Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary

RARB genetic variants might contribute to the risk of chronic obstructive pulmonary disease based on a case-control study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that severely impairs patients' respiratory function and quality of life. RARB is involved in COPD progression by affecting inflammatory reactions, cell proliferation, and apoptosis. The impact of single nucleotide polymorphisms (SNPs) within RARB on COPD susceptibility remains unclear. Here, we aimed to evaluate the association between RARB SNPs and COPD risk.

METHODS

A total of 270 COPD patients and 271 healthy controls were enrolled. The MassARRAY iPLEX platform tested the genotype of the SNPs. The association was analyzed using logistic regression analysis. The false-positive report probability (FPRP) analysis was performed to validate the significant findings. The relationship between SNPs and RARB expression was evaluated using the GTEx database.

RESULTS

Our study found a significant association between rs6799734 and COPD susceptibility (OR 1.88, p = 0.008, p (FDR) = 0.047). The stratified analysis revealed that this association was particularly pronounced among individuals aged ≤ 71 years (OR 2.34, p = 0.011, p (FDR) = 0.045), males (OR 2.60, p = 0.002, p (FDR) = 0.013), those with a BMI ≥ 24 (OR 3.95, p = 0.018, p (FDR) = 0.108), and smokers (OR 2.48, p = 0.020, p (FDR) = 0.120). Additionally, rs1286641 and rs1881706 showed significant associations with COPD risk in females and smokers. These associations were further validated by FPRP analysis. Preliminary mechanism studies indicated that rs1286641 and rs1881706 were related to RARB expression.

CONCLUSION

Our findings suggest a potential role of RARB SNPs in influencing COPD risk.

Clinical characteristics and outcomes of chronic obstructive pulmonary disease patients with family history of chronic airway disease

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous condition with different risk factors, including family history. This study aimed to explore association between a family history of chronic airway disease and features and outcomes of COPD.

METHODS

Participants were obtained from the RealDTC study between December 2016 and December 2022. Data on demographics, pulmonary function, history of exacerbation at baseline, acute exacerbation during 1-year follow-up and survival status during 3-years follow-up were collected.

RESULTS

5020 patients were enrolled, with 1307 patients (26.0%) having a family history of chronic airway diseases. Compared with patients without a family history of chronic airway diseases, patients with a family history had a lower forced expiratory Volume in one second (FEV1), higher Modified Medical Research Council (mMRC) score and COPD Assessment Test (CAT) score, higher rate of acute exacerbation and hospitalization in the past year (p < 0.05) and rate of acute exacerbation and hospitalization during 1 year follow-up period (p < 0.05). It was an independent risk factor for acute exacerbation (OR = 2.196; 95% CI =1.873-2.576) and hospitalization (OR = 2.199; 95% CI =1.812-2.670). Over 3 years of follow-up, there were no significant differences in mortality rates and annual changes in FEV1 between two groups.

CONCLUSION

COPD patients with a family history of chronic airway disease are not rare, and they tend to have more severe symptoms and a higher risk of future deterioration. In the management of COPD, special attention should be paid to patients with a family history of chronic airway disease.

Effect of acupuncture on patients with chronic obstructive pulmonary disease: A multicenter randomized controlled trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a common and frequently occurring disease that seriously endangers health, causing a heavy economic burden on patients and society. Acupuncture has been reported to have a therapeutic effect on patients with chronic obstructive pulmonary disease (COPD). However, compared with medications, it is difficult to identify a superior therapy. Therefore, the aim of this study was to evaluate the efficacy and safety of acupuncture, conventional drug and acupuncture plus conventional drug in the treatment of COPD.

METHODS

This was a multicenter, open-label randomized controlled trial (RCT) through a central randomization system. A total of 150 COPD patients were randomly assigned at a 1:1:1 ratio to the acupuncture group, conventional drug group or acupuncture plus conventional drug group for 12 weeks of treatment, followed by 12 weeks of untreated follow-up. The primary outcomes included the six-minute walk distance (6MWD) and St. George's Respiratory Questionnaire (SGRQ), and the secondary outcomes included the modified Medical Research Council dyspnea scale (mMRC), acute exacerbation, lung function, and quality of life (COPD assessment test). Statistical analysis was conducted via SPSS software (version 26.0).

RESULTS

A total of 150 patients were included in the study, and 143 patients completed the trial. There were time effects, group effects and interaction effects in the three groups (P < 0.05). Compared with that in the conventional drug group, the 6MWD in the acupuncture plus conventional drug group increased significantly at 4, 8, and 12 weeks of treatment and at 12 weeks of follow-up. The difference was statistically significant (P < 0.05). The symptom scores, motor scores, impact scores and total SGRQ scores at different time points in the three groups tended to change with time, with a time effect (P < 0.05), and there was no group or interaction effect (P > 0.05). Among the secondary outcomes, there were time effects on the number of acute exacerbations, forced expiratory volume in one second (FEV1) and forced expiratory volume in one second/forced vital capacity (FEV1/FVC) at different time points in the three groups (P < 0.05). mMRC had time and group effects (P < 0.05). CAT had time effects, group effects and interaction effects (P < 0.05).

CONCLUSIONS

Compared with the acupuncture group and the conventional drug group, the acupuncture plus conventional drug group was better at improving exercise ability, improving quality of life, and reducing dyspnea. It is safe and effective for the treatment of chronic obstructive pulmonary disease in the stable period, which can provide a reference for further related research.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03169504. Registered on 30 May 2017.

Correlation between self-management, psychological cognitive impairment, and quality of life in elderly chronic obstructive pulmonary disease patients

BACKGROUND

The correlation conclusions between self-management, frailty, and quality of life (QoL) of chronic obstructive pulmonary disease (COPD) patients are inconsistent.

AIM

To comprehensively assess the current status of self-management, psychological cognitive impairment, and QoL in elderly patients with COPD.

METHODS

Convenient sampling was employed to select 312 elderly patients with COPD who were receiving treatment in the respiratory and critical care medicine department of a tertiary grade A hospital from November 2023 to February 2024. The study utilized demographic information and clinical characteristics, self-management behavior, occurrence of psychological cognitive impairment, and QoL as evaluated through general information questionnaires, the COPD patient self-management scale, simple frailty scale, simple mental status scale, clinical dementia assessment scale, and the clinical COPD assessment test questionnaire. This research aims to describe the current status and correlations among self-management behavior, cognitive impairment occurrence, and QoL.

RESULTS

The average score for self-management behavior in elderly COPD patients was 136.00 (119.00, 164.50), indicating a moderate level overall. There were 98 cases of cognitive impairment, accounting for 31.4%, with a mental status score of 3 (2, 3.75). The average QoL score was 24 (19, 28), indicating a low level. Additionally, there was a negative correlation between total self-management behavior score and cognitive impairment occurrence (r = -0.589, P < 0.001), and QoL total score (r = -0.409, P < 0.001). Cognitive impairment occurrence was positively correlated with QoL total score (r = 0.345, P < 0.001). Disease course and self-management behavior score were independent factors affecting the total QoL score in elderly COPD patients (P < 0.05).

CONCLUSION

The self-management behavior of elderly patients with COPD is at a moderate level. However, the occurrence of cognitive impairment is high and significantly influenced by disease course, level of self-management, and mental status. The QoL is low, emphasizing the urgent need to intervene in the self-management behaviors of elderly COPD patients, actively reduce the occurrence of cognitive impairment, and mitigate the impact of the disease on QoL.

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

INTRODUCTION

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

AREAS COVERED

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

EXPERT OPINION

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

Epigenetic profiles integrated with transcriptomic reveal the difference between COPD and PRISm in KOCOSS-NIH

In 2023, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) introduced a provision regarding preserved ratio-impaired spirometry (PRISm), a presumed pre-stage of Chronic Obstructive Pulmonary Disease (COPD), into the COPD guidelines. However, further research in this area is needed. Our study aimed to investigate the epigenetic differences between PRISm and COPD. EWAS (n = 572) and RNA-sequencing (n = 60) were performed on blood samples from the COPD registry, and EWAS was replicated in the KoGES cohort data (n = 98). Our findings revealed significant epigenetic differences between patients with PRISm and COPD. 39,980 CpG-sites displayed differential methylation between PRISm and COPD. Seven gene regions-EEF1A2, EMP2, EPCAM, MTSS1L, ARHGEF10, HYDIN, and FADS2 were not only differentially methylated but also exhibited differential expression. The consistency of differential methylation of CpG sites in five genes, excluding ARHGEF10 and MTSS1L, was replicated in the KoGES study, affirming the distinction between COPD and PRISm. Our research identified seven gene regions as critical contributors related to the modulation of gene expression, including CpG sites that differentiate COPD from PRISm. These results highlight the significance of DNA methylation changes in distinguishing PRISm from COPD and shed light on potential mechanisms by which methylation alterations impact lung function.

