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

The Role of Autophagy and Cell Communication in COPD Progression: Insights from Bioinformatics and scRNA-seq

Chronic obstructive pulmonary disease (COPD) is characterized by restricted airflow that leads to significant respiratory difficulties. This progressive disease often results in diminished pulmonary function and the onset of additional respiratory conditions. Autophagy, a critical cellular homeostasis mechanism, plays a significant role in the exacerbation of COPD. In this study, we utilized various bioinformatics tools to identify autophagy-related genes activated by smoking in individuals with COPD. Furthermore, we explored the immune landscape of COPD through these genes, analyzing cell communication patterns using scRNA-seq data. This analysis focused on key pathways between epithelial cells and other cellular subpopulations with different autophagy scores, essential for understanding the initiation and progression of COPD.

METTL3‑mediated m6A methylation and its impact on OTUD1 expression in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and chronic inflammation, often exacerbated by cigarette smoke exposure. Ovarian tumor protease domain‑containing protein 1 (OTUD1), a deubiquitinase, has previously been identified as a negative regulator of inflammation through its suppression of NF‑κB signaling. The present study explored the role of OTUD1 in COPD and the regulatory effects of N6‑methyladenosine (m6A) methylation on OTUD1 expression. The expression of OTUD1 in COPD was analyzed using public datasets (GSE38974 and GSE69818). In addition, BEAS‑2B cells were exposed to cigarette smoke extract (CSE) to investigate OTUD1 expression changes. OTUD1 overexpression and knockdown models were also constructed, and the levels of inflammation‑related genes and proteins, inflammatory cytokines and cell pyroptosis were measured using reverse transcription‑quantitative PCR, western blotting, ELISA and flow cytometry. The role of methyltransferase‑like 3 (METTL3)‑mediated m6A methylation in regulating OTUD1 was also examined. Notably, OTUD1 expression was significantly reduced in advanced COPD compared with that in the earlier stage. Furthermore, CSE exposure suppressed OTUD1 expression, which was associated with increased cell pyroptosis and elevated levels of the inflammatory cytokines IL‑1β and IL‑18. OTUD1 overexpression mitigated these effects, indicating its protective role against CSE‑induced cellular damage. Furthermore, METTL3‑mediated m6A methylation inhibited OTUD1 expression, with YTH m6A RNA binding protein 2 (YTHDF2) acting as the reader of this modification. Knockdown of METTL3 or YTHDF2 reduced m6A methylation and restored OTUD1 expression, highlighting a potential mechanism by which cigarette smoke suppresses OTUD1 through enhanced m6A methylation. In conclusion, OTUD1 may serve a protective role in COPD by inhibiting inflammation and reducing cell damage caused by cigarette smoke exposure. The suppression of OTUD1 through METTL3‑mediated m6A methylation and YTHDF2 interaction represents a novel mechanism contributing to COPD pathogenesis, suggesting potential therapeutic targets for mitigating disease progression.

Joint analysis of diet quality, inflammatory potential of diet and ultra-processed food exposure in relation to chronic respiratory diseases and lung cancer mortality

OBJECTIVE

Examined the combined effects of ultra-processed food (UPF), Dietary Inflammatory Index (DII), Healthy Eating Index-2015 (HEI-2015), and Dietary Antioxidant Index (DAI) on mortality from chronic respiratory diseases (CRDs), chronic obstructive pulmonary disease (COPD), and lung cancer.

METHODS

A prospective analysis included 96,607 participants (53 % women). Diet intake was measured using food frequency questionnaire. Associations of dietary exposures with CRD, COPD, and lung cancer mortality were examined using Cox regression.

RESULTS

During 1,459,299 person-years of follow-up, there were 30,623 all-cause deaths, including 5218 from CRDs, 1613 from COPD, and 2127 from lung cancer. A 10 % increase in UPF intake (% grams/day) showed a non-linear association with higher CRD and COPD mortality but not lung cancer. Stronger curvature was observed between DII and mortality from all three conditions. However, HEI-2015 was inversely associated with CRD, COPD, and lung cancer mortality, while DAI showed an inverse relationship with CRD and COPD mortality but not lung cancer. Adjusting for DII attenuated UPF-related mortality risks by 39 % (CRD), 11 % (COPD), and 18 % (lung cancer), while HEI-2015 adjustment showed less attenuation. Additionally, the DII-mortality associations were less attenuated after adjusting for UPF intake but were offset after adjusting for HEI-2015. However, the HEI-2015-mortality associations remained unaffected when adjusted for UPF, DII, or DAI.

CONCLUSIONS

The findings highlight that the UPF-mortality relationship is potentially explained by DII and, to a lesser extent, by HEI-2015. Adhering to HEI-2015 guidelines can counterbalance the effects of DII on respiratory health but may not offset the effects associated with UPF.

ASK1 inhibition by selonsertib attenuates elastase-induced emphysema in mice

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with its most severe form being pulmonary emphysema, for which no effective treatment currently exists. Apoptosis signal-regulating kinase 1 (ASK1) has been implicated in lung inflammation and injury. Here, we investigated the experimental treatment of elastase-induced emphysema in mice with selonsertib, an ASK1 inhibitor. Animals received intratracheal elastase and were subsequently treated with intranasal selonsertib at different doses. On day 21, bronchoalveolar lavage fluid and lung tissues were collected for histological and biochemical analyses. Results showed that elastase-instilled mice developed pulmonary emphysema, whereas treatment with selonsertib at a dose of 2 mg/kg significantly reduced mean alveolar diameter. Moreover, higher doses of selonsertib were effective in reducing inflammatory cytokines (CX3CL1, IL-6, CCL2, and IL-1β), reactive oxygen species, and apoptosis. These findings suggest that ASK1 plays a critical role in the development of elastase-induced emphysema in mice and could be a target for COPD treatment.

Mediating effects of gastroesophageal reflux disease and smoking behavior on the relationship between depression and chronic obstructive pulmonary disease: Trans-ethnic Mendelian randomization study

BACKGROUND

This study seeks to elucidate the association between depression and the risk of chronic obstructive pulmonary disease (COPD) by Mendelian randomization (MR) analysis, motivated by prior observational studies indicating a potential link between these conditions.

METHODS

Data from individuals of European (EUR) and East Asian (EAS) ancestries diagnosed with major depressive disorder (MDD) were selected for analysis. The primary method utilized was inverse variance weighted (IVW) method, supplemented by a series of sensitivity analyses and false discovery rate (FDR) corrections. Subsequently, multivariable and mediation MR analyses were conducted to assess the impact of potential confounders and their mediating effects.

RESULTS

IVW revealed a significant causal relationship between MDD and COPD within EUR ancestry (OR 1.425, 95 % CI 1.243-1.633, P = 3.56 × 10-7, PFDR = 2.14 × 10-6). Additionally, replication datasets provided consistent evidence for these causal associations. Multivariable and mediation MR analyses identified gastroesophageal reflux disease (GORD) as a complete mediator (mediation effect: 98.97 %, P = 1.38 × 10-15), while smoking initiation (SI) (26.30 %, 5.54 × 10-9), age of smoking initiation (ASI) (18.73 %, 0.019), and cigarettes per day (CPD) (18.72 %, 0.004) were identified as partial mediators of this causal relationship. No causal association was detected in EAS ancestry, nor was reverse analysis.

CONCLUSIONS

This study established a causal relationship between MDD and COPD risk in EUR ancestry, identifying GORD and smoking as pivotal mediators. Future research involving larger cohorts is essential to validate the generalizability of these findings across other ancestries.

USP4-mediated deubiquitination of SRC-1 regulates macrophage polarization and asthma inflammation

Background: Asthma, the most common chronic respiratory disorder affecting individuals of all ages, is driven by inflammation that leads to airway hyperresponsiveness, airway wall remodeling, and mucus production. While inhaled corticosteroids remain the primary treatment despite their limitations, further research into the molecular mechanisms of asthma is needed to identify new therapeutic targets. Methods: A mouse model of asthma was created by treating mice with OVA. HE and PAS staining were used to detect histopathology. Gene and protein expression levels were assessed using qPCR, Western blot, and ELISA. The relationship between USP4 and SRC-1 was examined using Co-IP assay. The ubiquitination levels of SRC-1 were detected using IP assay while macrophage polarization was analyzed by flow cytometry. Results: The ovalbumin-induced mouse model of asthma exhibited a large quantity of inflammatory cell infiltration, proliferation of goblet cells, and increased mucus secretion. SRC-1 expression was upregulated in an OVA-induced mouse model of asthma. Downregulation of SRC-1 reduced macrophage polarization to the M1 phenotype, protecting against OVA-induced asthma, whereas SRC-1 overexpression inhibited M2 macrophage polarization by suppressing the NF-kB signaling pathway. Furthermore, USP4 was found to deubiquitinate SRC-1, enhancing its protein stability. The regulatory axis between USP4 and SRC-1 was validated in vivo. Conclusion: This study demonstrates that USP4 regulates the deubiquitination of SRC-1, which inhibits M2 macrophage polarization and reduces asthma-related inflammation. These findings suggest that USP4 and SRC-1 may serve as potential therapeutic targets for asthma treatment.HighlightsSRC-1 is upregulated in OVA-induced asthma and correlated to macrophage.SRC-1 knockdown reduces M1 macrophage polarization and airway inflammation in the asthma model.SRC-1 overexpression or USP4 overexpression suppresses IL-4-induced M2 polarization via the NF-κB pathway.USP4 regulates the deubiquitination of SRC-1, influencing macrophage polarization and inflammation.

Causal Effects Between Genetically Determined Human Serum Metabolite Levels on the Risk of Idiopathic Pulmonary Fibrosis: A Mendelian Randomization Study

BACKGROUND

The incidence of idiopathic pulmonary fibrosis (IPF) is increasing every year; however, the potential biological mechanisms have not been completely clarified. The objective of this study is to reveal the etiologic effects of circulating metabolites on IPF.

METHODS

This research evaluated the causal relationship between serum metabolites and IPF utilizing two-sample Mendelian randomization (MR) analysis. IVW served as the main method of analysis; concurrently, MR-Egger, weighted median, and MR-PRESSO acted as supplementary analyses. Sensitivity analyses were performed with Cochran's Q test, MR-Egger's intercept test, and leave-one-out method of analysis. All statistical analyses were accomplished in R software.

