Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease

The Miasma Mentality: Investigating the Association Between Beliefs in Noxious Fumes and Obstructive Pulmonary Disease (COPD), Symptoms, and Quality of Life

Background

Chronic Obstructive Pulmonary Disease (COPD) significantly impacts morbidity and mortality globally. While established risk factors like smoking and occupational exposures are well-documented, patients' beliefs-especially those from the miasma theory attributing disease to "bad air" in cultures like China-may also significantly influence health outcomes.

Methods

This case-control study was conducted at Hospital of Hebei University of Traditional Chinese, involving 500 individuals diagnosed with COPD and 500 matched control participants. Each participant completed questionnaires that gathered information on demographic details, clinical history, and beliefs about the causes of COPD. Clinical data were collected, including spirometry tests to assess lung function, the COPD Assessment Test (CAT) to evaluate symptom burden, and the St. George's Respiratory Questionnaire (SGRQ) to measure health-related quality of life.

Results

The study found that 81% of COPD patients endorsed high miasma beliefs, compared to 28% of controls (p < 0.01). Those with strong beliefs reported significantly worse symptoms (mean CAT score: 23 vs 14, p < 0.001) and poorer quality of life (mean SGRQ score: 48 vs 39, p < 0.001) compared to low-belief individuals. Higher levels of anxiety and depression were also observed in patients with strong miasma beliefs. Laboratory biomarkers such as neutrophils, RDW width, and CRP were also elevated in the high-belief group compared to the low-belief group.

Conclusion

The findings suggest that adherence to miasma theory beliefs is associated with adverse health outcomes in COPD patients. Addressing these beliefs through targeted education may enhance patient engagement and adherence to evidence-based treatments, ultimately improving health outcomes.

Multi-modal evaluation of respiratory diaphragm motion in chronic obstructive pulmonary disease using MRI series and CT images

PURPOSE

Chronic obstructive pulmonary disease (COPD), characterized by airflow limitation and breathing difficulty, is usually caused by prolonged inhalation of toxic substances or long-term smoking habits. Some abnormal features of COPD can be observed using medical imaging methods, such as magnetic resonance imaging (MRI) and computed tomography (CT). This study aimed to conduct a multi-modal analysis of COPD, focusing on assessing respiratory diaphragm motion using MRI series in conjunction with low attenuation volume (LAV) data derived from CT images.

MATERIALS AND METHOD

This study utilized MRI series from 10 normal subjects and 24 COPD patients, along with thoracic CT images from the same patients. Diaphragm profiles in the sagittal thoracic MRI series were extracted using field segmentation, and diaphragm motion trajectories were generated from estimated diaphragm displacements via registration. Re-sliced sagittal CT images were used to calculate regional LAVs for four distinct lung regions. The similarities among diaphragm motion trajectories at various positions were assessed, and their correlations with regional LAVs were analyzed.

RESULTS

Compared with the normal subjects, patients with COPD typically exhibited fewer similarities in diaphragm motion, as indicated by the mean normalized correlation coefficient of the vertical motion component (0.96 for normal subjects vs. 0.76 for severity COPD patients). This reduction was significantly correlated with the LAV% in the two lower lung regions with a regression coefficient of 0.81.

CONCLUSION

Our proposed evaluation method may assist in the diagnosis and therapy planning for patients with COPD.

Investigation of the Relationship Between the Measured Alpha Angle in Capnography and Readmission Within Thirty Days in Chronic Obstructive Pulmonary Disease Patients Who Presented to the Emergency Department

BACKGROUND

Individuals with chronic obstructive pulmonary disease (COPD) constitute a significant portion of patients who present to the emergency department with dyspnea. However, there is no ideal method for predicting mortality or making hospitalization decisions in the emergency department (ED). In this regard, objective findings are needed for these patients. Since there are no objective findings regarding the hospitalization decision, there may be an increase in the re-admission rate of patients who needed hospitalization but were decided to be discharged. Side-stream end-tidal carbon dioxide (EtCO2) measurements offer a non-invasive, easy-to-interpret, quickly accessible, and reproducible method that can be applied at the bedside.

OBJECTIVES

The aim of this study was to evaluate the relationship between the alpha angle values obtained by capnography and readmission rates within 30 days for patients experiencing COPD exacerbations who presented to the ED with dyspnea and were discharged after treatment.

METHODS

In this study, we studied with 130 participants presented to the emergency department of a tertiary care university hospital with dyspnea, who are >18 y. Forty patients were excluded after evaluation for eligibility for the study. Thus, the data of 90 patients included were analyzed. We obtained alpha angle and EtCO2 values for all patients at the time of admission and also after treatment. The primary outcome measure of the study was the relationship between the patients' readmission situations within 30 days of the alpha angle measurements. The secondary outcome measure was the association between patients' EtCO2 values ​​and readmission within 30 days.

RESULTS

It was observed that both the pretreatment alpha angle values and the posttreatment alpha angle variables were statistically significant in predicting the readmission of the patients within 30 days (p = 0.001, p = 0.003) CONCLUSION: The results of this study show that alpha angle values measured for patients with COPD who present to the ED with the complaint of dyspnea may be used to predict readmission.

Exploring the association between ultra-processed foods and COPD: a case-control study

BACKGROUND

While it is known that the overconsumption of ultra-processed foods (UPFs) is associated with a heightened risk of respiratory ailments, the specific effects of UPF intake on COPD remain unclear. This study was designed to explore the potential link between COPD and the consumption of UPFs among adult individuals in Iran.

METHODS

In this hospital-based case-control study conducted at Alzahra University Hospital in Isfahan, Iran, we enrolled 84 patients newly diagnosed with COPD, along with 252 healthy controls matched for age and sex. COPD was defined based on the results of spirometry tests, specifically when the forced expiratory volume per second (FEV1) was less than 80% or the ratio of FEV1 to forced vital capacity (FVC) was less than 70%. To evaluate the dietary intake of the participants, we utilized a validated food frequency questionnaire (FFQ) consisting of 168 items. Additionally, we gathered data on potential confounding factors using a pre-tested questionnaire.

RESULTS

The mean ages for the case and control groups were 57.07 and 55.05 years, respectively. Our study found no significant association between the intake of ultra-processed foods (UPFs) and the likelihood of COPD, with an odds ratio (OR: 0.78, 95% CI: 0.34-1.77). This lack of association persisted even after adjusting for factors such as energy intake, sex, and age (OR: 0.48; 95% CI: 0.19-1.21). Further controlling for potential confounders like body mass index (BMI), physical activity, and smoking status did not alter this finding (OR: 0.367; 95% CI: 0.123-1.1008, P = 0.074).

CONCLUSIONS

In our study, we observed no significant association between the intake of Ultra-Processed Foods (UPFs) and the odds of Chronic Obstructive Pulmonary Disease (COPD). This finding remained consistent even after adjusting for factors such as energy intake, sex, age, Body Mass Index (BMI), physical activity, and smoking status. Therefore, within the scope of our study, it appears that the consumption of UPFs does not significantly impact the likelihood of developing COPD. However, we recommend further research to deepen our understanding of the intricate relationship between dietary habits and respiratory health.

Meditative movement for breathlessness in advanced COPD or cancer: a systematic review and meta-analysis

The effect of meditative movement, which includes yoga, tai chi and qi gong, on breathlessness in advanced disease is unknown. This systematic review aims to comprehensively assess the evidence on the effect of meditative movement on breathlessness (primary outcome), health-related quality of life, exercise capacity, functional performance and psychological symptoms (secondary outcomes) in advanced disease. 11 English and Chinese language databases were searched for relevant trials. Risk of bias was assessed using the Cochrane tool. Standardised mean differences (SMDs) with 95% confidence intervals were computed. 17 trials with 1125 participants (n=815 COPD, n=310 cancer), all with unclear or high risk of bias, were included. Pooled estimates (14 studies, n=671) showed no statistically significant difference in breathlessness between meditative movement and control interventions (SMD (95% CI) 0.10 (-0.15-0.34); Chi2=30.11; I2=57%; p=0.45), irrespective of comparator, intervention or disease category. Similar results were observed for health-related quality of life and exercise capacity. It was not possible to perform a meta-analysis for functional performance and psychological symptoms. In conclusion, in people with advanced COPD or cancer, meditative movement does not improve breathlessness, health-related quality of life or exercise capacity. Methodological limitations lead to low levels of certainty in the results.

Personal and community-level exposure to air pollution and daily changes in respiratory symptoms and oxygen saturation among adults with COPD

Background

Air pollution exposure is associated with hospital admissions for Chronic Obstructive Pulmonary Disease (COPD). Few studies have investigated whether daily personal exposure to air pollutants affects respiratory symptoms and oxygenation among COPD patients.

Methodology

We followed 30 former smokers with COPD for up to 4 non-consecutive 30-day periods in different seasons. Participants recorded worsening of respiratory symptoms (sub-categorized as breathing or bronchitis symptoms) by daily questionnaire, and oxygen saturation by pulse oximeter. Personal and community-level exposure to fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), and ozone (O₃) were measured by portable air quality monitors and stationary monitors in the Boston area. We used generalized and multi-level linear mixed-effects models to estimate associations of the 24-hour average of each pollutant in the previous day with changes in respiratory symptoms and oxygen saturation.

