Definition and Nomenclature of Chronic Obstructive Pulmonary Disease: Time for Its Revision

Current Smoker: A Clinical COPD Phenotype Affecting Disease Progression and Response to Therapy

Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition of the lungs, characterized by chronic respiratory symptoms, primarily dyspnea, cough, and sputum production, due to airway and/or alveoli abnormalities that cause persistent, and often progressive, airflow obstruction. Although the underlying mechanisms responsible for COPD remain poorly understood, over the last several decades, clinical phenotypes and endotypes have been suggested. These include frequent exacerbator and eosinophilic groups that guide tailored therapies for patients with that clinical expression. In the developed world, smoking is the main known cause of COPD, responsible for ~80% of cases. Active smokers have more severe disease, with more rapid lung function decline and impaired quality of life, than former smokers. Unfortunately, smoking is still highly prevalent. Rates range between 3% and 37% globally, with factors including sex, age, race, education level, and geography influencing the rate of addiction. Importantly, several studies have shown that smoking detrimentally affects treatment efficacy of COPD medications; this is particularly true of inhaled corticosteroids and macrolides. In this review, we discuss the effects of smoking on the pathophysiology of COPD and the clinical impact of smoke exposure in patients with COPD. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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

Background

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

Methods

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

Results

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

Conclusion

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

Activity Trackers in Physical Therapy for People With Chronic Obstructive Pulmonary Disease in the Netherlands: Cross-Sectional Study on Current Use and Implementation Determinants

Background

In the Netherlands, 545,900 people experienced chronic obstructive pulmonary disease (COPD) in 2022. Physical therapy following the Royal Dutch Society for Physiotherapy (Koninklijk Nederlands Genootschap voor Fysiotherapie) guidelines for COPD treatment is a proven effective treatment for people with COPD. The revised guidelines include a new recommendation: a patient's physical activity level should be assessed with an activity tracker (AT). Literature shows that the implementation of eHealth in clinical practice, in this case, ATs, is challenging.

Objective

This study aims (1) to assess how and why ATs are currently used in physical therapy in patients with COPD and (2) to determine which barriers and facilitators are of relevance for optimal implementation of ATs during the clinical reasoning process of physical therapists in patients with COPD.

Methods

A cross-sectional study was used to evaluate the implementation of ATs in physical therapy. Included participants were physical therapists who were affiliated with Chronisch ZorgNet and had a specialization in COPD treatment. The survey content was based on the Consolidated Framework for Implementation Research, the theory of planned behavior, the framework "experiences of patients with commercially available ATs," and the Koninklijk Nederlands Genootschap voor Fysiotherapie guidelines for COPD. Physical therapists were questioned via a digital survey.

Results

In total, 211 completed surveys were analyzed. Of the 211 participating physical therapists, 108 (51.2%) used ATs, whereas most of them (n=82, 75.9%) already used ATs before it was advised in the guidelines. Physical therapists indicated that the most important reason to use ATs is that they experience it as an added health care value. Both users and nonusers indicated that the most important reason why they do not use ATs is because their patients do not want to use an AT. The second reason was a lack of knowledge in the nonuser group. Moreover, both users and nonusers indicated that the implementation of ATs was not prepared and planned for within their center.

Conclusions

Overall, these results show that ATs are not yet fully implemented in the Dutch general physical therapy practice in patients with COPD, as recommended by current evidence-based guidelines. Physical therapists need guidance for the successful implementation of ATs. This could be accomplished by providing training for physical therapists, integrating ATs into the education of (future) physical therapists, and providing support during the implementation process of ATs for both the physical therapists and management.

Chronic Airflow Limitation, Lower Respiratory Symptoms, COPD and Chronic Rhinosinusitis in a Middle-Aged Population: The Swedish CArdioPulmonary bioImage Study (SCAPIS). A Link Between the Lower and Upper Airways

Purpose

Chronic rhinosinusitis (CRS) is related to asthma and chronic obstructive pulmonary disease (COPD). However, combined data on CRS, pulmonary function, lower airway symptoms, and cigarette smoking from the general population are lacking. The current study investigates the relationships between CRS and chronic airflow limitation (CAL), lower airway symptoms and COPD in a middle-aged population of ever-smokers and never-smokers.

Patients and Methods

All subjects from the Swedish CArdioPulmonary bioImage Study (SCAPIS) were included. Subjects underwent spirometry after bronchodilation. Chronic airflow limitation was defined as FEV1/FVC ratio <0.7. Computed tomography imaging of the thorax was performed to detect the presence of emphysema, and the subjects answered a comprehensive questionnaire on CRS, lower airway symptoms, asthma, chronic bronchitis, and cigarette smoking habits.

Results

In total, 30,154 adult subjects in the age range of 50-64 years were included. The prevalence of CRS was 5.6%. CRS was more-prevalent among subjects in the following categories: CAL (7.6%), lower airway symptoms (15.7%), current smokers (8.2%), asthma (13.6%), never-smokers and ever-smokers with COPD (17.6% and 15.3%, respectively), emphysema (6.7%), and chronic bronchitis (24.5%). In the adjusted regression model, CRS was significantly associated with CAL (OR 1.40), lower airway symptoms (OR 4.59), chronic bronchitis (OR 6.48), asthma (OR 3.08), and COPD (OR 3.10).

Conclusion

In this national, randomly chosen population sample of more than 30,000 middle-aged men and women, CRS is associated with CAL, lower airway symptoms, chronic bronchitis, asthma, and COPD. In patients with CRS and in patients with lower airway inflammation, it is important to consider the inflammatory status of the entire airway system.

SIRT1 regulates cigarette smoke extract‑induced alveolar macrophage polarization and inflammation by inhibiting the TRAF6/NLRP3 signaling pathway

M1 macrophages activated by cigarette smoke extract (CSE) serve a pro‑inflammatory role in chronic obstructive pulmonary disease (COPD). The expression of silent information regulator 1 (SIRT1) is decreased in the alveolar macrophages of patients with COPD. However, whether SIRT1 is involved in COPD by regulating macrophage polarization remains unknown. Rat Alveolar Macrophage NR8383 cells were exposed to CSE. Cell Counting Kit‑8 assay, western blot assay and ELISA showed that with increasing concentration of CSE, the activity of NR8383 cells and expression of SIRT1 gradually decreased, while the release of inflammatory cytokines TNFα, IL‑1β and IL‑6 increased. As shown in western blot or Immunofluorescence assays, exposure to CSE also increased expression levels of the M1 markers inducible nitric oxide synthase and CD86, whereas it downregulated expression of the M2 markers arginase 1 and CD206. In addition, CSE increased expression of TNF receptor associated factor 6 (TRAF6), NOD‑like receptor thermal protein domain associated protein 3 (NLRP3) and cleaved caspase‑1 protein in NR8383 cells. Overexpression plasmids of SIRT1 and TRAF6 significantly reversed the aforementioned changes induced by CSE. Moreover, immunoprecipitation demonstrated that TRAF6 could bind to NLRP3. The overexpression of TRAF6 notably attenuated the regulatory effects of overexpression of SIRT1 on polarization and inflammation in NR8383 cells. Conversely, overexpression of SIRT1 inhibited the TRAF6/NLRP3 signaling pathway, thereby suppressing CSE‑induced M1 polarization and release of inflammatory factors in NR8383 cells. The present study demonstrates that SIRT1 regulates CSE‑induced alveolar macrophage polarization and inflammation by inhibiting the TRAF6/NLRP3 signaling pathway.

Integrating bulk and single-cell RNA sequencing data: unveiling RNA methylation and autophagy-related signatures in chronic obstructive pulmonary disease patients

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung disease influenced by epigenetic modifications, particularly RNA methylation. Emerging evidence also suggests that autophagy plays a crucial role in immune cell infiltration and is implicated in COPD progression. This study aimed to investigate key RNA methylation regulators and explore the roles of RNA methylation and autophagy in COPD pathogenesis. We analyzed tissue-based bulk RNA sequencing and single-cell RNA sequencing (scRNA-seq) datasets from COPD and non-COPD patients, sourced from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified between COPD and non-COPD samples, and protein-protein interaction networks were constructed. Univariate logistic regression identified shared genes between DEGs and RNA methylation gene sets. Functional enrichment analyses, including Gene Ontology (GO), gene set enrichment analysis (GSEA), and gene set variation analysis (GSVA), were performed. Weighted gene co-expression network analysis (WGCNA) and immune infiltration analysis were conducted. Integration with scRNA-seq data further elucidated changes in immune cell composition, and cell communication analysis assessed interactions between macrophages and other immune cells. AddModuleScore analysis quantified RNA methylation and autophagy effects. Finally, a COPD mouse model was used to validate the expression of critical RNA methylation genes (FTO and IGF2BP2) in lung macrophages via RT-qPCR and flow cytometry. As revealed, we identified 13 RNA methylation-related genes enriched in translation and methylation processes. GSEA and GSVA revealed significant enrichment of these genes in immune and autophagy pathways. WGCNA analysis pinpointed key hub genes linking RNA methylation and autophagy. Integrated scRNA-seq analysis demonstrated a marked reduction of macrophages in COPD, with FTO and IGF2BP2 emerging as critical RNA methylation regulators. Macrophages with elevated RNA methylation and autophagy scores had increased interactions with other immune cells. In COPD mouse models, decreased expression of FTO and IGF2BP2 in lung macrophages was validated. Taken together, this study highlights the significant roles of RNA methylation in relation to autophagy pathways in the context of COPD. We identified key RNA methylation-related hub genes, such as FTO and IGF2BP2, which were found to have decreased expression in COPD macrophages. These findings provide novel genetic insights into the epigenetic mechanisms of COPD and suggest potential avenues for developing diagnostic and therapeutic strategies.

