Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis

Mendelian randomisation studies for causal inference in chronic obstructive pulmonary disease: A narrative review

BACKGROUND AND OBJECTIVE

Most non-randomised controlled trials are unable to establish clear causal relationships in chronic obstructive pulmonary disease (COPD) due to the presence of confounding factors. This review summarises the evidence that the Mendelian randomisation method can be a powerful tool for performing causal inferences in COPD.

METHODS

A non-systematic search of English-language scientific literature was performed on PubMed using the following keywords: 'Mendelian randomisation', 'COPD', 'lung function', and 'GWAS'. No date restrictions were applied. The types of articles selected included randomised controlled trials, cohort studies, observational studies, and reviews.

RESULTS

Mendelian randomisation is becoming an increasingly popular method for identifying the risk factors of COPD. Recent Mendelian randomisation studies have revealed some risk factors for COPD, such as club cell secretory protein-16, impaired kidney function, air pollutants, asthma, and depression. In addition, Mendelian randomisation results suggest that genetically predicted factors such as PM2.5, inflammatory cytokines, growth differentiation factor 15, docosahexaenoic acid, and testosterone may have causal relationships with lung function.

CONCLUSION

Mendelian randomisation is a robust method for performing causal inferences in COPD research as it reduces the impact of confounding factors.

Association of mild chronic obstructive pulmonary disease with all-cause mortality: A systematic review and meta-analysis

BACKGROUND

It is unclear whether patients with Global Initiative for Chronic Obstructive Lung Disease stage 1 (mild) chronic obstructive pulmonary disease (COPD) have worse respiratory outcomes than individuals with normal spirometry.

METHODS

For this systematic review and meta-analysis, we conducted a search of PubMed, Embase, and Web of Science for all literature published up to 1 March 2023. Studies comparing mortality between mild COPD and normal spirometry were included. A random-effects model was used to estimate the combined effect size and its 95% confidence interval (CI). The primary outcome was all-cause mortality. Respiratory disease-related mortality were examined as secondary outcomes.

RESULTS

Of 5242 titles identified, 12 publications were included. Patients with mild COPD had a higher risk of all-cause mortality than individuals with normal spirometry (pre-bronchodilator: hazard ratio [HR] = 1.21, 95% CI: 1.11-1.32, I2 = 47.1%; post-bronchodilator: HR = 1.19, 95% CI: 1.02-1.39, I2 = 0.0%). Funnel plots showed a symmetrical distribution of studies and did not suggest publication bias. In jackknife sensitivity analyses, the increased risk of all-cause mortality remained consistent for mild COPD. When the meta-analysis was repeated and one study was omitted each time, the HR and corresponding 95% CI were >1. Patients with mild COPD also had a higher risk of respiratory disease-related mortality (HR = 1.71, 95% CI: 1.03-2.82, I2 = 0.0%).

CONCLUSIONS

Our results suggest that mild COPD is associated with increased all-cause mortality and respiratory disease-related mortality compared with normal spirometry. Further research is required to determine whether early intervention and treatment are beneficial in mild COPD.

Issue 3-The occupational burden of respiratory diseases, an update

INTRODUCTION AND AIMS

Workplace exposures are widely known to cause specific occupational diseases such as silicosis and asbestosis, but they also can contribute substantially to causation of common respiratory diseases. In 2019, the American Thoracic Society (ATS) and the European Respiratory Society (ERS) published a joint statement on the occupational burden of respiratory diseases. Our aim on this narrative review is to summarise the most recent evidence published after the ATS/ERS statement as well as to provide information on traditional occupational lung diseases that can be useful for clinicians and researchers.

RESULTS

Newer publications confirm the findings of the ATS/ERS statement on the role of workplace exposure in contributing to the aetiology of the respiratory diseases considered in this review (asthma, COPD, chronic bronchitis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, infectious pneumonia). Except for COPD, chronic bronchitis and infectious pneumonia, the number of publications in the last 5 years for the other diseases is limited. For traditional occupational lung diseases such as silicosis and asbestosis, there are old as well as novel sources of exposure and their burden continues to be relevant, especially in developing countries.

CONCLUSIONS

Occupational exposure remains an important risk factor for airways and interstitial lung diseases, causing occupational lung diseases and contributing substantially in the aetiology of common respiratory diseases. This information is critical for public health professionals formulating effective preventive strategies but also for clinicians in patient care. Effective action requires shared knowledge among clinicians, researchers, public health professionals, and policy makers.

Previous Moraxella catarrhalis Infection as a Risk Factor of COPD Exacerbations Leading to Hospitalization

Haemophilus influenzae (H. influenzae) and Moraxella catarrhalis (M. catarrhalis) are associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD); however, their role in the pathogenesis of COPD is unknown. We retrospectively analysed the clinical data of patients with AECOPD (modified British Medical Research Council scale score, Global Initiative for Chronic Obstructive Lung Disease [GOLD] classification, pre-admission antibiotic and inhalant usage, sputum culture and epidemic influenza virus antigen test) for association with admission frequency. Among 169 eligible patients, pathogens were and were not detected in 64 and 105, respectively. The GOLD classification grade was higher in the non-detection group with a prior antimicrobial administration rate of 21.9% than in the detection group. H. influenzae and M. catarrhalis, each identified in 24.6% of the total number of detected pathogens, were the most common infectious bacteria. The GOLD classification grade was higher in the re-hospitalisation group than in the one-time hospitalisation group (p < 0.01). Regarding type of pathogen, M. catarrhalis infection (n = 16) was more common in the re-hospitalisation group. History of M. catarrhalis, H. influenzae infection and GOLD grade ≥ III were risk factors for re-hospitalisation, with odds ratios of 92.7 (95% confidence interval [CI]: 3.68-2340.0, p < 0.01), 20.1 (CI: 1.48-274.0, p < 0.05) and 9.83 (CI: 2.33-41.4, p < 0.01), respectively. These bacterial infections and severe airway limitation were associated with increased AECOPD frequency. Routine microbial monitoring may be useful for AECOPD prevention, reducing medical burden and improving prognosis.

Linking Chronic Obstructive Pulmonary Disease and Asthma with Gallstones: Evidence from a Cross-Sectional Study and Mendelian Randomization

OBJECTIVE

To investigate whether chronic obstructive pulmonary disease (COPD) and asthma increase the risk of gallstones based on the National Health and Nutrition Examination Survey (NHANES) and Mendelian randomization (MR).

METHODS

Data from the NHANES 2017-2023 were included in the cross-sectional study. Diagnoses of COPD, asthma and gallstones were obtained from self-report questionnaires. Multivariate logistic regression, subgroup analyses and interaction tests were applied to explore these associations. Data for MR analysis were obtained from the Finnish cohort and the Integrative Epidemiology Unit (IEU). The inverse variance weighting (IVW) estimate was applied as the main approach to determine the causality of associations.

RESULTS

A total of 8,728 participants were enrolled in the cross-sectional study. Both COPD (OR 1,842, 95% CI 1.144, 2.968, p = 0.015) and asthma (OR 1.434, 95% CI 1.093, 1.883, p = 0.012) were associated with increased gallstone risk before and after covariate adjustments, and diabetes history may interact with the COPD-gallstone association (p = 0.020). In MR analysis, although a causal association was observed between COPD and gallstones (OR 1.216, 95% CI 1.023, 1.445; p = 0.026), leave-one-out analysis suggested that the causal association disappeared without serpin family A member 1 (SERPINA1). No causal association was observed between asthma and gallstones (OR 1.016, 95% CI 0.932, 1.108; p = 0.718).

CONCLUSIONS

Although both COPD and asthma were positively associated with gallstones based on NHANES, the COPD-gallstone association was largely driven by SERPINA1, and no causality was observed in asthma-gallstone association. The available evidence provided limited support for causal associations between obstructive lung diseases and gallstones.

Efficacy and Safety of Lung Volume Reduction with Endobronchial Coil #2 and Coil #4 Results of the German Emphysema Registry-Lungenemphysemregister e.V

BACKGROUND

Clinical trials have shown beneficial results from lung volume reduction with endobronchial coils in patients with emphysema, but comprehensive safety data are not yet available for a new coil type, Coil #4. The objective of this study is to generate real-world data (RWD) on the safety and efficacy of endobronchial Coil #2 and Coil #4.

METHODS

This is a cohort study of prospectively collected data from the multicenter German Lung Emphysema Registry e.V. (LE-Registry) for patients with advanced lung emphysema undergoing lung volume reduction. All patients treated with Coil #2 or Coil #4 were evaluated at baseline and at 3 months for pulmonary function tests (FEV1, FVC, RV, DLCO, pCO2), exercise capacity, quality of life (mMRC, CAT, SGRQ), and adverse events. Descriptive statistics were used to analyze response rates and changes in clinical outcomes.

RESULTS

Data from 73 patients (37 Coil #2, 36 Coil #4) enrolled between 2017 and 2024 were evaluated. At 3 months, outcome data were available for 32 Coil #2 and 26 Coil #4 patients. In the Coil #2 cohort significant improvements in RV and SGRQ were observed. The Coil #4 cohort shows significant improvements in FVC, RV, SGRQ, and CAT. Complications occurred in 37% of Coil #2 and 37% of Coil #4 patients, with 26% of patients treated with Coil #4 experiencing pneumothorax.

CONCLUSIONS

The outcomes observed in this RWD study are consistent with other published coil studies. The higher pneumothorax rate with Coil #4 is surprising and should be minimized by adapting the technique.

TRIAL REGISTRATION

DRKS00021207 registered on 29/05/2020.

Host-pathogen interaction profiling of nontypeable Haemophilus influenzae and Moraxella catarrhalis coinfection of bronchial epithelial cells

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory lung disease and the third leading cause of death globally. Nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat) are common pathogens in individuals with COPD. Acquisition of NTHi or Mcat can cause acute exacerbations of COPD. NTHi and/or Mcat also persist for months in the lower airways and lead to chronic inflammation. We hypothesized that infection by NTHi or Mcat, singly or during coinfection, requires regulation of specific bacterial and host cell pathways. We investigated this phenomenon using an in vitro cell culture model consisting of lung carcinoma H292 cell lines, infected with NTHi, Mcat, or both species. Samples were fractionated into "apical fluid," containing free-floating bacteria, and adhered/invaded bacteria on or within H292 cells. We used transcriptomic profiling with RNA-seq and various bioinformatic analyses to disentangle host-pathogen interactions in epithelial cell infection from the perspective of each species. Several biological pathways were differentially regulated across all conditions (31, NTHi; 22, Mcat; and 169, human). NTHi transcriptomic profiles differed during mono-infection and coinfection; examples included downregulation of iron-sulfur metabolism (IscR regulon) and differential regulation of quorum sensing in coinfection compared to mono-infection. Mcat was comparatively less affected by the presence of NTHi during coinfection. H292 epithelial cells responded broadly to all infections with distinct responses to mono-infection and coinfection. Enriched host pathways included influenza/interferon/Wnt and proinflammatory responses. These findings suggest common and distinct processes involved in NTHi and/or Mcat-induced COPD pathogenesis and have implications for therapeutic intervention.IMPORTANCEChronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. Bacteria such as nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat) can cause exacerbations of COPD, and they can persist in the lungs for months, which increases inflammation. We studied how these bacteria interact with lung cells by infecting a cell culture model with NTHi, Mcat, or both. We used RNA sequencing and bioinformatic analysis to examine how the bacteria and host cells respond. When NTHi and Mcat were present together, they behaved differently than when each was alone. We found that different host biological pathways were activated during infection, including those related to inflammation and immune responses. These results provide insights into how NTHi and Mcat contribute to COPD progression and suggest potential targets for new treatments.

