Risk factors for chronic obstructive pulmonary disease in a European cohort of young adults

Montelukast's potential as a neuroprotective agent against acrylamide induced neurotoxicity: In vivo and computational modelling

Tobacco consumption, a leading cause of over 8 million deaths annually, exposes individuals to acrylamide (ACY), a neurotoxin in cigarette smoke that disrupts neurotransmitter function and induces oxidative stress, contributing to neurodegeneration. This study evaluated neuroprotective potential of montelukast (MTLU), a leukotriene receptor antagonist with anti-inflammatory and antioxidant properties, against ACY-induced neurotoxicity. Cognitive performance was assessed using elevated plus maze, novel object recognition, and Y-maze tests over 14 days. Biomarkers associated with neurodegeneration (BACE1, GSK-3β, AChE), neuroinflammation (COX-2, PGE2, TNF-α, NF-κB), oxidative stress (GSH, MDA, CAT), and apoptosis (Bcl-2, Caspase-3, Bax) were analyzed. Histopathological analyses of brain tissues were conducted to examine structural damage, and computational studies provided additional support for selected in vivo findings. MTLU significantly ameliorated ACY-induced cognitive deficits and reduced levels of GSK-3β, AChE, COX-2, PGE2, TNF-α, NF-κB, MDA, Bax, and Caspase-3 while enhancing antioxidant defenses (GSH) and upregulating Bcl-2. Histopathological analysis confirmed reduced structural brain damage, and molecular docking indicated strong binding potential for MTLU with AChE, COX-2, GSK-3β, BACE-1, and Caspase-3. While these findings suggest a protective role for MTLU in mitigating ACY-induced cognitive impairments, oxidative stress, neuroinflammation, and apoptosis, further research is needed to confirm its therapeutic potential and clinical relevance.

Clinical characteristic of patients with COPD-A

BACKGROUND

The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) document proposed the COPD-A subtype as a condition of COPD with asthma. We examined the characteristics of COPD-A patients and analyzed them according to smoking history and inhaled corticosteroid (ICS) use.

METHODS

Patients in the COPD cohort with a history of asthma were included. The patients were divided into two groups according to their smoking history (< 10 vs. ≥10 pack-years) and their clinical characteristics were compared. The association between patients' ICS use and the occurrence for exacerbations during 1 year follow-up period was analyzed.

RESULTS

Of the 970 patients included in the analysis, the group with a smoking history less than 10 pack-years (n = 158) had a significantly higher BMI, FEV1 (%), FEV1/FVC (%), DLco, ESR, and prevalence of osteoporosis. Among 560 patients who were followed up for 1 year, the patients with ICS (n = 274) had a higher exacerbation rate than without ICS (n = 286) (54% vs. 44.1%, p = 0.018). However, in multivariable analysis, ICS use was not significantly associated with exacerbation. In subgroup analysis of patients with blood eosinophil count ≥ 300 cells/µl, ICS use showed a trend to reduce the risk for exacerbation (IRR = 0.907, p = 0.708). In patients with blood eosinophil count < 300 cells/µl, ICS use significantly increased the risk for exacerbation (IRR = 1.547, p = 0.005).

CONCLUSIONS

COPD-A patients with a smoking history of less than 10 pack-years had better pulmonary function test results, BMI, ESR, and prevalence of osteoporosis. The use of ICS did not decrease exacerbations in COPD-A.

Distinct risks of exacerbation and lung function decline between never-smokers and ever-smokers with COPD

BACKGROUND

Chronic obstructive pulmonary disease (COPD) can occur in patients without a history of smoking, which is a strong risk factor for COPD. However, few studies have focused on the prognosis of never-smokers with COPD. We investigated the difference of the longitudinal clinical outcomes between never-smokers and ever-smokers with COPD.

METHODS

We retrospectively analyzed patients with COPD who underwent chest computed tomography and longitudinal lung function tests from January 2013 to December 2020. We classified patients according to smoking status and examined their histories of acute exacerbation and long-term changes in lung function.

RESULTS

Among 583 patients with COPD, 75 (12.9%) had no smoking history. These never-smokers with COPD were predominantly women; they had a lower forced vital capacity and a higher prevalence of asthma, history of tuberculosis, tuberculosis-destroyed lung, and bronchiectasis, but a lower prevalence of emphysema, relative to ever-smokers with COPD. Never-smokers with COPD had significantly lower risks of subsequent moderate to severe exacerbation (β ± standard error, - 0.4 ± 0.12; P = 0.001), any exacerbation (adjusted odds ratio, 0.46; 95% confidence interval, 0.26 - 0.8; P = 0.006), and frequent exacerbation (adjusted odds ratio, 0.28; 95% confidence interval, 0.09 - 0.89; P = 0.03) than ever-smokers with COPD. Never-smokers with COPD also showed significantly slower annual decline of forced expiratory volume in 1 s than ever-smokers with COPD (- 15.7 ± 4.7 vs. -30.4 ± 2.9 mL, respectively; P = 0.03).

CONCLUSIONS

Never-smokers with COPD had significantly fewer acute exacerbations and slower decline of lung function than ever-smokers with COPD during longitudinal follow-up.