Associations of short-term exposure to air pollution with outpatient visits and treatment costs for chronic obstructive pulmonary disease in Xinxiang, China (2016-2021)

The acute health effects of air pollution on the risk of chronic obstructive pulmonary disease (COPD) have not been adequately studied and results remain inconsistent. Furthermore, fewer studies have explored the impact of air pollution on the cost of treating patients with COPD. Generalized additive models (GAM) based on Poisson distribution and gamma were applied to evaluate the association between short-term exposure to air pollution and daily COPD outpatient visits and daily COPD treatment costs. A total of 14,611 outpatient in Xinxiang from 2016 to 2021 were included for analysis. We found that short-term exposure to PM2.5, PM10, NO2 and CO were positively associated with COPD outpatient visits, and gaseous pollutants appeared to have greater effects on outpatient visits than particulate matter. For the largest effect, per 10 μg/m3 increment in (per 1 mg/m3 increment in CO concentration) CO (lag 01), NO2 (lag 01), PM2.5 (lag 02) and PM10 (lag 06) were significantly associated with 7.859 % (95 % CI:3.421,12.488), 4.894 % (95 % CI:3.422,6.386), 0.627 % (95 % CI:0.010, 1.248) and 0.531 % (95 % CI:0.050,1.014) increase in daily COPD outpatient visits, respectively. Short-term exposure to air pollutants (PM10, CO and NO2) was positively associated with COPD treatment costs. No significant sex or age differences were found in the stratified analysis of outpatient visits. The effect of gaseous pollutants (NO2) on COPD outpatient visits was greater in the cold season (October to March) (P < 0.05), whereas the effect of particulate matter (PM2.5 and PM10) was greater in the warm season (April to September) (P < 0.05). Greater health benefits could be obtained when pollutant concentrations meet WHO standards. In conclusion, short-term exposure to PM2.5, PM10, NO2 and CO was significantly associated with increased COPD outpatient visits, and gaseous pollutants appeared to have greater effects on outpatient visits than particulate matter. Further larger-scale studies are needed to validate our findings.

Multidisciplinary Evaluation for COPD Management

Background: COPD is a heterogeneous disorder. We developed a multidisciplinary evaluation scheme to identify patients with COPD who may benefit from phenotype-specific therapy. Methods: Our team of general and interventional pulmonologists, thoracic surgeons, radiologists, respiratory therapists, and advanced practice nurses meets monthly to discuss patients with advanced COPD. For each patient, pulmonary function tests, imaging, and other pertinent data are reviewed. Emphysema is assessed visually and by quantitative computed tomography modalities. A consensus is sought for medical, bronchoscopic, and/or surgical treatments and recommendations are relayed to the referring physician. Results: The multidisciplinary team reviewed 510 cases between November 2015 and December 2022. Eighty five of 510 patients were found to be appropriate candidates for lung-volume-reduction surgery and 36 underwent the procedure. Patients in the post-multidisciplinary evaluation cohort experienced improvement in mean ± SD FEV1 of 0.23 ± 0.38 L (P = .52) and mean ± SD reduction in residual volume by 0.78 ± 0.98 L (P = .085) 6 months after surgery, which was similar to the improvements in pre-multidisciplinary evaluation patients (P = .52 and P = .085, respectively). Of the 202 patients referred for bronchoscopic lung volume reduction, 28 patients underwent the procedure. Mean ± SD improvement in FEV1 was 0.14 ± 0.18 L and mean ± SD reduction in residual volume was 0.68 ± 0.80 L (P = .002 and P = .001, respectively) at 6 months after the procedure. Most patients were not suitable candidates for lung volume reduction due to anatomical, physiologic, or phenotypical exclusions. Management was found to be optimal in the majority of patients who were not candidates for lung volume reduction (53.7%). A survey of meeting attendees indicated high confidence in managing these patients with a high likelihood of changing management decisions after multidisciplinary discussion. Conclusions: Most symptomatic advanced patients are not candidates for lung-volume-reduction interventions. There is an unmet need for novel therapeutic options in this population. The multidisciplinary evaluation consensus recommendations provide assurance and guidance to clinicians.

Land surface temperature predicts mortality due to chronic obstructive pulmonary disease: a study based on climate variables and impact machine learning

INTRODUCTION

Chronic Obstructive Pulmonary Disease (COPD) mortality rates and global warming have been in the focus of scientists and policymakers in the past decade. The long-term shifts in temperature and weather patterns, commonly referred to as climate change, is an important public health issue, especially with regard to COPD.

METHOD

Using the most recent county-level age-adjusted COPD mortality rates among adults older than 25 years, this study aimed to investigate the spatial trajectory of COPD in the United States between 2001 and 2020. Global Moran's I was used to investigate spatial relationships utilising data from Terra satellite for night-time land surface temperatures (LSTnt), which served as an indicator of warming within the same time period across the United States. The forest-based classification and regression model (FCR) was applied to predict mortality rates.

RESULTS

It was found that COPD mortality over the 20-year period was spatially clustered in certain counties. Moran's I statistic (I=0.18) showed that the COPD mortality rates increased with LSTnt, with the strongest spatial association in the eastern and south-eastern counties. The FCR model was able to predict mortality rates based on LSTnt values in the study area with a R2 value of 0.68.

CONCLUSION

Policymakers in the United States could use the findings of this study to develop long-term spatial and health-related strategies to reduce the vulnerability to global warming of patients with acute respiratory symptoms.

Symptom Network and Subgroup Analysis in Patients with Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

Purpose

This study aims to construct a contemporaneous symptom network of inpatients with Exacerbation of Chronic Obstructive Pulmonary Disease (ECOPD) based on the symptom cluster, identify core and bridge symptoms, and patient subgroups with different symptom clusters based on individual differences in the intensity of patient symptom experiences.

Patients and Methods

This study used convenience sampling to collect demographic, symptom, auxiliary examination, and prognosis information of 208 inpatients with ECOPD from April 2022 to October 2023. The data underwent exploratory factor analysis (EFA), symptom network analysis, latent class analysis (LCA), Spearman correlation analysis, Wilcoxon signed-rank test, single-factor regression and multiple-factor stepwise regression.

Results

In hospitalized patients with ECOPD, symptom network analysis revealed that loss of appetite was the core symptom, while chest distress was the bridge symptom. Through LCA analysis, two symptom subgroups were identified: a high-symptom group (53.8%) and a low-symptom group (46.2%). This suggests that there is significant heterogeneity in symptom experience among ECOPD individuals. Patients in the high-symptom group had a higher probability of experiencing symptom clusters related to nutrition-sleep.

Conclusion

The combination of symptom network analysis and LCA comprehensively captures the symptom/symptom cluster characteristics and accounts for the heterogeneity of ECOPD patients from both individual and group perspectives. This study identifies core symptoms, bridge symptoms, and symptom subgroups, offering valuable insights for precision symptom management in ECOPD.

The Association Between the CALLY Index and All-Cause Mortality in Patients with COPD: Results from the Cohort Study of NHANES 2007-2010

Purpose

The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is a newly developed biomarker that combines measurements of CRP, serum albumin, and lymphocyte count. This index provides a thorough assessment of a patient's inflammation level, nutritional condition, and immunological function. The objective of this study is to examine the correlation between the CALLY index and all-cause mortality in COPD patients.

Methods

We calculated the CALLY index using data from the National Health and Nutrition Examination Survey (NHANES) for the 2007-2008 and 2009-2010 cycles, extracted from the participants' peripheral blood samples. The study utilized Kaplan-Meier curves, restricted cubic spline (RCS) curves, and Cox regression analysis to evaluate the relationship between the CALLY index and the risk of all-cause mortality in COPD patients. To assess the predictive accuracy of the CALLY index, we calculated the area under the receiver operating characteristic (ROC) curve (AUC).

Results

The study included 1,048 participants and found a significant negative correlation between the CALLY index and all-cause mortality in patients with COPD. The CALLY index was a major predictor of survival in COPD patients [fully adjusted model: in the 3rd quartile, HR = 1.61, 95% CI: 1.02-2.52, p = 0.039; in the 2nd quartile, HR = 2.11, 95% CI: 1.22-3.65, p = 0.008; in the 1st quartile, HR = 3.12, 95% CI: 2.00-4.85, p < 0.001]. The RCS curves demonstrated a non-linear association between the CALLY index and all-cause mortality in COPD patients. The areas under the curve (AUC) in predicting 5- and 10-year all-cause mortality were 0.693 and 0.656.

Conclusion

The CALLY index has a strong relationship with all-cause mortality in patients with COPD in the US and could serve as a prognostic biomarker for these patients.

Optimal vocal therapy for respiratory muscle activation in patients with COPD: effects of loudness, pitch, and vowels

Background

Vocal therapy, such as singing training, is an increasingly popular pulmonary rehabilitation program that has improved respiratory muscle status in patients with chronic obstructive pulmonary disease (COPD). However, variations in singing treatment protocols have led to inconsistent clinical outcomes.

Objective

This study aims to explore the content of vocalization training for patients with COPD by observing differences in respiratory muscle activation across different vocalization tasks.

Methods

All participants underwent measurement of surface electromyography (sEMG) activity from the sternocleidomastoid (SCM), parasternal intercostal muscle (PARA), seventh intercostal muscle (7thIC), and rectus abdominis (RA) during the production of the vowels/a/,/i/, and/u/at varying pitches (comfortable, +6 semitones) and loudness (-10 dB, +10 dB) levels. The Visual Analog Scale (VAS) was used to evaluate the condition of patients concerning vocalization, while the Borg-CR10 breathlessness scale was utilized to gauge the level of dyspnea following the task. Repeated-measure (RM) ANOVA was utilized to analyze the EMG data of respiratory muscles and the Borg scale across different tasks.

