Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

Prognostic value of composite inflammatory markers in patients with chronic obstructive pulmonary disease: A retrospective cohort study based on the MIMIC-IV database

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease, and inflammation plays a key role in the pathogenesis of COPD. The aim of this study is to investigate the association between systemic immune inflammation index (SII), systemic inflammatory response index (SIRI),pan-immune inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) and all-cause mortality in patients with chronic obstructive pulmonary disease (COPD), and to evaluate the effect of composite inflammatory markers on the prognosis of COPD patients. We obtained data on COPD patients from the Medical Information Mart for Intensive Care (MIMIC) -IV database and divided patients into four groups based on quartiles of baseline levels of inflammatory markers, The primary outcomes were in-hospital and ICU mortality. We comprehensively explored the association between composite inflammatory markers and mortality in patients with COPD using restricted cubic splints (RCS), COX proportional hazards regression models, Kaplan-Meier curves, receiver operating characteristic (ROC), and subgroup analyses. A total of 1234 COPD patients were included in this study. RCS results showed that SII, SIRI, PLR, PIV and NLR were positively and non-linearly correlated with the increased risk of in-hospital mortality in COPD patients. Multivariate COX regression analysis showed that compound inflammatory markers were independent risk factors for in-hospital mortality in COPD patients. The KM curve results showed that COPD patients with higher SII, SIRI, PLR and PIV had a significantly lower survival probability. 5 kinds of compound between inflammatory markers and mortality in patients with COPD is related to nonlinear correlation, can increase the risk of mortality in patients with COPD is a risk factor for the prognosis of patients with COPD, and may serve as potential biomarkers for clinical COPD risk stratification and treatment management in critical patients.

The role of neutrophils in allergic disease

Neutrophils are short-lived cells of the innate immune system and represent 50-70% of the circulating leucocytes. Their primary role is antimicrobial defence which they accomplish through rapid migration to sites of inflammation followed by phagocytosis, degranulation, and the release of neutrophil extracellular traps (NETosis). While previously considered terminally differentiated cells, they have been shown to have great adaptability and to play a role in conditions ranging from cancer to autoimmunity. This review focuses on their role in allergic disease. In particular: their role as potential amplifiers of type 1 hypersensitivity reactions leading to anaphylaxis; their involvement in alternative pathways of food and drug allergy; their role in allergic rhinitis and asthma and neutrophil dysfunction in atopic dermatitis. The use of potential biomarkers and therapeutic targets is also discussed with a view to guiding future research.

Association between oxidative balance score and all-cause, CVD and respiratory-related mortality in the US older adults of asthma patients with diabetes

Background

This study aims to investigate the correlation between oxidative balance score (OBS) and all-cause, cardiovascular disease (CVD) and respiratory-related mortality within a cohort that includes older asthma patients with diabetes.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2001 to 2018, which included 611 participants, were analyzed. Mortality outcomes were determined by linking the data to National Death Index (NDI) records through December 31, 2019. Cox regression modeling was employed to examine the relationship between OBS and all-cause, CVD and respiratory-related mortality. Restricted cubic splines (RCS), subgroup analyses and interaction tests were also conducted in this study.

Results

Over a median follow-up of 78.96 months, there were 216 all-cause deaths and 57 CVD-related deaths. A significant negative association was found between the OBS and all-cause and CVD mortality. We did not observe OBS could reduce respiratory-related mortality in older asthma patients with diabetes. RCS analysis indicated a linear and inverse association between the OBS and all-cause and CVD mortality. Subgroup analyses and interaction tests indicated the negative association between OBS and CVD mortality was significantly influenced by alcohol consumption.

Conclusion

In this sample, higher OBS was associated with lower all-cause and CVD mortality risks. These findings stressed the importance of infection status in assessing oxidative balance's impact on health.

The gut microbiota-SCFA-inflammation axis in patients with AECOPD

OBJECTIVES

The aim of the study was to explore the alteration of microbiota and SCFA in gut and inflammation in acute exacerbation chronic obstructive pulmonary disease (AECOPD) patients, and to test the hypothesis that a disorder of gut microbiota will lead to the alteration of SCFA, which will aggravate inflammation in AECOPD patients.

METHODS AND RESULTS

24 patients with AECOPD and 18 healthy volunteers were included in the study. Gut microbiota were analyzed by 16S rDNA and serum was used to detect levels of inflammatory factors by ELISA. Fatty acid concentrations were determined in lumen via gas chromatography-mass spectrometry. The richness and diversity of gut microbiota were decreased in AECOPD patients. β-diversity analysis revealed differences between AECOPD patients and healthy controls. p_Bacteroidetes, g_Paraprevotella, g_Ruminococcus2, g_Parasutterella, o_Rhodospirillales, and g_Romboutsia in the healthy controls and p_Firmicutes, o_Actinomycetales, f_Actinomycetadeae, g_Actinomyces, g_Mogibacterium, f_Veillonellaceae, f_Enterococcaceae, and g_Enterococcus in AECOPD patients were the most abundant microbiota. SCFA levels were decreased in patients with AECOPD. In addition, the results demonstrated that except for a reduction in IL-6, there was no change in inflammatory markers in AECOPD patients.

CONCLUSION

In AECOPD patients, the gut microbiota-SCFA-inflammation axis is augmented, with decreased diversity and abundance of gut microbiota, leading to a reduction in SCFA and an imbalance of inflammation.

Age-standardized incidence, prevalence, mortality rates and future projections of autoimmune diseases in China: a systematic analysis based on GBD 2021

This study assessed trends in age-standardized incidence (ASIR), prevalence (ASPR), and mortality rates (ASMR) per 100,000 population for asthma, Type 1 Diabetes Mellitus (T1DM), Inflammatory Bowel Disease (IBD), Multiple Sclerosis (MS), Psoriasis, and Rheumatoid Arthritis (RA) in China from 1990 to 2021 and projected ASIR trends through 2046. Data were obtained from the Global Burden of Disease (GBD) 2021 study. Trends in ASIR, ASPR, and ASMR were analyzed using Joinpoint regression to calculate annual percentage change (APC) and average APC (AAPC). Bayesian age-period-cohort (BAPC) modeling was applied to project future ASIR trends. In 2021, asthma had the highest ASIR (364.17/100,000), followed by psoriasis (59.70/100,000) and RA (13.70/100,000), while MS (0.16/100,000) and IBD (1.40/100,000) were the least common. Asthma exhibited significant declines in ASIR (-1.23% AAPC), ASPR (-1.49%), and ASMR (-4.4%). Conversely, T1DM showed rising ASIR (+ 1.16%) and ASPR (+ 1.15%) alongside declining ASMR (-2.62%). Psoriasis (+ 0.74%) and IBD (+ 2.09%) also showed rising ASIR. Gender differences were notable, with greater T1DM ASIR increases in males and more significant asthma improvements in females. By 2046, the ASIR of T1DM, psoriasis, and RA is projected to reach 5.8, 80.9, and 15.54 per 100,000, respectively, while asthma is expected to decline to 330.98 per 100,000. The rising ASIR and ASPR for most autoimmune diseases in China contrast with declining ASMR, highlighting the dual challenge of managing increasing disease burdens while sustaining reductions in mortality. Targeted prevention and management strategies are essential to address these evolving public health needs.

Effect of ambient O3 on respiratory mortality and synergies with meteorological factors in Shenyang, China

The impact of O3 on the respiratory system is a significant global problem. Nevertheless, there is insufficient information about its impact on respiratory disorders in northeast China. In this study, we used a generalized additive model (GAM) to determine the correlation between O3 concentrations and respiratory deaths based on the daily meteorological data, pollutant concentrations, and respiratory deaths from 2014 to 2016 in Shenyang, a typical city in northeast China. Single and cumulative lag structures and seasonal modification were considered to investigate the link between O3 exposure and respiratory mortality in Shenyang, northeast China. Synergic effects of O3 and meteorological factors were also evaluated. Results indicated that there was a significant correlation between O3 and the number of deaths caused by respiratory diseases on a daily basis, regardless of the time delay between exposure and the occurrence of the deaths. A 10 µg/m3 rise in O3 concentration was associated with a 0.85% (95% CI 0.18-1.52%) increase in respiratory death at a lag of 1 day and a 1.43% (95% CI 0.40-2.48%) increase at a cumulative lag of 3 days. Stratified analyses revealed that O3 had a greater impact on health under warm conditions compared to cold settings. Additionally, O3 had a more pronounced effect on females than on males. The results for this study could provide some scientific guidance for local environment and health departments.

Exploring Cistanche's therapeutic potential and molecular mechanisms in asthma treatment

Asthma, a prevalent chronic respiratory disease, is characterized by airway inflammation and hyperresponsiveness, significantly impacting global health. Current treatments, including corticosteroids, face limitations due to variable patient responses and side effects. This study explores the therapeutic potential of Cistanche, a traditional Chinese medicinal herb, in an asthmatic mouse model induced by house dust mites (HDM). We employed a multidisciplinary approach, including transcriptomics, mass spectrometry, Weighted Gene Co-expression Network Analysis (WGCNA), and experimental validation in animal and cellular models. Our findings demonstrate that Cistanche significantly attenuates airway hyperresponsiveness, cellular infiltration, and mucus hypersecretion in asthmatic mice. Transcriptomic analysis identified 643 differentially expressed genes (DEGs), with Cistanche treatment disrupting pathways associated with IL-4, IL-5, and eosinophils. Gene Set Enrichment Analysis (GSEA) revealed Cistanche's involvement in glucocorticoid processes, suggesting its potential as an alternative or complementary therapy to conventional glucocorticoids. Liquid Chromatography-High Resolution Mass Spectrometry (LCHRMS) analysis identified Pinoresinol 4-O-Beta-D-Glucopyranoside (PG) as a key active component of Cistanche, with targets predominantly associated with the PI3K-AKT pathway. WGCNA analysis of an asthma dataset identified the "skyblue" module as highly associated with asthma, with inducible nitric oxide synthase (iNOS) emerging as a core gene. Molecular docking confirmed a strong binding affinity between PG and iNOS, with Cistanche treatment down-regulating iNOS expression, suggesting a potential mechanism for its anti-inflammatory effects. In conclusion, Cistanche exhibits therapeutic effects in asthma by modulating immune responses and targeting key asthma-related genes and proteins. Our study provides novel insights into the treatment of asthma with natural products and highlights the potential of Cistanche as an alternative or complementary therapeutic agent. Further research is warranted to validate these findings and explore the integration of Cistanche into clinical asthma management.

