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

Associations of anxiety and depression with prognosis in chronic obstructive pulmonary disease: A systematic review and meta-analysis

The associations between anxiety, depression, and the prognosis of COPD remain uncertain. The present study aims to investigate the associations of anxiety and depression with 30-day readmission rates and acute exacerbations of COPD (AECOPD). Four databases were searched to identify relevant studies published before 13 March 2024. Studies that report on the impact of anxiety and depression on the prognosis of AECOPD were included. The pooled effect size and its 95% confidence interval (CI) were calculated using a random effects model. The primary outcomes were 30-day readmission and AECOPD within the first year after discharge in COPD patients. Of the 5,955 studies screened, 14 studies were included in the analysis. Patients with anxiety had a higher risk of AECOPD within the first year after discharge compared to those without anxiety (HR: 2.10, 95% CI: 1.28-3.45, p = 0.003). Patients with depression also had a higher risk of AECOPD within the first year after discharge (HR: 1.36, 95% CI: 1.10-1.69, p = 0.004). Similar results were observed in the associations of anxiety and depression with 30-day readmission. Our results suggested that anxiety and depression were associated with an increased risk of 30-day readmission and AECOPD in patients with COPD.

Vaccination in post-tuberculosis lung disease management: A review of the evidence

INTRODUCTION AND OBJECTIVES

Post-tuberculosis lung disease (PTLD), as other chronic respiratory disorders, may have infectious complications; some of them can be prevented with vaccinations. So far, no document has discussed the potential role of vaccination in PTLD. Therefore, the objective of this review was to describe vaccination recommendations to prevent infections potentially capable of complicating PTLD.

MATERIALS AND METHODS

A non-systematic review of the literature was conducted. The following keywords were used: tuberculosis, vaccination, vaccines and PTLD. PubMed/MEDLINE and Embase were used as the search engine, focusing on English-language literature only.

RESULTS

We identified 9 vaccines potentially useful in PTLD. Influenza, pneumococcal and anti-COVID-19 vaccinations should be recommended. Patients with PTLD can also benefit from vaccination against shingles. Vaccination against pertussis is mainly relevant during childhood. Diphtheria, tetanus and measles vaccination are recommended for general population and should be considered in patients with PTLD not previously vaccinated. Tdap (Tetanus, diphtheria, and pertussis) booster should be repeated in every adult every ten years. Vaccination against BCG retains its importance during early childhood in countries where TB is endemic.

CONCLUSIONS

Vaccination deserves to be considered among the strategies to prevent and/or mitigate PTLD complications. Further evidence is necessary to better understand which vaccines have the greatest impact and cost-benefit.

Identification of genetic variants of the IL18R1 gene in association with COPD susceptibility

BACKGROUND

Although existing studies have identified some genetic loci associated with chronic obstructive pulmonary disease (COPD) susceptibility, many variants remain to be discovered. The aim of this study was to further explore the potential relationship between IL18R1 single nucleotide polymorphisms (SNPs) and COPD risk.

METHODS

Nine hundred and ninety-six subjects were recruited (498 COPD cases and 498 healthy controls). Five candidate SNPs of IL18R1 were selected and genotyped using MassARRAY iPLEX platform. Logistic regression analysis was performed to assess the association of these SNPs with COPD risk. Multifactor dimensionality reduction (MDR) software was applied to calculate the interaction of SNP-SNP on COPD risk.

RESULTS

IL18R1 rs9807989 (OR = 0.42, p < .001), rs3771166 (OR = 0.40, p < .001) and rs6543124 (OR = 0.44, p < .001) were associated with the reduced COPD risk, while rs2287037 (OR = 2.71, p < .001) and rs2058622 (OR = 2.06, p < .001) might be the risk-increasing factor for COPD occurrence in both the overall analysis and subgroup analysis (age, gender, drinking, and smoking). The best multi-locus model was the combination of rs2058622 and rs3771166.

CONCLUSION

Our study provided a reference and basis for investigating the association of IL18R1 polymorphisms with COPD risk.

Knowledge Domain and Emerging Trends in the Treatment of Patients with Chronic Obstructive Pulmonary Disease Combined with Respiratory Failure: A Scientometric Review Based on CiteSpace Analysis

OBJECTIVE

To analyze the status of research on treating chronic obstructive pulmonary disease (COPD) combined with respiratory failure internationally to reveal its development trends through visualization methods and to provide a reference and suggestions for future research directions.

METHODS

Literature on the treatment of COPD combined with respiratory failure published from the year of inception of the Web of Science database to December 31, 2023, was searched. CiteSpace 6.2.R7 software was used to visualize and analyze the published articles. A bibliometric analysis of the publications, keyword co-occurrence analysis, keyword clustering analysis, and keyword emergence analysis were performed to draw a correlation map and analyze the results.

RESULTS

A total of 369 articles were analyzed. An overall increasing trend was observed in the number of publications. The network of researchers was relatively dense, and a core team was clearly observed. The researchers' affiliations were mainly European universities and hospitals, and close cooperation between institutions was observed. The keyword analysis obtained high-frequency keywords such as "noninvasive ventilation", "mechanical ventilation", and "positive pressure ventilation". The keyword clustering analysis revealed 10 clusters, and the keyword emergence analysis yielded 20 keywords.

CONCLUSIONS

The focus of attention internationally has been on respiratory failure classification and types of ventilation support, such as high-flow oxygenation and noninvasive positive pressure ventilation. Future directions should include clinical research on high-flow oxygen administration to improve patient prognosis and the application of extracorporeal carbon dioxide removal technology to enhance patients' quality of life.

A Systematic Review and Meta-Analysis on the Safety and Efficacy of Rosuvastatin as an Adjunctive Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Purpose

Acute exacerbations of chronic obstructive pulmonary disease (COPD) severely impact patient health, and current treatments often fail to adequately control inflammation and lung function decline. Statins have shown potential in managing AECOPD. This study conducts a systematic review and meta-analysis to evaluate the effects of rosuvastatin, aiming to provide precise treatment recommendations.

Research methods

Using "Pulmonary Disease, Chronic Obstructive" and "Rosuvastatin Calcium" as MeSH terms, randomized controlled trials (RCTs) evaluating the efficacy and safety of rosuvastatin in AECOPD patients were retrieved from databases including PubMed, EMBASE, the Cochrane Library, Sinomed, CNKI, WanFang Data, and QIVIP. The search period extended through September 15, 2024. Two researchers independently screened the literature, extracted data, and assessed the risk of bias in the included studies. Meta-analysis was performed using RevMan 5.3 software, while sensitivity analyses and publication bias tests were conducted with Stata 17.0.

Results

Eleven RCTs involving 911 patients were included, with a certain risk of bias. Rosuvastatin was found to improve forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and peak expiratory flow (PEF). Additionally, it significantly reduced levels of hs-CRP, TNF-α, IL-6, IL-8, NE, and Gal-3.

Conclusion

Despite the limited number of studies and potential bias, evidence suggests that rosuvastatin improves lung function and reduces inflammation in AECOPD, underscoring its potential value and emphasizing the need for further high-quality research.

Characteristics of Older Individuals with Asthma Being Treated with Biologics

Purpose

Biologic (antibody) therapy is a safe, effective, and guideline-recommended treatment for patients with severe and otherwise uncontrolled asthma. The number of older individuals with asthma is increasing but there is a lack of data on the use of biologics in this cohort. Therefore, this study reports the characteristics of older individuals receiving biologic therapy for severe asthma.

Patients and Methods

This study was a retrospective data analysis conducted at two centers in Germany.

Results

Eighty-eight patients were included (52 aged 50-59 years and 36 aged ≥60 years). There was a high rate of comorbidities and associated pharmacological therapy use. Nearly half (49%) of participants were current or ex-smokers and 29% had chronic obstructive pulmonary disease. The older age group (≥ 60 years) had significantly more cardiovascular comorbidities, more comorbidities overall, and a worse diffusion capacity compared with the group aged 50-59 years. Baseline lung function parameters, and the change in lung function after 6 months of biologic therapy, did not differ significantly between the two age groups. Participants aged ≥60 years used self-injection less than those aged 50-59 years.

Conclusion

These data help to characterize the specific population of older people receiving biologic therapy for severe asthma, and showed a high rate of comorbidities, polypharmacy, and poor diffusion capacity in this group.

Burden of Exacerbations in Patients Newly Initiating an Inhaled Regimen for COPD: A Claims Analysis

Background

Chronic obstructive pulmonary disease (COPD) is a progressive disease that has a great impact on healthcare resource utilization (HRU). Large-scale real-world evidence studies evaluating the clinical and economic impact of current maintenance inhaler therapies are scarce.

Objective

To assess annual exacerbation rate and COPD-related HRU in patients with COPD before and after initiation of an inhaled treatment regimen.

Methods

The Optum Clinformatics® Data Mart database was used to identify inpatient, outpatient, and pharmacy claims from patients aged ≥40 years with COPD in the United States from January 2016 to June 2023. The index date was the date of the first prescription claim for a new inhaled maintenance therapy after a 12-month maintenance treatment-free baseline period. The primary outcome was the proportion of patients with ≥1 moderate/severe exacerbation within 12 months post-index. The average number of moderate/severe exacerbations per patient and the proportion of patients with inpatient, emergency department (ED), office, and outpatient visits within 12 months post-index were also assessed.

Results

Of the 137,691 included patients, 51.5% were female and 74.6% were White, with a mean (standard deviation [SD]) age of 70.9 (9.49) years and a mean (SD) Elixhauser Comorbidity Index of 5.67 (3.29). Most (48.3%) patients were initiated on long-acting beta-agonists/inhaled corticosteroids (LABA/ICS). The proportions of patients with exacerbations significantly decreased overall (pre-index, 45.5%; post-index, 37.0%; P < 0.001). However, more than one-third of patients still experienced an exacerbation 12 months after initiating treatment. The proportion of patients with COPD-related HRU generally decreased; however, 5.0% and 2.9% of patients had inpatient and ED care post-index, respectively.

