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

Age-differentiated comparison of health-related quality of life and impacting factors in patients with COPD receiving long-term home non-invasive ventilation

BACKGROUND

Non-invasive ventilation (NIV) is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). While studies have demonstrated benefits for mortality, hospitalization rates, and health related quality of life (HRQL), evidence is particularly sparse regarding HRQL determinants in the older population.

METHODS

In a prospective, monocentric observational study, HRQL was assessed using the established Severe Respiratory Insufficiency Questionnaire (SRI). The study was prospectively registered in the German Clinical Trials Register on 17 June 2015 under the registration number DRKS00008759. Patients were categorized into two age-based groups: older patients (≥ 65 years) and younger patients (< 65 years). Multiple linear regression analyses were used to analyze factors on HRQL, including SRI scores, anemia, autonomy impairment, exacerbation history and other factors.

RESULTS

237 Patients with COPD with CHRF receiving NIV therapy were included. The mean SRI summary score was 49.9 ± 16.8. with 23.2% (N = 55) suffering from anemia and 36.7% (N = 87) experiencing ≥ 2 exacerbations annually. Autonomy impairment was observed in 49.4% (N = 117) of patients. The updated Charlson Comorbidity Index (uCCI) was 2.2 ± 1.86. No significant differences were found in SRI Summary Scale scores between age groups (p = 0.581), but notable disparities were present in the uCCI (p = 0.014). Multiple regression analysis revealed a negative association of exacerbation history (Young group: -9.2; 95% CI = -14.8/ -3.55 vs. Older group: -6.17; 95% CI = -11.91/ -0.43) and level of autonomy impairment (e.g. Level of Care 2 Young group: -13.91; 95% CI = -21.4/ -6.43 vs. Older group: -14.94; 95% CI = -22.64/ -7.24) on SRI scores with age-related differences. Anemia only had a negative association on the SRI scores in younger patients with COPD (Young group: -7.9; 95% CI = -14.0/ -1.75 vs. Older group: -1.78; 95% CI = -9.21/ 5.65).

DISCUSSION

Frequent exacerbations and a higher level of autonomy impairment had a negative association on HRQL across all ages. However only higher levels of impairment (≥ 2) have a detrimental impact on older patients. Anemia was a negative HRQL factor in younger patients, where it was more prevalent. Overall, HRQL was found to be comparably favorable in both older and younger patients, despite age-specific differences in influencing factors.

REGISTRATION OF THE CLINICAL TRIAL

The study from which the data were analyzed was prospectively registered in the German Clinical Trials Register (DRKS00008759) on June 17, 2015.

A Two-Staged, Risk-Stratified Strategy Combining FEV1/FEV6 and COPD Diagnostic Questionnaire Acts as an Accurate and Cost-Effective COPD Case-Finding Method

BACKGROUND AND OBJECTIVE

Symptom-based questionnaires and handheld lung function devices are widely used for COPD case finding, but the optimal combination remains unclear. This study aimed to compare the diagnostic accuracy (DA) of various combinations of handheld lung function devices and questionnaires and develop a COPD case-finding strategy.

METHODS

This cross-sectional, prospective, observational study enrolled participants aged ≥ 40 years with respiratory symptoms and ≥ 10 smoking pack-years. Participants completed three questionnaires (COPD diagnostic questionnaire [CDQ], lung function questionnaire; COPD Population Screener) and 2 handheld lung function devices (peak flow meter, microspirometer), followed by spirometry to confirm COPD (post-bronchodilation FEV1/FVC < 0.7). DA is assessed using the area under the ROC curve (AUROC).

RESULTS

Among 224 participants, COPD incidence was 29%. Individually, handheld devices showed significantly higher DA than questionnaires (AUROC 0.678-0.69 for questionnaires vs. 0.807 for peak expiratory flow rate [PEFR] and 0.888 for FEV1/FEV6; all pairwise p < 0.05). FEV1/FEV6-based combinations outperformed PEFR-based combinations (all n = 224; AUROC 0.897-0.903 vs. 0.810-0.818; p < 0.05). The CDQ and FEV1/FEV6 combination reached the highest DA (AUROC 0.903). FEV1/FEV6 < 0.76 was the optimal cutoff value. A two-staged strategy (sensitivity/specificity 0.82/0.84) was proposed: low-risk participants (CDQ ≤ 13) need no further testing; middle-risk (CDQ 14-26) should undergo FEV1/FEV6; and high-risk (CDQ ≥ 27) and middle-risk with FEV1/FEV6 < 0.76 require confirmatory spirometry. This approach would reduce misdiagnoses and save costs and time compared to FEV1/FEV6 alone.

CONCLUSION

FEV1/FEV6 and CDQ combination achieves the highest DA. A two-staged, risk-stratified strategy combining CDQ and FEV1/FEV6 can be accurate and cost-effective to detect at-risk, undiagnosed COPD subjects. External validation is required.

Perioperative and Midterm Outcomes of Branched or Fenestrated Endovascular Aneurysm Repair for Type 1A Endoleak after Endovascular Aneurysm Repair

BACKGROUND

The treatment of a failing endovascular aneurysm repair (EVAR) due to loss of proximal sealing is challenging. Branched or fenestrated endovascular aneurysm repair (B/FEVAR) offers a promising endovascular solution. This study evaluates B/FEVAR outcomes for managing type 1A endoleak after EVAR.

METHODS

All consecutive patients who underwent B/FEVAR surgery to treat a type 1A endoleak after EVAR at a large teaching hospital between 2019 and 2024 were included in this study. Outcomes analyzed included aneurysm-related mortality, overall survival, technical success, endoleaks, aneurysm sac dynamics, reinterventions, target vessel patency, target vessel instability, and other complications. Regular follow-up after B/FEVAR surgery included imaging at 1, 6, and 12 months, and annually thereafter.

RESULTS

Among 24 patients (96% male, median age 73 (range: 66-80), the median interval between EVAR and B/FEVAR was 6.6 years (range: 2-11). No aneurysm-related mortality was observed during follow-up. The median follow-up was 20 months (range: 3-67), and overall survival was 96%. The primary technical success rate was 88%, and the assisted primary technical success rate was 92%. Type 2 endoleaks were observed in 33% of patients, while type 3 endoleaks occurred in 13% of patients. Aneurysm sac regression during follow-up was reported in 17%, stabilization in 71%, and expansion in 13% of patients. Reinterventions were required in 25% of patients. Primary target vessel patency and assisted primary target vessel patency were 95% and 97%. Target vessel instability was 8%.

CONCLUSION

B/FEVAR appears to be a safe, and effective option for managing type 1A endoleaks after prior EVAR based on midterm outcomes.

Respiratory Diseases in Women

Respiratory diseases exhibit diverse patterns in prevalence, clinical presentations, and outcomes between men and women. Historically, certain conditions were more prevalent in men, but trends have shifted, highlighting the need to understand sex disparities in respiratory health. Social, environmental, and healthcare changes have reshaped the landscape of respiratory diseases, complicating diagnosis and treatment. Moreover, the underrepresentation of women in clinical trials has limited our understanding of their specific needs. In this review, we explore the sex differences in the prevalence, clinical characteristics, and presentation of respiratory diseases, emphasizing the importance of tailored approaches to diagnosis and management. By recognizing and addressing these disparities, we can advance toward more equitable and effective respiratory healthcare for all individuals.

Clinical and Social Characterization of Patients Hospitalized for COPD Exacerbation Using Machine Learning Tools

OBJECTIVE

This study aims to employ machine learning (ML) tools to cluster patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) based on their diverse social and clinical characteristics. This clustering is intended to facilitate the subsequent analysis of differences in clinical outcomes.

METHODS

We analysed a cohort of patients with severe COPD from two Pulmonary Departments in north-western Spain using the k-prototypes algorithm, incorporating demographic, clinical, and social data. The resulting clusters were correlated with metrics such as readmissions, mortality, and place of death. Additionally, we developed an intelligent clinical decision support system (ICDSS) using a supervised ML model (Random Forest) to assign new patients to these clusters based on a reduced set of variables.

