Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019

A computational fluid dynamics analysis of BiPAP pressure settings on airway biomechanics using a CT-based respiratory tract model

Central and Obstructive Sleep Apnea (CSA and OSA), Chronic Obstructive Pulmonary Disease (COPD), and Obesity Hypoventilation Syndrome (OHS) disrupt breathing patterns, posing significant health risks and reducing the quality of life. Bilevel Positive Airway Pressure (BiPAP) therapy offers adjustable inhalation and exhalation pressures, potentially enhancing treatment adaptability for the above diseases. This is the first-ever study that employs Computational Fluid Dynamics (CFD) to examine the biomechanical impacts of BiPAP under four settings: Inspiratory Positive Airway Pressure (IPAP)/Expiratory Positive Airway Pressure (EPAP) of 12/8, 16/6, and 18/8 cmH2O, compared to a without-BiPAP scenario of zero-gauge pressure. Utilizing a computed-tomography-based respiratory tract model from the nasal cavity extending to the 13th generation, we analyzed parameters such as static pressure, shear stress, and airway wall normal force across different airway regions. Our results indicate that BiPAP, particularly at higher IPAP settings, effectively increases static pressure, thereby improving airway patency and potentially reducing the risk of airway collapse in both CSA and OSA. Lower EPAP, on the other hand, helps reduce the work of breathing during exhalation, which is particularly useful for patients who have difficulty exhaling against higher pressures or need to exhale CO2 more effectively. This comparative analysis confirms that BiPAP not only maintains open airways but does so with an adjustable approach that can be used for the specific needs of patients with various respiratory dysfunctions, thereby offering a versatile and effective treatment option.

Lung ultrasound on first postoperative day predicts out-of-hospital pulmonary complications following video-assisted thoracic surgery: A prospective cohort study

BACKGROUND

The integration of enhanced recovery after surgery (ERAS) protocols into the peri-operative management of video-assisted thoracic surgery (VATS) has facilitated rapid patient recovery, enabling discharge within 48 h. However, postoperative pulmonary complications (PPCs) postdischarge pose significant concerns for patient welfare. Despite the established utility of lung ultrasound (LUS) in diagnosing the causes of dyspnoea, the effectiveness of quantitative LUS in predicting PPCs after VATS remains uncertain.

OBJECTIVES

To determine whether quantitative LUS performed 24 h after surgery can identify patients with a higher risk of developing PPCs within 30 days after discharge from hospital.

DESIGN

Single-centre prospective cohort study.

SETTING

Academic tertiary care medical centre.

PATIENTS

Adults scheduled for elective VATS under general anaesthesia from November 2022 to January 2023.

MAIN OUTCOME MEASURES

This primary aim was to verify the association between lung ultrasound score (LUSS) on postoperative day 1 (POD1) and PPCs. The secondary aim was to identify other relevant peri-operative factors closely related to PPCs and establish a model capable of predicting the risk of PPCs in patients undergoing fast-track VATS.

RESULTS

Of the 200 recruited patients, 182 completed the LUS examination and 30-day follow-up. Of these, 66 (36.2%) developed various types of PPCs. These patients had a higher LUSS on POD 1 ( P  < 0.001), and more subpleural consolidation areas compared to those without PPCs ( P  < 0.001). Receiver-operating characteristics (ROC) analysis identified the optimal LUSS cut-off value at 6 points for predicting the occurrence of PPCs, with an area under the curve (AUC) of 0.838 (95% CI, 0.768 to 0.909). Patients with PPCs had higher rates of immune system diseases and ARISCAT score, longer hospital stay and procalcitonin levels, increased frequency of lobar resection, longer durations of surgical and mechanical ventilation, and greater incidence of unplanned hospital readmissions within 30 days postdischarge, compared with those without PPCs (all P  < 0.001). Multivariable logistic regression analysis indicated that the comorbidity of immune system disease, along with postoperative 24 h LUSS, were independent risk factor for PPCs within 30 days after VATS.

CONCLUSION

LUSS on POD 1 emerged as an independent risk factor for PPCs in fast-track VATS patients and reliably predicted the occurrence of PPCs within 30 days of hospital discharge.

TRIAL REGISTRATION

ClinicalTrials. gov No. ChiCTR2200065865.

PTX 3 (pentraxin3) is associated with lung function among people with stable-stage smoking-related chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic respiratory illness. Pentraxin-3 (PTX3) is abnormally elevated in the plasma of patients with acute exacerbation of COPD. However, the role and significance of PTX3 in the clinical diagnosis of COPD remain unclear.

OBJECTIVES

This study was to explore the functional role of plasma PTX3 in COPD and its relationship with lung function metrics and influence on the severity of the disease.

METHODS

We prospectively recruited 170 patients with stable-stage COPD admitted to our hospital between June 2020 and May 2023 and healthy study participants as study participants. Based on their smoking history, all participants were classified into those with a history of smoking and those without a smoking history.

RESULTS

Stable-stage smoking-related COPD patients exhibited lower values for FEV1(% predicted) and reduced FEV1/FVC ratios, with increased values for smoking index, red cell distribution width, fibrinogen, d-dimer, white blood cell counts, neutrophil to lymphocyte ratio (NLR), Medical Research Council (mMRC) scores, COPD assessment test (CAT) score, and plasma PTX3 level. There was a positive correlation of PTX3 levels with mMRC and CAT scores and a negative correlation with FEV1 % predicted and FEV1/FVC. Increased smoking index and plasma PTX3 and NLR were independent risk factors for exacerbation in stable smoking-related COPD patients. The area under the curve (AUC) for plasma PTX3 in predicting severe COPD was 0.831.

CONCLUSIONS

A plasma PTX3 level > 246.2 ng/mL could be a valuable indicator for predicting exacerbations in patients with stable-stage smoking-associated COPD exacerbation.

Prediction of Hospital Readmission Using the CORE and CORE+ Scores in Persons With COPD

Background: Identifying persons with COPD at high risk for hospital readmission provides opportunities for efficient and appropriate care to lower readmission risk. This study examined 30-d and 60-d hospital readmission prediction of the COPD-readmission (CORE) score and a newly developed CORE+ score. The relationship between CORE and CORE+ scores and ICU admission, endotracheal intubation, and in-hospital noninvasive ventilation (NIV) use was explored. Methods: A retrospective cohort study evaluated participants with spirometry-confirmed COPD from 2 Midwestern academic hospitals. The CORE score variables included eosinophil blood count, FEV1/FVC (<0.70) and FEV1 (≤40% of predicted), triple inhaler therapy, previous hospitalization, and presence of neuromuscular disease. Out-of-hospital NIV use and Charlson comorbidity index were added to compose the CORE+ score. Researchers assessed associations between variables and outcomes with chi-square test or Fisher exact test, compared results of CORE and CORE+ scores with Wilcoxon signed-rank test, assessed each score's 30-d and 60-d readmission predictive power with multiple logistic regression, and evaluated predictive accuracy with AUC of receiver operating characteristic using alpha < 0.05. Results: Of 391 participants, the study found a 22% 30-d, all-cause readmission rate and a 16% 60-d, all-cause readmission rate. CORE+ score had better predictive accuracy than the CORE score for 30-d readmission (area under the curve 0.81 [95% CI 0.76-0.86]; AUC 0.73 [95% CI 0.66-0.79], P < .001) and 60-d readmission (AUC 0.77 [95% CI 0.71-0.83]; AUC 0.75 [95% CI 0.69-0.81], P < .001). Participants who used in-hospital NIV had higher median CORE+ scores (P = < .001). Conclusions: CORE and CORE+ scores demonstrated good to very good predictive accuracy for 30-d and 60-d readmission, respectively. Moreover, this study demonstrated a linear relationship between in-hospital NIV use and CORE+ score.

Age, period and cohort processes in chronic obstructive pulmonary disease related emergency department visit rate in Taiwan, 2001-2015

PURPOSE

Emergency room (ER) physicians must deal with patients with clinically suspected symptoms, such as dyspnea, cough, and increased sputum production, on the frontlines of medical care if patients present with severe chronic obstructive pulmonary disease (COPD). This study aims to investigate the longitudinal tendencies of COPD-related ER visits.

PATIENTS AND METHODS

A total of 360,313 patients were included in this study. The COPD-related ER visit rates between 2001 and 2015 were categorized using the International Classification of Disease (ICD) codes (496). The effects of age, period, and cohort on COPD-related ER visit rates were determined using an age-period-cohort (APC) model.

RESULTS

Age was associated with a high risk of COPD in the pediatric and older populations. A significant increase was observed in the period effect, from 2001 to 2015. The cohort effect tended to oscillate from 1918 to 1973, and was reversed in the latest cohort. Furthermore, the COPD-related ER visit rate increased between 2001 and 2015 in both men and women.

CONCLUSION

Age, period, and cohort were observed to increase COPD visit rates. The APC model can be used to determine trends in COPD-related ER visits.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Animal models of chronic obstructive pulmonary disease and their role in drug discovery and development: a critical review

INTRODUCTION

The use of laboratory animals is essential to understand the mechanisms underlying COPD and to discover and evaluate new drugs. However, the complex changes associated with the disease in humans are difficult to fully replicate in animal models.

AREAS COVERED

This review examines the most recent literature on animal models of COPD and their implications for drug discovery and development.

EXPERT OPINION

Recent advances in animal models include the introduction of transgenic mice with an increased propensity to develop COPD-associated features, such as emphysema, and animals exposed to relevant environmental agents other than cigarette smoke, in particular biomass smoke and other air pollutants. Other animal species, including zebrafish, pigs, ferrets and non-human primates, are also increasingly being used to gain insights into human COPD. Furthermore, three-dimensional organoids and humanized mouse models are emerging as technologies for evaluating novel therapeutics in more human-like models. However, despite these advances, no model has yet fully captured the heterogeneity and progression of COPD as observed in humans. Therefore, further research is needed to develop improved models incorporating humanized elements in experimental animals, that may better predict therapeutic responses in clinic settings and accelerate the development of new treatments for this debilitating disease.

Frequency of Exacerbations of Chronic Obstructive Pulmonary Disease Associated with the Long-Term Exposure to Air Pollution in the AIREPOC Cohort

Background

Exacerbations of chronic obstructive pulmonary disease (COPD-E) have been associated with levels of air pollution. The occurrence of COPD-E is associated with increased mortality in this population.

Purpose

To determine the association between long-term exposure to PM2.5 and NO2, and the frequency of COPD-E in patients belonging to AIREPOC, an institutional integrated care program for COPD in Bogota, Colombia.

Patients and Methods

Retrospective cohort study included patients with COPD living in Bogotá, between 2018 and 2021, who received health care in the AIREPOC program. Each patient´s home address was geolocated. Information from local air quality network stations was used to estimate daily and annual mean PM2.5 and NO2 exposure level for each patient using the inverse distance squared weighted regression (IDWR) method. The effect of PM2.5 and NO2 concentrations categorized at 15 µg/m3 and 25 µg/m3 respectively on the frequency of COPD-E was estimated using a zero-truncated negative binomial model adjusted for potential confounders. Goodness-of-fit was assessed by residuals.