Exploring the causal relationship between asthma in the metabolic syndrome: a Mendelian randomization study

BACKGROUND

Previous observational studies have indicated a potential association between metabolic syndrome (MetS) and asthma, though the causal nature of this connection is still uncertain. Our study used Mendelian randomization (MR) to examine the causal relationship between metabolic syndrome (MetS) and its components with asthma.

METHODS

This study utilized single nucleotide polymorphisms (SNPs) related to MetS and its components, sourced from publicly available genome-wide association studies (GWAS) data, in combination with asthma data from the FinnGen database. Statistical analyses were conducted using the inverse variance weighted method (IVW), MR-Egger, and weighted median method. The robustness of the findings was confirmed through various sensitivity analyses.

RESULTS

The IVW analysis indicated that MetS was associated with an increased risk of asthma (OR = 1.0781, 95% CI = 1.0255-1.1333, p = 0.0032). Among the components of MetS, waist circumference (WC) showed a strong association with asthma (OR = 1.4777, 95% CI = 1.3412-1.6281, p = 2.8707 × 10-15). Conversely, high-density lipoprotein cholesterol (HDL-C) was found to be inversely related to the risk of asthma (OR = 0.9186, 95% CI = 0.8669-0.9734, p = 0.0041).

CONCLUSION

The findings of this study support that MetS and its specific components, particularly abdominal obesity, are linked to a higher risk of asthma, while HDL-C might offer protective effects against asthma. These findings provide a foundation both for further research and possible therapeutic interventions.

Asthma and the risk of cardiovascular diseases and mortality: a meta-analysis of cohort studies

BACKGROUND

It has been shown that asthma is potentially linked to a higher risk of cardiovascular disease (CVD) and cardiovascular mortality (CVM).

OBJECTIVES

This study aims to systematically review and summarize epidemiological evidence on the relationship between asthma and these cardiovascular outcomes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES AND METHODS

This meta-analysis, registered with PROSPERO (CRD 42024576126), utilized data from PubMed, Embase, the Cochrane Library, and references from included studies. The search covered literature from the inception of these databases until July 17, 2024. We included observational studies examining the link between asthma and CVD and CVM. Bias risk was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). We calculated pooled relative risk (RR) with a 95% confidence interval (CI) using a random-effects model.

RESULTS

A total of 29 studies encompassing 11,380,027 participants were included. The overall risk for CVD in asthma patients was 1.30 (95% CI: 1.20-1.42). Specific CVD risks were elevated for coronary heart disease (CHD, RR 1.35; 95% CI: 1.27-1.42), angina pectoris (AP, RR 1.48; 95% CI: 1.16-1.89), myocardial infarction (MI, RR 1.33; 95% CI: 1.25-1.41), and heart failure (HF, RR 1.53; 95% CI: 1.04-2.23). Asthma was also associated with a higher risk of CVM (RR 1.26; 95% CI: 1.05-1.51).

CONCLUSION

Asthma is associated with a higher risk of developing CVD, including specific types such as CHD, AP, MI, and HF. In addition, asthma patients face an increased risk of cardiovascular mortality compared to non-asthmatics.

Associations between maternal fish intake and polyunsaturated fatty acid status with childhood asthma in a high fish-eating population

BACKGROUND

Studies investigating associations between prenatal polyunsaturated fatty acid status (PUFAs), in particular the anti-inflammatory n-3 PUFAs, and the development of childhood asthma have yielded conflicting results.

OBJECTIVE

To determine the associations between maternal fish intake (a rich source of the n-3 PUFAs), maternal or cord PUFAs with the prevalence of childhood asthma in a high fish-eating population.

METHODS

We examined these associations between fish intake and PUFA concentrations with childhood asthma prevalence in the Seychelles Child Development Study Nutrition Cohort 2, a large observational study in a high fish-eating population. Maternal fish intake during pregnancy and child's fish intake at 7 years were assessed by questionnaire, with frequency reported as meals/week. Serum concentrations of PUFAs were quantified in maternal blood collected at 28 weeks' gestation (n = 1448) and in cord blood (n = 1088). Asthma in children at 7 years was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire (n = 1098).

RESULTS

A total of 97 children (10.5%) were reported to have asthma. In regression analysis, the odds of childhood asthma were not associated with maternal fish intake or maternal PUFA status. Cord DHA concentrations were associated with increased asthma prevalence when the highest quartile (≥0.123 mg/mL) was compared with the lowest (<0.061 mg/mL).

CONCLUSION

The results from this current study add to the growing body of evidence that fish consumption during pregnancy is not associated with asthma development in offspring. The associations between cord blood DHA and asthma prevalence are unexpected and warrant further investigation.

Chlorinated paraffins in particulate matter associated with asthma and its relative symptoms in school-aged children and adolescents: A cross-sectional survey in South China

Particulate matter (PM) and contaminants attached to PM can increase the risk of respiratory diseases. However, the health risk assessment of chlorinated paraffins (CPs), an emerging pollutant occupying a high proportion of persistent organic pollutants (POPs) in PM, remains scarce. This study aimed to evaluate the association between PM2.5-bound CPs and asthma, along with relative symptoms, in school-aged children and adolescents. A large sample size cross-sectional study (n = 131,304) was conducted in the Pearl River Delta (PRD). The results showed that increased quantiles of ∑CPs were associated with odds ratios (ORs) of 1.22 (95%CI: 1.20-1.25), 1.38 (95%CI: 1.35-1.41), 1.17 (95%CI: 1.15-1.19), 1.52 (95%CI: 1.48-1.56), 1.66 (95%CI: 1.61-1.71), and 1.33 (95%CI: 1.30-1.37) for ever diagnosed asthma, current asthma, wheeze, current wheeze, persistent phlegm, and persistent cough, respectively. Additionally, C11-, C12-SCCPs and C14-, C17-MCCPs contributed the most positive weight to the risk of asthma and relative symptoms. These findings provide cutting-edged evidence for the health risk assessment of CPs, which is crucial for developing effective CPs management strategy.

Triple inhaler therapy in adolescents and adults with moderate or severe persistent asthma

ABSTRACT

Expert guidelines, meta-analyses, and multiple randomized controlled trials have demonstrated the effectiveness of long-acting inhaled antimuscarinic agents (LAMAs) as an additive medication for patients with poorly controlled moderate or severe persistent asthma. LAMAs play an essential role in blocking acetylcholine binding to muscarinic receptors and reducing bronchoconstriction and mucus production. By adding this medication to other combination inhalers, patients can use a triple inhaler to improve FEV1 values and reduce exacerbations.

Association between comorbidity and chronic obstructive pulmonary disease: a systematic review and meta-analysis of Mendelian randomization studies

BACKGROUND

Chronic obstructive pulmonary disease (COPD) often coexists with various systemic diseases, forming a comorbid condition. The causal evidence from Mendelian randomization (MR) studies on the impact of comorbidities on COPD is accumulating, yet information for comprehensive summary is limited.

OBJECTIVES

This study aimed to systematically summarize the evidence from MR studies on the impact of comorbidities on COPD.

DESIGN

Systematic review and meta-analysis of MR studies.

DATA SOURCES AND METHODS

Eight electronic databases were searched to identify relevant MR studies about comorbidities associated with COPD from inception to June 3, 2024. Strengthening the Reporting of Observational Studies in Epidemiology-Mendelian Randomization (STROBE-MR) guidelines were used for reporting quality assessment. We used either a random-effects model or a fixed-effects model to estimate pooled causal evidence from MR studies of comorbidities and COPD.

RESULTS

A total of 26 studies were included, of which 8, 4, and 3 studies summarized the causal effects of GERD, depression, obesity on the risk of COPD, respectively. Overall, the studies included had high reporting quality. Our meta-analysis using inverse variance weighted (IVW) of main MR analyses revealed positive causal effects of GERD (OR: 1.64; 95% CI: 1.47-1.84), depression (OR: 1.31, 95% CI: 1.01-1.71), and obesity (OR: 1.51; 95% CI: 1.25-1.83) on COPD. Our qualitative analysis also identified multisystem diseases such as asthma, bronchiectasis, peptic ulcers, heart failure, hypertension, rheumatoid arthritis, and osteoarthritis, as well as systemic conditions like anemia and frailty, were related to the risk of COPD.

CONCLUSIONS

This study revealed the causal effects of comorbidities on COPD, providing new scientific evidence for the prevention and treatment of COPD, and aiding in the guidance of effective clinical strategies.

REGISTRATION

This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (No CRD42024575341).

Association between diet-derived antioxidants and asthma: Insights from the NHANES survey 2003-2018 and Mendelian randomization analysis

BACKGROUND

Many studies have reported correlations between diet-derived antioxidants and asthma. Nevertheless, the probable association between diet-derived antioxidants and asthma remains a matter of discussion.

OBJECTIVES

We explored the association between Diet-Derived Antioxidants and Asthma.

METHODS

We used data from the 2003-2018 National Health and Nutrition Examination Survey (NHANES) to assess the relationship between diet-derived antioxidants and asthma and a two-sample Mendelian randomization (MR) study was employed to assess the causal associations between lifelong diet-derived circulating antioxidant levels and the risk of asthma.

RESULTS

Participants with asthma were more likely to be young-to-middle-aged females, smokers, have lower income, belong to non-Hispanic Black ethnicity, have a high school education, have a BMI over 30. The dietary intakes of vitamin C, zinc, selenium, and CDAI were negatively associated with asthma risk (Vitamin C: OR = 0.76, 95 % CI: 0.63-0.91, P = 0.032; Zinc: OR = 0.86, 95 % CI: 0.75-1.00, P = 0.046; Selenium: OR = 0.85, 95 % CI: 0.73-0.98, P = 0.004; CDAI: OR = 0.80, 95 % CI: 0.65-0.97, P = 0.027). There was a significant nonlinear relationship between the dietary intake of vitamin C, zinc, and selenium and the risk of asthma (Pnon-linear < 0.05). However, no causal link between circulating antioxidants and asthma risk was found in the MR analysis. Sensitivity analyses supported the robustness of the results.