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

BACKGROUND

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

METHODS

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

RESULTS

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

DISCUSSION

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

REGISTRATION OF THE CLINICAL TRIAL

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

The Implications of Oxygen-Dependent Chronic Obstructive Pulmonary Disease on Sac Growth and Mortality Following Endovascular Aneurysm Repair

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a known risk factor for abdominal aortic aneurysm (AAA) growth and rupture. The impact of COPD on AAA sac behavior following endovascular aneurysm repair (EVAR) is poorly understood. This study aimed to determine the association between COPD and sac remodeling after EVAR.

METHODS

We identified all EVAR patients (2010-2021) in the Society for Vascular Surgery-Vascular Quality Initiative database. COPD severity (none, medication-treated, oxygen (O2)-dependent) was the primary exposure variable. The primary end point was 1-year sac growth post-EVAR. Mixed effects linear and logistic regression were used to assess the effects of COPD severity on sac remodeling, controlling for covariates. Cox proportional hazards regression and competing risks regression identified predictors of mortality and reintervention.

RESULTS

30,686 patients met inclusion criteria. COPD was present in 24% of patients (no COPD, 75.8% [n = 23,260], medication-treated COPD, 19.7% [n = 6,057], O2-dependent COPD, 4.5% [n = 1,369]). O2-dependent COPD was associated with persistent sac growth (mean difference: +0.55 mm, 95% confidence interval [CI] [0.05-1.05], P = 0.03) following EVAR implantation; however, medication-treated COPD was not (mean difference: -0.06 mm, 95% CI [-0.32 to 0.19]; P = 0.64). O2-dependent COPD patients did not experience increased reintervention rates (hazard ratio [HR] 0.82, 95% CI [0.65-1.02], P = 0.07) but were identified to have significantly increased mortality (HR 1.8, 95% CI [1.52-2.22], P < 0.0001).

CONCLUSION

O2-dependent COPD was significantly associated with increased sac growth after EVAR. O2-dependent COPD did not correlate with increased reintervention, likely due to the disproportionately elevated mortality rates in this group. These findings highlight that patients with O2-dependent COPD have limited life expectancy and potentially less favorable sac remodeling, and elective EVAR should thus be reserved for only those at greatest risk for AAA-related mortality.

Pulmonary hypertension aetiologies in different parts of the world

Pulmonary hypertension is a serious condition characterised by elevated blood pressure in the pulmonary arteries, caused by various aetiologies and via different pathological processes. Over the past seventy years, our understanding and management of this disorder have greatly improved, resulting in increased diagnosis and effective clinical management. Current epidemiological estimates are challenged by the increased awareness of this condition and the changing definitions and classification systems. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has also shown temporal changes in the epidemiology of pulmonary hypertension over the last thirty years, contributing to regional variations in prevalence and incidence. This review explores the complexities of global and regional variations in different types of pulmonary hypertension reported through many registries, databases and regional studies. Although these tools can help estimate prevalence and incidences, they may also underestimate the actual number of cases due to the continuously changing understanding of the condition and increase awareness globally. Therefore, continued research, international collaboration, and standardised data collection are essential for achieving a more accurate global view of pulmonary hypertension and developing effective management strategies for this serious condition that significantly impacts general health.

Additive impact of chronic obstructive pulmonary disease (COPD) and cardiovascular disease(CVD) on all-cause and disease-Specific mortality: a longitudinal nationwide population-based study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) are two age-related diseases commonly found in the elderly population, and they are associated with severe health consequences. However, it is currently unclear how patients with either one of these diseases or both diseases simultaneously compare to patients without COPD and CVD in terms of the additive impact on overall mortality, CVD-related mortality, and respiratory system disease-related mortality.

METHOD

The study included 42,317 participants from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. The main objective of the study was to assess the outcomes of all-cause mortality, CVD mortality, and respiratory system disease mortality. We utilized the National Death Index(NDI) Public Access File, up until December 31, 2019, to determine the participants' mortality status and causes of death, with a mean follow-up period of 9.25 years. To ensure the reliability of the results, we employed Cox proportional hazards models to calculate the hazard ratios (HR) and 95% confidence intervals (CI) for mortality rates, along with conducting sensitivity analyses.

RESULTS

Among the 42,317 participants, 36,251 individuals (85.7%) had neither COPD nor CVD (COPD-/CVD-). Additionally, 4,252 people (10.0%) had only CVD (COPD-/CVD+), 1,237 people (2.9%) had only COPD (COPD+/CVD-), and 577 people (1.4%) had both COPD and CVD (COPD+/CVD+). Compared to the COPD-/CVD- group, the all-cause mortality rates increased by 1.58-fold (95% CI: 1.46, 1.70), 1.56-fold (95% CI: 1.38, 1.76), and 2.02-fold (95% CI: 1.72, 2.37) in the COPD-/CVD + group, COPD+/CVD- group, and COPD+/CVD + group, respectively, with the COPD+/CVD + group having the highest all-cause mortality risk. Compared to the COPD-/CVD- group, the other three groups showed increased CVD mortality rates, with a HR of 2.35 for the COPD-/CVD + group and COPD+/CVD + group, respectively. Compared to the COPD-/CVD- group, the other three groups had increased respiratory system disease mortality rates, with a HR of 5.00 (95% CI: 3.70, 6.75) for the COPD+/CVD- group and 6.62 (95% CI: 4.56, 9.61) for the COPD+/CVD + group (All trend p-values < 0.0001).

CONCLUSION

Patients with COPD or CVD, or those who have both conditions, are at an increased risk of all-cause mortality, CVD-related mortality, and respiratory system disease-related mortality. Individuals with either of these diseases require more stringent management to prevent the progression of the other disease and reduce mortality rates.

Immediate and Late Effects of a Single, Low-Intensity Inspiratory Muscle Intervention on Voice and Breathing in Chronic Obstructive Pulmonary Disease

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation, exacerbations, and systemic inflammatory effects that can impair functional capacity and respiratory muscle strength, potentially affecting voice production.

OBJECTIVE

To examine the immediate and late effects of a single low-intensity inspiratory muscle training (IMT) intervention on voice and airflow limitation parameters in subjects with COPD.

METHODS

Randomized clinical trial with seventeen subjects (40 to 80 years old, both genders) randomly divided into two groups: IMT and simulated inspiratory muscle training (SIMT). The following outcomes were assessed before, immediately after, and 30 days post intervention: Vocal Symptom Scale, maximum phonation time (MPT), and numerical count time (MPTC); numerical count (CN); inspiratory muscle strength; peak expiratory flow; and dyspnea sensation.

RESULTS

There were no significant differences between the groups immediately after intervention. The MPT/e/ increased significantly in the IMT group, and the perception of vocal symptoms was significantly reduced in the SIMT group immediately after intervention. At follow-up, according to the analysis of variance, these effects were not maintained.

CONCLUSION

Low-intensity IMT in people with COPD showed immediate positive results on MPT/e/, but these were not sustained after 30 days. There was no immediate effect on measures of airflow limitation, suggesting that the continuation of low-intensity IMT for long periods would provide benefits to subjects with COPD.

Effect of chronic kidney disease on survival in patients with chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease associated with several comorbidities. Although chronic kidney disease (CKD) has been recognized as one such comorbidity, the effect of CKD on survival in patients with COPD remains uncertain. This study investigated the clinical impact of CKD in patients with COPD, accounting for clinically characteristics and 6-min walking test (6MWT) results.

MATERIALS AND METHODS

Patients with COPD who completed the 6MWT and a 3-year follow-up were retroactively enrolled in the study. Data on clinical information, 6MWT parameters, and outcomes were collected and analyzed.

RESULTS

Among the 141 patients with COPD enrolled, 33 (23.4 %) had comorbid CKD. Patients with CKD were significantly older and more likely to experience heart failure, mortality, and FEV1 decline than patients without CKD. Multivariate analysis revealed that 6-min walking distance <350 m (odds ratio [OR]: 3.65, 95 % confidence interval [CI]: 1.05-12.06, p = 0.041) and CKD (OR: 4.66, 95 % CI: 1.30-16.76, p = 0.018) were independent risk factors for mortality.

CONCLUSIONS

Comorbid CKD was associated with an increased mortality rate and rapid FEV1 decline in patients with COPD. Patients with COPD and comorbid CKD may require intensive monitoring during treatment.

FlexO2: A patient-controlled oxygen flow selector improving autonomy and daily function in long-term oxygen therapy (LTOT)

BACKGROUND

Chronic respiratory insufficiency associated with severe resting hypoxemia necessitates long-term oxygen therapy (LTOT), yet existing devices often impede daily activities due to cumbersome flow adjustments, increasing reliance on caregivers. FlexO2 is a novel mechanical regulator that enables switching between preset oxygen flow rates for rest and activity. This proof-of-concept study evaluated its impact on patient autonomy, physical activity, and quality of life.

METHODS

In a consecutive, non-randomized pre-post intervention proof-of-concept study at Karolinska University Hospital, 26 patients on LTOT (median age 77; 69% COPD) used FlexO2 for three months. The device, worn around the neck, allowed patients to self-adjust oxygen doses without accessing the concentrator. Outcomes included ease of use measured by visual analogue scale (VAS), physical activity levels, COPD Assessment Test (CAT), EQ-5D-5 L index, and frequency of dose adjustments.

RESULTS

Ease of dose adjustment increased from a VAS score of 14 to 92 (p < 0.001), with 92% of patients reporting improved ease of adjustment (baseline 7.7%; p < 0.001). Daily adjustment frequency doubled (8 to 15; p = 0.001). Patient-reported activity capacity improved from a VAS of 11 to 80 (p < 0.001). Quality-of-life scores measured by VAS increased from 19 to 61 (p < 0.001), while CAT scores decreased from a median of 26.0 to 22.5 (p = 0.05). The EQ-5D-5 L index remained stable (0.68 to 0.70; p = 0.7), although 38% of patients showed individual improvements. Device usability was high (83% satisfaction), though 15% reported tubing tangling or airflow issues.

CONCLUSION

FlexO2 significantly improved the ease of oxygen dose adjustment and physical activity capacity, potentially enhancing patient autonomy in LTOT. While overall patient-reported quality-of-life scores improved, objective quality-of-life outcomes remained stable. Further studies are warranted to explore long-term clinical outcomes and the potential impact on caregiver burden.

