Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey

Increased plasma interleukin-1β is associated with accelerated lung function decline in non-smokers

Interleukin-1β is one of the major cytokines involved in the initiation and persistence of airway inflammation in chronic obstructive pulmonary disease (COPD). However, the association between plasma interleukin-1β and lung function decline remains unclear. We aimed to explore the association between plasma interleukin-1β and lung function decline. This longitudinal evaluation of data from the Early COPD study analysed the association between the plasma interleukin-1β concentration, lung function decline, and COPD exacerbation. Overall, 1,328 participants were included in the baseline analysis, and 1,135 (85%) completed the 1-year follow-up. Increased plasma interleukin-1β was associated with accelerated lung function decline in non-smokers (forced expiratory volume in 1 s: per unit natural log-transformed increase, adjusted unstandardised β [95% confidence interval] 101.46 [16.73-186.18] mL/year, p=0.019; forced vital capacity: per unit natural log-transformed increase, adjusted unstandardised β [95% confidence interval] 146.20 [93.65-198.75] mL/year, p<0.001), but not in smokers. In non-smokers, participants with an interleukin-1β concentration in the top 30% (>5.02 pg/mL) had more respiratory symptoms, more severe emphysema and air trapping, and higher levels of inflammation-related biomarkers. In this study, a subgroup with increased plasma interleukin-1β was identified among non-smokers, and increased plasma interleukin-1β was associated with lung function accelerated decline.

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.

Association of pectoralis muscle area on computed tomography with airflow limitation severity and respiratory outcomes in COPD: A population-based prospective cohort study

BACKGROUND

Previous studies have shown that patients with chronic obstructive pulmonary disease (COPD) of severe or very severe airflow limitation have a reduced pectoralis muscle area (PMA), which is associated with mortality. However, whether patients with COPD of mild or moderate airflow limitation also have a reduced PMA remains unclear. Additionally, limited evidence is available regarding the associations between PMA and respiratory symptoms, lung function, computed tomography (CT) imaging, lung function decline, and exacerbations. Therefore, we conducted this study to evaluate the presence of PMA reduction in COPD and to clarify its associations with the referred variables.

METHODS

This study was based on the subjects enrolled from July 2019 to December 2020 in the Early Chronic Obstructive Pulmonary Disease (ECOPD) study. Data including questionnaire, lung function, and CT imaging were collected. The PMA was quantified on full-inspiratory CT at the aortic arch level using predefined -50 and 90 Hounsfield unit attenuation ranges. Multivariate linear regression analyses were performed to assess the association between the PMA and airflow limitation severity, respiratory symptoms, lung function, emphysema, air trapping, and the annual decline in lung function. Cox proportional hazards analysis and Poisson regression analysis were used to evaluate the PMA and exacerbations after adjustment.

RESULTS

We included 1352 subjects at baseline (667 with normal spirometry, 685 with spirometry-defined COPD). The PMA was monotonically lower with progressive airflow limitation severity of COPD after adjusting for confounders (vs. normal spirometry; Global Initiative for Chronic Obstructive Lung Disease [GOLD] 1: β=-1.27, P=0.028; GOLD 2: β=-2.29, P<0.001; GOLD 3: β=-4.88, P<0.001; GOLD 4: β=-6.47, P=0.014). The PMA was negatively associated with the modified British Medical Research Council dyspnea scale (β=-0.005, P=0.026), COPD Assessment Test score (β=-0.06, P=0.001), emphysema (β=-0.07, P<0.001), and air trapping (β=-0.24, P<0.001) after adjustment. The PMA was positively associated with lung function (all P<0.05). Similar associations were discovered for the pectoralis major muscle area and pectoralis minor muscle area. After the 1-year follow-up, the PMA was associated with the annual decline in the post-bronchodilator forced expiratory volume in 1 s percent of predicted value (β=0.022, P=0.002) but not with the annual rate of exacerbations or the time to first exacerbation.

CONCLUSION

Patients with mild or moderate airflow limitation exhibit a reduced PMA. The PMA is associated with airflow limitation severity, respiratory symptoms, lung function, emphysema, and air trapping, suggesting that PMA measurement can assist with COPD assessment.

Analyzing the role of genetic variants in microRNAs and its role as a modulator towards Chronic Obstructive Pulmonary disease (COPD) susceptibility in North Indian population

BACKGROUND

miRNAs can target numerous genes, with slight expression changes potentially leading to significant alterations in protein-coding gene expression, affecting various biological processes and possibly worsening conditions like COPD.

OBJECTIVES

This study examines the link between six miRNA SNPs (MIR605, MIR608, MIR3117, MIR149, MIR499, and MIR25) and COPD risk in a North Indian population and the functional impact of these miRNA-SNPs on COPD-related pathological factors.

MATERIALS AND METHODS

To assess genotypes, a case-control study was conducted with 323 COPD cases and 350 hospital controls. Logistic regression determined the odds ratio and 95% confidence interval for the SNP-COPD association, with stratified analysis for clinical parameters, symptoms, and risk factors. SNP-SNP interactions were analyzed using combinatorial analysis, MDR, and CART analysis.

RESULTS

MIR25 SNP rs1527423 and MIR608 SNP rs4919510 were significantly associated with COPD risk (OR = 6.38; p < 0.0001 and OR = 1.43, p = 0.02, respectively). rs1527423 remained significant in stratified analysis for age (OR = 6.19; pc = 0.0005), gender (males; OR = 5.93; pc < 0.0001), and smoking status (smokers; OR = 5.02; pc = 0.0006). rs4919510 was associated with COPD risk in patients aged ≥ 65 years (OR = 2.38, pc = 0.0054). MIR605 SNP rs2043556 had a protective effect in non-smokers (OR = 0.142; pc = 0.048). MIR3117 SNP rs4655646 was linked to COPD symptoms. Doublet combinations of each SNP with rs1527423 increased COPD risk. CART analysis identified rs1527423 as a critical factor, with the genotypic combination of 149(M)-3117(M; W)-605(M; W)-608(M; H)-25(W) showing the highest COPD risk (OR = 11; p = 0.0445).

CONCLUSIONS

The study suggests MIR25 SNP rs1527423 as a risk factor for COPD in North Indian populations.

Reliability and usability of a portable spirometer compared to a laboratory spirometer

BACKGROUND

Access to spirometry remains limited due to the expense and inconvenience of stationary laboratory spirometers, which may compromise the diagnosis and management of chronic respiratory diseases (CRDs), such as chronic obstructive pulmonary disease (COPD) and asthma. Portable spirometers offer potential advantages over laboratory spirometers in terms of affordability, user-friendliness, and portability. The objective of this study is to evaluate the reliability and usability of a portable spirometer (Medcaptain VC-30 Pro) compared to a conventional laboratory spirometer (Jaeger MasterScreen PFT).

METHODS

In this multi-center, randomized, open-label crossover study, 132 subjects from two hospitals were recruited to perform pulmonary function tests using both the portable spirometer and the laboratory spirometer. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow (PEF), forced expiratory flow between 25 and 75% of FVC (FEF25-75%), vital capacity (VC), maximal voluntary ventilation (MVV), and forced expiratory volume in six seconds (FEV6) were compared for correlation and agreement between two spirometers. The concordance of their spirometric abnormality diagnoses and severity classifications was assessed. An additional 30 healthy volunteers were recruited to perform a pulmonary function test by themselves after a session guided by specialists to evaluate the usability of the portable spirometer.

RESULTS

A total of 126 recruited participants achieved acceptable pulmonary function test results. The intraclass correlation coefficients (ICCs) for primary outcomes FEV1 and FVC were 0.994 and 0.993, respectively (both p < 0.001). ICCs for other outcomes ranged from 0.968 to 0.995 (all p < 0.001). The Bland-Altman analysis showed that FEV1 and FVC met preset acceptable criteria, with 96.0% of values falling within the 95% limits of agreement (LoA). Cohen's kappa statistics for the diagnosis of spirometric abnormality and classification of severity were 0.872 and 0.878, respectively. In the usability test, 28 out of 30 volunteers obtained a Grade A result.

CONCLUSIONS

The portable spirometer exhibited a strong correlation and agreement with a high-quality laboratory spirometer, as well as concordance in spirometric abnormality diagnosis and severity classification. Non-specialist can obtain acceptable results using this portable spirometer.

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).

Associations of small airway dysfunction assessed by impulse oscillometry with lung function decline and exacerbations in participants with chronic obstructive pulmonary disease: A prospective cohort study in China

INTRODUCTION

Small airway dysfunction (SAD) assessed by impulse oscillometry (IOS) was common in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the associations between IOS-defined small airway dysfunction (SAD) and the long-term prognosis of COPD. This study aimed to explore the associations between IOS-defined SAD, lung function decline and exacerbations in patients with COPD.

METHODS

We analyzed baseline and 2-year follow-up data from the prospective cohort study in China. We defined SAD using IOS parameters Z-score greater than the 1.645 or less than -1.645. Subsequently, these patients were divided into three groups based on the different criteria defined SAD using IOS (normal group [none IOS parameters abnormalities], inconsistent SAD [any IOS parameters abnormalities, but not all], consistent SAD [all of IOS parameters abnormalities]). Negative binomial regression was conducted to analyze the associations between SAD and exacerbations, while a multivariable linear regression model was utilized to identify associations between SAD and lung function decline.

RESULTS

833 patients with COPD were enrolled in our study. SAD (defined by X5, AX, and Fres z-score) was associated with a faster decline in lung function and higher risk of exacerbation. Meanwhile, for inconsistent diagnosis of SAD, we observed that patients with consistent SAD and inconsistent SAD experienced a faster decline in FEV1 and higher risk of exacerbations than those with normal group.

CONCLUSIONS

IOS-defined SAD was associated with worse outcomes in patients with COPD, and further clinical trials are needed to clarify whether early intervention to reduce the severity of small airway lesions can delay the progress of COPD.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900024643. Registered on 19 July 2019.

Lung function decline and incidence of chronic obstructive pulmonary disease in participants with spirometry-defined small airway dysfunction: a 15-year prospective cohort study in China

BACKGROUND

Small airway dysfunction (SAD) is common but little is known about the longitudinal prognosis of spirometry-defined SAD. Therefore, we aimed to evaluate the risk of lung function decline and incident chronic obstructive pulmonary disease (COPD) of spirometry-defined SAD.

METHODS

It was a population-based prospective cohort study conducted in Guangdong, China. Participants were enrolled in the years 2002, 2008, 2012, 2017, and 2019, and those who completed baseline demographic data, a standardized epidemiological questionnaire for COPD, and spirometry were included. Follow-up visits were conducted every three years after enrolment, with a maximum follow-up time of 15 years and a minimum follow-up time of 3 years. Spirometry-defined SAD was defined as having at least two out of three parameters (maximal mid-expiratory flow, forced expiratory flow 50%, and forced expiratory flow 75%) below 65% of the predicted value. Non-obstructive SAD and obstructive SAD were further differentiated based on the presence of airflow obstruction (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] < 0.70). Pre- and post-bronchodilator spirometry measurements were analyzed separately.