CONCLUSION

In the observational study, we identified a negative correlation between the dietary intake of vitamin C, zinc, selenium, and CDAI and asthma risk, while our MR analyses did not find evidence to support a causal relationship between diet-derived antioxidants and the risk of asthma.

Healthcare professionals' representation toward optimal palliative care provision for COPD patients: a cross-sectional survey

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a condition causing chronic physical symptoms, psychological burdens, as well as social consequences. This contributes to a major decrease in quality of life (QoL). Palliative care (PC) is a person-centered approach intended to relieve physical, psychological, social, and spiritual suffering. Despite international practice guidelines, patients with COPD have limited access to PC, mostly during end-of-life (EoL) care. It is therefore important to explore healthcare professionals' (HPs) point of view about PC to improve access for COPD patients to PC.

OBJECTIVES

This study aimed to describe the perceptions of HPs working with COPD patients in Switzerland in different settings on PC provision, implementation, access, and organization. Additionally, we aimed to identify gaps, barriers, training needs, and solutions for HPs related to PC needs.

DESIGN

This is a cross-sectional survey study with quantitative and open-ended questions.

METHODS

We used an electronic survey sent to HPs working with patients suffering from COPD in the inpatient, outpatient, and home-based settings.

RESULTS

A total of 56 out of 98 participants (57%) answered the questionnaire of which 41.1% were nurses. 47.2% of participants were uncertain about the good timing of addressing COPD patients to PC and did it after several acute exacerbations, during EoL, or at the request of the patient. 45.5% did not know the availability of a local specialized PC. Lack of skills/training was identified as one of the hindering factors to discuss EoL (42.9% N = 56).

CONCLUSION

Despite recognizing the importance of PC, several barriers were identified, including a lack of knowledge about when to initiate a PC and limited utilization of tools for identifying PC needs. Multidisciplinary teamwork and the identification of a nurse coordinator could improve earlier referrals to PC and improve QoL for COPD patients.

Role of circRMRP and circRPL27 in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death and disability worldwide, and circRNA dysregulation is functionally associated with COPD. This study explored the potential of circRMRP and circRPL27 as biomarkers of COPD. Blood samples from COPD patients and healthy controls were collected. COPD patients were divided into mild, moderate, and severe groups according to lung function. Quantitative real-time polymerase chain reaction technology was used to determine the expression of circRPL27 and circRMRP in COPD. Receiver operating characteristic curve was drawn to explore the value of circRMRP and circRPL27 in diagnosing COPD. circRMRP and circRPL27 levels were elevated in serum of COPD patients and increased with the severity of COPD. CircRMRP and circRPL27 were associated with smoking history, WBC, and FEV1/FVC, and were positively correlated with smoking history and WBC, and negatively correlated with FEV1/FVC. In COPD, both circRMRP and circRPL27 had diagnostic values, but circRPL27 was better. circRMRP and circRPL27 may be useful non-invasive biomarkers for COPD diagnosis.

An atlas of the shared genetic architecture between atopic and gastrointestinal diseases

Comorbidity among atopic diseases (ADs) and gastrointestinal diseases (GIDs) has been repeatedly demonstrated by epidemiological studies, whereas the shared genetic liability remains largely unknown. Here we establish an atlas of the shared genetic architecture between 10 ADs or related traits and 11 GIDs, comprehensively investigating the comorbidity-associated genomic regions, cell types, genes and genetically predicted causality. Although distinct genetic correlations between AD-GID are observed, including 14 genome-wide and 28 regional correlations, genetic factors of Crohn's disease (CD), ulcerative colitis (UC), celiac disease and asthma subtypes are converged on CD4+ T cells consistently across relevant tissues. Fourteen genes are associated with comorbidities, with three genes are known treatment targets, showing probabilities for drug repurposing. Lower expressions of WDR18 and GPX4 in PBMC CD4+ T cells predict decreased risk of CD and asthma, which could be novel drug targets. MR unveils certain ADs led to higher risk of GIDs or vice versa. Taken together, here we show distinct genetic correlations between AD-GID pairs, but the correlated genomic loci converge on the dysregulation of CD4+ T cells. Inhibiting WDR18 and GPX4 expressions might be candidate therapeutic strategies for CD and asthma. Estimated causality indicates potential guidance for preventing comorbidity.

Association of dietary patterns with chronic respiratory health among U.S. adults

Background

Respiratory health is closely related to immune system function, and diet can also influence immune homeostasis. Diet, an important part of a healthy lifestyle, is also linked to respiratory health. We aimed to explore the relationship between different dietary patterns and the risk of chronic respiratory diseases (CRDs), including chronic bronchitis (CB), emphysema, and asthma.

Method

A total of 23,042 adults from the United States were selected from the National Health and Nutrition Examination Survey (NHANES) dataset between 2007 and 2018. Diet quality was assessed using 2-day, 24-hour dietary recall data and quantified as the Healthy Eating Index-2020 (HEI-2020), the Dietary Inflammation Index (DII), the Mediterranean Dietary Index (MEDI), and the Dietary Approaches to Stop Hypertension Index (DASHI). Binary logistic regression models, restricted cubic splines (RCS), and the weighted quartile sum (WQS) models were used to assess the relationship between diet quality and the risk of CB, emphysema, and asthma.

Results

In logistic regression analyses of the four dietary indices with the three chronic respiratory diseases, it was consistently observed that higher dietary quality scores were linked to a reduced risk of respiratory disease. These consistent trends were also evident in the assessments of the dose-response relationship between dietary quality score and the risk of respiratory disease. Furthermore, evaluations of the combined effects of dietary components across different dietary indices in the risk of chronic respiratory disease yielded results consistent with the logistic regression models. Notably, high-quality protein, minerals, and fiber-rich fruits and vegetables emerged as the food groups making the most significant contributions to health across different dietary indices.

Conclusion

Low-quality diets, lacking in high-quality protein, minerals, and fruits and vegetables rich in dietary fiber, are associated with a higher risk of chronic respiratory disease, regardless of the dietary index used to measure diet quality.

Silencing SMAD4 inhibits inflammation and ferroptosis in asthma by blocking the IL-17A signaling pathway

BACKGROUND

The TGF-β/SMAD signaling pathway is crucial in the pathogenesis of asthma. However, SMAD family member 4 (SMAD4), a key mediator of TGF-β, its roles and underlying mechanisms in asthma remain unclear.

METHODS

The in vivo and in vitro roles of SMAD4 in asthma were investigated through an ovalbumin (OVA)-induced mouse model and an interleukin-13 (IL-13)-induced cell model. The molecular mechanism of SMAD4 influenced asthma was examined using transcriptome sequencing, followed by feedback experiments involving recombinant human interleukin 17 A (rhIL-17 A), an IL-17 A signaling pathway activator.

RESULTS

SMAD4 was highly expressed in the asthma models. SMAD4 silencing alleviated damage to lung tissue and decreased inflammatory infiltration. Expression levels of Caspase-3, IgG, and inflammatory factors were reduced after silencing SMAD4. Silencing SMAD4 suppressed ferroptosis. Silencing SMAD4 also enhanced IL-13-induced BEAS-2B cell proliferation and suppressed apoptosis. Furthermore. IL-17 A signaling pathway was promoted in the asthma models, as evidenced by elevated IL-17RA, IL-17 A, and Act1 protein levels. SMAD4 silencing inhibited the expression levels of these IL-17 A pathway-associated proteins. Moreover, rhIL-17 A treatment notably reversed the impacts of SMAD4 silencing on asthma in the IL-13-induced cell model and OVA-induced mouse model, indicating that silencing SMAD4 inhibited inflammation and ferroptosis in asthma by blocking the IL-17 A signaling pathway.

CONCLUSION

Silencing SMAD4 prevents inflammation and ferroptosis in asthma by inhibiting the IL-17 pathway, which provides a novel potential approach for asthma therapy.

When patient-reported respiratory symptoms shed light on pathophysiology in adult asthma: a cross-sectional study

While studies have demonstrated the impact of asthma symptoms on quality of life, very few studies have investigated the relationship between detailed asthma symptoms, as reported by the patient, and lung function and inflammation. A cross-sectional study was conducted on treated (ICS/LABA) adult (> 18 years) asthma patients recruited from the Liege University Hospital Asthma Clinic (Belgium) between 2018 and 2023 (n = 505). The intensity of asthma symptoms (dyspnea, wheezing, chest tightness, cough, and airway secretion) was measured using five-point Likert scales (5 expressing the greatest intensity). Multiple linear regression models including all independent variables were carried out to evaluate whether lung function and inflammatory parameters were independently associated with distinct symptoms. Cough associated with female gender (p < 0.05), smoking (p < 0.01), low FeNO (p < 0.05) and FEV1% pred. (p < 0.05), and high blood and sputum eosinophils (p < 0.05 for both). Airway secretion associated with smoking (p < 0.05). Chest tightness associated with young age (p < 0.001), female gender (p < 0.05) and low FEV1% pred. (p < 0.01). Dyspnea associated with female gender (p < 0.001), high BMI (p < 0.05), low FEV1% pred. (p < 0.0001) and high FEV1/FVC % (p < 0.01). Wheezing associated with young age (p < 0.01), high BMI (p < 0.05), smoking (p < 0.01), low FEV1% pred. (p < 0.0001) and high FEV1/FVC % (p < 0.05). Different respiratory symptoms are associated with distinct demographic, functional and inflammatory features paving the way for personalized therapeutic interventions.