Results

Forty-one patients completed the experiment. Neural respiratory drive (NRD) in the SCM muscle did not significantly increase at high loudness levels (VAS 7-8) compared with that at low loudness levels (F (2, 120) = 1.548, P = 0.276). However, NRD in the PARA muscle (F (2, 120) = 55.27, P< 0.001), the 7thIC muscle (F (2, 120) = 59.08, P < 0.001), and the RA muscle (F (2, 120) = 39.56, P < 0.001) were significantly higher at high loudness compared with that at low loudness (VAS 2-3). Intercostal and abdominal muscle activation states were negatively correlated with maximal expiratory pressure (r = -0.671, P < 0.001) and inspiratory pressure (r = -0.571, P < 0.001) in the same loudness.

Conclusion

In contrast to pitch or vowel, vocal loudness emerges as a critical factor for vocalization training in patients with COPD. Higher pitch and loudness produced more dyspnea than lower pitch and loudness. In addition, maximal expiratory/inspiratory pressure was negatively correlated with respiratory muscle NRD in the same loudness vocalization task.

Global, regional, and national burden of chronic obstructive pulmonary disease and its attributable risk factors from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021

BACKGROUND

Chronic obstructive pulmonary disease (COPD) continues to be a significant issue, leading to premature death or reduced quality of life. It's important to assess the current burden of COPD and its risk factors on a geographical basis to guide health policy.

METHODS

Data on the prevalence, deaths, and disability-adjusted life years (DALYs) related to COPD, and risk-attributable burden were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 database. The relationship between COPD DALYs and the sociodemographic index (SDI) was estimated using Smoothing Splines models.

RESULTS

Between 1990 and 2021, the changes were -1.46% (95% uncertainty interval [UI] -3.36% to 0.39%) in age-standardized prevalence, -37.12% (-43.37% to -27.68%) in mortality, and -36.98% (-42.37% to -28.54%) in DALYs rate. In 2021, a total of 213.39 million prevalent cases of COPD were estimated. The age-standardized prevalence of COPD increased with age and was more common in males. The age-standardized COPD DALYs had a reversed U-shaped relationship with SDI at the regional level, with the highest burden at an SDI of about 0.45. At the global level, smoking had the highest influence on COPD DALYs, accounting for 34.8%, followed by ambient particulate matter pollution (22.2%), household air pollution from solid fuels (19.5%), and occupational particulate matter, gases, and fumes (15.8%).

CONCLUSIONS

The overall burden of COPD has been increasing despite improvements in some rates since 1990. It's crucial to focus on interventions such as smoking cessation and addressing environmental and occupational exposures.

Perspectives on Palliative Care Approaches in People with Advanced COPD: A Qualitative Study of Patients Attending a Breathe Easy Clinic and Day Hospice

Introduction

People with advanced chronic obstructive pulmonary disease (COPD) are well recognised to experience high levels of unaddressed physical and psychosocial symptom burden. Palliative care provides viable support that strives to relieve the sufferings and optimise quality of life for patients. This study aimed to identify factors that contribute to satisfaction and well-being of people with advanced COPD while attending services which offer palliative care approaches.

Methods

A descriptive exploratory qualitative study using semi-structured interviews was conducted. Nineteen participants (67 ± 9 years) were recruited through Breathe Easy clinic (n = 13), and day hospice (n = 6) in the United Kingdom.

Results

Both types of services were noted for bringing substantial contributions to patients' lives. Healthcare professionals' empathy and skilled communication were particularly important, with participants adjusting and accepting their limitations more easily when they understood their disease. Early introduction to services with palliative care approaches, along with referrals to support groups and education, helped normalise their experiences and improve symptom management.

Conclusion

Providing psychological and educational interventions can lead to improvements in social aspects of patients' lives or the development of self-management techniques to cope with the disease both physically and mentally. Early palliative care involvement is essential in this population.

Latent profile analysis of dyspnea-related kinesiophobia in older adults with chronic obstructive pulmonary disease

BACKGROUND

Dyspnea-related kinesiophobia refers to restrictions or avoidance of activities due to fear of dyspnea and is prevalent among older adults with chronic obstructive pulmonary disease (COPD). Hence, there is a need to identify subgroups of dyspnea-related kinesiophobia among older adults with COPD to support the development of strategies to increase activity levels.

OBJECTIVE

The purpose of this study was to investigate dyspnea-related kinesiophobia among older adults with COPD, explore heterogeneity in kinesiophobia within subgroups of this population, and analyze the characteristics of different subgroups of kinesiophobia.

METHOD

This cross-sectional study was conducted from November to December 2023 in Fenyang City, Shanxi Province, China, via face-to-face questionnaire surveys of hospitalized adults with COPD aged over 60 years in four secondary or tertiary hospitals. The Breathlessness Beliefs Questionnaire (BBQ) was used to measure dyspnea-related kinesiophobia. Latent profile analysis was employed to classify the subgroups. CChi-square tests and binary logistic regression were used to examine the effects of sociodemographic factors, marital status, education, income, daily activities, general health, and COPD severity across different profiles.

RESULTS

A total of 384 older adults with COPD (Male N = 228, aged 60-88) were included in the study. Their average BBQ score was (39.15±5.59). Latent profile analysis identified two groups: 230 participants (59.9 %) in the low-level kinesiophobia group (C1) and 154 participants (40.1 %) in the high-level kinesiophobia group (C2). Multivariable stepwise binary logistic regression analysis revealed that older adults with COPD who engaged in exercise less than three days weekly reported an average monthly household income of <3000 CNY, unmarried status (including unmarried, divorced, or widowed), a Charlson Comorbidity Index (CCI) >1, more than three exacerbations within one year or with moderate (GOLD 2 Criteria)-severe (GOLD3) COPD were more likely to be the high-level kinesiophobia group (p < 0.05).

CONCLUSION

Dyspnea-related kinesiophobia manifests in two groups among older adults. Targeted interventions for different subgroups should be further developed to promote health and reduce nursing burdens.

Depression and anxiety disorders in chronic obstructive pulmonary disease patients: Prevalence, disease impact, treatment

Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder that often co-occurs with depression and anxiety, worsening disease progression and reducing quality of life. A thorough review of the existing literature was conducted, including searches in PubMed, Embase, PsycINFO, and Cochrane Library databases up to 2024. This review encompasses a critical analysis of studies reporting on the prevalence, impact, and management of depression and anxiety in COPD patients. We found a high prevalence of psychological comorbidities in COPD patients, which were associated with worse disease outcomes, including increased exacerbations, hospitalizations, and reduced health-related quality of life. Diagnosing and managing these conditions is complex due to overlapping symptoms, necessitating a comprehensive patient care approach. While there has been progress in understanding COPD comorbidities, there is a need for more personalized and integrated treatments. This review emphasizes the need for increased awareness, tailored treatment plans, and further research for effective interventions.

Bile acids in the lower airways is associated with airway microbiota changes in chronic obstructive pulmonary disease: an observational study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a complex disorder with a high degree of interindividual variability. Gastrointestinal dysfunction is common in patients with COPD and has been proposed to influence the clinical progression of the disease. Using the presence of bile acid(s) (BA) in bronchoalveolar lavage (BAL) fluid as a marker of gastric aspiration, we evaluated the relationships between BAs, clinical outcomes and bacterial lung colonisation.

METHODS

We used BAL specimens from a cohort of patients with COPD and healthy controls. BAs were profiled and quantified in BAL supernatants using mass spectrometry. Microbial DNA was extracted from BAL pellets and quantified using quantitative PCR. We profiled the BAL microbiota using an amplicon sequencing approach targeting the V3-V4 region of the 16S rRNA gene.

RESULTS

Detection of BAs in BAL was more likely at the earliest clinical stages of COPD and was independent of the degree of airway obstruction. BAL specimens with BAs demonstrated higher bacterial biomass and lower diversity. Likewise, the odds of recovering bacterial cultures from BAL were higher if BAs were also detected. Detection of BAs in BAL was not associated with either inflammatory markers or clinical outcomes. We also observed different bacterial community types in BAL, which were associated with different clinical groups, levels of inflammatory markers and the degree of airway obstruction.

CONCLUSION

Detection of BAs in BAL was associated with alterations in the airway bacterial communities. Further studies are needed to evaluate whether BAs in BAL can be used to stratify patients and predict disease progression trajectories.

Dynamic microbial changes in exacerbation of chronic obstructive pulmonary disease

Background

Microbial profiles in patients with chronic obstructive pulmonary disease (COPD) provide insights for predicting, preventing, and treating exacerbations. This study aimed to analyze the impact of microbial diversity and spectrum on COPD exacerbation.

Methods

From November 1, 2018, to May 31, 2023, we prospectively enrolled patients with stable disease (SD) and exacerbation of COPD (ECOPD). Sputum samples were collected for microbiome DNA sequencing, and amplicon sequence variants were analyzed.

Results

We collected sputum samples from 38 patients: 17 samples from patients with SD and samples from patients with ECOPD at two time points-during exacerbation (AE-1: 21 samples) and again during stabilization after 2 weeks of treatment (AE-2: 17 samples). Alpha diversity indices, specifically observed feature count and Fisher's alpha index, were significantly higher in SD (133.0 [98.0-145.0]; 17.1 [12.7-19.6]) compared to AE-1 (88.0 [72.0-125.0], p = 0.025; 10.9 [8.5-16.1], p = 0.031). The SD showed significantly higher abundances of Neisseria (linear discriminant analysis [LDA] 4.996, adj.p = 0.021), Fusobacterium (LDA 3.688, adj.p = 0.047), and Peptostreptococcus (LDA 3.379, adj.p = 0.039) at the genus level compared to AE-1. At the species level, N. perflava (LDA 5.074, adj.p = 0.010) and H. parainfluenzae (LDA 4.467, adj. p = 0.011) were more abundant in SD. Hub genera in the microbial network included Haemophilus, Granulicatella, Neisseria, Lactobacillus, and Butyrivibrio in SD and Streptococcus, Gemella, Actinomyces, Klebsiella, and Staphylococcus in AE-1.