Results

During the observation period, 580 COPD-E occurred in 722 patients. Significant associations were found between COPD-E and NO2 concentrations ≥25 µg/m3 (incidence density ratio, RDI: 1.29, 95% CI: 1.02-1.67) after adjustment for sun exposure, COPD severity, depression, and ambient humidity. No association was found between the frequency of COPD-E and PM2.5 concentrations ≥15µg/m3.

Conclusion

Prolonged exposure to high levels of NO2 increases the frequency of COPD exacerbations in patients residing in Bogotá. These results highlight the importance of strengthening air quality control measures and educating people with COPD to know and interpret the local air quality indices and to follow the recommendations derived from its alterations.

Identification of Five NK Cell-Related Hub Genes in COPD Using Single-Cell RNA Sequencing Analysis

Background

COPD is a healthcare problem. However, the underlying mechanism remains unclear. Our study aimed to explore the key genes involved in immune infiltration in COPD using bioinformatic tools.

Methods

In this study, scRNA-seq analysis was utilized to explore specific marker genes of each immune cell subtype in COPD. TSNE analysis was used to evaluate the relationship between each immune cell cluster. Lasso regression identified 21 genes as characteristics of COPD modulated by the single-cell NK cell subpopulation. The "limma" package was used for differentially expressed analysis. The pseudotime analysis reveals the continuous changes of NK cells along their developmental trajectory. Further, we constructed a hub gene network to examine the correlation between hub genes and immune factors, transcriptional regulation factors, and potential therapeutic drugs. GO and KEGG enrichment analysis revealed the biological functions of the hub genes. RT-qPCR was used for validation of the five hub in COPD patients.

Results

NK cell subtypes are closely related to other immune cell subtypes and considered as the most important immune cells in the immune microenvironment of COPD patients. LASSO regression identified 21 genes as NK cells-characteristic genes for COPD. The GSE57148 as the training set has a AUC of 0.9489 and GSE8581 as the validation set has a AUC of 0.7303. The GO semantic similarity further confirmed five NK cell-related hub genes, C1orf56, S100A6, IGFBP7, ANXA1, and PTPN7. RT-qPCR experiment revealed that the mRNA expression of five hub genes in the normal group was lower than that in the disease group. We also found that five hub genes correlated with immune cell infiltration. The potential therapeutic agents for COPD may be zalcitabine, PP-2, PD-98059, and TGX-221 based on the CMap database prediction.

Conclusion

We proposed that peripheral NK cells may play a role in the pathogenesis of COPD through bioinformatic analysis. These hub genes may provide insights into mechanistic research and new targets for new therapies in patients with COPD.

Inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review and meta-analysis on mortality protection - making a long story short

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide, primarily due to persistent airflow limitation from tobacco and biomass smoke exposure. While inhaled corticosteroids (ICS) combined with long-acting bronchodilators, namely long-acting β2-adrenoreceptor agonists (LABA) and long-acting muscarinic antagonists (LAMA), are recommended for symptom control and exacerbation reduction, their effect on mortality remains uncertain. Recent randomized controlled trials (RCTs) suggest potential mortality benefits with triple ICS/LABA/LAMA therapy, though findings are not definitive.

METHODS

We conducted a systematic review and network meta-analysis (NMA) to evaluate the impact of ICS-containing therapies on all-cause mortality in COPD. Searches were performed across ClinicalTrials.gov, Cochrane Library, EMBASE, MEDLINE, and SCOPUS, focusing on RCTs measuring mortality as an efficacy outcome.

RESULTS

A total of 42,784 COPD patients from five high-quality studies were included. Pairwise meta-analysis showed a significant reduction in all-cause mortality with ICS-containing therapies (RR 0.80, 95% CI 0.68-0.95), particularly with ICS/LABA and ICS/LABA/LAMA combinations. The NMA ranked ICS/LABA/LAMA as the most effective treatment (SUCRA 0.89).

CONCLUSIONS

This study provides compelling evidence that ICS-containing therapies, particularly triple therapy, significantly reduce all-cause mortality in COPD patients. Future research should identify patient subgroups most likely to benefit while minimizing adverse effects.

REGISTRATION

PROSPERO registration ID: CRD42024607568.

Protective effect of Astragaloside II against lung injury in COPD based on mTORC1/GSK-3β signaling pathway

BACKGROUND

Astragaloside II (AST II) is one of the principal bioactive components of Astragalus mongholicus Bunge, exhibiting multiple pharmacological properties. However, the therapeutic efficacy of AST II in Chronic Obstructive Pulmonary Disease (COPD) remains to be fully elucidated. The study explored the effects and mechanisms of AST II in a COPD model induced by exposure to cigarette smoke (CS) and lipopolysaccharide (LPS) in mice.

METHODS

An animal model of COPD was established by intratracheal instillation of LPS and cigarette smoking in mice. Serum samples were collected to determine inflammatory cell infiltration and cytokine levels. Lung tissues were collected for histological, immunofluorescence and Western blot analysis. The RAW264.7 macrophage cell line was employed to investigate the molecular mechanism of AST II in vitro.

RESULTS

Lung dysfunction, histopathological damage, inflammatory infiltration, and pro-inflammatory factors secretion in COPD mice induced by CS and LPS were mitigated by AST II. AST II exerted an anti-inflammatory effect by enhancing the activation of the mammalian target of rapamycin complex 1 (mTORC1)/glycogen synthase kinase-3β (GSK-3β) signaling pathway, which promoted the binding of CREB-binding protein (CBP) to CREB, thereby antagonizing the binding to nuclear factor-κB (NF-κB) and inhibiting its transcriptional activity. However, AST II did not demonstrate a protective effect against LPS-induced inflammatory damage to RAW264.7 cells when mTORC1 was inhibited by rapamycin.

CONCLUSION

AST II exhibits potential therapeutic benefits as an alternative medication for COPD and other respiratory inflammatory conditions since it may reduce lung injury and inflammatory response in mice exposed to CS and LPS.

Lung Function as a Biomarker for Glaucoma: The UK Biobank Study

Purpose

To investigate the associations of lung function with glaucoma and related traits, explore the interactions between glaucoma genetic risk and lung function, and assess the causal relationships using Mendelian randomization (MR).

Methods

This cross-sectional study involved 85,369 participants with lung function measurements at baseline from the UK Biobank. Associations between lung function parameters and glaucoma and related traits were tested by multivariable logistic and linear regression. Two-sample MR analyses were conducted using summary statistics from large genetic datasets.

Results

Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC ratio were inversely associated with glaucoma, with the lowest quartiles conferring odds ratios (ORs) of 1.51 (95% confidence interval [CI], 1.31-1.74; P = 7.6 × 10-8), 1.58 (95% CI, 1.37-1.81; P = 4.7 × 10-10) and 1.20 (95% CI, 1.08-1.34; P = 0.002), respectively, compared with the highest quartiles (P trends < 0.001 observed for each). Similar associations were found for impaired lung function (FEV1 <80% Global Lung Initiative predicted FEV1: OR, 1.22, 95% CI, 1.11-1.33; P = 1.2 × 10-5; FEV1/FVC <0.7: OR, 1.13, 95% CI, 1.03-1.24; P = 0.01). Lower lung function was associated with lower intraocular pressure (IOP), thinner macular retinal nerve fiber layer thickness, and thinner ganglion cell-inner plexiform layer thickness. No interactions were observed between glaucoma genetic risk and lung function. MR analyses did not suggest causal relationships.

Conclusions

Lower FVC, FEV1, FEV1/FVC, and impaired lung function are potential biomarkers for glaucoma risk. These findings may facilitate clinical strategies for glaucoma management, particularly for individuals with impaired lung function.

Glittre-ADL tests in three laps as an alternative to the five laps test

BACKGROUND

The Glittre-ADL test is a comprehensive test to evaluate functional capacity in patients with chronic obstructive pulmonary disease (COPD).

AIM

The primary aim was to validate the Glittre-ADL test with and without the backpack performed in three laps as an alternative to five laps in people with COPD.

METHODS

Forty-eight participants with mild to severe COPD (mean ± SD age: 71 ± 7 years; FEV1: 46 ± 17 %predicted) were recruited and performed two 6-min walk tests (visit 1); two Glittre-ADL tests with backpack (visit 2), and the Glittre-ADL test with and without the backpack, in random order (visit 3).

RESULTS

The Glittre-ADL tests were performed in five laps and symptoms, heart rate and oxygen saturation were recorded for three and five laps. The Glittre-ADL test performed in three laps provoked the same oxygen desaturation [mean ± SD oxygen saturation (SpO2): 90 ± 6 vs 90 ± 6, p = 0.249] and rate of perceived exertion (RPE) [RPE legs: 2.91 ± 2.23 vs 3.08 ± 2.56, p = 0.380; RPE arms: 1.91 ± 1.77 vs 2.16 ± 1.92, p = 0.306] to the Glittre-ADL test performed in five laps for both Glittre with the backpack and without the backpack SpO2 [mean ± SD: 90 ± 6 vs 90 ± 7, p = 0.249], and RPE [legs: 3.02 ± 2.28 vs 3.25 ± 2.37, p = 0.380; arms: 2.13 ± 1.91 vs 2.03 ± 1.84, p = 0.306]. The heart rate and dyspnoea were significantly lower for both Glittre-ADL tests performed in three laps.

CONCLUSION

The 3-lap Glittre-ADL test may be a more practical alternative to the 5-lap test, while still remaining a good test of functional capacity for activities of daily living.

Inpatient Complication Rates of Bronchoscopic Lung Volume Reduction in the United States

BACKGROUND

Early randomized controlled trials (RCTs) of bronchoscopic lung volume reduction (BLVR) have shown clinically meaningful benefits in lung function, dyspnea, and quality of life in patients with severe emphysema. Safety outcome data obtained after BLVR in the United States are scarce outside the RCTs.

RESEARCH QUESTION

What is the rate of inpatient complications after BLVR in the real world in the United States?

STUDY DESIGN AND METHODS

We used the National Inpatient Sample database to identify in-hospital complications after BLVR from 2018 through 2020. Complications were defined as pneumothorax, COPD exacerbation, pneumonia, hemoptysis, acute respiratory failure, and valve removal. We also analyzed all-cause in-hospital mortality and length of stay (LOS).