Clinical-Epidemiological Profile of Patients With Chronic Obstructive Pulmonary Disease Treated at the Pneumology Outpatient Clinic of a Brazilian University Hospital

Background Chronic obstructive pulmonary disease (COPD) is a significant illness that affects many Brazilians. It is a complex and extremely prevalent disease, and thus, understanding the clinical-epidemiological profile of the patients afflicted with this disease is of utmost importance for the adequate management of these patients by multidisciplinary teams. Objective The aim of the study was to describe the clinical and epidemiological profile of COPD patients in a specialized outpatient clinic. Methods This was a cross-sectional study. The sample comprised 198 patients who attended a specialized outpatient clinic in 2018. All variables were collected from the patients' medical records. Results The mean age of the patients was 69.56 ± 8.98 years (CI 95%: 68.30 - 70.82). Of the 198 patients, 115 (58.1%) were male, while 83 (41.9%) were female. Of all patients, 158 (79.8%) were active smokers or former smokers. The mean value for the forced expiratory volume in the first second (FEV1) was 53.35% ± 21.22 of the expected value (CI 95%: 49.76 - 56.94). The mean number of comorbidities presented by the patients was 2.51 ± 1.81 (CI 95%: 2.25 - 2.76) and the average number of drugs the patients were taking for COPD was 2.83 ± 1.24 drugs (IC95%: 2.66 - 3.01). Conclusion This study reveals a complex population, with moderate to severe COPD and a high burden of comorbidities. Thereby, it becomes clear that pulmonologists must consider the COPD patient as a whole due to the high prevalence of factors that can worsen the prognosis in this population.

Sleep Deficiency, Sleep Apnea, and Chronic Lung Disease

With sleep occupying up to one-third of every adult's life, addressing sleep is essential to overall health. Sleep disturbance and deficiency are common in patients with chronic lung diseases and associated with worse clinical outcomes and poor quality of life. A detailed history incorporating nocturnal respiratory symptoms, symptoms of obstructive sleep apnea (OSA) and restless legs syndrome, symptoms of anxiety and depression, and medications is the first step in identifying and addressing the multiple factors often contributing to sleep deficiency in chronic lung disease. Additional research is needed to better understand the relationship between sleep deficiency and the spectrum of chronic lung diseases.

Variation of All-Cause Mortality with Fat-Free Mass Index (FFMI) and Fat Mass Index (FMI) in Individuals with Asthma: Results from the NHANES Database Retrospective Cohort Study

BACKGROUND

The relationship between fat-free mass index (FFMI), fat mass index (FMI), and mortality in patients with asthma remains unknown. This study aimed to examine the associations between FFMI and FMI and all-cause mortality in a cohort of American adults diagnosed with asthma.

METHODS

This study included 15,200 adults from NHANES. To assess mortality, we linked participant records to the National Death Index. FMI and FFMI were measured and evaluated using dual-energy X-ray absorptiometry (DXA). Survival differences across quintiles of FFMI and FMI were explored using Kaplan-Meier plots and log-rank tests, with the proportional hazards assumption assessed using Schoenfeld residuals. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for mortality associated with FFMI and FMI, adjusting for potential confounders including age, sex, smoking status, physical activity, and other relevant factors. Additionally, stratified analyses based on theoretical considerations were conducted to identify subgroups of individuals exhibiting an elevated risk of mortality. This study also examined the nonlinear relationships between FFMI, FMI, and mortality using restricted cubic splines (RCS).

RESULTS

After a median follow-up of 184 months, 12.11% of individuals had died. Kaplan-Meier plots revealed significant differences in all-cause mortality among patients with asthma across the FFMI and FMI quintiles. Specifically, individuals in the lowest FFMI quintile (Q1, 10.4-16.0, representing the range of FFMI values) exhibited a significantly increased risk of all-cause mortality (HR: 4.63; 95% CI: 1.59, 13.5; p < 0.01). Similarly, elevated risks of all-cause mortality were observed in the upper three quintiles of FMI, with Q3 (4.8-6.1) having an HR of 2.9 (95% CI: 1.20, 7.00; p < 0.05), Q4 (6.2-8.3) having an HR of 3.37 (95% CI: 1.41, 8.03; p < 0.01), and Q5 (8.4-22.8) having an HR of 4.6 (95% CI: 1.31, 16.2; p < 0.05). Moreover, the risk of all-cause mortality increased with increasing FMI and decreasing FFMI (p for non-linearity < 0.001 in both cases). Subgroup analyses further elucidated these associations across different categories. In examining the association between FMI and all-cause mortality among asthma patients across various subgroups, a heightened mortality risk found among males, individuals with medium education levels, medium income levels, and those who consume alcohol.

CONCLUSIONS

The study shows that both high FMI and low FFMI are associated with increased mortality in patients with asthma. These findings underscore the critical role of FMI and FFMI in the health management of asthma patients. Therefore, it is recommended that clinicians proactively monitor and adjust these indices to improve patient prognosis and enhance health outcomes for individuals with asthma..

Modeling severe uncontrolled asthma: Transitioning away from health states

Background

Models developed to date to simulate long-term outcomes of asthma have been criticized for lacking granularity and ignoring disease heterogeneity.

Objective

To propose an alternative approach to modeling asthma and apply it to model long-term outcomes in a population with moderate-to-severe type 2 asthma (patients with raised fractional exhaled nitric oxide or eosinophils) and treated with conventional therapy.

Methods

A discretely integrated condition event (DICE) approach was adopted, simulating individual profiles with asthma over patients' lifetime in terms of exacerbations, asthma-related death, and death unrelated to asthma. The timing of these events is dependent on profile characteristics including lung function, asthma control, exacerbation history, and other baseline characteristics or contextual factors. Predictive equations were derived from a clinical trial to model time to exacerbation, change in asthma control, lung function, and utility. Real-world studies were used to supplement data gaps. Outcomes evaluated included life expectancy, quality-adjusted life-years (QALY), number of exacerbations, and lung function over time.

Results

Average annual rates of severe and moderate exacerbations were 1.82 and 3.08 respectively, with rates increasing over time. Lung function declined at a higher rate compared with the general population. Average life expectancy was 75.2 years, compared with 82.4 years in a matched general population. The majority of life-years were spent with uncontrolled asthma and impaired lung function.

Conclusion

Patients with moderate-to-severe type 2 asthma and a history of exacerbations suffer from frequent exacerbations and reduced lung function and life expectancy. Capturing multiple conditions to simulate long-term outcomes in patients with asthma may provide more realistic projections of exacerbation rates.

Trends in disease burden and risk factors of asthma from 1990 to 2019 in Belt and Road Initiative countries: evidence from the Global Burden of Disease Study 2019

This study outlines asthma burden trends across age, sex, regions and risk factors in 'Belt and Road' (B&R) countries from 1990 to 2019 using the Global Burden of Disease Study 2019 data. Incidence, mortality, prevalence, years lived with disability (YLDs), disability-adjusted life years (DALYs) and risk factors for asthma were measured. India, China and Indonesia bore the heaviest burden in 2019. Despite the significant decline in the average annual percent change for age-standardized mortality and years of life lost from 1990 to 2019, increases were observed in several East Asian, Central Asian, North African and Middle Eastern countries between 2010 and 2019. For both sexes, YLDs decreased in most B&R countries but increased in Montenegro, Saudi Arabia, Armenia, Vietnam and Oman. YLDs in Georgia, the United Arab Emirates and Albania increased in males but decreased in females. YLDs increased for those aged <15 years in Central Asia and Europe, while China's 50-74-year age group showed the lowest YLD change. High body mass index (BMI) led to increased YLDs in East, Central and Southeast Asia; North Africa; and the Middle East. Conclusively, asthma burden varies significantly by country. Tailoring control efforts to specific regions, sex and high BMI could enhance asthma management.

Long-term safety of mepolizumab for up to ∼10 years in patients with severe asthma: open-label extension study

OBJECTIVES

Long-term safety monitoring of mepolizumab is necessary to support real-world use for the treatment of severe asthma. This Long-Term Access Program assessed the safety and benefit:risk of mepolizumab in pediatric, adolescent, and adult patients with severe asthma.

MATERIALS AND METHODS

This was a multicenter, Phase IIIb safety, open-label extension study of multiple prior studies assessing mepolizumab in addition to standard of care (Aug 2015 - Aug 2022). Adults/adolescents (≥12 years of age) received mepolizumab 100 mg subcutaneously (SC) every 4 weeks until mepolizumab was commercialized. Pediatric patients (6-11 years of age) received mepolizumab 40 mg or 100 mg SC (bodyweight <40 or ≥40 kg, respectively) every 4 weeks. Safety was assessed every 4 weeks and benefit:risk every 12 weeks.

RESULTS

Of the 514 patients enrolled, 57% were female and the mean age was 51.1 (standard deviation: 14.9) years; 24 (5%) patients were 6-17 years of age. Total cumulative mepolizumab exposure across all mepolizumab studies included in this analysis was 1500.59 patient-years; median exposure was 2.03 (range, 0.08 to 9.97) years. Overall, 37 (7%) patients experienced on-treatment serious adverse events (SAEs): 34/502 (7%) in the 100 mg SC group and 3/7 (43%) in the 40 mg SC pediatric group. Two patients experienced SAEs considered to be treatment-related by the investigator. Infections were the most common SAEs of special interest (9 [2%] patients). Physician-assessed benefit:risk of mepolizumab supported continued treatment over the study period.

CONCLUSIONS

This long-term safety analysis of mepolizumab was consistent with previous reports, with no emerging safety concerns; most patients had a favorable benefit:risk up to ∼10 years.

CLINICAL TRIAL IDENTIFIER

NCT00244686 (GSK ID 201956).

Global burden due to modifiable risk factors for autoimmune diseases, 1990-2021: Temporal trends and socio-demographic inequalities

BACKGROUND

Autoimmune diseases arise from a combination of non-modifiable risk factors, such as gender and genetic predispositions, and modifiable factors, including lifestyle choices and environmental exposures. Given the potential to alter modifiable risk factors, this study aims to evaluate the global burden, temporal trends, and inequalities of autoimmune diseases attributed to modifiable risk factors from 1990 to 2021. The study will provide up-to-date evidence to inform strategies for mitigating the impact of these risk factors on autoimmune diseases worldwide.

METHODS

Data on the global burden of autoimmune diseases attributed to modifiable risk factors were obtained from the Global Burden of Diseases study 2021. Temporal trends in age standardized disability-adjusted life-years (DALYs) rates were evaluated by estimated annual percentage changes (EAPC). Spearman rank correlation test was used to explore the association between two variables. Slope index of inequality (SII) and concentration index (CI) were used to evaluated the absolute and relative inequalities in DALY rates and numbers, respectively.

