECRHS phases II and III. We assessed interactions of air pollution and greenness, and of atopic status (defined by nasal allergies and hay fever status) and greenness, on these outcomes.

RESULTS

The analysis included 1675 participants, resulting in 119 emergency visits and 48 hospitalizations. Increased PM2.5 by 5 μg/m³ was associated with higher relative risk (RR) of emergency visits (1990: RR 1.16, 95% CI: 1.00-1.35; 2000: RR 1.24, 95% CI: 0.98-1.57; 1990-2000: RR 1.17, 95% CI: 0.97-1.41) and hospitalizations (1990: RR 1.42, 95% CI: 1.00-2.01; 2000: RR 2.20, 95% CI: 1.43-3.38; 1990-2000: RR 1.44, 95% CI: 1.04-2.00). Similar trends were observed for PM10, BC, and NO2, with only PM10 showing significant associations with hospitalizations across all periods. No associations were found for O3. Greenness exposure was linked to more emergency visits in 2000 but to fewer hospitalizations in 1990. Significant interactions were observed between greenness and atopic status for emergency visits, and between NDVI with O3 and BC for some time windows.

CONCLUSION

Long-term exposure to particulate matter was associated with increased emergency room visits and hospitalizations. Significant associations were observed for BC and NO2 with hospitalizations. No link was found with O3. Greenness indicated a lower risk of hospitalizations, but increased risks for emergency visits for those with atopic status.

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

Background

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

Methods

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

Results

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

Conclusion

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

[Expert consensus for the organization of smoking management in Spain]

OBJECTIVE

To generate a cost-effective healthcare model for the management of smoking in Spain.

MATERIAL AND METHODS

This was a qualitative study based on nominal group methodology and a literature review. Nine tobacco experts (3 pulmonologists, 3 primary care physicians, and 3 community pharmacists) analysed the current smoking care context and available evidence on interventions. Based on this information, they generated a healthcare model for the management of smoking.

RESULTS

A total of 11 general principles were agreed upon, including, for example, the recognition of smoking as a chronic disease, the need for a comprehensive, coordinated approach adjusted to the characteristics and needs of the smokers, or the training of health care professionals on smoking cessation. Two proposed levels of smoking care were established and described (characteristics, competencies, resources, etc.); one is non-specialized (primary care, hospital care and community pharmacy) and another is specialized (smoking units). The objective of the non-specialized level is to identify the smoker, establish the diagnosis, evaluate the patients, and provide at least a brief intervention. The non-specialized level provides highly specialized comprehensive assistance to smokers with special characteristics. The document summarizes the evidence of the main interventions on smoking and has recommendations and care algorithms (actions in the patients' first and subsequent visits and referral criteria).

CONCLUSIONS

Smoking in Spain requires a comprehensive, structured, interdisciplinary, coordinated, and efficient approach adapted to the characteristics and needs of the smokers.

Association between body roundness index and weight-adjusted waist index with asthma prevalence among US adults: the NHANES cross-sectional study, 2005-2018

This study investigated the connection between asthma in US individuals and their body roundness index (BRI) and weight-adjusted waist index (WWI). According to data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES), 3609 of the 25,578 persons in the survey who were 18 years of age or older reported having asthma. After adjusting for all confounders, the probability of asthma prevalence increased by 8% for every unit rise in BRI (OR = 1.08, 95% CI 1.06,1.11). The probability of asthma prevalence increased by 16% for every unit rise in WWI (OR = 1.16, 95% CI 1.08,1.25). The BRI and WWI indices were associated with prevalence and were nonlinearly correlated. The inflection points for threshold saturation effects were 4.36 and 10.69, respectively (log-likelihood ratio test, P < 0.05). Relationship subgroup analyses showed that the positive associations between BRI and WWI and asthma were generalized across populations and there was no significant interaction in most subgroups. In addition, sensitivity analyses verified the robustness of these results, further confirming the conclusion of BRI and WWI as independent risk factors for asthma. Finally, receiver operating characteristic (ROC) analysis showed that BRI outperformed WWI in predicting asthma, suggesting the potential of BRI in early asthma screening. Overall, BRI and WWI are independent risk factors for asthma with important clinical applications.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Sex differences in asthma and COPD hospital admission, readmission and mortality

BACKGROUND

Asthma and chronic obstructive pulmonary disease (COPD) outcomes vary by sex. We investigated whether males and females with asthma or COPD are managed differently in-hospital when admitted for an exacerbation.

METHODS

Data from the National Asthma and COPD Audit Programme were used to determine three cohorts of people hospitalised for an exacerbation: (1) adults with asthma, (2) children and young people (CYP) with asthma, and (3) adults with COPD. Outcomes included the following in-hospital interventional measures: spirometry recording, respiratory specialist review, respiratory medication administration and discharge bundle recording. Linked hospital data were used to determine 30-day and 90-day readmissions and Office for National Statistics data for 90-day mortality. Random effects logistic regression was used to investigate the association between sex and in-hospital outcomes, readmission and mortality.

RESULTS

16 370 adults with asthma, 7156 CYP with asthma and 28 354 adults with COPD were included. Female adults with asthma had higher odds of being seen by a respiratory specialist (aOR 0.1.13, 1.02-1.26) and higher odds of readmission within 30 and 90 days (aOR 1.22, 1.10-1.37, aOR 1.34, 1.23-1.46) compared with males. Female adults with COPD had higher odds of being seen by a respiratory specialist, (aOR 1.10,1.02-1.19), being administered non-invasive ventilation (aOR 1.18, 1.09-1.29), and receiving a discharge bundle (aOR 1.07, 1.00-1.14), and lower odds of readmission within 90 days (aOR 0.95, 0.90-1.01), or mortality within 90 days (aOR 0.88, 0.81-0.96). Lastly, female CYP had higher odds of steroids administered within 1 hour (aOR 1.13, 1.00-1.28) and higher 30-day and 90-day readmission compared with males (aOR 1.21, 1.00-1.44 and 1.17, 1.03-1.34).

INTERPRETATION

Sex differences in in-hospital care exist in adults COPD, which may impact readmissions and mortality; however, little to no sex differences in in-hospital care were seen in people with asthma yet females were more likely to be readmitted to hospital.