Conclusion

Despite use of inhaled treatments for COPD, patients continue to experience exacerbations and HRU. Better implementation of guideline-based COPD care and novel therapies for persistent exacerbation burden are needed to improve care of the COPD population in real-world settings.

Prediction of potential active ingredients and mechanism of Forsythia suspense leaf green tea extract in treating COPD mice based on UPLC-MS and network pharmacology

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease and the third leading cause of death worldwide, with chronic inflammation as its primary pathogenesis. The dried leaves of Forsythia suspensa (Thunb.) have anti-inflammatory pharmacological activity and potential clinical promise for the treatment of COPD; however, its pharmacodynamic activity and mechanism of action remain to be clarified.

RESULTS

In total, 82 compounds were identified from F. suspense leaf green tea extract (STW), mainly lignans, flavonoids, phenolic acids and phenylethanol glycosides, were identified in STW. STW alleviates enlargement of the alveolar sac and cavity, thickening of the alveolar wall and infiltration of inflammatory cells in COPD mice. In the model group, the contents of interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-8, IL-1β and malondialdehyde were decreased, and the levels of superoxide dismutase and catalase were increased in a dose-dependent manner (P < 0.05). Network pharmacological analysis identified 19 active STW components and 81 potential targets for the treatment of COPD. The key components include quercetin, ferulic acid, phillygenin, rutin and phillyri, whereas the core targets included TNF, protein kinase B alpha, epidermal growth factor receptor and metalloproteinase-9. Mainly through phosphatidylinositol 3-kinase/protein kinase B, calcium ions, nuclear factor-kappa B and other signaling pathways.

CONCLUSION

STW affects multiple pathways and targets in the treatment of COPD, and mainly plays a role in alleviating pulmonary inflammation. © 2025 Society of Chemical Industry.

Association of early enoxaparin prophylactic anticoagulation with ICU mortality in critically ill patients with chronic obstructive pulmonary disease: a machine learning-based retrospective cohort study

Background

Chronic obstructive pulmonary disease (COPD) is a major contributor to global morbidity and mortality, particularly during acute exacerbations that frequently require intensive care unit (ICU) admissions. Considering the hypercoagulability associated with COPD, which intensifies during acute episodes, prophylactic anticoagulation therapy may help reduce ICU mortality. However, this potential has not been explored specifically in this population of patients.

Methods

We conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care IV, spanning patient records from 2008 to 2019 at the Beth Israel Deaconess Medical Center in Boston. This study focused on critically ill patients with COPD, employing feature selection methods, to identify key variables influencing clinical outcomes. The impact of prophylactic enoxaparin on prognosis was assessed using logistic regression models and Kaplan-Meier survival analysis.

Results

Our analysis included 4,433 critically ill patients with COPD, of whom 446 received enoxaparin within the first 72 h of ICU admission. The primary analysis showed that patients treated with enoxaparin experienced a 48% lower ICU mortality (odds ratio 0.52 [95% confidence interval 0.31-0.86]) than that of those not treated with enoxaparin, with an E-value of 3.26. This association between enoxaparin use and lower ICU mortality persisted across all subgroups examined. Additionally, a visual analysis of patients with varying Oxford acute severity of illness score (OASIS) indicated that early enoxaparin use was linked to an improved prognosis in critically ill patients with COPD who had higher OASIS than in those without.

Conclusion

Early initiation of prophylactic enoxaparin therapy was significantly associated with low ICU mortality in critically ill patients with COPD, especially in high-risk subgroups. These findings support the need for randomized controlled trials to confirm the effectiveness of thromboprophylaxis in this specific patient population and to evaluate the potential bleeding risks.

Triglyceride-glucose index as an independent predictor of mortality in patients with chronic respiratory diseases

Objective

The consequences of chronic pulmonary illness are known to exacerbate in individuals with metabolic syndrome and insulin resistance. However, the relationship between triglyceride-glucose (TyG) index, a reliable alternative biomarker of metabolic dysfunction, and chronic respiratory diseases (CRDs) are inconclusive.

Research design and methods

Our research involved a total of 7,819 adult individuals diagnosed with CRDs who participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018. To assess the correlation between the TyG index and survival rates, we employed multivariable weighted Cox regression analysis, smoothing curve fitting, survival curve analysis and subgroup analysis to investigate the relationship.

Results

Higher TyG index among CRDs shown a substantial positive correlation with all-cause mortality after controlling for relevant confounders. The restricted cubic spline analysis showed a nonlinear relationship between the TyG score and all-cause mortality in CRDs. Patients with higher TyG indexes had a greater risk of all-cause mortality according to Kaplan-Meier survival curves.

Conclusion

The clinical relevance of the TyG index in predicting the life expectancy of individuals with CRDs is highlighted by our research. The TyG index can serve as a substitute biomarker for monitoring the wellbeing of the individuals with CRDs.

SERPINB10 promotes macrophage M2 polarization and airway inflammation in asthma

BACKGROUND

Macrophage M2 polarization plays a critical role in type 2 airway inflammation in asthma. We previously reported that serine peptidase inhibitor, clade B, member 10 (SERPINB10) promotes airway eosinophilic inflammation in asthma.

OBJECTIVE

To investigate the role of SERPINB10 in macrophage M2 polarization and airway inflammation in asthma.

METHODS

The expression of SERPINB10 was detected in bronchoalveolar lavage (BAL) cells from 15 control subjects and 36 asthma patients. Serpinb10 knockout mice and wild type mice were sensitized and challenged with ovalbumin (OVA). Macrophage polarization and airway inflammation were evaluated. An adoptive transfer experiment of Serpinb10-deficient macrophages to macrophage-depleted mice was performed to assess the effect of Serpinb10 deficiency in macrophages on the airway inflammation in the model. The role of SERPINB10 in the activation of IL-4 receptor (IL-4R) signaling pathway and macrophage M2 polarization was investigated in cell cultures.

RESULTS

SERPINB10 expression was markedly elevated in BAL cells from asthmatic patients, and was significantly correlated with fractional exhaled nitric oxide and CD206, a marker for macrophage M2 polarization. In the OVA-induced allergic airway inflammation mouse model, Serpinb10 deficiency significantly inhibited airway inflammation, mucous cell metaplasia and airway hyperresponsiveness. Moreover, Serpinb10 deficiency suppressed the expression of M2 markers including Cd206, Arg1 in mouse lung tissues and the protein levels of M2 macrophage effector cytokines including Ccl17 and Ccl22 in BAL fluid. Adoptive transfer of Serpinb10-deficient bone marrow-derived macrophages (BMDMs) to wild type mice depleted macrophages significantly suppressed the airway inflammation and mucous cell metaplasia. Mechanistically, SERPINB10 suppresses the degradation of IL-4Rα in macrophages, thereby upregulating the phosphorylation of Stat6 and Akt and leading to macrophage M2 polarization.

CONCLUSIONS

SERPINB10 promotes macrophage M2 polarization by suppressing IL-4Rα degradation and upregulating IL-4R signaling. SERPINB10 is a potential therapeutic target for asthma.

Nasopharyngeal microbiota is influenced by agricultural air pollution in individuals with and without COPD

Respiratory health in chronic obstructive pulmonary disease (COPD) is influenced by environmental factors such as air pollution, yet the role of the airway microbiota in this relationship remains unclear. We investigated the association between exposure to air pollution from livestock farms and the nasopharyngeal microbiota in individuals with COPD compared to healthy control subjects. The study included nasopharyngeal swabs from 186 currently non-smoking participants in the Netherlands, including 65 individuals with COPD and 121 without from a regional rural cohort. Additionally, 116 individuals from a population-wide cohort were included as national controls. Samples were taken at three time points over 12 weeks. The nasopharyngeal microbiota was studied using 16 S rRNA gene-based sequencing for all baseline samples and a random selection of 6-weeks and 12-weeks samples. Dispersion models were used to determine the average concentrations of livestock-related PM10, endotoxin, and ammonia at the participants' home addresses. Individuals with COPD had a higher absolute abundance of anaerobic bacteria, such as Peptoniphilus, Anaerococcus, Finegoldia magna, and Prevotella. Importantly, residential exposure to ammonia was identified as the most important driver of the microbial community composition, explaining 6.6% of the variation in nasopharyngeal microbiota in individuals with COPD. Higher ammonia concentrations were associated with decreased levels of key commensals and increased abundance of anaerobic bacteria. Furthermore, individuals living in areas with high livestock density exhibited greater microbial diversity compared to the broader national population. The study highlights the influence of residential exposure to livestock-related air pollution, particularly ammonia, on nasopharyngeal microbiota composition in individuals with COPD. Our findings suggest that environmental factors significantly impact microbial communities and underscore the potential role of anaerobic bacteria in COPD pathology. Future research should further investigate the mechanisms by which environmental air pollutants affect microbial communities and explore potential interventions to mitigate their effects on respiratory health.

Bisoprolol for patients with chronic obstructive pulmonary disease at high risk of exacerbation: the BICS RCT

Background

Observational studies of people with chronic obstructive pulmonary disease using beta-blockers for cardiovascular disease indicate that beta-blocker use is associated with reduced risk of chronic obstructive pulmonary disease exacerbation. However, at the time this study was initiated, there had been no randomised controlled trials confirming or refuting this.

Objective(s)

To determine the clinical and cost-effectiveness of adding bisoprolol (maximal dose 5 mg once daily) to usual chronic obstructive pulmonary disease therapies in patients with chronic obstructive pulmonary disease at high risk of exacerbation.

Design

A multicentre, pragmatic, double-blind, randomised, placebo-controlled clinical trial.