Outpatient utilization trend of bronchodilator and anti-inflammatory agents in the pandemic and beyond

As COVID-19 primarily affects the respiratory system, it may have impacted utilization patterns of drugs used in obstructive airway diseases (DOADs). We examined nationwide DOAD utilization trends before, during, and after pandemic measures. We collected data on DOADs (ATC-Code: R03) between 01.01.2017-28.02.2023 from IQVIA-Turkey. National outpatient sales and prescription projections were converted into consumption data, expressed as defined daily dose per 1,000 inhabitants (DID). We compared mean monthly consumption, costs, and quarterly DOADs use across "before restrictions" (BfR), "during restrictions" (DuR), and "after restrictions" (AfR) periods. We identified 433.5 million DOAD units consumed, costing €3.3 billion; inhaled-DOADs accounted for 73.1%. Mean monthly DOAD consumption remained stable (BfR: 67.8 ± 3.1 DID; DuR: 74.2 ± 12.5 DID; AfR: 74.2 ± 14.6 DID; p > 0.05). Inhaled-DOADs exhibited a similar pattern, except the anticholinergics with a significant increase in the DuR (19.4 ± 3.3 DID) compared to the BfR (16.1 ± 2.3 DID, p < 0.001). Also inhaled-corticosteroid monotherapy rose significantly between BfR (4.1 ± 0.9 DID) and AfR (5.3 ± 1.3 DID, p < 0.05). Montelukast, constituting 76.6% of systemic-DOADs, had higher consumption in AfR (15.0 ± 2.8 DID) than in BfR (11.7 ± 2.2 DID, p < 0.001) and DuR (12.9 ± 2.4 DID, p < 0.05). Overall DOAD prescriptions declined in DuR and trended upward in AfR but didn't reach pre-pandemic levels, except for new users of montelukast and long-acting beta agonists. Our study showed increased use of inhaled anticholinergics, glucocorticoid monotherapy, and montelukast within a generally stable overall DOAD utilization. This may reflect varied responses to bronchodilation and anti-inflammatory treatment needs during the pandemic and beyond.

Evolution of Peak Inspiratory Flow During Hospitalization of Patients with COPD - A Prospective Monocentric Observational Study

Purpose

Effective treatment of chronic obstructive pulmonary disease (COPD) primarily relies on treatment delivered through inhaler devices. The effectiveness of dry powder inhalers is compromised by insufficient peak inspiratory flow (PIF). Understanding the evolution of PIF during hospitalization is crucial for optimizing inhaler selection and improving patient outcomes.

Patients and Methods

A prospective monocentric observational study was conducted at Fribourg Hospital, Switzerland, from August 2022 to December 2022. PIF was assessed at hospital admission and discharge in all patients with COPD admitted to the internal medicine division. The primary outcome was the evolution of maximum PIF at a fixed medium-low resistance (R2) during hospitalization. Secondary outcomes included the variation of PIF in the intra-assessment evaluation and transitioning between sufficient and insufficient PIF.

Results

Forty-nine patients were enrolled, 61% were men and 65% experienced an acute COPD exacerbation (AECOPD). The maximum PIF for R2 increased from 64.8 ± 17.2 L/min at admission to 70.7 ± 17.9 L/min at discharge, showing a 5.9 L/min improvement (95% CI: 2.4-9.5, p < 0.01). A hospitalization >5 days in patients hospitalized for an AECOPD is associated with a higher increase in PIF (p < 0.05). In the intra-assessment measurement, we observed an increase in PIF in the successive measurements (p < 0.01).

Conclusion

Hospitalized patients with COPD experienced a significant increase in PIF during their stay. These results appear to be independent of the reason for hospitalization but need to be confirmed with a larger sample. Nevertheless, these findings underscore the importance of regular PIF assessment and influence inhaler selection.

Analysis and prediction of the burden of COPD in original BRICS countries from 1990 to 2050

BACKGROUND

The Original BRICS countries (Brazil, Russia, India, China, and South Africa) face similar challenges of a significant increase in the burden of chronic obstructive pulmonary disease (COPD).

RESEARCH DESIGN AND METHODS

This analysis, based on data from the 2021 Global Burden of Disease (GBD 2021), examined trends in the incidence, mortality, and disability-adjusted life years (DALYs) rates of COPD in Original BRICS countries from 1990 to 2021. Linear regression was used to estimate the annual percentage change (EAPC) of age-standardized rates (ASR), and Bayesian age-period-cohort (BAPC) model was used to predict the COPD burden in 2050.

RESULTS

The disease burden increased with age in 2021, particularly after 45 years old, with significant gender disparities. From 1990 to 2021, the EAPC for age-standardized incidence, mortality, and DALYs rates decreased, with China experiencing the sharpest decline. The COPD burden is predicted to be alleviated across Original BRICS countries in 2050, although men will still be more affected than women.

CONCLUSION

Despite the substantial improvements, the burden of COPD remains substantial in Original BRICS countries. In 2050, COPD is expected to more pronouncedly affect middle-aged and elderly populations, as well as people exposed to tobacco and environmental pollution.

Comparison of SGLT2 and DPP4 inhibitors on clinical outcomes in COPD patients with diabetes: A nationwide cohort study

BACKGROUND

This study aimed to evaluate the association between sodium-glucose cotransporter 2 inhibitor (SGLT2i) use and the risk of exacerbation and mortality among patients with chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM).

METHODS

Taiwan's National Health Insurance Research Database was used to select the COPD patients with DM and those prescribed SGLT2i and dipeptidyl peptidase-4 inhibitor (DPP4i). To reduce the selection and confounding bias, an active comparator new user design was used in current study to estimate the SGLT2i effects. The risk of COPD exacerbation and mortality was calculated using Cox regression model.

RESULTS

We identified 188 SGLT2i-useres and 181 DPP4i users. SGLT2i use was associated with a significantly lower risk of overall COPD exacerbation (HR, 0.69; 95% CI, 0.52-0.92). In addition, SGLT2i users demonstrated a significantly lower risk of severe acute exacerbations with Hazard ratio of 0.35 (95% CI, 0.20-0.61) than DPP4i users. However, no significant differences in mortality were observed between groups (HR, 1.51, 95% CI, 0.53-4.25).

CONCLUSION

SGLT2i use in COPD patients with DM was associated with reduced risks of COPD exacerbation, particularly for severe acute exacerbation compared with DPP4i. This finding suggested that SGLT2i therapy may have a protective effect against severe exacerbations in COPD management.

Association of dietary calcium intake with chronic bronchitis and emphysema

OBJECTIVE

Chronic bronchitis and emphysema (CBE) are two main types of chronic obstructive pulmonary disease (COPD). We aimed to investigate the relationship between dietary calcium intake and the risk of CBE.

METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. The ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) < 0.7 was used to define airflow obstruction. Multivariate logistic regression was performed to assess the effects of dietary calcium intake on CBE and airflow obstruction. Dietary calcium intake was divided into quartiles, with the lowest quartile set as the reference group. Linear regression models were applied to explore the association between dietary calcium intake and lung function.

RESULTS

A total of 10,143 participants were enrolled in the study, including 594 CBE and 9549 non-CBE individuals. The average dietary calcium intake was 908.5 ± 636.1 mg/day in the CBE group and 951.9 ± 599.7 mg/day in the non-CBE group. When using the lowest quartile of dietary calcium intake as a reference, the second, third, and fourth quartiles reduced the risk of CBE by 0.803 [95% confidence interval (CI): 0.802-0.804; P < 0.001], 0.659 (95% CI: 0.659-0.660; P < 0.001) and 0.644 (95% CI: 0.643-0.644; P < 0.001) times, respectively. Increased dietary calcium intake was correlated with reduced risk of airflow obstruction. Dietary calcium intake positively predicts FEV1 (β = 0.225, P < 0.001) and FVC (β = 0.232, P < 0.001).

CONCLUSION

Increased intake of dietary calcium may contribute to higher lung function, a lower risk of CBE and airflow obstruction. Since the cross-sectional design makes it difficult to determine a causal relationship, further research is needed to confirm these findings and explore the underlying mechanisms.

Use of inhaled corticosteroids in bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)

INTRODUCTION

Current bronchiectasis guidelines advise against the use of inhaled corticosteroids (ICS) except in patients with associated asthma, allergic bronchopulmonary aspergillosis (ABPA) and/or chronic obstructive pulmonary disease (COPD). This study aimed to describe the use of ICS in patients with bronchiectasis across Europe.

METHODS

Patients with bronchiectasis were enrolled into the European Bronchiectasis Registry from 2015 to 2022. Patients were grouped into ICS users and non-users at baseline and clinical characteristics associated with ICS use were investigated. Patients were followed up for clinical outcomes of exacerbation, hospitalisation and mortality for up to 5 years. We evaluated if elevated blood eosinophil counts (above the laboratory upper limit of normal) modified the effect of ICS on exacerbations.

RESULTS

19 324 patients were included for analysis and 10 109 (52.3%) were recorded as being prescribed ICS at baseline. After exclusion of patients with a history of asthma, COPD and/or ABPA, 3174/9715 (32.7%) patients with bronchiectasis were prescribed ICS. Frequency of ICS use varied across countries, ranging from 17% to 85% of included patients. ICS users had more severe disease, with significantly worse lung function, higher Bronchiectasis Severity Index scores and more frequent exacerbations at baseline (p<0.0001). Overall, ICS users did not have a reduced risk of exacerbation or hospitalisation during follow-up, but a significant reduction in exacerbation frequency was observed in the subgroup of ICS users with elevated blood eosinophil counts (relative risk 0.70, 95% CI 0.59 to 0.84, p<0.001).