RESULTS

Our results showed that 23 metabolites have a causal connection with IPF. Following sensitivity analysis, 2 robust and 12 potential causal association pairs were identified among the known metabolites. These 14 causal pairs concerned six metabolites.

CONCLUSION

This study presents a novel perspective on potential mechanisms involved in IPF with important significance for screening, prevention, and treatment.

Pulmonary rehabilitation utilization in patients with chronic respiratory diseases: 2014-2019

BACKGROUND

Chronic respiratory diseases are associated with significant disability and death. Pulmonary rehabilitation (PR) is recommended in the management of chronic respiratory diseases. There is limited population level data comparing PR utilization and completion among patients with chronic respiratory diseases.

METHODS

A retrospective, cross sectional analysis concerning PR use in adults residing in the U.S. with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), idiopathic pulmonary fibrosis (IPF), pulmonary hypertension, and bronchiectasis was conducted using the Merative™ MarketScan® Research Databases. PR use was identified using current procedural terminology (CPT) and healthcare common procedure coding system (HCPCS) codes. Demographics, comorbidities, oxygen use, medications, initiation and participation of PR by disease state were collected. Analysis involved chi-square tests and generalized estimating equations.

RESULTS

From 2014 to 2019, we identified 892,741 adults with chronic respiratory diseases and COPD was the most prevalent. PR initiation occurred in 2.3 % and annual participation ranged from 1.5 % to 1.7 %. The IPF group had the largest proportion of patients that initiated PR compared to other groups. Completion of ≥8 sessions was greatest for the group with IPF (60.8 %), followed by non IPF ILD (56.2 %), bronchiectasis (55.3 %), pulmonary hypertension (55.1 %) and COPD (53.9 %). Completion of ≥8 sessions was significantly greater for the IPF group compared to the COPD group, (p < 0.0001).

CONCLUSION

PR was underutilized among individuals with chronic respiratory disease, however the group with IPF demonstrated the greatest proportion of PR initiation and completion compared with other groups.

A Randomized, Double-Blinded, Placebo-Controlled Study of the Use of Traditional Chinese Medicine for Treating Patients With Mild/Moderate Chronic Obstructive Pulmonary Disease

AIM

Chronic obstructive pulmonary disease (COPD) is a critical disease, with lung function closely linked to disease severity. This study aimed to evaluate the clinical efficacy of treatments for stable COPD in patients with pulmonary function Grades I and II.

PATIENTS AND METHODS

We conducted a multicenter, randomized, double-blind, placebo-controlled trial (registration number: NCT01486186). A total of 502 patients were randomly assigned to an experimental group (n = 251, treated with Bufei, Bufei Jianpi, and Bufei Yishen granules based on traditional Chinese medicine [TCM] syndromes) and a control group (n = 251, treated with a Chinese medicine-based placebo). Acute exacerbations (AEs), lung function, clinical symptoms, 6-min walking distance (6MWD), and dyspnea were assessed over 12 months of treatment and 12 months of follow-up.

RESULTS

A total of 432 patients, including 214 and 218 patients in the experimental and control groups, respectively, completed the trial. The early treatment group had fewer AEs (p < 0.05), better clinical symptom scores (p < 0.05), longer 6MWD (p < 0.05), and better Modified Medical Research Council (mMRC) scores than the control group (p < 0.05). No significant differences were found in forced vital capacity (FVC) and forced expiratory volume in first second (FEV1%) between the two groups, but there was a significant difference in FEV1 and the annual rate of FEV1 decline between the groups over 2 years (p < 0.05).

CONCLUSION

Treatment with TCM for stable COPD significantly reduced AEs, increased the 6MWD, and alleviated dyspnea in patients with pulmonary function Grades I and II. FEV1 was improved, and the slower FEV1 decline indicates a potential benefit in mitigating disease progression.

Association of triglyceride glucose and obesity indices with chronic obstructive pulmonary disease in US adults: data from 2013 to 2018 NHANES

BACKGROUND

The impact of insulin resistance (IR) on chronic obstructive pulmonary disease (COPD) has caught increasing attention, and the triglyceride-glucose (TyG) index and related indices are deemed reliable indicators for evaluating IR. Nevertheless, the potential associations of TyG and obesity-related indexes with COPD are currently understudied. Hence, this paper was to inspect the links of TyG and obesity-related indices with COPD.

METHODS

This was a cross-sectional study based on data from the NHANES 2013-2018. Weighted logistic regression (WLR), restricted cubic sample (RCS), and receiver operating characteristic (ROC) curves were leveraged to examine the links of the TyG index and obesity indices with COPD. The stability of the correlations was also assessed via subgroup analyses.

RESULTS

Data from 6383 participants were finally included, including 583 patients with COPD. WLR discovered positive associations of TyG, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), and TyG-waist height ratio (TyG-WHtR) with COPD regardless of covariate adjustment (p-value < 0.05, p for trend test < 0.05). After adjusting for all confounders, RCS analysis signaled notable linear links of TyG and obesity-related indices with COPD (p-value < 0.05, p for nonlinear > 0.05). TyG-WHtR showed the highest association with COPD among the indices tested, albeit with limited discriminative ability (AUC = 0.643, 95% CI: 0.619 ~ 0.665). Subgroup analyses further validated the stability and reliability of the results.

CONCLUSION

TyG and its combination with obesity-related indicators are associated with COPD. Among these, TyG-WHtR showed the strongest association with COPD, although causal relationships cannot be inferred and its discriminative ability remained modest. Further prospective studies are warranted to validate these findings.

CLINICAL TRIAL NUMBER

Not applicable.

Histone lactylation-induced premature senescence contributes to 1-nitropyrene-Induced chronic obstructive pulmonary disease

Our previous study revealed that mice exposed to 1-nitropyrene (1-NP) develop pulmonary fibrosis and senescent alveolar cells. However, the impacts of chronic 1-NP on chronic obstructive pulmonary disease (COPD) and the underlying mechanism are unclear. Our research suggested that chronic 1-NP evoked alveolar structure damage, inflammatory cell infiltration, and pulmonary function decline in mice. Moreover, 1-NP increased p53 and p21 expression, the number of β-galactosidase-positive cells, and cell cycle arrest in mouse lungs and MLE-12 cells. Moreover, 1-NP promoted glycolysis and upregulated lactic dehydrogenase A (LDHA) and lactate production in mouse lungs and MLE-12 cells. Elevated glycolysis provoked histone lactylation, but not histone acetylation in pulmonary epithelial cells. Mechanistically, histone H3 lysine 14 lactylation (H3K14la) was upregulated in pulmonary epithelial cells. P53 knockdown mitigated 1-NP-induced cell cycle arrest and senescence in MLE-12 cells. CUT&Tag and ChIP-qPCR experiments confirmed that increased H3K14la directly upregulated p53 transcription in pulmonary epithelial cells. As expected, LDHA knockdown alleviated 1-NP-triggered cell cycle arrest and senescence in MLE-12 cells. In addition, supplementation with oxamate, an inhibitor of LDH, attenuated 1-NP-incurred premature senescence and the COPD-like phenotype in mice. These data revealed for the first time that histone lactylation-induced the increase in p53 transcription contributes to pulmonary epithelial cell senescence during 1-NP-induced COPD progression. Our results provide a basis for repressing lactate production as a promising therapeutic strategy for COPD.

Lianhua qingke alleviates cigarette smoke induced cellular senescence in COPD mice by regulating the Sp1/SIRT1/HIF-1α pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Lianhua Qingke (LHQK) has been utilized as a complementary therapy for respiratory diseases like tracheobronchitis and acute exacerbations of COPD in China. However, its therapeutic efficacy and underlying mechanisms for COPD remain elusive.

AIM OF THE STUDY

This study aimed to elucidate the mechanisms underlying the effects of LHQK on COPD, focusing on its anti-senescence properties.

MATERIALS AND METHODS

The therapeutic effects of LHQK were assessed by chronic cigarette smoke exposure induced COPD mice model. Lung function, histopathology investigation, cytokines detection and bio-molecular analysis were conducted to assess the impact of LHQK on pulmonary inflammation, mucin secretion, and cellular senescence of cigarette smoke (CS)-induced COPD mice.

RESULTS

A comprehensive analysis identified a total of 41 compounds as the key compounds of LHQK. Oral administration of LHQK markedly reversed the decline in pulmonary function, suppressed inflammation and mucus secretion, mitigated emphysema, and histopathology damage in lungs of COPD mice. In addition, LHQK attenuated secretory phenotype associated with cellular senescence in pulmonary and circulatory, and reduced the senescence-associated markers levels, such as SA-β-gal, miR-125a-5p, p21, p27 and p53. Network pharmacology and molecular assays indicated that LHQK enhanced Sp1 and SIRT1 expression, resulting to repression of HIF-1α, finally alleviating cellular senescence in COPD mice.

CONCLUSIONS

LHQK demonstrates potential as a complementary therapy for COPD, attenuating CS-triggered emphysema and pulmonary inflammation by targeting cellular senescence processes and modulation of Sp1/SIRT1/HIF-1α pathway.

Yangke powder alleviates OVA-induced allergic asthma by inhibiting the PI3K/AKT/NF-κB signaling pathway

BACKGROUND

Asthma is a chronic inflammatory airway disease that remains inadequately controlled by existing conventional treatments. A traditional Chinese medicine (TCM) formula of Yangke powder (yǎng ké sǎn-YKS) has demonstrated potential in alleviating asthma symptoms and reducing its acute exacerbation. Despite clinical evidence supporting its benefit, there is still insufficient understanding of the active compounds in YKS and their underlying mechanisms, which limits its broader clinical application.

OBJECTIVE

This study aims to identify the key active ingredients in YKS and explore their mechanisms, particularly through the PI3K/AKT/NF-κB pathways, to provide a scientific basis for its application in asthma treatment.