RESULTS

We identified 467 admissions related to BLVR procedures. The number of procedures doubled between 2019 and 2020 (from 153 to 295 procedures). The median age was 67.9 years (interquartile range, 61.1-72.8 years), 210 patients (45.0%) were female, 401 patients (85.8%) were White, and Medicare was the primary expected payer for 72.8% of patients. Most procedures were performed in urban teaching hospitals (56.9%). The rate of pneumothorax was 26.3%, that of acute respiratory failure was 19.5%, that of COPD exacerbation was 8.8%, that of pneumonia was 7.3%, and that of hemoptysis was 5.3%. Chest tube placement was required in 84 of 123 patients (68.3%) with pneumothorax. The endobronchial valve had to be removed in 69 patients (14.8%). The median LOS was 2.8 days (interquartile range, 2.3-4.5 days). The number of in-hospital deaths was fewer than 11 (< 2.3%). Overall, the subgroup who experienced in-hospital complications did not differ significantly from the others in terms of comorbidities, demographics, and hospital characteristics.

INTERPRETATION

We found that the real-world complication rate after BLVR was similar to the published complication rates from early randomized clinical trials. In-hospital mortality was low, suggesting that aside from the commonly anticipated complications, BLVR is a safe treatment option for severe emphysema.

The relationship between fatigue levels and psychosocial adjustment in elderly individuals with chronic obstructive pulmonary disease: A descriptive study

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) is associated with physical limitations and significant social, psychological, and behavioral challenges. This study investigates the relationship between fatigue levels and psychosocial adjustment in COPD patients, considering their sociodemographic characteristics.

METHODS

A descriptive study was conducted with 160 COPD patients hospitalized in the Pulmonology Department of a university hospital. Data were collected via face-to-face interviews using a patient information form, the COPD and Asthma Fatigue Scale (CAFS), and the Psychosocial Adjustment to Illness Scale-Self-Report (PAIS-SR). Statistical analyses included Independent Sample t-test, One-Way ANOVA, Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation analysis, with significance set at p < 0.05.

RESULTS

The mean age of participants was 68.70 ± 9.41 years; 71.9% were male, and 67.9% had COPD for over six years. Most participants (74.4%) reported limitations in daily living activities due to the disease, and 91.9% reported having social support. Mean scores were 58.03 ± 15.80 on the CAFS and 64.19 ± 6.41 on the PAIS-SR. Significant differences were observed in fatigue and psychosocial adjustment scores based on gender, social support, and disease impact on daily activities (p < 0.05). A weak positive correlation was found between fatigue levels and psychosocial adjustment (p < 0.05).

CONCLUSIONS

COPD patients experience moderate-to-high fatigue levels and challenges in psychosocial adjustment, with fatigue negatively influencing adjustment. Interventions should focus on enhancing coping strategies, addressing psychosocial needs, and leveraging social support systems to improve patient outcomes.

Pulmonary rehabilitation under supervision of health-professional at institute versus conventional exercise-based pulmonary rehabilitation at home in COPD patients: A longitudinal cohort study

OBJECTIVES

To evaluate the efficacy and safety of pulmonary rehabilitation under the supervision of health professionals at the institute versus conventional exercise-based pulmonary rehabilitation at home in Chronic Obstructive Pulmonary Disease (COPD) patients.

METHODS

Patients of COPD received pulmonary rehabilitation under the supervision of a professional at the institute (PI cohort, n = 115) or self-driven traditional Chinese methods-based pulmonary rehabilitation at home (CE cohort, n = 127) or did not receive any type of pulmonary rehabilitation (ME cohort, n = 155). All patients received inhaled pharmacological treatment for COPD.

RESULTS

Before commencing inhaled pharmacological treatment with or without pulmonary rehabilitation (BT) COPD patients had 5 (5-4) / patient BODE (body-mass index, airflow obstruction, dyspnea, and exercise capacity) index score and 12 (13-12) / patient exacerbations (in 6-months) reported. After 6 months of inhaled pharmacological treatment for COPD with or without pulmonary rehabilitation (AT), a six-minute walking test was improved and the BODE index score and exacerbations during 6 months were decreased for patients of the PI cohort as compared to BT conditions and compared to those of the CE and ME cohorts in AT conditions (p < 0.05 for all). Patients of PI, CE, and ME cohorts had the risk of under treatment for <0.01 BODE index score, <1.32 BODE index score, and <3.14 BODE index score, respectively.

CONCLUSIONS

Chinese patients with COPD have worse clinical conditions. After 6 months of inhaled pharmacological treatment for COPD with pulmonary rehabilitations at institutes improves the conditions of COPD patients.

Development and Validation of a Quantitative Score for the Criteria Clinical Control in Stable COPD Proposed in the Spanish COPD Guidelines (GesEPOC): Results of the EPOCONSUL Audit

Introduction/Objective: the concept of clinical control of COPD is a measure proposed in the Spanish COPD Guidelines (GesEPOC), which aims to help clinicians assess the clinical status in order to adapt the treatment plan at follow-up. However, studies that have evaluated clinical practice reveal that the degree of control of COPD is not always assessed, which underlines the need to promote its assessment through a scoring system. To develop a scoring system that quantitatively assesses the validated criteria defining the degree of COPD control. Methods: this study used data from the EPOCONSUL audit in respiratory clinics across Spain. We included in this analysis all patients with a COPD clinical control grade estimated and reported by the physician at the visit, who had registered the criteria necessary to define the degree of clinical control validated and established in GesEPOC. Patients were randomly assigned to either the development or validation cohorts. The development cohort included 485 patients and the validation cohort included 341 patients. Score modelling was conducted using a multivariate logistic regression model, and calibration of the model and score was assessed using the Hosmer-Lemeshow goodness-of-fit test and GiViTi Calibration belts. The model and generated score's discrimination capacity were analyzed by calculating the Area Under the Curve (AUC). Results: the scoring system was developed using four criteria as predictors of poor clinical control of COPD reported by the treating physician:adjusted dyspnoea severity, use of rescue inhaler more than three times per week, walking less than 30 min per day, and COPD exacerbations in the last three months. The scoring system attributed scores from 0 to 8. Calibration was satisfactory in both development and validation cohorts, and the score's discrimination power, as indicated by the AUC, was 0.892. Conclusions: this scoring system provides an easy-to-use quantitative assessment of clinical control of COPD that we believe will help to measure COPD control and its evolution during patient follow-up. Future research will be needed to prospectively evaluate this score as a predictor of outcome.

Assessing the Clinical and Functional Status of COPD Patients Using Speech Analysis During and After Exacerbation

Background

Chronic obstructive pulmonary disease (COPD) affects breathing, speech production, and coughing. We evaluated a machine learning analysis of speech for classifying the disease severity of COPD.

Methods

In this single centre study, non-consecutive COPD patients were prospectively recruited for comparing their speech characteristics during and after an acute COPD exacerbation. We extracted a set of spectral, prosodic, and temporal variability features, which were used as input to a support vector machine (SVM). Our baseline for predicting patient state was an SVM model using self-reported BORG and COPD Assessment Test (CAT) scores.

Results

In 50 COPD patients (52% males, 22% GOLD II, 44% GOLD III, 32% GOLD IV, all patients group E), speech analysis was superior in distinguishing during and after exacerbation status compared to BORG and CAT scores alone by achieving 84% accuracy in prediction. CAT scores correlated with reading rhythm, and BORG scales with stability in articulation. Pulmonary function testing (PFT) correlated with speech pause rate and speech rhythm variability.

Conclusion

Speech analysis may be a viable technology for classifying COPD status, opening up new opportunities for remote disease monitoring.

The use of the Prospector calculator reduces antibiotic therapy in exacerbations of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) exacerbations frequently cause patient consultations in both out- and inpatient settings. Recent data suggest that only 40-60% of exacerbations are of bacterial origin and mandate antibiotic treatment. However, a reliable tool to justify prescribing antibiotics for COPD exacerbation is still lacking. This study was designed to explore the hypothesis that utilization of a novel decision-making tool called Prospector would lead to lower consumption of antibiotics and provide a more rational approach to managing COPD exacerbations versus standard therapy in patients with COPD. The study included 77 COPD patients who experienced a COPD exacerbation and were treated in outpatient settings. The Prospector group (PG) (n = 40) were treated by the study author using the Prospector calculator (a tool designed by the first author that translates: patient symptoms, exacerbation, and medical history of COPD into a decision on the use of antibiotics in COPD exacerbation treatment). Other primary care specialists treated the control group (CG) (n = 37) in the same outpatient clinic; antibiotic therapies were implemented at the physician's discretion, most often using Anthonisen's criteria. All other medications were administered at the physician's discretion. Safety endpoints were set as: death, hospitalization, and number of exacerbations. Antibiotics were administered in 32.8% and 81.2% of exacerbations in the PG and CG, respectively (p < 0.0001). A comparable percentage was verified positively in both PG patient subsets: those that did and did not receive antibiotics at visit 1 (94.7% and 94.9%, respectively). Twenty-eight patients in the PG and 37 in the CG were followed for up to 35 months. Failure to recover (defined as deterioration or lack of improvement) in 30 days following exacerbation was 10.7% in the PG and 47.2% in the CG. In the CG, the failure rate was significantly higher (p = 0.0043). Hospitalization rates in the PG and the CG were 42.9% and 94.4%, respectively. In the CG, the hospitalization rate was significantly higher (p < 0.0001). COPD hospitalization rates in the PG and the CG were 17.9% and 33.3%, respectively (p = 0.1643). This preliminary study suggests that using the Prospector calculator results in markedly reduced antibiotic prescription for COPD exacerbations. No new safety signals have been identified for the method.

Association between lipid accumulation product and chronic obstructive pulmonary disease: a cross-sectional study based on U.S. adults

Background

Lipid Accumulation Product (LAP), which is derived from measurements of waist circumference and triglyceride (TG) levels, serves as a comprehensive indicator of lipid accumulation. Emerging research indicates that lipid accumulation dysfunction might significantly contribute to the pathogenesis of Chronic Obstructive Pulmonary Disease (COPD). Nevertheless, the investigation into the association between LAP and COPD risk is still insufficient, particularly in population-based research. This research intends to examine the possible correlation between LAP and the likelihood of developing COPD.

Methods

This study, designed as a cross-sectional analysis, made use of data gathered from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2017 to 2020, encompassing a total of 7,113 eligible participants. LAP, the exposure variable, was calculated using waist circumference and triglyceride concentration. COPD diagnosis was determined using participants' self-reported information. To explore the association between LAP and COPD, multivariate logistic regression models were applied, and smoothing curve fitting was employed to examine any potential nonlinear patterns. Further analysis included stratified subgroup evaluations to assess how variables such as sex, smoking habits, and alcohol intake might impact the relationship between LAP and COPD.

Results

The findings indicated a significant increase in COPD risk with each one-unit rise in ln LAP, as evidenced by an Odds Ratio (OR) of 1.16 [95% Confidence Interval (CI): 1.04-1.30, p < 0.01]. Furthermore, a quartile-based analysis revealed that individuals in the highest ln LAP category had a considerably higher likelihood of developing COPD compared to those in the lowest category, with an OR of 1.35 (95% CI: 1.04-1.75, P for trend <0.01). Furthermore, the smoothing curve fitting identified a nonlinear and positive association between ln LAP and COPD, suggesting a steeper increase in risk as ln LAP values rise. Subgroup analysis suggested that this association remained fairly consistent across various demographic groups.