RESULTS

Pre-bronchodilator spirometry dataset included 4680 participants (mean age 55.3 [10.8] years, 2194 [46.9%] males). Participants with pre-bronchodilator SAD had a significantly faster annual decline of FEV1 % of predicted value (0.31 ± 0.05 vs. 0.20 ± 0.03 %/year; difference: 0.12 [95% confidence interval: 0.01-0.23]; P = 0.023), FVC, and FVC % of predicted value compared to those without pre-bronchodilator SAD. The annual decline of lung function in participants with pre-bronchodilator non-obstructive SAD was not significantly different from that in pre-bronchodilator healthy controls, but they were more likely to progress to spirometry-defined COPD (adjusted hazard ratio: 2.92 [95% confidence interval: 2.28-3.76], P < 0.001). Post-bronchodilator spirometry dataset yielded similar results.

CONCLUSIONS

Individuals with spirometry-defined SAD have a faster decline in lung function compared to those without SAD, and non-obstructive SAD is more likely to progress to spirometry-defined COPD.

TRIAL REGISTRATION

Chinese Clinical Trials Registration ChiCTR1900024643. Registered on 19 July 2019.

Impaired Ventilatory Efficiency Identifies High-Risk Mild-to-Moderate Chronic Obstructive Pulmonary Disease

OBJECTIVES

Identifying high-risk patients is fundamental to slowing disease progression in mild-to-moderate COPD. Over one-fifth of these patients have impaired ventilatory efficiency, strongly associated with advanced disease severity, while its unclear prognostic value for high-risk case identification persists.

METHODS

This was a prospective cohort study conducted from July 2019 to September 2024 (encompassing the COVID-19 pandemic period) in China. Non-COPD subjects and mild-to-moderate COPD patients who completed questionnaires, lung function tests and cardiopulmonary exercise tests at baseline were annually followed up over 3 years. Subjects with predefined high-risk criteria, including CAT score≥10, mMRC score≥2, postbronchodilator FEV1<60% predicted, and frequent exacerbations, were further excluded. Impaired ventilatory efficiency was defined as a nadir minute ventilation/CO2 output≥the upper limit of normal. Outcomes included annual lung function decline, exacerbation risks, and symptom scores.

RESULTS

A total of 780 subjects were included, with 684 (88%) completing follow-up. Patients with impaired ventilatory efficiency displayed a greater annual decline in postbronchodilator FEV1 (54 [95% CI: 32-76]mL/year) than patients with normal ventilatory efficiency (31 [15-47] mL/year, adjusted P=0.008) and non-COPD subjects (31 [22-40]mL/year, adjusted P=0.001). However, no significant difference existed between patients with normal ventilatory efficiency and non-COPD subjects (adjusted P=0.756). Similar results were observed for exacerbation risks and symptom scores.

CONCLUSIONS

Impaired ventilatory efficiency can identify high-risk mild-to-moderate COPD patients with poor prognosis independently of established risk factors. Further studies are needed to explore effective interventions for patients with impaired ventilatory efficiency.

Primary regional disparities in clinical characteristics, treatments, and outcomes of a typically designed study of valvular heart disease at 46 tertiary hospitals in China: Insights from the China-VHD Study

BACKGROUND

Valvular heart disease (VHD) has become increasingly common with the aging in China. This study aimed to evaluate regional differences in the clinical features, management strategies, and outcomes of patients with VHD across different regions in China.

METHODS

Data were collected from the China-VHD Study. From April 2018 to June 2018, 12,347 patients who presented with moderate or severe native VHD with a median of 2 years of follow-up from 46 centers at certified tertiary hospitals across 31 provinces, autonomous regions, and municipalities in Chinese mainland were included in this study. According to the locations of the research centers, patients were divided into five regional groups: eastern, southern, western, northern, and central China. The clinical features of VHD patients were compared among the five geographical regions. The primary outcome was all-cause mortality or rehospitalization for heart failure. Kaplan-Meier survival analysis was used to compare the cumulative incidence rate.

RESULTS

Among the enrolled patients (mean age, 61.96 years; 6877 [55.70%] male), multiple VHD was the most frequent type (4042, 32.74%), which was mainly found in eastern China, followed by isolated mitral regurgitation (3044, 24.65%), which was mainly found in northern China. The etiology of VHD varied significantly across different regions of China. The overall rate of valve interventions was 32.67% (4008/12,268), with the highest rate in southern China at 48.46% (205/423). In terms of procedure, the proportion of transcatheter valve intervention was relatively low compared to that of surgical treatment. Patients with VHD in western China had the highest incidence of all-cause mortality or rehospitalization for heart failure. Valve intervention significantly improved the outcome of patients with VHD in all five regions (all P  <0.05).

CONCLUSIONS

This study revealed that patients with VHD in China are characterized by significant geographic disparities in clinical features, treatment, and clinical outcomes. Targeted efforts are needed to improve the management and prognosis of patients with VHD in China according to differences in geographical characteristics.

REGISTRATION

ClinicalTrials.gov , NCT03484806.

Clinical efficacy of Bufei Yishen and Qutan Tongluo Cream on the treatment of patients with stable chronic obstructive pulmonary disease

Background

Traditional Chinese medicine has been used for the treatment of chronic obstructive pulmonary disease (COPD). However, the effect of Bufei Yishen and Qutan Tongluo Cream (BYQTC) on the amelioration clinical symptoms of COPD remains unclear.

Methods

The enrolled COPD patients were randomly divided into control and observation groups. The efficacy of BYQTC was assessed by the reduction rate of syndrome scores. The improvement effect of BYQTC in COPD patients was evaluated using forced expiratory volume in 1 s, 6-minute walk test, modified British Medical Research Council and COPD Assessment Test. The level of serum interleukin 8 (IL-8) and matrix metalloproteinase 9 (MMP-9) was evaluated by enzyme-linked immunosorbent assay.

Results

The observation group had a higher clinical control and effectual rate than the control group. After treatment, the improvement of pulmonary function and movement endurance in the observation group was stronger than that in the control group. Meanwhile, the clinical symptoms of COPD were alleviated more in the observation group. Additionally, the decrease in serum IL-8 and MMP-9 levels in the observation group was higher than that in the control group. Finally, the acute exacerbation and rehospitalization of the COPD patient in the observation group was less than that in the control group.

Conclusion

BYQTC significantly enhances the efficacy of conventional therapy in stable COPD patients, resulting in improvements in clinical symptoms, lung function, and overall quality of life. Notable enhancements were observed in FEV1%, 6MWT distance, and reductions in mMRC and CAT scores. Additionally, BYQTC treatment led to substantial decreases in IL-8 and MMP-9 levels, and reduced the incidence of acute exacerbations and rehospitalizations, demonstrating its superior therapeutic benefit compared to standard treatment.

Pulmonary fibrosis complicated by lung cancer: bibliometric analysis from 2004 to 2024 - research status, trends and future directions

Objective

Although research on the association between pulmonary fibrosis and lung cancer is of great significance, to date, no bibliometric analysis has been conducted on the comorbidity of these two diseases. This study aims to explore the current status and cutting - edge trends in this field through bibliometric analysis, and to establish new directions for future research.

Methods

Using the Web of Science Core Collection database, statistical calculations, graphic, and data visualization tools such as CiteSpace, VOSviewer, and Biblimatrix - biblioshiny were adopted.

Results

A total of 2,234 original Articles and Reviews on pulmonary fibrosis complicated by lung cancer published between 2004 and 2024 were identified. A slow growth trend in publications related to pulmonary fibrosis complicated by lung cancer was observed. The United States, Japan, and China were the countries with the greatest contributions. Professor Michael Kreuter from Marienhaus Clinic, Mainz, Germany, and the University of Michigan published the most articles. Through cluster analysis of co - cited literature, five main clusters were identified. Keyword analysis predicted that "nintedanib", "pirfenidone", "immunotherapy", etc. might become hot topics in the field of the comorbidity of pulmonary fibrosis and lung cancer.

Conclusion

This bibliometric analysis shows that the literature related to the comorbidity of pulmonary fibrosis and lung cancer is on a continuous upward trend. The research hotspots and trends identified in this study provide a reference for in - depth research in this field, aiming to promote the development of research on the comorbidity of pulmonary fibrosis and lung cancer.

AutoCOPD-A novel and practical machine learning model for COPD detection using whole-lung inspiratory quantitative CT measurements: a retrospective, multicenter study

Background

The rate of diagnosis for chronic obstructive pulmonary disease (COPD) is low worldwide. Quantitative computed tomography (QCT) parameters add value to quantify alterations in airway and lung parenchyma for COPD. This study aimed to assess the performance of QCT features in COPD detection using a whole-lung inspiratory CT model.

Methods

This multicenter retrospective study was performed on 4106 participants. The derivation cohort containing 1950 participants who enrolled in Guangzhou communities from August 2017 to December 2019, was separated for training and internal validation cohorts, and three external validation cohorts containing 1703 participants were recruited from the public hospitals (Cohort 1: the First Affiliated Hospital of Guangzhou Medical University; Cohort 2: Xiangyang central hospital; Cohort 3: the Second Affiliated Hospital of Xi'an Jiaotong University) in China between April 2017 and May 2024. Questionnaire information, CT reports, and QCT features derived from inspiratory CT were extracted for model development. A novel multimodal framework using eXtreme gradient boosting and hybrid feature selection was established for COPD detection. National Lung Screening Trial (NLST) cohort (n = 453) was applied to validate the multiracial extrapolation and robustness on low-dose CT scans.

Findings

The QCT model (referred to as AutoCOPD) with ten features achieved the highest AUC of 0·860 (95% CI: 0·823-0·898) in the internal validation cohort, and showed excellent discrimination when externally validated [Cohort 1: AUC = 0·915 (95% CI: 0·898-0·931); Cohort 2: AUC = 0·903 (95% CI: 0·864-0·943); Cohort 3: AUC = 0·914 (95% CI: 0·882-0·947); NLST: AUC = 0·881 (95% CI: 0·846-0·915)]. Decision curve analysis demonstrated that AutoCOPD was valuable across a range of COPD risk thresholds between 0·12 and 0·66 compared with intervention in all patients with COPD or no intervention.

Interpretation

Heterogeneous COPD can be well identified using AutoCOPD (https://lwj-lab.shinyapps.io/autocopd/) constructed by a subset of only ten QCT features. It may be generalizable across clinical settings and serve as a feasible tool for early detecting patients with mild or asymptomatic COPD to reduce delayed diagnosis in routine practice.

Funding

The National Natural Science Foundation of China, Guangzhou Laboratory, Natural Science Foundation of Guangdong Province, Guangzhou Municipal Science and Technology grant, State Key Laboratory of Respiratory Disease.