METHODS

We employed UPLC-Q-Exactive Orbitrap-MS to analyze YKS constituents, identified key ingredients, and explored asthma treatment mechanisms through bioinformatics, network pharmacology, Mendelian randomization, and molecular docking. The asthma model was evaluated using ovalbumin (OVA) and pulmonary function tests, while pathological examination was conducted using hematoxylin and eosin (HE), periodic acid-Schiff (PAS), and Masson trichrome stains. Concentrations of IgE, IL-4, and IL-5 were measured by ELISA, and protein and mRNA expressions were confirmed via qPCR, immunohistochemistry, and Western blot analysis.

RESULTS

A total of 174 compounds were identified in YKS by UPLC-MS, with 49 detected in the bloodstream, indicating their role as active ingredients. Bioinformatics analysis revealed 353 asthma-related targets and 972 potential targets for YKS. Key targets such as AKT1, TNF, and IL1B were validated by molecular docking. Our studies indicated that YKS modulates asthma primarily through the PI3K/Akt and NF-κB pathways, improving airway resistance, reducing inflammation, mucus production, and airway remodeling, and decreasing Th2 cytokines and IgE levels.

CONCLUSION

This investigation identifies Kaempferol, Norephedrine, Cynaroside, Genistein, and Rutin as critical active ingredients in YKS, impacting key biomarkers such as AKT1, TNF, and IL1B. These substances effectively modulate the PI3K/AKT/NF-κB pathway, enhancing the management of allergic asthma.

Effect of chronic kidney disease on survival in patients with chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease associated with several comorbidities. Although chronic kidney disease (CKD) has been recognized as one such comorbidity, the effect of CKD on survival in patients with COPD remains uncertain. This study investigated the clinical impact of CKD in patients with COPD, accounting for clinically characteristics and 6-min walking test (6MWT) results.

MATERIALS AND METHODS

Patients with COPD who completed the 6MWT and a 3-year follow-up were retroactively enrolled in the study. Data on clinical information, 6MWT parameters, and outcomes were collected and analyzed.

RESULTS

Among the 141 patients with COPD enrolled, 33 (23.4 %) had comorbid CKD. Patients with CKD were significantly older and more likely to experience heart failure, mortality, and FEV1 decline than patients without CKD. Multivariate analysis revealed that 6-min walking distance <350 m (odds ratio [OR]: 3.65, 95 % confidence interval [CI]: 1.05-12.06, p = 0.041) and CKD (OR: 4.66, 95 % CI: 1.30-16.76, p = 0.018) were independent risk factors for mortality.

CONCLUSIONS

Comorbid CKD was associated with an increased mortality rate and rapid FEV1 decline in patients with COPD. Patients with COPD and comorbid CKD may require intensive monitoring during treatment.

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.

Clinical characteristic of patients with COPD-A

BACKGROUND

The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) document proposed the COPD-A subtype as a condition of COPD with asthma. We examined the characteristics of COPD-A patients and analyzed them according to smoking history and inhaled corticosteroid (ICS) use.

METHODS

Patients in the COPD cohort with a history of asthma were included. The patients were divided into two groups according to their smoking history (< 10 vs. ≥10 pack-years) and their clinical characteristics were compared. The association between patients' ICS use and the occurrence for exacerbations during 1 year follow-up period was analyzed.

RESULTS

Of the 970 patients included in the analysis, the group with a smoking history less than 10 pack-years (n = 158) had a significantly higher BMI, FEV1 (%), FEV1/FVC (%), DLco, ESR, and prevalence of osteoporosis. Among 560 patients who were followed up for 1 year, the patients with ICS (n = 274) had a higher exacerbation rate than without ICS (n = 286) (54% vs. 44.1%, p = 0.018). However, in multivariable analysis, ICS use was not significantly associated with exacerbation. In subgroup analysis of patients with blood eosinophil count ≥ 300 cells/µl, ICS use showed a trend to reduce the risk for exacerbation (IRR = 0.907, p = 0.708). In patients with blood eosinophil count < 300 cells/µl, ICS use significantly increased the risk for exacerbation (IRR = 1.547, p = 0.005).

CONCLUSIONS

COPD-A patients with a smoking history of less than 10 pack-years had better pulmonary function test results, BMI, ESR, and prevalence of osteoporosis. The use of ICS did not decrease exacerbations in COPD-A.

Distribution of two CD4+FOXP3+ T cell subpopulations reflects disease phenotypes and prognosis in COPD

Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, with varying clinical phenotypes and prognoses. Regulatory T cells (Tregs), particularly CD4+FOXP3+ T cell subpopulations, are crucial in modulating immune responses. This study investigates the distribution of two CD4+FOXP3+ T cell subpopulations in bronchoalveolar lavage fluid (BALF) from COPD patients and their association with disease phenotypes and prognosis. Patients were classified into Type A (lower frequencies of inflammatory FOXP3lo T cells) and Type B (higher frequencies of inflammatory FOXP3lo T cells). Type B COPD patients, who demonstrated more severe emphysema, heightened inflammatory responses, faster lung function decline, and more pronounced osteoporosis, showed a significant increase in FOXP3lo non-suppressive T cells. In contrast, Type A patients exhibited a higher proportion of FOXP3hi Treg cells, which correlated with milder disease phenotypes. The distinct distribution of CD4+FOXP3+ T cell subpopulations provides insights into the progression of COPD and suggests that these cells could serve as potential biomarkers for disease severity and prognosis. Further research may offer new therapeutic avenues by targeting these Treg subpopulations in COPD management.

Acceptability of pulmonary rehabilitation in Malawi: a qualitative study

BACKGROUND

Pulmonary rehabilitation (PR) is an effective non-pharmacological intervention for people with chronic respiratory diseases (CRDs), but its acceptability in Malawi was unknown.

OBJECTIVES

To explore patients' acceptability of PR at Queen Elizabeth Central Hospital, Blantyre, Malawi.

METHODS

This was a pre-post cohort study where participants were offered a two times per week hospital-based PR programme for 6 weeks, consisting of endurance and strengthening exercises. Following programme completion, face-to-face semistructured in-depth interviews with the participants were conducted. Interview transcripts were thematically analysed using a deductive approach.

RESULTS

10 adults (five females and five males) out of 14 invited (~70% uptake) participated in the PR programme and subsequent in-depth interviews. Five key themes emerged: (1) debilitating symptom experience of CRD prior to PR; (2) positive impact of PR on living with CRD; (3) contextual programme design improved participants' experience with PR; (4) one size does not fit all and (5) challenges and opportunities for home-based PR. Participants reported experiencing improvements in physical, psychological and social health associated with PR programme participation. The provision of transport was considered a key facilitator for PR programme completion. Realising the gained PR benefits, participants were willing to continue exercising at their homes.

CONCLUSION

The PR programme improved the participants' perceived health status and was well-accepted. Addressing barriers related to transport facilitated immediate implementation while providing a challenge for the scaling and sustainability of PR beyond the project duration. These findings support the drive for shifting chronic care, including rehabilitation, towards primary care and community.

TRIAL REGISTRATION NUMBER

Prospective; 27 August 2021; ISRCTN13836793.

Effects of long-term oxygen therapy on acute exacerbation and hospital burden: the national DISCOVERY study

BACKGROUND

Long-term oxygen therapy (LTOT) improves survival in patients with chronic severe resting hypoxaemia, but effects on hospitalisation are unknown. This study evaluated the potential impact of starting LTOT on acute exacerbation and hospital burden in patients with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD) and pulmonary hypertension (PH).

METHODS

Longitudinal analysis of consecutive patients in the population-based Swedish DISCOVERY cohort who started LTOT between 2000 and 2018 with a follow-up duration≥3 months. Total and hospitalised acute exacerbations of the underlying disease, all-cause hospitalisations, and all-cause outpatient visits were annualised and compared between the year before and after LTOT initiation for each disease cohort, and by hypercapnic status in patients with COPD.

RESULTS

Patients with COPD (n=10 134) had significant reduction in annualised rates of total and hospitalised acute exacerbations, as well as all-cause hospitalisations, following LTOT initiation, with increment in those with ILD (n=2507) and PH (n=850). All-cause outpatient visits increased across all cohorts following LTOT initiation. Similar findings were observed in patients with hypercapnic and non-hypercapnic COPD. Sensitivity analyses of patients with 12 months of follow-up showed reduced acute exacerbations and all-cause hospitalisations in the ILD and PH cohorts.

CONCLUSION

LTOT is associated with reduced rates of both total and hospitalised acute exacerbations and all-cause hospitalisations in patients with COPD, as well as patients with ILD and PH with 12 months of follow-up. There is increased all-cause outpatient visits in all disease groups following LTOT initiation.

The effectiveness and feasibility of virtual pulmonary rehabilitation in patients with chronic respiratory diseases: A systematic review and meta-analysis

OBJECTIVE

To evaluate the effectiveness and feasibility of virtual pulmonary rehabilitation (PR) in patients with chronic respiratory diseases (CRDs).

METHODS

PubMed, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, Wanfang, VIP and APA PsycInfo database were searched since the establishment of the database to July 26, 2024. Data extraction and quality assessment were independently conducted by two reviewers. The methodological quality was assessed using the Cochrane Risk of Bias Tool 2. RevMan v5.4 was performed to meta-analysis.

RESULTS

This meta-analysis and systematic review included 19 studies (1222 CRDs patients). Meta-analysis showed that compared with the control group, virtual PR increased exercise capacity (MD: 22.88, 95 % CI: 15.54 to 30.23), quality of life (QOL) [COPD Assessment Test (CAT): -3.23, -3.62 to 2.85] and dyspnea (Modified Medical Research Council: -0.38, -0.62 to -0.14). Virtual PR demonstrated statistical significance in improving lung function (forced expiratory volume in 1 s in predicted: 6.30, 3.39 to 9.21; the ratio of forced expiratory volume to forced vital capacity in the first second: 9.18, 8.02 to 10.33) and compliance (4.05, 2.26 to 7.27). Mean changes in CAT, anxiety, depression, and cognitive function reached Minimal clinically important difference (MCID) thresholds. However, Borg score, St George' s respiratory questionnaire (SGRQ) did not show any change. In narrative analysis, virtual PR reported fewer adverse reactions, but the economic benefits should be considered.

CONCLUSIONS

This systematic review thoroughly investigates the effectiveness and feasibility of virtual PR for patients with CRDs, and preliminarily verifies the potential promotion value of virtual PR.

