Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 Guidelines Reviewed

Roflumilast reduces the number of lung adenocarcinomas, inflammation, and emphysema in a smoking-induced mouse model

BACKGROUND

The prognosis of lung cancer complicated by chronic obstructive pulmonary disease is poor, and effective prophylactic agents have not been established. Given that inflammation is a shared pathogenic mechanism of both diseases, we aimed to evaluate the efficacy of roflumilast, a novel anti-inflammatory drug, in preventing emphysema and lung cancer using a smoking-induced lung cancer mouse model.

METHODS

Male A/J mice were exposed to 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, a potent carcinogen, and intermittent mainstream cigarette smoke for 20 weeks. Roflumilast or vehicle was administered via intragastric gavage once daily. Lung tissues were assessed for tumor nodules and emphysema, and bronchoalveolar lavage fluid was collected for cell counting. Emphysema severity and concentrations of inflammatory cytokines (IL-6, IL-1β, and TNF-α) were assessed. RAW 264.7 macrophage cells were used to assess cellular responses to cigarette smoke extract.

RESULTS

Roflumilast attenuated the increase in total cells and macrophages in bronchoalveolar lavage fluid induced by intermittent smoking exposure and significantly suppressed smoking-induced expressions of IL-6, IL-1β, and TNF-α. Roflumilast also reduced emphysematous changes and the number of lung tumors. In vitro, roflumilast attenuated cigarette smoke extract-induced expression of IL-6, IL-1β, and TNF-α in RAW 264.7 cells.

CONCLUSIONS

This study highlights the potential use of roflumilast as a chemopreventive agent for patients with chronic obstructive pulmonary disease who are at risk of lung cancer and underscores its relevance for future clinical application and research on phosphodiesterase-4 inhibitors.

Distance travelled in the six-minute walk test in patients with chronic obstructive pulmonary disease as a predictor of mortality

BACKGROUND

Exercise intolerance in patients with COPD has significant implications for quality of life, hospitalization rates, and survival.

OBJECTIVE

To assess functional capacity using the six-minute walk test (6MWT) by categorizing the distance walked in six minutes (6MWD) into tertiles and to assess the impact of this functional capacity on predictors of survival over a 24-month follow-up in patients with Chronic Obstructive Pulmonary Disease (COPD).

METHODS

This prospective cohort study followed 118 patients with COPD for 24 months. Participants were stratified based on the 6MWD: Group 1 (mean distance 590-424 m); Group 2 (mean distance 423-337 m); and Group 3 (mean distance < 336 m). Symptoms and disease severity were assessed using CAT scores. Kaplan-Meier was used to determine the association between 6MWD and all-cause mortality.

RESULTS

The 6MWD, stratified by functional performance, was a significant predictor of survival in patients with COPD, despite heterogeneity in disease severity between groups. The 6MWD, stratified by functional performance, was a significant predictor of survival in patients with COPD, despite heterogeneity in disease severity between groups. Furthermore, in regression analysis for mortality, it was identified for 6MWD (CI 0.994; p = 0.043) and peripheral oxygen saturation (SpO₂) (CI 0.735; p < 0.001). Kaplan-Meier survival analysis revealed that patients who walked less than 336 m in the 6MWD had the lowest probability of survival at 24 months (log-rank p < 0.05).

CONCLUSION

The 6MWD is a robust predictor of mortality over a 2-year period in patients with COPD, reflecting a broad spectrum of disease severity. Poorer 6MWD performance is associated with increased desaturation, impaired heart rate recovery, and greater symptom burden during exercise, as indicated by CAT scores.

CLINICAL TRIAL NUMBER

Not applicable.

Inhalation safety and tolerability of a novel fixed-dose combination of glycopyrronium-vilanterol powder in Wistar rats

Fixed-dose combinations (FDCs) offer therapeutic benefits like enhanced efficacy, reduced adverse effects, and better patient compliance, making them cost-effective. They are particularly effective in managing chronic obstructive pulmonary disease (COPD). Combining a long-acting muscarinic antagonist with a long-acting beta-agonist improves lung function, reduces the need for rescue bronchodilators, alleviates respiratory symptoms, and enhances the overall quality of life in COPD patients. This study evaluated the safety and tolerability of a novel FDC containing vilanterol, a selective β2-adrenoreceptor agonist, and glycopyrronium, an antimuscarinic agent, in Wistar rats. Vilanterol promotes bronchodilation, while glycopyrronium reduces bronchoconstriction. Repeated-dose toxicity testing at three dosage levels (6.25 + 12.5 mcg/kg/day, 12.5 + 25 mcg/kg/day, and 25 + 50 mcg/kg/day) through nose-only exposure showed that the FDC was well-tolerated, with no significant clinical signs of toxicity. Key parameters, including body weight, feed consumption, ophthalmic examination, clinical pathology, and bronchoalveolar lavage fluid analysis, showed no adverse effects. Minimal, non-dose-related microscopic lesions and normal alveolar macrophage responses were observed. The no-observed-adverse-effect level, based on actual concentration and duration of exposure, was established at 25 + 50 mcg/kg/day, indicating the FDC's safety and suitability for further development in COPD management.