Conclusion

COPD exacerbations are linked to changes in specific strains of normal flora. Maintaining microbial diversity and balance within the microbial network is critical for preventing and managing COPD exacerbations.

People Living with Chronic Obstructive Pulmonary Disease (COPD) and Inhalers: Insights and Suggestions from a Human Factors Study on NEXThaler

Purpose

COPD treatment relies mostly on drug administration via inhaler. Adherence to therapy is highly dependent on inhaler features and patient training. With the aim of identifying patients' unmet needs and expectations about inhalers, data from a recent human factors study involving COPD patients have been analyzed. The specific use of the NEXThaler, a multidose dry powder inhaler that is activated by the patient's inhalation, and its potential impact on adherence was explored.

Methods

Adult patients with moderate to severe COPD were interviewed across 8 European countries using 90-minute semi-structured interviews to assess symptoms, services, challenges, patient expectations, and feedback on current inhalers. Patients participated in a simulation of NEXThaler use and watched a training video; they were asked to rate the device's key features regarding treatment experience, confidence, and quality of life and provide suggestions for improvement.

Results

The 62 patients interviewed most appreciated an inhaler's ease of use, followed by the presence of an inhalation counter and a comfortable mouthpiece. Some patients were more interested in the drug itself rather than in the delivery device. Overall, the participants had positive feedback about NEXThaler, appreciating its ease of use, the low inhalation effort required to activate it, and the presence of both the inhalation click (referred to as the "click of confidence" because it gives COPD patients confidence that the dose has been released correctly) and the inhalation counter.

Conclusion

NEXThaler has been appreciated for its three differentiating features (click of confidence, low inhalation effort, and inhalation counter), which have been shown to have a positive impact on patient's lives, treatment experience, and confidence. This can potentially translate into improved medication adherence with a positive impact on the QoL of people living with COPD.

Genetic Variants in the Adhesive G Protein-Coupled Receptor ADGRG6 are Associated with Increased Susceptibility to COPD in the Elderly Han Chinese Population of Southern China

Background

Mutations in ADGRG6 are associated with a variety of cancers and multiple types of diseases. However, the impact of genetic variations in ADGRG6 on chronic obstructive pulmonary disease (COPD) susceptibility has not yet been evaluated.

Methods

Considering the high prevalence of COPD among the elderly population in China, this study specifically targets the elderly Han population in Southern China as the study subject. Following the acquisition of participants' whole-genome DNA, genotyping was conducted using the Agena MassARRAY platform. The online tool 'SNPStats', which utilizes logistic regression, was employed to analyze and assess the correlation. Multi-factor dimensionality reduction was utilized to clarify the impact of "SNP-SNP" interactions on COPD risk. The False-Positive Report Probability (FPRP) was applied to determine whether significant results are noteworthy findings.

Results

The mutant allele "C" of rs11155242 was a protective genetic factor against COPD susceptibility (OR = 0.57, 95% CI = 0.36 to 0.91, p = 0.017). The heterozygous mutant genotype "CA" of rs11155242 was found to be significantly associated with reduced COPD risk (CA Vs AA: OR = 0.53, 95% CI = 0.32 to 0.90, p = 0.018). ADGRG6-rs11155242 was found to be strongly associated with a reduced risk of COPD in males, non-smokers, and subjects with a BMI below 24 kg/m2 (OR < 1, p < 0.05). The FPRP analysis indicated that the positive results identified in this study are noteworthy new findings.

Conclusion

The mutant allele "C" and mutant genotype "CA" of rs11155242 act as protective genetic factors against COPD susceptibility. This study will provide a new research direction for the personalized prevention and treatment of COPD in the elderly Han population in southern China, and lay a potential scientific basis.

Comparison of the effectiveness of nebulizer treatment applications in acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial

OBJECTIVE

In addition to oxygen support, bronchodilator therapy constitutes the most essential treatment step in patients with chronic obstructive pulmonary disease. Our study aimed to compare the effectiveness of nebulizer treatments in patients who presented to the emergency department with acute exacerbation of chronic obstructive pulmonary disease.

METHODS

Our study included 60 Group E chronic obstructive pulmonary disease patients admitted to the emergency department due to acute exacerbation of chronic obstructive pulmonary disease between June and September 2023 (NCT: 06178068). Patients were randomized as follows: Group 1: jet nebulizer treatment; Group 2: dry air nebulizer treatment; and Group 3: classic nebulizer treatment.

RESULTS

While an increase in forced vital capacity (FVC) and forced expiratory volume 1 (FEV1) levels was observed in Group 1 patients (in the order of p=0.009 and 0.007), a decrease in residual volume (RV) and total lung capacity (TLC) levels was observed (p=0.02 and 0.05, respectively). At the same time, an increase in FEV1 levels was observed in Group 2 and 3 patients (p=0.04 and 0.04, respectively). A decrease was observed in RV and TLC levels (p=0.02, 0.05, 0.02, and 0.04, respectively). When comparing the respiratory function test parameters at the beginning and on the fifth day of treatment, FEV1 and peak expiratory flow 25/75 (PEF25/75) levels were higher in Group 1 patients than in Group 2 and 3 patients (p=0.01 and 0.02, respectively).

CONCLUSION

In chronic obstructive pulmonary disease patients, jet nebulizer treatment is more effective regarding bronchodilator activity than other nebulizer treatments. However, dry air nebulizer treatment may be preferred in chronic obstructive pulmonary disease patients because it is easily applicable and sterilizable.

Elucidating the beneficial impact of exercise on chronic obstructive pulmonary disease and its comorbidities: Integrating proteomic and immunological insights

BACKGROUND AND PURPOSE

Physical activity is an effective therapeutic protocol for treating chronic obstructive pulmonary disease (COPD). However, the mechanisms underlying the benefits of physical activity in COPD are not fully elucidated.

EXPERIMENTAL APPROACH

In a mouse model of COPD, analysis of biological markers and lung proteomics identified the molecular pathways through which exercise ameliorates COPD.

KEY RESULTS

Exercise improved pulmonary function, emphysema, small airway disease, pulmonary inflammation, glucose metabolic dysregulation, and insulin resistance in COPD mice. Proteomic analysis revealed 430 differentially expressed proteins (DEPs) between the COPD and COPD + Exercise (COPD + Ex) groups. GO analysis indicated that the enriched pathways were predominantly related to the immune response, inflammatory processes, insulin secretion, and glucose metabolic processes. GO analysis revealed IL-33 as a crucial target for the exercise-related amelioration of COPD. KEGG analysis showed that DEPs were significantly enriched in primary immunodeficiency, the intestinal immune network for IgA production, and the NF-κB signalling pathway. Exercise inhibited NF-κB activation by suppressing the CD14/TLR4/MyD88 and TNF-α/TNF-R1/TRAF2/5 pathways in COPD mice. Exercise inhibited expression of BCR, IgM, IgD, IgG, IgE, and IgA by suppressing B-cell receptor signalling. Exercise attenuated glucose metabolic dysregulation and insulin resistance through the suppression of proinflammatory mediators, including MHC I, MHC II, TNF-α, IFN-γ, and IL-1β, while concurrently increasing insulin expression. The qRT-PCR results were consistent with the proteomic results.

CONCLUSION AND IMPLICATIONS

In a mouse model, exercise improved COPD and its metabolic comorbidities through immune system regulation and inflammation suppression, offering insights into potential therapeutic targets.

Effect of selective manual therapy techniques in chronic obstructive pulmonary disease: A randomized control trial

Objective

To investigate the effect of selective manual therapy (MT) techniques on chest expansion, pulmonary function (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV1], and FEV1/FVC ratio), craniovertebral angle (CVA), kyphosis angle, functional capacity, and dyspnea in patients with chronic obstructive pulmonary disease (COPD).

Methods

A parallel double-blinded randomized controlled trial involved 52 male subjects with a mean age of 56.23 ± 3.54. Patients were randomly assigned to two groups, each consisting of 26 subjects: the control group (A) received only conventional physical therapy, and the experimental group (B) received both MT and conventional physical therapy. Treatment was administered three times per week for 8 weeks. Chest expansion by chest caliper; FVC, FEV1, and FEV1/FVC ratio by spirometry; CVA and kyphosis angle by Kinovea software; functional capacity by the 6-min walk test (6MWT); and dyspnea by the modified Medical Research Council dyspnea index all were measured at baseline and after 8 weeks.

Results

Prior to treatment, there was no statistically significant differences between the two groups in the between-group analyses (p > 0.05). After treatment,a statistically significant difference was found between both groups, with a predilection for the experimental group in FEV1 middle difference (MD) of 0.55 L, FVC MD = 0.39 L, FEV1/FVC% MD = 18.97, dyspnea MD = -2.58, 6MWT MD = 92.81 m, CVA MD = 5.21°, kyphosis angle MD = 3.1°, anteroposterior (AP) chest expansion MD = 1.08 cm, and lateral chest expansion MD = 1.54 cm.

Conclusion

The combination of MT approaches with conventional physical therapy leads to a clinically significant difference in AP chest expansion, FVC, FEV1, CVA, functional capacity, and dyspnea, and a statistically significant difference in kyphosis angle, FEV1/FVC%, and lateral chest expansion compared to using conventional physical therapy only in patients with COPD.