PROSPERO REGISTRATION NUMBER

CRD42024581851.

Association analysis of factors influencing psychosomatic diseases among middle-aged and elderly people in China

OBJECTIVE

This study aimed to explore the association between psychological factors and noncommunicable chronic diseases (NCDs).

METHODS

This study used CLHLS database and included a sample of 10,702 cases. Single-factor and multi-factor logistic regression analyses were used to determine the possible risk factors for developing psychosomatic diseases.

RESULTS

Univariate logistic regression found statistically significant associations between the development of psychosomatic disorders and depression, anxiety, sleep duration, and dyslipidemia (P < 0.05). Multivariate logistic regression concluded that depression, anxiety, sleep duration <7 h, and dyslipidemia were risk factors for developing psychosomatic disorders. Depression was a significant risk factor for the development of diabetes (OR = 1.419; 95 %CI: 1.034, 1.946), bronchitis (OR = 1.416; 95 %CI: 1.025, 1.956), gastrointestinal ulcers (OR = 1.541; 95 %CI: 1.223, 1.942), and arthritis (OR = 1.225; 95 %CI: 1.047, 1.433). Anxiety was a significant risk factor for developing bronchitis (OR = 1.240; 95 %CI: 1.061, 1.449), gastrointestinal ulcers (OR = 1.257; 95 %CI: 1.017, 1.554), and arthritis (OR = 1.303; 95 %CI: 1.123, 1.512). Sleep duration <7 h was associated with the development of diabetes (OR = 1.473; 95 %CI: 1.200, 1.808), bronchitis (OR = 1.213; 95 %CI: 1.011, 1.455), gastrointestinal ulcers (OR = 1.795; 95 %CI: 1.356, 2.377), and arthritis (OR = 1.532; 95 %CI: 1.272, 1.845). Dyslipidemia was a significant risk factor for developing diabetes (OR = 3.945; 95%CI: 3.254, 4.783), bronchitis (OR = 1.769; 95 %CI: 1.398, 2.239), gastrointestinal ulcers (OR = 3.244; 95 %CI: 2.491, 4.226), and arthritis (OR = 3.733; 95 %CI: 3.114, 4.571).

CONCLUSIONS

The monitoring of psychological factors as a prospective observation sentinel for NCDs prevention and control should be improved, the traditional intervention model of NCDs prevention and control should be changed.

Angiotensin receptor blockers use and lung cancer risk in Chinese patients with chronic obstructive pulmonary disease: a population-based cohort study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent specific chronic respiratory diseases. It could worsen the development of cardiovascular diseases (CVD) and lung cancer. We aimed to elucidate the relationship between the use of angiotensin receptor blockers (ARBs) and the incidence of lung cancer among the COPD population in China.

METHODS

This retrospective cohort included COPD patients identified by the international classification of diseases 10th edition (ICD-10) codes in the Yinzhou Regional Health Care Database. The use of ARBs was defined according to the use and cumulative use. The lung cancer was defined by ICD-10 code (up to 2023). Time-varying Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the use of ARBs on the risk of lung cancer.

RESULTS

This population-based COPD cohort comprised 25,436 patients with an average age of 68.2 years (standard deviation [SD]: 12.59 years), of which 60.6% were male. A total of 8,611 patients received at least one prescription for ARBs. After adjusting for multiple covariates, the results showed that cumulative annual exposure to ARBs was associated with a reduced risk of lung cancer (HR: 0.93, 95% CI: 0.90-0.97). The results of sensitivity analyses and negative control exposure analyses indicated that the associations were largely consistent and less likely to be influenced by unobserved confounding.

CONCLUSIONS

The use of ARBs may reduce the risk of lung cancer among patients with COPD.

Relationship between advanced lung cancer inflammation index and all-cause and cause-specific mortality among chronic inflammatory airway diseases patients: a population-based study

Background

Chronic inflammatory airway diseases (CIAD), such as asthma, chronic bronchitis, and chronic obstructive pulmonary disease, pose a significant threat to public health, with its prognosis closely tied to the body's inflammation level and nutritional status. As a composite indicator, the advanced lung cancer inflammation index (ALI) integrates inflammation and nutritional status. Despite its potential utility, the link between ALI and the prognosis of patients with CIAD remains unexplored. This study aimed to investigate this relationship.

Methods

We gathered data from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. The National Death Index was used to calculate mortality until December 31, 2019. Kaplan-Meier analysis was employed to investigate the relationships between ALI and all-cause and cause-specific mortality in patients with CIAD. Furthermore, weighted univariable and multivariable Cox proportional hazards models were employed to further examine their relationship. Multiple factors that could impact the results were adjusted in the analysis. We also utilized a restricted cubic spline analysis to estimate the non-linear relationships between ALI and all-cause and cause-specific mortality rates in patients with CIAD. Finally, subgroup and sensitivity analyses were conducted to ensure the reliability of the findings.

Results

The study involved 2,884 CIAD patients. An elevated ALI was significantly related to a decreased risk of all-cause mortality, as well as mortality from cardiovascular and respiratory diseases among CIAD patients. Results from RCS analysis revealed a reverse J-shaped non-linear association between ALI and all-cause mortality in CIAD patients, with an inflection point at 99 (p for nonlinearity <0.0001). The inflection point in the J-shaped relationship represents the ALI value with the lowest risk of mortality. For ALI values below 99, a 10-unit rise in ALI was linked to a 14% reduction in the risk of all-cause mortality (HR: 0.86, 95% CI:0.81-0.92, Ptrend=0.01). Conversely, if ALI exceeded 99, a 10-unit increase in ALI resulted in a 3% rise in the risk of all-cause mortality (HR: 1.03, 95% CI:1.01-1.06, Ptrend=0.02). A similar J-shaped association was observed in mortality due to cardiovascular and respiratory diseases, with inflection points at 94 and 96, respectively. These findings were consistent across sociodemographic and prior disease-related subgroups, and remained stable in sensitivity analyses.

Conclusion

This study revealed a novel association between elevated ALI level and reduced all-cause and cause-specific mortality risk in patients with CIAD. Furthermore, the relationship between ALI and mortality rates from all cause, as well as cardiovascular and respiratory diseases, exhibited an non-linear, J-shaped curve. These findings underscore the importance of maintaining optimal ALI levels within a specific range to promote long-term survival in CIAD patients. The dynamic variation in ALI over time also can help clinicians establish personalized ALI standards to maximize the long-term outcomes for CIAD patients.

Quantitative CT Scoring for Local COPD Severity

Chronic obstructive pulmonary disease (COPD) is complex, and its course is difficult to predict due to its diverse pathophysiology. Small airway disease (SAD), a key component of COPD and potential target for emerging therapeutics, may be reversible in mild COPD, but left unchecked, may worsen, leading to airway loss and emphysema. The dual nature of SAD complicates clinical management of COPD patients, necessitating more accurate monitoring methods. To meet this need, we developed elastic Parametric Response Mapping (ePRM), a tiered scoring system that classifies local lung volumes by the degree of PRM-derived SAD, normal, and emphysematous tissue. In individuals with or at risk for COPD, we demonstrate that chest CT ePRM can categorize local lung tissue into distinct tiers of disease severity that distinguish between tissue characterized by early reversible SAD and progressive destruction. This level of characterization is crucial to developing personalized treatment strategies for COPD.

Are Smart Watches Really Smart? Comparison of Blood Oxygen Saturation Values Measured by Smart Watch, Pulse Oximetry and Arterial Blood Gases in Patients with Chronic Obstructive Pulmonary Diseases

Objective

Oxygen saturation is an important parameter for the follow-up of Chronic Obstructive Pulmonary Disease (COPD) patients. Pulse oximeters are the most common non-invasive way to assess peripheral blood saturation. Invasive way for this is blood gas analyses. Smart watches are actually developed as sports and physical activity watches in order to be used in daily routine by assessing vital parameters such as heart rate, blood pressure and oxygen saturation. In this sense, they can help better monitoring for patients with COPD on the other hand accuracy of these devices is the major concern.

Background

This study aims to evaluate the correlation of oxygen saturation assessed by smart watch, pulse oximetry and blood gas analyses in COPD patients.

Methods

This is a cross-sectional study evaluating the pulse oximetry technology of smart watch by comparing it real time oxygen saturation measurements of conventional pulse device and arterial blood gas (ABG) analysis in 100 patients with COPD.

Results

A moderate correlation was found between oxygen saturation levels obtained by smart watch, pulse oximetry and ABG.

Conclusion

Smart watches are really smart. Thus, COPD patients can use smart watches to measure oxygen saturation levels in their daily lives. However, SpO2 measurements should be tested in other patient groups and also different degrees of COPD.

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.

Prevalence of chronic respiratory disease using case-finding tools in adults living with noncommunicable disease in low- and middle-income countries: a systematic review

BACKGROUND

Chronic respiratory diseases (CRD) often coexist with other non-communicable diseases (NCD) and are responsible for nearly three-quarters of all deaths in low- and middle-income countries (LMIC). People living with NCD are considered at higher risk of having CRD, but the prevalence of CRD in those with other NCD in LMIC is not well described. This study aimed to identify the prevalence of CRD and/or abnormal spirometry identified through case-finding tools in adults living with NCD in LMIC.

METHODS

This systematic review followed the PRISMA guidelines and included Lilacs, PubMed, Scielo, Embase and Web of Science databases. Two reviewers independently examined the titles and abstracts of studies identified from the search to determine eligibility for inclusion. Searching was carried out until May 16, 2024, and was updated in February 2025. Cross-sectional studies that used case finding tools to identify CRD in adults living with other NCD in LMIC were eligible. The studies were exported to Rayyan software, and duplicates were manually removed. Data were extracted including study characteristics, and quality was assessed using the modified Newcastle-Ottawa Scale risk of bias tool. A descriptive analysis of the prevalence of respiratory diseases and spirometric abnormalities was reported considering 95% confidence intervals.