Conclusion

This study found a significant link between higher LAP levels and an elevated risk of COPD, with the association displaying a nonlinear pattern. As a marker of lipid accumulation abnormalities, LAP may serve as a valuable tool for assessing COPD risk and could inform strategies for early identification and targeted clinical management.

Wnt3a Enhances Mesenchymal Stem Cell Engraftment and Differentiation in a Chronic Obstructive Pulmonary Disease Rat Model

Background

Bone marrow mesenchymal stem cell (BMSC) therapy is a novel approach for treating COPD. However, the difficulty in engraftment and easy clearance of BMSCs in vivo has hindered their clinical application. Hence, exploring effective methods to improve the engraftment and differentiation rates of BMSCs in vivo is urgent.

Methods

We constructed BMSCs overexpressing Wnt3a by lentivirus infection and transplanted them into a COPD rat model. The damage level of COPD rat lung tissue was assessed by pathology analysis and inflammatory cytokines analysis. The engraftment of BMSC was detected by immunofluorescence staining. Statistical analysis was performed using GraphPad Prism 7.

Results

We found that Wnt3a significantly enhanced the engraftment rate of BMSCs in the lungs of rats and further increased their differentiation rate into type II alveolar epithelial cells. We also assessed the expression of inflammatory factors in the lung tissues of COPD rats and discovered that Wnt3a reduced the levels of the inflammatory factors IL-6 and IL-1β while increasing the level of the anti-inflammatory factor IL-10. Our study demonstrates that Wnt3a can improve the engraftment and differentiation rates of BMSCs in the host and further alleviate COPD symptoms by regulating the secretion of inflammatory factors.

Conclusion

Constructing BMSCs overexpressing Wnt3a could serve as a new strategy for stem cell therapy in COPD.

Peripheral Blood NMLR Can Predict 5-Year All-Cause Mortality in Patients with Chronic Obstructive Pulmonary Disease

Background

Chronic obstructive pulmonary disease (COPD) is characterized by pulmonary and systemic inflammation. The peripheral blood (neutrophil + monocyte)/lymphocyte ratio (NMLR) can predict the clinical outcomes of several inflammatory diseases. However, its prognostic value in COPD remains unknown.

Methods

This retrospective study included 870 patients with COPD due to acute exacerbation, and the 5-year all-cause mortality of these patients was recorded. The Kaplan-Meier method was used to compare the mortality risk of these patients according to their NMLR value. Multivariable COX hazard regression and restricted cubic spline model were used to assess the relationship between the NMLR and 5-year all-cause mortality of patients with COPD.

Results

The NMLR values of non-surviving patients with COPD were significantly increased compared to the survivors [3.88 (2.53-7.17) vs 2.95 (2.08-4.89), P=0.000]. The area under the NMLR receiver operating characteristic curve for predicting the 5-year all-cause mortality of COPD patients was 0.63. Kaplan-Meier survival curves showed that the 5-year all-cause mortality of COPD patients was significantly increased when the admission peripheral blood NMLR was ≥ 5.90 (27.3% vs 12.4%, P=0.000). The COX regression model showed that NMLR was an independent predictor of 5-year all-cause mortality in COPD patients (hazard ratio=1.84, 95% confidence interval: 1.28-2.64, P=0.001). Moreover, the restricted cubic spline model showed a non-linear relationship between NMLR and COPD death risk (Pnon-linear < 0.05).

Conclusion

The admission peripheral blood NMLR is a significant predictor of 5-year all-cause mortality in patients with COPD, and high NMLR values may indicate a poor clinical prognosis.

Circulating visfatin concentrations in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis

Objective

The current study was designed with the aim of conducting a systematic review and meta-analysis to determine the circulating levels of visfatin in patients with chronic obstructive pulmonary disease (COPD) compared to healthy individuals.

Methods

Until March 2024, we searched the Web of Science, PubMed/Medline, and Scopus databases. The analysis included case-control studies assessing the association between circulating visfatin and COPD. The random effects model was utilized to analyse the results with the help of Standard Mean of Differences (SMD) and 95% confidence interval (CI). The heterogeneity of the data was assessed using Cochrane Q and I2 values.

Results

Seven studies were eligible to be included in the meta-analysis, with the COPD and healthy (control) groups having 265 and 244 subjects, respectively. The pooled results showed that although the circulating concentration of visfatin was lower in patients with COPD, no significant difference was observed (SMD: -0.48 mg/L; 95% CI: -1.67 to 0.70; p = 0.43). Subgroup analysis revealed that visfatin levels were significantly reduced in FEV1 less than 50% (p < 0.001) and in GOLD grade I-II (p < 0.05). Visfatin was shown to be significantly associated with IL-6 (p < 0.001) and TNF-α (p < 0.01) in the correlation meta-analysis. Meta-regression analysis revealed a significant correlation between the pooled SMD visfatin and pooled SMD age (p < 0.01), BMI (p < 0.001), FEV1 (p < 0.001), and IL-6 (p < 0.001).

Conclusion

The findings showed an insignificant decline in visfatin level among COPD patients, but additional research is necessary due to the heterogeneity in study results.

Systematic review registration

PROSPERO (CRD42023450851), https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023450851.

Factors related to the progression of chronic obstructive pulmonary disease: a retrospective case-control study

OBJECTIVES

To explore the factors related to the progression of chronic obstructive pulmonary disease (COPD).

METHODS

80 COPD patients treated between January 2020 and December 2022. The patients' pulmonary functions at their first hospital admission were categorized into four groups: Grade I, Grade II, Grade III and Grade IV. Each group was further divided into a progression group and a non-progression group based on the disease progression over one year or several years of follow-up. Patients with other respiratory diseases, malignant tumors, severe heart, kidney, liver dysfunctions, or immune deficiencies affecting the prognosis were excluded. General information, clinical data, treatment data, and statistical analysis of the patients.

RESULTS

In comparison with the non-progression group, the progression group had significantly higher age, smoking behavior, COPD history, hemoptysis history, CRP levels, IL-6 levels, and Pneumonia Severity Index (PSI) scores, exhibiting significantly lower FEV1, FEV1% predicted, PaO2, and PaCO2. More frequent use of antibiotics, corticosteroids, oxygen therapy, and mechanical ventilation were observed in the progression group than that in the non-progression group (P < 0.05). As a consequence, the progression group had a worse prognosis as indicated by higher hospitalization costs, longer hospital stay, and higher rate of acute exacerbations than the non-progression group (P < 0.05). Multifactorial logistic regression analysis showed that age ≥ 65 years, PSI score ≥ 130 points, and multidrug-resistant bacteria infection were independent risk factors for the progression of COPD (P < 0.05).

CONCLUSIONS

Older COPD patients, higher PSI score, and multidrug-resistant bacteria infection have a worse prognosis and need more intensive treatment and follow-up.

Protective effects of statins on pulmonary function in patients with persistent hyperlipidemia: a retrospective cohort study

BACKGROUND

Pulmonary function tests offer crucial parameters for evaluating lung health and predicting clinical outcomes. Hyperlipidemia, a prevalent metabolic disorder, has been linked to declining pulmonary function. Statins are an essential therapy for lowering lipid levels in hyperlipidemia.

OBJECTIVES

This study aims to investigate the therapeutic potential of statins in mitigating the decline in pulmonary function.

DESIGN

This is a retrospective cohort study.

METHODS

Out of 8286 patients who underwent spirometry testing from January 2018 to December 2020, 492 patients were included in the final analysis. The relationship between statin usage, dosage, along with other biometric indices and spirometry parameters were evaluated. Multivariate logistic regression analyses were employed to assess the association between statin use and the decline in pulmonary function.

RESULTS

In patients with persistent hyperlipidemia, the use of statins was associated with a higher predicted percentage of forced expiratory volume in 1 second (FEV1) compared to non-users (84.0% vs 78.0%, p = 0.015). Logistic regression models further revealed that statin use independently prevented FEV1 decline, irrespective of dosage (adjusted OR 0.036, 95% CI: 0.002-0.618 in lower statins dose group and adjusted OR 0.170, 95% CI: 0.019-1.552 in higher statins dose group).

CONCLUSION

The findings suggested that statin usage, regardless of dosage, independently mitigated the decline in pulmonary function among patients with persistent hyperlipidemia. Early initiation of statin therapy may hold promise for individuals experiencing hyperlipidemia and declining pulmonary function.

Heart failure associated with chronic Chagas cardiomyopathy increases the risk of impaired lung function and reduced submaximal functional capacity

BACKGROUND

With the evolution of chronic Chagas cardiomyopathy (CC) and the progression towards heart failure (HF), patients may show a decline in inspiratory muscle strength, lung function, and functional capacity.

OBJECTIVE

We compared respiratory function and submaximal functional capacity in patients with CC with versus without HF.

METHODS

This observational, cross-sectional study was carried out with CC patients divided into CCG, a group without HF (n = 28), and HFG, a group with HF (n = 27). Spirometry (percent predicted forced vital capacity (ppFVC), forced expiratory volume in one second of FVC (ppFEV1), forced expiratory flow between 25 % and 75 % of FVC (ppFEF25-75%), and maximum voluntary ventilation (ppMVV)) and submaximal functional capacity (six-minute step test: 6MST) were evaluated. Mann-Whitney (comparison of pulmonary function and functional capacity between groups) and linear regression (association between the presence of HF and other variables) were performed.

RESULTS

We included 55 participants, with median age of 67 years (56.25-71.75) and 54.55 % males. Dyslipidemia was the most recurrent comorbidity (49.09 %). HFG presented lower ppFVC (P = 0.000), ppFEV1 (P = 0.011), ppFEF25-75% (P = 0.017), and ppMVV (P = 0.003) than the CCG. The ppFVC (B = -18.95; P = 0.000), ppFEV1 (B = -16.29; P = 0.021), ppFEF25-75% (B = -19.57; P = 0.014), ppMVV (B = -16.59; P = 0.003), and 6MST (B = -17.13; P = 0.034) were negatively associated with the presence of HF.

CONCLUSION

Our data suggest that impaired lung function, compatible with a restrictive pulmonary pattern, is present among adults with CC and HF.