RESULTS

The cohort consisted of 524 patients, with an average age of 70.30±9.35 years, 77.67% male, and an average FEV1 of 44.43±15.4. Four distinct clusters (A-D) were identified with varying clinical-demographic and social profiles. Cluster D showed the highest levels of dependency, social isolation, and increased rates of readmissions and mortality. Cluster B was characterized by prevalent cardiovascular comorbidities. Cluster C included a younger demographic, with a higher proportion of women and significant psychosocial challenges. The ICDSS, using five key variables, achieved areas under the ROC curve of at least 0.91.

CONCLUSIONS

ML tools effectively facilitate the social and clinical clustering of patients with severe COPD, closely related to resource utilization and prognostic profiles. The ICDSS enhances the ability to characterize new patients in clinical settings.

SEPAR Position Paper on the Use of High Flow Nasal Cannula Therapy in the Home Setting

The purpose of this document is to establish SEPAR's official position on the use of high-flow nasal cannula (HFNC) therapy in the home management of patients with chronic respiratory diseases. This position statement is deemed necessary considering current evidence regarding HFNC use in chronic respiratory conditions, with the objective of standardizing its application. This consensus was developed by a panel of experts comprising specialists with established expertise in chronic respiratory failure and high-flow nasal cannula therapy. The panel of experts stablished recommendations in COPD, bronchiectasis, interstitial lung diseases, palliative care, rehabilitation, and chronic treatment settings.

Analysis and prediction of immune cell infiltration characteristics in COPD: Folium isatidis and its active ingredients are able to combat lung lesions caused by COPD by correcting immune cell infiltration

Objective

As a respiratory disease, chronic obstructive pulmonary disease (COPD) has become a common fatal disease worldwide. We aimed to screen active traditional Chinese medicines (TCMs) for the treatment of COPD by COPD-related transcriptome gene chip analysis and verify their therapeutic activity for COPD.

Methods

We used bioinformatics analysis to predict potential therapeutic TCMs based on the immune cell infiltration characteristics in COPD. Further, BALB/c female mice were divided into different treatment groups to investigate the effect of indirubin (IDR) and FI on COPD. After 12 weeks of intranasal lipopolysaccharide instillation and passive smoking, we started giving drug treatment to mice, including distilled water (control and model groups), dexamethasone, IDR and FI. The lung function, visceral index, degree of lung tissue damage, and immune cell infiltration were assessed.

Results

We identified 109 differential genes, 22 immune cells, and 50 TCMs associated with the alleviation of COPD. The in vivo experimental results showed that IDR and FI had protective effects against lung injury in mice and could inhibit COPD. The mechanism of this effect may be related to their ability to regulate the proportion and distribution of immune infiltration of B lymphocytes, CD4+ and CD8+ T lymphocytes, Treg cells, NK cells, myeloid-derived suppressor cells, and eosinophils.

Conclusion

IDR and FI can ameliorate disease development in COPD model mice by regulating immune cell infiltration. This offers an experimental groundwork for delving deeper into the mechanisms through which TCMs impact COPD treatment and for identifying possible therapeutic drugs for COPD.

Evaluation of a near infrared spectroscopy based method for the estimation of substance P in saliva of patients with COPD

Identifying noninvasive specific disease biomarkers that can provide valuable information about chronic obstructive pulmonary disease (COPD) progression, potential complications, or treatment response is of paramount importance. In this study, we propose the validation of an innovative near-infrared (NIR) device that utilizes near-infrared light reflectance techniques combined with data validation through a convolutional neural network for the detection of substance P in non-invasive saliva samples. We conducted an analytical observational cross-sectional study at a leading university hospital between January and March 2022, including patients with COPD and controls without the disease. Following the collection of clinical data, a saliva sample was obtained for the determination of substance P which was analyzed both by the NIR device and an Enzyme-Linked Immunosorbent Assay. Direct comparisons were made, and Bland-Altman plots were constructed to assess the level of agreement between the two measurements. The sample consisted of 102 subjects, 44 with COPD and 58 controls. The average differences between the two measurement methods yielded similar results with no significant differences between them, showing a value of 110.2 (16.1) pg/ml for the NIR device and 110.5 (16.7) pg/ml for the ELISA determination (p > 0.05). The Bland-Altman plots show a small difference and a level of agreement consistent with good measurement by the NIR device. The results of this study validate the efficacy of a NIR device combined with a convolutional neural network for detecting substance P in the saliva of COPD patients.

Effects of glucocorticoid administration routes on patients with acute exacerbations of chronic obstructive pulmonary disease in China: A propensity score-matched longitudinal analysis

BACKGROUND

Glucocorticoids are widely used for managing acute exacerbations of chronic obstructive pulmonary disease (AECOPD); however, limited studies have described the comparative effectiveness of inhaled corticosteroids (ICS), systemic corticosteroids administered orally or intravenously (oral/intra), and a combination of ICS and oral/intra for AECOPD treatment in China. Thus, we aimed to explore the effects of different glucocorticoid administration routes during hospitalization on both short- and long-term patient prognosis in AECOPD.

METHODS

Data were collected from the Acute Exacerbations of Chronic Obstructive Pulmonary Disease Inpatient Registry study, a nationwide multicenter, prospective, observational study conducted in China from September 2017 to November 2021. The study involved 179 hospitals. The patients were categorized into three groups according to their treatment profiles as follows: (1) ICS alone, (2) ICS combined with oral/intra, and (3) oral/intra. Propensity score-matching was utilized to minimize potential bias, using a caliper value <0.1. Competing risk models were used to calculate the relative risks for short-(30 days) and long-term (12 months) severe exacerbations, COPD-specific readmission, and all-cause readmission.

RESULTS

After propensity score matching, each group included 572 patients. In the ICS group, the cumulative incidence of short-term severe exacerbations, COPD-specific readmission, and all-cause readmission was 2.4%, 2.2%, and 2.7%, respectively, which was comparable to that in the ICS + oral/intra group (3.7%, 3.4%, and 4.2%, respectively). However, the incidence in the ICS + oral/intra group was significantly lower than that in the oral/intra group (5.4% for short-term severe exacerbations, 5.2% for COPD-specific readmission, and 5.7% for all-cause readmission). The 12-month incidence did not significantly differ among the groups. Compared with the ICS group, the short- or long-term risks did not differ in the ICS + oral/intra group, whereas the short-term risk was higher in the oral/intra group (severe exacerbations: hazards ratio [HR] = 2.29, 95% confidence interval [CI]: 1.09-4.82; COPD-specific readmission: HR = 2.44, 95% CI: 1.12-5.30; and all-cause readmission: HR = 2.18, 95% CI: 1.07-4.45).

CONCLUSION

The use of systemic corticosteroids alone during hospitalization for AECOPD increases the short-term risk of outcomes but does not affect the long-term prognosis.

Persistent Blood Eosinophilia and Eosinopenia: Relationship with Outcomes in Bronchiectasis

INTRODUCTION

Blood eosinophil counts (BEC) have been related to the severity of bronchiectasis and its response to inhaled corticosteroids. However, only the baseline BEC has been used to assess this relationship and it is known that BEC could change over time. The objective of this study is to analyse the association of persistent eosinophilia or eosinopenia with outcomes in bronchiectasis.

METHODS

Multicentre, prospective and observational study from 43 centres in Spain derived from the Spanish Bronchiectasis Registry (RIBRON). Asthma and anti-eosinophil treatments were excluded. Patients with at least two yearly BEC measures (including the baseline measure) were included. Persistent eosinophilia (at least 300cells/μL) or persistent eosinopenia (less than 100cells/μL) were defined as the persistence in the same eosinophil group after three yearly measures (being the baseline the first measure).