Clinical Characteristics of Chronic Obstructive Pulmonary Disease according to Smoking Status

Chronic obstructive pulmonary disease (COPD) can be caused by various factors, including lung infections, asthma, air pollution, childhood growth disorders, and genetic factors, though smoking is the predominant risk factor. The main pathological mechanisms in COPD involve small airway disease, emphysema, mucus hypersecretion, and vascular disorders. COPD in non-smokers is characterized by a normal 1-second forced expiratory volume decline, equal sex distribution, younger age of onset, fewer comorbidities, milder airflow obstruction, preserved diffusing capacity of the lungs for carbon monoxide, and radiological features such as more air-trapping and less severe emphysema compared to COPD in smokers. Nevertheless, non-smokers with COPD still experience a high prevalence of acute exacerbations, nearly equal to that of smokers with COPD. Moreover, COPD itself is an independent risk factor for developing lung cancer, regardless of smoking status. Given that COPD coexists with numerous comorbidities, effectively managing these comorbidities is crucial, requiring multifaceted efforts for comprehensive treatment.

Occupational Exposure to Charcoal Smoke and Dust, a Major Risk Factor for COPD: A Multiregional Cross-Sectional Study in the Democratic Republic of Congo

BACKGROUND

Occupational exposure to charcoal smoke and dust is a threat to workers' respiratory systems.

RESEARCH QUESTION

What is the prevalence of COPD in charcoal workers compared with that of farmers in rural areas of Democratic Republic of Congo (DRC)?

STUDY DESIGN AND METHODS

This cross-sectional, comparative, and multisite study was performed in the charcoal-producing provinces of southwestern DRC. We randomly included charcoal workers and compared them with farmers (age range, 18-70 years). Air quality indexes, anthropometric features, physical activity, sociodemographic characteristics, and related medical events data were recorded. A lung function questionnaire was used to assess respiratory symptoms and spirometry was performed. COPD was defined as the presence of respiratory symptoms for > 3 months with an FEV1 to FVC ratio less than the lower limit of normal. The prevalence of COPD was calculated, and logistic regression was used to identify COPD-associated factors.

RESULTS

We included 485 participants between August 2020 and July 2021. Charcoal producers (CPs; n = 229) were compared with farmers (n = 118), and charcoal saleswomen (n = 72) were compared with vegetable saleswomen (n = 66). Respective groups were similar in age, job seniority, height, and weight. The air was more polluted at charcoal workplaces. The prevalence of COPD was higher in CPs than in farmers (39.7% vs 14.4%; P < .0001) and higher in charcoal saleswomens compared with vegetable saleswomen (40.3% vs 13.6%; P < .0001). Being a charcoal worker was associated independently with COPD in the CP and farmers groups (adjusted OR, 3.54; 95% CI, 1.94-6.46) and in the saleswomen group (adjusted OR, 7.85; 95% CI, 2.85-21.5), where it was also associated independently with young age (adjusted OR, 0.85; 95% CI, 0.80-0.93) and monthly income (adjusted OR, 0.88; 95% CI, 0.83-0.96).

INTERPRETATION

In rural areas of DRC, producing or selling charcoal is associated with a higher risk of COPD.

A Study on the Association between Cough Sensitivity and Acute Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

OBJECTIVE

To investigate the relationship between cough sensitivity and acute exacerbation in stable chronic obstructive pulmonary disease (COPD) patients.

METHODS

Stable COPD patients who visited our department from July 2022 to June 2023 were included. They were subjected to cough sensitivity test, spirometry, induced sputum cytology examination, questionnaire assessment such as cough symptom score, etc. They were followed up for 12 months, and were divided into the acute exacerbation (AE) group and the stable group according to whether acute exacerbation occurred during the follow-up period. We compared the differences in cough sensitivity, pulmonary function, and questionnaires between the two groups, analyzed the relationship between cough sensitivity and acute exacerbation, and screened the risk factors for AECOPD.

RESULTS

A total of 145 patients with stable COPD were included. AE group (n = 94) had lower FEV1/FVC (50.08 ± 11.11 versus 54.28 ± 11.58, p = 0.03) and cough sensitivity lgC5 [-0.01(0.90) versus 0.59(0.90), p < 0.01] than those in the stable group (n = 51) patients, the daytime cough symptom score [2(2) versus 1(2), p = 0.02] and VAS score [50(40) versus 30(50), p < 0.01] were higher than stable group. Multivariate logistic regression analysis showed lgC5 (OR = 0.34, 95% CI = 0.16-0.71, p < 0.01) was an independent risk factor for AECOPD. When lgC5 was used to predict acute exacerbation in stable COPD patients, the AUC was 0.69, the sensitivity was 59.57%, and the specificity was 72.55%.

CONCLUSION

Although causality is not necessarily demonstrated, baseline cough sensitivity lgC5 in stable COPD patients is an independent risk factor for AECOPD, and it has some predictive value for future acute exacerbations.

Association between metabolic syndrome and chronic obstructive pulmonary disease development in young individuals: a nationwide cohort study

BACKGROUND

The association between metabolic syndrome (MetS) and chronic obstructive pulmonary disease (COPD) has not been studied well, particularly in young individuals. We investigated the risk of COPD development in young individuals based on MetS and its components.

METHODS

We used the Korean National Health Information Database to identify 6,891,400 individuals aged 20-39 years who participated in the national health check-up service between 2009 and 2012. Then, we identified individuals with MetS and investigated COPD development based on health insurance claims. Cox proportional hazard regression models were used to calculate the adjusted hazard ratio (aHR) for the risk of COPD development.

RESULTS

During a mean follow-up period of 8.35 years, 13,784 individuals were newly diagnosed with COPD. MetS was associated with an increased risk of COPD (aHR, 1.18; 95% confidence interval [CI], 1.11-1.24). Among the MetS components, except for hyperglycemia, abdominal obesity (aHR, 1.27; 95% CI, 1.19-1.34), hypertension (aHR, 1.05; 95% CI, 1.01-1.10), hypertriglyceridemia (aHR, 1.11; 95% CI, 1.07-1.16), and low high-density lipoprotein cholesterol levels (aHR, 1.16; 95% CI, 1.11-1.22) were significantly associated with COPD development. A higher number of MetS components correlated with an increased risk of COPD development, with the highest risk observed when all five MetS components were present (aHR, 1.55; 95% CI, 1.28-1.87).