Results

Higher community-level exposure to air pollutants was associated with worsening respiratory symptoms. An interquartile range (IQR) higher community-level O₃ was associated with a 1.35 (95%CI: 1.07-1.70) higher odds of worsening respiratory symptoms. The corresponding ORs for community-level PM_2.5 and NO₂ were 1.18 (95%CI: 1.02-1.37) and 1.06 (95%CI: 0.90-1.25), respectively. Community-level NO₂ was associated with worsening bronchitis symptoms (OR=1.25, 95%CI: 1.00-1.56), but not breathing symptoms. Personal PM_2.5 exposure was associated with lower odds of worsening respiratory symptoms (OR=0.91; 95%CI: 0.81-1.01). Personal exposure to NO₂ was associated with 0.11% lower oxygen saturation (95%CI: -0.22, 0.00) per IQR.

Conclusions

In this COPD population, there was a pattern of worsening respiratory symptoms associated with community-level exposure to O₃ and PM_2.5, and worsening oxygenation associated with personal exposure to NO₂.

Serum levels of erythropoietin in patients with chronic obstructive pulmonary disease and anemia

The important association of erythropoietin (EPO) serum levels and chronic obstructive pulmonary disease (COPD) with anemia has been inadequately studied and remains a controversial issue. We aimed to shed light on this matter by comparing EPO levels in anemic and non-anemic COPD patients, along with a review of published literature. This cross-sectional study was conducted on COPD patients referred to the pulmonary clinic of Shahid Faghihi Hospital and Motahari clinic, Shiraz, Iran, for one year. We measured complete blood count, red blood cell indices, serum iron, TIBC and ferritin levels, serum EPO levels, and body mass index. Among 35 patients in this study, 28 males and 7 females were enrolled with a mean age of 54.57 ± 8.07 years. The average Forced expiratory volume in first second (FEV1) was 37.26 ± 7.33% and FEV1/FVC was 0.46 ± 0.12. Mean EPO levels were 30.29 ± 2.066 mU/mL. No statistically significant association was observed among erythropoietin levels and Hb, COPD severity, and age. There was no significant difference in EPO levels between anemic and non-anemic patients. EPO level, against the traditional expectation, didn't increase in COPD patients. EPO production also didn't compensate for the anemia of chronic disease which considers as a common comorbid disorder in these patients.

THE FRAMEWORK OF THE PILOT PROJECT FOR TESTING A TELEMEDICINE MODEL IN THE FIELD OF CHRONIC DISEASES - HEALTH CHALLENGES AND JUSTIFICATION OF THE PROJECT IMPLEMENTATION

OBJECTIVE

Aim: To present the essentials of the pilot project for testing a telemedicine model in the field of chronic diseases, along with a snapshot of the health challenges.

PATIENTS AND METHODS

Materials and Methods: This review paper use the synthetic method summarizing the main objectives of the telemedicine project in the field of chronic diseases with a focus on COPD. The described project will have a pilot character and is aimed at clinical verification through the implementation of a new method and accompanying organizational and technological solutions (platform, devices) in an area where current models and schemes of therapeutic and diagnostic support were insufficient. The main (primary) outcome will be the leveling of social inequalities in health by reducing the residence and income factor in access to screening and medical services through the use of telemedicine.

CONCLUSION

Conclusions: Implementation of telemedicine solutions creates an opportunity for patients diagnosed with COPD and their families by improving access to specialized medical care. With early detection of COPD exacerbation symptoms (deterioration of remotely monitored spirometric parameters), it will be possible to introduce appropriate preventive measures for these patients offsetting the adverse consequences.

Feasibility of a pulmonary rehabilitation programme for patients with symptomatic chronic obstructive pulmonary disease in Georgia: a single-site, randomised controlled trial from the Breathe Well Group

OBJECTIVES

To assess the feasibility of delivering a culturally tailored pulmonary rehabilitation (PR) programme and conducting a definitive randomised controlled trial (RCT).

DESIGN

A two-arm, randomised feasibility trial with a mixed-methods process evaluation.

SETTING

Secondary care setting in Georgia, Europe.

PARTICIPANTS

People with symptomatic spirometry-confirmed chronic obstructive pulmonary disease recruited from primary and secondary care.

INTERVENTIONS

Participants were randomised in a 1:1 ratio to a control group or intervention comprising 16 twice-weekly group PR sessions tailored to the Georgian setting.

PRIMARY AND SECONDARY OUTCOME MEASURES

Feasibility of the intervention and RCT were assessed according to: study recruitment, consent and follow-up, intervention fidelity, adherence and acceptability, using questionnaires and measurements at baseline, programme end and 6 months, and through qualitative interviews.

RESULTS

The study recruited 60 participants (as planned): 54 (90%) were male, 10 (17%) had a forced expiratory volume in 1 second of ≤50% predicted. The mean MRC Dyspnoea Score was 3.3 (SD 0.5), and mean St George's Respiratory Questionnaire (SGRQ) 50.9 (SD 17.6). The rehabilitation specialists delivered the PR with fidelity. Thirteen (43.0%) participants attended at least 75% of the 16 planned sessions. Participants and rehabilitation specialists in the qualitative interviews reported that the programme was acceptable, but dropout rates were high in participants who lived outside Tbilisi and had to travel large distances. Outcome data were collected on 63.3% participants at 8 weeks and 88.0% participants at 6 months. Mean change in SGRQ total was -24.9 (95% CI -40.3 to -9.6) at programme end and -4.4 (95% CI -12.3 to 3.4) at 6 months follow-up for the intervention group and -0.5 (95% CI -8.1 to 7.0) and -8.1 (95% CI -16.5 to 0.3) for the usual care group at programme end and 6 months, respectively.

CONCLUSIONS

It was feasible to deliver the tailored PR intervention. Approaches to improve uptake and adherence warrant further research.

TRIAL REGISTRATION NUMBER

ISRCTN16184185.

Quality of Life (QoL) Assessment in the Patients Operated with Either Laparoscopic or an Open Aortobifemoral Bypass for Aortoiliac Occlusive Disease (AIOD): 2 Years Results of a Randomized Controlled Trial

BACKGROUND

QoL assessment within surgical treatment is seldom investigated and sparsely reported in the medical literature. This study aimed to compare QoL in a randomized fashion in the patients treated with either a laparoscopic aortobifemoral bypass (LABFB) or an open aortobifemoral bypass (OABFB) for the treatment of AIOD.

PATIENTS AND METHODS

Seventy-one consecutive patients with AIOD, Trans-Atlantic Inter-Society Consensus II Type D lesions (TASC II, Type D) were randomized to LABFB or OABFB. Thirty-five patients in the LABFB and thirty-six in the OABFB groups were compared for the changes in the QoL, with the short-form health survey (SF-36), EuroQol 5 dimensions (EQ-5D), and EQ-5D visual analog scale (VAS) preoperatively, and postoperatively at 1, 3, 6, 12 and 24 months. Mann-Whitney U-Test and Wilcoxon sign-rank test were used for group comparison. Mixed model analysis was performed to examine the effect of different variables on the QoL.

RESULTS

In the patients treated with LABFB, physical component score (PCS) and mental component score (MCS) in SF-36 were significantly higher than OABFB, at 1 and 3 months postoperatively. PCS was also significantly higher in the LABFB group than OABFB at 24 months postoperatively. The preoperative QoL scores for both the laparoscopy and the open group were significantly lower than the age-matched general Norwegian population. EQ-5D median scores were significantly higher in the LABFB at all postoperative follow-up time points up to 12 months. The patients in the LABFB group also had a statistically significant increase in EQ-5D VAS compared to OABFB, at 1 and 12 months postoperatively (p = 0.005, and p = 0.037, respectively).

CONCLUSION

QoL seems better in patients treated with LABFB than OABFB, particularly during the early months after surgery.

The effect of lung-conduction exercise in chronic obstructive pulmonary disease: Randomized, assessor-blind, multicenter pilot trial

BACKGROUND

Pulmonary rehabilitation (PR) is a management modality that improves the quality of life of patients with chronic obstructive pulmonary disease (COPD); however, PR is not readily accessible. Therefore, we developed lung-conduction exercises (LCE) that can be performed easily without any limitations. The purpose of this randomized, assessor-blind, multicenter pilot trial was to compare the effects of LCE with PR and standard care (SC) in COPD patients.

METHODS

Twenty-five participants who met the eligibility criteria were randomly allocated to the SC group (only medication, n = 9), LCE group (medication + LCE, 5 times a week, n = 8), or PR group (medication + PR, 5 times a week, n = 8). The 6-minute walk distance (6WMD), pulmonary function test, modified Medical Research Council dyspnea scale, COPD assessment test (CAT), and St. George Respiratory Questionnaire (SGRQ) survey were carried out before starting the trial and after 4 and 8 weeks to determine motor performance, lung function, and dyspnea.

RESULTS

After 8 weeks, the pulmonary function test scores were the same. The 6MWD (PR, 28.3 ± 38.5; LCE, 14.5 ± 53.1; SC, 11.5 ± 20.5; P = .984), modified Medical Research Council dyspnea scale (PR, 0.8 ± 1.0; LCE, 0.8 ± 0.8; SC, 0.3 ± 0.5; P = .772), CAT (PR, 7.3 ± 6.2; LCE, 4.2 ± 5.2; SC, 1.0 ± 2.2; P = .232), and SGRQ scores (PR, 11.5 ± 15.4; LCE, 5.5 ± 13.1; SC, 4.8 ± 5.1; P = .358 [PR vs LCE], P = .795 [PR vs SC]) had improved in order of PR, LCE, and SC group. Although there were no statistically significant differences in the outcome measures between the groups, there were clinically significant improvements in the CAT and SGRQ scores.

CONCLUSIONS

In this trial, PR showed more improvement in symptoms and quality of life than SC alone. To seek a more precise use of LCE, further full-sized studies with a long duration and additional outcome measures such as psychological assessment tools and cost-effectiveness ratio should be conducted.