RESULTS

From 1990 to 2021, type 1 diabetes mellitus (T1DM) due to high temperature has shown an increasing trend in global age standardized DALY rates (EAPC = 0.88, 0.58 to 1.18), whereas all other autoimmune diseases due to specific risk factors have generally exhibited decreasing trends. Across Socio-demographic Index (SDI) quintiles, notable increases were observed in high SDI countries for T1DM due to high temperature (EAPC = 1.36, 0.92 to 1.80), in low and low-middle SDI countries for multiple sclerosis (MS) due to smoking (EAPC = 0.25, 0.23 to 0.27; 0.22, 0.21 to 0.23, respectively), and in low-middle SDI countries for asthma due to high body-mass index (BMI) (EAPC = 0.25, 0.20 to 0.29). In 2021, significant positive associations were observed between SDI and age-standardized DALY rates for rheumatoid arthritis (RA) and MS due to smoking, as well as T1DM due to low temperatures across 204 countries and territories (all P < 0.05). In contrast, all other autoimmune diseases attributed to certain risk factors exhibited significant negative associations (all P < 0.05). Women displayed higher global age-standardized DALY rates for asthma due to high BMI (44.1 per 100,000 population), while men exhibited higher global age-standardized DALY rates for all other autoimmune diseases due to specific risk factors. Except for narrowed inequalities in DALY rates for asthma due to smoking (SII = 20.4, 13.0 to 27.8 in 1990 to 6.7, 2.8 to 10.6 in 2021) and in DALY numbers for asthma due to high BMI (CI = 17.3, 24.5 to 9.5 in 1990 to -0.3, 8.2 to -8.6 in 2021), both absolute and relative SDI-related inequalities have remained stable for all other autoimmune diseases linked to specific risk factors.

CONCLUSIONS

Over the past three decades, substantial progress has been achieved in reducing global age-standardized DALY rates for autoimmune diseases attributed to modifiable risk factors, except for T1DM attributed to high temperatures. Despite these advancements, SDI-related inequalities have remained stable for most of these diseases attributed to risk factors, underscoring the urgent need for targeted public health strategies to address these persistent disparities.

The epithelial barrier theory and its associated diseases

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

Occupational exposures in low- and middle-income countries: A scoping review

Exposure to high levels of harmful agents in the workplace can significantly impact workers' health, contributing to morbidity and mortality. Levels of these exposures are often measured in high-income countries in research studies and, in some places, to monitor levels in line with health and safety regulations. However, less is known about workplace exposure levels in low- and middle-income countries (LMICs). Our aim was to describe the quantitative exposure measurements of different occupational agents across industries within LMICs. We conducted a scoping review of peer-reviewed publications available on Web of Science and PubMed from inception to 1 September 2023. Our search focused on quantitative occupational exposure measurements across industries in LMICs. We identified a total of 8,676 publications. After screening, 58 studies from 25 countries were retained for final review. China, Iran, and Tanzania contributed the greatest number of studies. Manufacturing, mining, and agriculture were the most studied sectors, with factory workers and miners being the most common job titles. Exposure measurements included vapour, gases, dust, and fumes (VGDF), solvents, metals, pesticides and particulate matter. Occupational exposure levels for the same industry varied widely across geographical regions. This review provides a comprehensive overview of occupational exposures in LMICs and highlights the absence of data in certain geographical areas and industries. The study contributes valuable insights for directing future research, and the need to optimise the assessment of occupational exposures in LMICs with the aim ultimately of reducing disease.

Mobile App for Patients With Chronic Obstructive Pulmonary Diseases During Home-Based Exercise Care: Usability Study

BACKGROUND

Digital health tools have demonstrated promise in the treatment and self-management of chronic diseases while also serving as an important means for reducing the workload of health care professionals (HCPs) and enhancing the quality of care. However, these tools often merely undergo large-scale testing or enter the market without undergoing rigorous user experience analysis in the early stages of their development, leading to frequent instances of low use or failure.

OBJECTIVE

This study aims to assess the usability of and satisfaction with a mobile app designed for the clinical monitoring of patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation at home.

METHODS

This study used a mixed methods approach involving two key stakeholders-patients with chronic obstructive pulmonary disease and HCPs-across three phases: (1) mobile app mock-up design, (2) usability testing, and (3) satisfaction evaluation. Using convenience sampling, participants were grouped as HCPs (n=12) and patients (n=18). Each received a tablet with mock-ups for usability testing through interviews, with audio recordings transcribed and analyzed anonymously in NVivo12.0, focusing on mock-up features and usability insights. Task difficulty was rated from 1 (very easy) to 5 (very difficult), with noncompletion deemed a critical error. Usability satisfaction was measured on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree).

RESULTS

The research indicated a notable difference in app usability perceptions: 66% (8/12) of HCPs found tasks "very easy," compared to only 22% (4/18) of patients. Despite this, no participant made critical errors or withdrew, and satisfaction was high. HCPs completed tasks in about 20 minutes, while patients took 30. Older adults faced challenges with touch screens and scroll menus, suggesting the need for intuitive design aids like auditory support and visual health progress indicators, such as graphs. HCPs noted potential data delays affecting service, while non-native-speaking caregivers faced interpretation challenges. A secure pairing system for privacy in teleconsultations proved difficult for older users; a simpler icon-based system is recommended. This study highlights the need to consider stakeholder abilities in medical app design to enhance function implementation.

CONCLUSIONS

Most HCPs (11/12, 91%) found the app intuitive, though they recommended adding icons to show patient progress to support clinical decisions. In contrast, 62% (11/18) of patients struggled with tablet navigation, especially with connectivity features. To ensure equitable access, the design should accommodate older users with diverse abilities. Despite challenges, both groups reported high satisfaction, with patients expressing a willingness to learn and recommending the app. These positive usability evaluations suggest that, with design improvements, such apps could see increased use in home-based care.

Exploring the mechanisms of chronic obstructive pulmonary disease and Crohn's disease: a bioinformatics-based study

This study explored the comorbid mechanisms between Crohn's disease (CD) and chronic obstructive pulmonary disease (COPD) using bioinformatics analysis. From the Gene Expression Omnibus (GEO) microarray dataset, 349 common differentially expressed genes (coDEGs) were identified, and 8 shared hub genes were found: CCL2, CXCL1, TLR2, ICAM1, PTPRC, ITGAX, PTGS2, and MMP9, which were vital for immune function and regulation of inflammatory responses. In addition, the study also analyzed the association between coDEGs and immune cell infiltration using the single-sample gene set enrichment algorithm (ssGSEA). Potential drugs related to these genes were identified using the connectivity map (CMap). These findings provided new perspectives for understanding the interaction between CD and COPD.

Association of the gut microbiome and different phenotypes of COPD and asthma: a bidirectional Mendelian randomization study

Mounting evidence has revealed the association between gut microbiota and both chronic obstructive pulmonary disease (COPD) and asthma; however, the causal association between gut microbiota and specific disease phenotypes remains to be determined. This study employed bidirectional two-sample Mendelian randomization (MR) analyses to investigate the potential causal relationship between gut microbiota and these conditions. The research utilized genome-wide association study (GWAS) data from the MiBioGen consortium for gut microbiota and the integrative epidemiology unit (IEU) Open GWAS for these conditions. Four MR analysis methods were employed: the inverse variance weighted (IVW) test, MR-Egger, weighted median, and weighted mode methods. The IVW method results are considered the primary findings. Sensitivity analyses, including heterogeneity tests, horizontal pleiotropy analysis, and leave-one-out analysis, were used to enhance robustness. Our MR study identified eight gut microbiota taxa potentially associated with the risk of different types of COPD and asthma. These include two taxa for early-onset COPD: Streptococcaceae [odds ratio (OR) = 1.315, 95% confidence interval (CI) = 1.071-1.616, P = 0.009] and Holdemanella (OR = 1.199, 95% CI = 1.063-1.352, P = 0.003); three for later-onset COPD: Acidaminococcaceae (OR = 1.312, 95% CI = 1.098-1.567, P = 0.003), Holdemania (OR = 1.165, 95% CI = 1.039-1.305, P = 0.009), and Marvinbryantia (OR = 0.814, 95% CI = 0.697-0.951, P = 0.009); one for allergic asthma: Butyricimonas (OR = 0.794, 95% CI = 0.693-0.908, P = 0.001); and two for non-allergic asthma: Clostridia (OR = 1.255, 95% CI = 1.043-1.511, P = 0.016) and Clostridiales (OR = 1.256, 95% CI = 1.048-1.506, P = 0.014).IMPORTANCEIndividuals with diverse phenotypes of chronic obstructive pulmonary disease (COPD) and asthma exhibit different responses to the conventional "one treatment fits all" approach. Recent research has revealed the significant role of the gut-lung axis in both COPD and asthma. However, the specific impact of gut microbiota on different subtypes of these conditions remains poorly understood. Our study has identified eight gut microbiota that may be associated with the risk of different types of COPD and asthma. These findings provide evidence suggesting a potential causal relationship between gut microbiota and various phenotypes of COPD and asthma. This offers a new perspective on the origins of different disease phenotypes and points toward future exploration of phenotype-specific and personalized therapies.

Clinical profile, inhaler technique, and predictors of inhaler adherence among asthma and COPD patients who attended the outpatient emergency department for acute exacerbation

Understanding the patients' clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. Convenience sampling was used in this study. The inhaler techniques and adherence of all subjects were evaluated. Regression analysis was used to identify predictors of inhaler adherence. We recruited 120 subjects with a mean age of 47.8 ± 16.0 and were predominantly asthma patients (n = 85, 70.8%). Most were on regular follow-up (n = 72, 60.0%) and adhered to their inhaler(s) (n = 86, 71.7%). Less than half of the subjects use their inhaler(s) correctly (n = 45, 37.5%). Three predictors of inhaler adherence were identified: regular follow-up (aOR 2.072, p = 0.041), correct inhaler technique (aOR 3.071, p = 0.039), and ability to explain inhalers' mode of action (aOR 10.906, p = 0.031). The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial.