CONCLUSION

ICS use is common in bronchiectasis, including in those not currently recommended ICS according to bronchiectasis guidelines. ICS use may be associated with reduced exacerbation frequency in patients with elevated blood eosinophils.

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

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

Segmental phase angle can predict incidence of severe exacerbation in male patients with COPD

OBJECTIVE

To investigate whether segmental phase angle (PhA) is a useful predictor of severe chronic obstructive pulmonary disease (COPD) exacerbation.

RESEARCH METHODS AND PROCEDURES

This prospective cohort study enrolled consecutive patients with COPD with a follow-up period of 3 years. The primary outcome was incidence of severe exacerbation. PhA was measured for the whole body and segmental body sites (trunk and upper and lower limbs). We used receiver operating characteristic (ROC) curves to determine the cut-off values and area under the curve (AUC) for predicting exacerbation based on PhA. We applied Cox proportional hazard regression analyses to estimate the independent prognostic effect of PhA on the incidence of severe exacerbation.

RESULTS

We analyzed 108 male participants (mean age 75.1±7.9 years) and the median follow-up period was 1082 [643-1103] days, with an annual severe exacerbation incidence rate of 0.23 per person-year. ROC analysis revealed that the AUC for Whole-body and segmental PhA were as follows: Whole-body: AUC = 0.69 (95% confidence interval [CI] = 0.59-0.79); right arm: AUC = 0.65 (95% CI = 0.53-0.77); left arm: AUC = 0.68 (95% CI = 0.56-0.79); right leg: AUC = 0.73 (95% CI = 0.64-0.82); left leg: AUC = 0.71 (95% CI = 0.62-0.81); trunk: AUC = 0.58 (95% CI = 0.46-0.69). Cox proportional hazard analysis demonstrated that PhA of the right leg (hazard ratio [HR]=3.50, 95% CI=1.33-9.20), left leg (HR=3.26, 95% CI=1.18-9.04), and left arm (HR=2.61, 95% CI=1.17-6.80) were independently and significantly associated with incidence of severe exacerbation. Whole and trunk PhA were not significantly associated with the incidence of severe exacerbation.

CONCLUSIONS

Segmental PhA may serve as a valuable predictive indicator of severe exacerbation in male patients with COPD. Notably, both leg PhA were strongly associated with the occurrence of severe exacerbations.

REGISTRY NUMBER

UMIN000044824.

Heterogeneity of reduced FEV1 in early adulthood: A looking forward, looking backwards analysis

BACKGROUND

Some individuals never achieve normal peak FEV1 in early adulthood. It is unknown if this is due to airflow limitation and/or lung restriction.

METHODS

To investigate this, we: (1) looked forward in 19,791 participants in the Dutch Lifelines general population cohort aged 25-35 years with 5-year follow-up; and (2) looked backwards in 2032 participants in the Swedish BAMSE birth cohort with spirometry at 24 years of age but also at 16 and/or 8 years.

RESULTS

(1) In Lifelines 8.5% of participants had reduced FEV1 at 25-35 years, 68% due to Preserved Ratio Impaired Spirometry ('PRISm') and 32% to airflow limitation ('low-limited'); besides, 3.8% participants with normal FEV1 showed airflow-limitation ('normal-limited'). Low-limited and normal-limited, but not PRISm, reported higher smoking exposures and asthma diagnosis than normal (p < 0.05). At 5-year follow-up, 91.2% of participants remained in the same group, and FEV1 decline was similar in normal and normal-limited participants, but statistically smaller (p < 0.05) in PRISm and low-limited; (2) these observations were largely reproduced in BAMSE at 24 years of age; and, (3) in BAMSE, low-limited or PRISm individuals were already identifiable at 8-16 years of age.

CONCLUSION

Low peak FEV1 in early adulthood is most often due to PRISm and results in a significant burden of respiratory symptoms. Only low-limited and normal-limited, but not PRISm, associate with a doctor diagnosis of asthma, and FEV1 decline was statistically different in PRISm indicating a need for differentiated clinical approaches. These spirometric abnormalities can be already identified in childhood and adolescence.

Effect of adaptive statistical iterative reconstruction-V algorithm and deep learning image reconstruction algorithm on image quality and emphysema quantification in COPD patients under ultra-low-dose conditions

PURPOSE

To explore the effect of different reconstruction algorithms (ASIR-V and DLIR) on image quality and emphysema quantification in chronic obstructive pulmonary disease (COPD) patients under ultra-low-dose scanning conditions.

MATERIALS AND METHODS

This prospective study with patient consent included 62 COPD patients. Patients were examined by pulmonary function test (PFT), standard-dose CT (SDCT) and ultra-low-dose CT (ULDCT). SDCT images were reconstructed with filtered-back-projection (FBP), while ULDCT images were reconstructed using FBP, 30%ASIR-V, 60%ASIR-V, 90%ASIR-V, low-strength (DLIR-L), medium-strength (DLIR-M) and high-strength DLIR (DLIR-H) to form 8 image sets. Images were analysed using a commercial computer aided diagnosis (CAD) software. Parameters such as image noise, lung volume (LV), emphysema index (EI), mean lung density (MLD) and 15th percentile of lung density (PD15) were measured. Two radiologists evaluated tracheal and pulmonary artery image quality using a 5-point scale. Measurements were compared and the correlation between EI and PFT indices was analysed.

RESULT

ULDCT used 0.46 ± 0.22 mSv in radiation dose, 93.8% lower than SDCT (P < .001). There was no difference in LV and MLD among image groups (P > .05). ULDCT-ASIR-V90% and ULDCT-DLIR-M had similar image noise and EI and PD15 values to SDCT-FBP, and ULDCT-DLIR-M and ULDCT-DLIR-H had similar subjective scores to SDCT-FBP (all P > .05). ULDCT-DLIR-M provided the best correlation between EI and the FEV1/FVC and FEV1% indices in PFT, and the lowest deviations with SDCT-FBP in both EI and PD15.

CONCLUSION

DLIR-M provides the best image quality and emphysema quantification for COPD patients in ULDCT.

ADVANCES IN KNOWLEDGE

Ultra-low-dose CT scanning combined with DLIR-M reconstruction is comparable to standard dose images for quantitative analysis of emphysema and image quality.

Factors associated with short- and medium-term mortality after hospitalization for COPD exacerbation

OBJECTIVE

Hospitalization due to exacerbation is a critical event for patients with chronic obstructive pulmonary disease (COPD). This study aimed to identify predictive factors for mortality in patients post-hospitalization for COPD exacerbation and to determine differences in these predictors in the short and medium term.

METHODS

A prospective observational study involving 1635 patients hospitalized for COPD exacerbation, followed for one year. Sociodemographic and clinical data, comorbidities, treatments, and quality of life questionnaires were assessed. Cox regression analysis identified mortality predictors at 2 months and >2-12 months post-hospitalization.

RESULTS

Mean age was 72.4 years with 76.6 % males. Overall, one-year mortality was 14.1 % (30.3 % of the deaths occurred within 2 months of discharge and 69.7 % occurred >2-12 months post-discharge). Short-term mortality predictors included: age (HR [95 % CI] = 2.483 [1.501-4.107]), lower Barthel index (HR [95 % CI] = 1.274 [1.063-1.526]), pulmonary function (FEV1 < 30 %: HR [95 % CI] = 5.153 [1.511-17.577]), and length of stay ≥8 days (HR [95 % CI] = 6.974 [2.504-19.419]). Medium-term predictors included: heart failure (HR [95 % CI] = 2.493 [1.318-4.717]), age (HR [95 % CI] = 1.690 [1.224-2.334]), lower Barthel index (HR [95 % CI] = 1.300 [1.149-1.472]), and pulmonary function (FEV1 < 30 %: HR [95 % CI] = 3.000 [1.351-6.658] and FEV1 30-50 %: HR [95 % CI] = 2.010 [1.046-3.862]).

CONCLUSIONS

Mortality risk factors with exacerbated COPD after hospitalization vary over time. In the short term, length of hospital stay is prominent, while heart failure is more significant in the medium term. Age, dependency and pulmonary function were common predictors in both periods. Tailoring clinical interventions over time may improve health outcomes in this population.

Computational fluid dynamics of small airway disease in chronic obstructive pulmonary disease

BACKGROUND

Small airways (<2 mm diameter) are major sites of airflow obstruction in chronic obstructive pulmonary disease (COPD). This study aimed to quantify the impact of small airway disease, characterized by narrowing, occlusion, and obliteration, on airflow parameters in smokers and end-stage patients with COPDs.

METHODS

We performed computational fluid dynamics (CFD) simulations of inspiratory airflow in three lung groups: control non-used donor lungs (no smoking/emphysema history), non-used donor lungs with a smoking history and emphysema, and explanted end-stage COPD lungs. Each group included four lungs, with two tissue cylinders. Micro-CT-scanned small airways were segmented into 3D models for CFD simulations to quantify pressure, resistance, and shear stress. CFD results were benchmarked against simplified linear and Weibel models.