RESULTS

Five hundred two patients with at least three BEC measures were included; 24.5% and 16.6% presented baseline eosinophilia or eosinopenia, respectively. Of these, 57.7% and 56.6% presented persistent eosinophilia and eosinopenia, respectively. Patients with persistent eosinophilia presented greater severity and a higher number/greater severity of exacerbations than those with non-persistent eosinophilia and those with persistent or non-persistent eosinopenia. Finally, patients with non-persistent eosinopenia presented more severity and a higher number/greater severity of exacerbations than those with non-persistent eosinophilia.

CONCLUSION

When only the baseline BEC was taken into account, patients with eosinopenia presented greater severity than those with eosinophilia. However, patients with persistent eosinophilia presented greater severity than those with persistent eosinopenia. Monitoring the BEC seems to be important in bronchiectasis.

Characterization of Inactive COPD Patients: Barriers to Physical Activity and Perceived Impact of Inactivity

BACKCROUND

Chronic obstructive pulmonary disease (COPD) is characterized by high morbidity and mortality, with physical inactivity being a major contributor to poor outcomes. This study aims to identify subgroups of inactive COPD patients by analyzing reported barriers to physical activity and the perceived impact of inactivity on their disease.

METHODS

In 91 consecutive stable COPD patients, physical activity was measured using a SenseWear armband and the SAQ-COPD questionnaire, to define inactivity as a physical activity level <1.69. Clinical and functional assessment included measurement of lung volumes, diffusing capacity, muscle strength, six-minute walk test and progressive cardiorespiratory exercise test. Cluster analysis was performed based on patients' responses to the profile and impact sections of SAQ-COPD questionnaire.

RESULTS

In 70 inactive COPD patients, three distinct clusters were identified: Cluster 1 showed significant functional limitations, particularly dyspnea and leg fatigue, alongside worse exercise tolerance and dynamic hyperinflation. Cluster 2 displayed few functional limitations but reported a lack of interest in physical activity as the primary reason for inactivity, with poorer sleep quality observed. Cluster 3 exhibited a high perceived impact of inactivity despite reporting fewer physical limitations, with psychological factors such as fear and discouragement acting as primary barriers. Factor analysis revealed two principal components: perceived impact of inactivity and limiting factors for exercise.

CONCLUSION

These findings highlight the heterogeneity among inactive COPD patients and emphasize the need for tailored interventions targeting both physical and psychological barriers. SAQ-COPD questionnaire may be a useful instrument for this individualized assessment of inactive COPD patients.

Predicting COPD Readmission: An Intelligent Clinical Decision Support System

Background: COPD is a chronic disease characterized by frequent exacerbations that require hospitalization, significantly increasing the care burden. In recent years, the use of artificial intelligence-based tools to improve the management of patients with COPD has progressed, but the prediction of readmission has been less explored. In fact, in the state of the art, no models specifically designed to make medium-term readmission predictions (2-3 months after admission) have been found. This work presents a new intelligent clinical decision support system to predict the risk of hospital readmission in 90 days in patients with COPD after an episode of acute exacerbation. Methods: The system is structured in two levels: the first one consists of three machine learning algorithms -Random Forest, Naïve Bayes, and Multilayer Perceptron-that operate concurrently to predict the risk of readmission; the second level, an expert system based on a fuzzy inference engine that combines the generated risks, determining the final prediction. The employed database includes more than five hundred patients with demographic, clinical, and social variables. Prior to building the model, the initial dataset was divided into training and test subsets. In order to reduce the high dimensionality of the problem, filter-based feature selection techniques were employed, followed by recursive feature selection supported by the use of the Random Forest algorithm, guaranteeing the usability of the system and its potential integration into the clinical environment. After training the models in the first level, the knowledge base of the expert system was determined on the training data subset using the Wang-Mendel automatic rule generation algorithm. Results: Preliminary results obtained on the test set are promising, with an AUC of approximately 0.8. At the selected cutoff point, a sensitivity of 0.67 and a specificity of 0.75 were achieved. Conclusions: This highlights the system's future potential for the early identification of patients at risk of readmission. For future implementation in clinical practice, an extensive clinical validation process will be required, along with the expansion of the database, which will likely contribute to improving the system's robustness and generalization capacity.

Development and Validation of a Quantitative Score for the Criteria Clinical Control in Stable COPD Proposed in the Spanish COPD Guidelines (GesEPOC): Results of the EPOCONSUL Audit

Introduction/Objective: the concept of clinical control of COPD is a measure proposed in the Spanish COPD Guidelines (GesEPOC), which aims to help clinicians assess the clinical status in order to adapt the treatment plan at follow-up. However, studies that have evaluated clinical practice reveal that the degree of control of COPD is not always assessed, which underlines the need to promote its assessment through a scoring system. To develop a scoring system that quantitatively assesses the validated criteria defining the degree of COPD control. Methods: this study used data from the EPOCONSUL audit in respiratory clinics across Spain. We included in this analysis all patients with a COPD clinical control grade estimated and reported by the physician at the visit, who had registered the criteria necessary to define the degree of clinical control validated and established in GesEPOC. Patients were randomly assigned to either the development or validation cohorts. The development cohort included 485 patients and the validation cohort included 341 patients. Score modelling was conducted using a multivariate logistic regression model, and calibration of the model and score was assessed using the Hosmer-Lemeshow goodness-of-fit test and GiViTi Calibration belts. The model and generated score's discrimination capacity were analyzed by calculating the Area Under the Curve (AUC). Results: the scoring system was developed using four criteria as predictors of poor clinical control of COPD reported by the treating physician:adjusted dyspnoea severity, use of rescue inhaler more than three times per week, walking less than 30 min per day, and COPD exacerbations in the last three months. The scoring system attributed scores from 0 to 8. Calibration was satisfactory in both development and validation cohorts, and the score's discrimination power, as indicated by the AUC, was 0.892. Conclusions: this scoring system provides an easy-to-use quantitative assessment of clinical control of COPD that we believe will help to measure COPD control and its evolution during patient follow-up. Future research will be needed to prospectively evaluate this score as a predictor of outcome.

Mucus production and chronic obstructive pulmonary disease, a possible treatment target: zooming in on N-acetylcysteine

Mucus hypersecretion is a trait of chronic obstructive pulmonary disease (COPD) associated with poorer outcomes. As it may be present before airway obstruction, its early treatment may have a preventive role. This narrative review of the literature presents the role of mucus dysfunction in COPD, its pathophysiology, and the rationale for the use of N-acetylcysteine (NAC). NAC can modify mucus rheology, improving clearance and reducing damage induced MUC5AC expression. It exerts a direct and indirect (glutathione replenishment) antioxidant mechanism; it interferes with inflammatory molecular pathways, including inhibition of nuclear factor-kB activation in epithelial airway cells and reduction in the expression of cytokine tumor necrosis factor α, interleukin (IL)-6, and IL-10. Some clinical experiences suggest that the adjunctive use of NAC may reduce symptoms and improve outcomes for patients with COPD. In conclusion, NAC may be a candidate drug for the early treatment of subjects at risk of COPD development.

Clinical control in COPD and therapeutic implications: The EPOCONSUL audit

OBJECTIVE

This study aimed to evaluate clinical control in chronic obstructive pulmonary disease (COPD), the consequences in terms of treatment decisions, and their potentially associated factors during follow-up of patients in real-life clinical practice.

METHODS

EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of COPD in respiratory clinics in Spain and multivariable logistic regression models to assess the relationships between clinical control and clinical inertia.

RESULTS

4225 patients from 45 hospitals in Spain were audited. Clinical control was analyzed in 1804 (42.7%) patients who met all the Spanish COPD Guidelines (GesEPOC) criteria. 49.1% of patients were classified as uncontrolled, and 42.2% of patients disagreed with the level of control determined by their doctor, which was reported as good during the visit. There was therapeutic inertia (TI), in other words not making any change or taking any action in the treatment of COPD, in 68.4% of uncontrolled patients and no action was taken during the visit for 9.1% of uncontrolled patients. Factors associated with TI in uncontrolled patients were disagreement with the degree of control reported by the doctor who performed the examination ☯physician classifies and reports disease as controlled versus uncontrolled, OR: 3.37 (2.33-4.88), p<0.001] and having a lower burden of associated comorbidities ☯Charlson comorbidity index ≥3 versus <3, OR 0.8 (0.1-3.0), p = 0.014]. The probability of disagreeing with the physician's classification of the degree of COPD control in uncontrolled patients was lower in patients with severe exacerbations ☯OR 0.3 (0.17-0.78), p = 0.009] and those with more exacerbations in the last year ☯OR 0.6 (0.4-0.9), p = 0.019].