CONCLUSION

MetS was associated with COPD development in young individuals. The risk of COPD development increased along with the increasing number of MetS components. These findings suggest that careful monitoring for COPD development is necessary in young individuals with MetS, especially those with multiple components of MetS.

Navigating COPD in Aging Populations: Insights Into Pathophysiology and Comprehensive Care

Chronic obstructive pulmonary disease (COPD) poses a significant and growing health burden among aging populations, marked by increasing prevalence and complex management challenges specific to elderly patients. This review explores the multifaceted interplay between COPD and aging, highlighting overlapping pathophysiological processes and comorbidities that complicate diagnosis and treatment. We examine age-specific management strategies, emphasizing the need for tailored approaches that account for the unique physical, cognitive, and health-related quality of life impacts on older adults. Additionally, we discuss preventive treatments and the critical roles of mental health, end-of-life care, and caregiver support in comprehensive disease management. The importance of integrative approaches to enhancing health care delivery is also underscored. Finally, we outline future directions, focusing on novel treatment pathways and the identification of biomarkers for early detection. Addressing these elements is essential for optimizing care in this vulnerable population and alleviating the significant societal and economic impacts of COPD among aging patients.

WISP1 and Macrophage Migration Inhibitory Factor in Respiratory Inflammation: Novel Insights and Therapeutic Potentials for Asthma and COPD

Recent advancements highlight the intricate interplay between the extracellular matrix (ECM) and immune responses, notably in respiratory diseases such as asthma and Chronic Obstructive Pulmonary Disease (COPD). The ECM, a dynamic structural framework within tissues, orches-trates a plethora of cellular processes, including immune cell behavior and tissue repair mecha-nisms. WNT1-inducible-signaling pathway protein 1 (WISP1), a key ECM regulator, controls immune cell behavior, cytokine production, and tissue repair by modulating integrins, PI3K, Akt, β-catenin, and mTOR signaling pathways. WISP1 also induces macrophage migration inhibitory factor (MIF) expression via Src kinases and epidermal growth factor receptor (EGFR) activation. MIF, through its wide range of activities, enhances inflammation and tissue restructuring. Rec-ognized for its versatile roles in regulating the immune system, MIF interacts with multiple immune components, such as the NLRP3 inflammasome, thereby sustaining inflammatory pro-cesses. The WISP1-MIF axis potentially unveils complex molecular mechanisms governing im-mune responses and inflammation. Understanding the intricate roles of WISP1 and MIF in the pathogenesis of chronic respiratory diseases such as asthma and COPD could lead to the identi-fication of novel targets for therapeutic intervention to alleviate disease severity and enhance patient outcomes.

Untreated pulmonary sequestration with recurrent superinfection -supporting COPD development in a 42 year old male patient

BACKGROUND

Pulmonary sequestration is a congenital malformation in which nonfunctional lung tissue develops without connection to the bronchial system. The main complication is the occurrence of recurrent pneumonia.

CASE PRESENTATION

We describe the case of a patient who was incidentally diagnosed with PS as part of the diagnostic algorithm for community-acquired pneumonia. Due to the relatively late diagnosis, the recurrent bronchopulmonary was conducive to the development of COPD and pulmonary emphysema. For prognostic reasons, surgical resection was performed by posterolateral thoracotomy.

CONCLUSIONS

Although cigarette smoking is the main risk factor for developing COPD, recurring lung infections may have a synergistic effect. Sometimes recurrent infections are caused by a congenital malformation. Especially in adults who have had recurrent pneumonia since childhood.

The severity of non-smoking chronic obstructive pulmonary disease is correlated with biomass fuel exposure and COPD assessment test score

BACKGROUND AND OBJECTIVE

Tobacco smoking is an established risk factor for chronic obstructive pulmonary disease (COPD). Current evidence suggests that non-tobacco-related risk factors vary geographically and are less understood than smoking. This study aims to compare the risk factors, symptoms, and clinical features of smoking (S-COPD) and non-smoking (NS-COPD) in a COPD population.

MATERIALS AND METHODS

In this retrospective cross-sectional study, 489 COPD patients were screened. Data on socio-demographics, smoking and medical history, other risk factors, symptoms, and clinical characteristics including COPD Assessment Test (CAT) score, and Modified Medical Research Council (mMRC) Dyspnea Scale were examined.

RESULTS

Of the total selected 416 COPD patients, 35.34% were NS-COPD while 64.66% were S-COPD. S-COPD was predominant in males, whereas NS-COPD was predominant in females (P < 0.0001). In NS-COPD, biomass fuel exposure was a major risk factor (P < 0.0001), and 61% of subjects had a biomass fuel exposure index of >60. In bivariate and multivariate analyses, no risk factors were correlated with forced expiratory volume in 1 second (FEV1)% predicted, while among clinical features, duration of illness (P = 0.001) was correlated with lower values of FEV1 in the multivariate table of S-COPD. In the multivariate analysis, biomass fuel exposure (P = 0.039) and CAT score (P < 0.0001) were correlated with FEV1(%) in NS-COPD.

CONCLUSION

Biomass fuel exposure is a substantial risk factor for NS-COPD and was correlated with FEV1(%) predicted. In addition, the CAT score correlated with disease severity in patients with NS-COPD. The development of COPD in non-smokers is being recognized as a separate phenotype and it should be managed according to risk factors.

