Chronic Obstructive Pulmonary Disease Combined with Interstitial Lung Disease

Explicate molecular landscape of combined pulmonary fibrosis and emphysema through explainable artificial intelligence: a comprehensive analysis of ILD and COPD interactions using RNA from whole lung homogenates

Combined pulmonary fibrosis and emphysema (CPFE) presents a unique challenge in respiratory disorders, merging features of interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). Using the random forest algorithm, our study thoroughly examines the molecular details of CPFE. Analyzing gene expression datasets from GSE47460 (ILD: 254, COPD: 220, control: 108), we identify key genes namely ADRB2, CDH3, IRS2, MATN3, CD38, PDIA4, VEGFC, and among twenty others, crucial in airway regulation, lung function, and apoptosis, shaping the complex pathogenesis of CPFE. Additionally, miRNAs (hsa-mir-101-3p, hsa-mir-1343-3p, hsa-mir-27a-3p, and miR-16-5p) showcase regulatory impacts on CPFE-related molecular pathways. Our machine learning model unveils these intricate interactions, offering a comprehensive insight into CPFE's molecular mechanisms. This research not only pinpoints potential therapeutic targets and biomarkers but also opens avenues for innovative approaches in managing CPFE, linking ILD and COPD within this complex respiratory condition.

Quantitative assessment of airway wall thickness in COPD patients with interstitial lung abnormalities

Background

Whether the airway is involved in the pathogenesis of interstitial lung abnormalities (ILA) is not well understood. Also the impact of ILA on lung function in COPD patients remains controversial. We aimed to assess the quantitative CT measurements of airway wall thickness (AWT) and lung function according to ILA status in COPD patients.

Methods

157 COPD patients discharged from our hospital from August 1, 2019 through August 31, 2022 who underwent chest CT imagings and pulmonary function tests were retrospectively enrolled. Linear regression analysis and multiple models were used to analyze associations between quantitative assessment of airway wall changes and the presence of ILA.

Results

In 157 COPD patients, 23 patients (14.6%) had equivocal ILA, 42 patients (26.8%) had definite ILA. The definite ILA group had the highest measurements of Pi10 (square root of theoretical airway wall area with a lumen perimeter of 10 mm), segmental AWT and segmental WA% (percentage of wall area), whereas the no ILA group had the lowest measurements of Pi10, segmental AWT and segmental WA%. In the adjusted analyses (adjusted by age, sex, body mass index, smoking intensity, COPD GOLD stage, lung function, slice thickness and scanner type), compared to COPD patients without ILA, the measurements of Pi10, segmental AWT and segmental WA% were higher in definite ILA group with differences of 0.225 mm (p = 0.012), 0.152 mm (p < 0.001), 4.8% (p < 0.001) respectively. COPD patients with definite ILA tended to have higher FEV1% predicted, FVC% predicted and lower MMEF75/25% predicted, but there were no statistically differences among the three groups.

Conclusion

Our study demonstrates the higher AWT measures in COPD patients with ILA compared to the patients without ILA. These findings suggest that the airway may be involved in the pathogenesis of ILA.

Epidemiology and clinical characteristics of interstitial lung disease in patients with rheumatoid arthritis from the JointMan database

Interstitial lung disease (ILD) is a progressive fibrotic disease associated with rheumatoid arthritis (RA); real-world data for evaluating RA-associated ILD (RA-ILD) are limited. We evaluated prevalence, time to onset, clinical characteristics and prognostic factors in patients diagnosed with RA (n = 8963) in the Discus Analytics JointMan database (2009-2019) with and without ILD. ILD prevalence was 4.1% (95% confidence interval 3.7-4.5); > 90% had an ILD diagnosis after RA diagnosis (mean time to onset 3.3 years). At baseline, a higher proportion of patients with RA-ILD were older (> 65 years), male, with history of chronic obstructive pulmonary disease (COPD) compared with patients in the RA cohort. Patients in the RA-ILD cohort were likely to have more severe RA characteristics and joint evaluation compared with patients without ILD, at baseline and before/after ILD diagnosis. In this large, real-world database patients with (vs without) ILD had a higher burden of RA characteristics. Previously established risk factors for RA-ILD were confirmed (age, baseline COPD, anti-cyclic citrullinated peptide positivity, C-reactive protein, Clinical Disease Activity Index score); thus, recognition of these factors and tracking routine disease activity metrics may help identify patients at higher risk of RA complications and lead to improved diagnosis and earlier treatment.

Bronchiectasis as co morbidity with COPD or ILD: complex interactions and severe consequences

Background

Bronchiectasis is a chronic pulmonary disease characterized by widened, malformed bronchi, with profuse expectoration and impaired quality of life. COPD and ILD are common co-morbidities with bronchiectasis.

Methods

The present study evaluated the clinical, laboratory& radiological characteristics of COPD and ILD with/without bronchiectasis. A hospital-based, retrospective study was conducted for 1 year.

Results

A total of 101 patients were analyzed, 60 patients had COPD, 34 had ILD and 7 patients had bronchiectasis without COPD or ILD. It was noticed that, out of the analyzed 60 COPD patients, 10 patients developed bronchiectasis (16.7%) versus10 patients of 34 ILD patients (29.4%). In COPD and ILD accompanied by bronchiectasis, the incidence of hemoptysis was significantly higher in comparison to those without bronchiectasis. Moreover, they showed a significant increase in partial pressure of carbon dioxide (PCO2) in comparison to those without bronchiectasis, as well as in comparison to bronchiectasis only. Sputum culture revealed that COPD with bronchiectasis were significantly associated with Staphlococcus aureus (77.8%), more than ILD with Bronchiectasis (33.3%). While S. pneumoniae were more evident in cases of ILD with bronchiectasis (22.2%). The bilateral, peripheral bronchiectasis was more common than the unilateral, central bronchiectasis among cases of COPD with bronchiectasis followed by ILD with bronchiectasis more than bronchiectasis only.

Conclusion

Patients with COPD /ILD with bronchiectasis can be associated with serious clinical manifestations as hemoptysis. Their sputum cultures detected more positive organisms than negative in comparison to cases of bronchiectasis only. Screening of COPD and ILD patients using HRCT Scanning is a recommended preventive measure for early detection of bronchiectasis.