CONCLUSIONS

Therapeutic inertia exists in more than half of uncontrolled patients and is more likely when there is disagreement with the assessment of the physician responsible for the visit, who reported there being good disease control, a situation that was more likely in patients with less history of exacerbations.

Phosphodiesterases: Evolving Concepts and Implications for Human Therapeutics

Phosphodiesterases (PDEs) are a superfamily of enzymes that hydrolyze cyclic nucleotides. While the 11 PDE subfamilies share common features, key differences confer signaling specificity. The differences include substrate selectivity, enzymatic activity regulation, tissue expression, and subcellular localization. Selective inhibitors of each subfamily have elucidated the protean role of PDEs in normal cell function. PDEs are also linked to diseases, some of which affect the immune, cardiac, and vascular systems. Selective PDE inhibitors are clinically used to treat these specific disorders. Ongoing preclinical studies and clinical trials are likely to lead to the approval of additional PDE-targeting drugs for therapy in human disease. In this review, we discuss the structure and function of PDEs and examine current and evolving therapeutic uses of PDE inhibitors, highlighting their mechanisms and innovative applications that could further leverage this crucial family of enzymes in clinical settings.

Low-carbohydrate diet score and chronic obstructive pulmonary disease: a machine learning analysis of NHANES data

Background

Recent research has identified the Low-Carbohydrate Diet (LCD) score as a novel biomarker, with studies showing that LCDs can reduce carbon dioxide retention, potentially improving lung function. While the link between the LCD score and chronic obstructive pulmonary disease (COPD) has been explored, its relevance in the US population remains uncertain. This study aims to explore the association between the LCD score and the likelihood of COPD prevalence in this population.

Methods

Data from 16,030 participants in the National Health and Nutrition Examination Survey (NHANES) collected between 2007 and 2023 were analyzed to examine the relationship between LCD score and COPD. Propensity score matching (PSM) was employed to reduce baseline bias. Weighted multivariable logistic regression models were applied, and restricted cubic spline (RCS) regression was used to explore possible nonlinear relationships. Subgroup analyses were performed to evaluate the robustness of the results. Additionally, we employed eight machine learning methods-Boost Tree, Decision Tree, Logistic Regression, MLP, Naive Bayes, KNN, Random Forest, and SVM RBF-to build predictive models and evaluate their performance. Based on the best-performing model, we further examined variable importance and model accuracy.

Results

Upon controlling for variables, the LCD score demonstrated a strong correlation with the odds of COPD prevalence. In compared to the lowest quartile, the adjusted odds ratios (ORs) for the high quartile were 0.77 (95% CI: 0.63, 0.95), 0.74 (95% CI: 0.59, 0.93), and 0.61 (95% CI: 0.48, 0.78). RCS analysis demonstrated a linear inverse relationship between the LCD score and the odds of COPD prevalence. Furthermore, the random forest model exhibited robust predictive efficacy, with an area under the curve (AUC) of 71.6%.

Conclusion

Our study of American adults indicates that adherence to the LCD may be linked to lower odds of COPD prevalence. These findings underscore the important role of the LCD score as a tool for enhancing COPD prevention efforts within the general population. Nonetheless, additional prospective cohort studies are required to assess and validate these results.

A CT-Based Lung Radiomics Nomogram for Classifying the Severity of Chronic Obstructive Pulmonary Disease

Background

Chronic obstructive pulmonary disease (COPD) is a major global health concern, and while traditional pulmonary function tests are effective, recent radiomics advancements offer enhanced evaluation by providing detailed insights into the heterogeneous lung changes.

Purpose

To develop and validate a radiomics nomogram based on clinical and whole-lung computed tomography (CT) radiomics features to stratify COPD severity.

Patients and Methods

One thousand ninety-nine patients with COPD (including 308, 132, and 659 in the training, internal and external validation sets, respectively), confirmed by pulmonary function test, were enrolled from two institutions. The whole-lung radiomics features were obtained after a fully automated segmentation. Thereafter, a clinical model, radiomics signature, and radiomics nomogram incorporating radiomics signature as well as independent clinical factors were constructed and validated. Additionally, receiver-operating characteristic (ROC) curve, area under the ROC curve (AUC), decision curve analysis (DCA), and the DeLong test were used for performance assessment and comparison.

Results

In comparison with clinical model, both radiomics signature and radiomics nomogram outperformed better on COPD severity (GOLD I-II and GOLD III-IV) in three sets. The AUC of radiomics nomogram integrating age, height and Radscore, was 0.865 (95% CI, 0.818-0.913), 0.851 (95% CI, 0.778-0.923), and 0.781 (95% CI, 0.740-0.823) in three sets, which was the highest among three models (0.857; 0.850; 0.774, respectively) but not significantly different (P > 0.05). Decision curve analysis demonstrated the superiority of the radiomics nomogram in terms of clinical usefulness.

Conclusion

The present work constructed and verified the novel, diagnostic radiomics nomogram for identifying the severity of COPD, showing the added value of chest CT to evaluate not only the pulmonary structure but also the lung function status.

Demographic and Clinical Characteristics of Mild, Young and Early COPD: A Cross-Sectional Analysis of 5468 Patients

Early, mild and young COPD concepts are not clearly defined and are often used interchangeably to refer to the onset of the disease. Objective: To describe and compare the characteristics of mild, young and early COPD in a large sample of COPD from primary and secondary care. Methods: Pooled analysis of individual data from four multicenter observational studies of patients with stable COPD (≥40 years, FEV1/FVC < 0.7, smoking ≥ 10 pack-years). Mild COPD was defined as FEV1% ≥ 65%; young COPD as <55 years; and early COPD as <55 years and smoking ≤ 20 pack-years. The relationship between FEV1(%), age and pack-years was analyzed with linear regression equations. Results: We included 5468 patients. Their mean age was 67 (SD: 9.6) years, and 85% were male. A total of 1158 (21.2%) patients had mild COPD; 636 (11.6%) had young COPD and 191 (3.5%) early COPD. The three groups shared common characteristics: they were more frequently female, younger and with less tobacco exposure compared with the remaining patients. Early COPD had fewer comorbidities and fewer COPD admissions, but no significant differences were found in ambulatory exacerbations. In linear regression analysis, the decline in FEV1(%) was more pronounced for the first 20 pack-years for all age groups and was even more important in younger patients. Conclusions: Mild, young and early COPD patients were more frequently women. The steepest decline in FEV1(%) was observed in individuals <55 years and smoking between 10 and 20 pack-years (early COPD), which highlights the importance of an early detection and implementation of preventive and therapeutic measures.

Evidence-based simulation: Fostering competency through structured and multisource feedback

ABSTRACT

Preclinical simulation is an evidence-based method for nurse practitioner (NP) students to improve clinical communication and disease management competency. During simulation, students may receive feedback from multiple sources, including standardized patients (SPs), faculty, peers, and themselves. Although evidence supports simulation with multisource feedback, its impact on clinical knowledge and communication has yet to be evaluated among NP students. We designed, implemented, and evaluated a preclinical simulation program with structured multisource feedback integrated into a disease management course within a Doctor of Nursing Practice curriculum. Differences in communication self-efficacy and disease management knowledge before and after participation, as well as perceptions of learning and importance of varying feedback sources, were evaluated using a single group pre-post mixed-methods design. On average, clinical communication self-efficacy was significantly higher, and disease management knowledge scores were significantly higher after participation. Learners rated feedback sources as important or very important and described varying feedback sources as complementary. Feedback from SPs, peers, learners themselves, and faculty was complementary and important to learning. This preclinical simulation program with purposeful integration of multisource feedback provides an evidence-based foundation for scaffolding multidomain competency development into curriculums to meet updated standards of advanced nursing education.