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

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

Severity of Airflow Obstruction Based on FEV1/FVC Versus FEV1 Percent Predicted in the General U.S. Population

Rationale: According to the Global Initiative for Obstructive Lung Disease (GOLD), the FEV1/FVC ratio is used to confirm the presence of airflow obstruction in the diagnosis of chronic obstructive pulmonary disease (COPD), whereas FEV1 percent predicted normal value (FEV1%pred) is used for grading its severity. The STaging of Airflow obstruction by the FEV1/FVC Ratio (STAR), and its prediction of adverse outcomes, has not been evaluated in general populations. Objectives: To compare the STAR (FEV1/FVC) and the GOLD (FEV1%pred) classifications for the severity of airflow limitation in terms of exertional breathlessness and mortality in the general U.S. population. Methods: Severity stages according to the STAR and GOLD were applied to the multiethnic National Health and Nutrition Examination Survey of 2007-2012, including people ages 18-80 years, using a postbronchodilatory FEV1/FVC ratio of <0.70 to define airflow obstruction in both staging systems. Prevalence of the severity stages STAR 1-4 and GOLD 1-4 was calculated, and associations with breathlessness and mortality were analyzed by multinomial logistic regression and Cox regression, respectively. Measurements and Main Results: STAR versus GOLD severity staging of airflow obstruction showed similar associations with breathlessness and all-cause mortality, regardless of ethnicity and/or race. In those with airflow obstruction, the correlation between the two classification systems was 0.461 (P < 0.001). STAR reclassified 59% of GOLD 2 subjects as having mild airflow obstruction (STAR 1). Compared with GOLD 1, STAR 1 was more clearly differentiated from nonobstruction in terms of both breathlessness and mortality. Conclusions: FEV1/FVC and FEV1%pred as measures of airflow limitation severity show similar predictions of breathlessness and mortality in the adult U.S. population across ethnicity groups. However, Stage 1 differed more clearly from nonobstruction on the basis of FEV1/FVC ratio than FEV1%pred.

Efficacy of Prophylactic Antibiotics in COPD: A Systematic Review

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a global health problem and the third leading contributor to mortality worldwide. This systematic review aims to summarize the results of previous studies tackling the question of the efficacy of long-term prophylaxis of antibiotics in COPD patients, with particular regard to exacerbation rate, time to first exacerbation, health status, airway bacterial load, inflammatory markers, cell counts in sputum samples, and potential adverse events. Results: Four studies found significant improvement in the exacerbation rate in patients receiving antibiotic intervention. One study found doxycycline to have negative effects on patients' exacerbation outcomes. Two studies recorded a reduction in total airway bacterial load using quantitative culture of sputum samples, but the prevalence of antibiotic-resistant bacteria increased in all studies that measured it. No change in inflammatory markers was observed; however, there was a decline in neutrophil cell counts and, subsequently, reductions in neutrophil elastase concentrations. Methods: PubMed and Web of Science databases were searched for English-language studies presenting data on the prophylactic use of antibiotics in COPD management. All included studies are randomized controlled trials (RCTs) and meet the inclusion criteria. Conclusions: Based on current evidence from RCTs, the prophylactic antibiotic approach utilizing macrolides is the most effective in reducing the incidence of COPD exacerbation. However, the emergence of antibiotic-resistant pathogens is notable. Whether the beneficial effects of macrolides on exacerbation are due to their antibacterial or immunomodulant properties is still inconclusive. Future studies are needed to better understand the interactions between antibiotics and the airway microbiome during COPD exacerbation.

Effect of Phytochemical-Rich Food Intake on Respiratory and Muscle Function in Middle-Aged Patients with COPD: A Cross-Sectional Study

Background: It is known that the consumption of single phytochemicals improves respiratory function in chronic obstructive pulmonary disease (COPD) patients. Since phytochemicals have a synergistic effect on health, a more comprehensive analysis is needed. The aim of this study was to estimate the intake of phytochemicals using the dietary phytochemical index (DPI) and assess their association with respiratory function, inspiratory muscle strength and function, and peripheral muscle strength. Methods: This study was conducted at the Special Hospital for Pulmonary Diseases in Zagreb (September 2023 to May 2024). The DPI was assessed using three 24 h recalls from 71 COPD patients (66.5 ± 8.4 years; 53.5% men). Anthropometric measurements, respiratory function, inspiratory muscle function and strength, and peripheral muscle strength were assessed during pulmonary rehabilitation following standard protocols. Results: Patients were divided into DPI tertiles with mean values of 7.3 ± 3.0, 16.0 ± 3.0, and 32.2 ± 8.8, respectively. After controlling for confounding factors, a significant association was found between DPI tertiles and FEV1 (p-trend < 0.001), FVC (p-trend = 0.002), FEV1/FVC (p-trend < 0.001), MIP (p-trend = 0.012), and MSUE (p-trend = 0.002). In addition, an inverse association was found between DPI tertiles and diaphragm thickness during inhalation (p-trend = 0.012) and exhalation (p-trend = 0.013). Conclusions: This study suggests that a higher intake of phytochemicals could be beneficial in dietary interventions for COPD therapy. Future prospective studies are needed to confirm these findings.

Assessing the Impact of New Technologies on Managing Chronic Respiratory Diseases

Chronic respiratory diseases (CRDs), including asthma and chronic obstructive pulmonary disease (COPD), represent significant global health challenges, contributing to substantial morbidity and mortality. As the prevalence of CRDs continues to rise, particularly in low-income countries, there is a pressing need for more efficient and personalized approaches to diagnosis and treatment. This article explores the impact of emerging technologies, particularly artificial intelligence (AI), on the management of CRDs. AI applications, including machine learning (ML), deep learning (DL), and large language models (LLMs), are transforming the landscape of CRD care, enabling earlier diagnosis, personalized treatment, and enhanced remote patient monitoring. The integration of AI with telehealth and wearable technologies further supports proactive interventions and improved patient outcomes. However, challenges remain, including issues related to data quality, algorithmic bias, and ethical concerns such as patient privacy and AI transparency. This paper evaluates the effectiveness, accessibility, and ethical implications of AI-driven tools in CRD management, offering insights into their potential to shape the future of respiratory healthcare. The integration of AI and advanced technologies in managing CRDs like COPD and asthma holds substantial potential for enhancing early diagnosis, personalized treatment, and remote monitoring, though challenges remain regarding data quality, ethical considerations, and regulatory oversight.

Lung Tissue Multilayer Network Analysis Uncovers the Molecular Heterogeneity of Chronic Obstructive Pulmonary Disease

Rationale: Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition. Objectives: We hypothesized that the unbiased integration of different COPD lung omics using a novel multilayer approach might unravel mechanisms associated with clinical characteristics. Methods: We profiled mRNA, microRNA and methylome in lung tissue samples from 135 former smokers with COPD. For each omic (layer), we built a patient network on the basis of molecular similarity. The three networks were used to build a multilayer network, and optimization of multiplex modularity was used to identify patient communities across the three distinct layers. Uncovered communities were related to clinical features. Measurements and Main Results: We identified five patient communities in the multilayer network that were molecularly distinct and related to clinical characteristics, such as FEV1 and blood eosinophils. Two communities (C#3 and C#4) had both similarly low FEV1 values and emphysema but were molecularly different: C#3, but not C#4, presented B- and T-cell signatures and a downregulation of secretory (SCGB1A1/SCGB3A1) and ciliated cells. A machine learning model was set up to discriminate C#3 and C#4 in our cohort and to validate them in an independent cohort. Finally, using spatial transcriptomics, we characterized the small airway differences between C#3 and C#4, identifying an upregulation of T-/B-cell homing chemokines and bacterial response genes in C#3. Conclusions: A novel multilayer network analysis is able to identify clinically relevant COPD patient communities. Patients with similarly low FEV1 and emphysema can have molecularly distinct small airways and immune response patterns, indicating that different endotypes can lead to similar clinical presentation.

Impact of Individual Characteristics on Hospital Outcomes in Exacerbated COPD in a Biomass-Exposed Turkish Population

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally, and factors such as biomass exposure, demographic characteristics, and comorbidities significantly influence patient outcomes during exacerbations. Aim: This study aims to clarify the impact of patient characteristics on key hospital outcomes, including ICU admissions, hospital length of stay, and in-hospital mortality, focusing on the contextual role of biomass exposure rather than its direct impact. Methods: Using a multicenter, retrospective cohort design, we analyzed the medical records of patients admitted with COPD exacerbations from January 2021 to December 2023. Eligible patients were over 40 years old with confirmed COPD exacerbation, excluding those with other significant lung conditions, severe organ dysfunction, or incomplete data. The collected data included demographics, smoking history, comorbidities, medications, laboratory results, and clinical outcomes, with smoking status categorized into current, former, or never smokers. Results: Our analysis comprised 334 patients with a mean age of 69 ± 8.8 years, including 52 (15.6%) females. Biomass exposure, observed in 22% of patients, was associated with a higher likelihood of being female (p < 0.001), lower smoking rates (p < 0.001), higher prevalence of diabetes mellitus type 2 (p = 0.020), lower peripheral blood eosinophilia (p = 0.001), increased intensive care unit (ICU) admissions (p = 0.034), and higher in-hospital mortality (p = 0.043). Non-survivors tended to be older and had a higher prevalence of hypertension, a history of childhood pneumonia, longer COPD duration, greater need for non-invasive ventilation (NIV) during hospitalization, and more frequent ICU admissions. Univariate Cox regression analysis revealed no significant associations between characteristics and outcomes. Conclusions: Patients with biomass exposure were more likely to be female and had higher rates of ICU admission and in-hospital mortality.

Effects of cystic fibrosis transmembrane conductance regulator potentiators on clinical outcomes of chronic obstructive pulmonary disease: a systematic review and meta-analysis

INTRODUCTION

Excessive mucus secretion is pivotal in chronic obstructive pulmonary disease (COPD) pathophysiology, particularly in chronic bronchitis phenotypes. Cystic fibrosis transmembrane conductance regulator (CFTR) has been implicated in COPD-related hypersecretion with acquired dysfunction, and emerged as a therapeutic target. However, the clinical efficacy of CFTR-potentiators in COPD remains controversial.