Host Serine Proteases and Antiviral Innate Immunity as Potential Therapeutic Targets in Influenza A Virus Infection-Induced COPD Exacerbations

Lung manifestations of chronic obstructive pulmonary disease (COPD) are often exacerbated by influenza A virus infections; however, the underlying mechanisms remain largely unknown, and hence therapeutic options are limited. Using a physiologically relevant human lung airway-on-a-chip (Airway Chip) microfluidic culture model lined with human airway epithelium from COPD or healthy donors interfaced with pulmonary microvascular endothelium, we observed that Airway Chips lined with COPD epithelium exhibit an increased sensitivity to influenza virus infection, as is observed clinically in COPD patients. Differentiated COPD airway epithelial cells display increased inflammatory cytokine production, barrier function loss, and mucus accumulation upon virus infection. Transcriptomic analysis revealed gene expression profiles characterized by upregulation of serine proteases that may facilitate viral entry and downregulation of interferon-related genes associated with antiviral immune responses. Importantly, treatment of influenza virus-infected COPD epithelium with a protease inhibitor, nafamostat, ameliorated the disease phenotype, as evidenced by dampened viral replication, reduced mucus accumulation, and improved tissue barrier integrity. These findings suggest that targeting host serine proteases may represent a promising therapeutic avenue against influenza-afflicted COPD exacerbations.

Effectiveness of high-intensity interval training in rehabilitation nursing for mild-to-moderate stable COPD patients: a randomized controlled clinical trial

OBJECTIVE

The current study was conducted to explore the clinical impact of high-intensity interval training (HIIT) in rehabilitation nursing on improving cardiopulmonary function and exercise capacity in COPD patients.

METHODS

A total of thirty-one COPD patients underwent HIIT, while an equal number underwent moderate-intensity continuous training (MICT) were included in this randomized controlled clinical study. The randomization method used was stratified block randomization, stratified by center. During the 6 months follow-up period, the clinical data, including cardiopulmonary exercise testing (CPET) results, cardiopulmonary function index, quality of life, and follow-up outcomes, were collected before and after the interventions. The therapeutic effects of the two groups were compared.

RESULTS

After the intervention, the HIIT group exhibited significantly higher peak power, exercise test duration, anaerobic threshold, peak oxygen uptake, peak ventilation, FEV1/FVC ratio, FEV1% of expected value, LVEF (%), and SF-36 scores compared to the MICT group (P < 0.05). Moreover, LVEDD was significantly lower in the HIIT group compared to the MICT group (P < 0.05). At the 6-month follow-up, the incidence of COPD acute exacerbation in the HIIT group was significantly lower than in the MICT group (P < 0.05).

CONCLUSION

Implementation of HIIT in rehabilitation nursing effectively improved cardiopulmonary function and exercise capacity in COPD patients during clinical treatment, highlighting its promising application potential.

TRIAL REGISTRATION

This study was previously registered at Chinese Clinical Trial Registry (Date 11/05/2022 Number ChiCTR2200059764).

Role of diaphragmatic ultrasound in patients with acute exacerbation of chronic obstructive pulmonary disease

Assessing diaphragm function status is vital for diagnosing and treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Diaphrag-matic ultrasound has become increasingly important due to its non-invasive nature, absence of radiation exposure, widespread availability, prompt results, high accuracy, and repeatability at the bedside. The diaphragm is a crucial respiratory muscle. Decline or dysfunction of the diaphragm can lead to dyspnea and even respiratory failure in AECOPD patients. In this editorial, we comment on an article, retrospectively analyzed ninety-four acute exacerbations of chronic obstructive pulmonary disease patients who received mechanical ventilation from January 2022 to December 2023. The study found that the diaphragm thickening fraction, an index from diaphragm ultrasound, can better predict the outcome of non-invasive ventilation in patients with AECOPD. The value of non-invasive ventilation in treating respiratory failure caused by AECOPD has been widely acknowledged. Diaphragmatic dysfunction diagnosed with ultrasound is associated with prolonged mechanical ventilation and weaning times and higher mortality.

Evaluating the Effectiveness of the COPD Assessment Test (CAT) in Screening for Chronic Obstructive Pulmonary Disease

Background

Chronic obstructive pulmonary disease (COPD) is a major public health problem that remains largely under-diagnosed, mainly due to the under-use of spirometry to establish the diagnosis. The aim of this study is to evaluate the effectiveness of the Moroccan Arabic dialect version of the COPD Assessment Test (CAT) in screening for COPD.

Methods

This was a cross-sectional study carried out in primary care facilities in Morocco, involving participants aged 40 and over. The performance of CAT in detecting cases of COPD was measured with reference to the results of spirometry, considered to be the gold Standard.

Results

A total of 477 participants were included in the study. The prevalence of COPD was 6.7%. Internal consistency of the Moroccan Arabic dialect version of the CAT was high, with a Cronbach's alpha of 0.89. The total score of the CAT and of each item was significantly higher in subjects with COPD than in those without (P=0.000). Significantly negative correlations were found between CAT total score and FEV1 (r = -0.33, p=0.000), CAT and FVC (r = -0.22, p=0.000), CAT and FEV1/FVC ratio (r = -0.22, p=0.000). The receiver operating characteristic curve showed an area under the curve of 0.93. A CAT score of 10 was the optimal cut-off value for COPD screening, with a sensitivity, specificity, positive predictive value, and negative predictive value of 78.1%, 93.9%, 48.1% and 98.4%, respectively.

Conclusion

The results of the present study showed that the CAT could be used as a screening tool for COPD. The use of this tool by healthcare professionals in primary care settings will improve and promote early diagnosis of this chronic disease.