Real World Study on the Reasons for eScalation or de-Escalation of Inhaled ThEraPies in COPD Patients: the STEPINCOPD Multicenter Observational Study

BACKGROUND

There is limited data on the reasons for escalation or de-escalation of COPD inhaled therapies in routine clinical practice, especially after the follow-up pharmacological treatment guidance on the 2019 GOLD report and the 2020 ERS guideline on ICS withdrawal.

METHODS

The STEPINCOPD study was a 12-week, two-visit, prospective observational study that aimed to describe the reasons for change of inhaled therapies, in accordance with GOLD recommendations 2021. Only patients that had a recent change in their inhaled medication were enrolled. Moreover, we investigated associations between physicians' and patients' characteristics and adherence to GOLD recommendations.

RESULTS

1429 patients were enrolled from 146 centers (138 private practice and 8 hospitals) throughout Greece. At enrollment, the most frequent reasons for treatment change were lack of clinical (78.9%) or spirometric (49.5%) response to previous treatment, change in CAT score (45.1%), and mMRC score (28.2%). At the follow-up visit, most common reasons were lack of clinical response to previous treatment (71.4%), COPD exacerbations (59.5%), changes in CAT score (52.4%), lack of spirometric response (42.9%) and lower respiratory tract infections (31%). We observed high adherence to the GOLD 2021 recommendations (81.6% at enrollment and 92.9% at follow-up). Physicians' age and consideration of GOLD recommendations for prescription choice, as well as patients' CAT score were significant predictors of adherence to GOLD.

CONCLUSION

The STEPINCOPD study highlights the reasons for inhaled treatment change in Greek physicians with high adherence to GOLD recommendations and provides insights for future research that may inform the development of decision support tools.

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.

Comparison of Efficacy and Safety of Different Types of One-Way Valves in Endoscopic Lung Volume Reduction in Patients with Severe Lung Emphysema

INTRODUCTION

Endoscopic lung volume reduction (ELVR) with valves is an effective intervention in patients with severe lung emphysema. Two types of valves are established in clinical practice: Zephyr endobronchial valves (EBVs) and Spiration Valve System (SVS). We aimed to compare outcomes and the safety associated with these two types of one-way valves.

METHODS

Data were collected from three German lung emphysema centers as part of a prospective observational study focusing on lung volume reduction. Two groups were formed based on valve types. In both groups, lung function (FEV1, RV, diffusion capacity of the lung for carbon monoxide, pCO2), 6-min walking distance (6MWD), quality of life (SGRQ, mMRC, CAT), and complication rate were recorded at baseline and at follow-up 3 to 6 months later.

RESULTS

A total of 54 patients were treated with SVS valves and 99 patients with EBV. There were no significant differences between both groups at baseline. Notably, both types of valves exhibited significant enhancements in lung function and quality of life. Interestingly, there were no significant differences in the median change of all measured parameters for both groups, suggesting comparable improvements in EBV and SVS. Pneumothorax was the most common complication for both valve types. The incidence of adverse events did not differ significantly between groups.

CONCLUSION

Our study suggests that both types of valves are safe and effective in the treatment of severe lung emphysema. We recommend choosing the valve type based on individual bronchial anatomy. However, further randomized studies are needed to confirm our results.

A Qualitative Study on Illness Perception and Coping Behaviors Among Patients with Chronic Obstructive Pulmonary Disease: Implications for Intervention

Background

Understanding patients' perceptions of their illness may be more beneficial for healthcare providers in maintaining vigilance than merely focusing on the clinical status of patients. As patients' perceptions can significantly influence their behavior, it is possible that health care providers who are aware of patients' thoughts in advance may help improve their intervention programs, such as increased treatment adherence. However, current research offers limited insight into the subjective perceptions of disease among patients with Chronic Obstructive Pulmonary Disease (COPD). This study aims to deeply explore COPD patients' illness perception and coping behaviors.

Methods

A descriptive qualitative approach was used, conducting semi-structured in-depth interviews with 32 COPD patients, and verbatim data recording. Data analysis was based on thematic analysis methods proposed by Braun and Clarke.

Results

Through data analysis, we identified three themes to describe participants' perceptions and coping behaviors related to COPD: inadequate knowledge regarding the disease, improper self-management of the disease, and diverse impacts resulting from the disease.

Conclusion

Illness perception is crucial for COPD patients. Participants' descriptions underscored their perceptions of the disease as well as the various challenges and consequences they face when dealing with it. To enhance care for individuals with COPD, researchers and healthcare professionals should increase awareness about the disease among patients, understanding their coping strategies, beliefs, and recognizing its significant impacts.

Silent Airway Mucus Plugs in COPD and Clinical Implications

BACKGROUND

Airway mucus plugs are frequently identified on CT scans of patients with COPD with a smoking history without mucus-related symptoms (ie, cough, phlegm [silent mucus plugs]).

RESEARCH QUESTION

In patients with COPD, what are the risk and protective factors associated with silent airway mucus plugs? Are silent mucus plugs associated with functional, structural, and clinical measures of disease?

STUDY DESIGN AND METHODS

We identified mucus plugs on chest CT scans of participants with COPD from the COPDGene study. The mucus plug score was defined as the number of pulmonary segments with mucus plugs, ranging from 0 to 18, and categorized into three groups (0, 1-2, and ≥ 3). We determined risk and protective factors for silent mucus plugs and the associations of silent mucus plugs with measures of disease severity using multivariable linear and logistic regression models.

RESULTS

Of 4,363 participants with COPD, 1,739 had no cough or phlegm. Among the 1,739 participants, 627 (36%) had airway mucus plugs identified on CT scan. Risk factors of silent mucus plugs (compared with symptomatic mucus plugs) were older age (OR, 1.02), female sex (OR, 1.40), and Black race (OR, 1.93) (all P values < .01). Among those without cough or phlegm, silent mucus plugs (vs absence of mucus plugs) were associated with worse 6-min walk distance, worse resting arterial oxygen saturation, worse FEV1 % predicted, greater emphysema, thicker airway walls, and higher odds of severe exacerbation in the past year in adjusted models.

INTERPRETATION

Mucus plugs are common in patients with COPD without mucus-related symptoms. Silent mucus plugs are associated with worse functional, structural, and clinical measures of disease. CT scan-identified mucus plugs can complement the evaluation of patients with COPD.

Comparison of the Determinants of the "Chronic Obstructive Pulmonary Disease Assessment Test" (CAT) and the "Asthma Control Test" (ACT) in Patients with Asthma-COPD Overlap

Objective: The objective of this study was to investigate which of two short questionnaires, the Asthma Control Test (ACT) or the COPD Assessment Test (CAT), correlates better with severity variables and whether they share similar determinants in patients with asthma-COPD overlap. Method: This observational, cross-sectional, multicentric study included smokers and former smokers of more than 10 pack-years, with non-fully reversible airflow obstruction and either a concomitant diagnosis of asthma or signs of type 2 inflammation, from 15 centres in Spain. Results: A total of 157 patients were included, 109 (69.4%) were men, the mean age was 63.3 (SD: 9) years and the mean FEV1 (%) was 59.7% (SD: 20.5%). The mean CAT score was 14.5 (SD: 8.7), and the mean ACT score was 17.9 (SD: 5.2). Both scores showed good correlations (r = 0.717; p < 0.001). In the multivariate analysis, the Hospital Anxiety and Depression Scale and mMRC dyspnoea scores were independently and significantly associated with both the CAT and ACT scores; however, age was only significantly associated with the CAT, and the EQ-5D scores and the number of exacerbations in the previous year were only significantly associated with the ACT scores. The ACT had a slightly better predictive value for exacerbations than the CAT (AUC = 0.70 (95% CI: 0.62 to 0.79 vs. 0.65 (95% CI: 0.56 to 0.74))). Conclusions: There is a good correlation between ACT and CAT scores in patients with ACO. However, severe patients scored worse on the CAT than the ACT. Anxiety, depression and dyspnoea were significantly associated with both the CAT and ACT scores. The ACT was a slightly better predictor of exacerbations than the CAT in this population.