Setting

Seventy-six United Kingdom primary and secondary care sites.

Participants

People aged ≥ 40 years with a diagnosis of at least moderately severe chronic obstructive pulmonary disease with a history of at least two exacerbations in the previous year.

Interventions

Participants were randomised (1 : 1) to receive either bisoprolol or placebo for 1 year. During a 4- to 7-week titration period, the maximum tolerated dose was established (1.25 mg, 2.5 mg, 3.75 mg, 5 mg once daily).

Primary outcome

A number of participant-reported exacerbations during the 1-year treatment period.

Results

In total, 519 participants were recruited and randomised. Four post-randomisation exclusions left 259 in the bisoprolol group and 256 in the placebo group. Treatment groups were balanced at baseline: mean (standard deviation) age 68 (7.9) years; 53% men; mean (standard deviation) pack year smoking history 45 (25.2); mean (standard deviation) 3.5 (1.9) exacerbations in previous year. Primary outcome data were available for 99.8% of participants (bisoprolol 259, placebo 255). The mean (standard deviation) number of exacerbations was 2.03 (1.91) in the bisoprolol group and 2.01 (1.75) in the placebo group (adjusted incidence rate ratio 0.97, 95% confidence interval 0.84 to 1.13), p = 0.72. The number of participants with serious adverse events was similar between the two groups (bisoprolol 37, placebo 36). The total number of adverse reactions was also similar between the two groups. As expected, bisoprolol was associated with a higher proportion of vascular adverse reactions (e.g. hypotension, cold peripheries) than placebo, but was not associated with an excess of other adverse reactions, including those classified as respiratory. Adding bisoprolol resulted in a statistically insignificant trend towards higher costs (£636, 95% confidence interval £118 to £1391) and fewer quality-adjusted life-years (0.035, 95% confidence interval 0.059 to 0.010) compared to placebo.

Limitations

The study findings should be interpreted with caution as the target sample size of 1574 was not achieved because the funder considered the study to be unviable in the COVID-19 pandemic clinical research environment. Although 28% of participants did not initiate bisoprolol/placebo (1.6%) or ceased during the treatment period (26.2%), this is consistent with similar trials in the United Kingdom.

Conclusions

In this underpowered study, the addition of bisoprolol to usual chronic obstructive pulmonary disease treatment did not reduce the likelihood of exacerbations, and bisoprolol cannot be recommended as a treatment for chronic obstructive pulmonary disease.

Future work

To incorporate definitive statements into appropriate clinical guidelines about the safety of bisoprolol for cardiovascular indications in people with chronic obstructive pulmonary disease.

Trial registration

This trial is registered as ISRCTN10497306.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/130/20) and is published in full in Health Technology Assessment; Vol. 29, No. 17. See the NIHR Funding and Awards website for further award information.

Longitudinal trajectories of tobacco and alcohol use following first or consecutive admissions for respiratory diseases

BACKGROUND

Smoking and alcohol use worsen Chronic Respiratory Diseases (CRD). Smoking cessation is a cornerstone of treatment. We aim to describe the trajectories of alcohol and tobacco use in patients admitted due to first (FE) or consecutive episodes (CE) of CRD.

METHODS

This prospective study assessed tobacco and alcohol use in 219 patients upon admission for CRD and one year later. Generalized multilevel mixed-effect models analyzed changes within and between groups.

RESULTS

Significant differences between groups were observed in tobacco use prevalence (p = 0.001) and quantity (p = 0.009). Although overall tobacco use prevalence remained stable over time (p = 0.08) and no significant group-by-time interaction was found, weekly cigarette consumption decreased over time (from 32.1 to 19.7 in FE, 15.5 to 4.9 in CE) (p = 0.009). Alcohol use prevalence remained at approximately 50% in both groups and time points. The number of standard drink units per week (SDU)/week showed significant group effects (p = 0.03).

CONCLUSIONS

Admission for a respiratory event alone is not sufficient to induce smoking cessation in many patients. Alcohol use prevalence remains high without significant changes. This gap could be reversed by implementing integrated brief interventions based on motivational interviewing for these patients.

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.

Interleukin-35 inhibits NETs to ameliorate Th17/Treg immune imbalance during the exacerbation of cigarette smoke exposed-asthma via gp130/STAT3/ferroptosis axis

Cigarette smoke (CS) exposure amplifies neutrophil accumulation. IL-35, a novel cytokine with anti-inflammatory properties, is involved in protection against asthma. However, the biological roles of neutrophils and the precise molecular mechanisms of IL-35 in CS exposed-asthma remain unclear. We showed that the exacerbation of CS exposed-asthma leads to dramatically increased neutrophil counts and an imbalance in DC-Th17/Treg immune responses. RNA sequencing revealed that NETs, part of a key biological process in neutrophils, were significantly upregulated in the context of CS exposed-asthma exacerbation and that IL-35 treatment downregulated NET-associated gene expression. Targeted degradation of NETs, rather than neutrophil depletion, alleviated the CS exposed-asthma. Mechanistically, STAT3 phosphorylation promoted ferroptosis, exacerbating NET release, which in turn enhanced dendritic cell (DC) antigen presentation, activated T cells, and specifically promoted Th17 cell differentiation while inhibiting Treg cells. IL-35 acting on the gp130 receptor alleviated STAT3-mediated ferroptosis-associated NET formation. In summary, our study revealed a novel mechanism by which IL-35 inhibited NET formation, subsequently alleviating neutrophilic inflammation and restoring the DC-Th17/Treg imbalance in CS exposed-asthma, highlighting the potential of IL-35 as a targeted therapeutic strategy.

Cyclic nucleotide phosphodiesterases as drug targets

Cyclic nucleotides are synthesized by adenylyl and/or guanylyl cyclase, and downstream of this synthesis, the cyclic nucleotide phosphodiesterase families (PDEs) specifically hydrolyze cyclic nucleotides. PDEs control cyclic adenosine-3',5'monophosphate (cAMP) and cyclic guanosine-3',5'-monophosphate (cGMP) intracellular levels by mediating their quick return to the basal steady state levels. This often takes place in subcellular nanodomains. Thus, PDEs govern short-term protein phosphorylation, long-term protein expression, and even epigenetic mechanisms by modulating cyclic nucleotide levels. Consequently, their involvement in both health and disease is extensively investigated. PDE inhibition has emerged as a promising clinical intervention method, with ongoing developments aiming to enhance its efficacy and applicability. In this comprehensive review, we extensively look into the intricate landscape of PDEs biochemistry, exploring their diverse roles in various tissues. Furthermore, we outline the underlying mechanisms of PDEs in different pathophysiological conditions. Additionally, we review the application of PDE inhibition in related diseases, shedding light on current advancements and future prospects for clinical intervention. SIGNIFICANCE STATEMENT: Regulating PDEs is a critical checkpoint for numerous (patho)physiological conditions. However, despite the development of several PDE inhibitors aimed at controlling overactivated PDEs, their applicability in clinical settings poses challenges. In this context, our focus is on pharmacodynamics and the structure activity of PDEs, aiming to illustrate how selectivity and efficacy can be optimized. Additionally, this review points to current preclinical and clinical evidence that depicts various optimization efforts and indications.

The management of type 2 inflammatory respiratory diseases: a Chinese expert consensus [2024]

Background

Type 2 (T2) inflammatory respiratory diseases encompass a range of conditions characterized by inflammation affecting the airways and lung parenchyma, with their pathogenesis rooted in T2 inflammation. Biological treatments that mitigate T2 inflammation revolutionize the therapeutic landscape for these respiratory diseases. However, there are decision-making difficulties in terms of the target population, timing of initiation, and type selection for biological targeted therapy.

Methods

Search strategies were focused on relevant issues related to T2 inflammatory respiratory diseases from PubMed with search date from 2014 to 2024. The quality of evidence and grading recommendations were assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Consensus was achieved through two rounds of anonymous voting with a strong recommendation demanding at least 70% approval from the participants.

Results

A total of 370 basic research results and clinical evidence-based medical data were collected and reviewed. The latest research advances, clinical evidence, and expert insights relating to the use of biological treatments aiming at T2 inflammation in respiratory diseases and their co-morbidities were discussed rigorously and iteratively by an expert panel, and a consensus report with recommendations is presented.

Conclusions

This consensus outlines the pathogenesis, assessment of T2 inflammation, biological therapies targeted at T2 inflammation, and management strategies for T2 inflammatory respiratory diseases and their comorbidities. It will serve as a valuable guide for clinicians in China, empowering them to diagnose and manage these conditions more effectively.

Senolytic therapy reduces inflammation in epithelial cells from COPD patients and in smoke-exposure mice

Introduction

Chronic obstructive pulmonary disease (COPD) is a disease of accelerated lung aging, with increased numbers of senescent cells found within the COPD Lung. Senescent cells may drive pathology by causing defective tissue repair and driving chronic inflammation via the release of inflammatory mediators known as the senescence-associated secretory phenotype (SASP). Senolytics are a new class of drugs that selectively remove senescent cells but have not previously been studied in COPD. We examined whether senescent cells are maintained during differentiation of COPD airway epithelial cells at the air-liquid interface and examined the role of the senolytic combination of dasatinib and quercetin on these cells and in a smoke-exposure mouse model.

Methods

Non-smoker and COPD bronchial epithelial cells were differentiated at air-liquid interface (ALI). Senescence markers (p16INKA and p21WAF1) were determined using Western blotting and SASP factors via Olink proteomics and Meso Scale Diagnostics (MSD). Cells and 11 days cigarette smoke (CS)-exposed mice were treated with the senolytic cocktail of dasatinib and quercetin (D + Q).

Results

Increased senescence markers were maintained in COPD ALI epithelium when differentiated at air-liquid interface, and treatment with D + Q reduced senescence markers, proteases, and Th2 cytokines. Therapeutic oral treatment of D + Q to CS-exposed mice reduced senescence burden while reducing inflammatory cell infiltrates and mouse CXCL1.