TRIAL REGISTRATION

KCT0004724.

The prognostic factors of in-hospital death among patients with pneumonic COPD acute exacerbation

BACKGROUND

Pneumonic acute exacerbation of chronic obstructive pulmonary disease (COPD-AE) is associated with worse outcomes compared with non-pneumonic COPD-AE. We aimed to explore prognostic factors among patients with pneumonic COPD-AE.

METHODS

This multicentered retrospective cohort study was conducted across five hospitals in Japan. Hospitalized patients ≥40 years of age with pneumonic COPD-AE who were administered systemic corticosteroids during hospitalization were included. Patients with other causes of respiratory failure, daily systemic steroid users, and patients who were not treated with systemic steroids were excluded. Based on existing clinical prediction models, the following potential prognostic factors were selected in advance: age, blood eosinophil count, blood urea nitrogen, respiratory rate, diastolic blood pressure, and altered mental status. Multivariate logistic regression was conducted to determine the association between potential prognostic factors and in-hospital death.

RESULTS

After excluding 897 patients based on the exclusion criteria, 669 patients with pneumonic COPD-AE who were administered systemic corticosteroids were included. The in-hospital mortality rate was 5.1%. Altered mental status was associated with mortality (odds ratio, 4.47; 95% confidence intervals, 2.00 to 10.00), and eosinophilia was associated with a lower risk of mortality (odds ratio, 0.19; 95% confidence intervals: 0.06 to 0.56).

CONCLUSIONS

Altered mental status may be a prognostic factor for in-hospital death among patients with pneumonic COPD-AE who were administered systemic corticosteroids. Moreover, eosinophilia may be a prognostic factor for lower in-hospital mortality rate among these patients.

Personal protective equipment use during industrial hog operation work activities and acute lung function changes in a prospective worker cohort, North Carolina 2014-2015

INTRODUCTION

Occupational activities related to industrial hog operation (IHO) worker lung function are not well defined. Therefore, we aimed to identify IHO work activities associated with diminished respiratory function and the effectiveness, if any, of personal protective equipment (PPE) use on IHOs.

METHODS

From 2014 to 2015, 103 IHO workers were enrolled and followed for 16 weeks. At each biweekly visit, work activities and PPE use were self-reported via questionnaire and lung function measurements were collected via spirometry. Generalized linear and linear fixed-effects models were fitted to cross-sectional and longitudinal data.

RESULTS

Increasing years worked on an IHO were associated with diminished lung function, but baseline and longitudinal work activities were largely inconsistent in direction and magnitude. Unexpectedly, a -0.3 L (95% confidence interval: -0.6, -0.04) difference in forced expiratory volume in the first second (FEV₁ ) was estimated when workers wore PPE consistently (≥80% of the time at work) versus those weeks they did not. In post-hoc analyses, we found that coveralls and facemasks were worn less consistently when workers experienced worse barn conditions and had more contact with pigs, but coveralls were worn more consistently as cleaning activities increased.

CONCLUSIONS

Similar to past studies, baseline estimates were likely obscured by healthy worker effect bias, but showed decrements in worker lung function as years of work increased. A challenge to disentangling the effect of work activities on lung function was the discovery that IHO workers used PPE differently according to the work task. These data suggest that interventions may be targeted toward improving barn conditions so that workers can consistently utilize IHO-provided PPE.

Incident obstructive lung disease and mortality among people with HIV and a history of injecting drugs

OBJECTIVE

People with HIV (PWH) experience increased prevalence of obstructive lung disease (OLD), regardless of greater observed smoking behaviors. We investigated whether the effect of incident OLD on mortality differed by HIV and HIV viral suppression among persons who inject drugs (PWID) and report smoking history.

DESIGN

ALIVE is a longitudinal, observational cohort study of HIV-positive and seronegative PWID. This analysis included participants who had at least one spirometry measure to assess OLD between 2007 and 2016, excluding those who never smoked (5%, n = 62) or had baseline OLD (17%, n = 269).

METHODS

Incident OLD occurred when the first prebronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) less than 0.70 during follow-up. The effect of incident OLD on all-cause mortality was estimated in PWH and seronegative participants using inverse-probability-of-treatment-weighted marginal structural models controlling for baseline (age, race, sex, calendar year, smoking pack-years) and time-varying (smoking intensity, viral suppression, and calendar time) confounders.

RESULTS

Among 1204 participants, 269 (22.3%) and 157 (13.0%) experienced incident OLD and death, respectively, over a median of five person-years of follow-up. There was no effect of OLD on mortality among seronegative participants [hazard ratio = 0.84, 95% confidence interval (CI): 0.47-1.48]; however, PWH diagnosed with OLD experienced an increased mortality risk (hazard ratio = 1.71, 95% CI: 1.04-2.80) during follow-up. HIV viral suppression did not confound or modify the effect of OLD on mortality among PWH.

CONCLUSION

There was an apparent effect of OLD on all-cause mortality irrespective of viral suppression among PWH but not among seronegative persons, after accounting for baseline and time-varying confounders. These results highlight the need for enhanced screening and management of OLD among PWH.

Tai Chi for Chronic Obstructive Pulmonary Disease (COPD): An Overview of Systematic Reviews

OBJECTIVE

Since current systematic reviews (SRs) show that results of effectiveness on Tai Chi for chronic obstructive pulmonary disease (COPD) are inconsistent, the purpose of this study is to find the reasons of the disparity by comprehensively appraising the related SRs.

METHODS

Six databases were systematically searched from the inception date to April 17, 2021. The methodological quality, the risk of bias, the reporting quality, and the quality of evidence were independently assessed by two reviewers with the AMSTAR 2, ROBIS, PRISMA, and GRADE.

RESULTS

A total of 12 studies met the inclusion criteria: 10 SRs were rated critically low quality and two SRs were low quality by AMSTAR 2. By the ROBIS, four out of 12 SRs were rated as "low risk". According to PRISMA, nine out of 12 SRs were adequately reported over 80%. With the GRADE tool, three out of 12 SRs rated the FEV1 as "Moderate", one out of 12 SRs (1/12, 9%) rated the FEV1/FVC (%) as "Moderate", three out of 12 SRs assessed the 6MWD as "Moderate", three out of 12 SRs evaluated the SGRQ as "Moderate", and the remaining evidence was fully rated as "Low" or "Very Low".

CONCLUSION

We found that the methodological quality, risk of bias, reporting quality, and quality of evidence of the included SRs on Tai Chi for COPD were suboptimal. These limitations may have a negative impact on SRs, consequently leading to inconsistent results. Further well-conducted SRs with less risk of bias, more rigorous methodology, normative reporting and high-quality of evidence are needed to provide robust evidence on Tai Chi for COPD.

REGISTRATION NUMBER

This study has been registered in the PROSPERO International Prospective Register of Systematic Reviews (registration number: CRD42019126600).

The effect of Clip-tone® and its smartphone application on optimisation of metered-dose inhalers inhalation technique

BACKGROUNDS

Although metered-dose inhalers (pMDI) therapy is convenient and widely prescribed, its use usually results in repetitive inhalation technique errors. One of the most repetitive errors is inhaling too fast through the pMDI. The present study aimed to evaluate the effect of Clip-tone^® along with smartphone visual feedback application on the subject's inhalation time.

METHODS

Two hundred subjects were included in the study. They were randomised into four groups. Group 1 received only verbal counselling; group 2 received verbal counselling with resistance (a modified Clip-tone^® that does not produce whistle attached to their pMDI); group 3 received verbal counselling plus whistle (as audio feedback) from ordinary Clip-tone^® and group 4 received verbal counselling plus audio feedback (whistle) from Clip-tone^® and visual feedback (smartphone application). Inhalation time through the pMDI for each subject was recorded three times and inter and intra-subjects variations were calculated.

RESULTS

Verbal counselling plus audio feedback and verbal counselling plus audio and visual feedbacks groups had 45/50 (90%) and 37/50 (74%) subjects respectively, having correct inhalation flow (inhaling at between 3 to 7 seconds). Verbal counselling plus audio feedback and verbal counselling plus audio and visual feedbacks groups' inter and intra-subjects variations were lower than that of verbal counselling and verbal counselling with resistance groups which had 28/50 (52%) and 20/50 (40%) subjects respectively, with inhalation time between 3 and 7 seconds.

CONCLUSIONS

Providing audio feedback by the Clip-tone^® along with smartphone visual feedback application maintained the deep and slow inhalation through pMDI much better compared to verbal counselling only. We recommend the patients to take all their inhaled doses using pMDI attached to a training device like Clip-tone^® along with a smartphone visual feedback application for optimisation of the aerosol delivery from the pMDI.

The use of personal protective equipment during common industrial hog operation work activities and acute lung function changes in a prospective worker cohort, North Carolina, USA

Introduction

As occupational activities related to acute industrial hog operation (IHO) worker lung function are not well defined, we aimed to identify IHO work activities associated with diminished respiratory function and the effectiveness, if any, of personal protective equipment (PPE) on IHOs.

Methods

From 2014-2015, 103 IHO workers were enrolled and followed for 16 weeks. At each bi-weekly visit, lung function measurements were collected via spirometry and work activities and PPE use were self-reported via questionnaire. Generalized linear and linear fixed-effects models were fitted to cross-sectional and longitudinal data.