RESULTS

A total of 8,939 citations were screened based on titles and abstracts. Thirteen full-text articles were assessed for eligibility. Five studies were excluded for not providing sufficient data, two for inadequate outcome ascertainment, two for being conducted in developed countries, and one for only including patients with a previous COPD diagnosis. Three cross-sectional studies met the inclusion criteria, one conducted in India, and two in Brazil. Considering studies with a low risk of bias, the prevalence of CRD was between 1% and 5.2% in patients with hypertension. The prevalence of abnormal spirometry was between 11% and 17% in patients with coronary artery disease.

CONCLUSION

The prevalence of CRD identified through case-finding tools in adults with NCD in LMIC varies according to the NCD in which it was investigated. These findings highlight the opportunity to case-find CRD by assessing people accessing care for other NCD.

REGISTRATION

PROSPERO 2024 CRD42024534734.

Optimising participation in a pulmonary rehabilitation programme for people living with chronic respiratory diseases in rural India: a feasibility study

Background

Pulmonary rehabilitation (PR) plays a vital role in managing chronic obstructive pulmonary disease and other chronic respiratory diseases (CRDs). However, implementation of this multidisciplinary approach in resource-poor settings may not be sufficient because of referrers' uncertainty regarding the effectiveness of PR, inconvenient timing, travel issues, patients' lack of motivation, and poor family support. The aim was to test the feasibility of a peer-led, professionally assisted community-based PR programme for CRD patients in a rural, low literacy setting.

Methods

We conducted a single-centre, pre-post feasibility study. Participants with a confirmed diagnosis of CRD were recruited and treatment was optimised. After completing baseline assessments, the participants underwent eight weeks of PR training (16 sessions) in six groups at five local facilities led by peers selected by the participants and assisted by professionals. Exercise capacity was assessed with 6-Minute Walk Test. Other outcomes were: International Physical Activity Questionnaire; Hospital Anxiety and Depression Scale; London Chest Activity of Daily Living scale. Upper and lower limb strength were assessed using a handheld dynamometer and cycle ergometer, respectively. Descriptive analysis was performed, and pre-and post-outcomes were compared using parametric tests.

Results

Thirty participants (20 chronic obstructive pulmonary disease and 10 asthma; 15 female; median age 57.5 years) completed baseline and endline assessments. Seventy percent completed at least 12/16 sessions. After eight weeks of training, the 6-Minute Walk Test had improved from 263.3 (standard deviation (SD) = 72.3) to 319.6 (SD = 84.7) metres (P < 0.001) with significant improvement in modified Medical Research Council (P = 0.022), London Chest Activity of Daily Living scale (P < 0.001) and dominant handgrip strength (P < 0.001) but no significant change in physical activity (P = 0.791).

Conclusions

The community-based PR led by peer volunteers and supported by professionals proved to be feasible in our low-resource setting and was associated with improved exercise tolerance and other outcomes.

Registration

The study was registered at the Clinical Trials Registry - India (CTRI/2020/09/027818).

At-home validation of a non-contact, radar-based breathing monitor for long-term care of patients with respiratory diseases: A proof-of-concept study

Long-term monitoring of respiratory rate (RR) is an important component in the management of chronic respiratory diseases (CRDs). Specifically, predicting acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is of significant scientific and clinical interest. This study aimed to evaluate the long-term validity of a novel contactless sleep monitor (CSM) in the home environment of CRD patients receiving ventilatory support. Additionally, we assessed patient acceptance, device usability, and RR fluctuations associated with AECOPD to establish a robust foundation for future research.In this prospective proof-of-concept study, nineteen patients requiring non-invasive ventilation (NIV) were provided with the CSM in their home environment for six months and seven patients requiring invasive mechanical ventilation (IMV) for one month. The primary indication for NIV therapy was chronic obstructive pulmonary disease (COPD).The CSM was validated under real-life conditions by comparing its nocturnal RR values with software data from both types of ventilators. Acceptability and usability of the sensor were assessed using a questionnaire. Additionally, COPD exacerbations occurring during the study period were analyzed for potential RR fluctuations preceding these events.Mean absolute error (MAE) of median RR between the NIV device and the CSM, based on 2326 nights, was 0.78 (SD: 1.96) breaths per minute (brpm). MAE between the IMV device and the CSM was 0.12 brpm (SD: 0.52) for 215 nights. The non-contact device was accepted by the patients and proved to be easy in use. In some of the overall only 13 cases of AECOPD, RR time courses showed variations of increased nocturnal respiratory activity a few days before the occurrence of such events.The present CSM is suitable for valid long-term monitoring of nocturnal RR in patients' home environment and is well accepted by the patients. The exploratory findings related to AECOPD events may serve as a starting point for larger studies aimed at developing robust prediction rules.

Trends in the burden of chronic diseases attributable to diet-related risk factors from 1990 to 2021 and the global projections through 2030: a population-based study

Background

The global burden of diet-related chronic diseases and their future projections remain unclear. To address this gap, we present the latest data on deaths and disability-adjusted life years attributable to dietary factors from 1990 to 2021, focusing on noncommunicable diseases worldwide. Additionally, we provide predictions of mortality rates across different age groups through 2030.

Methods

Data from the Global Burden of Disease Study 2021 were analyzed to evaluate correlations between dietary factors and trends in chronic disease burden over a 30-year period. Moreover, we predicted the burden of chronic dietary diseases up to 2030.

Results

From 1990 to 2021, global age-standardized mortality rates and disability-adjusted life year (DALY) rates associated with dietary factors decreased by approximately one-third for neoplasms and cardiovascular diseases (CVDs). In high sociodemographic index (SDI) regions, neoplasm-related deaths showed a stronger correlation with dietary factors, particularly high red meat intake. In cardiovascular diseases, the leading dietary factors are low-grain diets, whereas in diabetes, it is due to increased intake of processed meat. In low-SDI regions, diets low in vegetables showed the strongest association with neoplasm-related mortality, while diets low in fruits were significantly linked to CVD and diabetes burden. High-sodium diet was a significant risk factor for CVD in the middle-SDI regions. Moreover, the 2030 projections indicated a decline in mortality from neoplasms and CVDs, with a slight increase in mortality rates from diabetes.

Conclusion

The global burden of chronic diseases linked to dietary factors shows varying trends across different countries and regions, particularly influenced by their economic development levels. This variation underscores the necessity of enhancing dietary structures to mitigate chronic disease prevalence and foster overall health.

The relationship between multiple chronic diseases and sleep quality among the older people ≥ 60 years in China

BACKGROUND

High-quality sleep is essential for both physical well-being and mental health, particularly in promoting the health and longevity of older adults. However, limited evidence exists regarding the relationship between chronic diseases and sleep quality in this population.

METHODS

The study investigated 35 common chronic diseases among 1186 older individuals aged 60 and above from six rural communities in northwest China. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multiple logistic regression and interaction analyses were employed to explore the relationship between multiple chronic diseases and sleep quality.

RESULTS

Compared with the first quartile (≤ 1) of the number of chronic diseases, the second (2), third (3-4), and fourth (≥ 5) quartile ORs were 1.771 (95% CI: 1.191-2.631, p = 0.005), 2.434 (95% CI: 1.660-3.567, p < 0.001), and 3.180 (95% CI: 2.039-4.959, p < 0.001), respectively. For the duration of chronic diseases, compared with the first quartile (≤ 4.32 years) of duration of chronic diseases, the second (4.33-7.49 years), third (7.50-11.32 years) and fourth (≥ 11.33 years) quartile ORs were 1.350 (95% CI: 0.931-1.957, p = 0.113), 1.381 (95% CI: 0.953-2.000, p = 0.088), and 1.629 (95% CI: 1.122-2.365, p = 0.010), respectively. Older adults with multimorbidity and a longer duration of chronic diseases (≥ 7.5 years) had poorer sleep quality than those without multimorbidity and shorter duration of chronic diseases.

CONCLUSION

The higher number and longer duration of chronic diseases are associated with poorer sleep quality among older adults, with a stronger correlation observed in females compared to males.

Seasonal variation of pediatric asthma exacerbations and its association with asthma phenotypes

BACKGROUND

The objective of this study was to examine the associations of blood inflammatory phenotypes with acute pediatric asthma exacerbations during different seasons and the COVID-19 pandemic.

METHODS

A retrospective study was conducted involving 32,160 pediatric asthma patients from January 2008 to December 2021. Asthma blood inflammatory phenotypes were categorized based on low (L) and high (H) eosinophils (E) and neutrophils (N) (LBE/HBE: ≥ 0.25 × 109/L and LBN/HBN: ≥ 5 × 109/L, respectively) and logistic regression was used to examine the odds ratio (OR) of outcome variables.

RESULTS

A 109/L increase of neutrophils and eosinophils was associated with a 1.015-fold (95% CI: 1.009-1.021) and a 1.057-fold increase in the OR (95% CI: 1.026-1.088) for asthma exacerbations of hospitalized pediatric asthma patients. An increase in HBE/LBN phenotype was associated with a respective 1.232-fold (95% CI: 1.081-1.404) and 1.248-fold (95% CI: 1.101-1.414) increase in the OR for asthma exacerbations of hospitalized pediatric asthma patients before the COVID-19 pandemic in the winter and autumn seasons. However, an increase of LBE/LBN phenotype was associated with a respective 0.873-fold (95% CI: 0.769-0.991), 0.872-fold (95% CI: 0.771-0.986), and 0.813-fold (95% CI: 0.709-0.932) decrease in the OR for asthma exacerbations in the winter, spring and summer seasons.

CONCLUSIONS

HBE/LBN phenotype had a higher risk of asthma exacerbations among hospitalized pediatric asthma patients in the winter and autumn, while LBE/LBN phenotype had a lower risk in the winter, spring, and summer.

IMPACT

Blood eosinophils and neutrophils have been indicated to have a potential influence on pediatric asthma development and severity. HBE/LBN phenotype was associated with increased asthma exacerbations among hospitalized pediatric asthma patients during winter and autumn. Eosinophil and neutrophil predominance exhibited a higher influence on pediatric asthma exacerbations.