Conclusion

COPD subjects show increased airway epithelial senescence, and these cells can be cleared therapeutically using the senolytic cocktail of D + Q, reducing broad-spectrum pulmonary inflammation in vitro and in vivo.

Association of Preserved Ratio Impaired Spirometry and Mortality Outcomes Compared With Normal Spirometry: A Meta-Analysis

Background: One of the leading causes of death in the United States is chronic lung disease, with COPD being the most common. One of the hallmarks of COPD is spirometric obstruction as evidenced by a reduced FEV1/FVC ratio. Preserved ratio impaired spirometry (PRISm) is a spirometric pattern characterized as a low FEV1 coupled with a preserved FEV1/FVC ratio. This systematic review and meta-analysis sought to understand better the relationship between PRISm and cardiovascular, respiratory, and all-cause mortality. Methods: We systematically searched PubMed and clinicaltrials.gov for articles published between 2014 and 2023, providing data regarding the association of PRISm compared with normal spirometry in terms of morality outcomes. The generic inverse variance method was used to assess the pooled hazard ratio value at a 95% CI, and forest plots were created using RevMan for analysis. P < .05 was considered to be significant. Results: Our analysis included 690,015 subjects from four prospective studies and three retrospective studies. The pooled hazard ratio for all-cause, cardiovascular, and respiratory-related mortality was 1.70, 1.95, and 5.70 for all prospective studies, respectively, and 1.62, 1.66, and 3.35, in combined prospective and retrospective studies, respectively, which were statistically significant in the random effect model (P < .001). However, 76% heterogeneity was observed in respiratory-related mortality (P = .009). After excluding studies associated with publication bias, a "leave-out" sensitive analysis resulted in a significant pooled hazard ratio of 1.98 with a high significance (P < .001). Conclusions: PRISm, often labeled as GOLD-U, is associated with mortality outcomes and should not be overlooked while treating patients with chronic lung diseases. This meta-analysis provides a stronger correlation of PRISm with all-cause mortality, cardiovascular mortality, and respiratory mortality compared with normal spirometry.

Correlation between self-management, psychological cognitive impairment, and quality of life in elderly chronic obstructive pulmonary disease patients

BACKGROUND

The correlation conclusions between self-management, frailty, and quality of life (QoL) of chronic obstructive pulmonary disease (COPD) patients are inconsistent.

AIM

To comprehensively assess the current status of self-management, psychological cognitive impairment, and QoL in elderly patients with COPD.

METHODS

Convenient sampling was employed to select 312 elderly patients with COPD who were receiving treatment in the respiratory and critical care medicine department of a tertiary grade A hospital from November 2023 to February 2024. The study utilized demographic information and clinical characteristics, self-management behavior, occurrence of psychological cognitive impairment, and QoL as evaluated through general information questionnaires, the COPD patient self-management scale, simple frailty scale, simple mental status scale, clinical dementia assessment scale, and the clinical COPD assessment test questionnaire. This research aims to describe the current status and correlations among self-management behavior, cognitive impairment occurrence, and QoL.

RESULTS

The average score for self-management behavior in elderly COPD patients was 136.00 (119.00, 164.50), indicating a moderate level overall. There were 98 cases of cognitive impairment, accounting for 31.4%, with a mental status score of 3 (2, 3.75). The average QoL score was 24 (19, 28), indicating a low level. Additionally, there was a negative correlation between total self-management behavior score and cognitive impairment occurrence (r = -0.589, P < 0.001), and QoL total score (r = -0.409, P < 0.001). Cognitive impairment occurrence was positively correlated with QoL total score (r = 0.345, P < 0.001). Disease course and self-management behavior score were independent factors affecting the total QoL score in elderly COPD patients (P < 0.05).

CONCLUSION

The self-management behavior of elderly patients with COPD is at a moderate level. However, the occurrence of cognitive impairment is high and significantly influenced by disease course, level of self-management, and mental status. The QoL is low, emphasizing the urgent need to intervene in the self-management behaviors of elderly COPD patients, actively reduce the occurrence of cognitive impairment, and mitigate the impact of the disease on QoL.

Identification and validation of differentially expressed genes in allergic asthma pathogenesis using whole-transcriptome sequencing

Objective

This study aims to systematically identify differential gene expression profiles in patients with allergic asthma through whole-transcriptome sequencing and validate the role of these genes in asthma pathogenesis, thereby uncovering potential molecular mechanisms.

Methods

This study recruited a cohort of 80 individuals diagnosed with allergic asthma and 40 healthy controls. RNA was extracted from both peripheral blood and airway samples, and sequencing was performed using the Illumina NovaSeq 6000 platform. Potential differential genes were confirmed through three independent techniques to validate the findings: quantitative reverse transcription polymerase chain reaction (qRT-PCR), immunohistochemistry, and Western blot analysis. Differential gene expression was analyzed using DESeq2 software, providing a rigorous statistical framework for RNA-Seq data interpretation. Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were employed to elucidate the biological significance of the differentially expressed genes, offering insights into the molecular mechanisms underlying allergic asthma.

Results

Differential expression analysis identified multiple genes with significant differences between the patient and control groups. Inflammatory-related genes such as IL1B, CCL17, and MUC5AC were significantly upregulated in the patient group (p < 0.05), while regulatory immune factors such as FOXP3 and IFNG showed significantly higher expression in the control group (p < 0.05). Functional enrichment analysis indicated that the differential genes were mainly enriched in immune response, T-cell activation, and MAPK signaling pathways. Experimental validation demonstrated consistency between transcriptomic data and RNA and protein expression levels, further supporting the involvement of these genes in asthma.

Conclusion

Differential gene expression profiles play a crucial role in the pathogenesis of asthma. This study provides important evidence for understanding the molecular mechanisms of asthma and developing novel targeted therapeutic strategies.

PM2.5 increases the risk of early-onset COPD mediated by smoking and shared genes: a large-scale genetic analysis

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality worldwide. However, whether air pollutants can cause COPD remains unknown. Summary data for the genome-wide association study of each phenotype were obtained from the publicly available datasets. Using single-nucleotide polymorphisms as instrumental variables, we performed Mendelian randomization (MR) to assess the relationship among PM2.5, smoking and early-onset COPD. A large-scale genetic analysis is performed to investigate the biological pathways. In MR, exposure to higher PM2.5 increased the risk of early-onset COPD (IVW, OR (95% CI) = 1.63 (1.15, 2.31), p = 5.60E-03) but had no association with later-onset COPD. In addition, cigarettes per day (IVW, OR (95% CI) = 1.71 (1.46, 1.99), p = 1.60E-11) was positively associated with the risk of early-onset COPD, while age of smoking initiation (IVW, OR (95% CI) = 0.39 (0.27, 0.57), p = 1.21E-06) had a negative effect. In addition, two smoking behaviors could be mediators between PM2.5 and early-onset COPD (p < 0.05). Furthermore, 136 significantly enriched biological pathways of PM2.5 potentially causing early-onset COPD were identified in a large-scale genetic analysis. This study provides strong evidence that exposure to higher PM2.5 was causally associated with smoking behavior and early-onset COPD. Smoking behavior acted as a mediator between PM2.5 and early-onset COPD. More attention should be given to people exposed to higher PM2.5 for the prevention of smoking and COPD.

Budesonide/formoterol turbuhaler vs pMDI salbutamol for acute asthma in outpatient emergency department: a prospective, randomized, open-label study

BACKGROUND

The Global Initiative for Asthma (GINA) has suggested the need for more studies on inhaled corticosteroid (ICS)-formoterol in the Emergency Department (ED).

OBJECTIVES

We aimed to compare the outcomes of budesonide/formoterol (160/4.5 mcg/inhalation) turbuhaler versus pressurized metered-dose inhaler (pMDI) salbutamol (100 mcg/puff) in acute asthma in the outpatient ED.

METHODS

This single-centre, prospective, randomized, and open-label study involved adult asthma patients with mild to moderate asthma exacerbation who attended the outpatient ED of a tertiary hospital in Malaysia. The intervention arm received budesonide/formoterol (Symbicort® 160/4.5 mcg) turbuhaler, while the control arm received pMDI salbutamol with a valved holding chamber. Stratified randomization with variable baseline ICS use was employed. Direct discharge rate from outpatient ED was the primary outcome. Vital signs pre- and post-treatment between the two arms were also compared.

RESULTS

Seventy-four (n = 37 for each arm) asthma patients were recruited. Baseline clinical characteristics were comparable between the two arms. Direct discharge rates from ED were comparable between the intervention (94.6%) and the control (91.9%) arms (p = 1.000). Post-treatment outcomes (respiratory rate, oxygen saturation, peak expiratory flow rate) were similar between the two arms, except for the higher increment of heart rate (p < 0.001) and lesser reduction of blood pressure in the control arm (p = 0.013). Intravenous hydrocortisone use was significantly higher in the control arm (n = 19, 51.4%) than in the budesonide/formoterol arm (n = 6, 16.2%) (p = 0.001).

CONCLUSION

Budesonide/formoterol turbuhaler is as effective as pMDI salbutamol in treating asthma exacerbation in the outpatient ED with less effect on heart rate and lower usage of intravenous corticosteroids.

Global, regional and national temporal trends in Parkinson's disease incidence, disability-adjusted life year rates in middle-aged and older adults: a cross-national inequality analysis and Bayesian age-period-cohort analysis based on the global burden of disease 2021

BACKGROUND

Parkinson's disease (PD) ranks as the second most prevalent neurodegenerative disorder; however, its epidemiological characteristics among middle-aged and older adults at global, regional, and national levels remain inadequately documented.