Results

At baseline, increasing years worked on an IHO were associated with diminished lung function, but other activities were less consistent in direction and magnitude. In longitudinal models, only reports of working in feeding/finisher barns, showed a consistent association. However, a -0.3 L (95% confidence interval: -0.6, -0.04) difference in FEV ₁ was estimated when workers wore PPE consistently versus those weeks they did not. In post-hoc analyses, we found that coveralls and facemasks were worn less consistently when workers experienced worse barn conditions and had more contact with pigs, but coveralls were worn more consistently as cleaning activities increased.

Conclusions

Similar to past studies, baseline estimates were likely obscured by healthy worker bias. Also making it challenging to disentangle the effect of work activities on lung function was the discovery that IHO workers used PPE differently according to work task. These data suggest that interventions may be targeted toward improving barn conditions so that workers can consistently utilize IHO-provided PPE.

KEY MESSAGES

What is already known about this subject?: Working on industrial hog operations may be deleterious to long- and short-term respiratory health due to airborne bacteria, endotoxin, hazardous gases, dust, and dander in barns. In efficacy studies PPE has been shown to be protective, but studies have shown that PPE utilization among hog workers has historically been sub-optimal.What are the new findings?: As barn conditions worsened and contact with pigs increased, workers in this cohort reported wearing coveralls and face masks less often; however, they reported increased PPE use as they conducted more cleaning activities at work. During weeks when workers wore PPE their lung function declined, a possible cause being the improper use of the equipment leading to a false sense of protection or re-exposure to hazardous contaminants.How might this impact on policy or clinical practice in the foreseeable future?: Given COVID-19, the H1N1 "swine flu" pandemic, our knowledge of antimicrobial resistant pathogens, and increasing awareness about how food systems are linked to the spread of emerging infectious diseases, occupational health intervention research and workplace policies may focus on creating barn environments that are more conducive to PPE use which could help protect workers and consequently the community.

Airway Epithelial Cell Immunity Is Delayed During Rhinovirus Infection in Asthma and COPD

Respiratory viral infections, particularly those caused by rhinovirus, exacerbate chronic respiratory inflammatory diseases, such as asthma and chronic obstructive pulmonary disease (COPD). Airway epithelial cells are the primary site of rhinovirus replication and responsible of initiating the host immune response to infection. Numerous studies have reported that the anti-viral innate immune response (including type I and type III interferon) in asthma is less effective or deficient leading to the conclusion that epithelial innate immunity is a key determinant of disease severity during a rhinovirus induced exacerbation. However, deficient rhinovirus-induced epithelial interferon production in asthma has not always been observed. We hypothesized that disparate in vitro airway epithelial infection models using high multiplicity of infection (MOI) and lacking genome-wide, time course analyses have obscured the role of epithelial innate anti-viral immunity in asthma and COPD. To address this, we developed a low MOI rhinovirus model of differentiated primary epithelial cells obtained from healthy, asthma and COPD donors. Using genome-wide gene expression following infection, we demonstrated that gene expression patterns are similar across patient groups, but that the kinetics of induction are delayed in cells obtained from asthma and COPD donors. Rhinovirus-induced innate immune responses were defined by interferons (type-I, II, and III), interferon response factors (IRF1, IRF3, and IRF7), TLR signaling and NF-κB and STAT1 activation. Induced gene expression was evident at 24 h and peaked at 48 h post-infection in cells from healthy subjects. In contrast, in cells from donors with asthma or COPD induction was maximal at or beyond 72–96 h post-infection. Thus, we propose that propensity for viral exacerbations of asthma and COPD relate to delayed (rather than deficient) expression of epithelial cell innate anti-viral immune genes which in turns leads to a delayed and ultimately more inflammatory host immune response.

The effect of lung-conduction exercise in chronic obstructive pulmonary disease: Study protocol for randomized, assessor-blind, multicenter trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is an irreversible disease characterized by cough, sputum production, and dyspnea, and has a high prevalence and mortality. Pulmonary rehabilitation (PR) is a management that improves the quality of life for COPD patients; however, PR is not readily accessible. Therefore, we developed lung-conduction exercises (LCE) that can be performed without any limitations. LCE consists of breathing, stretching, and tapping to relieve dyspnea in COPD patients.

METHODS/DESIGN

This randomized, assessor-blind, multicenter trial aims to recruit 54 patients with moderate and severe COPD. Subjects will be randomly allocated to a control group (only medication), an LCE group (medication + LCE, 5 times a week), or a PR group (medication + PR, 5 times a week). The 6-minute walk distance, pulmonary function tests (forced expiratory volume at 1 second, forced vital capacity, and forced expiratory volume at 1 second/forced vital capacity), modified Borg scale, modified medical research council dyspnea scale, COPD assessment test, and St. George respiratory questionnaire will be measured before starting the trial and after the 4th and 8th weeks to determine motor performance, lung function, and dyspnea.

CONCLUSION

We aim to demonstrate that LCE is effective in improving symptoms and psychosomatic stability in COPD patients. Therefore, this trial will play an important role in fortifying the foundation of clinical application.

Difference in Long-Term Trends in COPD Mortality between China and the U.S., 1992⁻2017: An Age⁻Period⁻Cohort Analysis

Complications due to chronic obstructive pulmonary disease (COPD) is a leading cause of death in China and the United States (U.S.). This study aimed to investigate the long-term trends in COPD mortality in China and the U.S. using data from the Global Burden of Disease Study 2017 (GBD 2017) and explore the age, period, and cohort effects independently by sex under the age-period-cohort (APC) framework. Taking the age group 40-44 years old, the period 1992-1996, and the birth cohort 1913-1917 as reference groups, we found that the age relative risks (RRs) of COPD mortality increased exponentially in both China and the U.S., the period RRs increased in the U.S. but decreased in China; and the cohort RRs showed an overall downward trend in both China and the U.S. with the year of birth. From 1992 to 2017, the increased RRs of COPD mortality in the U.S. was mainly attributable to the increased prevalence of smoking before 1965, while the decreased RRs of COPD mortality in China was mainly attributable to reduced air pollution as well as improvements in medical technology and more accessible health services. Reducing tobacco consumption may be the most effective and feasible way to prevent COPD in China. However, we also need to pay more attention to COPD in nonsmokers in the future.

A Feasibility Study of Single-inhalation, Single-energy Xenon-enhanced CT for High-resolution Imaging of Regional Lung Ventilation in Humans

RATIONALE AND OBJECTIVES

The objective of this study was to assess the feasibility of single-inhalation xenon-enhanced computed tomography (XeCT) to provide clinically practical, high-resolution pulmonary ventilation imaging to clinics with access to only a single-energy computed tomography scanner, and to reduce the subject's overall exposure to xenon by utilizing a higher (70%) concentration for a much shorter time than has been employed in prior studies.

MATERIALS AND METHODS

We conducted an institutional review board-approved prospective feasibility study of XeCT for 15 patients undergoing thoracic radiotherapy. For XeCT, we acquired two breath-hold single-energy computed tomography images of the entire lung with a single inhalation each of 100% oxygen and a mixture of 70% xenon and 30% oxygen, respectively. A video biofeedback system for coached patient breathing was used to achieve reproducible breath holds. We assessed the technical success of XeCT acquisition and side effects. We then used deformable image registration to align the breath-hold images with each other to accurately subtract them, producing a map of lung xenon distribution. Additionally, we acquired ventilation single-photon emission computed tomography-computed tomography (V-SPECT-CT) images for 11 of the 15 patients. For a comparative analysis, we partitioned each lung into 12 sectors, calculated the xenon concentration from the Hounsfield unit enhancement in each sector, and then correlated this with the corresponding V-SPECT-CT counts.

RESULTS

XeCT scans were tolerated well overall, with a mild (grade 1) dizziness as the only side effect in 5 of the 15 patients. Technical failures in five patients occurred because of inaccurate breathing synchronization with xenon gas delivery, leaving seven patients analyzable for XeCT and single-photon emission computed tomography correlation. Sector-wise correlations were strong (Spearman coefficient >0.75, Pearson coefficient >0.65, P value <.002) for two patients for whom ventilation deficits were visibly pronounced in both scans. Correlations were nonsignificant for the remaining five who had more homogeneous XeCT ventilation maps, as well as strong V-SPECT-CT imaging artifacts attributable to airway deposition of the aerosolized imaging agent. Qualitatively, XeCT demonstrated higher resolution and no central airway deposition artifacts compared to V-SPECT-CT.

CONCLUSIONS

In this pilot study, single-breath XeCT ventilation imaging was generally feasible for patients undergoing thoracic radiotherapy, using an imaging protocol that is clinically practical and potentially widely available. In the future, the xenon delivery failures can be addressed by straightforward technical improvements to the patient biofeedback coaching system.

Mediation analysis for common binary outcomes

Mediation analysis provides an attractive causal inference framework to decompose the total effect of an exposure on an outcome into natural direct effects and natural indirect effects acting through a mediator. For binary outcomes, mediation analysis methods have been developed using logistic regression when the binary outcome is rare. These methods will not hold in practice when a disease is common. In this paper, we develop mediation analysis methods that relax the rare disease assumption when using logistic regression. We calculate the natural direct and indirect effects for common diseases by exploiting the relationship between logit and probit models. Specifically, we derive closed-form expressions for the natural direct and indirect effects on the odds ratio scale. Mediation models for both continuous and binary mediators are considered. We demonstrate through simulation that the proposed method performs well for common binary outcomes. We apply the proposed methods to analyze the Normative Aging Study to identify DNA methylation sites that are mediators of smoking behavior on the outcome of obstructed airway function.