Lysophospholipid Acyltransferase 9 Promotes Emphysema Formation via Platelet-activating Factor

Cigarette smoking is known to be the leading cause of chronic obstructive pulmonary disease (COPD). However, the detailed mechanisms have not been elucidated. PAF (platelet-activating factor), a potent inflammatory mediator, is involved in the pathogenesis of various respiratory diseases such as bronchial asthma and COPD. We focused on LPLAT9 (lysophospholipid acyltransferase 9), a biosynthetic enzyme of PAF, in the pathogenesis of COPD. LPLAT9 gene expression was observed in excised COPD lungs and single-cell RNA sequencing data of alveolar macrophages (AMs). LPLAT9 was predominant and upregulated in AMs, particularly monocyte-derived AMs, in patients with COPD. To identify the function of LPLAT9/PAF in AMs in the pathogenesis of COPD, we exposed systemic LPLAT9-knockout (LPALT9-/-) mice to cigarette smoke (CS). CS increased the number of AMs, especially the monocyte-derived fraction, which secreted MMP12 (matrix metalloprotease 12). Also, CS augmented LPLAT9 phosphorylation/activation on macrophages and, subsequently, PAF synthesis in the lung. The LPLAT9-/- mouse lung showed reduced PAF production after CS exposure. Intratracheal PAF administration accumulated AMs by increasing MCP1 (monocyte chemoattractant protein-1). After CS exposure, AM accumulation and subsequent pulmonary emphysema, a primary pathologic change of COPD, were reduced in LPALT9-/- mice compared with LPLAT9+/+ mice. Notably, these phenotypes were again worsened by LPLAT9+/+ bone marrow transplantation in LPALT9-/- mice. Thus, CS-induced LPLAT9 activation in monocyte-derived AMs aggravated pulmonary emphysema via PAF-induced further accumulation of AMs. These results suggest that PAF synthesized by LPLAT9 has an important role in the pathogenesis of COPD.

Centrilobular emphysema and airway dysanapsis: factors associated with low respiratory function in younger smokers

Background

Low respiratory function in young adulthood is one of the important factors in the trajectory leading to the future development of COPD, but its morphological characteristics are not well characterised.

Methods

We retrospectively enrolled 172 subjects aged 40-49 years with ≥10 pack-years smoking history who underwent lung cancer screening by computed tomography (CT) and spirometry at two Japanese hospitals. Emphysema was visually assessed according to the Fleischner Society guidelines and classified into two types: centrilobular emphysema (CLE) and paraseptal emphysema (PSE). Airway dysanapsis was assessed with the airway/lung ratio (ALR), which was calculated by the geometric mean of the lumen diameters of the 14 branching segments divided by the cube root of total lung volume on a CT scan.

Results

Among the subjects, CLE and PSE were observed in 20.9% and 30.8%, respectively. The mean ALR was 0.04 and did not differ between those with and without each type of emphysema. Multivariable regression analysis models adjusted for age, sex, body mass index and smoking status indicated that CLE and a low ALR were independently associated with lower forced expiratory volume in 1 s (FEV1)/forced vital capacity (estimate -1.64 (95% CI -2.68- -0.60) and 6.73 (95% CI 4.24-9.24), respectively) and FEV1 % pred (estimate -2.81 (95% CI -5.10- -0.52) and 10.9 (95% CI 5.36-16.4), respectively).

Conclusions

CLE and airway dysanapsis on CT were independently associated with low respiratory function in younger smokers.

Association of Exposure to Biomass Fuels with Occurrence of Chronic Obstructive Pulmonary Disease in Rural Western China: A Real-World Nested Case-Control Study

Background

This study investigated the potential contribution of biomass fuels exposure to the occurrence of chronic obstructive pulmonary disease (COPD) in rural areas of western China.

Methods

We analyzed data collected between October 2017 and October 2018 from a nested case-control study of individuals at least 40 years old in the general population in Mianyang City, Sichuan Province, China. Demographic information was collected using a custom-designed questionnaire, and lung function was measured using spirometry. We used multivariate logistic regression to explore the possible relationship between biomass fuels exposure and COPD, as well as between other potential risk factors and COPD. Bayes' theorem was used to estimate weights for different COPD risk factors.

Results

COPD was newly diagnosed in 500 of the 11398 adults surveyed, corresponding to an incidence of 4.39%. Individuals who were exposed to biomass fuels were at a significantly greater risk of developing COPD than those not exposed (OR 2.58, 95% CI 2.23-3.05). In subgroup analysis, exposure to biomass fuels increased the risk of COPD in men by 1.71 times (95% CI 1.09-2.68) and in women by 2.88 times (95% CI 2.01-3.48), in never-smokers by 2.18 times. Bayesian weights for COPD risk factors were highest for poor kitchen ventilation (W=31.13%) and biomass fuels exposure (W=18.08%).

Conclusion

Our data indicate that rural Chinese who are exposed to biomass fuels during cooking or heating are at greater risk of developing COPD. Efforts should be made to strengthen the construction of clean energy infrastructure, so as to reduce the use of biomass fuels and thereby help prevent COPD.

Mendelian randomization study shows a causal effect of asthma on chronic obstructive pulmonary disease risk

BACKGROUND

This study was performed to explore the causal association between asthma and chronic obstructive pulmonary disease(COPD).

METHODS

We obtained summary statistics for asthma from 408,442 Europeans in an open genome-wide association study (GWAS) from the UK Biobank to select strongly associated single nucleotide polymorphisms that could serve as instrumental variables for asthma (P < 5×10-8). Additional summary statistics for COPD were obtained from 193,638 individuals of European ancestry in the GWAS published by FinnGen. Univariable Mendelian randomization(UVMR) analysis was performed using inverse variance weighted (IVW) as the primary method of analysis. The reliability of the results was verified by multivariable MR(MVMR), reverse and replication MR analysis, and sensitivity analysis.