Chronic obstructive pulmonary disease is associated with a higher incidence of acute kidney injury in non-cardiac but not in cardiac surgery ICU-patients: a retrospective MIMIC-III database analysis

PURPOSE

Acute kidney injury (AKI) and chronic obstructive pulmonary disease (COPD) are both associated with high mortality. We hypothesized that COPD impacts the incidence of AKI and the outcome of surgical intensive care unit (ICU)-patients.

MATERIALS AND METHODS

We analyzed data of surgical ICU-patients from the Medical-Information-Mart-for-Intensive-Care-III-database. We compared the incidence of AKI, in-hospital-mortality, ICU-and hospital-length-of-stay (ICU-LOS, HLOS) in patients with and without COPD. In a subgroup analysis, we compared the outcomes of patients undergoing cardiac (CS) and non-cardiac surgery (NCS).

RESULTS

The data of 21,720 cases were analyzed, 9.7 % suffered from COPD. COPD-patients were younger compared to patients without COPD (64years(52-75)vs.71years(63-78),p < 0.001). Males were more frequently represented in both groups (58.3 %vs.61.2 %,p = 0.009). COPD-patients had a higher incidence of AKI (24.2 %vs.19.7 %,p < 0.001), higher in-hospital-mortality (8.7 % vs.6.4 %,p < 0.001), longer ICU-LOS (3.1days(IQR,1.6-7.0)vs.2.3days(IQR,1.3-5.0),p < 0.001), and HLOS (10days(IQR,6-17)vs.8days(IQR,5-15),p < 0.001). Multivariable analyses could not confirm a higher risk for AKI in surgical COPD-patients but for all other outcomes (in-hospital mortality,OR:1.59,95 %CI:1.24-2.04,p < 0.001; ICU-LOS,beta:1.1, 95 %CI:0.6-2.3,p < 0.001; HLOS,beta:1.7,95 %CI:0.9-2.4,p < 0.001). Subgroup analyses revealed that COPD was associated with a higher risk of AKI (OR,1.24,95 %CI:1.01-1.51,p = 0.038), longer ICU-LOS (beta:0.9,95 %CI:0.3-1.5,p = 0.006) and HLOS (beta:1.4,95 %CI:0.2-2.5,p = 0.018) but not with a higher risk for in-hospital mortality in NCS-patients. In CS-patients on the other hand, COPD was associated with a higher risk for in-hospital mortality (OR,1.73,95 %CI:1.02-2.94,p = 0.043) but neither for AKI, longer ICU-LOS or HLOS.

CONCLUSIONS

COPD has a different impact on outcomes in CS- and NCS-patients. While COPD was associated with a higher risk for in-hospital mortality in CS-patients, COPD was associated with a higher risk of AKI, longer ICU-LOS and HLOS in NCS-patients.

Association of blood eosinophil counts with pulmonary and extrapulmonary comorbidities in patients with chronic obstructive pulmonary disease: data from NHANES 2013-2018

BACKGROUND

Chronic obstructive pulmonary disease (COPD) involves systemic inflammation and is often accompanied by comorbidities. Blood eosinophil count (BEC) is a key marker of airway inflammation, used for patient stratification and treatment guidance. However, the association between BEC (< 300 vs. ≥ 300 cells/µL) and pulmonary or extrapulmonary comorbidities in COPD remains unclear.

METHODS

This study analyzed COPD patients from the 2013-2018 National Health and Nutrition Examination Survey (NHANES). Weighted multivariable logistic regression models examined associations between BEC and comorbidities, adjusting for potential confounders. Associations were quantified using odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

A total of 614 COPD patients were included (395 with BEC < 300 cells/µL, 219 with BEC ≥ 300 cells/µL). Patients with BEC ≥ 300 cells/µL had a higher prevalence of extrapulmonary comorbidities than those with BEC < 300 cells/µL (85.35% vs. 71.48%). Adjusted analysis showed that BEC ≥ 300 cells/µL was significantly associated with increased odds of any extrapulmonary comorbidity (OR = 2.03, 95% CI: 1.19-3.44, p = 0.009), congestive heart failure (OR = 1.69, 95% CI: 1.02-2.82, p = 0.043), and renal dysfunction (OR = 1.95, 95% CI: 1.01-3.79, p = 0.048), but not with pulmonary comorbidities. Sensitivity analyses using 3- and 4-level BEC categories revealed consistent trends, with higher BEC levels significantly associated with greater prevalence of at least one extrapulmonary comorbidity.

CONCLUSIONS

In COPD, higher BEC (≥ 300 cells/µL) is significantly associated with extrapulmonary comorbidities, particularly congestive heart failure and renal dysfunction, but not pulmonary comorbidities.

Association between CRP-Albumin-Lymphocyte (CALLY) index and Asthma-COPD overlap: analysis of NHANES 2015-2018 data

BACKGROUND

The CRP-Albumin-Lymphocyte (CALLY) index, a novel inflammatory biomarker combining serum albumin, lymphocyte count, and C-reactive protein (CRP), has been proposed for clinical use. This study aimed to investigate the association between CALLY index and Asthma-COPD Overlap (ACO) in the general US population.

METHODS

We analyzed data from 6,797 participants aged ≥ 40 years from the 2015-2018 National Health and Nutrition Examination Survey (NHANES). Participants were categorized into quartiles based on natural logarithmic transformed (ln) CALLY index. ACO was defined as self-reported physician-diagnosed asthma and COPD. Logistic regression models were used to examine the association between ln CALLY and ACO, adjusting for potential confounders across three models. Generalized additive models, subgroup analyses, and receiver operating characteristic (ROC) curve analysis were also performed.

RESULTS

The prevalence of ACO across the four CALLY quartiles was 5.56%, 1.89%, 1.54%, and 0.66%. In the fully adjusted model, for each 1-unit increase in ln CALLY, the risk of ACO decreased by 43% (OR = 0.57, 95% CI: 0.44-0.73, P = 0.001). Compared with Q1, the risk of ACO in Q2, Q3, and Q4 was reduced by 63% (OR = 0.37), 66% (OR = 0.34), and 87% (OR = 0.13), respectively (P for trend = 0.003). Generalized additive models showed a non-linear negative relationship (P < 0.001). Subgroup analysis revealed that the association remained consistent across different sexes, age groups, races, smoking status, and disease statuses (arthritis, DM, and hypertension). ROC curve analysis indicated moderate predictive ability of ln CALLY for ACO (AUC = 0.675, 95% CI: 0.636-0.714), with an optimal cutoff value of 8.007 (sensitivity 0.669, specificity 0.598).

CONCLUSION

Higher CALLY index is independently associated with lower risk of ACO, suggesting its potential value as a biomarker for ACO risk assessment in clinical practice. By integrating inflammation, immune, and nutritional status evaluation, the CALLY index offers a novel perspective for early identification of high-risk individuals in clinical practice.

Role of Digoxin in Preventing Cigarette Smoke-Induced COPD via HIF-1α Inhibition in a Mouse Model

Purpose

Hypoxia-inducible factor-1α (HIF-1α) plays an important regulatory role in inflammatory and hypoxic diseases. Higher HIF-1α level was found in the lungs of chronic obstructive pulmonary disease (COPD) patients, however, its role in cigarette smoke (CS)-induced COPD has not been fully studied. Digoxin has been showed to inhibit HIF-1α translation and block HIF-1α activity and thus is often used as the HIF-1α inhibitor. Therefore, in the present study, we chose digoxin as the inhibitor to investigate whether HIF-1α contributes to the progression in a mouse model of COPD and possible mechanism.

Methods

The COPD model was established by cigarette smoke (CS) exposed; animals were intragastrically treated with vehicle or different doses of digoxin (0.02 mg/kg and 0.1 mg/kg). COPD associated phenotypes such as pathological changes in lungs, inflammation, lung function and mucus secretion in airways were evaluated. Meanwhile, cigarette smoke extract (CSE) treated A549 cells were administrated with digoxin (50nM) or Smad3 inhibitor (S7959 100uM). Moreover, EMT associated markers together with HIF-1α/TGF-β1/Smad3 signaling pathway were detected both in vivo and in vitro.

Results

The level of HIF-1α was significantly increased in lungs of COPD mice and CSE-exposed A549 cells, which was markedly suppressed by digoxin. Moreover, digoxin inhibited CS-induced inflammatory responses, lung function decline, and mucus hyper-secretion in COPD mouse model. In vitro studies, digoxin decreased CSE-induced pro-inflammatory cytokine release. Importantly, CS-induced or CSE-induced EMT and up-regulation of HIF-1α/TGF-β1/Smad pathway were inhibited by digoxin in vitro. Additionally, S7959 mitigated CSE-induced EMT in A549 cells.

Conclusion

Digoxin can protect CS-induced COPD and prevent CS-induced EMT possibly through HIF-1α/TGF-β1/Smad3 signaling pathway in mice. This study suggests HIF1-α could be a potential intervention target for COPD prevention and treatment, especially for EMT in CS-induced COPD.

Single-Inhaler Triple Therapy in Primary Care Across Europe: Expert Panel Consensus on the Consequences of Payer-Driven Access Rules and Call to Action

Background

Chronic obstructive pulmonary disease (COPD) is a prevalent condition characterized by persistent airflow obstruction and respiratory symptoms. Single-Inhaler Triple Therapy (SITT) has been shown to improve patient adherence, reduce exacerbations, and lower healthcare resource utilization in patients who are not controlled despite being on dual therapy or Multiple-Inhaler Triple Therapy (MITT). Despite evidence supporting SITT, payer-driven access rules across Europe sometimes limit its use in primary care, creating barriers to optimal COPD management.

Purpose

Through expert consensus, the study seeks to generate a shared understanding of the unintended consequences of payer-driven access criteria for SITT in managing moderate-to-severe COPD in primary care.

Methods

A targeted literature review (TLR) was conducted to assess SITT initiation in primary care across Europe and examine the impact of access criteria. Semi-structured interviews were held with 14 experts from nine European countries, including clinicians, health economists, and patient advocacy representatives. A consensus generation workshop was conducted, where experts evaluated the findings and developed position statements to highlight the challenges posed by payer-driven access criteria.

Results

The TLR identified variability in access to SITT in Europe, with several countries restricting its initiation to specialists, thus limiting primary care physicians' (PCPs) ability to prescribe SITT. The expert panel generated seven consensus points stating that enabling PCPs to step up or switch eligible patients to SITT has the potential to support care continuity, enhance clinical autonomy for PCPs, reduce reliance on potentially less effective treatment options, improve patient and healthcare system outcomes, avoid unnecessary referrals to specialists, enable prompt initiation of guideline-directed medical therapy for COPD in primary care and reduce access inequalities.

Conclusion

Restrictions for SITT initiation in primary care may need to be revisited to mitigate their unintended health and cost consequences and improve equitable access to treatment. This should take into consideration each country's unique healthcare system.