Altered deposition of inhaled nanoparticles in subjects with chronic obstructive pulmonary disease

Background

Respiratory tract deposition of airborne particles is a key link to understand their health impact. Experimental data are limited for vulnerable groups such as individuals with respiratory diseases. The aim of this study is to investigate the differences in lung deposition of nanoparticles in the distal lung for healthy subjects and subjects with respiratory disease.

Methods

Lung deposition of nanoparticles (50 and 100 nm) was measured after a 10 s breath-hold for three groups: healthy never-smoking subjects (n = 17), asymptomatic (active and former) smokers (n = 15) and subjects with chronic obstructive pulmonary disease (n = 16). Measurements were made at 1300 mL and 1800 mL volumetric lung depth. Each subject also underwent conventional lung function tests, including post bronchodilator FEV₁, VC, and diffusing capacity for carbon monoxide, D_L,CO. Patients with previously diagnosed respiratory disease underwent a CT-scan of the lungs. Particle lung deposition fraction, was compared between the groups and with conventional lung function tests.

Results

We found that the deposition fraction was significantly lower for subjects with emphysema compared to the other subjects (p = 0.001–0.01), but no significant differences were found between healthy never-smokers and smokers. Furthermore, the particle deposition correlated with pulmonary function tests, FEV_1%Pred (p < 0.05), FEV₁/VC_%Pred (p < 0.01) and D_L,CO (p < 0.0005) when all subjects were included. Furthermore, for subjects with emphysema, deposition fraction correlated strongly with D_L,CO (Pearson’s r = 0.80–0.85, p < 0.002) while this correlation was not found within the other groups.

Conclusions

Lower deposition fraction was observed for emphysematous subjects and this can be explained by enlarged distal airspaces in the lungs. As expected, deposition increases for smaller particles and deeper inhalation. The observed results have implications for exposure assessment of air pollution and dosimetry of aerosol-based drug delivery of nanoparticles.

Comparison of Left Ventricular Function and Myocardial Infarct Size Determined by 2-Dimensional Speckle Tracking Echocardiography in Patients With and Without Chronic Obstructive Pulmonary Disease After ST-Segment Elevation Myocardial Infarction

Patients with chronic obstructive pulmonary disease (COPD) have a high risk of mortality after acute ST-segment elevation myocardial infarction (STEMI). We compared STEMI patients with versus without COPD in terms of infarct size and left ventricular (LV) systolic function using advanced 2-dimensional speckle tracking echocardiography. Of 1,750 patients with STEMI (mean age 61 ± 12 years, 76% male), 133 (7.6%) had COPD. With transthoracic echocardiography, left ventricular ejection fraction (LVEF) and wall motion score index were measured. Infarct size was assessed using biomarkers (creatine kinase and troponin T). LV global longitudinal strain (GLS), reflecting active LV myocardial deformation, was measured with 2-dimensional speckle tracking echocardiography to estimate LV systolic function and infarct size. STEMI patients with COPD were significantly older, more likely to be former smokers, and had worse renal function compared with patients without COPD. There were no differences in infarct size based on peak levels of creatine kinase (1315 [613 to 2181] vs 1477 [682 to 3047] U/l, p = 0.106) and troponin T (3.3 [1.4 to 7.3] vs 3.9 [1.5 to 7.8] µg/l, p = 0.489). Left ventricular ejection fraction (46% vs 47%, p = 0.591) and wall motion score index (1.38 [1.25 to 1.66] vs 1.38 [1.19 to 1.69], p = 0.690) were comparable. In contrast, LV GLS was significantly more impaired in patients with COPD compared with patients without COPD (-13.9 ± 3.0% vs -14.7 ± 3.9%, p = 0.034). In conclusion, despite comparable myocardial infarct size and LV systolic function as assessed with biomarkers and conventional echocardiography, patients with COPD exhibit more impaired LV GLS on advanced echocardiography than patients without COPD, suggesting a greater functional impairment at an early stage after STEMI.

Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery

OBJECTIVES

Laparoscopic aortobifemoral bypass has become an established treatment option for symptomatic aortoiliac obstructive disease at dedicated centers. Minimally invasive surgical techniques like laparoscopic surgery have often been shown to reduce expenses and increase patients' health-related quality of life. The main objective of our study was to measure quality-adjusted life years (QALYs) and costs after totally laparoscopic and open aortobifemoral bypass.

PATIENTS AND METHODS

This was a within trial analysis in a larger ongoing randomized controlled prospective multicenter trial, Norwegian Laparoscopic Aortic Surgery Trial. Fifty consecutive patients suffering from symptomatic aortoiliac occlusive disease suitable for aortobifemoral bypass surgery were randomized to either totally laparoscopic (n=25) or open surgical procedure (n=25). One patient dropped out of the study before surgery. We measured health-related quality of life using the EuroQol (EQ-5D-5L) questionnaire at 4 different time points, before surgery and for 6 months during follow-up. We calculated the QALYs gained by using the area under the curve for both groups. Costs were calculated based on prices for surgical equipment, vascular prosthesis and hospital stay.

RESULTS

We found a significantly higher increase in QALYs after laparoscopic vs open aortobifemoral bypass surgery, with a difference of 0.07 QALYs, (p=0.001) in favor of laparoscopic aortobifemoral bypass. The total cost of surgery, equipment and hospital stay after laparoscopic surgery (9,953 €) was less than open surgery (17,260 €), (p=0.001).

CONCLUSION

Laparoscopic aortobifemoral bypass seems to be cost-effective compared with open surgery, due to an increase in QALYs and lower procedure-related costs.

MicroRNA-125a and -b inhibit A20 and MAVS to promote inflammation and impair antiviral response in COPD

Influenza A virus (IAV) infections lead to severe inflammation in the airways. Patients with chronic obstructive pulmonary disease (COPD) characteristically have exaggerated airway inflammation and are more susceptible to infections with severe symptoms and increased mortality. The mechanisms that control inflammation during IAV infection and the mechanisms of immune dysregulation in COPD are unclear. We found that IAV infections lead to increased inflammatory and antiviral responses in primary bronchial epithelial cells (pBECs) from healthy nonsmoking and smoking subjects. In pBECs from COPD patients, infections resulted in exaggerated inflammatory but deficient antiviral responses. A20 is an important negative regulator of NF-κB-mediated inflammatory but not antiviral responses, and A20 expression was reduced in COPD. IAV infection increased the expression of miR-125a or -b, which directly reduced the expression of A20 and mitochondrial antiviral signaling (MAVS), and caused exaggerated inflammation and impaired antiviral responses. These events were replicated in vivo in a mouse model of experimental COPD. Thus, miR-125a or -b and A20 may be targeted therapeutically to inhibit excessive inflammatory responses and enhance antiviral immunity in IAV infections and in COPD.

Comparison of the acute-phase response after laparoscopic versus open aortobifemoral bypass surgery: a substudy of a randomized controlled trial

PURPOSE

Minimally invasive surgical techniques have been shown to reduce the inflammatory response related to a surgical procedure. The main objective of our study was to measure the inflammatory response in patients undergoing a totally laparoscopic versus open aortobifemoral bypass surgery. This is the first randomized trial on subjects in this population.

PATIENTS AND METHODS

This is a substudy of a larger randomized controlled multicenter trial (Norwegian Laparoscopic Aortic Surgery Trial). Thirty consecutive patients with severe aortoiliac occlusive disease eligible for aortobifemoral bypass surgery were randomized to either a totally laparoscopic (n=14) or an open surgical procedure (n=16). The inflammatory response was measured by perioperative monitoring of serum interleukin-6 (IL-6), IL-8, and C-reactive protein (CRP) at six different time points.

RESULTS

The inflammatory reaction caused by the laparoscopic procedure was reduced compared with open surgery. IL-6 was significantly lower after the laparoscopic procedure, measured by comparing area under the curve (AUC), and after adjusting for the confounding effect of coronary heart disease (P=0.010). The differences in serum levels of IL-8 and CRP did not reach statistical significance.

CONCLUSION

In this substudy of a randomized controlled trial comparing laparoscopic and open aortobifemoral bypass surgeries, we found a decreased perioperative inflammatory response after the laparoscopic procedure measured by comparing AUC for serum IL-6.

Obstructive Lung Diseases in HIV: A Clinical Review and Identification of Key Future Research Needs

HIV infection has shifted from what was once a disease directly impacting short-term mortality to what is now a chronic illness controllable in the era of effective combination antiretroviral therapy (ART). In this setting, life expectancy for HIV-infected individual is nearly comparable to that of individuals without HIV. Subsequent to this increase in life expectancy, there has been recognition of increased multimorbidity among HIV-infected persons, with prevalence of comorbid chronic illnesses now approaching 65%. Obstructive lung diseases, including chronic obstructive pulmonary disease (COPD) and asthma, are prevalent conditions associated with substantial morbidity and mortality in the United States. There is overlap in risk factors for HIV acquisition and chronic lung diseases, including lower socioeconomic status and the use of tobacco and illicit drugs. Objectives of this review are to (1) summarize the current state of knowledge regarding COPD and asthma among HIV-infected persons, (2) highlight implications for clinicians caring for patients with these combined comorbidities, and (3) identify key research initiatives to reduce the burden of obstructive lung diseases among HIV-infected persons.

Targeting PI3K-p110α Suppresses Influenza Virus Infection in Chronic Obstructive Pulmonary Disease

RATIONALE

Chronic obstructive pulmonary disease (COPD) and influenza virus infections are major global health issues. Patients with COPD are more susceptible to infection, which exacerbates their condition and increases morbidity and mortality. The mechanisms of increased susceptibility remain poorly understood, and current preventions and treatments have substantial limitations.

OBJECTIVES

To characterize the mechanisms of increased susceptibility to influenza virus infection in COPD and the potential for therapeutic targeting.