METHODS

This study assessed temporal trends in PD among middle-aged and older adults by extracting incidence rates, disability-adjusted life year (DALY) rates, and corresponding age-specific rates (ASRs) from the Global Burden of Disease (GBD) database spanning 1990 to 2021. Estimated annual percentage change (EAPC) was employed to analyze trends over the past 30 years. The slope index of inequality (SII) and concentration index (CI) were utilized to evaluate disparities in the burden of PD across various countries. Additionally, Bayesian age-period-cohort (BAPC) modeling was applied to project DALY figures for the next 15 years.

RESULTS

In 2021, the global incidence and DALY rates for middle-aged and older adults with PD stood at 79.68 and 477.50 cases per 100,000 population, respectively. Both incidence and DALY rates have exhibited an upward trajectory over the past 32 years, with EAPCs of 1.2 (95% UI: 1.1-1.3) and 0.6 (95% UI: 0.5-0.7), respectively. Among the five sociodemographic index (SDI) regions, the high-middle SDI region reported the highest incidence and DALY rates for PD in 2021, at 93.93 and 512.29 cases per 100,000 population, respectively. A positive correlation was observed between the SDI and age-specific incidence rate (ASIR) as well as age-specific DALY rate (ASDR). Disparities in the burden of PD among middle-aged and older adults, associated with SDI, are on the rise and are primarily concentrated in high SDI countries. It is projected that the global incidence and DALY rates for middle-aged and older adults with PD will experience significant increases over the next 15 years.

CONCLUSIONS

The global burden of PD among middle-aged and older adults has markedly escalated over the past 32 years, particularly in high-middle SDI regions. These findings underscore the necessity for the development of effective interventions and public health policies, contributing to the attainment of the sustainable development goals established by the World Health Organization (WHO).

The Direct and Indirect Role of IgE on Airway Epithelium in Asthma

Asthma is a chronic airway inflammatory disorder, affecting over 350 million people worldwide, with allergic asthma being the most common form of the disease. Allergic asthma is characterized by a type 2 (T2) inflammatory response triggered by numerous allergens beginning in the airway epithelium, which acts as a physical barrier to allergens as well as other external irritants including infectious agents, and atmospheric pollutants. T2 inflammation is propagated by several key cell types including T helper 2 (Th2) cells, eosinophils, mast cells, and B cells. Immunoglobulin E (IgE), produced by B cells, is a key molecule in allergic airway disease and plays an important role in T2 inflammation, as well as being central to remodeling processes within the airway epithelium. Blocking IgE with omalizumab has been shown to be efficacious in treating allergic asthma however, the role of IgE on airway epithelial cells is less communicated. Developing a deeper explanation of the complex network of interactions between IgE and the airway epithelium will facilitate an improved understanding of asthma pathophysiology. This review discusses the indirect and direct roles of IgE on airway epithelial cells, with a focus on allergic asthma disease.

The short-term effects of different cold spell definitions on asthma outpatient visits in Lanzhou, China

BACKGROUND

With global warming, most studies have focused on the health impacts of heat waves, while the health effects of cold spells, especially in developing countries, still need to be explored. Additionally, existing research on temperature extremes and asthma primarily targets severe asthma cases requiring hospitalization or emergency care, neglecting outpatients with mild symptoms. This study aimed to identify the optimal definition of cold spells in Lanzhou, China, and examine their association with outpatient asthma visits, identifying potentially vulnerable populations.

METHODS

This study collected daily asthma outpatient records, along with meteorological and air pollutant data, from January 1, 2017, to December 31, 2020, in Lanzhou, Gansu Province. Twenty-four cold spell definitions were developed using four temperature indices (daily mean, daily minimum, daily mean apparent, and daily minimum apparent temperatures), two thresholds (P10 and P5), and three durations (2, 3, and 4 days). A time-series fitted poisson generalized linear model (PGLM) and distributed lag nonlinear model (DLNM) were applied to estimate the short-term effects of cold seasons (November to March) on outpatient asthma visits, controlling for confounding factors such as humidity, air pollutants, time trends, holidays, and weekdays. Stratified analyses by sex and age were conducted to identify vulnerable populations and examine the influence of cold spell duration on asthma clinic visits.

RESULTS

Various definitions of cold spells influenced asthma outpatient visits, with similar trends observed. The model fit was best when the daily minimum apparent temperature was below the 10th percentile, and the duration was more significant than or equal to 4 days. Based on this optimal definition, for the total population, the main effect of the cold spell on asthma occurred at Lag0, Lag1, Lag6, and Lag7, with Lag7 producing the most significant effect (RR = 1.208, 95% CI: 1.052 ± 1.388). In the subgroup analyses, the cumulative effect of lag 0-7 days (Lag0-7) was higher for females and those in the 0-18 age group than for males and other age groups, respectively. In addition, the longer the duration of the cold spell from lag 3 days (Lag3) onwards, the greater its effect.

CONCLUSION

Cold spells in Lanzhou City can notably increase asthma outpatient visits, with females and individuals aged 0-18 particularly affected. Moreover, the longer a cold spell persists, the greater its impact, especially in the latter days of the event.

Lung CD4+ resident memory T cells use airway secretory cells to stimulate and regulate onset of allergic airway neutrophilic disease

Neutrophilic asthma is a vexing disease, but mechanistic and therapeutic advancements will require better models of allergy-induced airway neutrophilia. Here, we find that periodic ovalbumin (OVA) inhalation in sensitized mice elicits rapid allergic airway inflammation and pathophysiology mimicking neutrophilic asthma. OVA-experienced murine lungs harbor diverse clusters of CD4+ resident memory T (TRM) cells, including unconventional RORγtnegative/low T helper 17 (TH17) cells. Acute OVA challenge instigates interleukin (IL)-17A secretion from these TRM cells, driving CXCL5 production from Muc5achigh airway secretory cells, leading to destructive airway neutrophilia. The TRM and epithelial cell signals discovered herein are also observed in adult human asthmatic airways. Epithelial antigen presentation regulates this biology by skewing TRM cells toward TH2 and TH1 fates so that TH1-related interferon (IFN)-γ suppresses IL-17A-driven, CXCL5-mediated airway neutrophilia. Concordantly, in vivo IFN-γ supplementation improves disease outcomes. Thus, using our model of neutrophilic asthma, we identify lung epithelial-CD4+ TRM cell crosstalk as a key rheostat of allergic airway neutrophilia.

Effect of the gut microbiome, skin microbiome, plasma metabolome, white blood cells subtype, immune cells, inflammatory proteins, and inflammatory cytokines on asthma: a two-sample Mendelian randomized study and mediation analysis

Background

Asthma is a chronic inflammatory disorder arising from incompletely understood heterogenic gene-environment interactions. This study aims to investigate causal relationships among gut microbiota, skin microbiota, plasma metabolomics, white blood cells subtype, immune cells, inflammatory proteins, inflammatory cytokines, and asthma.

Methods

First, two-sample Mendelian randomization analysis was used to identify causal relationships. The summary statistics of 412 gut microbiota traits (N = 7 738), 150 skin microbiota traits (N = 579), 1 400 plasma metabolite traits (N = 8 299), white blood cells subtype counts (N = 746 667), 731 immune cell traits (N = 3 669), 91 circulating inflammatory proteins (N = 14 744), 41 inflammatory cytokine traits (N = 8 293), and asthma traits (N = 244 562) were obtained from publicly available genome-wide association studies. Inverse-variance weighted regression was used as the primary Mendelian randomization method. A series of sensitivity analyses was performed to test the robustness of causal estimates. Subsequently, mediation analysis was performed to identify the pathway from gut or skin microbiota to asthma mediated by plasma metabolites, immune cells, and inflammatory proteins.

Results

Mendelian randomization revealed the causal effects of 31 gut bacterial features (abundances of 19 bacterial pathways and 12 microbiota), 10 skin bacterial features, 108 plasma metabolites (81 metabolites and 27 ratios), 81 immune cells, five circulating inflammatory proteins, and three inflammatory cytokines and asthma. Moreover, the mediation analysis results supported the mediating effects of one plasma metabolite, five immunophenotypes, and one inflammatory protein on the gut or skin microbiota in asthma pathogenesis.

Conclusion

The findings of this study support a causal relationship among gut microbiota, skin microbiota, plasma metabolites, immune cells, inflammatory proteins, inflammatory cytokines, and asthma. Mediating pathways through which the above factors may affect asthma were proposed. The biomarkers and mediation pathways identified in this work provide new insights into the mechanism of asthma and contribute to its prevention and treatment.

The impact of phthalates on asthma and chronic obstructive pulmonary disease: a comprehensive analysis based on network toxicology and molecular docking

Introduction

Phthalates (PAEs) are widely used plasticizers in polyvinyl chloride (PVC) products since the 1930s, and recent research indicates a significant association between exposure to these substances and the development and progression of asthma and chronic obstructive pulmonary disease (COPD). Understanding the underlying mechanisms is crucial due to their public health implications.

Methods

In this study, we utilized innovative network toxicology and molecular docking techniques to systematically examine the effects of seven typical phthalates on asthma and COPD. By integrating information from multiple databases, we identified key target genes linked to these compounds and conducted functional enrichment analyses to elucidate their roles in pathological processes.

Results

Our results demonstrate that these phthalates affect the pathogenesis of asthma and COPD by modulating various target genes, including PTGS2, MMP9, and CASP3, which are involved in essential biological pathways such as apoptosis and immune response. Interestingly, certain inflammation-related genes and signaling pathways displayed novel regulatory patterns when exposed to phthalates, revealing new pathological mechanisms. Molecular docking analyses further confirmed stable interactions between phthalates and essential target genes, providing molecular-level insights into their pathogenic mechanisms.