Genome wide interaction study of genetic variants associated with lung function decline

Some genetic variants are associated with lung function decline and chronic obstructive pulmonary disease (COPD), but functional studies are necessary to confirm causality. We investigated the genetic susceptibility-associated lung function decline with or without COPD, using data from a community-based cohort (N = 8554). A genome-wide interaction study was conducted to identify the association between genetic variants and pulmonary function, and the way variants relate to lung impairment in accordance with smoking status and amount was examined. We further used a linear mixed model to examine the association and interaction to time effect. We found annual mean FEV1 declines of 41.7 mL for men and 33.4 mL for women, and the annual rate of decline in FEV1 was the fastest for current smokers. We also found a previously identified locus near FAM13A, the most significant SNPs from the results of two likelihood ratio tests for FEV1/FVC (P = 1.56 × 10-10). These selected SNPs were located in the upstream region of FAM13A on chromosome 4 and had similar minor allele frequencies (MAFs). Furthermore, we found that certain SNPs tended to have lower FEV1/FVC values, and lung function decreased much faster with time interactions. The SNP most associated with lung function decline was the rs75679995 SNP on chromosome 7, and those SNPs located within the TAD of the DNAH11 region and the eQTL of rs9991425 revealed a higher expression of MFAP3L and AADAT genes (P = 2.28 × 10-7 and 2.01 × 10-6, respectively). This is the first study to investigate gene-time interactions in lung function decline as a risk factor for COPD in the Korean population. In addition to replicating previously known signals for FAM13A, we identified two genomic regions (DNAH11, AADAT) that are potentially involved in gene-environment interactions, warranting further investigation to confirm their roles.

Current status of pharmacists in community pharmacies in China in the health management of chronic respiratory diseases

BACKGROUND

Effective management of chronic respiratory diseases (CRDs) is critical, and community pharmacists play a key role. This study evaluates pharmacists' knowledge, attitude, technology use and patient education in CRDs management across various regions in China.

METHODS

This cross-sectional study conducted a survey of pharmacists across nine provinces and two municipalities in China from January to September 2024, using a stratified convenience sampling method based on regional GDP. A total of 733 questionnaires were distributed through online platforms and pharmacy networks, yielding 699 valid responses, resulting in a response rate of 95.4%.

RESULTS

61.5% of pharmacists correctly answering 5 or fewer questions on knowledge-related topics. Additionally, 68.1% of the pharmacists demonstrated an accuracy rate of less than 50% in COPD-related questions, and 58.7% had an accuracy rate below 50% in asthma-related questions. Pharmacists in developed regions showed higher scores in knowledge, attitude, and patient education compared to those in underdeveloped areas (P < 0.05). Higher education and professional certifications were associated with better scores (P < 0.05). Frequent CRDs patient management and positive attitudes enhanced technology use, while longer working hours were linked to lower technology use and patient education scores (P < 0.05). Higher knowledge and attitude scores were significantly associated with better patient education (P < 0.05).

CONCLUSION

Community pharmacists display significant knowledge gaps in managing CRDs, particularly COPD and asthma. Developed regions, higher education, certification, and frequent CRDs management correlate with better scores. These findings highlight the need for ongoing education and improved working conditions to strengthen pharmacists' roles in CRDs management, aligning with the Healthy China initiative.

Impact of intensive health education on influenza vaccination and acute exacerbations in outpatients with chronic obstructive pulmonary disease: a real-world study

Background

The influenza vaccination rate of chronic obstructive pulmonary disease (COPD) patients in China was very low. In this study, we aimed to evaluate the effect of clinician-led intensive health education on influenza vaccination in outpatients with COPD and the effect of influenza vaccination on the risk of acute exacerbations in the real world.

Methods

Participants were from the Real World Research of Diagnosis and Treatment of COPD study, a real-world prospective cohort study. COPD patients were included from December 2016 to April 2023 and followed up for one year. In January 2022, clinicians began strengthening health education for outpatients with COPD. We identified patients visiting the clinic from January 2022 to April 2023 as the intensive health education group and those visiting from December 2016 to December 2021 as the control group. We analysed factors associated with influenza vaccination and the effect of influenza vaccine on acute exacerbations by multivariate analysis.

Results

7834 patients were included. Compared with the control group, the intensive health education group had a higher rate of influenza vaccination (1.6% vs. 12.2%, P < 0.01). Smoking cessation, high school education or above, influenza vaccination in the past year and intensive health education were independently associated with influenza vaccination. Influenza vaccination reduced the incidence of future acute exacerbations (adjusted odds ratio (aOR) = 0.48; 95% confidence interval (CI) = 0.33-0.68, P < 0.01), frequent acute exacerbations (aOR = 0.47; 95% CI = 0.27-0.82, P = 0.01), and severe acute exacerbation (aOR = 0.38; 95% CI = 0.23-0.63, P < 0.01) in COPD patients.

Conclusions

Influenza vaccination reduced the risk of future acute exacerbations in patients with COPD. Clinician-led intensive health education can improve the influenza vaccination of outpatients with COPD, and clinicians and policymakers should pay attention to and apply this method.

Associations between lifestyle habits, environmental factors and respiratory diseases: a cross-sectional study from southwest China

Background

Numerous studies have demonstrated that lifestyle habits and environmental factors influence the incidence and progression of respiratory diseases. However, there is a paucity of similar research conducted in southwest China.

Objective

This study aims to investigate the prevalence and primary influencing factors of respiratory diseases among residents in a specific region of southwest China, and to identify vulnerable populations.

Method

From February 2024 to May 2024, a multi-stage stratified random sampling method was employed in a specific region of southwest China. Three monitoring points were randomly selected from six jurisdictions within this region, resulting in the collection of relevant information from a total of 4,507 residents through offline interviews. Lasso-logistic regression was conducted using R version 4.3.0 to develop a nomogram for estimating disease probabilities. Interaction analysis was performed with gender and age group serving as grouping variables, while other dimensional factors were utilized as analysis variables.

Result

A total of 4,507 respondents participated in this study, of whom 956 (21.21%) were identified as sick. The older adult group (>65 years) exhibited the highest prevalence (30.3%). Results from the Lasso-logistic model indicated that current smoking, alcohol abuse, passive smoking, coupled with poor indoor and outdoor environments were significant risk factors. Additionally, a history of respiratory disease, a family history of respiratory issues, negative emotions, and high stress levels may also contribute to the risk of the disease. Protective factors identified include regular exercise, adequate indoor lighting, frequent ventilation, and regular disinfection practices. The nomogram developed in this study demonstrated good discrimination, calibration, and clinical efficacy. Multiplicative interaction analysis indicated that gender and age group exhibited varying degrees of interaction with factors such as smoking, passive smoking, alcohol abuse, regular exercise, household smoke, house disinfection, dust mites, history of respiratory allergies, use of velvet products, and family history of respiratory conditions. Notably, females, adolescents, and the older adult were identified as particularly susceptible and at-risk groups for these interactions.

Conclusion

The prevalence of respiratory diseases is notably higher among the permanent population in southwest China. High-risk lifestyles, coupled with poor indoor and outdoor environments, pose particularly significant threats to women, adolescents, and the older adult. Consequently, improving living habits, renovating aging communities, enhancing the quality of the living environment, and prioritizing vulnerable populations remain central to the objectives of primary health services.

Impulse oscillometry-derived equation for prediction of abnormal FEV1/FVC ratio for COPD screening in Chinese population: a multicenter cross-sectional study

Background

The diagnosis of chronic obstructive pulmonary disease (COPD) is based on spirometry that requires a forced expiratory manoeuvre, which is laborious and difficult for mass screening. Impulse oscillometry (IOS) is easier than spirometry and performed with tidal breathing. We sought to develop an equation for predicting forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and screening COPD using IOS parameters.

Methods

Data from patients who simultaneously underwent spirometry and IOS were obtained from databases at five tertiary hospitals in China. Multivariable linear regression analysis was used to develop a predictive model for pre-bronchodilator (BD) FEV1/FVC. Model performance was analyzed against spirometric criteria of airflow obstruction (AO, defined as pre-BD FEV1/FVC < 0.7) and COPD (post-BD FEV1/FVC < 0.7).

Findings

Using 15,113 patients and externally validated with 9586 patients, the model estimated FEV1/FVC ratio could identified AO and spirometry-defined COPD in internal (AUC = 0.822 and 0.849, respectively) and external (AUC = 0.790 and 0.828, respectively) validation. A clinical algorithm was constructed to classify patients into three different groups: estimated FEV1/FVC < 0.7: likely COPD; estimated FEV1/FVC ≥ 0.7 and ≤0.73: suspicious for COPD; estimated FEV1/FVC > 0.73: unlikely COPD. The sensitivity and specificity for detecting spirometry-defined COPD were 88.0% and 77.0%, respectively, while the negative predictive value ranged from 93.7% to 98.6% and positive predictive value ranged from 26.5% to 62.1% across different COPD prevalence groups in the Chinese population.

Interpretation

This equation could be useful to screen for COPD particularly in community and primary care settings.

Funding

The Financial Budgeting Project of Beijing Institute of Respiratory Medicine.

Comparing spirometry, impulse oscillometry with computed tomography for assessing small airway dysfunction in subjects with and without chronic obstructive pulmonary disease

BACKGROUND

Studies on consistency among spirometry, impulse oscillometry (IOS), and histology for detecting small airway dysfunction (SAD) remain scarce. Considering invasiveness of lung histopathology, we aimed to compare spirometry and IOS with chest computed tomography (CT) for SAD detection, and evaluate clinical characteristics of subjects with SAD assessed by these three techniques.

METHODS

We collected baseline data from the Early COPD (ECOPD) study. CT-defined SAD was defined as parametric response mapping quantifying SAD (PRMfSAD) ≥ 15%. Spirometry-defined SAD was defined as at least two of maximal mid-expiratory flow (MMEF), forced expiratory flow 50% (FEF50), and forced expiratory flow 75% (FEF75) less than 65% of predicted. IOS-defined SAD was defined as peripheral airway resistance R5 - R20 > 0.07 kPa/L/s. The consistency of spirometry, IOS and CT for diagnosing SAD was assessed using Kappa coefficient. Correlations among the three techniques-measured small airway function parameters were assessed by Spearman correlation analysis.