An Exploratory Study of Alternative Time Frames and Descriptors for EQ-5D-5L in Obstructive Airway Diseases Using Mixed Methods

OBJECTIVES

EQ-5D-5L with its recall time of "today" may limit its ability to capture episodic symptoms and exacerbations in chronic obstructive airway diseases (OAD). We examined whether longer time frames and changing the intensity response scales to frequency scales could improve the measurement properties of EQ-5D-5L.

METHODS

We used a mixed-method design starting with in-depth interviews with 20 patients and clinicians to elicit preferred time frames using concept elicitation techniques and content analyses. We then administered the top 4 preferred variants using 1- and 4-weeks' time frames with the original intensity or an alternative frequency response scale alongside EQ-5D-5L and St George Respiratory Questionnaire to OAD patients during 2 different visits. We compared the ceiling effects and construct validity by testing a priori hypotheses in relation to St George Respiratory Questionnaire and clinical outcomes via correlation and receiver operating characteristic (ROC) analyses, respectively. Follow-up patients were categorized into "better," "stable," and "worse" groups to assess reliability using intraclass correlation coefficient (ICC) or Cohen's Kappa (k) and responsiveness using ROC analysis.

RESULTS

A total of 184 patients (mean [SD] age: 54[18]; female: 37.0%) completed baseline assessments. A total of 120 patients also completed follow-up assessments (mean [SD] interval: 2.8 [1.7] months). The ceilings were lower in the variants compared with EQ-5D-5L (P < .001). Reliability of the variants were comparable to or higher than EQ-5D-5L. The c-statistic values derived from ROC analyses of the variants were consistently higher than EQ-5D-5L.

CONCLUSIONS

Use of longer time frames with the original intensity or the frequency response scales may improve EQ-5D-5L's psychometric properties in OAD patients.

The role of 14-3-3β in acute asthma in children and analysis of the risk factors for asthma exacerbation

OBJECTIVE

To investigate the role of 14-3-3β in acute asthma exacerbations in children and analyze the risk factors for asthma exacerbations.

METHODS

This study recruited 101 children with acute asthma exacerbations, 101 children with stable asthma, and 65 healthy children. Serum 14-3-3β was compared among the three groups. Factors such as asthma family history, skin prick test, serum-specific IgE test, coinfections, and clinical indicators (FeNO, FEV1, white blood cells, eosinophils, and serum IgE level) were compared between the asthma groups. Risk factors associated with acute asthma exacerbations were identified using multivariate logistic regression models. ROC curve was drawn to determine the diagnostic sensitivity and specificity of 14-3-3β.

RESULTS

Serum 14-3-3β was significantly greater in the acute asthma group than in the stable asthma and control groups. Serum 14-3-3β was higher in severe acute asthma group than in mild-moderate asthma group. There were no significant differences in serum 14-3-3β levels between stable asthma and control groups (p > .05). Multivariate logistic regression analysis revealed that serum 14-3-3β level, FeNO, coinfection, and FEV1 z-score significantly increased the odds of acute asthma exacerbations in children. The optimal 14-3-3β cutoff value (39.79 ng/mL), had a sensitivity of 69.3% and specificity of 94.1% for predicting acute asthma exacerbations.

CONCLUSIONS

14-3-3β is elevated in children with acute exacerbations of asthma, and increases with exacerbation severity. 14-3-3β, FeNO, FEV1, and coinfection could be independent risk factors for predicting asthma exacerbations. The optimal 14-3-3β cutoff value for predicting asthma exacerbations was 39.79 ng/mL.

House dust mite allergens, store-operated Ca2+ channels and asthma

The house dust mite is the principal source of aero-allergen worldwide. Exposure to mite-derived allergens is associated with the development of asthma in susceptible individuals, and the majority of asthmatics are allergic to the mite. Mite-derived allergens are functionally diverse and activate multiple cell types within the lung that result in chronic inflammation. Allergens activate store-operated Ca2+ release-activated Ca2+ (CRAC) channels, which are widely expressed in multiple cell types within the lung that are associated with the pathogenesis of asthma. Opening of CRAC channels stimulates Ca2+-dependent transcription factors, including nuclear factor of activated T cells and nuclear factor-κB, which drive expression of a plethora of pro-inflammatory cytokines and chemokines that help to sustain chronic inflammation. Here, I describe drivers of asthma, properties of mite-derived allergens, how the allergens are recognized by cells, the signalling pathways used by the receptors and how these are transduced into functional effects, with a focus on CRAC channels. In vivo experiments that demonstrate the effectiveness of targeting CRAC channels as a potential new therapy for treating mite-induced asthma are also discussed, in tandem with other possible approaches.

Influence and distinctions of particulate matter exposure across varying etiotypes in chronic obstructive pulmonary disease (COPD) mouse model

BACKGROUND

Air pollution, notably particulate matter (PM), significantly impacts chronic respiratory disease such chronic obstructive pulmonary disease (COPD). Although asthma-COPD overlap (ACO), considered one of the COPD etiotype, is associated with greater severity in both symptoms and outcomes, effects of PM exposure remain unclear. Thus, this study aimed to evaluate impact of PM on chronic airway disease animal models.

METHODS

We established two distinct COPD etiotypes, cigarette smoking-related COPD (COPD-C) and COPD with asthma (COPD-A), using porcine pancreatic elastase (PPE) for COPD-C and a combination of PPE with ovalbumin for COPD-A. To reflect smoking influence, cigarette smoking extract was administered to both disease models. To assess impact of PM exposure, bronchoalveolar lavage fluid (BALF), proinflammatory cytokines, lung histology, and cellular damage mechanisms were analyzed.

RESULTS

In the COPD-A model, cell counts and type 2 cytokines were elevated in BALF independent of PM exposure. All models exhibited increased lung inflammation and emphysema due to PM exposure. Expression levels of apoptosis-related protein B-cell lymphoma protein 2 (Bcl-2) associated X (Bax) showed an inclination to increase with PM exposure. In the COPD-A model, decreased expression of basal nuclear factor erythroid-derived 2-like 2 (Nrf-2) and increased production of reactive oxygen species (ROS) due to PM exposure were noted.

CONCLUSION

We developed two distinct models for the etiotypes of COPD and found increased vulnerability to cell damage in COPD-A after PM exposure. Moreover, the control group displayed escalated airway inflammation and emphysema due to PM exposure, substantiating the risk of respiratory diseases.

Causal relationship between air pollution and chronic obstructive pulmonary disease in European and East Asian populations: a Mendelian randomization study

Epidemiologic studies have suggested a possible association between air pollution and chronic obstructive pulmonary disease (COPD), but it is controversial and difficult to draw causal inferences. Five methods were adopted to evaluate the causal relationship between air pollution and COPD in European and East Asian populations by using MR Analysis. A statistically significant causal relationship between PM2.5 and COPD was observed in the European population (OR: 2.34; 95% CI: 1.06-5.05; p = 0.033). Statistical significance remained after adjustment for confounding factors (adjusted OR: 2.28; 95% CI: 1.01-5.20; p = 0.048). In East Asian populations, PM2.5 absorbance, a proxy for black carbon, was statistically associated with COPD (OR: 1.41; 95% CI: 1.09-1.81; p = 0.007). We did not adjust for confounders in East Asian populations, as the association was independent of known confounders (e.g. smoking, respiratory tract infections, etc.). In conclusion, increased concentrations of PM2.5 and PM2.5 absorbance were associated with an increased risk of COPD.

Access to Treatment for Chronic Obstructive Pulmonary Disease in the Americas: A Call for Action. A Joint Perspective from the Brazilian Thoracic Society, Canadian Thoracic Society, Latin American Thoracic Society, and the American Thoracic Society

Chronic obstructive pulmonary disease (COPD) is a major public health problem in the Americas (a region of the world comprising North, Central, and South America), although there is substantial variation in disease prevalence, morbidity, and mortality between and within nations. Across the Americas, COPD disproportionately affects vulnerable populations, including minoritized populations and impoverished persons, who are more likely to be exposed to risk factors such as tobacco use, air pollution, infections such as tuberculosis, and biomass smoke, but less likely to have adequate healthcare access. Management of COPD can be challenging across the Americas, with some barriers being specific to certain countries and others shared across the United States, Canada, and Latin America. Because most cases of COPD are undiagnosed because of suboptimal access to health care and pulmonary function testing and, thus, cannot be treated, increased access to spirometry would have a substantial impact on disease management across the Americas. For individuals who are diagnosed, access to medications and other interventions is quite variable across and within nations, even in those with universal healthcare systems, such as Canada and Brazil. This emphasizes the importance of collaborative treatment guidelines, which should be adapted for the healthcare systems and policies of each nation or region, as appropriate. To have a positive impact on COPD management in the Americas, we propose actionable items, including the need for all our respiratory societies to engage key stakeholders (e.g., patient-led organizations, professional societies, and governmental and nongovernmental agencies) while advocating for campaigns and policies to ensure clean air for all; eliminate tobacco use and enhance coverage for treatment of nicotine dependence; and improve access to early case finding, diagnosis, and treatment for all patients, including underserved and vulnerable populations.

Chronic obstructive pulmonary disease exacerbations' management in Portuguese hospitals - EvaluateCOPDpt, a multicentre, observational, prospective study

INTRODUCTION AND OBJECTIVES

In order to improve the quality of chronic obstructive pulmonary disease (COPD) patients' care, better knowledge of clinical practice and the factors associated with patient outcomes are needed. This study aimed to evaluate the relation between clinical practice and the outcomes of patients admitted for COPD exacerbations in Portuguese hospitals.

MATERIALS AND METHODS

Observational, multicentre, prospective study with a 60-days follow-up period, in 11 hospitals, including patients aged ≥ 30 years, admitted to hospital for at least 24 hours due to an acute exacerbation of COPD. Demographic and clinical data were collected, including sex, age, smoking habits, hospitalisations, pulmonary function, comorbidities, COPD symptoms, and treatment. Sixty days after discharge, COPD exacerbations management, outcome measures, and readmission data were evaluated through a structured phone follow-up interview.