Discussion

Overall, this study highlights the harmful impacts of these seven phthalates on asthma and COPD, establishing new connections between the compounds and disease-related genes, and emphasizing their relevance as emerging environmental toxins. These findings provide valuable perspectives for risk assessment and public health policy, underscoring the need for stricter regulations and interventions regarding phthalate exposure.

Structured Cardiac Assessment and Treatment Following Exacerbations of COPD (SCATECOPD): A Pilot Randomised Controlled Trial

Background/Objectives: Heart disease is common in COPD, yet it is underdiagnosed and undertreated. Heart failure (HF) is undiagnosed in up to 20% of hospital inpatients. Hospitalised exacerbations of COPD (ECOPD) confer high mortality and readmission rates, with an elevated temporal cardiac risk. We performed a pilot randomised controlled trial examining the feasibility and effect of inpatient structured cardiac assessment (SCA) to diagnose and prompt guideline-recommended treatment of heart disease. Methods: A total of 115 inpatients with ECOPD were randomised 1:1 to receive usual care (UC) or SCA, comprising transthoracic echocardiography, CT coronary artery calcium scoring, 24 h ECG, blood pressure, and diabetes assessment. Follow-up was for 12 months. The prevalence of underdiagnosis and undertreatment of heart disease were captured, and potential outcome measures for future trials assessed. Results: Among patients undergoing SCA, 42/57 (73.7%) received a new cardiac diagnosis and 32/57 (56.1%) received new cardiac treatment, compared with 11/58 (19.0%; p < 0.001) and 5/58 (8.6%; p < 0.001) in the UC group. More patients in the SCA group were newly diagnosed with HF (36.8% vs. 12.1%; p = 0.002). When heart disease was diagnosed, the proportion receiving optimal treatment at discharge was substantially higher in SCA (35/47 (74%) vs. 4/11 (34%); p = 0.029). The occurrence of a major adverse cardiovascular event (MACE) showed promise as an appropriate clinical outcome for a future definitive trial. MACEs occurred in 17.2% in usual care vs. 10.5% in SCA in one year, with a continued separation of survival curves during follow up, although statistical significance was not shown. Conclusions: A structured cardiac assessment during ECOPD substantially improved diagnosis and treatment of heart disease. HF and coronary artery disease were the most common new diagnoses. Future interventional trials in this population should consider MACEs as the primary outcome.

Relationship between systemic immune response index (SIRI) and COPD: a cross-sectional study based on NHANES 2007-2012

Although the link between inflammation and chronic obstructive pulmonary disease (COPD) is increasingly recognized, the correlation between systemic immune response index (SIRI), a novel marker of inflammation, and COPD is unknown. This cross-sectional study used data from patients with complete lung function in NHANES 2007-2012 to explore the relationship between SIRI and COPD. We performed a series of statistical analyses on a total of 5056 participants, including multiple linear regression, smoothed curve fitting, ROC curve analysis, and subgroup analysis. In the fully corrected model, the logistic multiple regression showed that SIRI was associated with a high risk of COPD (OR1.350, 95% CI:1.220,1.493). The ROC curve showed that SIRI (AUC = 0.596) was significantly more efficient than other inflammatory factors in predicting COPD. Smoothed curve fit effect and threshold effect analyses showed a linear correlation between SIRI COPD prevalence, and subgroup analyses showed that the effect of SIRI on COPD was more pronounced in still smokers (OR 1.58, 95% CI: 1.34, 1.86) versus men (OR 1.62, 95% CI: 1.44, 1.83). The results of the interaction test provide evidence supporting SIRI as an independent risk factor for COPD.

The association between abdominal obesity and pulmonary function trajectories among patients with COPD

The association between abdominal obesity and pulmonary function trajectories among patients with COPD remain to be unclear. This study aimed to explore the association between abdominal obesity and pulmonary function trajectories among patients with COPD. Data were collected from the China Health and Retirement Longitudinal Study, which was a nationally representative investigation. The pulmonary function indicator was peak expiratory flow (PEF). Abdominal obesity was assessed using waist circumference, which was categorized into two groups: < 90/85 cm and ≥ 90/85 cm, in men/women. Latent class growth analysis was used to identify distinct pulmonary function trajectories. The logistic regression was used to assess the association between abdominal obesity and pulmonary function trajectories. Finally, a total of 775 patients with COPD aged 45 years and older were included, and 301 participants (38.84%) were abdominal obesity. The mean PEF value showed a decreasing trend, with respective average values of 205.84 L/min (SD = 104.16), 199.99 L/min (SD = 99.52), and 196.06 L/min (SD = 86.74) in 2011, 2013 and 2015. Two PEF trajectories were identified: "above average-high descending" trajectory (n = 187, 24.13%) and "low-maintenance" trajectory (n = 588, 75.74%). Unadjusted and adjusted analysis showed that baseline higher waist circumference was associated with "low-maintenance" trajectory. A negative association between abdominal obesity and pulmonary function trajectories was observed among patients with COPD. This suggests that increased abdominal fat may accelerate the decline of pulmonary function over time. These findings provide evidence for designing targeted programs to improve pulmonary function, particularly for patients with COPD of abdominal obesity.

Clinical characteristics and biological treatment responses of patients with late-onset asthma phenotype

Background: The data on subphenotypes and treatment responses to biologicals in late-onset asthma (LOA) is limited. This study aims to compare the clinical characteristics and treatment responses in severe asthma patients receiving biological treatments, categorized into early-onset asthma (EOA) and LOA groups. Methods: Patients treated with omalizumab or mepolizumab for at least six months at a tertiary care adult allergy clinic between December 2015 and December 2023 were included. Patients with persistent respiratory symptoms starting at age ≥40 years were categorized as LOA, while those with onset <40 years were categorized as EOA. Changes in Asthma Control Questionnaire (ACQ-6) scores, forced expiratory volume in one second (FEV1) percentages, and blood eosinophil counts were assessed at baseline and 6 months. The percentage change in FEV1 (liters) at 6 months relative to baseline was measured. Clinical remission rates were evaluated in those completing one year of treatment. Results: Among 87 patients, 38 (43.7%) had LOA and 49 (56.3%) had EOA. Of these, 22 (25.3%) received omalizumab and 65 (74.7%) received mepolizumab, with a mean treatment duration of 24.7 (±19.7) months. LOA patients had higher obesity rates and tobacco consumption compared to EOA patients (p = 0.041 and p = 0.024, respectively). There were no significant differences between LOA and EOA groups in ACQ scores, FEV1 percentage, the percentage change in FEV1 in liters and eosinophil counts (p = 0.531, p = 0.219, p = 0.632, p = 0.700, respectively). Within LOA patients, ACQ scores did not significantly differ between those treated with omalizumab and mepolizumab (p = 0.801). At 6 months, eosinophil counts significantly decreased with mepolizumab but not with omalizumab (p = 0.002). Conclusion: Biological treatment responses were similar between LOA and EOA groups. Omalizumab and mepolizumab showed comparable efficacy, with the exception of eosinophil count changes in LOA patients.

Effect of game-based asthma management interventions on pediatric asthma control, knowledge, attitudes, hospitalizations, and emergency visits: A systematic review and meta-analysis

PURPOSE

Many studies have used game-based interventions to educate children about asthma. The study aims to determine the effectiveness of these games in improving asthma control and related outcomes in children.

METHODS

Seven databases were searched: PubMed, Cochrane Library, Scopus, CINAHL, Embase, Web of Science, and PsycINFO'. All research papers published until June 2023 were included. MeSH terms and keywords were used in the literature search. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments was used to assess the risk of bias.

RESULTS

This systematic review and meta-analysis included nine studies with a total sample size of 694 children. The effect size for hospitalization rates was not statistically significant (p > 0.05), although the association was significant (p = 0.004). Conversely, a statistically significant reduction in emergency visits was observed (p < 0.05), with an effect size estimate of 0.376. The analysis also revealed a significant improvement in asthma knowledge (p < 0.05), with an effect size estimate of 0.677 (95 % CI: 0.240 to 1.114, p = 0.002), and an increase in asthma control (p < 0.05), although the association was not statistically significant (p = 0.120) with an effect size estimate of 0.169 (95 % CI: -0.044 to 0.381). Conversely, no statistically significant effect was observed for asthma attitude (p > 0.05).

CONCLUSION

Game-based interventions have shown promise in improving asthma management in children by enhancing knowledge and control and reducing emergency visits. This approach is increasingly recommended in clinical settings, though there is notable heterogeneity in study design and participant demographics.

The Phenotypes of Asthma-Bronchiectasis Overlap: Clinical Characteristics and Outcomes

BACKGROUND

Asthma-bronchiectasis overlap (ABO) encompasses heterogeneous manifestations, which may predict distinct clinical outcomes. We sought to identify the clinical phenotypes of ABO and compare them to asthma alone or bronchiectasis alone.

METHODS

In this retrospective cohort study, we extracted electronic medical records from 292 inpatients with ABO, 901 inpatients with asthma alone, and 1,192 inpatients with bronchiectasis alone who were hospitalized between 2015 and 2020. We phenotyped ABO using 2-step unsupervised clustering analysis by using an independent cohort (n = 76).

RESULTS

Compared to asthma or bronchiectasis alone, ABO exhibited greater disease severity and worse clinical outcomes. We identified 3 ABO phenotypes: asthma-dominant ABO (ABO-A, n = 100) with more prominent asthma symptoms; bronchiectasis-dominant ABO (ABO-B, n = 89) with more pronounced features of bronchiectasis; and co-existence of asthma and severe bronchiectasis (ABO-S, n = 103) with worse clinical outcomes. Compared to ABO-B, both ABO-A and ABO-S were associated with significantly higher blood neutrophil ratios (55.8% vs. 59.1% vs. 64.4%, P < 0.001), poorer lung function (FEV1% predicted: 79.1% vs. 67.5% vs. 50.1%, P < 0.001), longer hospital stay (6.0 vs. 7.0 vs. 7.0 days, P = 0.004), and higher risks of hospitalization within the next 2 years (ABO-A: hazards ratio [HR], 3.76, 95% confidence interval [CI], 1.12-12.62, P = 0.032; ABO-S: HR, 4.05, 95% CI, 1.14-14.36, P = 0.031).