RESULTS

In the UVMR analysis, asthma increased the risk of COPD, with an odds ratio (OR) of 1.27 (95% confidence interval (CI) = 1.16-1.39, P = 5.44×10-7). Estimates were consistent in MVMR analyses by the adjustments of smoking initiation, age of smoking initiation, cigarettes per day, PM 2.5, and the combination of the above factors. In the reverse MR analysis, there was no evidence of a causal effect of COPD on asthma risk(OR = 1.02, 95% CI = 0.97-1.07, P = 0.3643). In the replication MR analysis, asthma still increased the risk of COPD. Sensitivity analyses validated the robustness of the above associations.

CONCLUSIONS

We found that genetically predicted asthma was positively associated with the risk of COPD. Additionally, there was no evidence that COPD increases the risk of asthma. Further clarification of this link and underlying mechanisms is needed to identify feasible measures to promote COPD prevention.

A review of therapeutic impacts of saffron (Crocus sativus L.) and its constituents

Application of herbal medicines in the treatment of diseases is in the center of attention of medical scientific societies. Saffron (Cricus sativus L.) is a medicinal plant belonging to the Iridaceae family with different therapeutic properties. The outcomes of human and animal experiments indicate that therapeutic impacts of saffron and its constituents, crocin, crocetin, and safranal, mainly are mediated via inhibiting the inflammatory reactions and scavenging free radicals. It has been suggested that saffron and crocin extracted from it also up-regulate the expression of sirtuin 1 (SIRT1) and nuclear factor erythroid 2-related factor 2 (Nrf2), down-regulate nuclear factor kappa B (NF-κB) signaling pathway and untimely improve the body organs dysfunction. Inhibition of inducible nitric oxide synthase and cyclooxygenase-2 (COX2) also is attributed to crocin. The current review narrates the therapeutic effects of saffron and its constituents on various body systems through looking for the scientific databases including Web of Science, PubMed, Scopus, and Google Scholar from the beginning of 2010 until the end of 2022.

Effect of smoking on the development of chronic obstructive pulmonary disease in young individuals: a nationwide cohort study

Background

Cigarette smoking is an important risk factor for developing chronic obstructive pulmonary disease (COPD). However, the effect of smoking on the development of COPD in young individuals remains unclear. We aimed to evaluate the effect of smoking on COPD development in young individuals.

Methods

Using the Korean National Health Information Database, we screened individuals aged 20-39 years who participated in the national health check-up between 2009 and 2012. We defined physician-diagnosed COPD based on health insurance claims and searched the database until December 2019. We identified 6,307,576 eligible individuals, and 13,789 had newly developed COPD. We used multivariate Cox proportional hazards models to estimate the adjusted hazard ratio (aHR) of risk factors for COPD.

Results

The incidence rate for developing COPD was 0.26/1000 person-year. The risk of developing COPD was significantly higher in current smokers [aHR 1.46, 95% confidence interval (CI) 1.39-1.53] and former smokers (aHR 1.21, 95% CI 1.14-1.29) than in non-smokers. Furthermore, the risk increased with increasing smoking amounts (≥20 pack-years, aHR 2.24; 10-20 pack-years, aHR 1.55; <10 pack-years, aHR 1.27). Female participants had a higher relative risk of developing COPD due to smoking, compared with their male counterparts.

Conclusion

Cigarette smoking increased the risk of developing COPD in young individuals. Current and heavy smokers had higher risks of developing COPD than non-smokers. Female smokers were more likely to develop COPD than male smokers.

Chronic Obstructive Pulmonary Disease Is Associated with Worse Oncologic Outcomes in Early-Stage Resected Pancreatic and Periampullary Cancers

Pancreatic ductal adenocarcinoma (PDAC) is the 3rd leading cause of cancer mortality in the United States. Hypoxic and hypercapnic tumor microenvironments have been suggested to promote tumor aggressiveness. The objective of this study was to evaluate the association between chronic obstructive pulmonary disease (COPD) and oncologic survival outcomes in patients with early-stage PDAC and periampullary cancers. In this case-control study, patients who underwent a pancreaticoduodenectomy during 2014-2021 were assessed. Demographic, perioperative, histologic, and oncologic data were collected. A total of 503 PDAC and periampullary adenocarcinoma patients were identified, 257 males and 246 females, with a mean age of 68.1 (±9.8) years and a mean pre-operative BMI of 26.6 (±4.7) kg/m². Fifty-two percent of patients (N = 262) reported a history of smoking. A total of 42 patients (8.3%) had COPD. The average resected tumor size was 2.9 ± 1.4 cm and 65% of the specimens (N = 329) were positive for lymph-node involvement. Kaplan-Meier analysis showed that COPD was associated with worse overall and disease-specific survival (p < 0.05). Cox regression analysis showed COPD to be an independent prognostic factor (HR = 1.5, 95% CI 1.0-2.3, p = 0.039) along with margin status, lymphovascular invasion, and perineural invasion (p < 0.05 each). A 1:3 nearest neighbor propensity score matching was also employed and revealed COPD to be an independent risk factor for overall and disease-specific survival (OR 1.8 and OR 1.6, respectively; p < 0.05 each). These findings may support the rationale posed by in vitro laboratory studies, suggesting an important impact of hypoxic and hypercapnic tumor respiratory microenvironments in promoting therapy resistance in cancer.