METHODS

We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal (CSTJ), and Wanfang Database to retrieve eligible studies published before 28 May 2024.

RESULTS

A total of 1172 COPD patients were included, meta-analysis showed that CFTR-potentiators significantly increased forced expiratory volume in 1 s (FEV1) and decreased sweat chloride and fibrinogen levels, with moderate-to-high quality evidence. However, no significant effects were observed on the percentage of detected FEV1 to predicted FEV1 (FEV1% predicted), forced vital capacity (FVC), COPD assessment test (CAT) score, St. George's Respiratory Questionnaire (SGRQ) score, or acute exacerbation times, with low-to-moderate quality evidence.

CONCLUSION

Our meta-analysis demonstrated CFTR-potentiators' potential efficacy in increasing FEV1, decreasing sweat chloride and fibrinogen levels, despite limited impacts on FEV1% predicted, FVC, CAT score, SGRQ score, and acute exacerbations, underscoring the necessity for future research to evaluate its effects on mucus hypersecretion, acute exacerbations, hospitalizations, and mortality in COPD management. Review registration PROSPERO Identifier: CRD42024538708.

Correlation of Two-Minute and Six-Minute Walk Tests With Spirometric Indices in Patients With Severe Chronic Obstructive Pulmonary Disease at a Selected Tertiary Care Hospital in Puducherry

Background Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterised by airflow limitation and reduced exercise capacity. The Six-Minute Walk Test (6MWT) and Two-Minute Walk Test (2MWT) are commonly used to assess functional exercise capacity in COPD patients. This study aims to evaluate the correlation between the distance covered in the 2MWT and 6MWT with spirometric indices (such as Forced Expiratory Volume in 1 second (FEV₁), Forced Vital Capacity (FVC), and FEV₁/FVC) in COPD patients. Materials and methods This cross-sectional study involved 50 severe and very severe COPD patients diagnosed according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Systematic random sampling was adopted to select the study participants. Each patient underwent spirometry to measure FEV₁, FVC, and FEV₁/FVC ratio. Following spirometry, both the 2MWT and 6MWT were conducted on separate days under standardised conditions. Results The average distance covered by the patients with very severe obstruction in 6MWT and 2MWT was 148±5.0 and 113.60±4.4. Patients with severe obstruction in 6MWT and 2MWT covered an average distance of 163.10±12.4 and 125.73±11.8, respectively. The mean FEV₁/FVC ratio and the mean FEV₁ % in 6MWT were 38.4 and 30.6 with a significant p-value of <0.001. The mean FEV₁/FVC ratio and the mean FEV₁ % in 2MWT were 32 and 29, respectively, with a significant p-value of <0.003. Both 2MWT and 6MWT distances were significantly correlated with spirometric indices, particularly FEV₁ and FEV₁/FVC ratio. Conclusion We found that there was no significant difference among spirometric indices between the two groups. Hence, 2MWT can be used as a reliable prognostic screening tool as it poses an advantage like decreasing the exhaustion for COPD patients as they find it more difficult to complete the 6MWT, resulting in increased heart rate and easy fatiguability.

Analysis of Predictive Value of Cellular Inflammatory Factors and T Cell Subsets for Disease Recurrence and Prognosis in Patients with Acute Exacerbations of COPD

Objective

To explore the predictive value of cellular inflammatory factors and T cell subsets for disease recurrence and prognosis in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).

Methods

Serum samples were collected from the two groups to detect and compare the levels of inflammatory cytokines [interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], T cell subsets (CD4+, CD8+), and clinical related indicators. Pearson correlation analysis was used to analyze the correlation between inflammatory cytokines, T cell subsets, and clinical indicators. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of serum inflammatory factors and T cell subsets for acute exacerbations of COPD.

Results

The observation group had higher levels of IL-1β, IL-6, TNF-α, and CD8+, and lower CD4+ levels (P<0.05). The ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) was lower, while procalcitonin (PCT) and white blood cell count (WBC) were higher (P<0.05). Correlation analysis showed positive correlations between IL-1β, IL-6, TNF-α, and CD8+, and negative correlations with CD4+ and FEV1/FVC (P<0.05). After 6 months, 15 out of 73 patients had acute recurrences, with higher IL-1β, IL-6, TNF-α, and CD8+ levels (P<0.05). Binary logistic regression identified IL-1β, IL-6, TNF-α, and CD8+ as significant predictors of exacerbations, while CD4+ was protective. ROC analysis showed that combined biomarkers had the highest predictive efficiency (AUC = 0.907).

Conclusion

This study is the first to integrate multiple serum inflammatory factors and T cell subsets into a comprehensive predictive model for acute recurrence of COPD within six months (AUC = 0.907), offering a more accurate prediction than traditional methods. The findings underscore the value of these biomarkers in clinical follow-up and highlight their independent predictive power, providing new insights into the interaction between immune markers and clinical indicators in COPD exacerbations.

Dietary patterns and risk of Chronic Obstructive Pulmonary Disease (COPD) and clinical outcomes in diagnosed patients: A scoping review

BACKGROUND & AIMS

Limited research exists on the association between dietary patterns (DP) and COPD risk or health-related outcomes. We reviewed existing literature to identify DP as a potential factor influencing COPD development and associated health outcomes in diagnosed individuals.

METHODS

We followed the Joanna Briggs Institute methodology for this scoping review, conducting searches on PubMed, Scopus, Embase, and Web of Science to identify studies meeting our inclusion criteria (P, population - adults from the general population with or without COPD diagnosis; C, concept - DP; C, context - any setting). Two reviewers screened titles and abstracts, confirmed eligibility through full-text examination, extracted data using Redcap®, and assessed bias risk with the Newcastle Ottawa Scale.

RESULTS

We analyzed 24 studies with sample sizes ranging from 121 to 421,426 individuals aged 20 to 75. Eighty-three percent investigated the role of DP in the COPD etiology, while 16.7 % examined health-related COPD outcomes. Food frequency questionnaires predominated (75 %) in exploring 23 distinct DP. Sixty-seven percent employed a priori-defined DP, focusing on the Mediterranean Diet (MedDiet) and Healthy Eating Index (HEI), while 33.3 % utilized a posteriori-defined DP, mainly represented by the Prudent and Traditional DP. Sixty percent of the studies reported significant associations between DP and COPD risk/odds. However, studies examining DP and COPD patient outcomes produced varied results.

CONCLUSIONS

Most studies focused on assessing COPD risk using a priori-defined DP, particularly emphasizing the Med Diet and HEI. Overall, the studies found that healthy DPs are associated with reduced risk of COPD and improved outcomes in diagnosed patients.

Assessment of Metabolic Syndrome in Patients with Chronic Obstructive Pulmonary Disease: A 6-Month Follow-Up Study

BACKGROUND/OBJECTIVES

The association between chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS) is a common one, with long-term therapeutic and prognostic impact. In view of the high pulmonary and cardiovascular morbidity and mortality, self-management contributes to decreasing the risk of an acute cardiac event or pulmonary decompensation.

METHODS

We conducted a prospective cohort study on 100 patients admitted to Iasi Clinical Rehabilitation Hospital who were divided into two groups according to the presence (67 patients) or absence (33 patients) of MetS. All patients benefited from multidisciplinary counseling sessions on their active role in improving modifiable cardiovascular risk factors and thus increasing quality of life. The aim of this study was to examine the impact of metabolic syndrome on lung function and the role of self-management in a 6-month follow-up period. The demographic, anthropometric, cardiovascular risk factors, and respiratory function were analyzed at baseline and at 6 months.

RESULTS

The presence of MetS was associated with higher fasting blood glucose (p = 0.004) and triglycerides (p = 0.003) but not with higher levels of interleukins or TNF-alpha. At the 6-month follow-up, abdominal circumference, forced expiratory volume in one second (FEV1), dyspnea severity, and blood pressure values improved in male patients with COPD. Systolic and diastolic blood pressure decreased in the COPD group as a whole, but especially in male patients with and without associated MetS. BMI was positively correlated with FEV1 (r = 0.389, p = 0.001) and the FEV1/forced vital capacity (FVC) ratio (r = 0.508, p < 0.001) in all COPD patients and in the MetS subgroup. In the COPD group as a whole. the six-minute walk test (6MWT) results (m) were positively correlated with FEV1 and FVC. The correlation remained significant for FVC in COPD patients with and without MetS. An increase in BMI by one unit led to an increase in TG values by 3.358 mg/dL, and the presence of metabolic syndrome led to an increase in TG values by 17.433 mg/dL.

CONCLUSIONS

In our study, MetS is a common comorbidity in patients with COPD and is associated with higher BMI, fasting glucose, and triglycerides but not with the inflammatory parameters. A mixed pulmonary-cardiovascular rehabilitation intervention leads to improvement in various parameters in both female and male COPD patients.