CONCLUSIONS

The radiologic severity of bronchiectasis and the use of systemic corticosteroids can identify the clinical phenotypes of ABO. The heterogeneity of clinical manifestations may help formulate personalized management strategies and predict the prognosis of ABO.

Asthma Increases Long-Term Risk of Death by Suicide: A Nationwide Population-Based Cohort Study

BACKGROUND

Previous studies have identified an increased risk of suicidal behaviors among individuals with asthma.

OBJECTIVE

To evaluate the long-term risk and factors related to suicide in the adult population with asthma.

METHODS

This study used the Korean National Health Insurance Service data. We investigated the risk of suicide concerning the presence or absence of asthma and potential risk factors for suicide among 3,914,041 adults aged 20 years or more.

RESULTS

During a median follow-up of 12.3 years (interquartile range, 12.1-12.6 years), 1383 (0.48%) individuals with asthma died by suicide. Individuals with asthma had an increased risk of suicide compared with controls (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.19-1.33). Suicide risk was especially high in individuals with asthma phenotypes: hospitalization-prone (aHR, 1.61; 95% CI, 1.40-1.84), nonobese (aHR, 1.37; 95% CI, 1.27-1.64), and asthma-chronic obstructive pulmonary disease overlap (aHR, 1.47; 95% CI, 1.22-1.76). Coexisting underweight status (aHR, 2.54; 95% CI, 2.05-3.16), mental health disorders (schizophrenia [aHR, 3.38; 95% CI, 2.28-5.02], depression [aHR, 3.24; 95% CI, 2.85-3.68], and anxiety disorder [aHR, 2.47; 95% CI, 2.00-3.05]), and cancers (aHR, 2.22; 95% CI, 1.73-2.84) further increased the suicide risk.

CONCLUSIONS

Asthma was associated with an increased risk of suicide, particularly in hospitalization-prone, nonobese, and asthma-chronic obstructive pulmonary disease overlap phenotypes. The risk was further increased when asthma coexisted with underweight status, mental health disorders, or cancers.

Tissue-Resident Th2 Cells in Type 2 Immunity and Allergic Diseases

Type 2 immunity represents a unique immune module that provides host protection against macro-parasites and noxious agents such as venoms and toxins. In contrast, maladaptive type 2 immune responses cause allergic diseases. While multiple cell types play important roles in type 2 immunity, recent studies in humans and murine models of chronic allergic diseases have shown that a distinct population of tissue-resident, CD4+ T helper type 2 (Th2) cells play a critical role in chronic allergic inflammation. The rules regulating Th2 cell differentiation have remained less well defined than other T cell subsets, but recent studies have shed new light into the specific mechanisms controlling Th2 cell biology in vivo. Here, we review our current understanding of the checkpoints regulating the development and function of tissue-resident Th2 cells with a focus on chronic allergic diseases. We discuss evidence for a barrier tissue checkpoint in initial Th2 cell priming, including the role of neuropeptides, damage-associated molecular patterns, and dendritic cell macro-clusters. Furthermore, we review the evidence for a second barrier tissue checkpoint that instructs the development of multi-cytokine producing, tissue-resident Th2 cells that orchestrate allergic inflammation. Lastly, we discuss potential approaches to therapeutically target tissue-resident Th2 cells in chronic allergic diseases.

Bayesian learning-based agent negotiation model to support doctor-patient shared decision making

BACKGROUND

Agent negotiation is widely used in e-commerce negotiation, cloud service service-level agreements, and power transactions. However, few studies have adapted alternative negotiation models to negotiation processes between healthcare professionals and patients due to the fuzziness, ethics, and importance of medical decision making.

METHOD

We propose a Bayesian learning based bilateral fuzzy constraint agent negotiation model (BLFCAN). It support mutually beneficial agreement on treatment between doctors and patients. The proposed model expresses the imprecise preferences and behaviors of doctors and patients through fuzzy constrained agents. To improve negotiation efficiency and social welfare, the Bayesian learning method is adopted in the proposed model to predict the opponent's preference.

RESULTS

The proposed model achieves 55.4% to 64.2% satisfaction for doctors and 69-74.5% satisfaction for patients in terms of individual satisfaction. In addition, the proposed BLFCAN can increase overall satisfaction by 26.5-29% in fewer rounds, and it can alter the negotiation strategy in a flexible manner for various negotiation scenarios.

CONCLUSIONS

BLFCAN reduces communication time and cost, helps avoid potential conflicts, and reduces the impact of emotions and biases on decision-making. In addition, the BLFCAN model improves the agreement satisfaction of both parties and the total social welfare.

Associations between asthma and Life's Essential 8: a cross-sectional study

Background

Asthma is a serious respiratory disease attributed to multiple factors. The Life's Essential 8 (LE8), introduced by the American Heart Association, aims to improve and maintain cardiovascular health. However, the correlation between LE8 components and asthma remains unclear. We hypothesized that LE8 is a protective factor against asthma.

Materials and methods

Multiple logistic regression analysis, restricted cubic spline (RCS) analysis, and subgroup analysis were used to analyze the data collected from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018.

Results

A total of 3,360 participants with asthma were included in the analysis. With all confounders controlled for, LE8 scores were negatively correlated with asthma prevalence (odds ratio (OR) per 10-point increment, 0.85 [95% confidence interval (CI), 0.82-0.88]). Compared to low LE8 scores, moderate and high LE8 scores were associated with reduced asthma risk, with adjusted ORs (95% CIs) of 0.59 (0.51-0.68) and 0.48 (0.39-0.58), respectively. Non-linear correlations were observed between LE8 scores and asthma (p non-linear = 0.01) and between health factor scores and asthma (p non-linear = 0.01). However, a linear dose-response correlation was noted between health behavior scores and asthma (p non-linear = 0.30). Subgroup analysis showed no significant interaction effects (p > 0.05), except in the sex and drinking status subgroups (p for interaction = 0.02).

Conclusion

Asthma is associated with components of LE8, which warrants further attention and may contribute to reducing asthma prevalence.

Efficacy and safety profile of doxofylline in asthma: a meta-analysis

OBJECTIVE

This work aims to explore the effectiveness and safety of doxofylline in asthma treatment.

DATA SOURCES

Relevant studies published before March 2023 were retrieved from EMBASE, Cochrane Library, PubMed, and Web of Science databases.

STUDY SELECTIONS

Risk of Bias tool (RoB 2) was applied to determine the quality of randomized controlled trials (RCTs). Relative risks (RR, 95% confidence intervals [CI]) and weighted mean differences (WMD, 95% CI) were calculated for dichotomous and continuous outcomes, respectively, under fixed or random-effects models.

RESULTS

A total of eight clinical trials comprising 1627 patients were analyzed. The meta-analysis revealed no notable change in forced expiratory volume in 1 s (FEV1) (WMD = 0.48; 95% CI: -2.09 to 3.05), the use of albuterol as a rescue medication (WMD = -0.02; 95% CI: -0.57 to 0.52), forced vital capacity (FVC) (WMD = 0.19; 95% CI: -0.28 to 0.67) and FEV1 predicted value (WMD = 1.53; 95%CI: -0.88 to 3.94) between doxofylline and control groups. However, doxofylline treatment significantly reduced adverse reactions (RR = 0.71; 95% CI: 0.60 to 0.84) and decreased the incidence of asthma events (WMD = -0.18; 95% CI: -0.33 to 0.03). Subgroup analysis results indicated that the improvement in FEV1 with doxofylline combined with budesonide was superior to that of budesonide combined with montelukast or tiotropium but inferior to that of budesonide plus formoterol combination.

CONCLUSION

Doxofylline treatment significantly reduces the risk of asthma events and adverse events (AEs), demonstrating good safety and longer-term benefits.

Nutrition and Dietary Pattern Associated With Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is one of the world's most significant causes of illness and mortality. It is vital to identify modifiable risk factors for COPD prevention and therapy, and the scientific community has started to focus closely on nutrition as a crucial component of COPD management, from prevention to treatment. For the progression, and management of obstructive lung illnesses like asthma and COPD, diet and nutrition may be modifiable risk factors of COPD. This review examined the connection between dietary habits, nutrient consumption, and obstructive lung disorders. Additionally, this review highlights and summarizes the evidence from observational and clinical studies regarding the influence of nutrients and dietary habits on lung function and the onset, progression, and outcomes of COPD and lung disease. Regarding the advancement or prevention of COPD, supplemental nutrition has an impact on the onset, progression, and treatment of COPD. Better pulmonary function, less deterioration in lung function, and a lower risk of COPD linked to nutraceuticals, particularly those with antioxidant and anti‐inflammatory effects, when combined with balancepatterns. Health providers may use an evidence‐based lifestyle approach to help counsel patients toward improved lung health if they are aware of the dietary implications of COPD.

Impact of IL13 genetic polymorphisms on COPD susceptibility in the Chinese Han population

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation. Interleukin-13 (IL13), associated with T-helper type 2 cells, plays a crucial role in COPD pathophysiology. This study aimed to investigate the relationship of single nucleotide polymorphisms (SNPs) in IL13 to COPD risk.

METHODS

Five candidate SNPs of IL13 were genotyped using MassARRAY iPLEX platform in a cohort of472 COPD patients and 472 healthy controls. Logistic regression analysis was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs). Additionally, Multifactor dimensionality reduction (MDR) software was utilized to assess the combined impact of SNP-SNP interactions on COPD risk.