A Peptide Encoded by lncRNA HOXB-AS3 Promotes Cigarette Smoke-Induced Inflammation in Bronchial Epithelial Cells via EZH2-Mediated H3K27me3 Modification

Background

Chronic obstructive pulmonary disease (COPD) primarily results from cigarette smoke (CS)-induced chronic inflammation. Although numerous long non-coding ribonucleic acids (lncRNAs) have been extensively studied for their crucial roles in COPD, the peptides encoded by these lncRNAs have garnered limited attention. This study aimed to investigate the role of a peptide encoded by lncRNA HOXB-AS3 in cigarette smoke extract (CSE)-induced inflammation and in 16HBE cells.

Methods

Open reading frames (ORF) Find software was utilized to predict the encoding potential of HOXB-AS3. Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to detect the levels of peptide HOXB-AS3-32aa in peripheral blood mononuclear cells (PBMCs) from both healthy controls and COPD patients and in 16HBE cells exposed to different CSE. To establish an in vitro inflammatory cell model of COPD, 16HBE cells were treated with 2% CSE. Enzyme-Linked Immunosorbent Assay (ELISA) measured inflammatory cytokines, while CCK-8 assay assessed cell viability. Flow cytometry was employed to assess cell apoptosis. Western blot analysis was performed to measure the expression of HOXB-AS3-32aa, EZH2, and H3K27me3 proteins. Co-Immunoprecipitation (Co-IP) was conducted to verify the interaction between EZH2 and HOXB-AS3-32aa.

Results

Our findings revealed elevated expression of HOXB-AS3-32aa in PBMCs of COPD patients compared to controls. CSE treatment dose-dependently increased HOXB-AS3-32aa expression. Overexpression of HOXB-AS3-32aa exacerbated CS-induced inflammation in bronchial epithelial cells, leading to inhibited cell proliferation and increased cell apoptosis. Furthermore, HOXB-AS3-32aa suppressed EZH2 and H3k27me3 protein levels in 16HBE cells. Co-IP results confirmed the interaction between HOXB-AS3-32aa and EZH2 protein.

Conclusion

Our results demonstrate that the novel peptide HOXB-AS3-32aa encoded by lncRNA HOXB-AS3 promotes CS-induced inflammation and apoptosis in 16HBE cells via EZH2-mediated H3K27me3 modification.

Association of heart rate variability index with depressive symptoms and lung function in chronic obstructive pulmonary disease

BACKGROUND

Depression is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD). Research indicates that COPD affects cardiac autonomic control, and heart rate variability (HRV) serves as a simple, non-invasive measure of autonomic nerve activity. However, the relationship between HRV and lung function, as well as the impact of depressive symptoms, remains unclear.

AIM

To investigate the correlation between HRV indicators and depressive symptoms and lung function in patients with COPD.

METHODS

A retrospective cross-sectional study involving 120 COPD patients hospitalized from January 2018 to January 2024 at our institution was conducted. Demographic and clinical characteristics were collected, and depressive symptoms were assessed using the Beck Depression Inventory (BDI). Patients were categorized into a depressed group (BDI ≥ 16) and a non-depressed group (BDI < 16). A control group consisting of 60 healthy volunteers who underwent check-ups at the same institution was also included. Statistical analyses were performed using SPSS 26.0 software. Pearson correlation coefficients were calculated to determine and compare the relationships between HRV parameters, lung function measures, and depressive symptoms across the groups.

RESULTS

Of the 120 patients with COPD, 35.8% (43/120) were diagnosed with depression, compared to 5.0% (3/60) in the control group. The HRV index in COPD patients was significantly lower than that in the control group (P < 0.05), and the value in the depressed group was significantly lower than that in the non-depressed group (P < 0.05). Similarly, the COPD group had a significantly lower pulmonary forced vital capacity (FVC), first-second expiratory volume (FEV1) and FEV1/FVC ratios than the control group (P < 0.05), and the depressed group was significantly lower than that in the non-depressed group (P < 0.05). Pearson correlation analysis revealed that the standard deviation of normal R-R intervals, standard deviation of the mean of 5-minute normal R-R intervals, root mean square of successive differences of normal R-R intervals, percentage of normal R-R intervals greater than 50 ms, high-frequency, and low-frequency indices showed positive correlations with lung function parameters (P < 0.05) and negative correlations with BDI scores (P < 0.05).

CONCLUSION

Compared to patients without COPD, the incidence of depressive symptoms is higher among patients with COPD and is negatively correlated with the patients’ HRV indices. In contrast, HRV indices are positively correlated with the patients’ pulmonary function parameters. Patients and healthcare professionals should enhance their awareness of depression, actively conduct depression assessment screenings, and incorporate HRV indices into disease management. This approach aims to improve the psychological health of patients and ultimately enhance their prognosis and quality of life.

A Multidimensional Diagnostic Approach for Chronic Obstructive Pulmonary Disease

Importance

Individuals at risk for chronic obstructive pulmonary disease (COPD) but without spirometric airflow obstruction can have respiratory symptoms and structural lung disease on chest computed tomography. Current guidelines recommend COPD diagnostic schemas that do not incorporate imaging abnormalities.

Objective

To determine whether a multidimensional COPD diagnostic schema that includes respiratory symptoms and computed tomographic imaging abnormalities identifies additional individuals with disease.

Design, Setting, and Participants

This cohort study included 2 longitudinal cohorts: the Genetic Epidemiology of COPD (COPDGene), which enrolled 10 305 participants between November 9, 2007, and April 15, 2011, with longitudinal follow-up through August 31, 2022; and the Canadian Cohort Obstructive Lung Disease (CanCOLD), which enrolled 1561 participants between November 26, 2009, and July 15, 2015, with follow-up through December 31, 2023.

Exposure

Exposure included the new multidimensional COPD diagnostic schema, defined by (1) major diagnostic category: presence of the major criterion (airflow obstruction based on postbronchodilator forced expiratory volume in the first second of expiration [FEV1]/forced vital capacity ratio <0.70) and at least 1 of 5 minor criteria (emphysema or bronchial wall thickening on computed tomography, dyspnea, poor respiratory quality of life, and chronic bronchitis); or (2) minor diagnostic category: presence of least 3 of 5 minor criteria (which must include emphysema and bronchial wall thickening for individuals with respiratory symptoms potentially due to other causes).

Main Outcomes and Measures

All-cause mortality, respiratory cause-specific mortality, exacerbations, and annualized change in FEV1.

Results

Among 9416 adults in COPDGene (mean [SD] age at enrollment, 59.6 [9.0] years; 5035 [53.5%] were men; 3071 [32.6%] were Black; 6345 (67.4%) were White; 4943 [52.5%] currently smoked), 811 of 5250 individuals (15.4%) without airflow obstruction were newly classified as having COPD by minor diagnostic category, and 282 of 4166 individuals (6.8%) with airflow obstruction were classified as not having COPD. Reclassified individuals with a new COPD diagnosis had greater all-cause mortality (adjusted hazard ratio, 1.98; 95% CI, 1.67-2.35; P < .001) and respiratory-specific mortality (adjusted hazard ratio, 3.58; 95% CI, 1.56-8.20; P = .003), more exacerbations (adjusted incidence rate ratio, 2.09; 95% CI, 1.79-2.44; P < .001), and more rapid FEV1 decline (adjusted β = -7.7 mL/y; 95% CI, -13.2 to -2.3; P = .006) compared with individuals classified as not having COPD. Among individuals with airflow obstruction on spirometry, those no longer classified as having COPD based on this new diagnostic schema had outcomes similar to those without airflow obstruction. Among 1341 adults in CanCOLD, individuals newly classified as having COPD experienced more exacerbations (adjusted incidence rate ratio, 2.09; 95% CI, 1.25-3.51; P < .001).

Conclusions and Relevance

A new COPD diagnostic schema integrating respiratory symptoms, respiratory quality of life, spirometry, and structural lung abnormalities on computed tomographic imaging newly classified some individuals as having COPD. These individuals had an increased risk of all-cause and respiratory-related death, frequent exacerbations, and rapid lung function decline compared with individuals classified as not having COPD. Some individuals with airflow obstruction without respiratory symptoms or evidence of structural lung disease were no longer classified as having COPD.

Association between oral microbiome diversity and chronic obstructive pulmonary disease in the US population

BACKGROUND

There is a dearth of population-based studies on the association between the diversity of the oral microbiome and the risk of chronic obstructive pulmonary disease (COPD). The study aims to investigate the association between oral microbiome diversity and COPD.

METHODS

In this cross-sectional study, data from the National Health and Nutrition Examination Survey (NHANES 2009-2012) were analyzed. The association between the oral microbiome α-diversity and COPD risk was examined via multivariable logistic regression, with Restricted cubic splines revealing potential non-linear trends. The β-diversity disparities between COPD and non-COPD groups were delineated using Principal Coordinate Analysis (PCoA) and Permutational Multivariate Analysis of Variance (PERMANOVA).

RESULTS

A total of 6061 participants were included in this study. For α-diversity, the observed ASVs were significantly associated with COPD risk (OR = 0.964, 95%CI: 0.936-0.993, P = 0.016). Similarly, Faith's phylogenetic Diversity showed a significant association with COPD risk (OR = 0.955, 95%CI: 0.919-0.993, P = 0.020). The Shannon-Weiner index was also associated with COPD risk (OR = 0.829, 95%CI: 0.702-0.981, P = 0.029). For β-diversity, PCoA and PERMANOVA analysis showed statistically significant differences in Bray-Curtis, unweighted, and weighted UniFrac distances (all P < 0.01) between the COPD and non-COPD groups.

CONCLUSIONS

Significant differences in oral microbiome α-diversity and β-diversity were found between COPD and non-COPD populations, with α-diversity (observed ASVs, Faith's Phylogenetic Diversity, Shannon-Weiner index) being negatively associated with the risk of COPD.

Influencing mechanisms of kinesiophobia in middle-aged and elderly patients with chronic obstructive pulmonary disease: a cross-sectional study

BACKGROUND

The aim of this study is to explore the mechanism of the role of kinesiophobia in patients with chronic obstructive pulmonary disease (COPD), to construct a structural equation model of the factors influencing kinesiophobia in patients with COPD, and to provide a theoretical basis for the development of targeted intervention strategies.

METHODS

The cross-sectional design was conducted from December 2023 to July 2024, and middle-aged and elderly patients with COPD from a tertiary hospital in Guangzhou, China, were selected using convenience sampling. A general demographic information questionnaire, Breathlessness Beliefs Questionnaire scale (BBQ), modified Medical Research Council Dyspnea Scale (mMRC), Fatigue Scale (FS-14), Hospital Anxiety and Depression Scale (HADS), Self-Efficacy for Exercise (SEE), and Social Support Rating Scale (SSRS) were used for data collection. Spearman correlation analysis and structural equation modeling (SEM) were used for data analysis.

RESULTS

A total of 278 COPD patients were included. Correlation analysis showed that dyspnoea (r = 0.689, p < 0.01), fatigue (r = 0.731, p < 0.01) and anxiety (r = 0.678, p < 0.01) were significantly positively correlated with kinesiophobia, whereas social support (r=-0.518, p < 0.01) and exercise self-efficacy (r=-0.740, p < 0.01) were significantly negatively correlated with kinesiophobia. SEM analyses revealed six significant pathways of action: dyspnoea, exercise self-efficacy was a direct predictor of kinesiophobia. Fatigue, and social support were indirect predictors of kinesiophobia. Anxiety was a direct and indirect predictor of kinesiophobia.