Chronic obstructive pulmonary disease's eosinophilic phenotype: Clinical characteristics, biomarkers and biotherapy

COPD is a chronic, heterogeneous inflammatory disorder of the airways with persistent and poorly reversible airflow limitation, causing symptoms such as cough, shortness of breath, and sputum production. Despite optimal treatment, some patients remain symptomatic due to the disease's heterogeneity, manifesting in various phenotypes. One notable phenotype involves eosinophilic inflammation, with a variable prevalence. Identifying eosinophilic phenotypes is crucial for tailored therapeutic strategies, as they respond favorably to corticosteroids and potentially biologics. Recent advances in both clinical trials and spontaneous research have helped understand the biological and clinical characteristics of this phenotype, although no universal consensus has been reached yet on the definition of the cut-off values of the eosinophil peripheral blood count. Moreover, there is evidence of novel emerging biomarkers which might go beyond the sole eosinophil count, while significant advancements in terms of pharmacological treatment have been made, with dupilumab being the first biological drug being licensed for COPD patients with elevated circulating eosinophils in the stable phase. In light of the above, although several papers have been written on the relationship between eosinophils and COPD, in the present work we endeavored to summarize and discuss the pivotal literature findings regarding the eosinophilic COPD in order to help define the biological and clinical features of this peculiar phenotype, with particular attention to the use of established and emerging biomarkers, as well as current and future therapeutic perspectives.

Predictors of pulmonary embolism in chronic obstructive pulmonary diseases patients admitted for worsening respiratory symptoms: An individual participant data meta-analyses

BACKGROUND

Pulmonary embolism (PE) and acute exacerbation of chronic obstructive pulmonary disease (COPD) have similar clinical symptoms, making PE diagnosis challenging. Previous studies have shown that the prevalence of PE among COPD patients admitted with worsening respiratory symptoms was not negligible, but that systematic search for PE did not provide a clinical benefit. Predictive factors for PE remain unknown.

OBJECTIVE

to identify predictive factors for PE among COPD patients with worsening respiratory symptoms.

METHODS

We conducted an individual participant data meta-analysis which included the patients from the prospective PEP cohort and those randomized to the intervention arm in the SLICE trial which included a systematic search for PE in COPD patients admitted for worsening respiratory symptoms. Univariable and multivariable analysis were used to assess factors associated with the diagnosis of PE during the initial management.

RESULTS

Among 1110 COPD patients, PE was diagnosed in 61 (5.49 %; 95 %CI 4.15 %-6.84 %). In univariable analysis, BNP (Brain natriuretic peptide) (odds ratio [OR] 1.02 per 100 ng/L increase, 95 %CI 1.01-1.04), prothrombin time (OR 0.78, 95 %CI 0.65-0.94), fibrinogen (OR 0.80, 95 %CI 0.64-0.98), atrial fibrillation (OR 4.74, 95 %CI 1.84-10.80), respiratory rate ≥30 min (OR 2.34, 95 %CI 1.13-4.6) and recent medical immobilization (OR 1.79, 95 %CI 0.99-3.13]) were associated with the risk of PE diagnosed during the initial management. In multivariable analysis, respiratory rate ≥30 (OR 2.77, 95 %CI 1.08-6.71) was a predictive factor for PE, as well as BNP (OR 1.02, 95 %CI 1.00-1.05) with an area under the curve =0.64, negative predictive value =0.15 (95 %CI 0.09-0.23), sensitivity =0.78 (95 %CI 0.74-0.82) and specificity =0.46 (95 %CI 0.29-0.63).

CONCLUSION

Among patients with COPD admitted for worsening respiratory symptoms, respiratory rate and BNP levels are predictor of PE, but with limited discriminatory power.

Efficacy and safety of tezepelumab versus placebo in adults with moderate to very severe chronic obstructive pulmonary disease (COURSE): a randomised, placebo-controlled, phase 2a trial

BACKGROUND

Tezepelumab is a human monoclonal antibody that blocks thymic stromal lymphopoietin, which has shown increased expression in patients with chronic obstructive pulmonary disease (COPD) compared with healthy individuals. We aimed to assess the efficacy and safety of tezepelumab in patients with moderate to very severe COPD despite receiving triple inhaled therapy.

METHODS

COURSE was a double-blind, randomised, placebo-controlled, phase 2a trial across 90 sites in ten countries in Asia, Europe, and North America. Eligible participants were aged 40-80 years, had moderate to very severe airflow limitation, were receiving triple inhaled maintenance therapy, and had at least two moderate to severe COPD exacerbations in the 12 months before enrolment. Patients were randomly assigned (1:1) to receive tezepelumab 420 mg or placebo subcutaneously every 4 weeks for up to 52 weeks. Randomisation was stratified by geographical region and by number of exacerbations in the 12 months before enrolment. Participants, investigators, site staff, and the study sponsor were masked to treatment assignment. The primary endpoint was the annualised rate of moderate or severe COPD exacerbations over 52 weeks. A prespecified subgroup analysis assessed the primary endpoint in patients grouped by baseline blood eosinophil counts (BECs). Efficacy and safety were assessed in all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT04039113 (completed).

FINDINGS

Between July 30, 2019, and Oct 4, 2022, 333 patients (mean age 67·2 years [SD 7·0]; 145 [44%] female and 188 [56%] male; 293 [88%] White, 34 [10%] Asian, and four [1%] Black or African American) were randomly assigned and treated with tezepelumab (n=165) or placebo (n=168). The annualised rate of moderate or severe COPD exacerbations over 52 weeks was 1·75 for tezepelumab versus 2·11 for placebo (rate ratio 0·83 [90% CI 0·64-1·06]; p=0·10 [one-sided]; the primary endpoint was not met). In prespecified subgroup analyses, the annualised rate of moderate or severe COPD exacerbations over 52 weeks was 2·04 with tezepelumab versus 1·71 with placebo (rate ratio 1·19 [95% CI 0·75-1·90]) in patients with a baseline BEC of less than 150 cells per μL, 1·64 versus 2·47 (0·66 [0·42-1·04]) in patients with a baseline BEC of 150 cells per μL to less than 300 cells per μL, and 1·20 versus 2·24 (0·54 [0·25-1·15]) in patients with a baseline BEC of 300 cells per μL or higher. Adverse events occurred in 133 (81%) of 165 patients in the tezepelumab group and 126 (75%) of 168 patients in the placebo group. Serious adverse events occurred in 49 (30%) patients in the tezepelumab group and 50 (30%) patients in the placebo group. Five patients died while receiving study treatment: two in the tezepelumab group and three in the placebo group. No deaths were determined to be causally related to study treatment by investigator assessment.

INTERPRETATION

A significant reduction was not observed in the annualised rate of moderate or severe COPD exacerbations with tezepelumab versus placebo. Further studies are required to evaluate the efficacy of tezepelumab in patients with moderate to very severe COPD, particularly in patients with a baseline BEC of 150 cells per μL or higher. Tezepelumab was well tolerated, with no safety concerns identified.

FUNDING

AstraZeneca and Amgen.

Prognostic value of procalcitonin in acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis

AIMS

To evaluate the prognostic role of procalcitonin(PCT) on all-cause mortality in acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

METHODS

Database including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to find relevant trials. We included studies with patients hospitalized for AECOPD, which assessed procalcitonin levels and reported on the association between procalcitonin and mortality..

RESULTS

Fourteen trials involving 2983 patients were included. We found PCT levels in patients hospitalized for AECOPD are not associated with increased risk of mortality (RR 1.03, 95%CI 0.99-1.08). However, subgroup analysis showed PCT levels are indeed associated with an increased risk of mortality in mild to moderate AECOPD(RR 1.74, 95%CI 1.11-2.73). Deceased patients had significantly higher PCT levels, compared to survivors (MD 0.61, 95%CI 0.30-0.92). In PCT positive group, there was a significant increase in all-cause mortality(OR 3.21, 95%CI 1.84-5.61).

CONCLUSIONS

Results from this meta-analysis suggest that procalcitonin levels at the time of hospital admission for mild to moderate AECOPD are positively correlated with mortality.

Pulmonary Hemodynamic Parameters Derived from 4D Flow MR Imaging Can Provide Sensitive Markers for Chronic Obstructive Pulmonary Disease (COPD) Patients with Right Ventricular Dysfunction

PURPOSE

To investigate the potential of 4D flow MRI-derived pulmonary hemodynamic parameters as sensitive markers for chronic obstructive pulmonary disease (COPD) patients with right ventricular dysfunction (RVD).

METHODS

We enrolled 15 COPD patients combined with RVD and 43 non-RVD participants, all of them underwent pulmonary function tests, thoracic CT and cardiac MR examinations, and the image post-processing analysis was completed. After comparing the 2 groups, the average flow velocity of the main pulmonary artery (Vavg-MPA) and the right pulmonary artery (Vavg-RPA) were identified as statistically significant confounding factors, propensity score matching was used to pair patients controlling for these 2 parameters. Univariate and multivariate logistic regression analyses were performed to assess the pulmonary hemodynamic parameters obtained from 4D flow MRI that could serve as sensitive markers for identifying COPD patients with RVD based on the matched participants dataset.

RESULTS

Fourteen COPD patients combined with RVD and 29 non-RVD participants were successfully matched. Logistic regression analysis showed that the decreased systolic pressure drop along the MRA-RPA tract (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.12-0.78; P =0.013) and the presence of vortex (OR: 8.82; 95% CI: 1.11-70.36; P =0.040) were identified as independent risk factors for RVD in COPD patients.

CONCLUSION

Pulmonary hemodynamic parameters derived from 4D flow MRI, specifically the systolic pressure drop along the MPA-RPA tract and the presence of vortex in the main pulmonary artery, can serve as sensitive indicators for predicting right ventricular dysfunction in COPD patients.

Effect of Baduanjin exercise on health and functional status in patients with chronic obstructive pulmonary disease: a community-based, cluster-randomized controlled trial

Baduanjin has been shown to be an effective method of exercise for promoting body function in patients with chronic obstructive pulmonary disease (COPD). However, this method is rarely used by rural doctors in rural communities. The aim of this study was to compare the therapeutic effects of Baduanjin exercise with those of conventional pulmonary rehabilitation (CPR) implemented by rural doctors in patients with COPD. A total of 472 COPD patients from 18 village clinics were randomly allocated to the Baduanjin group (n = 158), CPR group (n = 154), or control group (n = 160). The Baduanjin group received six months of Baduanjin training, the CPR group received six months of rehabilitation training, and the control group received usual care. The primary outcomes were changes in health status, as measured by the COPD Assessment Test (CAT), and dyspnoea, as assessed via the modified Medical Research Council (mMRC) dyspnoea scale. The secondary outcomes included six-minute walking distance (6MWD) performance and anxiety and depression scores on the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively). Baseline data were collected before randomization, and outcomes were ascertained at the six-month follow-up by blinded assessors. After six months of training, compared with the control group, the Baduanjin group presented significant improvements in CAT scores (t = 5.121, P < 0.001), mMRC scale scores (t = 5.719, P < 0.001), 6MWD performance (t = 12.608, P < 0.001), HADS-A scores (t = 6.210, P < 0.001), and HADS-D scores (t = 2.945, P = 0.010). The CPR group also presented significant improvements in CAT scores (t = 4.725, P < 0.001), mMRC scale scores (t = 5.499, P < 0.001), 6MWD performance (t = 11.662, P < 0.001), HADS-A scores (t = 5.697, P < 0.001), and HADS-D scores (t = 2.671, P = 0.023). In contrast, the control group participants showed no significant changes in CAT scores (t = -0.252, P = 0.801), mMRC scale scores (t = -0.085, P = 0.932), 6MWD performance (t = -0.463, P = 0.644), HADS-A scores (t = -2.75, P = 0.783), or HADS-D scores (t = -0.281, P = 0.779). No adverse events were reported during the study. The positive effects of Baduanjin exercise on the subjective symptoms of COPD patients are similar to those of CPR. The trial was registered with the Chinese Clinical Trials Registry (reference: ChiCTR-TRC-12001958) (22/02/2012).