RESULTS

196 patients were included (85.7% male, mean age 71.2 years), the majority admitted through the emergency service. Ex-smokers and current smokers accounted for 51% and 36%, respectively. On admission, 72.4% were on LAMA, 54.6% on LABA, and 45.5% were on LABA/LAMA. Inhaled corticosteroids (ICS) were used in 37.3% and systemic steroids (SCS) in 10.3%. 35.7 % had had at least one exacerbation, with hospitalisation, in the previous year. There was no spirometry data for 23.2%. On hospitalisation, 98.5% of patients were treated with oxygen and 38.3% with non-invasive ventilation. Additionally, 93.4% used SCS and 60.2% ICS. Antibiotics were administered to 85.2%. 95.4% of patients were discharged; 9 died, 5 of whom had a COPD-related death. The median length of stay was 12 days for discharged patients and 33 days for patients who died. At discharge, 79.1% were prescribed with LAMA, 63.6% SCS, 61.5% LABA and 55.6% LAMA+LABA. 26,2% were prescribed with ICS+LABA+LAMA. At follow-up, 44.4% had a scheduled medical appointment within the 60 days after being discharged, and 28.3% were later readmitted due to exacerbation, of whom 52.8% were hospitalised.

CONCLUSIONS

The severity of COPD, particularly in exacerbations, is directly related to impaired lung function and quality of life, mortality, and significant health system costs. Knowledge about COPD exacerbations' management in acute hospital admissions in Portugal may help stimulate a national discussion and review of existing data to engage clinicians, policymakers, managers, and patients, raising awareness and promoting action on COPD.

Air Pollution Metabolomic Signatures and Chronic Respiratory Diseases Risk: A Longitudinal Study

BACKGROUND

Although evidence has documented the associations of ambient air pollution with chronic respiratory diseases (CRDs) and lung function, the underlying metabolic mechanisms remain largely unclear.

RESEARCH QUESTION

How does the metabolomic signature for air pollution relate to CRD risk, respiratory symptoms, and lung function?

STUDY DESIGN AND METHODS

We retrieved 171,132 participants free of COPD and asthma at baseline from the UK Biobank, who had data on air pollution and metabolomics. Exposures to air pollutants (particulate matter with diameter ≤ 2.5 μm [PM2.5], particulate matter with a diameter ≤ 10 μm, nitrogen oxide [NOX], and NO2) were assessed for 4 years before baseline considering residential address histories. We used 10-fold cross-validation elastic net regression to identify air pollution-associated metabolites. Multivariable Cox models were used to assess the associations between metabolomic signatures and CRD risk. Mediation and pathway analysis were conducted to explore the metabolic mechanism underlying the associations.

RESULTS

During a median follow-up of 12.51 years, 8,951 and 5,980 incident COPD and asthma cases were recorded. In multivariable Cox regressions, air pollution was positively associated with CRD risk (eg, hazard ratio per interquartile range increment in PM2.5, 1.09; 95% CI, 1.06-1.13). We identified 103, 86, 85, and 90 metabolites in response to PM2.5, particulate matter with a diameter ≤ 10 μm, NOX, and NO2 exposure, respectively. The metabolomic signatures showed significant associations with CRD risk (hazard ratio per SD increment in PM2.5 metabolomic signature, 1.11; 95% CI, 1.09-1.14). Mediation analysis showed that peripheral inflammatory and erythrocyte-related markers mediated the effects of metabolomic signatures on CRD risk. We identified 14 and 12 perturbed metabolic pathways (energy metabolism and amino acid metabolism pathways, etc) for PM2.5 and NOX metabolomic signatures.

INTERPRETATION

Our study identifies metabolomic signatures for air pollution exposure. The metabolomic signatures showed significant associations with CRD risk, and inflammatory- and erythrocyte-related markers partly mediated the metabolomic signatures-CRD links.

Implications of DNA damage in chronic lung disease

DNA plays an indispensable role in ensuring the perpetuation of life and safeguarding the genetic stability of living organisms. The emergence of diseases linked to a wide spectrum of responses to DNA damage has garnered increasing attention within the scientific community. There is growing evidence that patterns of DNA damage response in the lungs are associated with the onset, progression, and treatment of chronic lung diseases such as chronic obstructive pulmonary disease (COPD), asthma, and bronchopulmonary dysplasia (BPD). Currently, some studies have analyzed the mechanisms by which environmental factors induce lung DNA damage. In this article, we summarize inducible factors of lung DNA damage, current indicators, and methods for diagnosing DNA damage in chronic lung diseases and explore repair mechanisms after DNA damage including nonhomologous end-joining and homology-directed repair end joining pathways. Additionally, drug treatments that may reduce DNA damage or promote repair after it occurs in the lungs are briefly described. In general, more accurate assessment of the degree of lung DNA damage caused by various factors is needed to further elucidate the mechanism of lung DNA damage and repair after damage, so as to search for potential therapeutic targets.

Experimental and modeling approaches to determine drug diffusion coefficients in artificial mucus

Asthma, usually characterized by inflammation and mucus accumulation, causes restricted airflow and impaired lung function. The physiological and biochemical characteristics of mucus pose a strong barrier for drugs administered orally or via the pulmonary route for asthma treatment. In this study, two drugs commonly employed in the treatment of asthma, theophylline and albuterol, were placed in contact with an artificial mucus layer, measuring their interface concentrations, and modeling the concentration profiles to determine their diffusion coefficients. To monitor the diffusion process, the upper surface of a mucus layer was placed in contact with the drug solutions and the lower mucus surface was in contact with a zinc selenide crystal to allow for time-resolved Fourier transform infrared spectroscopy (FTIR) measurements. FTIR spectra were collected at constant time intervals and monitored for quantitative changes in spectral peaks corresponding to functional groups specific to each of these drugs. Changes in peak heights were correlated to concentration via Beer's Law. Fick's 2nd Law of Diffusion was used along with Crank's trigonometric series solution for a planar semi-infinite sheet to analyze the concentration data and determine diffusion coefficients. Using this method, fitting the experimental data resulted in diffusivity coefficients of D = 6.56 x 10-6 cm2/s for theophylline and D = 4.66 x 10-6 cm2/s for albuterol through artificial mucus. The drug diffusivity coefficients align closely with literature reports, wherein, diffusivity data was obtained experimentally using a rotating-disk apparatus and intrinsic dissolution technique. By coupling analytical and experimentally determined drug diffusion data, this approach provides a fast, non-invasive method for quickly assessing drug diffusion profiles through complex media.

Nebulization of Hypoxic hUCMSC-EVs Attenuates Airway Epithelial Barrier Defects in Chronic Asthma Mice by Transferring CAV-1

Background

Nebulization of hypoxic human umbilical cord mesenchymal stem cell-derived extracellular vesicles (Hypo-EVs) can suppress airway inflammation and remodeling in a chronic asthmatic mouse; however, the exact mechanism remains unclear. Recently, airway epithelial barrier defects have been regarded as crucial therapeutic targets in asthma. The aim of this study was to investigate whether and how Hypo-EVs protect against the disruption of the airway epithelial barrier under asthmatic conditions.

Methods

The therapeutic effects of Hypo-EVs on airway epithelial barrier defects were evaluated in ovalbumin (OVA)-induced asthmatic mice and in IL-4 and IL-13-induced HBE135-E6E7 cell models by detecting cell monolayer leakage and junctional protein expression. The protein levels in Hypo-EVs were determined by Western blotting, and a gene knockdown approach was used to investigate the biofactors in Hypo-EVs.

Results

Nebulization of Hypo-EVs directly alleviated airway epithelial barrier defects in asthmatic mice, as evidenced by colocalization with bronchial epithelial cells, decreased albumin concentration, and increased ZO-1 and E-cadherin expression. In vitro, Hypo-EV treatment dramatically rescued the increase in airway cell permeability, and upregulated the ZO-1 and E-cadherin protein expressions. Based on WB analysis, we found that caveolin-1 (CAV-1) was strongly enriched in Hypo-EVs. The knockdown of CAV-1 protein levels in Hypo-EVs significantly impaired Hypo-EV-mediated barrier protection in vitro and in vivo. Moreover, CAV-1 knockdown significantly abolished the beneficial effects of Hypo-EVs on airway inflammation and remodeling in asthmatic mice. In addition, we showed that IL-4/IL-13-induced airway epithelial barrier defects were mainly related to activation of STAT6 phosphorylation (p-STAT6), and overexpression of CAV-1 or Hypo-EV treatment inhibited the levels of p-STAT6 in IL-4/IL-13-induced HBE135-E6E7 cells.

Conclusion

Nebulization of Hypo-EVs can attenuate airway epithelial barrier defects in asthma by delivering CAV-1 to inhibit p-STAT6 expression and may be used to treat other barrier defect diseases.

Correlation of dietary flavonoid intake with chronic bronchitis, emphysema, and asthma in U.S. adults: A large, national, cross-sectional study

OBJECTIVE

To explore the relationship between dietary flavonoids and bronchitis, emphysema and asthma.

METHOD

A total of 11743 United States adults were extracted from the National Health and Nutrition Examination Survey (NHANES) in 2007-2008, 2009-2010 and 2017-2018. Of these, 47.7% were male and 52.3% female. Dietary flavonoid intake assessed using FDNNS and 24-hour dietary recall data. Inclusion of demographics (gender, age, education, family income), behavioral factors (BMI, smoking, drinking status, diet), chronic disease information (diabetes, hypertension) as covariates to eliminate confounding. Stepwise logistic regression was used to analyze the association between total dietary flavonoid intake and the risk of chronic respiratory disease. Weighted quantile sum regression (WQS) was used to analyze the association between 29 dietary flavonoids and the risk of chronic respiratory disease. Restricted cubic spline was used to analyze the dose-response relationship between dietary flavonoid intake and risk of chronic respiratory disease.

RESULTS

Stepwise logistic regression results showed that higher flavonoid intake in men was associated with a lower risk of CB and asthma (OR of CB: 0.55(0.31-0.97); OR of asthma: 0.72(0.52-0.99)), and WQS results showed a mixed health effect for total flavonoids and chronic respiratory tract in response to the 29 flavonoid fractions (OR of asthma: 0.97(0.94-0.99); OR of emphysema: 0.95(0.90-0.99)). Glycitein had the highest health contribution of 26.2% for emphysema; Eriodictyol had the highest health contribution of 32.13% for asthma, respectively. The RCS showed a dose-response relationship between flavonoids and respiratory tract health. The maximum dose for ingesting flavonoids to gain respiratory health benefits is 1500 mg/d.

