The emerging Chinese COPD epidemic

Development of chronic obstructive pulmonary disease after a tuberculosis episode in a large, population-based cohort from Eastern China

BACKGROUND

Although smoking is considered the primary cause of chronic obstructive pulmonary disease (COPD), there is a growing realization that there may be important secondary risk factors. Tuberculosis may lead to lung impairment; however, whether residual lung damage results in clinically significant, long-term outcomes, independent of smoking, has not been well studied. We aimed to investigate the association between tuberculosis and the subsequent development of COPD using a large, population-based cohort study.

METHODS

We conducted a longitudinal cohort study within the Chinese Electronic Health Records Research in Yinzhou study between 2009 and 2021. We followed participants free of COPD at the beginning of the study, and investigated whether previous or current tuberculosis was an important risk factor. Tuberculosis was recorded based on the Chinese National Disease Reporting system which includes all diagnosed cases at the city, provincial and national levels. We assessed the relationship between tuberculosis and COPD using multivariable survival models, adjusting for demographic and lifestyle characteristics, education level, comorbidities and use of medications.

RESULTS

Among 477 046 participants, 198 882 were eligible for inclusion in our analysis. In a multivariable model, pulmonary tuberculosis and all tuberculosis were associated with a 2.57-fold [95% confidence interval (CI), 2.31-2.87)] and 1.67-fold (95% CI, 1.48-1.90) increased COPD risk, respectively. Stronger associations of pulmonary tuberculosis and all tuberculosis with COPD were seen in participants who were elderly, or with lower body mass index or education level (Pinteraction<0.001). People with tuberculosis were at an increased risk of COPD if they were current smokers [adjusted hazard ratio (aHR), 1.40; 95% CI, 1.02-1.93] or non-smokers (aHR, 1.72; 95% CI, 1.50-1.98).

CONCLUSIONS

Persons who developed tuberculosis were at much greater risk of developing COPD, even accounting for smoking and other potential confounders.

Frequent exacerbators of chronic obstructive pulmonary disease have distinguishable sputum microbiome signatures during clinical stability

INTRODUCTION

Frequent exacerbation phenotype of chronic obstructive pulmonary disease (COPD) represents a more concerning disease subgroup requiring better prevention and intervention, of which airway microbiome provides new perspective for further exploration.

METHODS

To investigate whether frequent exacerbators of COPD have distinguishable sputum microbiome during clinical stability, COPD patients at high disease grades with or without frequent exacerbation were recruited for sputum microbiome analysis. Sputum samples were collected during clinical stability and underwent 16S rRNA sequencing, which was then subjected for amplicon sequence variants (ASVs)-based microbiome analysis.

RESULTS

Our results revealed that compared with healthy controls and infrequent exacerbators, frequent COPD exacerbators have distinguishably dysbiotic sputum microbiome, as featured by fewer ASVs features, lower alpha diversity, distinct beta diversity patterns. Further taxonomic compositional analysis illustrated the structural distinctions between frequent COPD exacerbators and infrequent exacerbators at differential taxa levels and highlighted Stenotrephomonas due to its prominent elevation in frequent COPD exacerbators, providing a promising candidate for further exploration of microbiome biomarker. Moreover, we also demonstrated that frequent exacerbation phenotype is distinguishable from infrequent exacerbation phenotype with respect of functional implications.

CONCLUSION

Our study demonstrated the first positive correlation between the frequent exacerbation phenotype of COPD and the sputum microbiome during clinical stability in a single-center Chinese COPD cohort and provide potential diagnostic and therapeutic targets for further investigation.

Mediated Drug Release from Nanovehicles by Black Phosphorus Quantum Dots for Efficient Therapy of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is an intractable disease involving a sticky mucus layer and nanoagents with mucus-penetrating capability offer a new way to deliver drugs. However, drug release from nanovehicles requires optimization to enhance the therapeutic effects of COPD therapy. Herein, black phosphorus quantum dots (BPQDs) are combined with PEGylated chitosan nanospheres containing the antibiotic amikacin (termed PEG@CS/BPQDs-AM NPs). As a drug-delivery system, the hydrophilicity of PEG and positive charge of CS facilitate the penetration of nanovehicles through the mucus layer. The nanovehicles then adhere to the mucous membrane. Furthermore, the BPQDs degrade rapidly into nontoxic PO₄ ^3- and acidic H⁺ , thereby promoting the dissociation of PEGylated CS nanospheres, accelerating the release of AM, decreasing the vitality of biofilms for ease of eradication. Our results reveal that drug delivery mediated by BPQDs is a feasible and desirable strategy for precision medicine and promising for the clinical therapy of COPD.