Twenty years of changes in the definition of early chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory airway disease that affects the quality of life of nearly one-tenth of the global population. Due to irreversible airflow obstruction and progressive lung function decline, COPD is characterized by high mortality and disability rates, which imposes a huge economic burden on society. In recent years, the importance of intervention in the early stage of COPD has been recognized and the concept of early COPD has been proposed. Identifying and intervening in individuals with early COPD, some of whom have few or no symptoms, might halt or reverse the progressive decline in lung function, improve the quality of life, and better their prognosis. However, understanding of early COPD is not yet well established, and there are no unified and feasible diagnostic criteria, which complicates clinical research. In this article, we review evolution of the definition of early COPD over the past 20 years, describe the changes in awareness of this concept, and propose future research directions.

Polycyclic aromatic hydrocarbon exposure burden: Individual and mixture analyses of associations with chronic obstructive pulmonary disease risk

Accumulating data demonstrate that polycyclic aromatic hydrocarbons (PAH) exposure is linked to compromised respiratory diseases. This study aimed to analyze urinary PAH metabolites and their associations with chronic obstructive pulmonary disease (COPD) in a sample size of 3015 subjects from a total population of 50,588 from the National Health and Nutrition Examination Survey (NHANES) in 2007-2016. Results showed that the most predominant metabolite was 1-Hydroxynaphthalene (1-NAP, 84%) with a geometric mean concentration of 50,265 ng/L, followed by its homologue 2-NAP (10%), both of which arose from sources including road emission, smoking and cooking. Multiple logistic regression showed that seven of the ten major PAH metabolites were correlated with increased COPD risk: including 1-NAP (OR: 1.83, 95%CI: 1.25, 2.69), 2-Hydroxyfluorene (2-FLU, OR: 2.29, 95%CI: 1.42, 3.68) and 1-Hydroxyphenanthrene (1-PHE, OR: 2.79, 95%CI: 1.85, 4.21), when compared to the lowest tertile after adjusted for covariates. Total exposure burden per PAH congener sub-group demonstrated persistent positive correlation with COPD for ∑PHE (OR: 1.80, 95%CI: 1.34, 2.43) and ∑FLU (OR: 2.74, 95%CI: 1.77, 4.23) after adjusted for covariates. To address the contribution of PAH exposure as mixture towards COPD, weighted quantile sum (WQS) regression analyses revealed that 1-NAP, 9-Hydroxyfluorene (9-FLU), 3-Hydroxyfluorene (3-FLU) and 1-PHE were among the top contributors in the associations with COPD. Our results demonstrate the contemporary yet ongoing exposure burden of PAH exposure for over a decade, particularly towards NAPs and FLUs that contribute significantly to COPD risk, calling for more timely environmental regulation.

The therapeutic potential of quercetin for cigarette smoking-induced chronic obstructive pulmonary disease: a narrative review

Quercetin is a flavonoid with antioxidant and anti-inflammatory properties. Quercetin has potentially beneficial therapeutic effects for several diseases, including cigarette smoking-induced chronic obstructive pulmonary disease (CS-COPD). Many studies have shown that quercetin's antioxidant and anti-inflammatory properties have positive therapeutic potential for CS-COPD. In addition, quercetin's immunomodulatory, anti-cellular senescence, mitochondrial autophagy-modulating, and gut microbiota-modulating effects may also have therapeutic value for CS-COPD. However, there appears to be no review of the possible mechanisms of quercetin for treating CS-COPD. Moreover, the combination of quercetin with common therapeutic drugs for CS-COPD needs further refinement. Therefore, in this article, after introducing the definition and metabolism of quercetin, and its safety, we comprehensively presented the pathogenesis of CS-COPD related to oxidative stress, inflammation, immunity, cellular senescence, mitochondrial autophagy, and gut microbiota. We then reviewed quercetin's anti-CS-COPD effects, performed by influencing these mechanisms. Finally, we explored the possibility of using quercetin with commonly used drugs for treating CS-COPD, providing a basis for future screening of excellent drug combinations for treating CS-COPD. This review has provided meaningful information on quercetin's mechanisms and clinical use in treating CS-COPD.

Efficacy of air filtration and education interventions on fine particulate matter among rural Native American homes heated with wood stoves: Results from the EldersAIR randomized trial

BACKGROUND

Native Americans living in rural areas often rely upon wood stoves for home heating that can lead to elevated indoor concentrations of fine particulate matter (PM2.5). Wood stove use is associated with adverse health outcomes, which can be a particular risk in vulnerable populations including older adults.

OBJECTIVES

We assessed the impact of portable air filtration units and educational approaches that incorporated elements of traditional knowledge on indoor and personal PM2.5 concentrations among rural, Native American elder households with wood stoves.

METHODS

EldersAIR was a three-arm, pre-post randomized trial among rural households from the Navajo Nation and Nez Perce Tribe in the United States. We measured personal and indoor PM2.5 concentrations over 2-day sampling periods on up to four occasions across two consecutive winter seasons in elder participant homes. We assessed education and air filtration intervention efficacy using linear mixed models.

RESULTS

Geometric mean indoor PM2.5 concentrations were 50.5 % lower (95 % confidence interval: -66.1, -27.8) in the air filtration arm versus placebo, with similar results for personal PM2.5. Indoor PM2.5 concentrations among education arm households were similar to placebo, although personal PM2.5 concentrations were 33.3 % lower for the education arm versus placebo (95 % confidence interval: -63.2, 21.1).