Integrating genetic and clinical data to predict lung cancer in patients with chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is closely linked to lung cancer (LC) development. The aim of this study is to identify the genetic and clinical risk factors for LC risk in COPD, according to which the prediction model for LC in COPD was constructed.

METHODS

This is a case-control study in which patientis with COPD + LC as the case group, patientis with only COPD as the control group, and patientis with only LC as the second control group. A panel of clinical variables including demographic, environmental and lifestyle factors were collected. A total of 20 single nucleotide polymorphisms (SNPs) were genotyped. The univariate analysis, candidate gene study and multivariate analysis were applied to identify the independent risk factors, as well as the prediction model was constructed. The ROC analysis was used to evaluate the predictive ability of the model.

RESULTS

A total of 503 patients were finally enrolled in this study, with 188 patients for COPD + LC group, 162 patients for COPD group and 153 patients for LC group. The univariate analysis of clincial data showed compared with the patients with COPD, the patients with COPD + LC tended to have significantly lower BMI, higher smoking pack-years, and higher prevalence of emphysema. The results of the candidate gene study showed the rs1489759 in HHIP and rs56113850 in CYP2A6 demonstrated significant differences between COPD and COPD + LC groups. By using multivariate logistic regression analysis, four variables including BMI, pack-years, emphysema and rs56113850 were identified as independent risk factors for LC in COPD and the prediction model integrating genetic and clinical data was constructed. The AUC of the prediction model for LC in COPD reached 0.712, and the AUC of the model for predicting LC in serious COPD reached up to 0.836.

CONCLUSION

The rs56113850 (risk allele C) in CYP2A6, decrease in BMI, increase in pack-years and emphysema presence were independent risk factors for LC in COPD. Integrating genetic and clinical data for predicting LC in COPD demonstrated favorable predictive performance.

Consumption of wild edible plants in the Kofale and Heban-Arsi districts, West Arsi Zone, Oromia Regional State, Ethiopia

BACKGROUND

Wild edible plants (WEPs) are neglected and have received little attention despite their significant contributions to the sustenance and livelihoods of rural communities. This study was conducted in the Kofale and Heban-Arsi districts of the Oromia Regional State, Ethiopia, to document the diversity, to assess the most preferred WEPs, their utilization, and threats they face.

METHODS

The study was conducted in the Kofale and Heban-Arsi districts of the West Arsi Zone of the Oromia Regional State, Ethiopia. Data collection took place from February to September 2022 in Kofale and from November 2022 to April 2023 in Heban-Arsi district. To gather ethnobotanical information, the research employed semi-structured interviews, field observations, focus group discussions, and guided field walks. The interviews involved 290 informants who were selected via snowball sampling and systemic random sampling methods. Preference ranking values, direct matrix rankings, and use values (UVs) of documented species were computed.

RESULTS

A total of 62 WEPs species belonging to 38 families and 56 genera were identified. The Moraceae family includes 7 species, followed by Fabaceae and Rubiaceae (each 4 species), and Lamiaceae (3 species). Shrub was the dominant growth form (32 species), followed by herbs (13 species). The largest number (24 species) of WEPs was collected from grazing lands/fields, followed by forest habitats (17 species). The most widely used edible plant part was fruit (40 species) and leaf (11 species). Most WEPs were collected for consumption from March to May (30 species), and the majority of the species (48, 77.4%) were utilized in their raw state. A large number of WEP (41 species) were consumed only during periods of food shortage, and the remaining (21 species) were used as staple food supplements. Multiple other uses of WEPs in the study area also reported. Fifty-two species mentioned for medicinal use, and the species that had the highest use value was Cordia africana Lam. (0.9). The direct matrix ranking results indicated that agricultural expansion was a principal threat to the WEPs in the study area.

CONCLUSION

This study indicated that WEPs are widely used during food shortages in the study area, but many WEP species are under threat due to growing pressure from various anthropogenic factors. Thus, public awareness and community-based management need to be encouraged at all levels to conserve and sustainably use these resources to address food insecurity.

Examining the impact of obstructive sleep apnea on cognitive function in severe COPD

PURPOSE

This study aimed to examine the association between obstructive sleep apnea (OSA) and cognitive function in patients with severe chronic obstructive pulmonary disease (COPD).

METHODS

Patients with severe COPD, who had not previously been diagnosed with OSA, were recruited between January 2021 and January 2023. To evaluate cognitive function, the Montreal Cognitive Assessment (MoCA), a continuous reaction time test (CRT) and a driving simulator were used. OSA was identified using a CardioRespiratory Monitor (CRM). Cognitive tests were repeated for patients who were identified with and received treatment for OSA, to determine whether treatment improved cognitive function.

RESULTS

In total, 80 patients participated in the study and 50 patients (63%) were diagnosed with OSA, with or without nocturnal desaturation (ND), and six patients (8%) with ND only. Thirty-two patients (40%) had mild OSA and 18 (23%) had moderate/severe OSA. We found no statistically significant difference in the prevalence of cognitive impairment (CI) between patients with and without OSA and/or ND. However, a multiple regression analysis showed that patients with moderate/severe OSA had a significant lower CRT-index, indicating a decrease in attention and reaction time, compared to patients with mild OSA.

CONCLUSION

In patients with COPD and OSA, the degree of CI may depend on the severity of OSA. The 23% prevalence of moderate/severe OSA emphasizes the importance of OSA screening in severe COPD. The study was registered at www.

CLINICALTRIALS

gov in March 2020, with the identification number NCT04458038.

Analysis of COPD: Distinguishing Characteristics and Management of Smoking vs Never Smoking Patients

Background

Chronic obstructive pulmonary disease (COPD) is a significant public health issue characterized by gradually worsening airflow limitation. It is a leading cause of mortality and morbidity worldwide, yet research on COPD patients who have never smoked is limited. This study aims to document the demographic, symptomatic, and therapeutic characteristics of COPD patients receiving outpatient pulmonary care in Hungary, focusing on smoking history, and evaluate their distribution according to the GOLD A/B/E classification.

Methods

The study recorded demographic data, symptom severity, occurrence of severe and moderate exacerbations, treatment, comorbidities, quality of life, and COVID-19 vaccination status among COPD patients from November 2021 to January 2023. A total of 6974 patients were categorized into current smokers, former smokers, and never smokers.

Results

Patients had an average age of 67.2±8.9 years, with 48.2% male and 51.8% female. Of participants, 86.1% had a smoking history, while 13.9% had never smoked. COPD patients who had never smoked showed significantly better quality of life (CAT: 15.2±7.6 vs 15.8±6.9; p=0.006), oxygen saturation (SpO2%: 96.7±2.3 vs 95.8±2.4; p<0.001), higher body mass index (BMI: 29.4±5.9 vs 27.1±6.3; p<0.001), and better lung function (FEV1ref%: 67.9±20.7 vs 58.9±18.1; p<0.001) compared to smokers. However, non-smoking COPD patients had a higher frequency of comorbidities (3.5±2.2 vs 2.9±2.1; p<0.05). These differences may arise from complex genetic and environmental interactions.

Conclusion

COPD patients who have never smoked exhibited better quality of life, nutritional status, and lung function compared to smokers, indicating the need for tailored treatment approaches. Further long-term studies are essential to validate these differences in quality of life and lung function between smoking and non-smoking COPD patients.

The precision medicine strategy to treat COPD pulmonary traits in clinical practice: The role of N-acetylcysteine

Chronic obstructive pulmonary disease (COPD) is a progressive lung condition and a leading cause of physical decline and death. COPD prevalence is expected to increase steadily in the coming years, and as a result, the healthcare and social burden of this condition will intensify. In this scenario, a patient-centric approach, the treatable trait (TT) strategy, based on the identification of traits that are clinically relevant, identifiable, monitorable and treatable, has emerged. The TT strategy, which considers behavioral/risk factors, as well as pulmonary and extrapulmonary traits, has shown to be a promising strategy in COPD management. This work reviews the TT strategy in COPD, giving special attention to the most relevant pulmonary traits, such as frequent productive cough, chronic bronchitis, type 2 inflammation, neutrophilic inflammation, lung hyperinflation, bronchiectasis, exacerbations and non-reversible airflow limitation. N-acetylcysteine (NAC), a widely used mucolytic agent, might be a major player in this strategy. Indeed, through a thorough review of the literature, it has been possible to highlight that, besides being essential in the treatment of frequent productive cough, NAC could bring benefits in case of airflow limitations, airways inflammation, exacerbations and bronchiectasis. A clinical case in which the TT strategy was able to reduce symptoms and improve lung function and quality of life, minimizing unnecessary medication and side effects, is also presented. The identification of TTs and their proper treatment through personalized medicine remarkably ameliorates COPD management. Of note, the mucolytic, antioxidant, and anti-inflammatory activities of NAC might have beneficial effects on several TTs.

Prevalence and clinical significance of pre- and post-bronchodilator airflow obstruction in COPD patients

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by persistent airflow limitation. This study investigates the prevalence and clinical significance of pre-bronchodilator (PREO) and post-bronchodilator (POSTO) airflow obstruction in COPD.

METHODS

This retrospective cohort study analyzed data from 3252 COPD patients aged ≥40 years, registered from January 2012 to December 2019 at 54 medical centers in South Korea. Patients were categorized into three groups: PREO & post-bronchodilator non-obstruction (POSTN), pre-bronchodilator non-obstruction (PREN) & POSTO, and PREO & POSTO. The primary outcome was moderate-to-severe exacerbation over 3 years. Secondary outcomes included GOLD group progression and rapid FEV₁ decline.

RESULTS

The majority of patients (96.2 %) were in the PREO & POSTO group, with smaller proportions in the PREO & POSTN (2.8 %) and PREN & POSTO (1.0 %) groups. During the 3-year observation, 21.6 % of patients experienced moderate-to-severe exacerbations, 6.2 % exhibited GOLD group progression, and 20.0 % showed rapid FEV₁ decline. The PREO & POSTO group had a higher risk of exacerbations compared to the PREO & POSTN group (odds ratio = 8.33 [95 % CI = 1.53-45.4], P-value = 0.014), but this was not statistically significant in multivariable analysis. Post-bronchodilator spirometry patterns did not significantly impact GOLD group progression or FEV₁ decline.