RESULTS

2055 subjects were included in the final analysis. There was low agreement in SAD assessment between spirometry and CT (Kappa = 0.126, 95% confidence interval [CI]: 0.106 to 0.146, p < 0.001), between IOS and CT (Kappa = 0.266, 95% CI: 0.219 to 0.313, p < 0.001), as well as among spirometry, IOS, and CT (Kappa = 0.056, 95% CI: 0.029 to 0.082, p < 0.001). The correlation was moderate (|r|: 0.5 to 0.7, p < 0.05) between spirometry and CT-measured small airway function parameters, and weak (|r|< 0.4, p < 0.05) between IOS and CT-measured small airway function parameters. Only spirometry-defined SAD group had more lower lung function (FEV1/FVC: adjusted difference=-10.7%, 95% CI: -13.5% to -7.8%, p < 0.001) and increased airway wall thickness (Pi 10: adjusted difference = 0.3 mm, 95% CI: 0 to 0.6 mm, p = 0.046) than only CT-defined SAD group. Only IOS-defined SAD group had better lung function (FEV1/FVC: adjusted difference = 3.9%, 95% CI: 1.9 to 5.8%, p < 0.001), less emphysema (inspiratory LAA- 950: adjusted difference=-2.1%, 95% CI:-3.1% to -1.1%, P < 0.001; PRMEmph: adjusted difference=-2.3%, 95% CI: -3.2% to -1.4%, p < 0.001), and thicker airway wall (Pi 10: adjusted difference = 0.2 mm, 95% CI: 0.1 mm to 0.4 mm, p = 0.005) than only CT-defined SAD group.

CONCLUSIONS

There was low consistency in the assessment of SAD between spirometry and CT, between IOS and CT, as well as among spirometry, IOS, and CT.

CLINICAL TRIAL NUMBER

Not applicable.

Association between impaired diffusion capacity and small airway dysfunction: a cross-sectional study

Background

Small airway dysfunction (SAD) and impaired diffusion capacity of the lungs for carbon monoxide (D LCO) are positively associated with a worse prognosis. Individuals with both dysfunctions have been identified in clinical practice and it is unknown whether they have worse health status or need management. We conducted this study to explore the association between SAD and impaired D LCO, and the difference between the groups with two dysfunctions, with either one dysfunction and with no dysfunction.

Methods

This study involved subjects partly from those who had returned for the third-year follow-up (up to December 2022) of the Early Chronic Obstructive Pulmonary Disease study and those who newly participated. We assessed diffusion capacity, questionnaire, exacerbations, spirometry, impulse oscillometry (IOS) and computed tomography (CT). Impaired D LCO was defined as D LCO <80% predicted. Spirometry-defined SAD was defined using the percent predicted values of maximal mid-expiratory flow, and forced expiratory flow at 50% and 75% of forced vital capacity, at least two of these three values being <65% predicted after the use of a bronchodilator. IOS-defined SAD was defined when the difference in resistance at 5 and 20 Hz was >0.07 kPa·L-1·s. CT-defined SAD was defined when the percentage of expiratory low-attenuation areas <-856 HU comprised ≥15% of the total lung volume. Covariate analyses and logistic regression were performed to assess the association between impaired D LCO and SAD.

Results

This study involved 581 subjects. The occurrence of both spirometry- and CT-defined SAD was significantly higher in subjects with impaired D LCO than normal D LCO. Subjects with two dysfunctions were associated with worse preceding year's exacerbations than controls.

Conclusions

Impaired diffusion capacity is positively associated with SAD. Subjects with impaired diffusion capacity and SAD may have a worse health status and need additional management.

Intelligent wearable devices with audio collection capabilities to assess chronic obstructive pulmonary disease severity

Background

Intelligent wearable devices have potential for chronic obstructive pulmonary disease (COPD) monitoring, but the effectiveness of combining cough and blowing sounds for disease assessment is unclear.

Objective

The objective was to assess COPD severity via physiological parameters and audio data collected by a smartwatch.

Methods

COPD patients underwent lung function tests, electrocardiograms, blood gas analysis, and 6-min walk tests. The patients' peripheral arterial oxygen saturation (SpO2), heart rate variability (HRV), heart rate (HR), and respiratory rate (RR) were continuously monitored via a smartwatch for 7-14 days, and voluntary cough and forceful blowing sounds were recorded twice daily. The HR, SpO2, and RR were categorized into all-day, sleep, and wake periods and summarized using the mean, standard deviation, median, 25th percentile, 75th percentile and percent variation. The correlations among lung function, physiological parameters, and audio data were analyzed to develop a model for predicting COPD severity.

Results

Twenty-nine stable patients, with a mean age of 67.0 ± 5.8 years, were enrolled, and 89.7% were male. HR, HRV, RR, cough sounds, and blowing sounds were significantly correlated with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade, with cough sounds showing the highest correlation (r = 0.7617, p < .001). Cough sounds also had the strongest correlation with the mean 6-minute walking distance (r = 0.6847, p < .001), whereas blowing sounds had the strongest correlation with the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity index (r = -0.6749, p < .001). A logistic regression model using the RR and blowing sounds as key predictors achieved accuracies of 0.77-0.89 in determining the GOLD grade, with a Cohen's kappa coefficient of 0.6757.

Conclusions

Audio data were more strongly correlated with lung function in COPD patients than were physiological parameters. A smartwatch with audio collection capabilities effectively assessed COPD severity.

Trial Registration

ClinicalTrials.gov NCT05551169.

Association between body mass index and chronic obstructive pulmonary disease in young individuals: a nationwide population‑based cohort study

Body mass index (BMI) is associated with chronic obstructive pulmonary disease (COPD) risk. We investigated the association between BMI and the risk of COPD among young individuals. Using the Korean National Health Information Database, we screened individuals aged 20-39 years who participated in the national health examination between 2009 and 2012. We identified 6,304,769 eligible individuals, and 13,784 had newly developed COPD. BMI was categorized according to the Asian BMI criteria. We performed multivariate Cox proportional hazards models to estimate the adjusted hazard ratio (aHR) of risk factors for COPD development. Their mean age was 30.8 ± 5.0 years, and 3,732,656 (59.2%) were men. The incidence rate for developing COPD was 0.22/1,000 person-years. Compared to individuals with normal BMI (18.5-22.9 kg/m2), those who were underweight (< 18.5 kg/m2) had higher risks of COPD development (aHR: 1.37, 95% confidence interval [CI]: 1.29-1.46). Meanwhile, overweight or obese individuals (23-24.9 or 25-29.9 kg/m2) had lower risks for COPD development (aHR 0.90, 95% CI 0.86-0.95, and aHR 0.90, 95% CI 0.85-0.94, respectively). Although males showed tendencies similar to those of the total population, the risk was increased with increasing BMI among females. In the subgroup analysis, the risk reduction was not observed among non-smokers as BMI increased. In young individuals, being underweight was associated with an increased risk for COPD development, whereas being overweight and obese were associated with a decreased risk for COPD.

Investigation of Smoking Cessation Status and Its Influencing Factors in Patients with Chronic Obstructive Pulmonary Disease

Purpose

Chronic obstructive pulmonary disease (COPD) is a common disease with high prevalence, high mortality and high costs across the globe. Small airways are major sites contributing to airway resistance and the small airway disorder (SAD) is frequently implicated in early-stage COPD. Smoking is recognized as the leading cause of COPD and SAD. This study aimed to investigate the status quo and influencing factors of smoking cessation in patients with SAD or COPD, which is crucial for improving prevention and treatment of chronic airway diseases.

Patients and Methods

In this multicenter, prospective cohort investigation, questionnaire survey and one-year follow-up study were conducted in SAD and COPD patients with smoking history. The rate of quitting intention, quitting attempt and recent smoking cessation of SAD or different stages of COPD and their influencing factors were recorded, compared and analyzed.

Results

A total of 386 valid questionnaires were collected. The rate of quitting intention was 91.7% (95% CI: 88.53-94.07%), and quitting attempt was 73.6% (95% CI: 68.96-77.73%). Regular bronchodilator use, alcohol abstinence, and the lower Fagerstrom Test for Nicotine Dependence (FTND) scores were associated with a higher intention to quit smoking. Further, inpatients with higher mMRC scores, non-smoking parents, engagement in pulmonary rehabilitation exercises, and receipt of medical advice to quit were more likely to attempt quitting smoking. In the one-year follow-up survey, the overall recent smoking cessation rate was 23.9%. The multivariate logistic regression analysis revealed that higher mMRC grade, carrying out pulmonary rehabilitation exercise and the quitting intention were positive factors for quitting smoking, while outpatients with lower educational level, higher FTND score and Tobacco Craving Questionnaire-Short Form (TCQ-SF) scores were negative influencing factors for recent smoking cessation.

Conclusion

Patients with SAD and COPD generally had a high willingness to quit smoking, but a significant reduction in the success rate of smoking cessation. Factors influencing smoking cessation included the severity of the illness, nicotine dependence, patient self-control, lifestyle and environment.

Trends in the prevalence and incidence of chronic obstructive pulmonary disease among adults aged ≥50 years in the United States, 2000-2020

Background

Understanding the trends of the prevalence and incidence rate of chronic obstructive pulmonary disease (COPD) is vital for improving the control and prevention of COPD. We aimed to examine the trends in the prevalence and incidence rate of COPD among adults aged 50 years or older in the United States during 2000-2020.

Methods

Utilizing data from the Health and Retirement Study, we analyzed COPD prevalence across survey waves and calculated COPD incidence rates between consecutive interview waves, stratified by gender and race. We employed joinpoint regression models to investigate trends in COPD prevalence and incidence.

Results

The individuals reporting COPD are more likely to be women and Caucasians. The age-adjusted prevalence of COPD among adults aged 50 years and over showed an increasing trend throughout the study period, spanning from 9.02% in 2000 to 9.88% in 2020 (average biennial percent change [ABPC] = 0.41, 95% confidence interval [CI]: 0.10, 0.71; p = 0.01). The age-adjusted incidence rate of COPD among adults aged 50 and over showed a decreasing trend throughout the study period 1031.1 per 100,000 person-years in 2000 to 700.5 per 100,000 person-years in 2020 (ABPC = -1.63, 95% CI: -2.88, -0.36; p = 0.02).

Conclusion

Our findings indicate a rising prevalence of COPD among older adults in the United States since 2000, while the incidence rate of COPD has shown a declining trend.

Prevalence of non-smoking chronic obstructive pulmonary disease and its risk factors in China: a systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disorder in China, impacting a significant proportion of individuals aged > 40 years. In China, the prevalence of and risk factors for COPD among non-smokers remain largely unexplored. In this study, we aimed to determine the prevalence of COPD in non-smokers within the Chinese population and identify potential risk factors associated with COPD in non-smokers.

METHODS

Web of Science, PubMed, Embase, Chinese WanFang, Chinese China National Knowledge Infrastructure, and Weipu databases from inception to August 5, 2024, were searched. Studies reporting the percentage of never-smokers among those diagnosed with COPD and investigations exploring the risk factors associated with COPD in never-smokers in China were examined. Summary proportions and odds ratios (OR), along with their corresponding 95% confidence intervals (95% CI), were measured.

RESULTS

In total, 112 investigations with 491,812 participants were included. The percentage of never-smokers in people with COPD was 41.1% (95% CI: 37.5-44.6%). The prevalence of never-smokers among males diagnosed with COPD was 22.3% (95% CI: 18.8-25.7%), which differed from that among women (81.3%, 95% CI: 75.3-87.2%). The results showed an association between the utilization of biomass fuel and the occurrence of COPD in never-smokers (OR: 1.25, 95% CI: 1.06-1.44). Among never-smokers, the data showed a close association between being underweight (OR: 1.89, 95% CI: 1.78-2.00), tuberculosis history (OR: 1.71, 95% CI: 1.53-1.88) and COPD. Never-smokers living in rural areas or those with low educational status were more susceptible to COPD.