Psychiatric Disorders in Patients with Chronic Obstructive Pulmonary Disease: Clinical Significance and Treatment Strategies

Chronic obstructive pulmonary disease (COPD) is a debilitating lung disease characterized by chronic airflow limitation and persistent respiratory symptoms. It is a major cause of morbidity and mortality worldwide, significantly impacting healthcare systems with considerable socioeconomic consequences. The main risk factors include exposure to tobacco smoke, environmental pollutants, occupational dust, and genetic factors such as alpha-1 antitrypsin deficiency. COPD is often associated with extrapulmonary comorbidities, particularly psychiatric disorders like depression and anxiety, which worsen patients' quality of life and prognosis. The prevalence of these disorders in patients with COPD varies significantly but is always higher than in healthy controls. Psychiatric disorders can negatively influence COPD management and vice versa, creating a complex bidirectional interaction. Depression and anxiety are the most common psychiatric comorbidities in patients with COPD, influenced by factors such as social isolation, physical limitations, and fear of exacerbations. Diagnosis of these psychiatric disorders is complicated by the overlap of symptoms with those of COPD. However, some screening tools can facilitate early detection. The treatment of psychiatric disorders in patients with COPD in a rehabilitation setting requires a multidisciplinary approach involving pulmonologists, neurologists and psychologists. Pharmacological therapy with antidepressants shows mixed results in terms of efficacy and safety, with some studies reporting benefits on quality of life and others suggesting an increased risk of exacerbations and pneumonia. An integrated approach that includes the assessment and intervention of mental disorders is essential to improve the overall management of COPD and the quality of life of patients. This narrative review provides an overview of the main psychiatric comorbidities in COPD patients, aiming to fill gaps in the literature and suggest areas for future research.

Effects of Qingjin Huatan decoction on pulmonary function and inflammatory mediators in acute exacerbations of chronic obstructive pulmonary disease: a systematic review and meta-analysis

Background

The inflammatory response is the main pathophysiological basis of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and is a key factor leading to frequent exacerbations and disease progression. Suppressing the inflammatory response can improve pulmonary function, prognosis, and quality of life in AECOPD patients.

Purpose

To evaluate the effect of Qingjin Huatan decoction (QHD) on pulmonary function and inflammatory mediators in AECOPD patients.

Methods

Randomized controlled trials (RCTs) on the treatment of AECOPD with QHD were retrieved from eight Chinese and English electronic databases up to 31 May 2024. The quality of the studies was assessed using the Cochrane Risk of Bias Tool and the modified Jadad scale. Statistical analysis, sensitivity analysis, and publication bias assessment were performed using Stata 17.0 software.

Results

A total of 40 RCTs involving 3,475 AECOPD patients were included. Compared to conventional treatment, QHD significantly improved pulmonary function, with increases in FEV1 (MD = 0.30, 95% CI: 0.26 to 0.34, p = 0.000), FVC (MD = 0.34, 95% CI: 0.27 to 0.41, p = 0.000), FEV1/FVC (MD = 6.07, 95% CI: 5.55 to 6.58, p = 0.000), and PaO2 (MD = 7.20, 95% CI: 4.94 to 9.47, p = 0.000), and a decrease in PaCO2 (MD = -5.37, 95% CI: 7.99 to -2.74, p = 0.000). QHD also significantly suppressed the expression of inflammatory mediators, including TNF-α (MD = -10.87, 95% CI: 12.51 to -9.23, p = 0.000), IL-1β (MD = -13.63, 95% CI: -16.31 to -10.95, p = 0.000), IL-6 (MD = -7.58, 95% CI: -10.10 to -5.06, p = 0.000), IL-8 (MD = -9.45, 95% CI: -12.05 to -6.85, p = 0.000), CRP (MD = -5.62, 95% CI: -6.60 to -4.65, p = 0.000), and PCT (MD = -0.84, 95% CI: -1.07 to -0.62, p = 0.000). Additionally, QHD improved clinical efficacy (RR = 4.16, 95% CI: 3.26 to 5.30, p = 0.000) without increasing the incidence of adverse reactions (RR = 1.04, 95% CI: 0.68 to 1.61, p = 0.000).

Conclusion

Existing evidence suggests that QHD can significantly improve pulmonary function, suppress the expression of inflammatory mediators, and enhance clinical efficacy in AECOPD patients, with a good safety profile. Given the limitations of this study, more high-quality studies are needed to provide reliable evidence.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=559436, identifier CRD42024559436.

Temporal Dynamics of Cardiovascular Risk in Patients with Chronic Obstructive Pulmonary Disease During Stable Disease and Exacerbations: Review of the Mechanisms and Implications

Introduction

Exacerbations of chronic obstructive pulmonary disease (COPD) are risk factors for severe cardiovascular (CV) events, with the risk remaining significantly elevated long after the symptomatic phase of the exacerbation. The pathophysiology underpinning the relationship between acute events of both COPD and CV diseases has been understudied. Our objectives were to review the mechanisms by which COPD exacerbations increase the risk of CV events and understand the temporality of this risk.

Methods

A pragmatic and targeted literature review was conducted with a focus on identifying recent, high-impact papers up to June 2023, guided by insights from subject matter experts including pulmonologists and cardiologists.

Results

A substantial number of inter-related mechanisms underpin the spiral of anatomical and functional deterioration of lung and heart affecting COPD patients during stable state. In turn, an exacerbation of COPD may trigger a CV event, during and beyond the symptomatic phase, due to ventilation/perfusion mismatch, oxygen supply-demand imbalance, oxidative stress, systemic inflammation, hypercoagulable state, dynamic hyperinflation, pulmonary hypertension, and sympathetic activation. However, no study was identified that explored the mechanisms by which an exacerbation confers a sustained risk of CV event.

Conclusion

While our review identified multiple dynamic and interacting pathophysiological mechanisms during and after an exacerbation of COPD that contribute to increasing the risk of a wide range of cardiac events, little is known regarding the precise long-term mechanisms after acute exacerbation to explain the persistent increased CV event risk beyond the symptomatic phase. The temporal changes in static and dynamic substrates need further characterization to better understand the different risk factors and risk periods for a CV event following the onset of an exacerbation. Moreover, guideline-directed cardiopulmonary therapies should be implemented at every opportunity; preventing exacerbations and intensively treating traditional CV risk factors should be a focus in COPD management.

Developing Interventions for Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is an incurable, progressive respiratory disease that may have a significant negative impact on the morbidity and mortality of affected patients. A substantial portion of the world's population is affected by COPD, and despite optimal medical management with medications, supplemental oxygen, and pulmonary rehabilitation, many patients are left debilitated because of this disease. Bronchoscopic treatment modalities offer a less-invasive method for the treatment of refractory COPD compared to surgical interventions and have expanded the potential therapeutic options for these patients. Bronchoscopic lung volume reduction is aimed at decreasing the hyperinflation and air trapping that occur in emphysema, and the most studied and successful intervention is endobronchial valve placement. Endobronchial coils, polymeric sealants, and thermal ablation are other researched alternatives. Additional interventional procedures are being investigated for the treatment of the mucus hypersecretion and cough that are associated with the chronic bronchitis phenotype of COPD and include targeted lung denervation, metered dose spray cryotherapy, deobstruction balloon, and bronchial rheoplasty. This review summarizes the most recent evidence pertaining to available therapies for the management of COPD, including chronic bronchitis, with a particular focus on bronchoscopic interventions.

Assessment of the BODE Index and Its Association With Inflammatory Mediators in Chronic Obstructive Pulmonary Disease (COPD) Patients

Background Chronic obstructive pulmonary disease (COPD) is a respiratory condition impacting daily activities of susceptible individuals and increasing the risk of respiratory infections and cardiovascular disease. Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity (BODE) index is applied clinically to measure the survival of COPD patients. Inflammatory mediators, including cytokines and chemokines, significantly contribute to the COPD pathology. In this study, the association between the BODE index and systemic inflammatory mediators in stable COPD patients was evaluated. Methodology This was a cross-sectional observational study performed on 85 clinically stable COPD patients and the GOLD criteria were used for the diagnosis. The demographics and clinical history of the patients were documented. The clinical assessment comprising the Modified Medical Research Council (MMRC) dyspnea scale, COPD Assessment Test (CAT) and BODE index was measured. The serum levels of systemic inflammatory mediators, tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP) and interleukin-6 (IL-6) were measured. The association between the BODE index and inflammatory markers was analyzed using Pearson's correlation analysis. Results The majority of patients (61.2%) were in stage I BODE index and BODE index showed a significant correlation with GOLD stage severity (p=0.001). The CRP, TNF-α and IL-6 levels were increased in BODE stage IV when compared to stage III, II and I (p=0.001). The CRP (r=0.654; p=0.000), TNF-α (0.542; p=0.01) and IL-6 (r=0.498; p=0.02) showed significant correlation with BODE index. Conclusion The evaluation of the BODE index alongside systemic inflammatory markers is crucial for enhancing the management of COPD and subsequently improving patient outcomes.

[COPD inhaled therapy narrative review]

The basis of COPD maintenance treatment is the long-acting bronchodilators and the inhaled corticosteroids. Faced with the recent modifications in the clinical practice guidelines, we have carried out a review of studies that contrast the various therapeutic alternatives and pharmacological agents within each category, with the fundamental purpose of shedding light on which of these options prove to be more effective. Triple therapy stands out as essential in poorly controlled patients or with an eosinophilic phenotype, surpassing dual therapy. However, among the combinations of LAMA/LABA or LAMA/LABA/IC, no drug is observed to be superior in the reviewed evidence. Although triple therapies include corticosteroids, there does not appear to be a significant increase in side effects or pneumonia. Regarding monotherapy with LAMA, no significant differences are seen between the drugs, but in dual therapy with LABA/IC, the budesonide/formoterol combination seems to offer better control than fluticasone/salmeterol.