CONCLUSIONS

Dyspnoea, fatigue, anxiety, social support and exercise self-efficacy are important predictors of kinesiophobia in COPD patients. Clinical interventions should focus on the synergistic effects of these five types of variables to establish a multidimensional and comprehensive management programme.

TRIAL REGISTRATION

The protocol was reviewed by the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University (Ethics Code: LCYJ-2023-055).

Structure of Patients' Temperament Traits as a Risk Factor for Anxiety and Depression in Patients with Asthma and Chronic Obstructive Pulmonary Disease (COPD)

Introduction: Asthma and chronic obstructive pulmonary disease (COPD) are chronic respiratory illnesses frequently accompanied by anxiety and depression. These psychological symptoms often go undetected due to their overlap with somatic complaints. According to the regulatory theory of temperament (RTT), biologically based temperament traits may influence emotional responses to chronic illness. This study examined whether RTT-defined temperament traits predict depression and anxiety severity in patients with asthma and/or COPD. Material and Methods: The study included 210 adult patients with asthma and/or COPD recruited from a university hospital and pulmonology clinics. Individuals with a prior history of mental illness were excluded. Participants completed three validated questionnaires: the Formal Characteristics of Behavior-Temperament Inventory (FCB-TI), the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory (STAI). Additional demographic and clinical data were collected. Multiple linear regression was used to assess the predictive value of six temperament traits for depression, state anxiety, and trait anxiety. A significance threshold of α = 0.05 was used in all statistical tests. Results: Temperament structure significantly predicted all three mental health outcomes: depression (R2 = 0.37), state anxiety (R2 = 0.45), and trait anxiety (R2 = 0.35). Briskness negatively correlated with all outcomes, while emotional reactivity showed a positive correlation. No significant associations were found for the remaining four traits. Socioeconomic and lifestyle factors were not significant predictors. Conclusions: Temperament traits, particularly briskness and emotional reactivity, significantly influence depression and anxiety severity in asthma and COPD. Temperament assessment may serve as a low-cost, telemedicine-compatible tool to identify at-risk patients and support integrated, personalized care.

Association Between Lactate-to-Albumin Ratio and 28-Day All-Cause Mortality in Critical Care Patients with COPD: Can Both Arterial and Peripheral Venous Lactate Serve as Predictors?

Background

Lactate-to-albumin ratio (LAR) has been reported as a useful predictor for multiple critical illnesses. However, the association between LAR and mortality in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aims to clarify the correlation between LAR and 28-day all-cause mortality in patients with COPD and to investigate whether LAR calculated using arterial lactate (AL) or peripheral venous lactate (PVL) can serve as predictive indicators.

Methods

A total of 1428 patients from the Medical Information Mart for Intensive Care (MIMIC) IV database (version 2.2) and 2467 patients from the eICU Collaborative Research Database (eICU-CRD, version 2.0) were included in this study. Propensity score matching (PSM) method was conducted to control confounders. Cox proportional hazards model, Kaplan-Meier survival method, subgroup analysis and receiver operating characteristic (ROC) analysis were performed to assess the predictive ability of LAR. To verify our hypothesis, data from the two databases were analyzed individually.

Results

After adjusting for covariates, LAR calculated using either AL (MIMIC IV, HR = 1.254, 95% CI, 1.013-1.552, P = 0.038) or PVL (eICU-CRD, HR = 1.442, 95% CI, 1.272-1.634, P < 0.001) was independently associated with 28-day all-cause mortality in COPD patients. Kaplan-Meier analysis showed that patients with higher LAR value had significantly higher all-cause mortality (all P < 0.05). This association was consistent across subgroup analyses. In addition, the ROC analysis suggested that LAR calculated using PVL may have better predictive performance compared to using AL.

Conclusion

LAR calculated using both AL and PVL can independently predict the 28-day all-cause mortality after ICU admission in patients with COPD and higher level of LAR is related to higher mortality risk.

Prevalence of chronic respiratory disease using case-finding tools in adults living with noncommunicable disease in low- and middle-income countries: a systematic review

BACKGROUND

Chronic respiratory diseases (CRD) often coexist with other non-communicable diseases (NCD) and are responsible for nearly three-quarters of all deaths in low- and middle-income countries (LMIC). People living with NCD are considered at higher risk of having CRD, but the prevalence of CRD in those with other NCD in LMIC is not well described. This study aimed to identify the prevalence of CRD and/or abnormal spirometry identified through case-finding tools in adults living with NCD in LMIC.

METHODS

This systematic review followed the PRISMA guidelines and included Lilacs, PubMed, Scielo, Embase and Web of Science databases. Two reviewers independently examined the titles and abstracts of studies identified from the search to determine eligibility for inclusion. Searching was carried out until May 16, 2024, and was updated in February 2025. Cross-sectional studies that used case finding tools to identify CRD in adults living with other NCD in LMIC were eligible. The studies were exported to Rayyan software, and duplicates were manually removed. Data were extracted including study characteristics, and quality was assessed using the modified Newcastle-Ottawa Scale risk of bias tool. A descriptive analysis of the prevalence of respiratory diseases and spirometric abnormalities was reported considering 95% confidence intervals.

RESULTS

A total of 8,939 citations were screened based on titles and abstracts. Thirteen full-text articles were assessed for eligibility. Five studies were excluded for not providing sufficient data, two for inadequate outcome ascertainment, two for being conducted in developed countries, and one for only including patients with a previous COPD diagnosis. Three cross-sectional studies met the inclusion criteria, one conducted in India, and two in Brazil. Considering studies with a low risk of bias, the prevalence of CRD was between 1% and 5.2% in patients with hypertension. The prevalence of abnormal spirometry was between 11% and 17% in patients with coronary artery disease.

CONCLUSION

The prevalence of CRD identified through case-finding tools in adults with NCD in LMIC varies according to the NCD in which it was investigated. These findings highlight the opportunity to case-find CRD by assessing people accessing care for other NCD.

REGISTRATION

PROSPERO 2024 CRD42024534734.

The Prevalence of Emphysema in Patients Undergoing Lung Cancer Screening in a Middle-Income Country

Background: Chronic obstructive pulmonary disease (COPD) and lung cancer are the leading causes of death globally, which share common risk factors such as age and smoking exposure. In high-income countries, low-dose computed tomography (LDCT) lung cancer screening programs have decreased lung cancer mortality and facilitated the detection of emphysema, a key radiological indicator of COPD. This study aimed to assess the prevalence of emphysema during a pilot LDCT screening program for lung cancer in a middle-income country with a high smoking prevalence. Methods: A secondary analysis of the Lung Cancer Screening Database of the Autonomous Province of Vojvodina, Serbia, from 20 September 2020 to 30 May 2022. Persons aged 50-74 years, with a smoking history of ≥30 pack-years/or ≥20 pack-years with additional risks (chronic lung disease, prior pneumonia, malignancy other than lung cancer, family history of lung cancer, and professional exposure to carcinogens) were offered LDCT. Results: Of 1288 participants, mean age of 62.1 ± 6.7 years and 535 males (41.5%), 386 (30.0%) had emphysema. The majority of patients with emphysema (301/386, 78.0%) had no prior history of chronic lung diseases. Compared to the patients without emphysema, the patients with emphysema reported more shortness of breath (140/386, 36.3% vs. 276/902, 30.6%, p = 0.046), chronic cough (117/386, 30.3% vs. 209/902, 23.17% p = 0.007), purulent sputum expectoration (70/386, 18.1% vs. 95/902, 10.53%, p < 0.001), and weight loss (45/386, 11.7% vs. 63/902, 7.0%, p = 0.005). The patients with emphysema had more exposure to smoking (pack/years, 43.8 ± 18.8 vs. 39.3 ± 18.1, p < 0.001) and higher prevalence of solid or semisolid lung nodules (141/386, 36.5% vs. 278/902 30.8%, p = 0.04). Conclusions: Almost one-third of the patients who underwent the LDCT screening program in a middle-income country had emphysema that was commonly undiagnosed despite being associated with a significant symptom burden. Spirometry screening should be considered in high-risk populations.

At-home validation of a non-contact, radar-based breathing monitor for long-term care of patients with respiratory diseases: A proof-of-concept study

Long-term monitoring of respiratory rate (RR) is an important component in the management of chronic respiratory diseases (CRDs). Specifically, predicting acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is of significant scientific and clinical interest. This study aimed to evaluate the long-term validity of a novel contactless sleep monitor (CSM) in the home environment of CRD patients receiving ventilatory support. Additionally, we assessed patient acceptance, device usability, and RR fluctuations associated with AECOPD to establish a robust foundation for future research.In this prospective proof-of-concept study, nineteen patients requiring non-invasive ventilation (NIV) were provided with the CSM in their home environment for six months and seven patients requiring invasive mechanical ventilation (IMV) for one month. The primary indication for NIV therapy was chronic obstructive pulmonary disease (COPD).The CSM was validated under real-life conditions by comparing its nocturnal RR values with software data from both types of ventilators. Acceptability and usability of the sensor were assessed using a questionnaire. Additionally, COPD exacerbations occurring during the study period were analyzed for potential RR fluctuations preceding these events.Mean absolute error (MAE) of median RR between the NIV device and the CSM, based on 2326 nights, was 0.78 (SD: 1.96) breaths per minute (brpm). MAE between the IMV device and the CSM was 0.12 brpm (SD: 0.52) for 215 nights. The non-contact device was accepted by the patients and proved to be easy in use. In some of the overall only 13 cases of AECOPD, RR time courses showed variations of increased nocturnal respiratory activity a few days before the occurrence of such events.The present CSM is suitable for valid long-term monitoring of nocturnal RR in patients' home environment and is well accepted by the patients. The exploratory findings related to AECOPD events may serve as a starting point for larger studies aimed at developing robust prediction rules.

The Impact of Case Management on Elderly Patients with Chronic Obstructive Pulmonary Disease

Purpose

This study aims to investigate the effects of case management on elderly patients with chronic obstructive pulmonary disease (COPD) and compare changes in pulmonary function indicators, quality of life, dyspnea, and inhaled medication adherence before and after case management.

Patients and Methods

A total of 199 elderly COPD patients were enrolled from Beijing Tsinghua Changgung Hospital between January 2020 and November 2023. We implemented case management programs including regular patient education, personalized interventions, continuous support systems, and timely feedback mechanisms, and subsequently collected patient data at 1, 3, 6, and 12 months after initiating case management.

Results

After one year of case management, pulmonary function indicators (FEV1/FVC, FEV1, FEV1%pred, MMEF75/25 and MMEF75/25%) in elderly patients with COPD showed significant improvement (P < 0.001). The CAT score decreased from 17.96±6.57 (mean ± standard deviation) to 11.80±6.50, and mMRC score decreased from 2.35±0.66 to 1.14±0.92 (p<0.001). Additionally, 77.9% (155/199) of patients were able to maintain their use of the inhaler for 1 year.