CONCLUSION

This review confirmed the highly different proportions of never-smokers among male and female patients with COPD.

TRIAL REGISTRATION

PROSPERO: CRD42023420786.

Prevalence and Risk Factors for Chronic Obstructive Pulmonary Disease Among Adults Aged 50 and Above - 10 CKB Study Areas, China, 2020-2021

What is already known about this topic?

The prevalence of COPD in Chinese individuals aged 50 years and above was obviously higher than that in younger adults, but the risk factors for this age group were unclear.

What is added by this report?

The prevalence was estimated at 12.8% and 5.7% for males and females over 50 in 2020-2021, with confirmed risk factors of cigarette smoking, a family history of respiratory diseases, respiratory symptoms, and a history of cough or respiratory diseases during childhood.

What are the implications for public health practice?

The findings may help clinicians and the public identify individuals at high risk of COPD and take targeted measures in a timely manner.

Effect of high-dose N-acetylcysteine on exacerbations and lung function in patients with mild-to-moderate COPD: a double-blind, parallel group, multicentre randomised clinical trial

Evidence for the treatment of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) is limited. The efficacy of N-acetylcysteine (an antioxidant and mucolytic agent) for patients with mild-to-moderate COPD is uncertain. In this multicentre, randomised, double-blind, placebo-controlled trial, we randomly assigned 968 patients with mild-to-moderate COPD to treatment with N-acetylcysteine (600 mg, twice daily) or matched placebo for two years. Eligible participants were 40-80 years of age and had mild-to-moderate COPD (forced expiratory volume in 1 second [FEV1] to forced vital capacity ratio <0.70 and an FEV1 ≥ 50% predicted value after bronchodilator use). The coprimary outcomes were the annual rate of total exacerbations and the between-group difference in the change from baseline to 24 months in FEV1 before bronchodilator use. COPD exacerbation was defined as the appearance or worsening of at least two major symptoms (cough, expectoration, purulent sputum, wheezing, or dyspnoea) persisting for at least 48 hours. Assessment of exacerbations was conducted every three months, and lung function was performed annually after enrolment. The difference between the N-acetylcysteine group and the placebo group in the annual rate of total exacerbation were not significant (0.65 vs. 0.72 per patient-year; relative risk [RR], 0.90; 95% confidence interval [CI], 0.80-1.02; P = 0.10). There was no significant difference in FEV1 before bronchodilator use at 24 months. Long-term treatment with high-dose N-acetylcysteine neither significantly reduced the annual rate of total exacerbations nor improved lung function in patients with mild-to-moderate COPD. Chinese Clinical Trial Registration: ChiCTR-IIR-17012604.

Using machine learning for early detection of chronic obstructive pulmonary disease: a narrative review

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease and ranks third in global mortality rates, imposing a significant burden on patients and society. This review looks at recent research, both domestically and abroad, on the application of machine learning (ML) for early COPD screening. The review discusses the practical application, key optimization points, and prospects of ML techniques in early COPD screening. The aim is to establish a scientific foundation and reference framework for future research and the development of screening strategies.

The Nonlinear Relationship Between High-Density Lipoprotein and Changes in Pulmonary Structure Function and Pulmonary Function in COPD Patients in China

Background

The previous findings on the correlation between spirometry and high-density lipoprotein (HDL) cholesterol are intriguing yet conflicting. The aim of this research is to evaluate the relationship between HDL levels and spirometry as well as imaging parameters in patients with chronic obstructive pulmonary disease (COPD) in China.

Methods

This study encompasses a total of 907 COPD patients. Participants with complete data from questionnaire interviews, lipid profile examinations, spirometry testing, and computed tomography (CT) scans were included in the analysis. A generalized additive model was employed to identify the non-linear relationship between HDL levels and both spirometry and imaging parameters. In the presence of non-linear correlations, segmented linear regression model was applied to ascertain threshold effects.

Results

After adjusting for various factors, we found a non-linear correlation between HDL levels and spirometry/imaging parameters, with an inflection point at 4.2 (66 mg/dL). When Ln (HDL) was below 4.2, each unit increase correlated significantly with reduced post-bronchodilator FEV1 (0.32L, 95% CI: 0.09-0.55), decreased predicted FEV1% (11.0%, 95% CI: 2.7-19.3), and lowered FEV1/FVC (8.0%, 95% CI: 4.0-12.0), along with notable increases in Ln (LAA-950) by 1.20 (95% CI: 0.60-1.79) and Ln (LAA-856) by 0.77 (95% CI: 0.37-1.17). However, no significant associations were observed when Ln (HDL) was greater than or equal to 4.2.

Conclusion

A non-linear correlation existed between HDL levels with lung function and CT imaging in COPD patients. Prior to reaching 66 mg/dL, an elevation in HDL was significantly associated with impaired lung function, more severe gas trapping and emphysema.

The care cascade of chronic obstructive pulmonary disease in China: a cross-sectional study of individual-level data at enrolment into the national 'Happy Breathing' Programme

Background

Understanding the chronic obstructive pulmonary disease (COPD) care cascade is crucial for identifying where and when to intervene to improve COPD outcomes. We aimed to determine the proportion of patients with COPD seeking care in China's health system who are lost at each stage of the COPD care cascade and how the patterns of loss vary across geographical regions and population groups.

Methods

From November 3, 2018, to April 22, 2021, we used individual-level patient data from the national Chinese 'Happy Breathing' Programme, which aims to identify patients with COPD and provide appropriate care. COPD was defined as a post-bronchodilator ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) <0.70. We calculated the proportions of individuals who, at enrolment into the 'Happy Breathing' Programme, (i) had ever undergone a pulmonary function test, (ii) had been diagnosed with COPD in the past, (iii) were currently on treatment for COPD, and (iv) had achieved control of their COPD. We examined the association between reaching each stage of the care cascade and individual patient characteristics as well as regional-level economic development and available resources in the health system using multilevel regression.

Findings

Among the 29,201 patients with COPD in the 'Happy Breathing' Programme, 41.0% (95% confidence interval [CI]: 40.4-41.6%) had ever been tested for COPD, 17.6% (95% CI: 17.1-18.0%) had previously been diagnosed with COPD, 8.5% (95% CI: 8.2-8.8%) were currently on treatment for COPD, 4.6% (95% CI: 4.3-4.8%) of patients had mild or no exacerbations in the prior year, and 3.9% (95% CI: 3.7-4.2%) of patients had suffered no exacerbations in the prior year. On average, patients living in the cities of Beijing, Wuhan, and Yinchuan had progressed further along the COPD care cascade than patients living in Daqing and Luoyang. Using multilevel regression, we found that young age, rural residence, and low regional per-capita GDP were significantly associated with larger losses at each stage of the COPD care cascade.

Interpretation

Substantial proportions of patients with COPD are lost at each stage of the COPD care cascade in the Chinese health system. The largest losses occur during the initial stages of the cascade, when diagnosis first occurs. New policies and interventions are required to boost COPD care, especially screening and diagnosis, in the Chinese health system to reduce this large disease burden.

Funding

This work was supported by Major Programme of National Natural Science Foundation of China (82090011), CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-049), and Horizon Europe (HORIZON-MSCA-2021-SE-01; project number 101086139-PoPMeD-SuSDeV). TB was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt professorship award.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The status and influencing factors of COVID-19 vaccination in patients with COPD

In this study, we investigated the status and influencing factors of coronavirus disease 2019 (COVID-19) vaccination in patients with chronic obstructive pulmonary disease (COPD). A questionnaire on COVID-19 vaccination in patients with COPD was developed. The clinical characteristics, COVID-19 vaccination status, other relevant vaccinations, and vaccination status of the patients with COPD were collected anonymously. Logistic regression analysis was used to analyze the factors influencing COVID-19 vaccination in patients with COPD. There were 1898 returned questionnaires, of which 1874 were valid. The proportion of patients who completed the COVID-19 vaccination program was 78.60%. Factors influencing the COVID-19 vaccination rate were: the age of individuals who were 75-85 years old and > 85 years old, acute exacerbation 3-4 times in the previous year, comorbid cardiovascular and endocrine system diseases, failure to take regular medication for COPD, application of non-invasive ventilation machines, believing that their current health condition has deteriorated, believing that the current COVID-19 vaccine is not safe, medical staff not specifying whether they would recommend vaccination against COVID-19, medical staff not recommending the COVID-19 vaccine, and fear of adverse reactions and aggravation of COPD. Patients with COPD had a high COVID-19 vaccination rate in China, whereas patients with pneumonia, influenza, and herpes zoster had a low vaccination rate. Improving the patients' understanding of the safety and effectiveness of the vaccine and promoting effective communication between medical staff and patients would help increase the vaccination rate of patients with COPD.

Clinical features and associated factors of impaired ventilatory efficiency: findings from the ECOPD study in China

BACKGROUND

Impaired ventilatory efficiency during exercise is a predictor of mortality in chronic obstructive pulmonary disease. However, little is known about the clinical features and associated factors of impaired ventilatory efficiency in China.

METHODS

We conducted a cross-sectional community-based study in China and collected demographic and clinical information, cardiopulmonary exercise testing, spirometry, and CT data. Impaired ventilatory efficiency was defined by a nadir ventilatory equivalent for CO2 production above the upper limit of normal. Multivariable linear and logistic regression models were used to explore the clinical features and associated factors of impaired ventilatory efficiency.

RESULTS

The final analyses included 941 subjects, 702 (74.6%) of whom had normal ventilatory efficiency and 239 (25.4%) had impaired ventilatory efficiency. Participants with impaired ventilatory efficiency had more chronic respiratory symptoms, poorer lung function and exercise capacity, and more severe emphysema (natural logarithm transformation of the low-attenuation area of the lung with attenuation values below -950 Hounsfield units, logLAA-950: 0.19±0.65 vs -0.28±0.63, p<0.001) and air trapping (logLAA-856: 1.03±0.65 vs 0.68±0.70, p<0.001) than those with normal ventilatory efficiency. Older age (60-69 years, OR 3.10 (95% CI 1.33 to 7.21), p=0.009 and 70-80 years, OR 6.48 (95% CI 2.56 to 16.43), p<0.001 vs 40-49 years) and smoking (former, OR 3.19 (95% CI 1.29 to 7.86), p=0.012; current, OR 4.27 (95% CI 1.78 to 10.24), p=0.001 vs never) were identified as high risk factors of impaired ventilatory efficiency.

CONCLUSIONS

Impaired ventilatory efficiency was associated with poorer respiratory characteristics. Longitudinal studies are warranted to explore the progression of individuals with impaired ventilatory efficiency.