Comparison of Hospital Stay After Open Abdominal Aortic Aneurysm Repair With or Without Enhanced Recovery Protocol

Objective

Enhanced recovery after surgery (ERAS) is a protocol of evidence based practices applied in major surgery. Open aortic aneurysm repair is major surgery in terms of complications and mortality. This study aimed to compare early outcomes of ERAS with a traditional post-operative protocol in patients undergoing elective open aortic surgery.

Methods

This retrospective cohort study was conducted between 2018 - 2022 in two tertiary vascular surgery centres. The ERAS program was routinely implemented in one centre, while the other one used a standard peri-operative protocol. The primary outcome was post-operative length of stay (pLOS). Secondary outcomes were 30 day mortality rate, complications, re-interventions, and re-hospitalisations. Propensity score weighting was used to balance the two groups by comorbidities. Inverse probability of treatment weight (IPTW) was used to estimate the average treatment effect on the treated patients.

Results

A total of 198 patients were enrolled: 128 in the ERAS group (EG) and 70 in the standard group (SG). Mean age was 70.8 ± 6.7 years in EG and 71.1 ± 6.7 in SG (p = 0.39). No significant differences were observed in pre-operative cardiovascular risk factors. The median pLOS was 5 days (IQR 3, 6) in the EG group and 8 days (IQR 6, 11) in the SG group (p < 0.001). No differences in terms of mortality, re-operations, and re-hospitalisations were observed. The IPTW analyses showed a 40% reduction in pLOS and a significant reduction in major complications in EG (OR 0.41, 95% CI 0.26-0.66; p < 0.001). A 45% increase in pLOS in patients with chronic obstructive pulmonary disease was found in both groups.

Conclusion

Enhanced recovery after surgery is safe and feasible for elective open aortic surgery and is associated with earlier hospital discharge without differences in terms of mortality and lower complication rates compared with a standard protocol. Chronic obstructive pulmonary disease is a major risk factor for an increase in pLOS. The ERAS protocol is promising in terms of resource utilisation.

Serum Metabolomics Analysis Revealed Metabolic Pathways Related to AECOPD Complicated with Anxiety and Depression

Background

Anxiety and depression are two of the most common comorbidities of COPD, which can directly lead to the number of acute exacerbations and hospitalizations of COPD patients and reduce their quality of life. At present, there are many studies on anxiety and depression in stable COPD, but few studies on anxiety and depression in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients.

Objective

We aim to explore the changes of serum metabolomics in AECOPD complicated with anxiety and depression and to provide some clues for further understanding its pathogenesis.

Methods

This is an observational high-throughput experimental study based on retrospective data extraction. Twenty-one AECOPD with anxiety and depressive patients and 17 healthy controls (HCs) were retrospectively enrolled in the Second Affiliated Hospital of Anhui Medical University. Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) for anxiety and depression were used to assess the patients with AECOPD. Untargeted metabolomics analysis was carried out to investigate different molecules in the serum of all participants. General information of all participants, baseline data and clinical measurement data of AECOPD patients were collected. Statistical analysis and bioinformatics analysis were performed to reveal different metabolites and perturbed metabolic pathways.

Results

A total of 724 metabolites in positive ionization mode and 555 metabolites in negative ionization mode were different in AECOPD patients with anxiety and depression. The 1,279 serum metabolites could be divided into 77 categories. Based on multivariate and univariate analysis, 74 metabolites were detected in positive ionization mode, and 60 metabolites were detected in negative ionization as differential metabolites. The 134 metabolites were enriched in 18 pathways, including biosynthesis of unsaturated fatty acids, aldosterone synthesis and secretion, protein digestion and absorption, ovarian steroidogenesis, long-term depression, retrograde endocannabinoid signaling, and so on.

Conclusion

This work highlights the key metabolites and metabolic pathways disturbed in AECOPD patients with anxiety and depression. These findings support the use of metabolomics to understand the pathogenic mechanisms involved in AECOPD patients with anxiety and depression.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and chronic obstructive pulmonary disease: the mediating role of dietary inflammatory index

Background

Numerous studies have indicated a potential correlation between COPD, lipid metabolism, and dietary inflammation. However, the exact mechanisms by which dietary inflammation regulates the pathological processes of COPD related to lipid metabolism remain unclear. NHHR is a novel composite index of atherosclerotic lipid profiles, while the Dietary Inflammatory Index (DII) measures diet-induced inflammation. This study explores the relationship between NHHR and COPD and evaluates whether DII mediates this association.

Methods

We employed multivariable logistic regression, smooth curve fitting, threshold effect analysis, and subgroup analysis to explore the relationship between NHHR and the incidence of COPD. Additionally, we conducted a mediation analysis to explore the potential relationship between dietary inflammatory index (DII) levels and the relationship between NHHR and COPD.

Results

This analysis encompassed 13,452 participants, with 2,332 reporting incidents of COPD. Following adjustment for all covariates using multivariable logistic regression, each unit increase in NHHR level and DII level was associated with a 10% (OR = 1.10, 95% CI: 1.05, 1.16) and 8% (OR = 1.08, 95% CI: 1.04, 1.13) increase, respectively, in the incidence rate of COPD. Furthermore, compared to the lowest quartile, the highest quartile of NHHR level and DII level was associated with a 47% (p < 0.001) and 50% (p < 0.001) increase, respectively, in the incidence rate of COPD. Smooth curve fitting and threshold effect analysis revealed a nonlinear relationship between NHHR and the risk of COPD, with a breakpoint at 2.60. Mediation analysis indicated that DII mediated 7.24% of the association between NHHR and COPD (p = 0.004).

Conclusion

Higher NHHR levels are associated with an increased prevalence of COPD. Moreover, this association is mediated by DII, suggesting that an anti-inflammatory diet may be beneficial.

The Association between Dyslipidemia and Pulmonary Diseases

Dyslipidemia is one of the most common diseases worldwide. As a component of metabolic syndrome, the prevalence and mechanism by which dyslipidemia promotes cardiovascular diseases has been well studied, although the relationship between pulmonary diseases is not well understood. Because the lung is a respiratory organ with a large surface area and is exposed to the environment outside the body, it continuously inhales various substances. As a result, pulmonary diseases have a vast diversity, including chronic inflammatory diseases, allergic diseases, cancers, and infectious diseases. Recently, growing evidence has suggested that dyslipidemia plays a role in the pathogenesis and prognosis of various pulmonary diseases. We herein review the current understanding of the relationship between dyslipidemia and pulmonary diseases, including chronic obstructive pulmonary diseases, asthma, and lung cancer, and infectious pulmonary diseases, including community-acquired pneumonia, tuberculosis, nontuberculous mycobacterial pulmonary disease, and COVID-19. In addition, we focus on recent evidence of the utility of statins, specifically 3-hydroxy-3-methylglutaryl-coA reductase inhibitors, in the prevention and treatment of the various pulmonary diseases described above.

Predicting Acute Exacerbation Phenotype in Chronic Obstructive Pulmonary Disease Patients Using VGG-16 Deep Learning

INTRODUCTION

Exacerbations of chronic obstructive pulmonary disease (COPD) have a significant impact on hospitalizations, morbidity, and mortality of patients. This study aimed to develop a model for predicting acute exacerbation in COPD patients (AECOPD) based on deep-learning (DL) features.

METHODS

We performed a retrospective study on 219 patients with COPD who underwent inspiratory and expiratory HRCT scans. By recording the acute respiratory events of the previous year, these patients were further divided into non-AECOPD group and AECOPD group according to the presence of acute exacerbation events. Sixty-nine quantitative CT (QCT) parameters of emphysema and airway were calculated by NeuLungCARE software, and 2,000 DL features were extracted by VGG-16 method. The logistic regression method was employed to identify AECOPD patients, and 29 patients of external validation cohort were used to access the robustness of the results.