Conclusion

This study confirmed the significant role of case management in improving respiratory function, quality of life, and dyspnea in elderly patients with COPD. These findings not only provide a valuable reference for clinicians and patients, but also provide a strong foundation for further optimization of management strategies for elderly patients with COPD.

The effects of various nutritional supplements in patients with chronic obstructive pulmonary disease: a network meta-analysis

OBJECTIVE

To evaluate the effectiveness of various nutritional supplements as interventions for patients with Chronic Obstructive Pulmonary Disease (COPD) using network meta-analysis.

METHODS

We searched PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials on nutritional supplements for COPD patients, with the search updated to March 24, 2025. The risk of bias for each included study was assessed using appropriate tools, and the certainty of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Data synthesis was performed using R software, employing network meta-analysis methods to compare the relative efficacy of different nutritional interventions.

RESULTS

Thirty-seven studies involving 1975 COPD patients and 21 different nutritional supplements were analyzed. Butyrate [MD = 2.7, 95% CrI (1.0, 4.4)], Nanocurcumin [MD = 13, 95% CrI (5.4, 21)], and probiotics [MD = 7.1, 95% CrI (5.2, 9.1)] significantly improved Forced Expiratory Volume in One Second (FEV1). Nanocurcumin also slowed the decline in the ratio of Forced Expiratory Volume in One Second to Forced Vital Capacity (FEV1/FVC) [MD = 12, 95% CrI (5.5, 18)]. For exercise endurance, coenzyme Q10 combined with creatine [MD = 63, 95% CrI (36, 90)], Melatonin (MLT) [MD = 46, 95% CrI (1.3, 92)], Nitrate [MD = 30, 95% CrI (19, 41)], and whey proteins [MD = 11, 95% CrI (9.2, 13)] significantly improved 6-minute walk distance (6MWD). Regarding dyspnea reduction, MLT [MD = -0.90, 95% CrI (-1.6, -0.21)] and Yam-Epimedium [MD = -1.3, 95% CrI (-1.9, -0.67)] significantly lowered modified Medical Research Council (mMRC) scores. In terms of quality of life, MLT [MD = -8, 95% CrI (-12, -4.2)], Vitamin D (VD) [MD = -2.5, 95% CrI (-3.1, -1.9)], and whey proteins [MD = -0.70, 95% CrI (-0.99, -0.41)] reduced COPD Assessment Test (CAT) scores. Additionally, AKL1 [MD = -9.2, 95% CrI (-18, -0.41)], creatine [MD = -9.6, 95% CrI (-17, -2.8)], and Yam-Epimedium [MD = -24, 95% CrI (-34, -13)] lowered St. George's Respiratory Questionnaire (SGRQ) scores. The Surface Under the Cumulative Ranking Curve (SUCRA) analysis showed Nanocurcumin ranked highest for improving FEV1/FVC, coenzyme Q10 combined with creatine for 6MWD, Yam-Epimedium for reducing dyspnea and SGRQ, and MLT for lowering CAT scores.

CONCLUSION

This analysis indicates that various nutritional supplements, including Nanocurcumin, butyrate, probiotics, coenzyme Q10 combined with creatine, MLT, nitrate, whey proteins, VD, AKL1, creatine, and Yam-Epimedium, can potentially benefit COPD patients, demonstrating differing levels of effectiveness. Specifically, Nanocurcumin may be the best choice for improving lung function; coenzyme Q10 combined with creatine may be the most effective for enhancing exercise endurance; Additionally, Yam-Epimedium is the most likely supplement to reduce the symptoms of dyspnea in COPD patients. Yam-Epimedium and MLT may be the most effective for improving quality of life and overall health status.

Burden and predictors of chronic obstructive pulmonary disease occurrence and severity among an occupational cohort of United States Department of Energy former workers

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease that reduces lung function and primarily affects older adults. Evidence suggests that occupational exposures like diesel exhaust, cadmium, welding fumes, and silica increase the risk of COPD. Some United States Department of Energy (DOE) workers may be exposed to these noxious substances as they execute their job responsibilities. Assessment of the burden of COPD among these workers and identification of the potential associations between the condition and the above occupational exposures is important for guiding screening, prevention, and control programs. Therefore, the objectives of this study are to: (a) estimate the burden of COPD among former workers of the DOE in the United States and (b) investigate the association between occupational exposures and COPD occurrence and severity among these workers while controlling for environmental, behavioral, and socio-demographic factors.

METHODS

Retrospective data containing health screening records of former DOE workers, covering the time period 2006-2019, were obtained from the National Supplemental Screening Program. Multivariate imputation by chained equation was used to impute missing values. Binary and multinomial logistic regression models were used to investigate predictors of COPD occurrence and severity, respectively.

RESULTS

Of the 17,376 participants included in the study, 20.8% had COPD. History of asthma, age at exam, body mass index, and smoking were significant predictors of both COPD occurrence and severity. Individuals exposed to silica had higher odds of COPD compared to those that were not exposed to silica. Similarly, diesel exhaust exposure was significantly associated with risk of more severe COPD.

CONCLUSIONS

The findings of this study demonstrate the importance of considering occupational experience in the assessment of both COPD occurrence and severity. This information may be important for occupational screening programs as well as aiding in identifying modifiable risk factors to guide prevention and control efforts.

Leveraging Subjective Parameters and Biomarkers in Machine Learning Models: The Feasibility of lnc-IL7R for Managing Emphysema Progression

Background/Objectives: Chronic obstructive pulmonary disease (COPD) remains a leading cause of death worldwide, with emphysema progression providing valuable insights into disease development. Clinical assessment approaches, including pulmonary function tests and high-resolution computed tomography, are limited by accessibility constraints and radiation exposure. This study, therefore, proposed an alternative approach by integrating the novel biomarker long non-coding interleukin-7 receptor α-subunit gene (lnc-Il7R), along with other easily accessible clinical and biochemical metrics, into machine learning (ML) models. Methods: This cohort study collected baseline characteristics, COPD Assessment Test (CAT) scores, and biochemical details from the enrolled participants. Associations with emphysema severity, defined by a low attenuation area percentage (LAA%) threshold of 15%, were evaluated using simple and multivariate-adjusted models. The dataset was then split into training and validation (80%) and test (20%) subsets. Five ML models were employed, with the best-performing model being further analyzed for feature importance. Results: The majority of participants were elderly males. Compared to the LAA% <15% group, the LAA% ≥15% group demonstrated a significantly higher body mass index (BMI), poor pulmonary function, and lower expression levels of lnc-Il7R (all p < 0.01). Fold changes in lnc-IL7R were strongly and negatively associated with LAA% (p < 0.01). The random forest (RF) model achieved the highest accuracy and area under the receiver operating characteristic curve (AUROC) across datasets. A feature importance analysis identified lnc-IL7R fold changes as the strongest predictor for emphysema classification (LAA% ≥15%), followed by CAT scores and BMI. Conclusions: Machine learning models incorporated accessible clinical and biochemical markers, particularly the novel biomarker lnc-IL7R, achieving classification accuracy and AUROC exceeding 75% in emphysema assessments. These findings offer promising opportunities for improving emphysema classification and COPD management.

Effects of complications associated with chronic obstructive pulmonary disease on lung function and hospitalization expenses: A retrospective study

This study investigates the impact of complications associated with chronic obstructive pulmonary disease (COPD) on pulmonary function and inpatient medical expenditures in the Zhongshan region. A retrospective analysis of data from January 2012 to December 2021 was conducted, focusing on lung function and hospitalization expenses for COPD patients (n = 272). The included cases were initially categorized into a simple group (without comorbidities, n = 99) and a nonsimple group (with comorbidities, n = 173). Changes in lung function within each subgroup over a decade were evaluated, along with the average annual hospitalization rate, average duration of hospital stay, and mean hospitalization cost for COPD patients. A comparison between the simple group and the nonsimple group of COPD patient's uncovered statistically significant distinctions (P < .05) in age, extent of lung function alteration, average annual hospitalization frequency, and average hospitalization cost. Moreover, multivariable logistic regression analysis showed that, after adjusted for age, sex, smoking, and hospitalizations, patients with comorbidities (nonsimple group) were independently associated with lung function changes (β = 4.048, 95% CI: 1.435-6.659, P = .003) compared to those without comorbidities (simple group). Comorbidities have a substantial impact on the lung function of COPD patients. Furthermore, they are associated with increased hospitalization frequency, elevated hospitalization costs, and a higher economic burden of hospitalization for COPD patients.

Flores S, Esquivel E, Ding Y, Peitzsch M, Robles-Guirado JÁ, Regojo Zapata RM, Pozo-Kreilinger JJ, Iglesias C, Dwight T, Muir CA, Oleaga A, Garrido-Lestache Rodríguez-Monte ME, Del Cerro MJ, Martínez-Bendayán I, Álvarez-González E, Cubiella T, Lourenço DM, A. Pereira MA, Burnichon N, Buffet A, Broberg C, Dickson PV, Fraga MF, Llorente Pendás JL, Rueda Soriano J, Buendía Fuentes F, Toledo SP, Clifton-Bligh R, Dienstmann R, Villanueva J, Capdevila J, Gimenez-Roqueplo AP, Favier J, Nuciforo P, Young WF, Bechmann N, Opotowsky AR, Vaidya A, Bancos I, Weghorn D, Robledo M, Casteràs A, Dos-Subirà L, Adameyko I, Chiara MD, Dahia PL, Toledo RA. Convergent Genetic Adaptation in Human Tumors Developed Under Systemic Hypoxia and in Populations Living at High Altitudes

SIGNIFICANCE

This study reveals a broad convergence in genetic adaptation to hypoxia between natural populations and tumors, suggesting that insights from natural populations could enhance our understanding of cancer biology and identify novel therapeutic targets. See related commentary by Lee, p. 875.

Association of Exercise Tolerance with Respiratory Health Outcomes in Mild-to-Moderate Chronic Obstructive Pulmonary Disease

Rationale: Previous studies have identified exercise intolerance in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD). The association of exercise tolerance with lung function decline and acute exacerbation risk in mild-to-moderate COPD is unclear, especially in the community population. Objectives: We evaluated exercise tolerance in patients with mild-to-moderate COPD and analyzed its associations with respiratory health outcomes. Methods: We analyzed data from the community-based ECOPD (Early Chronic Obstructive Pulmonary Disease) study of patients with mild-to-moderate COPD (postbronchodilator forced expiratory volume in 1 second (FEV1):forced vital capacity < 0.70 and FEV1 ≥ 50% predicted). Patients who completed questionnaires, spirometry, and cardiopulmonary exercise testing at baseline were included. Annual exacerbation assessment and spirometry were conducted for 2 years consecutively. Exercise tolerance was defined as the percentage of predicted peak oxygen uptake ([Formula: see text]o2peak% predicted). We analyzed the association between exercise tolerance, annual lung function decline, and acute exacerbation risk. Results: Overall, 338 patients were included in the baseline analysis, and 319 completed the 2-year follow up. The mean ± standard deviation of [Formula: see text]o2peak% predicted was 79.8 ± 13.7%. Low [Formula: see text]o2peak% predicted was associated with more chronic respiratory symptoms, worse lung function, severer emphysema, and air trapping at baseline. During the 2-year follow up, a decrease of 13.7% (1 standard deviation) in [Formula: see text]o2peak% predicted was associated with a decline in prebronchodilator FEV1:forced vital capacity (difference, 0.4% [95% confidence interval, 0.1-0.7%]; P = 0.003) and higher total exacerbation risk (relative risk, 1.25 [95% confidence interval, 1.08-1.46]; P = 0.004) after adjustment. Conclusions: Patients with mild-to-moderate COPD and exercise intolerance have worse respiratory health outcomes, for which low exercise tolerance is a prognostic marker. Clinical trial registered with www.chictr.org.cn (ChiCTR1900024643).