SIGNIFICANCE

The strong partnership between academic and community partners helped facilitate a culturally acceptable approach to a clinical trial intervention within the study communities. Portable air filtration units can reduce indoor PM2.5 that originates from indoor wood stoves, and this finding was supported in this study. The educational intervention component was meaningful to the communities, but did not substantially impact indoor PM2.5 relative to placebo. However, there is evidence that the educational interventions reduced indoor PM2.5 in some subsets of the study households. More study is required to determine ways to optimize educational interventions within Native American communities.

Therapeutic Potential of Small Molecules Targeting Oxidative Stress in the Treatment of Chronic Obstructive Pulmonary Disease (COPD): A Comprehensive Review

Chronic obstructive pulmonary disease (COPD) is an increasing and major global health problem. COPD is also the third leading cause of death worldwide. Oxidative stress (OS) takes place when various reactive species and free radicals swamp the availability of antioxidants. Reactive nitrogen species, reactive oxygen species (ROS), and their counterpart antioxidants are important for host defense and physiological signaling pathways, and the development and progression of inflammation. During the disturbance of their normal steady states, imbalances between antioxidants and oxidants might induce pathological mechanisms that can further result in many non-respiratory and respiratory diseases including COPD. ROS might be either endogenously produced in response to various infectious pathogens including fungi, viruses, or bacteria, or exogenously generated from several inhaled particulate or gaseous agents including some occupational dust, cigarette smoke (CS), and air pollutants. Therefore, targeting systemic and local OS with therapeutic agents such as small molecules that can increase endogenous antioxidants or regulate the redox/antioxidants system can be an effective approach in treating COPD. Various thiol-based antioxidants including fudosteine, erdosteine, carbocysteine, and N-acetyl-L-cysteine have the capacity to increase thiol content in the lungs. Many synthetic molecules including inhibitors/blockers of protein carbonylation and lipid peroxidation, catalytic antioxidants including superoxide dismutase mimetics, and spin trapping agents can effectively modulate CS-induced OS and its resulting cellular alterations. Several clinical and pre-clinical studies have demonstrated that these antioxidants have the capacity to decrease OS and affect the expressions of several pro-inflammatory genes and genes that are involved with redox and glutathione biosynthesis. In this article, we have summarized the role of OS in COPD pathogenesis. Furthermore, we have particularly focused on the therapeutic potential of numerous chemicals, particularly antioxidants in the treatment of COPD.

Causal Path of COPD Progression-Associated Genes in Different Biological Samples

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory disease with pulmonary and extra-pulmonary complications. Due to the disease's systemic nature, many investigations investigated the genetic alterations in various biological samples. We aimed to infer causal genes in COPD's pathogenesis in different biological samples using elastic-net logistic regression and the Structural Equation Model. Samples of small airway epithelial cells, bronchoalveolar lavage macrophages, lung tissue biopsy, sputum, and blood samples were selected (135, 70, 235, 143, and 226 samples, respectively). Elastic-net Logistic Regression analysis was implemented to identify the most important genes involved in COPD progression. Thirty-three candidate genes were identified as essential factors in the pathogenesis of COPD and regulation of lung function. Recognized candidate genes in small airway epithelial (SAE) cells have the highest area under the ROC curve (AUC = 97%, SD = 3.9%). Our analysis indicates that macrophages and epithelial cells are more influential in COPD progression at the transcriptome level.

Chronic obstructive pulmonary disease in never-smokers: risk factors, pathogenesis, and implications for prevention and treatment

Chronic obstructive pulmonary disease (COPD) was traditionally thought to be caused by tobacco smoking. However, recognition of the importance of non-smoking-related risk factors for COPD has increased over the past decade, with evidence on the burden, risk factors, and clinical presentations of COPD in never-smokers. About half of all COPD cases worldwide are due to non-tobacco-related risk factors, which vary by geographical region. These factors include air pollution, occupational exposures, poorly controlled asthma, environmental tobacco smoke, infectious diseases, and low socioeconomic status. Impaired lung growth during childhood, caused by a range of early-life exposures, is associated with an increased risk of COPD. Potential mechanisms for the pathogenesis of COPD in never-smokers include inflammation, oxidative stress, airway remodelling, and accelerated lung ageing. Compared with smokers who develop COPD, never-smokers with COPD have relatively mild chronic respiratory symptoms, little or no emphysema, milder airflow limitation, and fewer comorbidities; however, exacerbations can still be frequent. Further research-including epidemiological, translational, clinical, and implementation studies-is needed to address gaps in understanding and to advance potential solutions to reduce the burden of COPD in never-smokers.

The Protective Role of Hydrogen Sulfide and Its Impact on Gene Expression Profiling in Rat Model of COPD

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide, which is usually caused by exposure to noxious particles or gases. Hydrogen sulfide (H2S), as an endogenous gasotransmitter, is involved in the pathogenesis of COPD, but its role in COPD is little known. To investigate the role of H2S in COPD, a rat model of COPD was established by cigarette smoking (CS) and intratracheal instillation of lipopolysaccharide (LPS). Rats were randomly divided into 4 groups: control, CS + LPS, CS + LPS + sodium hydrosulfide (NaHS, H2S donor), and CS + LPS + propargylglycine (PPG, inhibitor of cystathionine-γ-lyase, and CTH). Lung function in vivo, histology analysis of lung sections, malondialdehyde (MDA) concentration, CTH protein, total superoxide dismutase (T-SOD), and catalase (CAT) activity in lung tissues were assessed. Gene expression profiling of lung was assessed by microarray analysis. The results showed that rats in the CS + LPS group had lower body weight and lung function but higher lung pathological scores, MDA concentration, CTH protein, T-SOD, and CAT activity compared with the control. Compared with CS + LPS group, NaHS treatment decreased lung pathological scores and MDA concentration, while PPG treatment decreased body weight of rats and T-SOD activity, and no significant differences were detected in pathological scores by PPG treatment. Microarray analysis identified multiple differentially expressed genes, and some genes regulated by H2S were involved in oxidative stress, apoptosis, and inflammation pathways. It indicates that H2S may play a protective role in COPD via antioxidative stress and antiapoptosis pathway.