RESULTS

The model 3-B achieved an area under the receiver operating characteristic curve (AUC) of 0.933 and 0.865 in the testing cohort and external validation cohort, respectively. Model 3-I obtained AUC of 0.895 in the testing cohort and AUC of 0.774 in the external validation cohort. Model 7-B combined clinical characteristics, QCT parameters, and DL features achieved the best performance with an AUC of 0.979 in the testing cohort and demonstrating robust predictability with an AUC of 0.932 in the external validation cohort. Likewise, model 7-I achieved an AUC of 0.938 and 0.872 in the testing cohort and external validation cohort, respectively.

CONCLUSIONS

DL features extracted from HRCT scans can effectively predict acute exacerbation phenotype in COPD patients.

Limited Use and Potential Implementation Hurdles of Telemedicine Tools for the Remote Management of Patients With Chronic Obstructive Pulmonary Disease Among Members of SEPAR

Introduction

Telemedicine (TM) can help in the management of chronic obstructive pulmonary disease (COPD). This study examines knowledge, current use and potential limitations for practical implementation of TM for the remoted management of COPD patients among members of the COPD area of SEPAR (n = 3118).

Methods

An electronic survey was circulated three times to these 3118 health-care professionals. Their knowledge, current use and potential limitations for implementation of different forms of TM, including tele-monitoring, tele-education and self-care, tele-rehabilitation and mobile health, for the remote management of COPD patients were tabulated and described.

Results

Only 120 health-care professionals responded to the survey (3.9%). The rate of response varied greatly across different Autonomous Communities (AACC); 99.2% of responders declared being aware of TM, but only 60.5% knew about the different TM alternatives investigated here, and only 40.3% actually used some form of TM for their current management of patients with COPD. Of those using TM, 47.1% referred being satisfied with its use. Main identified barriers for implementation of TM in their institutions were technological limitations and data security.

Conclusions

The potential of TM for the clinical management of COPD is well known among interviewed health-care professionals, but only less than half used it currently. The potential for growth is therefore clear. We propose that SEPAR analyze critically this potential and promotes measures to achieve it for the benefit of COPD patients.

Triple Therapy and Clinical Control in B+ COPD Patients: A Pragmatic, Prospective, Randomized Trial

INTRODUCTION

Treatment with LABA/LAMA is recommended in GOLD B patients. We hypothesized that triple therapy (LABA/LAMA/ICS) will be superior to LABA/LAMA in achieving and maintaining clinical control (CC), a composite outcome that considers both impact and disease stability in a subgroup of GOLD B patients (here termed GOLD B+ patients) characterized by: (1) remaining symptomatic (CAT≥10) despite regular LABA/LAMA therapy; (2) having suffered one moderate exacerbation in the previous year; and (3) having blood eosinophil counts (BEC) ≥150cells/μL.

METHODS

The ANTES B+ study is a prospective, multicenter, open label, randomized, pragmatic, controlled trial designed to test this hypothesis. It will randomize 1028 B+ patients to continue with their usual LABA/LAMA combination prescribed by their attending physician or to begin fluticasone furoate (FF) 92μg/umeclidinium (UMEC) 55μg/vilanterol (VI) 22μg in a single inhaler q.d. for 12 months. The primary efficacy outcome will be the level of CC achieved. Secondary outcomes include the clinical important deterioration index (CID), annual rate of exacerbations, and FEV1. Exploratory objectives include the interaction of BEC and smoking status, all-cause mortality and proportion of patients on LABA/LAMA arm that switch therapy arms. Safety analysis include adverse events and incidence of pneumonia.

RESULTS

The first patient was recruited on February 29, 2024; results are expected in the first quarter of 2026.

CONCLUSIONS

The ANTES B+ study is the first to: (1) explore the efficacy and safety of triple therapy in a population of B+ COPD patients and (2) use a composite index (CC) as the primary result of a COPD trial.

Identifying COPD patients with poor health status and low exercise tolerance through the five-repetition sit-to-stand test and modified Medical Research Council Dyspnea Score

BACKGROUND

The objective of this study was to determine whether the concomitant presence of poor health status (COPD Assessment Test, CAT ≥ 10 points) and low exercise tolerance (6-Minute Walking Test, 6MWT < 350 m) is associated with worse clinical characteristics in patients with COPD. In addition, we aimed to develop a readily applicable diagnostic model to discriminate COPD patients with these conditions.

METHODS

A cross-sectional multicenter study involving 208 stable COPD patients (FEV1/FVC < 0.7, smoking history of at least 10 pack-years, and chronic respiratory symptoms) was carried out. The outcome measures were the 6MWT, CAT score, 5-repetition sit-to-stand test (5STS) and modified Medical Research Council Dyspnea Scale (mMRC). Patients were categorized into three groups: no condition (6MWT ≥ 350 m and CAT < 10 points), one condition (6MWT < 350 m or CAT ≥ 10 points), and both conditions (6MWT < 350 m and CAT ≥ 10 points).

RESULTS

A total of 26 patients (12,5%) presented both conditions. These patients experienced a higher degree of dyspnea (p = 0.001), smoking pack-years (p = 0.011), severe obstruction (p = 0.006), and time on 5STS (p = 0.001). The probability of having both conditions directly increased with the time spent on the 5STS (β=0.188; p = 0.010) and the degree of dyspnea (β=1.920; p < 0.001) (R2=0.413). The scoring system, using the 5STS and dyspnea as surrogate measures, demonstrated adequate calibration between the predicted and observed risk (linear R2=0.852).

CONCLUSIONS

COPD patients with concurrent conditions have worse clinical status. The diagnostic model developed to discriminate these patients shows good internal validation.

Expression of Siglec-9 in peripheral blood neutrophils was increased and associated with disease severity in patients with AECOPD

BACKGROUND

The pathogenesis and treatment strategies for chronic obstructive pulmonary disease (COPD) require further exploration. Abnormal neutrophil inflammation and the overexpression of neutrophil extracellular traps (NETs) are closely associated with acute exacerbations of COPD (AECOPD). Siglec-9, a specific receptor expressed on neutrophils that inhibits their function, prompted us to investigate its relationship with NETs found in induced sputum and the severity of the disease.

METHODS

We collected clinical data from patients with AECOPD and assessed the expression of Siglec-9 in peripheral blood neutrophils and the presence of NETs in induced sputum. We then observed the correlation between Siglec-9, the inflammatory response, and the severity of AECOPD.

RESULTS

We observed an increase in the expression of Siglec-9 in the peripheral blood neutrophils of patients with AECOPD. Concurrently, these patients exhibited more severe clinical symptoms, higher systemic inflammation levels, and a reduced quality of life compared to those with induced sputum NET expression. Further subgroup analysis of AECOPD patients with high Siglec-9 expression revealed worsened quality of life and more severe inflammation, particularly in indicators such as the BODE index, CRP, peripheral blood neutrophil count, IL-6, IL-8, TNF-α expression, and others. Furthermore, we noted a significant increase in NET-specific expression in the sputum of patients with high Siglec-9 expression levels. In comparison to patients with low Siglec-9 expression, those with high expression experienced more systemic inflammatory reactions and a lower quality of life. Correlation analysis of the aforementioned indicators revealed that the expression ratio of Siglec-9 in the peripheral blood of patients correlated with lung function, quality of life, and NETs in the induced sputum of patients with AECOPD.

CONCLUSION

The increased expression of Siglec-9 in peripheral blood neutrophils of AECOPD patients leads to elevated NET expression in induced sputum, exacerbating the systemic inflammatory response and worsening lung function and quality of life in these patients.