FINDINGS

CFD simulations showed higher pressures in COPD vs. controls (p = 0.0091) and smokers (p = 0.015), along with increased resistance (p = 0.0057 vs. controls; p = 0.0083 vs. smokers) and up to a tenfold rise in shear stress (p = 0.010 vs. controls). Narrowing and occlusion were shown to independently increase pressure, resistance, and shear stress, which were validated through segmentation corrections. Pressures and resistance assessed with simplified models were up to seven-fold higher for smokers and even 72 higher for COPD compared with CFD values.

INTERPRETATION

These findings show that increased airflow parameters can explain the association between small airway disease and airflow limitation in COPD, underscoring small airway vulnerability. Additionally, they highlight the limitations of theoretical models in accurately capturing small airway disease.

FUNDING

Supported by the KU Leuven (C16/19/005).

Integrated Nicotine Replacement and Behavioral Support to Reduce Smoking in Opioid Agonist Therapy: A Randomized Clinical Trial

Importance

Approximately 85% of individuals receiving opioid agonist therapy for opioid dependence smoke tobacco. Despite the significant health risks associated with smoking-related diseases, there has been limited evaluation of smoking interventions tailored to this population.

Objective

To determine the effectiveness of an intervention combining nicotine replacement with brief behavioral support in reducing cigarette use.

Design, Setting, and Participants

This multicenter randomized clinical trial was conducted from April 2022 to October 2023 in 7 specialized opioid agonist therapy clinics in Bergen and Stavanger, Norway. The analyst was blinded to patient groupings. Assessors (study nurses) were not fully blinded to participant allocation. Individuals diagnosed with opioid dependency receiving opioid agonist therapy at participating clinics and smoking at least 1 cigarette per day were eligible for participation. Data analysis was performed from December 2023 through October 2024.

Intervention

In addition to standard opioid agonist therapy, participants in the intervention group received a 16-week integrated treatment combining nicotine replacement with brief behavioral support. Participants in the control group received only standard opioid agonist therapy.

Main Outcomes and Measures

The primary outcome was at least a 50% reduction in the number of cigarettes smoked, self-reported as cigarette use in the past 7 days at week 16. The analysis followed intention-to-treat principles. Cigarette use was self-reported as per the timeline-follow-back method.

Results

Among the 259 participants (mean [SD] age, 48.5 [10.4] years; 80 [30.9%] female), 135 were allocated to the intervention group and 124 to the control group. The odds ratio of at least halving the number of cigarettes smoked was 2.07 (95% CI, 1.14-3.75) in the intervention group compared with the control group.

Conclusions and Relevance

Providing integrated nicotine replacement and behavioral support at opioid agonist treatment clinics effectively helped opioid-dependent participants reduce the number of cigarettes smoked.

Trial Registration

ClinicalTrials.gov Identifier: NCT05290025.

Lung cancer detection by electronic nose analysis of exhaled breath: a multi-center prospective external validation study

BACKGROUND

Electronic nose (eNose) analysis of exhaled breath shows potential for accurate and timely lung cancer diagnosis, yet prospective external validation studies are lacking. Our study primarily aimed to prospectively and externally validate a published eNose model for lung cancer detection in COPD patients and assess its diagnostic performance alongside a new eNose model, specifically tailored to the target population, in a more general outpatient population.

PATIENTS AND METHODS

This multi-center prospective external validation study included adults with clinical and/or radiological suspicion of lung cancer who were recruited from thoracic oncology outpatient clinics of two sites in The Netherlands. Breath profiles were collected using a cloud-connected eNose (SpiroNose®). The diagnostic performance of the original and new eNose model was assessed in various population subsets based on ROC-AUC, specificity, positive predictive value (PPV), and negative predictive value (NPV), targeting 95% sensitivity. For the new eNose model, a training and validation cohort were used.

RESULTS

Between March 2019 and November 2023, 364 participants were included. The original eNose model detected lung cancer with a ROC-AUC of 0.92 (95% CI: 0.85-0.99) in COPD patients (n=98/116; 84%) and 0.80 (95% CI: 0.75-0.85) in all participants (n=216/364; 59%). At 95% sensitivity, the specificity, PPV, and NPV, were 72% and 51%, 95% and 74%, and 72% and 88%, respectively. In the validation cohort, the new eNose model identified lung cancer across all participants (n=72/121; 60%) with a ROC-AUC of 0.83 (95% CI: 0.75-0.91), 94% sensitivity, 63% specificity, PPV of 79%, and NPV of 89%. Notably, accurate detection was consistent across tumour characteristics, disease stage, diagnostic centers, and clinical characteristics.

CONCLUSION

This multi-center prospective external validation study confirms that eNose analysis of exhaled breath enables accurate lung cancer detection at thoracic oncology outpatient clinics, irrespective of tumour characteristics, disease stage, diagnostic center, and clinical characteristics.

Factors Influencing Compliance with Pulmonary Rehabilitation in Patients with Stable COPD: a Cross Sectional Study

Background

Pulmonary rehabilitation (PR) is recognized as a cost-effective non-pharmacological treatment modality to promote quality of life and delay disease progression in patients with chronic obstructive pulmonary disease (COPD). Although PR has been shown to be effective, it is underutilized in clinical practice. This study aimed to investigate the factors associated with affecting compliance with PR in stable COPD patients.

Methods

This study is a cross-sectional survey. Patients with stable COPD were included using convenience sampling method. Data were collected using questionnaires including the demographic questionnaire, PR Compliance Questionnaire, mMRC dyspnea Scale, Family Support Scale, and Chronic Disease Self-Efficacy Scale (SES6G). Univariate analysis and multiple linear regression analysis were used to analyze the data.

Results

The 100 patients with stable COPD were moderately compliant with PR (3.51 ± 0.65), with the highest compliance with medication (4.10 ± 0.86) and the lowest with exercise (3.03 ± 1.16). Univariate analysis showed statistically significant influences on PR compliance were gender (P = 0.029), educational level (P = 0.021), exercise habits (P < 0.01), willingness to PR (P < 0.01), difficulty of PR (P = 0.030), mMRC (P = 0.002), and SES6G (P = 0.002). The following equation represents the multiple linear regression model: PR compliance = 0.235 × exercise habits + 0.609 × willingness to PR + 0.325 × difficulty of PR (P < 0.0001), adjusted R2 = 0.330, F=7.974, and Durbin-Watson ratio = 2.049. Patients' good exercise habits in regular life, stronger willingness to PR, and easier PR programs may contribute to improved PR compliance.

Conclusion

This study suggested that stable COPD patients were not sufficiently compliant with PR and revealed related important factors affecting the compliance. Exercise habits, willingness to PR, and PR difficulty were found to be significant influencing factors. The results of this study can provide evidence for developing a more appropriate PR program and promoting PR compliance in the future.

Associations of small airway dysfunction assessed by impulse oscillometry with lung function decline and exacerbations in participants with chronic obstructive pulmonary disease: A prospective cohort study in China

INTRODUCTION

Small airway dysfunction (SAD) assessed by impulse oscillometry (IOS) was common in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the associations between IOS-defined small airway dysfunction (SAD) and the long-term prognosis of COPD. This study aimed to explore the associations between IOS-defined SAD, lung function decline and exacerbations in patients with COPD.

METHODS

We analyzed baseline and 2-year follow-up data from the prospective cohort study in China. We defined SAD using IOS parameters Z-score greater than the 1.645 or less than -1.645. Subsequently, these patients were divided into three groups based on the different criteria defined SAD using IOS (normal group [none IOS parameters abnormalities], inconsistent SAD [any IOS parameters abnormalities, but not all], consistent SAD [all of IOS parameters abnormalities]). Negative binomial regression was conducted to analyze the associations between SAD and exacerbations, while a multivariable linear regression model was utilized to identify associations between SAD and lung function decline.

RESULTS

833 patients with COPD were enrolled in our study. SAD (defined by X5, AX, and Fres z-score) was associated with a faster decline in lung function and higher risk of exacerbation. Meanwhile, for inconsistent diagnosis of SAD, we observed that patients with consistent SAD and inconsistent SAD experienced a faster decline in FEV1 and higher risk of exacerbations than those with normal group.

CONCLUSIONS

IOS-defined SAD was associated with worse outcomes in patients with COPD, and further clinical trials are needed to clarify whether early intervention to reduce the severity of small airway lesions can delay the progress of COPD.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900024643. Registered on 19 July 2019.

Automatically titrating oxygen system versus constant flow oxygen system during exercise in patients with COPD: a systematic review and meta-analysis

BACKGROUND

Hypoxemia is a common symptom among patients with chronic obstructive pulmonary disease (COPD). The constant flow oxygen system (CFOS) is often insufficient to correct this symptom. The automatically titrating oxygen system (ATOS), a new oxygen therapy mode, remains undetermined in its ability to improve exercise performance more effectively than CFOS in COPD patients. The main objective of this meta-analysis was to explore this issue.

METHODS

We conducted a thorough search of randomized controlled trials (RCTs) in PubMed, Embase, Web of Science (from inception to 1 November 2024). Study selection, data extraction, and risk of bias assessment were performed independently by two authors. Data synthesis was conducted using Stata software (Version 17.0). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was utilized to rate evidence quality.