METHODS

We used a combination of primary bronchial epithelial cells (pBECs) from COPD and healthy control subjects, a mouse model of cigarette smoke-induced experimental COPD, and influenza infection. The role of the phosphoinositide-3-kinase (PI3K) pathway was characterized using molecular methods, and its potential for targeting assessed using inhibitors.

MEASUREMENTS AND MAIN RESULTS

COPD pBECs were susceptible to increased viral entry and replication. Infected mice with experimental COPD also had more severe infection (increased viral titer and pulmonary inflammation, and compromised lung function). These processes were associated with impaired antiviral immunity, reduced retinoic acid-inducible gene-I, and IFN/cytokine and chemokine responses. Increased PI3K-p110α levels and activity in COPD pBECs and/or mice were responsible for increased infection and reduced antiviral responses. Global PI3K, specific therapeutic p110α inhibitors, or exogenous IFN-β restored protective antiviral responses, suppressed infection, and improved lung function.

CONCLUSIONS

The increased susceptibility of individuals with COPD to influenza likely results from impaired antiviral responses, which are mediated by increased PI3K-p110α activity. This pathway may be targeted therapeutically in COPD, or in healthy individuals, during seasonal or pandemic outbreaks to prevent and/or treat influenza.

Viral Etiology of Chronic Obstructive Pulmonary Disease Exacerbations during the A/H1N1pdm09 Pandemic and Postpandemic Period

Viral infections are one of the main causes of acute exacerbations of chronic obstructive pulmonary disease (AE-COPD). Emergence of A/H1N1pdm influenza virus in the 2009 pandemic changed the viral etiology of exacerbations that were reported before the pandemic. The aim of this study was to describe the etiology of respiratory viruses in 195 Spanish patients affected by AE-COPD from the pandemic until the 2011-12 influenza epidemic. During the study period (2009–2012), respiratory viruses were identified in 48.7% of samples, and the proportion of viral detections in AE-COPD was higher in patients aged 30–64 years than ≥65 years. Influenza A viruses were the pathogens most often detected during the pandemic and the following two influenza epidemics in contradistinction to human rhino/enteroviruses that were the main viruses causing AE-COPD before the pandemic. The probability of influenza virus detection was 2.78-fold higher in patients who are 30–64 years old than those ≥65. Most respiratory samples were obtained during the pandemic, but the influenza detection rate was higher during the 2011-12 epidemic. There is a need for more accurate AE-COPD diagnosis, emphasizing the role of respiratory viruses. Furthermore, diagnosis requires increased attention to patient age and the characteristics of each influenza epidemic.

COPD and levels of Hsp70 (HSPA1A) and Hsp27 (HSPB1) in plasma and lymphocytes among coal workers: a case-control study

This case-control study aimed to investigate whether the levels of Hsp70 (HSPA1A) and Hsp27 (HSPB1) in plasma and lymphocytes were associated with the risk of chronic obstructive pulmonary disease (COPD) among coal workers. A total of 76 COPD cases and 48 age-matched healthy controls from a group of coal workers were included. The case group consisted of 35 COPD patients whose condition was complicated with coal workers' pneumoconiosis (CWP) and 41 COPD patients without CWP. Heat shock proteins (Hsps) in plasma and lymphocytes were detected by ELISA and flow cytometry, respectively. Multiple logistic regression models were applied to estimate the association between Hsp levels and COPD risk. Our results showed that plasma Hsp70 and lymphocyte Hsp27 levels were significantly higher and plasma Hsp27 levels were significantly lower in COPD cases than in controls (p < 0.01). No significant differences in lymphocyte Hsp70 levels were found between COPD cases and the matched subjects. Higher plasma Hsp70 levels (odds ratio (OR) = 13.8, 95 % confidence interval (CI) = 5.7-33.5) and lower plasma Hsp27 levels (OR = 4.6, 95 % CI = 2.0-10.5) were significantly associated with an increased risk of COPD after adjusting for confounders. Higher lymphocyte Hsp27 levels were only associated with an increased risk of COPD with CWP (OR = 6.6, 95 % CI = 2.0-22.1) but not with an increased risk of COPD without CWP (OR = 3.0, 95 % CI = 0.9-8.9). Additionally, there were strong joint effects of different Hsps on COPD risk. These results showed that higher levels of plasma Hsp70 and lower levels of plasma Hsp27 might be associated with an increased risk of COPD among coal workers. They may have the potential to serve as monitoring markers for COPD in coal workers.

Intervention in HCM: patient selection, procedural approach and emerging techniques in alcohol septal ablation

Hypertrophic cardiomyopathy (HCM) is a highly heterogeneous disease with varied patterns of hypertrophy. Basal septal hypertrophy and systolic anterior motion (SAM) of the mitral valve (MV) are the key pathophysiological components to left ventricular outflow tract (LVOT) obstruction in HCM. LVOT is associated with higher morbidity and mortality in patients with HCM. Percutaneous septal reduction therapy with alcohol septal ablation (ASA) can lead to a significant improvement in left ventricle haemodynamics, patient symptoms and perhaps prognosis. ASA delivers pure alcohol to an area of myocardium via septal coronary arteries; this creates damage to tissue akin to a myocardial infarction. The basal septal myocardium involved in SAM-septal contact is the target for this iatrogenic infarct. Appropriate patient selection and accurate delivery of alcohol are critical to safe and effective ASA. Securing the correct diagnosis and ensuring suitable cardiac anatomy are essential before considering ASA. Pre-procedural planning and intra-procedural imaging guidance are important to delivering precise damage to the desired area. The procedure is performed worldwide and is generally safe; the need for a pacemaker is the most prominent complication. It is successful in the majority of patients but room for improvement exists. New techniques have been proposed to perform percutaneous septal reduction. We present a review of the relevant pathophysiology, current methods and a summary of available evidence for ASA. We also provide a glimpse into emerging techniques to deliver percutaneous septal reduction therapy.

ICON: chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a public health problem that has a significant socio-economic impact. Moreover, the complexity of this disease due to its heterogeneous nature based on the underlying pathophysiology - leading to different disease variants - further complicates our understanding and directions for the most appropriate targeted treatment strategies. Several International/national guidelines/position papers and/or consensus documents are available that present the current knowledge and treatment strategies for CRS. Yet there are many challenges to the management of CRS especially in the case of the more severe and refractory forms of disease. Therefore, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), a collaboration between EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus (ICON) on Chronic Rhinosinusitis. The purpose of this ICON on CRS is to highlight the key common messages from the existing guidelines, the differences in recommendations as well as the gaps in our current knowledge of CRS, thus providing a concise reference. In this document we discuss the definition of the disease, its relevance, pharmacoeconomics, pathophysiology, phenotypes and endotypes, genetics and risk factors, natural history and co-morbidities as well as clinical manifestations and treatment options in both adults and children comprising pharmacotherapy, surgical interventions and more recent biological approaches. Finally, we have also highlighted the unmet needs that wait to be addressed through future research.

Association Between Chronic Respiratory Diseases and Helicobacter pylori: A Meta-Analysis

BACKGROUND

The prevalence of chronic respiratory diseases (CRDs), including chronic bronchitis and chronic obstructive pulmonary disease (COPD), has increased significantly over the past decades. Several studies suggest that Helicobacter pylori infection may be related to the development of CRDs, but the results were not consistent. We carried out a meta-analysis to evaluate the potential association of H.pylori infection with CRDs.

METHODS

We conducted a systematic literature search in PubMed, Embase, Ovid, Google Scholar and CNKI from inception to October 31, 2013. The following search terms were used: "chronic respiratory disease," "chronic bronchitis," "chronic obstructive pulmonary disease" or "COPD" in combination with "Helicobacter pylori" or "Campylobacter pylori." According to established inclusion criteria, we selected all eligible published papers and then extracted essential data. To evaluate the association of H.pylori with chronic bronchitis and COPD, an overall analysis and subgroup analyses were conducted.

RESULTS

A total of 9 case-control studies comprising 782 cases and 815 controls were included in the study. Pooled ORs were 2.30 (95%CI: 1.85-2.85) in the overall analysis, 2.90 (95%CI: 2.04-4.13) in the chronic bronchitis subgroup, and 2.11 (95%CI: 1.35-3.29) in the COPD subgroup.

CONCLUSIONS

The results of the overall analysis and subgroup analyzed suggest a significant association between H.pylori and CRDs. Further studies are needed to clarify the pathogenetic mechanisms involved.

Correlation of pulmonary function indexes determined by low-dose MDCT with spirometric pulmonary function tests in patients with chronic obstructive pulmonary disease

OBJECTIVE

The objective of our study was to evaluate the correlation between pulmonary function indexes determined by low-dose MDCT and those obtained from routine spirometric pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD).

MATERIALS AND METHODS

Lung function of patients with COPD stages 0-III was evaluated by both MDCT and spirometric PFTs. Scanning was performed at maximum end-inspiration and maximum end-expiration.

RESULTS

A very strong correlation was found between extrapolated expiratory lung volume (LVex) and COPD stage (r = 0.802, p < 0.001) and between extrapolated LVex and the ratio of forced expiratory volume in 1 second and percentage forced vital capacity (FEV1/FVC%) (r = -0.831, p < 0.001). Moreover, strong positive correlations were found between inspiratory lung volume (LVin) and total lung capacity (TLC) (r = 0.658, p < 0.001), LVex and residual volume (RV) (r = 0.683, p < 0.001), extrapolated LVex and RV (r = 0.640, p < 0.001), LVex and RV/TLC (r = 0.602, p < 0.001), LVex/LVin and RV/TLC (r = 0.622, p < 0.001), extrapolated LVex and RV/TLC (r = 0.663, p < 0.001), and LVex and COPD stage (r = 0.697, p < 0.001).