The potential protective effects of probiotics, prebiotics, or yogurt on chronic obstructive pulmonary disease: Results from NHANES 2007-2012

Chronic obstructive pulmonary disease (COPD) ranks among the world's three leading causes of mortality, owing to the increased smokers and aging populations. Previous studies showed that gut microbiota could help to ameliorate respiratory diseases. Hence, the current study aims to evaluate the effects of probiotics, prebiotics, or yogurt on the prevalence of COPD. A cross-sectional study was carried out by investigating data from three consecutive NHANES cycles during 2007-2012. Individuals who met the inclusion and exclusion criteria were studied. Prescription medications and dietary were reviewed to identify the intake of probiotics, prebiotics, or yogurt. The included participants were then divided into two groups depending on their consumption of probiotics, prebiotics, or yogurt. Multivariate logistic regression analysis was conducted to analyze the effects of probiotics, prebiotics, or yogurt consumption on the prevalence of COPD. Out of 7486 enrolled participants, 1656 (22.12%) were categorized into the probiotics, prebiotics, or yogurt intake group. This study indicated that consuming probiotics, prebiotics, or yogurt were correlated with a lower incidence of COPD, even when factors like gender, age, education, moderate-intensity activities, vigorous activities, hypertension, asthma, diabetes, smoking and alcohol consumption were accounted for (Model 1: OR, 0.68, 95% CI, 0.53-0.87; Model 2: OR, 0.77, 95% CI, 0.59-0.99; Model 3: OR, 0.75, 95% CI, 0.57-0.98). The findings reveal that consuming probiotics, prebiotics, or yogurt might play a beneficial role in preventing COPD.

Single-Breath Simultaneous Measurement of DLNO and DLCO as Predictor of the Emphysema Component in COPD - A Retrospective Observational Study

Background

Chronic Obstructive Pulmonary Disease (COPD) is a respiratory condition characterized by heterogeneous abnormalities of the airways and lung parenchyma that cause different clinical presentations. The assessment of the prevailing pathogenetic components underlying COPD is not usually pursued in daily practice, also due to technological limitations and cost.

Aim

To assess non-invasively the lung emphysema component of COPD by the simultaneous measurement of DLNO and DLCO via a single-breath (sDLNO and sDLCO).

Methods

COPD patients aged ≥40 years of both genders were recruited consecutively and labelled by computed tomography as "with significant" emphysema (>10% of CT lung volume) or "with negligible" emphysema otherwise. Current lung function tests such as sDLNO, sDLCO and Vc (the lung capillary blood volume) were measured. All possible subsets of independent spirometric and diffusive parameters were tested as predictors of emphysema, and their predicted power compared to each parameter alone by ROC analysis and area under the curve (AUC).

Results

Thirty-one patients with "significant emphysema" were compared to thirty-one with "negligible emphysema". FEV1 and FEV1/FVC seemed to be the best spirometric predictors (AUC 0.80 and 0.81, respectively), while sDLCO and Vc had the highest predicted power among diffusive parameters (AUC 0.92 and 0.94, respectively). sDLCO and Vc values were the parameters most correlated to the extent of CT emphysema. Six subsets of independent predictors were identified and included at least one spirometric and one diffusive parameter. According to goodness-to-fit scores (AIC, BIC, log-likelihood and pseudo R2), RV coupled with sDLCO or Vc proved the best predictors of emphysema.

Conclusion

When investigating the parenchymal destructive component due to emphysema occurring in COPD, sDLNO, sDLCO and Vc do enhance the predictive power of current spirometric measures substantially. sDLNO, sDLCO and Vc contribute to phenotype of the main pathogenetic components of COPD easily and with high sensitivity. Organizational problems, radiation exposure, time and costs could be reduced, while personalized and precision medicine could be noticeably implemented.

Stem cell therapies for chronic obstructive pulmonary disease: mesenchymal stem cells as a promising treatment option

Chronic obstructive pulmonary disease(COPD) is an inflammatory disease characterized by the progressive and irreversible structural and functional damage of lung tissue. Although COPD is a significant global disease burden, the available treatments only ameliorate the symptoms, but cannot reverse lung damage. Researchers in regenerative medicine have examined the use of stem cell transplantation for treatment of COPD and other diseases because these cells have the potential for unlimited self-renewal and the ability to undergo directed differentiation. Stem cells are typically classified as embryonic stem cells, induced pluripotent stem cells, and adult stem cells (which includes mesenchymal stem cells [MSCs]), each with its own advantages and disadvantages regarding applications in regenerative medicine. Although the heterogeneity and susceptibility to senescence of MSCs make them require careful consideration for clinical applications. However, the low tumourigenicity and minimal ethical concerns of MSCs make them appear to be excellent candidates. This review summarizes the characteristics of various stem cell types and describes their therapeutic potential in the treatment of COPD, with a particular emphasis on MSCs. We aim to facilitate subsequent in-depth research and preclinical applications of MSCs by providing a comprehensive overview.

Prevalence, mortality and risk factors for self-reported COPD among smokers and never smokers, NHANES 1999-2018

INTRODUCTION

Cigarette smoke is the main risk factor for chronic obstructive pulmonary disease (COPD), but 25% to 50% of cases occur in non-smokers. In the US, limited recent national data compare COPD prevalence between smokers and never smokers. Furthermore, our study seeks to explore the prevalence and mortality of self-reported COPD among smokers (including current smokers and ex-smokers) and never smokers in the US from 1999 to 2018, and to identify the risk factors and differences.

METHODS

This cross-sectional analysis used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Age-standardized prevalence of self-reported COPD among current smokers, ex-smokers, and never smokers was calculated using sample weights and 2010 US Census estimates. Risk factors were evaluated through weighted logistic regression models. Subsequently, participants who enrolled in the study cohort were followed until 31 December 2019, to determine all-cause mortality rates.

RESULTS

Between 1999 and 2018, the weighted prevalence of COPD among current smokers, ex-smokers, and never smokers in the U.S. was 12.6%, 9.6%, and 4.1%, respectively. The mortality rates observed were 21.1% among current smokers with COPD, 29% among ex-smokers with COPD, and 12% among never smokers with COPD. Over this period, among the general population in the U.S., the proportion of current smokers has declined, the proportion of never smokers has increased, and the proportion of ex-smokers has remained relatively stable. From 1999 to 2018, COPD prevalence rose from 13.7% to 21.9% among current smokers, stayed at 10.1% among ex-smokers, and dropped from 4.9% to 3.3% among never smokers. Independent risk factors for COPD across all groups included being female, older, and lower income. In particular, US citizens and non-Hispanic Whites (among ex-smokers and never smokers) were at higher risk compared to their counterparts.

CONCLUSIONS

The prevalence and all-cause mortality of COPD among current smokers and ex-smokers remain elevated. Although the prevalence of COPD among never smokers is gradually declining, it continues to be significant, thereby maintaining a substantial burden of disease. Furthermore, common independent risk factors for COPD across current smokers, ex-smokers, and never smokers include female gender, advanced age, lower income, and deviations from normal body weight whether overweight or underweight.

A Network Meta-Analysis of Aerobic, Resistance, Endurance, and High-Intensity Interval Training to Prioritize Exercise for Stable COPD

Purpose

While the benefits of exercises for chronic obstructive pulmonary disease (COPD) are well-established, the relative effectiveness of different exercise types for stable COPD remains unclear. This network meta-analysis aims to investigate the comparative effects of aerobic exercise (AE), resistance training (RT), endurance training (ET), and high-intensity interval training (HIIT) in stable COPD.

Methods

Electronic searches were performed in PubMed, Embase, and the Cochrane library to identify relevant randomized controlled trials (RCTs) investigating the effects of exercises on 6-minute walk test distance (6MWD), forced expiratory volume in one second (FEV1), and forced vital capacity (FVC), and St. George's Respiratory Questionnaire (SGRQ) score. Two authors screened the retrieved articles, extracted relevant data, and assessed the risk of bias. Network meta-analysis was conducted using Stata 14.0.

Results

This study included a total of 19 studies involving 951 patients with stable COPD. HIIT emerged as the most favorable exercise type for enhancing 6MWD, with a probability of 82.9%. RT exhibited the greatest efficacy in reducing SGRQ scores, with probability of 49.8%. Notably, ET demonstrated superiority in improving FEV1 and FVC, with probabilities of being most effective at 78.1% and 42.0%, respectively.

Conclusion

This study suggests that HIIT may be a viable intervention for improving exercise capacity in stable COPD patients, compared to AE, RR, and ET. RT may hold promise for improving quality of life, and ET may demonstrate superiority in improving pulmonary function. However, variation in response likely depends on patient characteristics, program parameters, and delivery context. Future research should explore the synergistic effects of combining RT with ET/HIIT, focusing on patient subgroups, optimal dosing, and settings, as current guidelines indicate this combination may offer the most significant benefits.

The Relationship Between Benefit Finding and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease: The Mediating Effects of Self-Management

Objective

To explore the relationships among benefit finding (BF), self-management, and quality of life (QOL) among patients with COPD.

Methods

A total of 205 patients with COPD were selected via a convenient sampling method. BF refers to the ability to find meaning or benefit from difficult situations. The Benefit Finding Scale (BFS), self-management scale, and 36-item Short-Form Health Survey (MOS SF-36) were used to investigate BF, self-management and QOL (including a physical component summary (PCS) and a psychological component summary (MCS)). Structural equation modeling was used to examine the relationships among BF, self-management and QOL in patients with COPD and to analyze the effects of BF and self-management on QOL.

Results

The total QOL score of patients with COPD was 61.38±21.15, and the PCS and MCS scores were 57.67±23.60 and 65.09±21.24, respectively. BF and self-management had positive predictive effects on both the PCS (βBF = 0.519, PBF = 0.012; βself-management = 0.473, Pself-management = 0.012) and MCS (βBF = 0.425, PBF = 0.013; βself-management = 0.535, Pself-management = 0.016) of patients with COPD, and self-management mediated the relationships of BF with the PCS (β = 0.144, P = 0.008) and MCS (β = 0.162, P = 0.007).

Conclusion

The QOL of patients with COPD needs to be improved, especially in terms of physical aspects. Helping COPD patients obtain better BF not only helps them improve their PCS and MCS directly but also indirectly through enhancing self-management to improve their PCS and MCS.