Efficacy of Indacaterol vs Tiotropium in COPD patients due to biomass exposure in improving quality of life and reducing symptoms

BACKGROUND

Few treatment trials have been tested on COPD patients associated with biomass smoke exposure (COPD-B). Patients with COPD-B improve hyperinflation 24 h after inhaling long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA), and after six months of treatment, improve symptoms, quality of life, and exacerbations. However, the usefulness of LAMA or LABA for an extended period for improving quality of life and symptoms has not yet been demonstrated in the COPD-B phenotype. The primary aim of this trial was to compare tiotropium (TIO) with indacaterol (IND) in improving the quality of life measured by the Saint George's Respiratory Questionnaire (SGRQ) in COPD-B after six months of treatment.

METHODS

A randomized, open-label, parallel-group clinical trial designed at a third-level health institute in Mexico City. Seventy-three COPD-B women were randomly assigned to either 150 mcg of indacaterol or 18 mcg of tiotropium once daily for 24 weeks.

RESULTS

197 patients underwent the screening visit, of which 73 were randomized. There was no significant change in the three domains nor the total score of the SGRQ in either treatment group. For secondary outcomes, the TIO group showed a substantial change in the IC of 160 mL (p = 0.016) after six month-treatment. For both treatment groups, a significant reduction in BDI/TDI score of 3 points was shown (p < 0.001).

CONCLUSIONS

Neither TIO nor IND improved quality of life, nor dyspnea evaluated by the mMRC scale, but TIO did improve inspiratory capacity, and TIO and IND improved dyspnea evaluated by BDI/TDI.

CLINICAL TRIAL REGISTRATION

NCT05506865.

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.

Short- and long-term outcomes of pulmonary emphysema patients on mechanical ventilation admitted to the intensive care unit for acute respiratory failure: A retrospective observational study

INTRODUCTION

Acute respiratory failure is a leading cause of admission to the intensive care unit (ICU), with mortality rates remaining stagnant despite advances in resuscitation techniques. Comorbidities, notably chronic obstructive pulmonary disease, significantly impact ICU patient outcomes. Pulmonary emphysema, commonly associated with chronic obstructive pulmonary disease, poses a significant risk, yet its influence on ICU mortality remains understudied.

OBJECTIVES

The aim of this study was to assess the short- and long-term outcomes of ICU patients with pulmonary emphysema requiring mechanical ventilation for acute respiratory failure, evaluating the impact of emphysema severity.

METHODS

A single-centre retrospective cohort study was conducted from 2015 to 2021. Patients with pulmonary emphysema requiring invasive ventilation were included. Emphysema severity was assessed using chest computed tomography scans. Data on mortality, length of stay, and ventilator-free days were collected. Statistical analyses were performed to identify factors associated with outcomes.

RESULTS

Of the 89 included patients, 31.5% died during their ICU stay, with a 39.3% mortality within 12 months postdischarge. Emphysema severity did not significantly correlate with mortality or ventilator-free days. Chronic heart failure emerged as a significant predictor of ICU and in-hospital mortality.

CONCLUSIONS

Emphysema severity does not appear to independently affect mortality in intubated ICU patients with acute respiratory failure. However, mortality rates remain high, warranting further investigation into contributing factors. Our findings underline the complexity of managing critically ill patients with pulmonary emphysema and emphasise the need for comprehensive patient assessment and personalised treatment approaches.

Effect of age, COPD severity, and cigarette smoke exposure on bronchial epithelial barrier function

We investigated the effect of age, cigarette smoke, and chronic obstructive pulmonary disease (COPD) severity on epithelial barrier function. Primary bronchial epithelial cells (PBECs) were obtained from bronchial brushings in eight younger and eight older never-smokers; seven older ex-smokers without COPD, eight patients with COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) I-III and six patients with COPD GOLD IV, and cultured in the absence/presence of cigarette smoke extract (CSE). Epithelial barrier function was assessed by electric resistance sensing and expression of junctional and antioxidant genes/proteins quantified by qPCR/immunodetection. Epithelial barrier function was comparable between PBECs from younger and older never-smokers. PBECs from ex-smokers had significantly lower barrier function compared with never-smokers, with a further decrease in COPD GOLD IV. CSE decreased epithelial barrier function from which PBECs from never-smokers, but not ex-smokers with and without COPD, recovered. Restoration of barrier function was accompanied by increased expression of barrier and antioxidant genes. At baseline, PBECs from ex-smokers with and without COPD had higher expression of junctional and antioxidant genes compared with never-smokers. However, exposure to CSE increased antioxidant (SOD1-3, CAT) gene expression only in PBECs from never-smokers and ex-smokers without COPD. In conclusion, our data indicate that cigarette smoking and COPD severity are associated with reduced epithelial barrier function, which is potentially driven by an imbalance in the antioxidant response.NEW & NOTEWORTHY Cigarette smoking and chronic obstructive pulmonary disease (COPD) severity are associated with reduced epithelial barrier function that is potentially driven by an imbalance in the antioxidant response.

Computed tomography characteristics of chronic bronchitis and its association with disease severity and clinical outcomes in viral pneumonia: a retrospective cohort study

Background

Chronic bronchitis (CB) patients' excessive mucus and airway changes may worsen viral pneumonia severity, but there is a lack of objective clinical/imaging assessment criteria. This study used quantitative computed tomography (CT) to link CB pathology with pneumonia severity/prognosis, guiding early interventions for high-risk groups.

Methods

This retrospective cohort study included 42 patients with CB diagnosed with viral pneumonia and 208 non-CB viral pneumonia controls. Baseline demographic, clinical, and laboratory parameters were collected alongside thoracic CT-derived metrics, including mucus plugging score (a bronchopulmonary segment-based scoring system quantifying mucus obstruction severity), CT severity score (range, 0-25 per lobe), and emphysema quantification. Follow-up CT imaging was performed at 3 months post-diagnosis to assess pulmonary structural remodeling, with longitudinal documentation of CT severity scores. Participants were stratified into two cohorts by mucus plugging score: high mucus burden (≥4, group 1) and low mucus burden (<4, group 2). Intergroup comparisons utilized Fisher's exact test for categorical variables, with continuous variables analyzed via independent t-tests (normally distributed) or Mann-Whitney U tests (non-parametric distributions). Multivariate logistic regression modeling identified independent predictors of disease progression.

Results

This study enrolled 260 patients who were categorized into group 1 (n=42; CB prevalence: 35.70%) and group 2 (n=218; CB prevalence:19.70%). Comparative analysis demonstrated that CB patients in group 2 were significantly older [70, interquartile range (IQR) (62, 77) vs. 79, IQR (74.5, 86.5) years; P<0.001] and exhibited a higher female predominance (74.4% vs. 25.6%; P=0.03), alongside lower red blood cell count (RBC) [3.73, IQR (3.39, 4.29)×1012/L vs. 4.05, IQR (3.81, 4.53)×1012/L; P=0.02] and hemoglobin levels [119, IQR (105.5, 131) vs. 124, IQR (115.5, 136) g/L; P=0.04] compared to non-CB counterparts. Imaging analysis revealed that non-CB patients had greater thoracic reticular patterns [6.02, IQR (1.42, 10.08) vs. 2.50, IQR (0.57, 6.19) cm3; P=0.02] and emphysema severity [0.21, IQR (0.04, 0.73) vs. 0.05, IQR (0.01, 0.19) cm3; P<0.001], whereas CB patients across both groups showed marked bronchial wall thickening [group 1: 21.60, IQR (10.30, 37.69) vs. 6.28, IQR (1.54, 15.71) cm3, P=0.03; group 2: 35.08, IQR (13.38, 51.59) vs. 18.90, IQR (3.43, 45.53) cm3, P=0.01]. Notably, CB patients in group 2 displayed larger bronchial lumen volumes [13.63, IQR (5.19, 25.29) vs. 5.00, IQR (0.67, 13.46) cm3; P<0.001]. Multivariate analysis of the low mucus burden group identified female sex [odds ratio (OR) =3.39], age (OR =1.06), and emphysema (OR =1.56) as independent risk factors for disease progression (all P<0.05). Longitudinal CT follow-up indicated stable severity scores in non-CB patients, whereas high mucus-secreting CB patients (group 1) demonstrated significant reductions in mucus plugging scores over time.

Conclusions

CB features-mucus hypersecretion, emphysema, and airway thickening-worsen viral pneumonia severity and prognosis. Key predictors include advanced age (OR =1.06), female sex (OR =3.39), and emphysema (OR =1.56). High-risk CB patients, especially with emphysema, need enhanced CT monitoring and therapies improving mucociliary clearance and airway repair.

Uniportal Video-Assisted Anatomical Lung Volume Reduction Surgery in Severe Emphysema

Lung volume reduction surgery (LVRS) is an important treatment option for patients with advanced emphysema and is typically performed in a non-anatomical fashion. This study reports the outcome of anatomical LVRS by means of uniportal video-assisted thoracoscopic surgery (VATS).We retrospectively evaluated patients who underwent anatomical LVRS between June 2017 and September 2023 at our institution. Patient characteristics, including demographic data, lung function, as well as morbidity and mortality, were extracted from hospital records.A total of 44 patients (17 males, 38.6%) underwent anatomical LVRS at our institution during the observation period. The preoperative forced expiratory volume per second (FEV1) and FEV1% were 35.4 ± 20.0% and 45.7 ± 18.2%, respectively. Lobectomy was performed in 37 patients (84.1%), while segmentectomy was performed in 10 patients (22.7%, duplicated). Postoperative FEV1 and FEV1% significantly improved compared to preoperative values at the initial follow-up (11.8 ± 6.9 months after the operation): 38.3 ± 19.5%, p < 0.002 and 49.4 ± 18.4%, p < 0.01, respectively. Unfortunately, two patients (4.5%) died within 30 days postoperation. A further follow-up lung function test was performed in 25 patients (56.8%) at 33.1 ± 13.8 months after the operation, showing that FEV1 and FEV1% remained similar to the preoperative values (33.9 ± 20.7%, p = 0.10 and 45.3 ± 18.1%, p = 0.06, respectively).Anatomical lung resection via uniportal VATS is an effective procedure for LVRS in patients with severe emphysema and is associated with acceptable morbidity and mortality.

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.