CONCLUSION

PREO & POSTO was common among COPD patients, while isolated PREO & POSTN was rare, supportingpre-bronchodilator spirometry as a screening tool. Although patients with PREO & POSTO showed higher exacerbation risks in univariable analysis, statistical significance disappeared after adjustment. GOLD group progression or FEV₁ decline did not significantly differ by post-bronchodilator spirometry patterns.

Causal Role of Immune Cells in Chronic Obstructive Pulmonary Disease: A Two-Sample Mendelian Randomization Study

Accumulating evidence has highlighted the importance of immune cells in the pathogenesis of chronic obstructive pulmonary disease (COPD). However, the understanding of the causal association between immunity and COPD remains incomplete due to the existence of confounding variables. In this study, we employed a two-sample Mendelian randomization (MR) analysis, utilizing the genome-wide association study database, to investigate the causal association between 731 immune-cell signatures and the susceptibility to COPD from a host genetics perspective. To validate the consistency of our findings, we utilized MR analysis results of lung function data to assess directional concordance. Furthermore, we employed MR-Egger intercept tests, Cochrane's Q test, MR-PRESSO global test, and "leave-one-out" sensitivity analyses to evaluate the presence of horizontal pleiotropy, heterogeneity, and stability, respectively. Inverse variance weighting results showed that seven immune phenotypes were associated with the risk of COPD. Analyses of heterogeneity and pleiotropy analysis confirmed the reliability of MR results. These results highlight the interactions between the immune system and the lungs. Further investigations into their mechanisms are necessary and will contribute to inform targeted prevention strategies for COPD.

Therapeutic effect of phycocyanin on chronic obstructive pulmonary disease in mice

INTRODUCTION

The prevention and treatment of chronic obstructive pulmonary disease (COPD) is closely tied to antioxidation and anti-inflammation. Phycocyanin (PC) has numerous pharmacological effects, such as antioxidation and anti-inflammation. However, it remains unclear whether PC can play a therapeutic role in COPD.

OBJECTIVE

As inflammation and oxidative stress can aggravate COPD, this study is to explore the effect of PC on COPD mice and its mechanisms.

METHODS

The COPD mice model was established by exposing them to lipopolysaccharide (LPS) and cigarette smoke (CS); PC was administrated in a concentration of 50 mg/kg for 30 days. On the last day, lung function was measured, and bronchoalveolar lavage fluid (BALF) was obtained and classified for cells. Lung tissue pathological change was analyzed, and organ indices statistics were measured. Based on molecular docking, the mechanism was explored with Western blotting, immunohistochemical, and immunofluorescence in vivo and in vitro.

RESULTS

PC significantly ameliorated the pulmonary function of COPD mice and reduced inflammation of the lung (p < 0.05), and hematoxylin and eosin (H&E) staining showed PC depressed lung inflammatory cell accumulation and emphysema. Periodic acid Schiff (PAS) and Masson staining revealed that PC retarded goblet cells metaplasia and collagen deposition (p < 0.05). In addition, in vivo PC regulated Heme oxygenase 1 (HO-1) (p < 0.05) and NAD(P)H dehydrogenase quinone 1 (NQO1) level (p < 0.01) in the lung, as well as NOX2 level in pulmonary macrophages. Molecular docking results indicate that phycocyanobilin (PCB) in PC had a good binding site in Keap1 and NOX2 proteins; the phycocyanobilin-bound phycocyanin peptide (PCB-PC-peptide) was obtained for further studies. In vitro, PCB-PC-peptide could depress the phospho-NF-E2-related factor 2 (p-Nrf2) and NQO1 protein expression in RAW264.7 cells induced by cigarette smoke extract (CSE) (p < 0.05).

CONCLUSION

PC exerts beneficial effects on COPD via anti-inflammatory and antioxidative stress, which may be achieved through PCB.

Use of Pulmonary Rehabilitation after Chronic Obstructive Pulmonary Disease Hospitalization: An Analysis of Statewide Patient and Hospital Data

Rationale: Pulmonary rehabilitation (PR) is a clinically effective and cost-effective outpatient treatment for chronic obstructive pulmonary disease (COPD) that remains highly underused. Existing analyses of PR use patterns have been focused largely on patient characteristics, but hospital-level analysis is lacking and is needed to inform interventions aimed at improving use after COPD hospitalization. Objectives: To evaluate PR use across hospitals after COPD hospitalization in the state of Michigan, with the goal of characterizing hospital-level variation and identifying the characteristics of high-performing hospitals. Methods: This is a retrospective study of patients with COPD hospitalizations between January 1, 2018, and December 31, 2021, using claims data from the Michigan Value Collaborative and hospital data from the American Hospital Association annual survey. Our primary outcome was the initiation of PR within 30 days of discharge. Chi-square tests and analysis of variance were used to test for differences in patient and hospital covariates. Multilevel logistic regression was used to analyze associations between patient covariates and the primary outcome and to characterize hospital-level variation. Results: A total of 36,389 patients and 99 hospitals were included in the analysis. The majority of patients were older than 65 years of age, female, White, and Medicare fee-for-service insured. The rate of PR initiation within 30 days after hospitalization was 0.8%. Adjusted rates of PR initiation by hospital ranged from 0.4% to 2.0%. Compared with the set reference groups, being female, in the fifth Distressed Community Index quintile, and older than 85 years of age independently decreased the odds of initiating PR. Some variation in initiation rate was attributed to the hospital level (7%; intraclass correlation coefficient = 0.07 [95% confidence interval, 0.03-0.15]). The median odds ratio was 1.6 for PR initiation by hospital. Conclusions: Rates of PR initiation after COPD hospitalization are universally low across all hospitals, though there is some variation. Interventions targeted at patients alone are not sufficient to improve use. Hospital-based strategies to improve PR use after discharge, adapted from those being successfully used with cardiac rehabilitation, should be further explored.

Real World Study on the Reasons for eScalation or de-Escalation of Inhaled ThEraPies in COPD Patients: the STEPINCOPD Multicenter Observational Study

BACKGROUND

There is limited data on the reasons for escalation or de-escalation of COPD inhaled therapies in routine clinical practice, especially after the follow-up pharmacological treatment guidance on the 2019 GOLD report and the 2020 ERS guideline on ICS withdrawal.

METHODS

The STEPINCOPD study was a 12-week, two-visit, prospective observational study that aimed to describe the reasons for change of inhaled therapies, in accordance with GOLD recommendations 2021. Only patients that had a recent change in their inhaled medication were enrolled. Moreover, we investigated associations between physicians' and patients' characteristics and adherence to GOLD recommendations.

RESULTS

1429 patients were enrolled from 146 centers (138 private practice and 8 hospitals) throughout Greece. At enrollment, the most frequent reasons for treatment change were lack of clinical (78.9%) or spirometric (49.5%) response to previous treatment, change in CAT score (45.1%), and mMRC score (28.2%). At the follow-up visit, most common reasons were lack of clinical response to previous treatment (71.4%), COPD exacerbations (59.5%), changes in CAT score (52.4%), lack of spirometric response (42.9%) and lower respiratory tract infections (31%). We observed high adherence to the GOLD 2021 recommendations (81.6% at enrollment and 92.9% at follow-up). Physicians' age and consideration of GOLD recommendations for prescription choice, as well as patients' CAT score were significant predictors of adherence to GOLD.

CONCLUSION

The STEPINCOPD study highlights the reasons for inhaled treatment change in Greek physicians with high adherence to GOLD recommendations and provides insights for future research that may inform the development of decision support tools.

Expression of Semaphorin3E/PlexinD1 in human airway smooth muscle cells of patients with COPD

Semaphorin3E (Sema3E) is a member of axon guidance proteins that have emerged recently as essential regulators of cell migration and proliferation. It binds to PlexinD1 with high affinity and is expressed in different cell types, including immune, cancer, and epithelial cells. Recent work in our lab has revealed a critical immunoregulatory role of Sema3E in experimental allergic asthma; however, its role in chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to investigate the expression of Sema3E and its receptor, PlexinD1, in the airways of patients with COPD and whether Sema3E regulates airway smooth muscle (ASM) cell proliferation, a key feature of airway remodeling in COPD. We first demonstrate that human ASM cells obtained from COPD express Sema3E and PlexinD1 at both mRNA and protein levels. Also, bronchial sections from patients with COPD displayed immunoreactivity of Sema3E and its receptor PlexinD1, suggestive of functional contribution of Sema3E in airway remodeling. In contrast to ASM cells from healthy donors, Sema3E did not inhibit the platelet-derived growth factor (PDGF) induced cell proliferation in ASM cells of patients with COPD that were consistent with the binding of endogenous Sema3E to its receptors on the cell surface and the expression and release of p61KDa-Sema3E isoform. Our results support the Sema3E-PlexinD1 axis involvement in COPD airway smooth muscle remodeling.NEW & NOTEWORTHY Semaphorin3E (Sema3E), a protein guiding cell movement, is found in various cell types like neural, immune, cancer, and epithelial cells. This study examines Sema3E in chronic obstructive pulmonary disease (COPD) airways. In patients with COPD, airway smooth muscle cells express Sema3E and its receptor PlxD1. Unlike healthy cells, Sema3E does not hinder cell proliferation in COPD, indicating involvement in airway remodeling. These findings highlight the Sema3E-PlxD1 axis in COPD airway changes.

The Application of Self-Made Disseminating and Descending Breathing Exercises in Home Rehabilitation of Stable COPD

To investigate the clinical effects and application value of self-made disseminating and descending breathing exercises on home rehabilitation of patients with stable chronic obstructive pulmonary disease (COPD). Seeking to generate concepts for creating novel, convenient, and efficient COPD prognosis rehabilitation exercises aimed at enhancing the well-being and rehabilitation confidence of both COPD patients and their families. A total of 70 COPD patients admitted to our outpatient department from July 2019 to September 2021 were randomly divided into the exercise group (n = 35) and the control group (n = 35). The control group received routine breathing training, while the exercise group was treated with self-made disseminating and descending breathing exercises. The respiratory function, including pulmonary function (FVC, FEV1, FEV1/FVC) and respiratory muscle strength (MIP, MEP), exercise tolerance (6-min walking distance, 6MWT), Modified Medical Research Council Dyspnea Scale (mMRC, Borg), COPD quality of life score (CAT, SGRQ), anxiety and depression scores (HAMA, HAMD) were compared between the two groups after 12-week exercise. After 12-week training, the FEV1, MIP, and MEP in the exercise group were significantly higher than those in the control group (p < 0.001), and the 6MWT was significantly increased in the exercise group compared to the control group (p < 0.001); while the mMRC, Borg score, the scores of CAT, SGRQ, HAMA, and HAMD were found significantly lower than those in the control group (p < 0.001). The self-made disseminating and descending breathing exercises can improve respiratory function and reduce symptoms of dyspnea in COPD patients, while enhancing exercise tolerance and relieving anxiety and depression, and are worthy of clinical application.