RESULTS

Five eligible studies (n = 120) were included. Compared to CFOS, ATOS was more effective in extending the distance (MD = 180.28 m, 95%CI:133.03 to 227.52) and duration (MD = 237.63 s, 95%CI: 181.18 to 294.07) of endurance shuttle walking test (ESWT). Besides, ATOS could better prolong the percentage time of sustaining targeted SpO2 (92%-96%) (MD = 29.43%,95%CI:21.15 to 37.71) and relieve dyspnea at isotime (MD = -1.65, 95%CI -3.19 to -0.11) during ESWT.

DISCUSSION

ATOS may have more advantages in improving exercise tolerance, sustaining targeted SpO2, and ameliorating dyspnea during exercise in COPD patients.

CLINICAL TRIAL REGISTRATION

The review was registered with PROSPERO (The website is https://www.crd.york.ac.uk/prosp ero/, and the ID is CRD 42024574955) and we didn't make a protocol.

Nomogram to predict progression from preserved ratio impaired spirometry to chronic obstructive pulmonary disease

Preserved Ratio Impaired Spirometry (PRISm) is a specific subtype of pre-chronic obstructive pulmonary disease (pre-COPD). People with PRISm are at risk of progression to chronic obstructive pulmonary disease (COPD). We developed a model to predict progression in subjects with PRISm. We screened 188 patients whose lung function transitioned from PRISm to COPD and 173 patients with PRISm who remained stable over two years. After excluding 78 patients due to incomplete clinical or laboratory data, a total of 283 patients were included in the final analysis. These patients were randomly divided into a training cohort (227 patients) and a validation cohort (56 patients) at a 8:2 ratio. LASSO regression and multivariate logistic regression were used to identify factors influencing progression. Among the 283 patients, 134 progressed to COPD. The model developed using six variables showed good performance, with areas under the receiver operating characteristic (ROC) curves of 0.87 in the training cohort and 0.79 in the validation cohort. The model demonstrated excellent calibration and was clinically meaningful, as shown by decision curve analysis (DCA) and clinical impact curve (CIC). We developed China's first prediction model for the progression of lung function from PRISm to COPD in a real-world population. This model is conducive to early identification of high-risk groups of pulmonary function deterioration, so as to provide timely intervention and delay the occurrence and progression of the disease.

Cordyceps militaris alleviates COPD by regulating amino acid metabolism, gut microbiota and short chain fatty acids

ETHNOPHARMACOLOGICAL RELEVANCE

Chronic obstructive pulmonary disease (COPD) is a global health challenge with the high morbidity and mortality. Cordyceps militaris (CM) is a medicinal fungus that has been widely used in Asia for centuries. It has the effects of tonifying the lung and kidney, replenishing essence, resolving phlegm, and stopping bleeding. CM has been used clinically for alleviating COPD in China. However, the potential mechanism of CM in treating COPD remains indistinct.

PURPOSE

This article aimed to evaluate the efficacy and investigate the underlying mechanism of CM in treatment of COPD.

METHODS

The ingredients in CM were identified by LC Q/TOF-MS. The effect of CM in COPD was evaluated. Untargeted metabolomics assay and 16S rDNA sequencing were employed to examine the changes in metabolites and gut microbiota in COPD mice. Gut microbiota ablation experiment and quantification of short chain fatty acids (SCFAs) were integrated to elucidate the systematic mechanism of CM in treatment of COPD.

RESULTS

A total of 22 ingredients were identified in CM. CM alleviated COPD significantly by improving lung function and inhibiting pulmonary inflammation. Subsequently, 11 differential metabolites regulated by CM were mainly associated with amino acid metabolism. CM ameliorated the dysbiosis of intestinal microbiota in COPD mice, which contributed to the treatment of COPD. Moreover, CM increased the contents of SCFAs, including acetate, propionate, butyrate and isobutyrate. Spearman correlation indicated a close relationship among pulmonary function, differential metabolites, and gut microbiota.

CONCLUSIONS

This study revealed that CM alleviated COPD by regulating amino acid metabolism, ameliorating the imbalance of gut microbiota and increasing the SCFAs. These findings not only establish a foundation for the research of CM but also provide a basis for new treatment strategies of COPD.

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

Objective

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

Methods

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

Results

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

Conclusion

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

New insights into the effects of PFOS exposure on rat lung development: morphological, functional, and single-cell sequencing analysis

Perfluorooctane sulfonate (PFOS), a widely persistent environmental pollutant, has been demonstrated to disrupt lung development in animal models. However, its cellular and molecular mechanisms remain insufficiently understood. This study examines the effects of prenatal PFOS exposure on lung development and function in offspring rats. Pregnant rats were exposed to PFOS at concentrations relevant to both environmental and occupational exposures, with doses of 0, 0.01, 0.1, and 1 mg/kg/day from gestational day 11-20. We primarily evaluated morphological changes, pulmonary function, bronchoalveolar lavage fluid composition, and alterations in trace element and fatty acid metabolism at postnatal days 0, 4, 14, 21, and 60. Single-cell RNA sequencing was employed to profile cellular and molecular responses in the lungs. Our results show that PFOS exposure leads to dose-dependent reductions in alveolar development, increased pulmonary injury, fibrosis, and impaired lung function. PFOS also changes lung cell composition, particularly affecting structural and immune cells, and shifts immune responses from innate to adaptive immunity. Differential gene expression analyses revealed the upregulation of Fam111a and downregulation of Stk35, implicating these genes in PFOS-induced lung injury and repair processes. In addition, pathway analyses demonstrated suppression of immune-related signaling pathways and disruption of cell adhesion and phagocytosis, which may exacerbate lung tissue injury. These findings provide novel insights into the developmental toxicity of PFOS and highlight its potential long-term health risks.

Exploring self-management's mediating role in health literacy and quality of life: evidence from COPD patients in Hunan, China

PURPOSE

This study aimed to investigate the relationship between health information literacy and quality of life and to explore the mediating role of self-management in this relationship among COPD patients in Hunan, China.

METHODS

Following the STROBE guidelines, this cross-sectional study employed convenience sampling to recruit 432 COPD patients from six tertiary hospitals in Hunan Province, China, between December 2022 and August 2023. Data collection instruments included the Health Literacy Self-Assessment Questionnaire (HLSQ), the COPD Self-Management Scale, and the COPD Assessment Test (CAT). Descriptive statistics were used to summarize participants' characteristics. Pearson correlation analysis and SPSS 26.0's macro program for mediation analysis were used, with a significance level set at p < 0.05.

RESULTS

Health information literacy showed a strong positive correlation with both self-management (r = 0.742, p < 0.001) and quality of life (r = -0.748, p < 0.001). Additionally, self-management was positively associated with quality of life (r = -0.861, p < 0.001). Self-management significantly mediated the relationship between health information literacy and quality of life, accounting for 67.4% of the total effect.

CONCLUSIONS

The mediating effect of self-management on the relationship between health information literacy and quality of life in COPD patients is established. Measures are needed to improve health information literacy, enhance self-management, and improve health outcomes.

Monoclonal Antibodies for the Treatment of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a common and complex disease characterized by persistent airflow limitation and the presence of exacerbations, resulting in significant morbidity and mortality. Although the pathogenesis of COPD is multifactorial, airway inflammation plays a significant role in disease progression. Despite the advantages of non-pharmaceutical and pharmaceutical interventions that have significantly improved the symptom burden and exacerbation frequency in COPD, there is a lack of disease-modifying therapies that target the underlying disease mechanisms. Monoclonal antibodies (mAbs), a drug class that has improved treatment in severe asthma by blocking mediators of the type 2 (Th2) and allergic inflammatory cascades, are currently under investigation for their efficacy in COPD. Our review summarizes the evidence for the use of monoclonal antibodies in COPD and discusses current limitations and promising advances. Although targeting Th1 inflammation has failed to improve COPD outcomes, recent clinical trials have shown beneficial effects of monoclonal antibodies targeting Th2 inflammation, providing evidence for a personalized approach in COPD treatment.

Development and validation of a predictive model for acute exacerbation in chronic obstructive pulmonary disease patients with comorbid insomnia

Aim

To develop and validate a risk prediction model for estimating the likelihood of insomnia in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Methods

This prospective study enrolled 253 patients with AECOPD treated at the Department of Respiratory and Critical Care Medicine, Chaohu Hospital Affiliated with Anhui Medical University, between September 2022 and April 2024. Patients were randomly assigned to a training set and a testing set in a 7:3 ratio. Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was conducted in the training set to identify factors associated with insomnia in patients with AECOPD. A nomogram was constructed based on four identified variables to visualize the prediction model. Model validation involved the Hosmer-Lemeshow test, and its performance was assessed through receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Model interpretability was further enhanced using SHapley Additive exPlanations (SHAP).

Results

PSQI grade, marital status (widowed), white blood cell (WBC) count, and eosinophil percentage (EOS%) were identified as significant predictors of insomnia in patients with AECOPD. The nomogram based on these predictors exhibited excellent predictive performance, with areas under the ROC curve (AUCs) of 0.987 and 0.933 for the training and testing sets, respectively. The calibration curves and Hosmer-Lemeshow test demonstrated strong agreement between predicted and observed outcomes, while DCA confirmed the model's superior clinical utility.