Portable spirometer-based pulmonary function test willingness in China: A nationwide cross-sectional study from the "Happy Breathing Program"

BACKGROUND

Understanding willingness to undergo pulmonary function tests (PFTs) and the factors associated with poor uptake of PFTs is crucial for improving early detection and treatment of chronic obstructive pulmonary disease (COPD). This study aimed to understand willingness to undergo PFTs among high-risk populations and identify any barriers that may contribute to low uptake of PFTs.

METHODS

We collected data from participants in the "Happy Breathing Program" in China. Participants who did not follow physicians' recommendations to undergo PFTs were invited to complete a survey regarding their willingness to undergo PFTs and their reasons for not undergoing PFTs. We estimated the proportion of participants who were willing to undergo PFTs and examined the various reasons for participants to not undergo PFTs. We conducted univariable and multivariable logistic regressions to analyze the impact of individual-level factors on willingness to undergo PFTs.

RESULTS

A total of 8475 participants who had completed the survey on willingness to undergo PFTs were included in this study. Out of these participants, 7660 (90.4%) were willing to undergo PFTs. Among those who were willing to undergo PFTs but actually did not, the main reasons for not doing so were geographical inaccessibility ( n  = 3304, 43.1%) and a lack of trust in primary healthcare institutions ( n  = 2809, 36.7%). Among the 815 participants who were unwilling to undergo PFTs, over half ( n  = 447, 54.8%) believed that they did not have health problems and would only consider PFTs when they felt unwell. In the multivariable regression, individuals who were ≤54 years old, residing in rural townships, with a secondary educational level, with medical reimbursement, still working, with occupational exposure to dust, and aware of the abbreviation "COPD" were more willing to undergo PFTs.

CONCLUSIONS

Willingness to undergo PFTs was high among high-risk populations. Policymakers may consider implementing strategies such as providing financial incentives, promoting education, and establishing community-based programs to enhance the utilization of PFTs.

Continuous Monitoring of Heart Rate Variability and Respiration for the Remote Diagnosis of Chronic Obstructive Pulmonary Disease: Prospective Observational Study

BACKGROUND

Conventional daytime monitoring in a single day may be influenced by factors such as motion artifacts and emotions, and continuous monitoring of nighttime heart rate variability (HRV) and respiration to assist in chronic obstructive pulmonary disease (COPD) diagnosis has not been reported yet.

OBJECTIVE

The aim of this study was to explore and compare the effects of continuously monitored HRV, heart rate (HR), and respiration during night sleep on the remote diagnosis of COPD.

METHODS

We recruited patients with different severities of COPD and healthy controls between January 2021 and November 2022. Vital signs such as HRV, HR, and respiration were recorded using noncontact bed sensors from 10 PM to 8 AM of the following day, and the recordings of each patient lasted for at least 30 days. We obtained statistical means of HRV, HR, and respiration over time periods of 7, 14, and 30 days by continuous monitoring. Additionally, the effects that the statistical means of HRV, HR, and respiration had on COPD diagnosis were evaluated at different times of recordings.

RESULTS

In this study, 146 individuals were enrolled: 37 patients with COPD in the case group and 109 participants in the control group. The median number of continuous night-sleep monitoring days per person was 56.5 (IQR 32.0-113.0) days. Using the features regarding the statistical means of HRV, HR, and respiration over 1, 7, 14, and 30 days, binary logistic regression classification of COPD yielded an accuracy, Youden index, and area under the receiver operating characteristic curve of 0.958, 0.904, and 0.989, respectively. The classification performance for COPD diagnosis was directionally proportional to the monitoring duration of vital signs at night. The importance of the features for diagnosis was determined by the statistical means of respiration, HRV, and HR, which followed the order of respiration > HRV > HR. Specifically, the statistical means of the duration of respiration rate faster than 21 times/min (RRF), high frequency band power of 0.15-0.40 Hz (HF), and respiration rate (RR) were identified as the top 3 most significant features for classification, corresponding to cutoff values of 0.1 minute, 1316.3 nU, and 16.3 times/min, respectively.

CONCLUSIONS

Continuous monitoring of nocturnal vital signs has significant potential for the remote diagnosis of COPD. As the duration of night-sleep monitoring increased from 1 to 30 days, the statistical means of HRV, HR, and respiration showed a better reflection of an individual's health condition compared to monitoring the vital signs in a single day or night, and better was the classification performance for COPD diagnosis. Further, the statistical means of RRF, HF, and RR are crucial features for diagnosing COPD, demonstrating the importance of monitoring HRV and respiration during night sleep.

Ct-defined emphysema prevalence in a Chinese and Dutch general population

PURPOSE

We determine and compare the prevalence, subtypes, severity, and risk factors for emphysema assessed by low-dose CT(LDCT) in Chinese and Dutch general populations.

METHODS

This cross-sectional study included LDCT scans of 1143 participants between May and October 2017 from a Chinese Cohort study and 1200 participants with same age range and different smoking status between May and October 2019 from a Dutch population-based study. An experienced radiologist visually assessed the scans for emphysema presence (≥trace), subtype, and severity. Logistic regression analyses, overall and stratified by smoking status, were performed and adjusted for fume exposure, demographic and smoking data.

RESULTS

The Chinese population had a comparable proportion of women to the Dutch population (54.9 % vs 58.9 %), was older (61.7 ± 6.3 vs 59.8 ± 8.1), included more never smokers (66.4 % vs 38.3 %), had a higher emphysema prevalence ([58.8 % vs 39.7 %], adjusted odds ratio, aOR = 2.06, 95 %CI = 1.68-2.53), and more often had centrilobular emphysema (54.8 % vs 32.8 %, p < 0.001), but no differences in emphysema severity. After stratification, only in never smokers an increased odds of emphysema was observed in the Chinese compared to the Dutch (aOR = 2.55, 95 %CI = 1.95-3.35). Never smokers in both populations shared older age (aOR = 1.59, 95 %CI = 1.25-2.02 vs 1.26, 95 %CI = 0.97-1.64) and male sex (aOR = 1.50, 95 %CI = 1.02-2.22 vs 1.93, 95 %CI = 1.26-2.96) as risk factors for emphysema.

CONCLUSIONS

Only never smokers had a higher prevalence of mainly centrilobular emphysema in the Chinese general population compared to the Dutch after adjusting for confounders, indicating that factors other than smoking, age and sex contribute to presence of CT-defined emphysema.

Clinical Characteristics and 2-Year Outcomes of Chronic Obstructive Pulmonary Disease Patients With High Blood Eosinophil Counts: A Population-based Prospective Cohort Study in China

BACKGROUND

High blood eosinophil count (BEC) is a useful biomarker for guiding inhaled corticosteroid therapy in patients with chronic obstructive pulmonary disease (COPD), yet its implications in a community setting remain underexplored. This study aimed to elucidate the clinical characteristics and outcomes of COPD patients with high BEC within the Chinese community.

METHODS

We obtained baseline and 2-year follow-up data from COPD patients (post-bronchodilator forced expiratory volume in 1 second/forced vital capacity <0.70) in the early COPD study. Patients with a BEC ≥300cells/μL were classified as the high BEC group. We assessed differences in the clinical characteristics and outcomes between high and low BEC patients. Subgroup analyses were conducted on COPD patients without a history of corticosteroid use or asthma.

RESULTS

Of the 897 COPD patients, 205 (22.9%) had high BEC. At baseline, high BEC patients exhibited a higher proportion of chronic respiratory symptoms, lower lung function, and more severe small airway dysfunction than low BEC patients. Over the 2-year period, high BEC patients experienced a significantly higher risk of acute exacerbations (relative risk: 1.28, 95% confidence interval: 1.09-1.49; P=0.002), even after adjusting for confounders. No significant difference was observed in lung function decline rates. The subgroup analysis yielded consistent results.

CONCLUSIONS

COPD patients with high BEC in a Chinese community exhibited poorer health status, more severe small airway dysfunction, and a higher risk of exacerbations. Future research should explore the pathological mechanisms underlying the poorer prognosis in patients with high BEC.

Learning and depicting lobe-based radiomics feature for COPD Severity staging in low-dose CT images

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a prevalent and debilitating respiratory condition that imposes a significant healthcare burden worldwide. Accurate staging of COPD severity is crucial for patient management and treatment planning.

METHODS

The retrospective study included 530 hospital patients. A lobe-based radiomics method was proposed to classify COPD severity using computed tomography (CT) images. First, we segmented the lung lobes with a convolutional neural network model. Secondly, the radiomic features of each lung lobe are extracted from CT images, the features of the five lung lobes are merged, and the selection of features is accomplished through the utilization of a variance threshold, t-Test, least absolute shrinkage and selection operator (LASSO). Finally, the COPD severity was classified by a support vector machine (SVM) classifier.

RESULTS

104 features were selected for staging COPD according to the Global initiative for chronic Obstructive Lung Disease (GOLD). The SVM classifier showed remarkable performance with an accuracy of 0.63. Moreover, an additional set of 132 features were selected to distinguish between milder (GOLD I + GOLD II) and more severe instances (GOLD III + GOLD IV) of COPD. The accuracy for SVM stood at 0.87.

CONCLUSIONS

The proposed method proved that the novel lobe-based radiomics method can significantly contribute to the refinement of COPD severity staging. By combining radiomic features from each lung lobe, it can obtain a more comprehensive and rich set of features and better capture the CT radiomic features of the lung than simply observing the lung as a whole.

The Association between Short-Term Exposure to PM1 and Daily Hospital Admission and Related Expenditures in Beijing

Ambient particulate matter (PM) pollution is a leading environmental health threat worldwide. PM with an aerodynamic diameter ≤ 1.0 μm, also known as PM1, has been implicated in the morbidity and mortality of several cardiorespiratory and cerebrovascular diseases. However, previous studies have mostly focused on analyzing fine PM (PM2.5) associated with disease metrics, such as emergency department visits and mortality, rather than ultrafine PM, including PM1. This study aimed to evaluate the association between short-term PM1 exposure and hospital admissions (HAs) for all-cause diseases, chronic obstructive pulmonary disease (COPD), and respiratory infections (RIs), as well as the associated expenditures, using Beijing as a case study. Here, based on air pollution and hospital admission data in Beijing from 2015 to 2017, we performed a time-series analysis and meta-analysis. It was found that a 10 μg/m3 increase in the PM1 concentration significantly increased all-cause disease HAs by 0.07% (95% Confidence Interval (CI): [0, 0.14%]) in Beijing between 2015 and 2017, while the COPD and RI-related HAs were not significantly associated with short-term PM1 exposure. Meanwhile, we estimated the attributable number of HAs and hospital expenditures related to all-cause diseases. This study revealed that an average of 6644 (95% CI: [351, 12,917]) cases of HAs were attributable to ambient PM1, which was estimated to be associated with a 106 million CNY increase in hospital expenditure annually (95% CI: [5.6, 207]), accounting for 0.32% (95% CI: [0.02, 0.62%]) of the annual total expenses. The findings reported here highlight the underlying impact of ambient PM pollution on health risks and economic burden to society and indicate the need for further policy actions on public health.