RESULTS

IL13 rs20541 (OR: 1.24, p: 0.028), rs1295685 (OR: 1.31, p: 0.006), rs848 (OR: 1.27, p: 0.016), and rs847 (OR: 1.30, p: 0.007) were associated with COPD risk. Moreover, IL13 variants were related to the increased COPD risk in females, individuals aged ≥68 year, non-smokers or non-drinkers. The optimal multi-locus model was identified as the combination of rs20541 and rs1295685.

CONCLUSION

Our findings indicated the association between IL13 variants and an elevated risk of developing COPD, especially rs1295685 and rs847. These findings could have implications for understanding the role of IL13 variants in COPD predisposition.

β-glucan nanoparticles alleviate acute asthma by suppressing ferroptosis and DNA damage in mice

Asthma is a severe respiratory disease marked by airway inflammation, remodeling, and oxidative stress. β-Glucan (BG), a polysaccharide constituent of fungal cellular structures, exhibits potent immunomodulatory activities. The investigational focus was on the anti-asthmatic and anti-ferroptotic properties of beta-glucan nanoparticles (BG-NPs) in a murine model of allergic asthma induced by ovalbumin (OVA). BG was extracted from Chaga mushrooms (Inonotus obliquus), and its BG-NPs were characterized utilizing techniques including FT-IR, UV visible spectroscopy, zeta potential analysis, DLS, XRD, and TEM. The Balb/C mice were allocated into five groups: control, untreated asthmatic, dexamethasone (Dexa)-treated (1 mg/kg), BG-treated (100 mg/kg), BG-NPs-treated (45 mg/kg), and BG-treated (100 mg/kg). Treatment with BG-NPs markedly diminished the entry of inflammatory cells into the respiratory passage, serum IgE concentrations, DNA damage, and markers of oxidative stress through the reduction of malonaldehyde (MDA) levels and enhancing the levels of reduced glutathione (GSH), glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT). Furthermore, BG-NPs reduced iron deposition and promoted the transcriptional activity of the GPx4 gene in pulmonary cells, attenuating ferroptosis. The results demonstrated that BG-NPs reduced asthma by inhibiting oxidative stress, inflammation, DNA damage, and ferroptosis. Our results suggest that BG-NPs could be used as potential treatments for allergic asthma.

Inula japonica Thunb. and its active compounds ameliorate airway inflammation by suppressing JAK-STAT signaling

Asthma, a chronic inflammatory disease, remains a global health challenge due to its complex pathophysiology and the limited treatment efficacy. This study explored the effect of Inula japonica Thunb. water extract (IJW) on asthma and its protective mechanisms. To assess the effects of IJW, we established an experimental asthma model in BALB/c mice using ovalbumin (OVA). Airway hyper-responsiveness (AHR) in response to methacholine was measured. We quantified inflammatory cell infiltration and cytokine and chemokine levels in bronchoalveolar lavage fluid (BALF), as well as total IgE levels in serum. Staining with hematoxylin and eosin and periodic acid-Schiff was used to examine the impact of IJW on lung pathology. We performed RNA sequencing to identify differentially expressed genes, which were subjected to Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses. We used interleukin (IL)-4/IL-13-treated human bronchial epithelial (HBE) cells to explore the associated mechanisms. IJW showed therapeutic effects against OVA-induced asthma by alleviating AHR, peribronchial inflammation, mucus hypersecretion, and collagen fiber deposition. It reduced total IgE levels in the serum and IL-4, IL-5, IL-13, eotaxin, macrophage-derived chemokines, and periostin levels in BALF. In IL-4/IL-13-treated HBE cells, IJW and its components suppressed the Janus kinase-signal transducer and activator of the transcription (JAK-STAT) signaling. These findings support IJW's potential as a pharmacological agent for allergic airway inflammation and asthma.

Benefits of chest wall mobilization on respiratory efficiency and functional exercise capacity in people with severe chronic obstructive pulmonary disease (COPD): A randomized controlled trial

BACKGROUND

Coexistence of chest wall hypomobility and lung hyperinflation compromises respiratory muscle function and respiratory efficiency in people with severe chronic obstructive pulmonary disease (COPD). This study aimed to investigate the effect of chest wall mobilization on functional exercise capacity, respiratory muscle activity and respiratory muscle tissue oxygen saturation for people with severe COPD.

METHODS

Thirty male adults (age: 75 ± 6) diagnosed with severe COPD completed a 6-week programme (twice/week) according to intervention randomization (chest wall mobilization group, CWMG, n = 15; control group, CG, n = 15). Both groups received standardized education and walking exercise, while CWMG also received chest wall and thoracic spine mobilization. Electromyography of the essential and accessory respiratory muscles and tissue oxygen saturation of the intercostal muscle (StO2, measured by near-infrared spectroscopy) during incremental cycle exercise test were measured and compared between the two groups at pre-programme, post-programme and 3-month follow-up.

RESULTS

Patients in CWMG demonstrated a significant increase in exercise tolerance from <3 METS to 4-6 METS (p = 0.000) after intervention. A significant decrease in activity of scalene, sternocleidomastoids and intercostal muscle during exercise test (p < 0.01) was found in CWMG, as compared to CG. A significant decrease in StO2 (p < 0.05) and greater decline in the slope of oxygenation dissociation (p = 0.000) were seen in CWMG during exercise test. These positive results were maintained at 3-month follow-up in CWMG.

CONCLUSION

Improvements in exercise tolerance, respiratory muscle efficiency and oxygenation extraction ability in CWMG suggest a potential clinical benefit of integrating chest wall and thoracic spine mobilization for rehabilitation of people with severe COPD.

Scutellaria baicalensis ameliorates allergic airway inflammation through agonism and transcriptional regulation of TAS2Rs

ETHNOPHARMACOLOGICAL RELEVANCE

Scutellaria baicalensis Georgi (SCB, Huangqin) is a traditional medicinal plant used to treat fever and respiratory diseases. SCB has a good therapeutic effect on asthma and anti-inflammation in traditional clinic use. However, the molecular mechanism and targets of SCB in treating asthma are still unclear.

AIM OF THE STUDY

Combining transcriptomic analysis and in vitro experimental validation, this study aimed to reveal the molecular mechanism and targets of SCB in treating asthma.

MATERIALS AND METHODS

The anti-asthmatic effects of SCB and its active components, scutellarin and oroxylin A, were evaluated in ovalbumin (OVA)-induced rats by analysis of pulmonary function and pathology. The signaling pathways in rat pulmonary tissue were analyzed using transcriptomics and protein interaction network analysis. Calcium mobilization assay and molecular docking were utilized to discover the active compounds from SCB with agonism activity of type 2 taste receptors (TAS2Rs). The anti-asthmatic effect and transcriptional regulation of TAS2Rs regulated by SCB and its active components were analyzed in vitro.

RESULTS

Extracts of SCB (ESB), scutellarin, and oroxylin A ameliorated airway function and inflammation in OVA-induced rats. The anti-asthma mechanism of ESB, scutellarin and oroxylin A was highly related to immune and taste transduction pathways based on transcriptomic analysis, especially the TAS2Rs signaling pathway. ESB was the direct agonist of TAS2R4 and TAS2R14 with EC50 of 209.1 and 217.2 μg/mL based on calcium mobilization assay, respectively. Baicalein was the main active component for TAS2R4 agonism activity, and scutellarin and oroxylin A had weak agonism activity of TAS2R4 and TAS2R14 through calcium mobilization assay and molecular docking. However, scutellarin and oroxylin A significantly upregulated the gene expression of Tas2r108 (the mouse ortholog of the TAS2R4) in lung tissue. ESB, scutellarin, and oroxylin A inhibited LPS-induced lactate dehydrogenase release and gene expression of TNF through transcriptional regulation of TAS2R4 and TAS2R14 on bronchial epithelial cells. ESB and oroxylin A ameliorated IgE-induced β-hexosaminidase release and gene expression of Il4 and Tnf and upregulated gene expression of Tas2r108.

CONCLUSION

These results provided new insight into the anti-asthmatic mechanism of SCB and active components, scutellarin and oroxylin A, through agonism and transcriptional regulation of TAS2Rs to ameliorate allergic airway inflammation.

Longitudinal association between hemoglobin and lung function with insights into the incidence of airflow obstruction: an observational study

BACKGROUND/AIMS

Evidence regarding the long-term association between hemoglobin (Hb) levels and lung function in individuals from the general population is scarce. This study aimed to determine the longitudinal association between Hb levels and lung function in a community-based population cohort in South Korea.

METHODS

We used linear mixed regression analysis to evaluate the longitudinal associations between Hb levels and lung function parameters, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC. Additionally, we used a generalized estimating equation to calculate the odds ratio (OR) of airflow obstruction (AO) according to the Hb level.

RESULTS

Over an 8-year biennial follow-up of 4,468 individuals (median age, 53.9 years; men, 49.0%), we observed that in men, Hb levels were positively associated with lung function (estimated values of FVC: 16.7 mL, FEV1: 15.5 mL, FEV1/FVC: 0.18%; all P < 0.001) and a decreased incidence of AO (OR = 0.83, P < 0.001). In women, Hb levels were positively associated with FVC but not with FEV1 or FEV1/FVC (estimated values of FVC: 4.7 mL, P = 0.045; FEV1: 3.1 mL, P = 0.142; FEV1/FVC: 0.01%, P = 0.838). The incidence of AO was not significantly different among women (OR = 0.93, P = 0.568). In postmenopausal women, higher Hb levels were associated with increased lung function (estimated values of FVC: 11.8 mL, P < 0.001; FEV1: 9.8 mL, P < 0.001; FEV1/FVC: 0.09%, P = 0.052), but the incidence of AO was not statistically significant (OR = 0.82, P = 0.129).

CONCLUSIONS

A decreased Hb level was associated with reduced lung function and an increased incidence of AO in men.

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

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