Conclusion

This study established a risk prediction model based on four variables to estimate the probability of insomnia in patients with AECOPD. The model exhibited excellent predictive accuracy and clinical applicability, offering valuable guidance for early identification and management of insomnia in this population.

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

Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) afflict millions of individuals globally and are significant sources of disease mortality. While the molecular mechanisms underlying such diseases are unclear, environmental and social factors, such as cigarette smoke and obesity, increase the risk of disease development. Yet not all smokers or obese individuals will develop chronic respiratory diseases. The MAPK p38α is abnormally active in such maladies, but its contribution, if any, to disease aetiology is unknown. To assess whether p38α activation per se in the lung could impose disease symptoms, we generated a transgenic mouse model allowing controllable expression of an intrinsically active variant, p38αD176A+F327S, specifically in lung alveolar type 2 (AT2) pneumocytes. Sustained expression of p38αD176A+F327S did not appear to induce obvious pathological outcomes or to exacerbate inflammatory outcomes in mice challenged with common respiratory disease triggers. However, mice expressing p38αD176A+F327S in AT2 cells and fed with a high-fat diet (HFD) exhibited increased numbers of airway eosinophils and lymphocytes, upregulated levels of pro-inflammatory cytokines and chemokines including interleukin-1β and eotaxin, as well as a reduction in levels of leptin and adiponectin within the lung. Neither HFD nor p38αD176A+F327S alone induced such outcomes. Perhaps in obese individuals with associated respiratory diseases, elevated p38α activity which happens to occur is the factor that promotes their development.

Effects of alcohol consumption from early adolescence on lung function and development of COPD - a retrospective cohort study

Background

Studies indicate a U-shaped relationship between alcohol consumption (AC) and chronic obstructive pulmonary disease (COPD) with low-moderate AC being protective. We investigated the influence of AC debut (ACD) at different ages on forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and COPD development.

Methods

In a multi-center cohort study, data on AC were collected through a questionnaire and spirometry performed at baseline and follow-up. COPD was defined as FEV1/FVC-ratio <0.7 on post-bronchodilator spirometry. Modelling determined odds ratio (OR) of COPD and mean differences in FEV1 and FVC in stratified age groups of ACD. Never drinkers were used as reference. Adjustments were made for age, sex, smoking parameters, asthma, and education.

Results

In total, 4,717 participated in the initial work-up and 2,751 completed follow-up. A higher FEV1 and FVC was found in all groups compared to never drinkers. Highest statistically significant difference in FEV1 and FVC was found in age group 14-16 (0.17 and 0,23 L, respectively). With rising age of ACD a smaller difference in FEV1 and FVC was observed with the smallest difference in age group >25 (0.11 L) and age group 17-18 (0.13 L), respectively. A lower, but not statistically significant OR for COPD in ACD age 14-16 (OR = 0.83) and higher OR in the remaining groups with 21-25 being highest (OR = 1.36) was indicated.

Conclusion

This study found higher FEV1 and FVC in all groups drinking alcohol compared to never drinkers with the highest among participants with ACD at age 14-16. The findings on risk of COPD development were not statistically significant.

The relationship between dyspnea-related kinesiophobia and physical activity in people with COPD: a moderated mediation model

This study aimed to assess the levels of physical activity (PA) in people with chronic obstructive pulmonary disease (COPD), investigate the impact of dyspnea-related kinesiophobia on them, and further examine the moderated mediation effects of exercise perception and exercise self-regulatory efficacy on this relationship. This cross-sectional study was conducted from December 2023 to May 2024. Data were collected using the Breathlessness Beliefs Questionnaire, International Physical Activity Questionnaire - Long Form, Exercise Benefits/Barriers Scale, and Exercise Self-Regulatory Efficacy Scale. Descriptive statistics and Process macro in the SPSS program were used for data analysis. A total of 239 patients with COPD were included, and median physical activities were 64.50 (28.00, 126.55) MET-h/week. Dyspnea-related kinesiophobia was negatively correlated with exercise perception, exercise self-regulatory efficacy, and PA (r = -0.503, -0.739, -0.657, P < 0.01). Exercise self-regulatory efficacy partially mediated the impact of dyspnea-related kinesiophobia on PA (β = -0.255, 95% CI [-0.353, -0.164]), and exercise perception moderating this mediating pathway (β = 0.100, P = 0.030; β = 0.412, P < 0.001). People with COPD commonly have dyspnea-related kinesiophobia and experienced physical inactivity. The moderated mediation model provides a better understanding of how dyspnea-related kinesiophobia, exercise self-regulatory efficacy, and exercise perception work together to influence PA. Interventions seeking to improve the levels of PA in patients with COPD should consider these elements.

ADAR1-HNRNPL-Mediated CircCANX Decline Promotes Autophagy in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a characteristic chronic airway inflammatory disease that worsens over time, however, there are currently limited clinical therapeutics to suspend its progression. Circular RNAs (circRNAs), which have emerged as functional regulators in various diseases, including COPD, may server as new pharmacological targets in COPD. Here, it is identified a nuclear circRNA, circCANX, that is preferentially decreased in COPD. The linear splicing of CANX pre-mRNA, enhanced by the ADAR1-HNRNPL interaction, is responsible for the circCANX decline. Clinically, the higher circCANX expression is associated with a worse lung function index of FEV1/FVC among patients with COPD. CircCANX suppresses autophagy and stress granule (SG) formation to strengthen inflammation of COPD in vivo and in vitro. Mechanistically, circCANX recruits the tumor suppressor protein P53 (P53) mRNA and RNA helicase upstream frameshift 1 (UPF1) to form a ternary complex, which mediates P53 mRNA degradation through nonsense-mediated mRNA decay (NMD) process. Together, this study reveals an important circCANX-mediated regulatory mechanism in COPD, and provides new insights into the potential of circRNA-based drug and biomarker development for COPD.

Diaphragmatic ultrasonographic evaluation as an assessment guide for predicting noninvasive ventilation failure in acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND

Dynamic hyperinflation in severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to diaphragmatic fatigue and causes acute respiratory failure. Ultrasound is reliable for evaluating diaphragmatic function. In this study, we aimed to assess the ability of diaphragmatic ultrasound to predict noninvasive ventilation (NIV) failure.

METHODS

This prospective single-center observational cohort study was performed on patients with AECOPD who required NIV in the emergency department between October 1, 2020, and September 30, 2022, at a tertiary healthcare center. The diaphragmatic ultrasound was measured using diaphragmatic excursion (DE) before applying NIV and diaphragmatic thickening fraction (DTF) during NIV use for 2 h. The area under the receiver-operating characteristic (AUROC) curves analysis and multivariable logistic regression was performed to assess the ability of diaphragmatic ultrasound to predict NIV failure in 48 h.

RESULTS

111 patients were included in this study. DTF was an independent variable associated with NIV failure, with an adjusted odds ratio of 0.91 (95 % confidence interval [CI] 0.85-0.98), with a p-value of 0.009. DE and DTF had AUROC of 0.905 (95 % CI 0.835-0.975) and 0.940 (95 % CI 0.894-0.986), respectively, to predict NIV failure within 48 h. The lower DE and DTF increased the probability of NIV failure. The cutoff value of the DTF was 20 %, with a sensitivity of 92.0 % (95 % CI 74.0 % - 99.0 %) and a specificity of 93.0 % (95 % CI 85.4 % - 97.4 %) and the cutoff of the DE was 1.2 cm, with a sensitivity of 88.0 % (95 % CI 68.8 % - 97.5 %) and a specificity of 84.9 % (95 % CI 75.5 % - 91.7 %).

CONCLUSION

Diaphragmatic ultrasound, especially DTF at 2 h during NIV use, is a validated tool for predicting NIV failure in patients with AECOPD. Early detection of diaphragmatic dysfunction with diaphragmatic ultrasound in AECOPD with NIV could help identify high-risk patients and guide clinical decisions. However, further benefits from its implementation in management are required.

Recent Evidences of Epigenetic Alterations in Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review

Chronic obstructive pulmonary disease (COPD) is a heterogeneous inflammatory condition characterized by progressive airflow limitation, which may be caused by genetic and environmental factors. Furthermore, epigenetic mechanisms could provide valuable insights into the complex interactions between environment and genes and subsequent development of the disease. The aim of this study is to provide a systematic review of the latest knowledge on epigenetic modifications that characterize COPD, summarizing epigenetic factors that could serve as potential novel biomarkers and therapeutic targets for the treatment of COPD patients. We queried the PubMed and Scopus electronic databases with specific keywords, in May 2024, according to the PRISMA guidelines, and articles were included if they met all the inclusion criteria and survived a quality assessment. We identified 5414 publications in our systematic search. Among them, only 51 articles met the criteria of COPD-associated epigenetic modifications in human patients compared to the control group. Eight studies described DNA methylation, one study histone modifications, and forty-two studies non-coding RNAs. Apoptosis and inflammatory pathways have been found to be the main mechanisms regulated by epigenetic elements in COPD patients. In addition, non-coding RNAs may be useful as biomarkers or therapeutic targets of pulmonary disease. Future studies will be needed to confirm the role of epigenetic elements associated with COPD.