Metabolic dysfunction associated steatotic liver disease is associated with an increased risk of multiple respiratory system diseases

Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significant public health concern. However, the relationship between MAFLD and different types of respiratory diseases is not yet fully understood. In UK Biobank prospective cohort, 11 types of respiratory diseases were identified according to the ICD-10 codes. Cox regression was used to determine the association between MASLD and respiratory disease risk. A total of 393,416 subjects with an average age of 56.6 years were included, MASLD patients account for 34.9%. After fully adjustment for confounding factors, 9 out of 11 respiratory diseases were significantly associated with MASLD, including influenza (hazard ratio (HR): 1.294), pneumonia (HR: 1.258), chronic lower respiratory diseases (HR: 1.297), asthma (HR: 1.222), lung diseases due to external agents (HR: 1.190), interstitial lung diseases (HR: 1.336), diseases of the pleura (HR: 1.175), pulmonary embolism (HR: 1.225), lung and bronchus cancer (HR: 1.212) and respiratory system death (HR: 1.108) (P < 0.05 for all). The risk of respiratory diseases increases with the severity of MASLD assessed by fibrosis score. The relationship between the MASLD phenotype and respiratory diseases is independent of polygenic risk scores and four related risk alleles. These findings emphasize the value of comprehensive prevention of respiratory diseases by targeting MASLD.

Exhaled volatile organic compounds as novel biomarkers for early detection of COPD, asthma, and PRISm: a cross-sectional study

BACKGROUND

Globally, chronic respiratory diseases have become the third leading cause of death, including chronic obstructive pulmonary disease (COPD) and asthma, and have been threatening human life for a long time. To alleviate the disease burden, it is crucial to develop rapid and convenient screening methods for COPD, preserved ratio impaired spirometry (PRISm), and asthma. Volatile organic compounds (VOCs) in breath can reflect the pathophysiological processes of disease, thereby having the potential to serve as a promising approach for diagnosing respiratory diseases. Can we identify VOC markers in breath with the potential to serve as classification indicators, and further establish learning models for the early detection of COPD, asthma, or PRISm patients?

METHODS

This is a cross-sectional study in which exhaled breath samples were collected from 184 patients with COPD, 66 patients with asthma, 72 PRISm individuals, and 45 healthy individuals. From August 2023 to June 2024, the breath samples were analyzed using portable micro gas chromatography (CXBA-Alpha, ChromX Health Co., Ltd.). Potential VOC markers for classification were identified by univariate and multivariate analyses. Subsequently, classification models were established by machine learning algorithms, based on these VOC markers along with baseline characteristics. The sensitivity, specificity, and accuracy of these models were calculated to assess their overall discriminatory performance.

RESULTS

A total of 367 patients were enrolled in our study. We identified nine VOCs distinguishing COPD patients from healthy controls, nine VOCs differentiating the PRISm population from healthy controls, five VOCs separating asthma patients from healthy controls, five VOCs distinguishing COPD patients from asthma patients, and seven VOCs differentiating the PRISm population from asthma patients based on breathomics feature selection. We utilized five algorithms to establish diagnostic models and selected the optimal one among them. The random forest model best distinguished COPD from healthy controls with an area under the receiver operating characteristic curve (AUC) of 0.92 ± 0.01. The support vector classifier (SVC) model was most effective in separating PRISm from healthy controls, achieving an AUC of 0.78 ± 0.01. Logistic regression performed well in discriminating asthma from PRISm (AUC, 0.74 ± 0.02) and COPD (AUC, 0.92 ± 0.01), in contrast, the random forest model differentiated asthma from healthy controls with an AUC of 0.81 ± 0.02.

CONCLUSION

VOC panel-based classification models have the potential to be a novel strategy for the discrimination of chronic respiratory diseases. Using the portal micro gas chromatography enables swift detection of chronic respiratory disease and, most importantly, facilitates the rapid identification of PRISm individuals within the population.

Effect of periodontal therapy on lung function: a twelve-month follow-up intervention study

BACKGROUND

Evidence suggest an inflammatory link between respiratory health and periodontitis. This study aims to evaluate the impact of periodontal therapy on lung function.

METHODS

Sixty-two never-smoking patients with mild periodontitis and without other medical conditions participated in this single-blind, prospective trial. Patients underwent periodontal therapy following an infection control approach. Lung function was measured using forced oscillation technique, assessing airway resistance and reactance, and spirometry evaluating FEV1, FVC, and FEV1/FVC. Lung function and fractional exhaled nitric oxide were assessed at baseline, three and six weeks, and every three months for a year. Periodontal parameters were recorded at baseline, six weeks, six and 12 months. Data were analysed using mixed-effects regression models.

RESULTS

Patients (mean age 36 years, 58% female) showed significant improvements in periodontal parameters (p < 0.001). Oscillometry revealed a significant decrease in airway resistance at 11 Hz and 19 Hz after six weeks, with further significant decreases throughout the study. Resistance at 5 Hz (R5) consistently declined, reaching significance at three months (p = 0.001). By one year, R5, R11, R19, and R5 - 20 showed significant reductions (all p < 0.05). Airway reactance at 5 Hz became less negative at three months (p = 0.002), while the reactance area (AX) decreased significantly at six months (p = 0.008). No significant changes were observed in spirometry or fractional exhaled nitric oxide.

CONCLUSION

A decrease in airway resistance was observed after periodontal therapy, underscoring its positive impact on small airway function. These findings suggest that oral infection control is valuable for respiratory health in young adults before chronic conditions establish.

CLINICAL TRIAL REGISTRATION

The trial was registered at ClinicalTrials.gov (NCT04781153) on February 19, 2021, prior to participant enrolment.

Association between life's crucial 9 and lung health: a population-based study

BACKGROUND

As a cardiovascular health (CVH) assessment tool, Life's Crucial 9 (LC9) is often associated with diverse chronic health indicators. However, no study has yet explored the association of LC9 with multifactorial components of lung health. Thus, this study aimed to investigate the correlation of LC9 with lung health.

METHODS

This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES), which covers individuals aged 40 years and older with complete LC9 and lung health data. Multiple regression was employed in linear relationships investigation, while Restricted Cubic Spline (RCS) was used to explore nonlinear relationships. Subgroup analyses and interaction tests demonstrated the stability of associations. Combining LC9 to build a Light Gradient Boosting Machine (LightGBM) machine learning (ML) model to predict lung health, Shapley Additive Explanations (SHAP) sorted the contribution of LC9 components to the model.

RESULTS

From a total of 10,461 study participants, 1725 had low CVH, 7476 had moderate CVH, and 1260 had high CVH. There was a strong positive correlation between LC9 score and lung health. This association remained consistent across subcomponent strata. RCS analysis revealed non-linear associations between LC9 and respiratory outcomes, including cough, asthma, and COPD. The LightGBM model incorporating LC9 demonstrated excellent predictive performance for lung health, with favorable metrics in Area Under the Curve (AUC), accuracy, and specificity. SHAP analysis identified depression, nicotine exposure, and BMI scores as the predominant contributors among LC9 components to the model's predictive capability.

CONCLUSION

Individuals with better CVH as assessed by LC9 tended to have better lung health. The combination of the LightGBM model could achieve better prediction results.

Beneficial effects of thermal waters on respiratory diseases: a systematic review

Respiratory diseases are extremely common conditions worldwide with a high social and economic impact. The aim of this systematic review was to summarize the scientific evidence on the efficacy of thermal inhalation treatments to manage the signs and symptoms of all type of upper and lower respiratory diseases. The review was conducted according to the PRISMA recommendations. The protocol was registered in the PROSPERO platform (ID: CRD42024510869). The bibliographic search was performed using PubMed, Scopus and Web of Science databases without time limits up to January 2nd 2025. All experimental and semi-experimental studies conducted on humans, published in Italian and English, aimed to evaluate the effects of thermal inhalation treatments in the treatment of respiratory diseases were considered eligible. The quality of the studies was assessed using the CLEAR NPT scale. Overall, 27 studies were included, related to chronic and chronic-recurrent upper and lower respiratory tract diseases. The results agree on beneficial effects of thermal waters use, with an improvement in the sensation of nasal obstruction, rhinorrhea, muco-ciliary transport time and lung function parameters. The therapeutic effects determined by thermal inhalation treatments is attributed to the composition and biochemical activity of the different waters, which lead, among other effects, to a regularization of the activity of the immune system. The results, although agreeing and encouraging, cannot be definitive due to the limitations of the studies included, especially their low quality and heterogeneity. Therefore, further clinical studies should be conducted using more appropriate methodologies, study designs and statistical analysis techniques.

Dupilumab reduces acute exacerbations and improves lung function in patients with COPD with type 2 inflammation irrespective of body mass index, airflow obstruction, dyspnea, and exercise capacity index scores

BACKGROUND

The body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index predicts 5-year mortality risk in chronic obstructive pulmonary disease (COPD); higher scores predict worse outcomes. Dupilumab, a fully human monoclonal antibody that blocks the shared receptor component for interleukin-4/13, reduced exacerbations and improved lung function in patients with COPD in the phase 3 BOREAS trial (NCT03930732). We assessed dupilumab efficacy in patients with COPD and type 2 inflammation by baseline BODE index.

METHODS

Patients with COPD, moderate-to-severe airflow limitation, screening blood eosinophils ≥300 cells/μL, and high exacerbation risk, on triple therapy, received 300 mg add-on dupilumab or placebo every 2 weeks for 52 weeks. Annualized moderate or severe COPD exacerbation rate and change from baseline in pre-bronchodilator forced expiratory volume in 1 s (FEV1) at Weeks 12 and 52 were assessed by baseline BODE index, categorized as low (≤4) or high (>4).

RESULTS

Of 934 patients with reported baseline BODE index scores (dupilumab: 470; placebo: 464), 61.8 % had scores ≤4. Dupilumab reduced exacerbations versus placebo, regardless of baseline BODE index group. Exacerbation reductions were similar by BODE index group; relative risk (95 % confidence interval) for patients with BODE index >4 versus ≤4 was 0.656 (0.496-0.868) versus 0.718 (0.547-0.944). At Weeks 12 and 52, dupilumab consistently improved pre-bronchodilator FEV1 versus placebo, regardless of baseline BODE index group.

CONCLUSION

Dupilumab reduced exacerbations and improved lung function in patients with COPD and type 2 inflammation irrespective of baseline BODE index score.

CLINICAL TRIAL REGISTRATION NUMBER

BOREAS trial NCT03930732.