CONCLUSION

Low-dose MDCT lung function indexes correlate well with spirometric PFT results, and the highest correlation is at end-expiration. Low-dose MDCT may be useful for evaluating lung function in patients with COPD.

Clinical factors associated with the humoral immune response to influenza vaccination in chronic obstructive pulmonary disease

Background and objective

Individuals with chronic obstructive pulmonary disease (COPD) are at a high risk of developing significant complications from infection with the influenza virus. It is therefore vital to ensure that prophylaxis with the influenza vaccine is effective in COPD. The aim of this study was to assess the immunogenicity of the 2010 trivalent influenza vaccine in persons with COPD compared to healthy subjects without lung disease, and to examine clinical factors associated with the serological response to the vaccine.

Methods

In this observational study, 34 subjects (20 COPD, 14 healthy) received the 2010 influenza vaccine. Antibody titers at baseline and 28 days post-vaccination were measured using the hemagglutination inhibition assay (HAI) assay. Primary endpoints included seroconversion (≥4-fold increase in antibody titers from baseline) and the fold increase in antibody titer after vaccination.

Results

Persons with COPD mounted a significantly lower humoral immune response to the influenza vaccine compared to healthy participants. Seroconversion occurred in 90% of healthy participants, but only in 43% of COPD patients (P=0.036). Increasing age and previous influenza vaccination were associated with lower antibody responses. Antibody titers did not vary significantly with cigarette smoking, presence of other comorbid diseases, or COPD severity.

Conclusion

The humoral immune response to the 2010 influenza vaccine was lower in persons with COPD compared to non-COPD controls. The antibody response also declined with increasing age and in those with a history of prior vaccination.

Right ventricular outflow tract function in chronic obstructive pulmonary disease

BACKGROUND

It is clinically important to evaluate the severity of right ventricular (RV) overload in patients with chronic obstructive pulmonary disease (COPD), which is often associated with changes in the structure and the function of the right ventricle. Noninvasive and reliable assessment of RV function would be an essential determinant of RV load and a clinically useful factor for assessing cardiovascular risk in COPD patients.

OBJECTIVE

The aim of this study was to investigate the clinical application value of right ventricular outflow tract (RVOT) systolic function measured by transthoracic echocardiography in patients with COPD.

PATIENTS AND METHODS

We prospectively investigated COPD male patients and compared them with healthy controls. In addition to RV conventional echocardiographic parameters, RVOT size and fractional shortening (RVOT-FS) parameters were also assessed.

RESULTS

Fifty-five COPD patients (all men; mean age, 62 ± 9 years) participated in the study, and were compared with a control group consisting of 21male, healthy, nonsmoking subjects with a mean age of 58 ± 11 years. The RVOT-FS was impaired in COPD patients than healthy controls (27.8 ± 15.5 vs. 57.5 ± 8.6, p < 0.001), and was correlated positively with tricuspid annular plane systolic excursion (TAPSE; r = 0.583, p < 0.001) and pulmonary acceleration time (r = 0.666, p < 0.001) and inversely with pulmonary artery systolic pressure (r = 0.605, p < 0.001) and functional capacity(r = - 0.589, p < 0.001). There was a statistically significant difference in RVOT-FS among the COPD subgroups with regard to New York Heart Association functional classification (p < 0.001).

CONCLUSION

The RVOT-FS is a noninvasive easily applicable measure of RV systolic function and is well correlated with functional capacity in COPD patients. Its combination with long-axis measurements via TAPSE and transtricuspid Doppler analysis may provide a comprehensive evaluation of the RV performance in COPD patients.

Transcriptional down-regulation of suppressor of cytokine signaling (SOCS)-3 in chronic obstructive pulmonary disease

BACKGROUND

Tobacco is a leading environmental factor in the initiation of respiratory diseases and causes chronic obstructive pulmonary disease (COPD). Suppressor of cytokine signaling (SOCS) family members are involved in the pathogenesis of many inflammatory diseases and SOCS-3 has been shown to play an important role in the regulation, onset and maintenance of airway allergic inflammation indicating that SOCS-3 displays a potential therapeutic target for anti-inflammatory respiratory drugs development. Since chronic obstructive pulmonary disease (COPD) is also characterized by inflammatory changes and airflow limitation, the present study assessed the transcriptional expression of SOCS-3 in COPD.

METHODS

Real-time PCR was performed to assess quantitative changes in bronchial biopsies of COPD patients in comparison to unaffected controls.

RESULTS

SOCS-3 was significantly down-regulated in COPD at the transcriptional level while SOCS-4 and SOCS-5 displayed no change.

CONCLUSIONS

It can be concluded that the presently observed inhibition of SOCS-3 mRNA expression may be related to the dysbalance of cytokine signaling observed in COPD.

Clinical trial simulation to assist in COPD trial planning and design with a biomarker-based diagnostic: when to pull the trigger?

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease with a wide range of clinical phenotypes that vary from predominantly airway disease (chronic bronchitis) to predominantly parenchymal disease (emphysema). Current advances for the treatment of COPD are increasingly focused on targeted treatments and development of novel biomarker-based diagnostics (Dx)'s to select the patients most likely to benefit. Clinical trial planning and design with biomarkers includes additional considerations beyond those for conventional trials in un-selected populations, e.g., the heterogeneity of COPD phenotypes in the population, the ability of a biomarker to predict clinically meaningful phenotypes that are differentially associated with the response to a targeted treatment, and the data needed to make Go/No Go decisions during clinical development. We developed the Clinical Trial Object Oriented Research Application (CTOORA), a computer-aided clinical trial simulator of COPD patient outcomes, to inform COPD trial planning with biomarkers. CTOORA provides serial projections of trial success for a range of hypothetical and plausible scenarios of interest. In the absence of data, CTOORA can identify characteristics of a biomarker-based Dx needed to provide a meaningful advantage when used in a clinical trial. We present a case study in which CTOORA is used to identify the scenarios for which a biomarker may be used successfully in clinical development. CTOORA is a tool for robust clinical trial planning with biomarkers, to guide early-to-late stage development that is positioned for success.

Evaluation of lung flute in sputum samples for molecular analysis of lung cancer

Background

Molecular analysis of sputum provides a promising approach for lung cancer diagnosis, yet is limited by the difficulty in collecting the specimens from individuals who can’t spontaneously expectorate sputum. Lung Flute is a small self-powered audio device that can induce sputum by generating sound waves and vibrating in the airways of the lungs. Here we propose to evaluate the usefulness of Lung Flute for sputum sampling to assist diagnosis of lung cancer.

Methods

Forty-three stage I lung cancer patients and 47 cancer-free individuals who couldn’t spontaneously cough sputum were instructed to use Lung Flute for sputum sampling. Expressions of two microRNAs, miRs-31 and 210, were determined in the specimens by qRT-PCR. The results were compared with sputum cytology.

Results

Sputum was easily collected from 39 of 43 (90.7%) lung cancer patients and 42 of 47 (89.4%) controls with volume ranges from 1 to 5 ml (median, 2.6 ml). The specimens had less than 4% oral squamous cells, indicating that sputum was obtained from low respiratory tract. Expressions of miRs-31 and 210 in sputum were considerably higher in cancer patients than cancer-free individuals (8.990 vs. 4.514; 0.6847 vs. 0.3317; all P <0.001). Combined use of the two miRNAs produced a significantly higher sensitivity (61.5% vs. 35.9%, P = 0.002) and a slightly lower specificity (90.5% vs. 95.2%, p = 0.03) compared with cytology for lung cancer diagnosis.

Conclusion

Lung Flute could potentially be useful in convenient and efficient collection of sputum for molecular diagnosis of lung cancer.

Video-assisted thoracoscopic lobectomy in non-small-cell lung cancer patients with chronic obstructive pulmonary disease is associated with lower pulmonary complications than open lobectomy: a propensity score-matched analysis

OBJECTIVES

Non-small-cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD) are at an increased risk of pulmonary complications after pulmonary resection. This study aimed to identify whether video-assisted thoracoscopic (VATS) lobectomy can reduce postoperative pulmonary complications compared with lobectomy by thoracotomy in NSCLC patients with COPD.

METHODS

Among a total of 1502 NSCLC patients who underwent lobectomy from April 2005 to June 2012 at the Seoul National University Hospital, 446 (29.7%) were diagnosed with COPD based on the spirometric criteria of the Global Initiative for COPD. Among the 446 patients, 283 presented with stage I NSCLC and were selected for this study. The study patients were divided into two groups: patients undergoing VATS (n = 160) lobectomy and patients undergoing thoracotomy (n = 123) lobectomy. A propensity analysis that incorporated preoperative variables, such as age, sex, Charlson comorbidity index, extent of smoking, preoperative pulmonary function, size of the mass, histological type of the tumour and additional lung resection, was performed, and postoperative outcomes were compared.

RESULTS

Matching based on propensity scores produced 91 patients in each group for the analysis of postoperative outcomes. There were only three operative mortalities in the thoracotomy group, and all of these patients died of postoperative pneumonia. The overall incidence of postoperative complications was 32.9% (30 of 91) and 22.0% (20 of 91) in the thoracotomy group and in the VATS group, respectively (P = 0.14). Compared with lobectomy by thoracotomy, VATS lobectomy was associated with a lower incidence of pulmonary complications (1.1 vs 12.1%; P < 0.01), shorter operation time (165 vs 201 min; P < 0.01) and shorter length of stay (6.0 vs 9.0 days; P = 0.04).