Development and Validation of a Simple Model to Predict Patient Height

Background

Height recorded in electronic health records (EHRs) is used extensively in diagnosis and treatment, either in isolation or as a component of body-mass index (BMI), but is often falsely high because many adults overestimate their height. Statistical models to predict height could therefore improve population health, but to date models have required extensive input and have not been externally validated.

Methods

We used the National Health and Nutrition Examination Survey (NHANES) to develop sex-stratified predictive models for examiner-measured height based on self-reported height and age in a random 90% sample of data. We internally validated the model in a held-out 10% sample and externally validated the model in two cohorts: The National Adolescent to Adult Longitudinal Health Study (Add Health) and the University of Michigan Health and Retirement Study (HRS). We assessed discrimination with C-index, calibration by visual inspection of calibration plots, and accuracy using root mean square error (RMSE).

Results

Models were trained using 62,032 NHANES subjects (51.9% women, 21.7% Black, 23.9% Hispanic or Latino, with median age 48 [IQR 31 - 64]), and evaluated in the NHANES held-out test set (n=6,846), Add Health (n=5,749), and HRS (n=5,655). Models demonstrated excellent discrimination in all validation cohorts (C-index range 0.88 - 0.89). Models were well-calibrated in all validation cohorts. Model-predicted height demonstrated lower root mean square error (RMSE) compared to self-reported height in all validation cohorts and when stratified by race and ethnicity, with greatest improvements in participants aged 45 and over.

Conclusions and Relevance

A model requiring minimal input data improves estimation of height over self-reported height at least as much as more complex models across stratifications of sex, age, race and ethnicity in internal validation, and is the first model to improve height estimation that has demonstrated external validity.

Application of Discrete Event Simulation Models for COPD Management: A Systematic Review

Background

This systematic review aims to comprehensively assess the current application of discrete event simulation (DES) models in managing chronic obstructive pulmonary disease (COPD). By synthesizing and analyzing multiple studies, we incorporate the latest evidence, evaluate research quality, identify gaps, and provide recommendations for the future application of DES in COPD management.

Methods

We systematically searched six electronic databases including PubMed, Web of Science, Embase, Cochrane, Econlit, and China National Knowledge Infrastructure (CNKI) for articles published up to August 22, 2024. Reference lists of the included articles were also manually checked. Depending on the study type, we assessed quality using either the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist or the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Practice Guidelines.

Results

Out of the 273 records identified, nine studies met the inclusion criteria. All of these studies focused on health economic evaluations using DES in COPD management, and were conducted in high-income countries. The studies were divided into three groups based on the modeling systems they used: cost-effectiveness analyses of different pharmacological treatments (n=3), economic evaluations of case detection strategies (n=3), and assessments of various interventions on COPD healthcare services (n=3). All studies reported model validation methods (n=9); however, only two studies performed subgroup analysis.

Conclusion

This review highlights the current use of DES in COPD management and suggests avenues for future research and resource allocation to enhance the effectiveness of COPD interventions.

Access to single-inhaler triple medicines for chronic obstructive pulmonary disease in China: a national survey on accessibility and utilisation

Background

The maintenance medicines for chronic obstructive pulmonary disease (COPD) include inhaled corticosteroids (ICS), long-acting muscarinic antagonists (LAMA) and long-acting β2-agonists (LABA). Budesonide/glycopyrronium/formoterol (BUD/GLY/FOR) and fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) are two representative drugs for prefixed ICS/LAMA/LABA association in a single inhaler and have shown comparable efficacy and safety with other ICS/LAMA/LABA open combination therapies in patients with moderate-to-very severe COPD. This study aimed to investigate the availability, price, affordability, and utilisation of single-inhaler triple medicines for COPD in China.

Methods

Quarterly data about the use of BUD/GLY/FOR and FF/UMEC/VI from 2020 to 2022 were collected from the Chinese Medicine Economic Information Network. We used the adjusted World Health Organization and Health Action International methodology to calculate the availability and affordability of the two investigated medicines in 596 tertiary general hospitals and 299 secondary general hospitals in 31 provincial administrative regions in China.

Results

The availability and consumption of BUD/GLY/FOR were significantly higher than those of FF/UMEC/VI during the study period. At the end of 2022, the availability of BUD/GLY/FOR and FF/UMEC/VI in tertiary general hospitals was 69.80% and 52.01% respectively, while in secondary general hospitals, it was 52.51% and 28.76% respectively. Both medications were equally affordable at 1.3 days of the minimum wage after reimbursement in 2022. In the first quarter of 2021, with the inclusion of both drugs in the Medicare catalog, their DDDc decreased significantly, which was accompanied by notable improvements in their availability, affordability and consumption.

Conclusions

The overall accessibility and consumption of BUD/GLY/FOR and FF/UMEC/VI were improved in China from 2020 to 2022. The implementation of the national drug price negotiation policy reduces the cost of drugs in China and plays an important role in improving the availability of the investigated drugs.

Association of once-daily single-device dual bronchodilators with prevention of rehospitalization for chronic obstructive pulmonary disease: A retrospective national inpatient database study

BACKGROUND

Optimal fixed-dose combination (FDC) dual bronchodilators for chronic obstructive pulmonary disease (COPD) are yet to be identified. We aimed to compare outcomes between two types of optimal once-daily FDC dual bronchodilators delivered by a dry powder inhaler (DPI) and soft mist inhaler (SMI).

METHODS

Using the Japanese Diagnosis Procedure Combination database, we identified patients with COPD, aged ≥40 years, who were prescribed DPIs or SMIs at discharge from 2015 to 2021. Patients who were prescribed inhaled corticosteroids were excluded. We used inverse probability of treatment weighting (IPTW) to compare COPD-related rehospitalization, outpatient prescription of antibiotics and oral corticosteroids, and cardiovascular event-related rehospitalization between the DPI and SMI groups.

RESULTS

Among 31,145 eligible patients, 18,359 patients were prescribed DPIs, and 12,786, SMIs. After IPTW, there were no differences in the proportions of patients with COPD-related rehospitalization (25.4 % vs. 24.7 %; P = 0.379) or outpatient prescription of antibiotics and oral corticosteroids (7.8 % vs. 7.8 %; P = 0.819) between the groups. The proportion of patients with cardiovascular event-related rehospitalizations was significantly smaller in the DPI group than in the SMI group (4.3 % vs. 5.2 %; P = 0.004). Subgroup analyses showed fewer COPD-related rehospitalizations among patients with Hugh-Jones classification 4-5 in the SMI group than in the DPI group (-2.1 %; 95 % confidence interval: -4.0 % to -0.3 %).

CONCLUSION

No significant difference was found in preventing COPD-related rehospitalization between DPI and SMI use. However, DPI use was associated with fewer cardiovascular event-related rehospitalizations than SMI use. SMI use may be effective in patients with severe dyspnoea.

Predictors of treatment REsponse to inhaled corticosteroids (ICS) in Chronic Obstructive pulmonary disease: randomised controlled trials individual participant Data re-Evaluation-protocol of the ICS-RECODE individual participant data meta-analysis

INTRODUCTION

Inhaled corticosteroids (ICS) can improve clinical outcomes in patients with chronic obstructive pulmonary disease (COPD) and eosinophilic airway inflammation, but they also increase the risk of side effects like pneumonia. Blood eosinophils guide ICS use, though evidence is limited. The predictors of treatment REsponse to ICS in COPD: a randomised controlled trials (RCTs) individual participant Data re-Evaluation (ICS-RECODE) research programme will leverage data from large RCTs to identify patients who benefit most from ICS with minimal risk. This protocol details an individual participant data (IPD) meta-analysis, assessing ICS safety, efficacy and treatment×covariate interactions to identify predictors of treatment response.

METHODS AND ANALYSIS

This meta-analysis will adhere to Cochrane, IPD handbook and Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. We will conduct a two-stage IPD meta-analysis of RCTs evaluating the addition of ICS to maintenance COPD treatments. Only RCTs with at least 500 participants across all eligible arms will be included, to allow for treatment×covariate interaction evaluation. Primary outcomes are severe and moderate or severe exacerbation rates; secondary outcomes assess both safety and efficacy. Data from each RCT will be reanalysed using rigorous, consistent statistical methods. Treatment×covariate interactions will be assessed at the RCT level. Trial treatment effects and the coefficients of treatment×covariate interaction analyses will be pooled using random effects model meta-analysis. Risk of bias will be appraised using RoB-2 informed by IPD, and certainty of evidence will be assessed with GRADE and the Instrument to assess the Credibility of Effect Modification Analyses.The ICS-RECODE IPD meta-analysis will make use of the best available data to define evidence-based, precision medicine approaches for ICS use in COPD.

ETHICS AND DISSEMINATION

The Health Research Authority approved the ICS-RECODE study, exempting it from ethics review (HRA UK, Reference: 24/HRA/0460). Our findings will be published in peer-reviewed journals and shared with the scientific and broader stakeholder communities.

PROSPERO REGISTRATION NUMBER

CRD42024508286.