Assessment of the Relationship Between Genetic Determinants of Obesity, Unhealthy Eating Habits and Chronic Obstructive Pulmonary Disease: A Mendelian Randomisation Study

Background: Clinical studies have shown that the onset and exacerbation of chronic obstructive pulmonary disease (COPD) are related to obesity and dietary behaviours, but the genetic relationship between them is not clear.Aims: To investigate the relationship between the genetic determinants of obesity, dietary habits (alcohol consumption, intake of sweets, salt intake) and COPD.Methods: Exposure and outcome datasets were obtained from the IEU Open GWAS project. The exposure dataset includes dietary habits (Salt added to food, Sweets intake, Alcohol consumption), obesity level (represented by body mass index (BMI) and body fat percentage (BFP) data sets.). The outcome dataset includes COPD and acute COPD admissions. The collected data were imported into the RStudio software and conducted Mendelian randomisation analysis. Additionally, heterogeneity and horizontal pleiotropy tests were conducted on the data to ensure the veracity of the results.Results: The results showed that BMI was positively correlated with the risk of acute COPD admission (OR = 1.74, 95% CI 1.39-2.18) and COPD (OR = 1.81, 95%CI 1.41-2.33). In addition, BFP was also a risk factor for COPD (OR = 1.98, 95% CI 1.42-2.77) and acute exacerbation of COPD admission (OR = 1.99, 95%CI 1.43-2.77). The increase of salt, sugar and alcohol consumption will not increase the risk of COPD and the risk of hospitalisation due to COPD.Conclusion: Therefore, we should strengthen the guidance of diet and living habits of obese patients. For patients with heavier weight and higher body fat rate, they should be instructed to lose weight and fat to prevent the occurrence of COPD. For obese patients with COPD, more attention should be paid to prevent the occurrence of acute exacerbation of COPD in advance.

Impact of Preliminary Bronchodilator Dose in Chronic Obstructive Pulmonary Disease Patients With Suboptimal Peak Inspiratory Flow

PURPOSE

Suboptimal peak inspiratory flow rate (PIFR) is highly prevalent in patients with chronic obstructive pulmonary disease (COPD) owing to the mismatch of their PIFR with the corresponding inhaler-device resistance. This study aimed to investigate the impact of a preliminary dose of pressurized metered dose inhalers (pMDIs) on patients with COPD with suboptimal PIFR using Diskus dry powder inhalers (DPIs).

METHODS

A prospective, randomized, case-control study included 24 patients with COPD. PIFR was measured using the In-Check Dial G16 with low-to-medium resistance. Spirodoc was used to measure baseline spirometric data and compare it before and 30 minutes after the administration of Diskus DPI. On a different day, the study dose was given to each suboptimal patient by the same aerosol generator with preceded 2 puffs of salbutamol pMDI and re-evaluated for spirometric parameters 30 minutes after the study dose.

FINDINGS

There was a significant difference between the optimal and suboptimal groups in peak expiratory flow (2.38 ± 1.20 vs 1.49 ± 1.06 L/s, P = 0.050). PIFR showed a statistically significant difference between the optimal and suboptimal groups (71.66 ± 6.15 vs 41.25 ± 9.79 L/min, P < 0.0001). There was a significant difference in forced vital capacity (ΔFVC) between optimal and suboptimal groups without a preliminary dose (0.42 ± 0.21 vs 0.16 ± 0.11 L, P = 0.002), forced expiratory volume in 6 seconds (ΔFEV6) (0.53 ± 0.49 vs 0.17 ± 0.11 L, P = 0.022), forced expiratory volume in 3 seconds (ΔFEV3) (0.41 ± 0.38 vs 0.1 ± 0.16 L, P = 0.013), forced expiratory volume in 1 second (ΔFEV1)/FVC (-2.38 ± 8.41 vs 2.96% ± 2.95%, P = 0.033), and ΔFEV1/FEV6 (-4.32 ± 11.23 vs 2.91% ± 4.35%, P = 0.015). There was a significant difference in ΔFVC between optimal and suboptimal groups with a preliminary dose (0.42 ± 0.21 vs 0.23 ± 0.18 L, P = 0.046), ΔFEV1/FVC (-2.38 ± 8.41 vs 5.67% ± 6.53%, P = 0.009), ΔFEV1/FEV6 (-4.32 ± 11.23 vs 5.16% ± 4.99%, P = 0.008), and forced expiratory time (ΔFET) (0.28 ± 0.45 vs -0.31 ± 0.70 seconds, P = 0.022). The only parameter that showed a significant difference between suboptimal groups without and with a preliminary dose is Δ peak expiratory flow (0.24 ± 0.59 vs 0.65 ± 0.68 L/s, P = 0.004).

IMPLICATIONS

Administering a preliminary dose of pMDI can minimally enhance the effectiveness of DPIs in patients with COPD with suboptimal PIFR and health outcomes.

The epithelial barrier theory and its associated diseases

The prevalence of many chronic noncommunicable diseases has been steadily rising over the past six decades. During this time, over 350,000 new chemical substances have been introduced to the lives of humans. In recent years, the epithelial barrier theory came to light explaining the growing prevalence and exacerbations of these diseases worldwide. It attributes their onset to a functionally impaired epithelial barrier triggered by the toxicity of the exposed substances, associated with microbial dysbiosis, immune system activation, and inflammation. Diseases encompassed by the epithelial barrier theory share common features such as an increased prevalence after the 1960s or 2000s that cannot (solely) be accounted for by the emergence of improved diagnostic methods. Other common traits include epithelial barrier defects, microbial dysbiosis with loss of commensals and colonization of opportunistic pathogens, and circulating inflammatory cells and cytokines. In addition, practically unrelated diseases that fulfill these criteria have started to emerge as multimorbidities during the last decades. Here, we provide a comprehensive overview of diseases encompassed by the epithelial barrier theory and discuss evidence and similarities for their epidemiology, genetic susceptibility, epithelial barrier dysfunction, microbial dysbiosis, and tissue inflammation.

Identification of immune-related hub genes in chronic obstructive pulmonary disease

OBJECTIVE

As a prevalent persistent respiratory disease, chronic obstructive pulmonary disease (COPD) is featured by airflow limitation and chronic inflammation. This study focused on the identification of immune-related hub genes in COPD.

METHODS

We employed the GSE38974 dataset to analyze differentially expressed genes (DEGs) of COPD. Then, we obtained COPD immune-related DEGs (COPD-IMDEGs) based on the intersection of DEGs and immune-related genes. Subsequently, we carried out Gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses on COPD-IMDEGs. We established a protein-protein interaction network based on COPD-IMDEGs. The hub genes were determined by utilizing the Maximal Clique Centrality method. We utilized receiver operating characteristic (ROC) curves to analyze the clinical significance of hub genes in COPD. In addition, potential drugs targeting hub genes were predicted based on interactions between hub gene-corresponding proteins and drugs.

RESULTS

A total of 45 COPD-IMDEGs were obtained through differential analysis. Enrichment analyses showed that COPD-IMDEGs were associated with cytokines, growth factors, and receptor ligands. Ten COPD-IMDEGs were identified as hub genes. As shown by ROC curves, these genes had potential value in identifying COPD patients. Drug prediction results showed that simvastatin and other drugs targeted hub genes.

CONCLUSION

This study analyzed the potential biological functions enriched by COPD-IMDEGs, identified ten genes as biological markers for diagnosing COPD, and predicted potential drugs for treating COPD.

Factors contributing to hospitalization expenditures for patients with COPD in Yunnan Province, China: a path analysis

OBJECTIVE

To understand the hospitalization expenditures and the composition of hospitalized patients with chronic obstructive pulmonary disease (COPD) in Yunnan Province from 2016 to 2022 and to identify the factors that influence them. The study aims to provide evidence-based information to health administration, hospitals, health insurance offices, and other related departments to help them formulate relevant policies.

METHODS

This study analyzed data from 728,980 COPD patients in Yunnan Province between 2016 and 2022. This study described trends in hospitalization expenditures and their components over a 7-year period. Path analysis was used to investigate the factors that affect hospitalization expenditures.

RESULTS

The average hospitalization expenditures for 2016-2022 were 7828 CNY. The total hospitalization expenditures were continuously increasing, from 828 million CNY to 967 million CNY, which is a 16.84% increase. However, the average expenditure per hospitalization decreased from 9185 CNY to 7261 CNY, which is a decrease of 20.95%. The main components of hospitalization expenditures were diagnostic fees, medication fees, and comprehensive medical service fees. The proportion of medication fees is decreasing, while the proportion of diagnostic fees and comprehensive medical services fees are increasing. The results of the path analysis indicate that age, gender, ethnicity, hospital level, admission route, medical payment method, COPD with acute lower respiratory tract infection, non-acute exacerbation of COPD, rehabilitation treatment experience, and comorbidity have both direct and indirect effects on hospitalization expenditures through length of stay (LOS). Additionally, marital status indirectly affects hospitalization expenditures through LOS.

CONCLUSION

Shortening the average LOS is crucial for hospitals to improve efficiency and reduce unnecessary expenses for patients. To achieve this, it is necessary to actively implement clinical pathway management and establish a standardized diagnosis and treatment system.

A Qualitative Study on Illness Perception and Coping Behaviors Among Patients with Chronic Obstructive Pulmonary Disease: Implications for Intervention

Background

Understanding patients' perceptions of their illness may be more beneficial for healthcare providers in maintaining vigilance than merely focusing on the clinical status of patients. As patients' perceptions can significantly influence their behavior, it is possible that health care providers who are aware of patients' thoughts in advance may help improve their intervention programs, such as increased treatment adherence. However, current research offers limited insight into the subjective perceptions of disease among patients with Chronic Obstructive Pulmonary Disease (COPD). This study aims to deeply explore COPD patients' illness perception and coping behaviors.

Methods

A descriptive qualitative approach was used, conducting semi-structured in-depth interviews with 32 COPD patients, and verbatim data recording. Data analysis was based on thematic analysis methods proposed by Braun and Clarke.

Results

Through data analysis, we identified three themes to describe participants' perceptions and coping behaviors related to COPD: inadequate knowledge regarding the disease, improper self-management of the disease, and diverse impacts resulting from the disease.

Conclusion

Illness perception is crucial for COPD patients. Participants' descriptions underscored their perceptions of the disease as well as the various challenges and consequences they face when dealing with it. To enhance care for individuals with COPD, researchers and healthcare professionals should increase awareness about the disease among patients, understanding their coping strategies, beliefs, and recognizing its significant impacts.