CONCLUSIONS

VATS lobectomy is associated with a lower incidence of pulmonary complications compared with lobectomy by thoracotomy in stage I NSCLC patients with COPD. VATS lobectomy may be the preferred strategy for appropriately selected NSCLC patients with COPD.

Pulmonary artery distensibility in chronic obstructive pulmonary disease

BACKGROUND

Pulmonary hypertension (PH) is an important complication in the natural history of chronic obstructive pulmonary disease (COPD) and is caused by the remodeling of pulmonary arteries impairing the distensibility and stiffness of the major pulmonary arteries.

OBJECTIVES

To evaluate the pulmonary artery distensibility by transthoracic echocardiography in patients with COPD.

METHOD

We prospectively investigated COPD male patients and compared with healthy controls. In addition to right ventricle (RV) conventional echocardiographic parameters, right pulmonary artery fractional shortening(RPA-FS) and new pulmonary artery stiffness (PAS) parameters were compared.

RESULTS

Fifty-four COPD patients participated in the study and compared with a control group consisting of 24, all men, healthy, nonsmoking subjects. Six patients were excluded from study due to poor quality of echocardiographic recordings. The distensibility of PA evaluated by the RPA-FS parameter was found to be significantly lower in patients with COPD than it was in normal subjects (13.3 ± 8.1 vs. 27.6 ± 4.9,P :< 0.001) and correlated positively with tricuspid annular systolic excursion (TAPSE) (r = 0.566, P < 0.001) and pulmonary acceleration time (r = 0.607, P < 0.001) and correlated inversely with pulmonary artery systolic pressure (r = -0.587, P < 0.001), PAS(r = -0.479, P < 0.001) and functional capacity (r = -0.586, P < 0.001). Similar to this, PAS found to be impaired in COPD patients (29.5 ± 13.6 vs. 15.7 ± 4.1, P < 0.001) and correlated inversely RPA-FS (r = -0.479, P < 0.001). There were statistically significant difference for pulmonary artery distensibility (RPA-FS) and PAS parameters among the COPD subgroups with regard to NYHA functional capacity (P < 0.001).

CONCLUSION

In this study, we found that PAS and distensibility were worsened in COPD patients and correlated with decreased functional capacity.

Prediction of chronic obstructive pulmonary disease exacerbation using physiological time series patterns

Chronic obstructive pulmonary disease (COPD) is responsible for significant morbidity and mortality worldwide. Recent clinical research has indicated a strong association between physiological homeostasis and the onset of COPD exacerbation. Thus the analysis of these variables may yield a means of predicting a COPD exacerbation in the near future. However, the accuracy of existing prediction methods based on statistical analysis of periodic snapshots of physiological variables is still far from satisfactory, due to lack of integration of long-term and interactive effects of the physiological variables. Therefore, developing a relatively accurate method for predicting COPD exacerbation is an outstanding challenge. In this paper, a regression-based machine learning technique was developed, using trend pattern variables extracted from COPD patients' longitudinal physiological records, to classify subjects into "low-risk" and "high-risk" categories, indicating their risk of suffering a COPD exacerbation event. Experimental results from cross validation assessment of the classifier model show an average accuracy of 79.27% using this method.

Association between obstructive lung disease and markers of HIV infection in a high-risk cohort

BACKGROUND

Evidence suggests an association between HIV infection and the presence of obstructive lung disease (OLD). However, the associations between specific markers of HIV infection and OLD remain unclear. A study was undertaken to determine the independent associations of HIV infection, CD4 cell count and plasma HIV viral load with the presence of OLD in an urban cohort.

METHODS

Clinical, laboratory and spirometric data from the AIDS Linked to the Intravenous Experience (ALIVE) study, an observational study of current and former injection drug users in Baltimore, Maryland, were analysed. Multivariable logistic regression models were generated to identify HIV infection indices independently associated with OLD.

RESULTS

Of 1077 participants (mean±SD age 48±8 years), 89% were African-American, 65% were men and 86% were current smokers. A total of 303 (28%) were HIV infected and 176 (16%) had spirometry-defined OLD. Higher viral load was independently associated with OLD. HIV-infected individuals with viral load >200,000 copies/ml had a 3.4-fold increase in the odds of OLD compared with HIV-negative participants (95% CI 1.24 to 9.39; p=0.02). The association between higher HIV viral load and OLD persisted after accounting for antiretroviral therapy use (OR 4.06, 95% CI 1.41 to 11.7; p=0.01). No association was observed between HIV serostatus or CD4 cell count and the presence of OLD.

CONCLUSION

In a cohort at risk for OLD and HIV infection, high viral load but not CD4 cell count was associated with an increased prevalence of spirometry-defined OLD. These findings suggest that higher viral load may contribute mechanistically to the increased risk of OLD in patients with HIV infection.

Changes in lung function of HIV-infected patients: a 4.5-year follow-up study

OBJECTIVE

To investigate the development of lung function in HIV-infected patients.

METHODS

In a prospective cohort study, 88 HIV-infected patients had a lung function test performed and 63 patients (72%) had their LFT repeated with a median follow-up period of 4.4 years. Forty-eight per cent were smokers, and at the re-examination, 97% were on combination antiretroviral therapy.

RESULTS

Carbon monoxide diffusion capacity was reduced and decreased over time in both smokers and non-smokers. Alveolar volume decreased and forced vital capacity increased similarly in both smokers and non-smokers. No changes were observed in forced expiratory volume or peak flow, but smokers had reduced values compared with those of the non-smokers at both examinations. FEV1/FVC was reduced especially in smokers and declined in both smokers and non-smokers.

CONCLUSIONS

Carbon monoxide diffusion capacity is reduced in HIV-infected patients and seems to decline over time. Additionally, signs of obstructive lung disease are present in HIV-infected patients and seem to increase over time, although only modestly.

Detection of microorganisms in exhaled breath condensate during acute exacerbations of COPD

BACKGROUND AND OBJECTIVE

One hallmark of COPD is colonization and infection of the lung. Acute exacerbations of COPD (AECOPD) are acute deteriorations of the chronic disease and are associated with a change of the pulmonary microbial balance. The collection of exhaled breath condensate (EBC) can be used to non-invasively determine markers of lung disease. The aim of the present study was to compare the results of assays based on the detection of microbial nucleic acids from EBC and from spontaneous sputum in patients with AECOPD.

METHODS

EBC and sputa of 29 adults with AECOPD were obtained. Isolated DNA or RNA were used as starting material for the PCR assays to detect Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae, Chlamydia pneumoniae, influenza viruses (AH 1, AH 3) and respiratory syncytial virus.

RESULTS

Bacterial or viral nucleic acids were identified in 14 EBC and 21 sputa from 29 patients. Results from EBC did not correlate well with those from sputum. Viral and S. pneumoniae nucleic acids were detected only in sputum, whereas L. pneumophila DNA was only found in EBC. In three EBC and 10 sputa nucleic acids of more than one microorganism was detected.

CONCLUSIONS

Bacterial nucleic acids can be identified in EBC of COPD patients with exacerbations. The results obtained from EBC and sputum did not correlate well.

Relationship between the anti-inflammatory properties of salmeterol/fluticasone and the expression of CD4⁺CD25⁺Foxp3⁺ regulatory T cells in COPD

BACKGROUND

Salmeterol and fluticasone combination (SFC) has anti-inflammatory effects and improves clinical symptoms in patients with chronic obstructive pulmonary disease (COPD). However, the anti-inflammatory mechanism of SFC remains unclear. In this study, we investigated the inflammatory responses of COPD, as well as the relationship of the inflammatory factors with the levels of CD4+CD25+Foxp3+ regulatory T cells (Foxp3+Tregs) after SFC therapy.

METHODS

Twenty-one patients with moderate or severe COPD received treatment with 50/500 μg of SFC twice a day for 12 weeks. Before and after treatment, the patients were evaluated using the Modified Medical Research Council (MMRC) dyspnea scale and by conducting a 6-min walk test. The number of neutrophils, monocytes and lymphocytes in induced sputum were counted. Levels of cytokines, including pre-inflammatory IL-8, TNF-α, IL-17A and cytokine IL-10, in the sputum supernatant and peripheral blood were measured by ELISA. The proportion of Foxp3+Tregs in the total CD4+ T cell of the peripheral blood was determined by flow cytometry. The relationship between IL-17A levels and the percentage of Foxp3+Tregs was analyzed by statistical analysis.

RESULTS

After treatment with SFC, the forced expiratory volume in 1 s as a percentage of predicted values (FEV1%) and the 6-min walk distance in the COPD patients significantly increased, while dyspnea scores decreased. The total number of cells, neutrophils, and the percentage of neutrophils in induced sputum reduced notably, while the proportion of monocytes was significantly increased. Levels of the inflammatory cytokines IL-8, TNF-α, and IL-17A in the sputum supernatant and in the blood were markedly lowered, while IL-10 levels were unchanged. The proportion of Foxp3+Tregs in the total CD4+T cell population in the peripheral blood was drastically higher than that before treatment. The level of IL-17A was negatively correlated with the proportion of Foxp3+Tregs in CD4+T cells.

CONCLUSION

SFC can reduce the levels of inflammatory factors and improve symptoms of COPD. The levels of inflammatory factors are associated with the variation of Foxp3+Tregs in COPD.

TRIAL REGISTRATION

This study was registered with http://www.chictr.org (Chinese Clinical Trial Register) as follows: ChiCTR-TNC-10001270.