Vitamin D Supplementation, Chronic Obstructive Lung Disease and Asthma Exacerbations, and Lung Function Decline

BACKGROUND

It remains unclear whether supplementation with vitamin D reduces risk of acute exacerbations of chronic obstructive lung disease (COPD) or asthma, major contributors to the world-wide burden of disease.

OBJECTIVES

To compare effects of vitamin D with placebo supplementation for the prespecified primary endpoints 1) acute exacerbations of COPD and 2) decline in pulmonary function measures of airflow obstruction. Prespecified secondary endpoints included asthma exacerbations and control.

METHODS

Lung VITamin D and OmegA-3 TriaL (VITAL) is an ancillary study of VITAL, a United States nationwide, randomized, placebo-controlled trial with a 2-by-2 factorial design of vitamin D3 (2000 IU/d) and marine n-3 fatty acids (1 g/d) among men 50 y and women 55 y of age or older. Of 25,871 randomly divided participants, 3632 at risk for respiratory exacerbations, including 1977 with COPD by diagnosis or symptoms and 1654 with self-reported asthma diagnosis, were followed annually for 5 y by self-administered respiratory questionnaire. Spirometry was performed at baseline and 2 y after randomization by 1648 participants from 12 urban centers. Decline in forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity was measured between baseline and follow-up.

RESULTS

Supplementation with vitamin D was not associated with lower risk of any primary or secondary end point. Over the 5-y follow-up, the number of COPD exacerbations was 0.27/y in the vitamin D group and 0.25/y in the placebo group (rate ratio 1.10; 95% confidence interval, 0.93, 1.29). Over the 2-y follow-up, supplementation was not associated with slower decline (mL/y) in FEV1.

CONCLUSIONS

Supplementation with vitamin D, compared with placebo, did not result in a lower rate of COPD exacerbations or improved pulmonary function in community-dwelling adults not selected for vitamin D deficiency. This trial was registered at Lung VITAL clinicaltrials.gov as NCT01728571 with Protocol ID 2010-P-000622 (https://prevention.cancer.gov/clinical-trials/clinical-trials-search/nct01728571).

Gut flora-derived succinate exacerbates Allergic Airway Inflammation by promoting protein succinylation

Allergic airway inflammation (AAI) is a prevalent respiratory disorder that affects a vast number of individuals globally. There exists a complex interplay among inflammation, immune responses, and metabolic processes, which is of paramount importance in the pathogenesis of AAI. Metabolic dysregulation and protein translational modification (PTM) are well-recognized hallmarks of diseases, playing pivotal roles in the onset and progression of numerous ailments. However, the role of gut microbiota metabolites in the development of AAI, as well as their influence on PTM modifications within this disease context, have not been thoroughly explored and investigated thus far. In AAI patients, succinate was identified as a key metabolite, positively correlated with certain immune parameters and IgE levels, and having good diagnostic value. In AAI mice, gut bacteria were the main source of high succinate levels. Mendelian randomization showed succinate as a risk factor for asthma. Exogenous succinate worsened AAI in mice, increasing airway resistance and inflammatory factor levels. Protein succinylation in AAI mice lungs differed significantly from normal mice, with up-regulated proteins in metabolic pathways. FMT alleviated AAI symptoms by reducing succinate and protein succinylation levels. In vitro, succinate promoted protein succinylation in BEAS-2B cells, and SOD2 was identified as a key succinylated protein, with the K68 site crucial for its modification and enzyme activity regulation. Gut flora-derived succinate exacerbates AAI in mice by increasing lung protein succinylation, and FMT can reverse this. These findings offer new insights into AAI mechanisms and potential therapeutic targets.

Association of Exercise Tolerance with Respiratory Health Outcomes in Mild-to-Moderate Chronic Obstructive Pulmonary Disease

Rationale: Previous studies have identified exercise intolerance in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD). The association of exercise tolerance with lung function decline and acute exacerbation risk in mild-to-moderate COPD is unclear, especially in the community population. Objectives: We evaluated exercise tolerance in patients with mild-to-moderate COPD and analyzed its associations with respiratory health outcomes. Methods: We analyzed data from the community-based ECOPD (Early Chronic Obstructive Pulmonary Disease) study of patients with mild-to-moderate COPD (postbronchodilator forced expiratory volume in 1 second (FEV1):forced vital capacity < 0.70 and FEV1 ≥ 50% predicted). Patients who completed questionnaires, spirometry, and cardiopulmonary exercise testing at baseline were included. Annual exacerbation assessment and spirometry were conducted for 2 years consecutively. Exercise tolerance was defined as the percentage of predicted peak oxygen uptake ([Formula: see text]o2peak% predicted). We analyzed the association between exercise tolerance, annual lung function decline, and acute exacerbation risk. Results: Overall, 338 patients were included in the baseline analysis, and 319 completed the 2-year follow up. The mean ± standard deviation of [Formula: see text]o2peak% predicted was 79.8 ± 13.7%. Low [Formula: see text]o2peak% predicted was associated with more chronic respiratory symptoms, worse lung function, severer emphysema, and air trapping at baseline. During the 2-year follow up, a decrease of 13.7% (1 standard deviation) in [Formula: see text]o2peak% predicted was associated with a decline in prebronchodilator FEV1:forced vital capacity (difference, 0.4% [95% confidence interval, 0.1-0.7%]; P = 0.003) and higher total exacerbation risk (relative risk, 1.25 [95% confidence interval, 1.08-1.46]; P = 0.004) after adjustment. Conclusions: Patients with mild-to-moderate COPD and exercise intolerance have worse respiratory health outcomes, for which low exercise tolerance is a prognostic marker. Clinical trial registered with www.chictr.org.cn (ChiCTR1900024643).

Associations of ambient fine particulate matter with lung function and nasal microbiota: A panel study in asthmatic children

Fine particulate matter (PM2.5) has been associated with an increased risk of asthma. However, the underlying mechanisms through which PM2.5 affects respiratory health in children with asthma remain poorly understood. To address this gap, we performed a panel study to investigate the associations of short-term PM2.5 exposure with lung function and nasal microbiota in asthmatic children. The study included 50 school-aged asthmatic children, who underwent repeated examinations every three months, including lung function testing and nasal swab sample collection. Linear mixed-effect models and the linear discriminant analysis effect size were adopted to evaluate the impacts of PM2.5 on lung function and nasal microbiota. Based on 160 lung function records and 160 nasal samples, we found that per interquartile range increase in PM2.5 concentration at lag 0-72 h was associated with a decrease of 0.09 L (95 % CI: 0.01, 0.16), 0.30 L/s (95 CI: 0.04, 0.57), 0.18 L/s (95 % CI: 0.03, 0.33), and 0.30 L/s (95 % CI: 0.07, 0.53) in forced expiratory volume in 1 s, forced expiratory flow at 50 % and 75 % of forced vital capacity, and the maximal mid-expiratory flow, respectively. Additionally, short-term exposure to PM2.5 was also associated with decreased Chao 1 and Simpson's index, decreased relative abundance in Corynebacterium and Staphylococcus, and increased relative abundance in Muribaculaceae, Ralstonia, and Moraxella. In conclusion, our study demonstrated that short-term exposure to PM2.5 may impair small airway function, reduce nasal microbiota evenness, and induce microbiota dysbiosis in asthmatic children.

Circular RNA circ_0004470 accelerates the occurrence of lung cancer by promoting DNA damage and cell cycle arrest

Defects in the DNA damage response are associated with tumorigenesis, and circular RNAs (circRNAs) can also affect the occurrence and progression of cancer by regulating gene expression. However, the relationship between DNA damage in lung cancer and circRNAs remains unexplored. In this study, circ_0004470 was significantly upregulated in various lung cancer cells (H446, A549, H1299) as well as in carcinogenic animal models and clinical lung cancer samples. Circ_0004470 promoted DNA damage and cell cycle S phase arrest in human pulmonary bronchial epithelial cells, inhibited DNA repair, and accelerated malignant transformation in response to continuous DNA damage-inducing stimulation. Circ_0004470 inhibited DNA repair and cell cycle progression by binding specifically to the nucleotide excision repair complex Xeroderma pigmentosum group C-complementing protein and damage-specific DNA binding protein 1, thus interacting with the DNA damage response process and accelerating the accumulation of DNA damage. These findings suggest that circRNAs are involved in regulating genetic damage-associated lung cancer and provide insight into the mechanism by which circ_0004470 affects the DNA damage response during carcinogenesis.

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.

Interleukin-35 inhibits NETs to ameliorate Th17/Treg immune imbalance during the exacerbation of cigarette smoke exposed-asthma via gp130/STAT3/ferroptosis axis

Cigarette smoke (CS) exposure amplifies neutrophil accumulation. IL-35, a novel cytokine with anti-inflammatory properties, is involved in protection against asthma. However, the biological roles of neutrophils and the precise molecular mechanisms of IL-35 in CS exposed-asthma remain unclear. We showed that the exacerbation of CS exposed-asthma leads to dramatically increased neutrophil counts and an imbalance in DC-Th17/Treg immune responses. RNA sequencing revealed that NETs, part of a key biological process in neutrophils, were significantly upregulated in the context of CS exposed-asthma exacerbation and that IL-35 treatment downregulated NET-associated gene expression. Targeted degradation of NETs, rather than neutrophil depletion, alleviated the CS exposed-asthma. Mechanistically, STAT3 phosphorylation promoted ferroptosis, exacerbating NET release, which in turn enhanced dendritic cell (DC) antigen presentation, activated T cells, and specifically promoted Th17 cell differentiation while inhibiting Treg cells. IL-35 acting on the gp130 receptor alleviated STAT3-mediated ferroptosis-associated NET formation. In summary, our study revealed a novel mechanism by which IL-35 inhibited NET formation, subsequently alleviating neutrophilic inflammation and restoring the DC-Th17/Treg imbalance in CS exposed-asthma, highlighting the potential of IL-35 as a targeted therapeutic strategy.

Prevalence and Risk Factors of Cognitive Impairment in COPD: A Systematic Review and Meta-Analysis

AIM

The aim of this systematic review is to present the pooled estimated prevalence and risk factors for cognitive impairment (CI) in patients with chronic obstructive pulmonary disease (COPD).