[The Lung Emphysema Registry: Improving quality of care in interventional emphysema therapy and health management for patients with advanced COPD and lung emphysema]

The Lungenemphysemregister e.V. (LE-Register) offers a specialized platform for the exchange of knowledge, the promotion of research and the improvement of the quality of care in interventional endoscopic and surgical therapies as well as the consideration of other socio-economic and health aspects of pulmonary emphysema. The current focus is primarily on endoscopic and surgical treatment approaches for patients. Through the networking of experts, the development of specific quality standards and the certification of centers, the LE Registry contributes to the evidence-based further development and optimization of these highly specialized therapies and with a focus on other aspects of health promotion in the future.

The association between emphysema detected on computed tomography and increased risk of lung cancer: a systematic review and meta-analysis

Background

Lung cancer, chronic obstructive pulmonary disease (COPD), and emphysema share common pathophysiological mechanisms, including diffuse chronic inflammation within lung tissue, oxidative stress, and lung destruction. This study aimed to evaluate the effectiveness of computed tomography (CT) imaging in predicting the risk of lung cancer development in patients with emphysema and COPD.

Methods

The databases of PubMed, Embase, Web of Science, and Cochrane Library were searched to identify studies examining the relationship between CT-detected emphysema, COPD, and the risk of developing lung malignancy. The severity of emphysema (from trace to severe) was assessed visually and quantitatively on CT. COPD severity was classified from Global Initiative for Chronic Obstructive Lung Disease (GOLD) I to GOLD IV. Quality Assessment of Diagnostic Accuracy Studies, version 2 (QUADAS-2) was used to assess risk of bias in the included studies. Pooled odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were calculated for overall and stratified analyses.

Results

Of the 6,114 studies screened, 12 (22,190 patients) were included. The overall pooled OR for lung cancer associated with CT-defined emphysema was 2.45 (95% CI: 2.01-2.99). In studies employing CT-based evaluation methods, the pooled OR for lung cancer was comparable between visual assessment (2.37; 95% CI: 1.93-2.80) and quantitative assessment (2.38; 95% CI: 1.85-3.05). The risk of lung cancer demonstrated a positive correlation with disease severity in both emphysema and COPD cases.

Conclusions

CT-defined emphysema was linked to an elevated risk of lung cancer, which was observed across various assessments. Moreover, the severity of COPD was found also to be a risk factor for the development of lung cancer.

Dupilumab for chronic obstructive pulmonary disease with type 2 inflammation: a pooled analysis of two phase 3, randomised, double-blind, placebo-controlled trials

BACKGROUND

Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for IL-4 and IL-13, which are key drivers of type 2 inflammation. We aimed to characterise the efficacy and safety of dupilumab in patients with COPD and type 2 inflammation.

METHODS

For this pooled analysis, we pooled and analysed data from all patients in the intention-to-treat populations of the phase 3, randomised, double-blind, placebo-controlled BOREAS and NOTUS trials, which comprised 206 hospitals and clinics in BOREAS and 217 in NOTUS in 38 countries across Europe, Asia, North America, South America, Africa, and Australia. Eligible patients were current or former smokers with 10 pack-years or more of smoking history, were aged 40-85 years, had physician-diagnosed COPD for at least 12 months before randomisation, had a post-bronchodilator FEV1/forced vital capacity (FVC) ratio of less than 0·7, had a post-bronchodilator percentage predicted FEV1 of 30-70%, had documented evidence of two moderate or one severe exacerbations of COPD in the previous year (at least one exacerbation had to have occurred on triple therapy), and had blood eosinophil counts 300 cells per μL or more during screening. Patients had to have symptomatic COPD and a reported chronic productive cough for at least 3 months in the previous year. Key exclusion criteria were history of asthma, pulmonary disease other than COPD, or other diagnosed pulmonary or systemic disease associated with elevated blood eosinophil. In both trials, eligible patients were randomly assigned (1:1) via block randomisation with block size 4 to receive subcutaneous dupilumab 300 mg or matching placebo once every 2 weeks for 52 weeks, alongside established background therapy with inhaled corticosteroids, a long-acting β2-agonist, and a long-acting muscarinic antagonist. The primary endpoint was the annualised rate of moderate or severe exacerbations over 52 weeks.

FINDINGS

1874 patients were randomly assigned in BOREAS and NOTUS from May 9, 2019, to May 23, 2023; 938 (50·1%) were randomly assigned to the dupilumab groups and 936 (49·9%) were randomly assigned to the placebo groups. Mean age across both groups was 65·1 years (SD 8·2). 622 (33·2%) of 1874 patients were female and 1252 (66·8%) were male. 1628 (86·9%) patients were White, 719 (38·4%) were from Eastern Europe, and 1316 (70·2%) were former smokers. During the 52-week treatment period, 559 moderate or severe exacerbations were reported in 338 (36·0%) of 938 patients in the dupilumab group and 774 exacerbations were reported in 394 (42·1%) of 936 patients in the placebo group. There was a reduction in the annualised rate of moderate or severe exacerbations compared with placebo (annualised exacerbation rate 0·794 in the dupilumab group and 1·156 in the placebo group; incidence rate ratio 0·687, 95% CI 0·595-0·793; p<0·0001). In the dupilumab group, the time to first severe exacerbation was longer than in the placebo group (0·611, 0·409-0·912; p=0·016). However, there was no reduction in the annualised rate of severe exacerbations (annualised exacerbation rate 0·084 in the dupilumab group and 0·124 in the placebo group; 0·674, 0·438-1·037; p=0·073). Treatment-emergent adverse events, serious adverse events, adverse events that led to permanent treatment discontinuation, and adverse events that led to death were similar between the two groups.

INTERPRETATION

Dupilumab, as an add-on to standard triple therapy, reduced the annualised rate of moderate or severe exacerbations compared with placebo, highlighting its potential for personalised treatment approaches in patients with COPD with specific clinical endotypes.

FUNDING

Sanofi and Regeneron Pharmaceuticals.

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

Introduction

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

Methods

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

Results

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

Conclusions

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

Using a fully automated, quantitative fissure integrity score extracted from chest CT scans of emphysema patients to predict endobronchial valve response

Purpose

We aim to develop and validate a prediction model using a previously developed fully automated quantitative fissure integrity score (FIS) extracted from pre-treatment CT images to identify suitable candidates for endobronchial valve (EBV) treatment.

Approach

We retrospectively collected 96 anonymized pre- and post-treatment chest computed tomography (CT) exams from patients with moderate to severe emphysema and who underwent EBV treatment. We used a previously developed fully automated, deep learning-based approach to quantitatively assess the completeness of each fissure by obtaining the FIS for each fissure from each patient's pre-treatment CT exam. The response to EBV treatment was recorded as the amount of targeted lobe volume reduction (TLVR) compared with target lobe volume prior to treatment as assessed on the pre- and post-treatment CT scans. EBV placement was considered successful with a TLVR of ≥ 350    cc . The dataset was split into a training set ( N = 58 ) and a test set ( N = 38 ) to train and validate a logistic regression model using fivefold cross-validation; the extracted FIS of each patient's targeted treatment lobe was the primary CT predictor. Using the training set, a receiver operating characteristic (ROC) curve analysis and predictive values were quantified over a range of FIS thresholds to determine an optimal cutoff value that would distinguish complete and incomplete fissures, which was used to evaluate predictive values of the test set cases.

Results

ROC analysis of the training set provided an AUC of 0.83, and the determined FIS threshold was 89.5%. Using this threshold on the test set achieved an accuracy of 81.6%, specificity (Sp) of 90.9%, sensitivity (Sn) of 77.8%, positive predictive value (PPV) of 62.5%, and negative predictive value of 95.5%.

Conclusions

A model using the quantified FIS shows potential as a predictive biomarker for whether a targeted lobe will achieve successful volume reduction from EBV treatment.

Delaying disease progression in COPD with early escalation to triple therapy: a modelling study (DEPICT-2)

Introduction

In patients with COPD, dual bronchodilator (long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA)) and triple therapy (inhaled corticosteroid/LAMA/LABA) reduce the risk of exacerbations and lung function decline in the short-mid-term, but their long-term impact is unknown. This modelling study explores long-term impact of these therapies on lung function decline, quality of life (QoL) and all-cause mortality.

Methods

This modelling approach used a longitudinal nonparametric superposition model using published data regarding exacerbations, QoL (assessed by St George's Respiratory Questionnaire (SGRQ)) and mortality. The model simulated disease progression from 40 to 75 years of age and assessed the impact of initiating dual bronchodilator at age 45 years ("LAMA/LABA only" group) and escalation to triple therapy at age 50 years ("Escalation to triple" group) on forced expiratory volume in 1 s (FEV1) decline, QoL and mortality.

Results

Model simulation predicted that by 75 years of age, "LAMA/LABA only" preserves 159.1 mL of FEV1 versus no treatment, while "Escalation to triple" preserves an additional 376.5 mL and 217.3 mL of FEV1 versus no pharmacotherapy and "LAMA/LABA only", respectively. In "LAMA/LABA only", the SGRQ score reduces (-3.2) versus no treatment, which further reduces to -7.5 in "Escalation to triple". In "LAMA/LABA only", mortality reduces by 5.4% by 75 years versus no treatment, while the "Escalation to triple" shows further decrease in mortality by 12.0%.

Conclusion

Early pharmacotherapy initiation and escalation from dual bronchodilator to triple therapy could slow disease progression by preserving lung function and improving QoL and survival in patients with COPD.

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.