Multidisciplinary Management of Patients With Chronic Obstructive Pulmonary Disease and Cardiovascular Disease

Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently coexist, increasing the prevalence of both entities and impacting on symptoms and prognosis. CVD should be suspected in patients with COPD who have high/very high risk scores on validated scales, frequent exacerbations, precordial pain, disproportionate dyspnea, or palpitations. They should be referred to cardiology if they have palpitations of unknown cause or angina pain. COPD should be suspected in patients with CVD if they have recurrent bronchitis, cough and expectoration, or disproportionate dyspnea. They should be referred to a pulmonologist if they have rhonchi or wheezing, air trapping, emphysema, or signs of chronic bronchitis. Treatment of COPD in cardiovascular patients should include long-acting muscarinic receptor antagonists (LAMA) or long-acting beta-agonists (LABA) in low-risk or high-risk non-exacerbators, and LAMA/LABA/inhaled corticosteroids in exacerbators who are not controlled with bronchodilators. Cardioselective beta-blockers should be favored in patients with CVD, the long-term need for amiodarone should be assessed, and antiplatelet drugs should be maintained if indicated.

The Natural History of Severe Chronic Obstructive Pulmonary Disease: The SPOCCAT Study Protocol

Introduction

Patients with severe chronic obstructive pulmonary disease (COPD) are often underrepresented in cohorts, creating uncertainty about the natural history and prognostic factors of this subgroup. Our goal was to describe the SPOCCAT (Severe COPD: Prospective Observational study of COPD in Catalonia) study protocol.

Material and methods

SPOCCAT is a non-interventional, multicenter, prospective cohort study of patients with severe COPD (FEV1% predicted < 50%). The study aims to: (1) establish a five-year prospective cohort; (2) identify demographic and clinical characteristics; (3) describe treatment patterns; (4) better understand the natural history of severe COPD, including lung function decline, exacerbation rates, and mortality; and (5) identify prognostic factors for poor outcomes.Recruitment began in January 2024, and the cohort will be followed for a minimum of five years (or until death or lung transplant) with follow-up visits every 12 months. Baseline data include demographics, laboratory analyses, comorbidities, lung function, respiratory symptoms, respiratory disease exacerbations and etiology, quality of life, physical activity, chest computed tomography, and treatment. Annual follow-up visits will assess changes in treatment, exacerbation frequency and severity, microbiological outcomes, complementary tests, and mortality. Participation requires written informed consent from all patients, with data collected in an anonymized electronic Case Report Form.

Results

The results of the SPOCCAT study will provide relevant information about the characteristics, treatment, and prognostic factors of severe COPD.

Conclusions

SPOCCAT has the potential to enhance understanding of severe COPD, exploring innovative aspects and establishing a robust research framework for future COPD-related projects.

Dynamic hyperinflation is a risk factor for mortality and severe exacerbations in COPD patients

OBJECTIVE

To assess if dynamic hyperinflation is an independent risk factor for mortality and severe exacerbations in COPD patients.

METHODS

A cohort of 141 patients with stable COPD and moderate to very severe airflow limitation, treated according to conventional guidelines, was followed for a median of 9 years. Clinical characteristics were recorded and arterial blood gases, pulmonary function tests, 6-min walk and incremental exercise test with measurement of respiratory pattern and operative lung volumes were performed. Endpoints were all-cause mortality and hospitalization for COPD exacerbation.

RESULTS

58 patients died during the follow-up period (1228 patients x year). The mortality rate was higher in patients with dynamic hyperinflation (n = 106) than in those without it (n = 35) (14.6; 95% CI, 14.5-14.8 vs. 7.2; 95% CI, 7.1-7.4 per 1000 patients-year). After adjusting for sex, age, body mass index, pack-years and treatment with inhaled corticosteroids, dynamic hyperinflation was associated with a higher mortality risk (adjusted hazard ratio [aHR], 2.725; 95% CI, 1.010-8.161), and in a multivariate model, comorbidity, peak oxygen uptake and dynamic hyperinflation were retained as independent predictors of mortality. The time until first severe exacerbation was shorter for patients with dynamic hyperinflation (aHR, 3.961; 95% CI, 1.385-11.328), and dynamic hyperinflation, FEV1 and diffusing capacity were retained as independent risk factors for severe exacerbation. Moreover, patients with dynamic hyperinflation had a higher hospitalization risk than those without it (adjusted incidence rate ratio, 1.574; 95% CI, 1.087-2.581).

CONCLUSION

In stable COPD patients, dynamic hyperinflation is an independent prognostic factor for mortality and severe exacerbations.

Chronic obstructive pulmonary disease mortality in Spain between 1999 and 2019

INTRODUCTION

Mortality from COPD has decreased in Spain in recent years, but it is unknown whether this decline has been homogeneous among the different regions.

METHODS

From the Statistical Portal of the Ministry of Health of Spain we obtained the age-adjusted mortality rates/100,000 inhabitants for men and women in Spain and the Autonomous Communities for the years 1999-2019, using the coding of the International Classification of Diseases (ICD 10, sections J40-J44). With the adjusted rates we performed a jointpoint regression analysis to estimate an annual percentage change (APC), as well as identify possible points of trend change. Statistical significance was considered for a value of p<0.05.

RESULTS

During the study period, COPD mortality rates adjusted in Spain decreased from 28.77 deaths/100,000 inhabitants in 1999 to 12.14 deaths/100,000 inhabitants in 2019. We observed a linear decline in COPD mortality in men at national level of -3.67% per year (95% CI -4.1 to -3.4; p<0.001), with differences between the Autonomous Communities. Mortality in women also experienced a decrease in mortality in two phases, with a first period from 1999 to 2006 with a fall of -6.8% per year (95% CI -8.6 to -5.0; p<0.001) and a second period from 2006 to 2019 with a decrease in mortality of -2.1% (95% CI -2.8 to -1.3; p<0.001), with again differences between the Autonomous Communities.

CONCLUSION

Mortality rates from COPD have decreased heterogeneously among the different Autonomous Communities in both men and women.

The short- and long-term effects of lower limb endurance training on outpatients with chronic obstructive pulmonary disease

OBJECTIVE

To explore the short- and long-term effects of lower-limb endurance training on chronic obstructive pulmonary disease outpatients.

DESIGN

Prospective quasi-experimental study.

SETTING

1383-bed teaching hospital in Taiwan.

PARTICIPANTS

Overall, 69 outpatients diagnosed with chronic obstructive pulmonary disease were enrolled. A total of 60 patients completed the study.

INTERVENTION

Training group: Lower-limb endurance training; control group: Education only.

MAIN MEASURES

The modified medical research council score, chronic obstructive pulmonary disease assessment test score, pulmonary function test, and number of acute exacerbation within a year.

RESULTS

The training group showed significant improvement in the chronic obstructive pulmonary disease assessment test total score, modified medical research council score (both P < 0.001) at third month sustaining to 12th month (P < 0.001) and presented less events of acute exacerbation (P = 0.011) at 12th month. The chronic obstructive pulmonary disease assessment test decreased by 8 points sustaining to 12th month. The training group presented significant post-training functional capacity improvements in 6-min walking distance, lowest oxygen saturation during 6-min walking test, peak workload, maximum inspiratory/ expiratory pressures, and calf circumference.

CONCLUSIONS

The lower-limb endurance training improved perceived dyspnea in daily activity and health status after completion of training and sustaining for a year. The lower-limb endurance training alleviated disease impacted on reduced acute exacerbations.

Inhaler Adherence in COPD: A Crucial Step Towards the Correct Treatment

COPD is a typical example of chronic disease. As such, treatment adherence tends to be as low as between 30% and 50%, with specific issues in COPD due to the use of inhaled therapies. Decreased adherence in COPD is associated with worse outcomes, with increased risk for exacerbations and long-term mortality. Factors that impact adherence are multiple, some related to patient, some related to clinicians and finally some related to healthcare system. Among clinician factors, prescription of simplified treatment regimens delivered by an inhaler adapted to the patient's characteristics is crucial. Although it has been observed a huge improvement in the design and usability of inhaler devices for COPD in the last two centuries, there is still a clear gap in this field. Smart inhalers as well as simplified treatment regimens could improve adherence and therefore improve long-term outcomes in COPD.