BACKGROUND

Patients with COPD suffer from progressive and irreversible airflow limitation, resulting in continuous impairment of lung function, which in addition to causing lesions in the lungs, often accrues to other organs as well. In recent years, a growing number of cross-sectional and longitudinal studies have shown that hypoxia is an important factor in causing CI and that there is an important link between them, but the assessment of co-morbid neurocognitive impairment and dysfunction is often overlooked. Some studies suggest that the diagnosis of mild cognitive impairment (MCI) is considered a precursor to dementia symptoms, with an annual conversion rate of 5%-10%, and it has been suggested that MCI is a potentially reversible state that can be used as a window for intervention. There is a lack of evidence on the prevalence and influencing factors of CI and its MCI.

DESIGN

A systematic review and meta-analysis.

METHODS

PubMed, Web of Science, the Cochrane Library, Ovid, Wiley, and Scopus were searched for cohort, case-control, and cross-sectional studies investigating the prevalence and risk factors of CI and MCI in COPD to June 2023 from building. Meta-analyses were performed to identify CI and MCI prevalence and risk factors using a random-effects model. The methodological quality assessment was conducted by the modified Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality (AHRQ). This study was registered on PROSPERO (CRD42021254124).

RESULTS

In total, 41 studies (21 cohort studies, 7 case-control studies, and 13 cross-sectional studies) involving 138,030 participants were eligible for inclusion. Current evidence suggests that the average prevalence of CI and MCI in COPD was 20%-30% (95% CI, 0.17-0.28) and 24% (95% CI, 0.17-0.32), respectively. Significant heterogeneity existed both in CI and MCI (I2 = 99.76%, 91.40%, p < 0.001). Mata-regression analysis showed that different region could be the source of heterogeneity in the pooled results. Cough, FEV1, PaO2, age, education, depression, and BODE index are influential factors in the development of CI in COPD.

CONCLUSION

Integrated epidemiological evidence supports the hypothesis that the prevalence of CI in the COPD population has shown an increasing trend, with differences by region and by instrument. Cough, FEV1, PaO2, age, education, depression, and BODE index are influential factors in the development of cognitive impairment in COPD patients. We should promote early screening and management of COPD patients and take targeted measures to prevent and reduce the incidence of CI.

IMPLICATIONS FOR PRACTICE

This systematic evaluation and meta-analysis identifies seven important risk factors for the development of CI among COPD patients and exposes their current epidemiological findings to provide a theoretical basis for public health administrators and healthcare professionals to effectively increase the screening rate of cognitive impairment in patients with COPD as well as to carry out early intervention.

TRIAL REGISTRATION

PROSPERO).crd. york.ac.uk.

Nationwide Assessment of Pulmonary Function Testing Practices and Safety Compliance During the COVID-19 Pandemic

OBJECTIVE

Coronavirus disease-2019 (COVID-19) presented considerable challenges to health services, particularly for a routine assessment method, the pulmonary function tests (PFTs), which can generate aerosols and require sharing common surfaces. Despite these risks, there is a need to continue testing, especially for vulnerable patient groups.

MATERIAL AND METHODS

An online survey was conducted from June 1 to June 26, 2020, to assess pulmonologists’ practices regarding PFTs before and during the pandemic’s first peak in Türkiye (March 11-May 20, 2020). The survey included 30 anonymized questions and received ethical committee approval. Statistical analysis was performed using the IBM Statistical Package for the Social Sciences statistical package.

RESULTS

Two hundred and forty-three respondents across 59 cities participated in the study. 93% were pulmonologists. 77.4% of PFT labs have adequate ventilation by having a window enabling room direct air exchange. 27.2% of the PFT labs continued testing during the first peak of the pandemic. 83.3% of the responding centers applied triage before testing. Ongoing tests included spirometry (100%), bronchodilator reversibility testing (62.1%), and carbon-monoxide diffusion testing (16.7%). 49% of the PFT labs conducted fewer than four tests daily, while 21.2% performed more than eight. PFT technicians used personal protective equipment, with 67.7% using eye protection and 75.3 % wearing FFP3 or FFP2 masks.

CONCLUSION

The survey found that pulmonologists have acted quickly and made moderate success in making preparations in PFT labs for the COVID-19 pandemic. Nevertheless, safer practice in PFT units still needs to be implemented.

The association between weight-adjusted waist index and respiratory symptoms in U.S adults: A national cross-sectional study

OBJECTIVE

This study aimed to evaluate the relationship between the weight-adjusted waist index (WWI) and respiratory symptoms, including cough, wheezing, and dyspnea, as well as the related respiratory diseases, namely chronic obstructive pulmonary disease (COPD) and asthma, in adults.

METHODS

This cross-sectional study included 14,760 adults aged over 40 years, drawn from the National Health and Nutrition Examination Survey (NHANES) conducted between 2003 and 2012. Weighted logistic regression analysis was employed to investigate the association between WWI and respiratory symptoms, including cough, wheezing, and dyspnea, as well as related respiratory diseases such as COPD and asthma. Subgroup analyses and interaction tests were performed to stratify the data by age, gender, and race. Additionally, smooth curve fitting and threshold effect analyses were utilized to explore potential non-linear relationships between WWI and respiratory symptoms, as well as the associated respiratory diseases.

RESULTS

After adjusting for covariates, a positive association was observed between WWI and respiratory symptoms, including cough, wheezing, and dyspnea [odds ratio (OR): 1.39, 95% confidence interval (CI): 1.29-1.50; OR: 1.62, 95% CI: 1.51-1.73; OR: 1.58, 95% CI: 1.50-1.67]. This association extended to related respiratory diseases such as COPD and asthma (OR: 1.42, 95% CI: 1.30-1.54; OR: 1.43, 95% CI: 1.33-1.54). Subgroup analyses indicated that the relationship between WWI and wheezing was modified by race, whereas dyspnea was influenced by age, gender, and race. For COPD, the association was affected by gender. Smoothed curve fitting revealed nonlinear, J-shaped associations between WWI and cough, COPD, and asthma (OR: 1.39, 95% CI: 1.29-1.50, P < 0.001; OR: 1.42, 95% CI: 1.30-1.54, P < 0.001; OR: 1.43, 95% CI: 1.33-1.54, P < 0.001). Furthermore, the breakpoint (K) was found to be 9.99 for both wheezing and dyspnea, with P < 0.05 for log-likelihood ratios in both instances.

CONCLUSIONS

This study provides evidence linking elevated levels of WWI to an increased risk of respiratory symptoms, including cough, wheezing, and dyspnea, as well as associated respiratory diseases such as COPD and asthma in U.S adults. These findings offer novel insights into the management of respiratory symptoms and diseases.

Effects of residential greenness during pregnancy on childhood asthma, rhinitis, eczema, and their comorbidity: findings from the French mother-child cohort Pélagie

Maternal exposure to residential greenness during pregnancy may influence childhood respiratory and allergic diseases development. Yet, evidence is limited and results are not consistent, furthermore most studies focus on urban areas. In a predominantly rural population, we aimed to assess the effect of maternal residential greenness during pregnancy on childhood asthma, rhinitis, eczema, and their comorbidity. We analyzed data from 1325 to 1119 participants in the 6- and 12-year follow-ups of the Pélagie mother-child cohort in Brittany, France. Ever asthma, rhinitis, and eczema were defined using validated questionnaires, and a multimorbidity phenotype was constructed. Greenness was assessed using the Normalized Difference Vegetation Index (NDVI) within a 300m buffer around the residential address. Adjusted logistic regressions per 0.1-unit increase in NDVI were performed, further stratifying by urban and rural areas. At inclusion, 78 % of mothers were non-smokers, 64 % lived in rural areas, and their average age was 30 ± 4 years; 50 % of children were boys. Median NDVI differed significantly between urban (0.45) and rural (0.57) areas (p=<0.0001). Asthma, rhinitis, and eczema prevalence were respectively around 10 %, 20 %, and 20 % at both follow-ups. Overall, the NDVI within 300m did not show significant associations at either follow-up, across the whole study population, except for eczema (0.87 (0.76-1.00), p=0.05), and the single-disease category of the multimorbidity phenotype (0.87, (0.76-0.99), p=0.03) at 6 years, where it showed protective associations. Our findings highlight the need for further research, particularly in rural populations, to clarify the relationship between prenatal residential greenness and childhood health outcomes.

Barriers and facilitators to implementing pulmonary rehabilitation guidelines in China: a qualitative study using implementation science frameworks

OBJECTIVE

To understand barriers and facilitators to the implementation of pulmonary rehabilitation guidelines in pulmonary and critical care medicine (PCCM) from an interdisciplinary perspective and to determine potential contextual implementation strategies.

DESIGN

A qualitative study guided by the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF).

SETTING

Four departments of pulmonary and critical care medicine in China.

PARTICIPANTS

Forty-two healthcare professionals (12 physicians, 22 nurses, 4 rehabilitation therapists, 2 respiratory therapists, and 2 physiotherapists).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

We conducted semi-structured interviews with healthcare professionals. Transcripts of the semi-structured interviews were analysed using content analysis. Data were coded using a deductive approach. Identified factors influencing non-adherence and utilization of guidelines were then mapped to corresponding intervention strategies from the CFIR-Expert Recommendations for Implementing Change compilation (ERIC) database.

RESULTS

Our analysis revealed barriers and facilitators across three themes: opportunity and support, staff characteristics and motivating factors. Key barriers to guideline implementation encompassed environmental hindrances, guideline complexity and time restriction, poor interdisciplinary communication, lack of awareness, knowledge or skills, capability concerns, and vague professional roles. Potential facilitators included social support and peer influence, MOH policies, robust evidence base and contextual adaptability, planning, monitoring, feedback, autonomous motivation, sense of optimism, and positive outcome expectations of guideline adoption. Environmental restructuring, educational meeting and ongoing training, clinician implementation team meetings and electronic order sets/digital proforma may be needed to facilitate guideline implementation.

CONCLUSIONS

CFIR and TDF provided valuable frameworks for evaluating both contextual-level and individual-level facilitators and barriers to implementing pulmonary rehabilitation guidelines and understanding what adaptations may be needed to improve compliance. These would be essential to inform future interventions in the PCCM and contribute to optimize pulmonary rehabilitation management.