Clinical features and 1-year outcomes of variable obstruction in participants with preserved spirometry: results from the ECOPD study in China

BACKGROUND

There are limited data on the clinical features and longitudinal prognosis of variable obstruction, particularly among never smokers and different variable obstruction types. Therefore, we aimed to evaluate the clinical characteristics of the participants with variable obstruction and determine the relationship between variable obstruction and the development of chronic obstructive pulmonary disease (COPD) and the decline of lung function in a community-dwelling study of Chinese, especially among never smokers and different variable obstruction subtypes.

METHODS

Participants with preserved spirometry (postbronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥0.70) at baseline from the Early COPD cohort were included in our analysis. Participants with variable obstruction (prebronchodilator FEV1/FVC <0.70) were compared with those without variable obstruction (prebronchodilator FEV1/FVC ≥0.70). We performed subgroup analyses in never smokers, former and current smokers, and different variable obstruction types (postbronchodilator FVC

RESULTS

The final analysis included 1140 participants with preserved spirometry (169 in the variable obstruction group) at baseline. Participants with variable obstruction were older, had lower lung function and had greater severe emphysema and computed tomography-defined air trapping than participants without variable obstruction. Participants with variable obstruction had a significantly increased risk of incident spirometry-defined COPD (relative risk: 3.22, 95% confidence interval 2.23 to 4.64, p <0.001) than those without variable obstruction after adjustment for covariates. These findings remained consistent among both former and current smokers, never smokers, and different variable obstruction types. Additionally, participants with variable obstruction had a faster decline in postbronchodilator FEV1/FVC (2.3±0.5%/year vs 0.9±0.4%/year, mean difference: 1.4 (95% confidence interval 0.5 to 2.3), p=0.002) than participants without variable obstruction after adjustment for covariates.

CONCLUSIONS

The results of our study revealed that variable obstruction can identify individuals who are at risk for the development of COPD and accelerated postbronchodilator FEV1/FVC decline in preserved spirometry.

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Key Words

• COPD epidemiology
• Respiratory Function Test

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MESH Headings

• Humans
• Male
• Spirometry
• Female
• Pulmonary Disease, Chronic Obstructive/physiopathology
• Pulmonary Disease, Chronic Obstructive/epidemiology
• Pulmonary Disease, Chronic Obstructive/diagnosis
• Middle Aged
• China/epidemiology
• Aged
• Forced Expiratory Volume
• Vital Capacity
• Smoking/epidemiology
• Smoking/adverse effects
• Lung/physiopathology
• Prognosis

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Grants

• the Local Innovative and Research Teams Project of Guangdong Pearl River Talents Programme
• the National Key Research and Development Programme

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Affiliation(s)

Fan Wu State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China Guangzhou National Laboratory, Guangzhou, Guangdong, China
Haiqing Li State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Zhishan Deng State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Huajing Yang State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China Guangzhou National Laboratory, Guangzhou, Guangdong, China
Youlan Zheng State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China Guangzhou National Laboratory, Guangzhou, Guangdong, China
Ningning Zhao State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Cuiqiong Dai State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Jieqi Peng State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China Guangzhou National Laboratory, Guangzhou, Guangdong, China
Lifei Lu State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Zihui Wang State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Xiang Wen State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Shan Xiao State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Kunning Zhou State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Xiaohui Wu State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Gaoying Tang State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Qi Wan State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Ruiting Sun State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Jiangyu Cui State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Changli Yang Wengyuan County People's Hospital, Shaoguan, Guangdong, China
Shengtang Chen Wengyuan County People's Hospital, Shaoguan, Guangdong, China
Jianhui Huang Lianping County People's Hospital, Heyuan, Guangdong, China
Shuqing Yu Lianping County People's Hospital, Heyuan, Guangdong, China
Yumin Zhou State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China Guangzhou National Laboratory, Guangzhou, Guangdong, China
Pixin Ran State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China Guangzhou National Laboratory, Guangzhou, Guangdong, China

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Short-Term Effects of Ambient Air Pollution on Chronic Obstructive Pulmonary Disease Admissions in Jiuquan, China

Recent findings indicate that air pollution contributes to the onset and advancement of chronic obstructive pulmonary disease (COPD). Nevertheless, there is insufficient research indicating that air pollution is linked to COPD in the region of inland northwest China. Daily hospital admission records for COPD, air pollutant levels, and meteorological factor information were collected in Jiuquan for this study between 1 January 2018 and 31 December 2019. We employed a distributed lag non-linear model (DLNM) integrated with the generalized additive model (GAM) to assess the association between air pollution and hospital admissions for COPD with single lag days from lag0 to lag7 and multiday moving average lag days from lag01 to lag07. For example, the pollutant concentration on the current day was lag0, and on the prior 7th day was lag7. The present and previous 7-day moving average pollutant concentration was lag07. Gender, age, and season-specific stratified analyses were also carried out. It is noteworthy that the delayed days exhibited a different pattern, and the magnitude of associations varied. For NO2 and CO, obvious associations with hospitalizations for COPD were found at lag1, lag01-lag07, and lag03-lag07, with the biggest associations at lag05 and lag06 [RR = 1.015 (95%CI: 1.008, 1.023) for NO2, RR = 2.049 (95%CI: 1.416, 2.966) for CO], while only SO2 at lag02 was appreciably linked to hospitalizations for COPD [1.167 (95%CI: 1.009, 1.348)]. In contrast, short-term encounters with PM2.5, PM10, and O3 were found to have no significant effects on COPD morbidity. The lag effects of NO2 and CO were stronger than those of PM2.5 and PM10. Males and those aged 65 years or older were more vulnerable to air pollution. When it came to the seasons, the impacts appeared to be more pronounced in the cold season. In conclusion, short-term encounters with NO2 and CO were significantly correlated with COPD hospitalization in males and the elderly (≥65).

Application and Prospects of Artificial Intelligence Technology in Early Screening of Chronic Obstructive Pulmonary Disease at Primary Healthcare Institutions in China

Chronic Obstructive Pulmonary Disease (COPD), as one of the major global health threat diseases, particularly in China, presents a high prevalence and mortality rate. Early diagnosis is crucial for controlling disease progression and improving patient prognosis. However, due to the lack of significant early symptoms, the awareness and diagnosis rates of COPD remain low. Against this background, primary healthcare institutions play a key role in identifying high-risk groups and early diagnosis. With the development of Artificial Intelligence (AI) technology, its potential in enhancing the efficiency and accuracy of COPD screening is evident. This paper discusses the characteristics of high-risk groups for COPD, current screening methods, and the application of AI technology in various aspects of screening. It also highlights challenges in AI application, such as data privacy, algorithm accuracy, and interpretability. Suggestions for improvement, such as enhancing AI technology dissemination, improving data quality, promoting interdisciplinary cooperation, and strengthening policy and financial support, aim to further enhance the effectiveness and prospects of AI technology in COPD screening at primary healthcare institutions in China.

Cost-effectiveness of population-based screening for chronic obstructive pulmonary disease in China: a simulation modeling study

Background

China has the highest disease burden of chronic obstructive pulmonary disease (COPD) in the world; however, the diagnosis rate remains low. Screening for COPD in the population may improve early diagnosis and long-term health outcomes for patients with COPD. In this study, we aimed to evaluate the cost-effectiveness of population-based COPD screening policies in China.

Methods

We developed a microsimulation model that simulated incidence, natural history, and clinical management of COPD over a lifetime horizon among the general population aged 35-80 years in China. We evaluated population-based screening policies with different screening methods (one-step with COPD Screening Questionnaire or two-step with additional portable spirometer test) and frequencies (one-time or every 1-10 years). We calculated the incremental cost-effectiveness ratio (ICER) of the screening policies compared with the status quo (without screening) and identified the most cost-effective screening policy. Scenario and sensitivity analyses were performed to assess the impact of key parameters and the robustness of model results.

Findings

Compared with the status quo, all population-based COPD screening policies were cost-effective with estimated ICERs ranging between $8034 and $13,209 per quality-adjusted-life-year (QALY), all under the willingness-to-pay value of $38,441/QALY (three times China's gross domestic product per capita). A total of 0.39%-8.10% of COPD-related deaths and 0.58%-2.70% of COPD exacerbations were projected to be averted by COPD screening. Among all screening policies, annual two-step screening was the most cost-effective. Improving the linkage from screening to diagnosis and treatment could further increase population health benefits and the cost-effectiveness of COPD screening.

Interpretation

Population-based screening for COPD could be cost-effective in China. Offering public programs for COPD screening similar to existing preventive health services for other chronic diseases could be a promising strategy to improve population health outcomes and mitigate the disease burden of COPD in China.

Funding

Alexander von Humboldt Foundation, National Natural Science Foundation of China, CAMS Innovation Fund for Medical Science, Chinese Academy of Engineering project, and Horizon Europe.

Integrated serum metabolomics and network pharmacology analysis on the bioactive metabolites and mechanism exploration of Bufei huoxue capsule on chronic obstructive pulmonary disease rats

ETHNOPHARMACOLOGICAL RELEVANCE

Bufei Huoxue capsule (BHC) as a classic Chinese patent medicine formula, has the efficacy of tonifying the lungs and activating the blood. It has been extensively used in China for the treatment of chronic obstructive pulmonary disease (COPD) clinically. However, its mechanism is still unclear, which hampers the applications of BHC in treating COPD.

AIM OF THE STUDY

The purpose of the present study was to demonstrate the protective efficacy and mechanism of BHC on COPD model rats by integrating serum metabolomics analysis and network pharmacology study.

MATERIALS AND METHODS

A COPD rat model was established by cigarette fumigation combined with lipopolysaccharide (LPS) airway drip for 90 consecutive days. After oral administration for 30 days, the rats were placed in the body tracing box of the EMKA Small Animal Noninvasive Lung Function Test System to determine lung function related indexes. Histopathological alteration was observed by H&E staining and Masson staining. The serum levels of inflammatory cytokine, matrix metalloprotein 9, and laminin were determined by ELISA kits. Oxidative stress levels were tested by biochemical methods. UHPLC-Q-TOF/MS analysis of serum metabolomics and network pharmacology were performed to reveal the bioactive metabolites, key components and pathways for BHC treating COPD. WB and ELISA kits were used to verify the effects of BHC on key pathway.

RESULTS

BHC could improve lung function, immunity, lung histopathological changes and collagen deposition in COPD model rats. It also could significantly reduce inflammatory response in vivo, regulate oxidative stress level, reduce laminin content, and regulate protease-antiprotease balance. Metabolomics analysis found 46 biomarkers of COPD, of which BHC significantly improved the levels of 23 differential metabolites including arachidonic acid, leukotriene B4 and prostaglandin E2. Combined with the results of network pharmacology, the components of BHC, such as calycosin, oxypaeoniflora, (S)-bavachin and neobavaisoflavone could play therapeutic roles through the arachidonic acid pathway. In addition, the results of WB and ELISA indicated that BHC could suppress the expressions of COX2 and 5-LOX in lung tissues and inhibit the generation of AA and its metabolites in serum samples. Regulation of arachidonic acid metabolic pathway may be the crucial mechanism for BHC treating COPD.