CONCLUSION

Higher dietary flavonoid intake was associated with lower chronic respiratory risk in adult U.S. men. Also 29 dietary flavonoid components have an overall health effect on respiratory health. Glycitein and Eriodictyol may have potential health effects on the respiratory system. 1500 mg/day may be the Tolerable Upper Intake Level of dietary flavonoids for respiratory health in U.S. adults.

Consensus palliative care referral criteria for people with chronic obstructive pulmonary disease

OBJECTIVE

People with advanced chronic obstructive pulmonary disease (COPD) have substantial palliative care needs, but uncertainty exists around appropriate identification of patients for palliative care referral.We conducted a Delphi study of international experts to identify consensus referral criteria for specialist outpatient palliative care for people with COPD.

METHODS

Clinicians in the fields of respiratory medicine, palliative and primary care from five continents with expertise in respiratory medicine and palliative care rated 81 criteria over three Delphi rounds. Consensus was defined a priori as ≥70% agreement. A criterion was considered 'major' if experts endorsed meeting that criterion alone justified palliative care referral.

RESULTS

Response rates from the 57 panellists were 86% (49), 84% (48) and 91% (52) over first, second and third rounds, respectively. Panellists reached consensus on 17 major criteria for specialist outpatient palliative care referral, categorised under: (1) 'Health service use and need for advanced respiratory therapies' (six criteria, eg, need for home non-invasive ventilation); (2) 'Presence of symptoms, psychosocial and decision-making needs' (eight criteria, eg, severe (7-10 on a 10 point scale) chronic breathlessness); and (3) 'Prognostic estimate and performance status' (three criteria, eg, physician-estimated life expectancy of 6 months or less).

CONCLUSIONS

International experts evaluated 81 potential referral criteria, reaching consensus on 17 major criteria for referral to specialist outpatient palliative care for people with COPD. Evaluation of the feasibility of these criteria in practice is required to improve standardised palliative care delivery for people with COPD.

The interaction effects between depression and sleep status on asthma: a national cross-sectional study

Background

Asthma, depression, and sleep problems are three significant public health issues that are closely interrelated. This study aims to explore the relationship between depression, sleep status and asthma, as well as the potential interaction among these conditions and their effects on asthma.

Method

This cross-sectional study utilized data from the 2005-2008 National Health and Nutritional Examination Survey, including information on asthma, depression, sleep status and confounding factors. Multivariate logistic regression analyses were conducted to investigate the relationship between depression, sleep status, and asthma. Subgroup analyses were conducted to test the p-interaction between depression and each stratified variable. Additionally, both multiplicative and additive approaches were employed to assess the interaction between depression and sleep status on asthma, as well as to quantify their combined effects.

Results

A total of 8,327 participants (mean age 46.53 years) were included in this study. Compared to the individuals without depression, those with depression have an increased risk of asthma [Odds ratio (OR) = 1.57, 95% Confidence interval (CI) = 1.22-2.03], and an increase in the severity of depressive symptoms is associated with a higher risk of developing asthma. Additionally, poor sleep quality, sleep disorders, and insufficient sleep was associated with an increased risk of asthma. Effect modification was observed between depression and PIR status, smoking status, and sleep disorders in relation to asthma (p-interaction <0.05). Moreover, we found a positive interaction between severe depression and excessive sleep (OR = 29.07, 95% CI = 3.24-260.38). Furthermore, we observed the quantitative additive interaction indicators between moderately severe depression and insufficient sleep [Relative excess risk due to interaction (RERI) = 1.63, 95%CI = 0.18-3.83; Attributable proportion (AP) = 0.51, 95%CI = 0.15-0.87; Synergy index (SI) = 3.92, 95%CI = 1.65-23.50] influencing asthma risk.

Conclusion

Our study revealed distinct associations between depression, the severity of depressive symptoms, poor sleep quality, sleep disorders, and insufficient sleep with asthma. Additionally, there was an interaction between moderately severe depression and insufficient sleep on asthma. Psychological and sleep assessment are essential in asthma management. Clinicians should consider the potential risk of depression and sleep problems in asthma patients and intervene. Further longitudinal research is needed to better understand the pathophysiological mechanisms behind the interactions between asthma, depression, and sleep problems.

The change of FeNO is correlated with asthma control and lung function

Objective

To investigate the changes in fractional exhaled nitric oxide (FeNO) after treatment and the association between FeNO changes and the prognosis and lung function of children with asthma.

Methods

A total of 144 children newly enrolled with non-standardized treatment of asthma were recruited between September 2020 and December 2021. The children were divided into two groups according to the initial FeNO (0 day), and the changes in FeNO after Budesonide/Formoterol Inhalation Powder Mist (B/FIPM) treatment were observed in different subgroups in correlation with future outcomes after 1 year (well controlled or partly controlled) and lung function.

Results

The study showed that B/FIPM therapy significantly reduced FeNO levels and eosinophils (EOS) counts, improving pulmonary function (P < 0.01). FeNO levels significantly decreased in the well controlled group after 1 week treatment but not after 2 weeks. The partly controlled group showed sustained benefits after 2 weeks treatment (P < 0.01). Besides, among the patients with initial FeNO ≤35 ppb, the proportion of well controlled outcome was significantly higher in the group of ΔFeNO >0 (72.73 %) than that in the ΔFeNO ≤0 group (53.85 %) (P = 0.042).

Conclusion

B/FIPM is effective in reducing FeNO levels and EOS counts and restoring lung function in children with asthma. In addition, post-treatment changes in FeNO were predictive of prognosis and correlated with post-treatment lung function.

Vitamin D status in patients with chronic obstructive pulmonary disease at Chris Hani Baragwanath Hospital, Johannesburg, South Africa

Background

There has been a growing interest in nutritional/lifestyle factors, including vitamin D, that may affect chronic obstructive pulmonary disease (COPD). Most data are from Caucasian populations and temperate climates, with minimal African data.

Objectives

The primary objective was to determine the prevalence of vitamin D deficiency (25-hydroxyvitamin D (25(OH)D) ≤20 ng/mL) and insufficiency (25(OH)D 21 - 29 ng/mL) among patients with COPD. Secondary objectives were to investigate the association between vitamin D and demographic/lifestyle factors, lung function parameters, markers of COPD severity and corticosteroid use.

Methods

A prospective, cross-sectional study of 76 patients with COPD was conducted at a tertiary hospital in Johannesburg, South Africa. Patients were interviewed regarding demographic/lifestyle factors, COPD severity markers and corticosteroid therapy. The most recent spirometry result was recorded. Blood samples were taken for measurement of calcium, alkaline phosphatase and vitamin D levels. Patients were stratified according to vitamin D status (deficiency and non-deficiency (25(OH)D >20 ng/mL, i.e. combined insufficiency and adequate levels)), and statistical analysis was performed to assess for associations.

Results

The sample included 72% males and 63% black African patients. The prevalences of vitamin D deficiency and insufficiency were 48% (95% confidence interval (CI) 42 - 54) and 35% (95% CI 30 - 41), respectively. A Modified Medical Research Council (mMRC) dyspnoea score ≥2 was associated with a relative risk of 1.34 (95% CI 1.05 - 1.7) for vitamin D deficiency in univariate analysis. In multivariate regression analysis, only sunlight exposure (<1 hour/day) was an independent predictor of vitamin D deficiency (odds ratio 2.4; 95% CI 1.3 - 4.5).

Conclusion

There was a high prevalence of suboptimal vitamin D levels in this COPD sample population. A higher mMRC score was associated with an increased risk of vitamin D deficiency, while low sunlight exposure was the only independent predictor of vitamin D deficiency.

Study synopsis

What the study adds. This is the first study to provide prevalence data regarding vitamin D status in COPD patients in sub-Saharan Africa. The study highlights a relationship between vitamin D status and both symptom severity and sunlight exposure.Implications of the findings. Owing to the high prevalence of suboptimal vitamin D status among COPD patients, it may be useful to screen patients for vitamin D deficiency, especially those with a more severe phenotype. There may be scope for further studies to evaluate whether vitamin D supplementation corrects the deficiency and provides any clinical outcome benefit.

Differences in cellular and molecular processes in exposure to PM2.5 and O3

Epidemiological and toxicological studies have shown that PM2.5 and O3 could pose significant risks to human health, such as an increased incidence of respiratory and cardiovascular diseases. Usually, the adverse health outcomes induced by PM2.5 and O3 exposure are similar. However, PM2.5 and O3 have distinct physical and chemical properties, with PM2.5 being a solid-liquid mixture and O3 being a strongly oxidizing gaseous pollutant. Therefore, we speculated that there are some differences in biological processes induced by PM2.5 and O3 exposure. In the present study, we investigated the differences induced by PM2.5 and O3 exposure from the perspective of cellular and molecular processes. Firstly, the pulmonary epithelial cells (BEAS-2B) were exposed to different concentrations of PM2.5 or O3 at different durations. Then, we chose experimental models with the concentrations and duration at which the cell survival rate was 50 % after exposure to PM2.5 and O3, which were 100 μg/mL for 24 h for PM2.5, and 200 ppb for 4 h for O3. Our findings indicate that PM2.5 infiltrates cells via endocytosis without causing significant damage to cell membranes, while O3 induces lipid peroxidation at the cell surface. Moreover, the detection of mitochondrial function showed that the content of ATP was significantly reduced after exposure to both PM2.5 and O3. However, we found a significant difference in mtDNA copy number. PM2.5 exposure increased the mtDNA copy number by up-regulating the expression of fission genes (Fis1, Mff, Dnm1). O3 exposure decreased it by up-regulating the expression of fusion gene (Mfn1, Mfn2) and down-regulating the expression of fission gene (Fis1, Dnm1). These results indicate that although both PM2.5 and O3 exposure induced almost exactly similar adverse health outcomes, significant differences do exist in cellular and molecular processes.