The prevalence and risk factors of pulmonary embolism in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

BACKGROUND

An increased prevalence of PE has been found in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Early identification of risk factors for the development of PE in patients with AECOPD and intervention is important. Therefore, we comprehensively pool and analyze the prevalence and risk factors of PE among patients experiencing AECOPD, aiming to provide valuable insights for clinical-based diagnostic determination and prevention of PE in the AECOPD patient population.

METHODS

A systematic literature search was conducted for studies reporting the incidence and risk factors for PE in patients with AECOPD. Study quality was assessed using the modified Newcastle-Ottawa Quality Assessment Scale. The degree of heterogeneity was assessed by the I2 statistic. The publication bias (studies ≥ 10) was evaluated using Egger's test.

RESULTS

Among the 1421 studies initially retrieved, 22 articles were ultimately selected and incorporated into the analysis. Based on the meta-analysis and the review's updated findings, the prevalence of PE in AECOPD is 17.82% (95% CI 12.72%-23.57%, P<0.001). The following factors were identified as risk factors for PE among patients with AECOPD: age(weighted mean difference [WMD] 2.0119, 95% CI 0.7126-3.3133, I2 = 51.8%, P = 0.02), males(odds ratio [OR] 0.9528, 95% CI 0.6869-1.3216, I2 = 65.0%, P<0.001), obesity(OR 1.3086, 95% CI 0.1895-9.0385, I2 = 74.5%, P = 0.02), malignant disease(OR 1.5902, 95%CI 0.9689-2.6097, I2 = 54.7%, P = 0.03), hypertension(OR 1.0663, 95%CI 0.7920-1.4355, I2 = 57.7%, P = 0.009), immobilization ≥ 3d(OR 3.9158, 95% CI 1.0925-14.0354, I2 = 91.6%, P<0.001), edema of lower limb(OR 2.1558, 95% CI 1.3365-3.4773, I2 = 75.4%, P<0.001), pulmonary hypertension(OR 1.3146, 95%CI 0.7481-2.3100, I2 = 70.1%, P = 0.04), cough(OR 0.7084, 95%CI 0.1304-3.8497, I2 = 88.8%, P<0.001), purulent sputum(OR 0.7570, 95%CI 0.4005-1.4309, I2 = 61.9%, P = 0.049), and D-dimer(WMD 0.8619, 95%CI 0.0449-1.6789, I2 = 91.4%, P<0.001), C-reactive protein(CRP)(WMD 0.8852, 95%CI -4.0639-5.8344, I2 = 76.4%, P = 0.005) or fibrinogen(WMD 0.8663, 95%CI -0.2572-1.9898, I2 = 92.2%, P<0.001) levels. Clinical risk factors(including S1Q3 pattern on electrocardiograph(ECG), hospital stay and home oxygen therapy) showed no significant association with the occurrence of PE (P>0.05).

CONCLUSIONS

This updated meta-analysis and systematic review revealed that the prevalence of pulmonary embolism in the AECOPD was 17.82%. This figure may vary depending on how the diagnostic procedure is carried out. Age, males, obesity, malignant disease, hypertension, immobilization ≥ 3d, edema of lower limb, pulmonary hypertension, cough, purulent sputum, and D-dimer, CRP or fibrinogen level may serve as potential risk factors for PE among patients with AECOPD.

Perceived barriers and facilitators to managing psychological distress in COPD: The perspectives of patients and carers - a qualitative study using the theoretical domains framework (TDF)

Psychological distress is highly prevalent in people with chronic obstructive pulmonary disease (COPD), however, remains under-recognised and under-treated. A qualitative study using semi-structured interviews was undertaken to explore lived experiences of psychological distress of people with COPD and their informal carers, as well as barriers and facilitators to uptake of mental health treatments. Participants were recruited via purposive sampling from respiratory clinics at two Australian tertiary hospitals. Thirteen people with COPD and comorbid mental illnesses and two informal carers participated. Interview transcripts were analysed using the Theoretical Domains Framework (TDF). Barriers to patients' acceptance of structured management for psychological distress in COPD included: limited understanding of overlapping symptoms, high burden of care from physical issues, stigma, and healthcare that did not align with individual preferences. Increased psychoeducation, supported self-management, and individualised care were possible facilitators. Multidisciplinary care integrating mental health services within primary care and pulmonary rehabilitation settings are required to overcome current challenges and improve patient outcomes.

Multi-omics characterization of early chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is projected to become the third leading cause of death globally by 2030, accounting for 71.9% of chronic respiratory diseases cases in 2019. Early COPD (ECOPD) diagnosis heavily relies on clinically monitoring of lung functions, with a strong influence from smoking exposures, which may not align well with disease progression. As such, the GOLD 2022-2024 guidelines emphasize the discovery of biological markers over clinical symptoms for early detection. This study explores the biological characteristics of ECOPD in a cohort of 176 adults from China Pulmonary Health Study, consisting 88 healthy controls (HC) and 88 clinically diagnosed ECOPD, matched for age, gender and smoking history. While lung function tests revealed differences between HC and ECOPD, no significant distinctions were observed in routine blood tests. Proteomics analysis identified 377 plasma proteins common to both groups, with low-intensity proteins driving group-specific differences. Univariable logistic regression and gene set enrichment analysis identified 248 proteins associated with ECOPD, particularly those involved in inflammation process. Validation in an independent cohort confirmed the association of 15 proteins with ECOPD. Metabolomics analysis of the plasma identified 1788 metabolites, 137 of which were found linked to ECOPD. Machine learning models indicated that a multi-omics approach provided the best predication of lung function (R2 = 0.74), while proteomics alone effectively diagnosed ECOPD (AUC = 0.949). Similarity network fusion and clustering revealed two ECOPD subgroups: one by markers of inflammatory-immune response, and the other by the presence of those related to hemostasis or the vascular smooth muscle function. These findings underscore the potential of multi-omics integration in distinguishing ECOPD subgroups and predicting disease risk.

Moderating role of live microbe between chronic inflammatory airway disease and depressive symptoms

Purpose

Our study aims to investigate the impact of dietary live microbe on the relationship between chronic inflammatory airway diseases (CIAD) and depressive symptoms.

Methods

We selected data from the NHANES database from 2007 to 2020. First, we explored the relationship between CIAD and depressive symptoms using logistic regression analysis. And subgroup analyses were conducted to demonstrate the relationship and whether there was an interaction effect between the two in each subgroup. Then, we further analyzed the effect of live microbe on depressive symptoms in CIAD patients. And subgroup analyses were conducted to assess whether the effect of dietary viable microbial levels on depressive symptoms held true in each subgroup and whether there was an interaction effect.

Results

A study included 23,072 participants, of whom 5,111 were diagnosed with CIAD, and 5,110 had live microbial information available. Multivariate logistic regression analysis revealed that, compared to those without CIAD, individuals with CIAD had an increased risk of depressive symptoms. Subgroup analysis indicated that, except for educational level and smoking status, all other subgroups demonstrated that CIAD increased the risk of depressive symptoms. Additionally, within the CIAD population, a higher level of live microbe was associated with a reduced risk of depressive symptoms. It is implied that live microbe can negatively modulate the relationship between CIAD and depressive symptoms. Subgroup analysis further showed no significant interaction effects across subgroups (p > 0.05).

Conclusion

Chronic inflammatory airway diseases can increase the risk of developing depressive symptoms. Dietary live microbe negatively modulate the relationship between CIAD and depressive symptoms. High levels of dietary live microbe significantly reduced the risk of depressive symptoms in patients with CIAD.

Association of Life's Essential 8 with the prevalence and mortality of chronic obstructive pulmonary disease

Objective

To study the correlation between Life's Essential 8 (LE8) and the occurrence of chronic obstructive pulmonary disease (COPD) among US adults, as well as the association between LE8 and all-cause and cardiovascular disease (CVD) mortality among individuals with COPD.

Methods

Data from National Health and Nutrition Examination Survey (2005-2018 year) were analyzed. The correlation between LE8 scores and the prevalence of COPD was evaluated using logistic regression models. Additionally, the Cox proportional hazards model was applied to investigate how LE8 scores relate to the risk of mortality from all causes and cardiovascular diseases. To ensure the robustness of the findings, sensitivity analyses and subgroup analyses were performed.

Results

In the overall population, an inverse relationship was observed between a 10-point increase in LE8 score and the risk of COPD [OR = 0.78, 95%CI (0.75 ~ 0.82), p < 0.001]. Those diagnosed with COPD experienced a 65% increased rate of all-cause mortality and 5% higher rate of mortality due to cardiovascular diseases compared to the non-COPD group. Within the COPD patient cohort, an inverse relationship was similarly observed between a 10-point increase in the LE8 score and the risk of all-cause mortality [HR = 0.87, 95%CI (0.8 ~ 0.95), p = 0.002]. However, no significant association was found between the LE8 score and CVD mortality [HR = 0.83, 95%CI (0.68 ~ 1.02), p = 0.073]. In further exploration through subgroup analysis, no statistically significant interactions were found, suggesting consistency across different demographic or clinical subgroups.

Conclusion

Higher LE8 adherence is linked to lower COPD prevalence and all-cause mortality, yet no clear link to CVD mortality was found. This highlights the need for more extensive research to clarify LE8's role in CVD outcomes.

The Effects of Smoking and Airway Restriction on Subclinical Atherosclerosis

Purpose

Chronic obstructive pulmonary disease (COPD) is a chronic disease associated with systemic inflammation that may accelerate the atherosclerotic process. Smoking is a common risk factor for COPD and atherosclerosis. The goal of this study was to investigate the effects of COPD and smoking on carotid intima-media thickness (CIMT), in order to emphasise their importance in terms of subclinical atherosclerosis.

Materials and Methods

The study involved 208 male patients aged 45-65 years and was designed as a prospective, observational case-control study. Patients were separated into three groups, as follows: Group 1-non-smokers without airway obstruction (control) (n= 70); Group 2-smokers without airway obstruction (n= 70); and Group 3-smokers with airway obstruction(COPD) (n= 68). They were also classified into thickened CIMT (≥0.8mm) and normal CIMT (<0.8mm) groups. Pulmonary function tests (PFT), carotid Doppler ultrasound, and biochemical and haematological tests were applied to all the participants.

Results

CIMT values were markedly increased in the COPD group (1.00 [0.90-1.30] mm), compared to the smoker group without airway obstruction (0.70 [0.58-0.90] mm) and the non-smoker control group (0.60 [0.50-0.70] mm). The factors associated with CIMT were FEV₁/FVC ratio (Exp B 0.0952, p=0.003), age (Exp B 1.082, p<0.001), and cigarette pack-years (Exp B 1.030, p=0.020). In feature importance analysis, the most influential factor on CIMT was the FEV₁/FVC ratio (0.54) indicating COPD, followed by age (0.33) and cigarette pack-years (0.13).

Conclusion

Among the factors influencing CIMT, the impact of a decreased FEV₁/FVC ratio was found to be the highest. Therefore, screening with carotid US should be considered for the early detection of subclinical atherosclerosis in patients with COPD.