CONCLUSIONS

In summary, the studies indicated that BHC exhibited the protective effect on COPD model rats by anti-inflammatory and anti-oxidative properties through arachidonic acid metabolism pathway. This study provided beneficial support for the applications of BHC in treating COPD.

Exploration the mechanism of Shenling Baizhu San in the treatment of chronic obstructive pulmonary disease based on UPLC-Q-TOF-MS/MS, network pharmacology and in vitro experimental verification

ETHNOPHARMACOLOGICAL RELEVANCE

Shenling Baizhu San (SLBZS) is a formula of traditional Chinese medicine (TCM) that enhances the functions of the qi, spleen, and lung. According to the theory of TCM, chronic obstructive pulmonary disease (COPD) is often caused by lung qi deficiency, and SLBZS is often used in the treatment of COPD and has achieved remarkable results. However, the active components of SLBZS absorbed in serum and the underlying mechanism of SLBZS in treating COPD remain unclear and require further studies.

AIM OF THE STUDY

The objective of this study is to investigate the active components of SLBZS in rat serum, as well as the crucial targets and signaling pathways involved in the therapeutic effects of SLBZS for COPD.

MATERIALS AND METHODS

First, the absorption components and metabolites of SLBZS in rat serum were identified using ultra-performance liquid chromatography-quadrupole time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS). Second, potential targets of SLBZS for the treatment of COPD were acquired from publicly accessible online sources. Cytoscape (v3.7.0) software was used to construct a component-target-pathway network and a protein-protein interaction (PPI) network. The Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis of potential targets was performed using the Metascape database. The binding status of the active components in SLBZS to the potential targets was assessed with molecular docking technology. Finally, a cell model of COPD was successfully developed for experimental validation In vitro.

RESULTS

A total of 108 active components were identified, including 30 prototype components and 78 metabolites. A total of 292 potential targets for the treatment of COPD were identified, including TNF, IL-6, TLR9, RELA, and others. The KEGG pathway included inflammatory mediator regulation of TRP channels, necroptosis, and the NF-κB signaling pathway, among others. The In vitro experiments showed that SLBZS-containing serum had the ability to decrease the levels of inflammatory factors and cell death. Additionally, it was observed that SLBZS-containing serum could control the expression levels of TLR9, MyD88, TRAF6, NF-κB, and IκBα at the mRNA and protein levels. These findings suggested that SLBZS-containing serum was likely to be involved in the regulation of the TLR9/NF-κB pathway.

CONCLUSIONS

The mechanism of action of SLBZS on COPD was preliminarily elucidated using UPLC-Q-TOF-MS/MS, network pharmacology, and In vitro experiments. The primary active components and potential targets of SLBZS were identified, providing a scientific foundation for further research.

Clinical characterization and outcomes of impulse oscillometry-defined bronchodilator response: an ECOPD cohort-based study

BACKGROUND

The clinical significance of the impulse oscillometry-defined small airway bronchodilator response (IOS-BDR) is not well-known. Accordingly, this study investigated the clinical characteristics of IOS-BDR and explored the association between lung function decline, acute respiratory exacerbations, and IOS-BDR.

METHODS

Participants were recruited from an Early Chronic Obstructive Pulmonary Disease (ECOPD) cohort subset and were followed up for two years with visits at baseline, 12 months, and 24 months. Chronic obstructive pulmonary disease (COPD) was defined as a post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio < 0.70. IOS-BDR was defined as meeting any one of the following criteria: an absolute change in respiratory system resistance at 5 Hz ≤ - 0.137 kPa/L/s, an absolute change in respiratory system reactance at 5 Hz ≥ 0.055 kPa/L/s, or an absolute change in reactance area ≤ - 0.390 kPa/L. The association between IOS-BDR and a decline in lung function was explored with linear mixed-effects model. The association between IOS-BDR and the risk of acute respiratory exacerbations at the two-year follow-up was analyzed with the logistic regression model.

RESULTS

This study involved 466 participants (92 participants with IOS-BDR and 374 participants without IOS-BDR). Participants with IOS-BDR had higher COPD assessment test and modified Medical Research Council dyspnea scale scores, more severe emphysema, air trapping, and rapid decline in FVC than those without IOS-BDR over 2-year follow-up. IOS-BDR was not associated with the risk of acute respiratory exacerbations at the 2-year follow-up.

CONCLUSIONS

The participants with IOS-BDR had more respiratory symptoms, radiographic structural changes, and had an increase in decline in lung function than those without IOS-BDR.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900024643. Registered on 19 July, 2019.

Contribution of small airway inflammation to the development of COPD

BACKGROUND

Little attention has been paid to the pathophysiological changes in the natural history of chronic obstructive pulmonary disease (COPD). The destructions of the small airways were visualized on thoracic micro-computed tomography scan. We investigated whether small airway inflammation (SAI) was the risk for the development of COPD.

METHODS

A total of 1062 patients were enrolled and analyzed in the study. The partitioned airway inflammation was determined by exhaled nitric oxide (NO) of FnNO, FeNO50, FeNO200, and calculated CaNOdual. Both FeNO200 and CaNOdual were compared to detect the promising predictor for peripheral airway/alveolar inflammation in COPD. The correlation between exhaled NO and white cell classification was evaluated to determine the inflammation type during the development of COPD.

RESULTS

Exhaled NO levels (FnNO, FeNO50, FeNO200, and CaNOdual) were the highest in the COPD group compared with all other groups. Furthermore, compared with controls, exhaled NO levels (FeNO50, FeNO200, and CaNOdual) were also significantly higher in the emphysema, chronic bronchitis, and smoking groups. FeNO200 was found to be a promising predictor for peripheral airway/alveolar inflammation (area under the curve [AUC] of the receiver operating characteristic [ROC] curve, area under the curve [AUC] = 0.841) compared with CaNOdual (AUC ROC = 0.707) in COPD. FeNO200 was the main risk factor (adjusted odds ratio, 2.191; 95% CI, 1.797-2.671; p = 0.002) for the development of COPD. The blood eosinophil and basophil levels were correlated with FeNO50 and FeNO200.

CONCLUSION

The complete airway inflammations were shown in COPD, whereas SAI was the main risk factor for the development of COPD, which might relate to eosinophil and basophil levels.

Association between occupational exposure and chronic obstructive pulmonary disease and respiratory symptoms in the Spanish population

INTRODUCTION

The aim of this study was to analyze the impact of occupational exposure on chronic obstructive pulmonary disease (COPD) and respiratory symptoms in the general Spanish population.

METHODS

This was a study nested in the Spanish EPISCAN II cross-sectional epidemiological study that included participants who had completed a structured questionnaire on their occupational history, a questionnaire on respiratory symptoms, and forced spirometry. The data were analyzed using Chi-square and Student's t tests and adjusted models of multiple linear regression and logistic regression.

RESULTS

We studied 7502 subjects, 51.1% women, with a mean age of 60±11 years. Overall, 53.2% reported some respiratory symptoms, 7.9% had respiratory symptoms during their work activity, 54.2% were or had been smokers, and 11.3% (851 subjects) met COPD criteria on spirometry. A total of 3056 subjects (40.7%) reported exposure to vapors, gases, dust or fumes (VGDF); occupational exposure to VGDF was independently associated with the presence of COPD (OR 1.22, 95% CI: 1.03-1.44), respiratory symptoms (OR 1.45, 95%: CI 1.30-1.61), and respiratory symptoms at work (OR 4.69, 95% CI: 3.82-5.77), with a population attributable fraction for COPD of 8.2%.

CONCLUSIONS

Occupational exposure is associated with a higher risk of COPD and respiratory symptoms in the Spanish population. These results highlight the need to follow strict prevention measures to protect the respiratory health of workers.

A Bibliometric Analysis of Comorbidity of COPD and Lung Cancer: Research Status and Future Directions

Objective

Although studies on the association between COPD and lung cancer are of great significance, no bibliometric analysis has been conducted in the field of their comorbidity. This bibliometric analysis explores the current situation and frontier trends in the field of COPD and lung cancer comorbidity, and to lay a new direction for subsequent research.

Methods

Articles in the field of COPD and cancer comorbidity were retrieved from Web of Science Core Collections (WoSCC) from 2004 to 2023, and analyzed by VOSviewer, CiteSpace, Biblimatrix and WPS Office.

Results

In total, 3330 publications were included. The USA was the leading country with the most publications and great influence. The University of Groningen was the most productive institution. Edwin Kepner Silverman was the most influential scholar in this field. PLOS One was found to be the most prolific journal. Mechanisms and risk factors were of vital importance in this research field. Environmental pollution and pulmonary fibrosis may be future research prospects.

Conclusion

This bibliometric analysis provided new guidance for the development of the field of COPD and lung cancer comorbidity by visualizing current research hotspots, and predicting possible hot research directions in the future.

An investigation of the risk factors of chronic obstructive pulmonary disease in natural population-based cohorts in China - a nested case-control study

Background

Chronic obstructive pulmonary disease (COPD) has become one of the most significant chronic diseases in China. According to conventional wisdom, smoking is the pathogenic factor. However, current research indicates that the pathophysiology of COPD may be associated with prior respiratory system events (e.g., childhood hospitalization for pneumonia, chronic bronchitis) and environmental exposure (e.g., dust from workplace, indoor combustion particles). Dyspnea, persistent wheezing, and other respiratory symptoms further point to the need for pulmonary function tests in this population. Reducing the burden of chronic diseases in China requires a thorough understanding of the various factors that influence the occurrence of COPD.

Methods

Using a cohort from the natural population, this study used nested case-control analysis. We carried out a number of researches, including questionnaire surveys and pulmonary function testing, in the Northwest and Southeast cohorts of China between 2014 and 2021. After removing any variations in the baseline data between patients and control subjects using propensity score matching analysis, the risk factors were examined using univariate or multivariate regression.

Result

It was discovered that prior history of chronic bronchitis, long-term wheezing symptoms, and environmental exposure-including smoking and biofuel combustion-were risk factors for COPD. Dyspnea, symptoms of mobility limitation, organic matter, and a history of hospitalization for pneumonia at an early age were not significant in the clinical model but their incidence in COPD group is higher than that in healthy population.

Discussion

COPD screening effectiveness can be increased by looking for individuals with chronic respiratory symptoms. Smokers should give up as soon as they can, and families that have been exposed to biofuels for a long time should convert to clean energy or upgrade their ventilation. Individuals who have previously been diagnosed with emphysema and chronic bronchitis ought to be extra mindful of the prevention or advancement of COPD.