Adverse early-life environmental exposures and their repercussions on adult respiratory health

OBJECTIVE

To review in the literature the environmental problems in early life that impact the respiratory health of adults.

SOURCES

Non-systematic review including articles in English. Search filters were not used in relation to the publication date, but the authors selected mainly publications from the last five years.

SUMMARY OF THE FINDINGS

In this review, the authors present the exposure pathways and how the damage occurs depending on the child's stage of development; the authors describe the main environmental pollutants - tobacco smoke, particulate matter, air pollution associated with traffic, adverse childhood experiences and socioeconomic status; the authors present studies that evaluated the repercussions on the respiratory system of adults resulting from exposure to adverse environmental factors in childhood, such as increased incidence of Chronic Obstructive Pulmonary Disease (COPD), asthma and allergies; and, a decline in lung function. The authors emphasize that evidence demonstrates that adult respiratory diseases almost always have their origins in early life. Finally, the authors emphasize that health professionals must know, diagnose, monitor, and prevent toxic exposure among children and women.

CONCLUSION

The authors conclude that it is necessary to recognize risk factors and intervene in the period of greatest vulnerability to the occurrence of harmful effects of environmental exposures, to prevent, delay the onset or modify the progression of lung disease throughout life and into adulthood.

The Relationship between Metal Exposure and Chronic Obstructive Pulmonary Disease in the General US Population: NHANES 2015–2016

The effects of metal on pulmonary function are inconsistent, and abnormal distribution of metals can decrease lung function. However, the effects of metals exposure on chronic obstructive pulmonary disease (COPD) are still unclear. This study aims to explore the relationship between metal exposure and COPD risk. Cross-sectional data from the National Health and Nutrition Survey (NHANES) 2015–2016 was analyzed. Inductively coupled plasma dynamic reaction cell mass spectrometry (ICP-DRC-MS) was used to measure the metals concentration in the blood. The multiple linear regression and restricted cubic spline (RCS) were used to analyze the relationship between metals exposure and COPD risk. In this study, 1399 participants were included, of which 107 participants were diagnosed with COPD using self-reported chronic bronchitis, emphysema, and COPD. The second and third tertiles of copper increased the COPD risk by 1.98-fold (95% CI: 1.08–3.62) and 2.43-fold (95% CI: 1.32–4.48) compared with the first tertile, using p = 0.005 for the trend after adjusting for the covariates. RCS showed a positive linear correlation between copper and COPD risk (p = 0.006 for overall association) in all participants. When stratified by sex, the multi-factor analysis showed that the third tertile of copper increased male’s COPD risk by 3.42-fold (95% CI: 1.52–7.76), with p = 0.003 for the trend, and RCS also showed a positive linear correlation (p = 0.013 for overall association). Although RCS showed that selenium can reduce the COPD risk (p = 0.008 for overall association) in males, an association between selenium and COPD was not observed (p > 0.05). Our findings suggest that a high concentration of copper may increase COPD risk in males in the general US population, and more research is needed to explore its possible mechanism of action.

Association between climatic factors and respiratory syncytial virus detection rates in Cheonan, Korea

The use of big data may facilitate the recognition and interpretation of causal relationships between disease occurrence and climatic variables. This study examined the effects of various climatic variables on the seasonal epidemiology of respiratory syncytial virus (RSV) infections in the temperate climate of Korea. Trends in RSV detection were analyzed using 9010 samples tested between January 1, 2012, and December 31, 2018, at Dankook University Hospital in Cheonan, Korea. Seasonal patterns in RSV detection frequency were compared with local climatic variables during the same period. RSV detection rate of 12.8% (n = 1150/9010) was observed, which was higher for RSV-A (7.1%) than RSV-B (5.8%) and RSV-A and RSV-B alternated each year. Children < 1 year exhibited high infection rates with RSV-A (68.5%) and RSV-B (58.7%). RSV-A and RSV-B infection rates in children under 9 years old were 96.2% and 92.1%, respectively. RSV had a significant relationship with several climatic factors. Air temperature, wind chill temperature, and particulate matter concentration were lower on days with a higher frequency of RSV detection. In contrast, atmospheric pressure was higher on days with lower RSV detection. Although the detection rates for RSV-A and RSV-B increased on days with lower air temperatures, those for RSV-B also increased on days with lower wind chill temperatures. Our findings suggest that climatic variables affect the RSV detection rate among children under 10 years of age. The present data may help predict the time when prevention strategies may be the most effective.

Solid Fuel Exposure and Chronic Obstructive Pulmonary Disease in Never-Smokers

Background: Chronic obstructive pulmonary disease (COPD) is a public health challenge globally. The burden of COPD is high in never-smokers but little is known about its causes. We aimed to find the prevalence and correlates of COPD in never-smokers, with a special focus on solid fuel exposure.

Methods: We conducted a cross-sectional study in Western China. COPD was defined by FEV1/FVC < lower limits of normal (LLN). Descriptive statistics and multivariable logistic regression were used for analyses.

Results: Six thousand two hundred and seventy one patients were enrolled between June 2015 and August 2016. The prevalence of COPD in never-smokers was 15.0% (95% confidence interval 14.1–15.9). The common independent predictors of COPD in never-smokers included age ≥60 years, exposure to solid fuel, living in a rural area and a history of tuberculosis. Participants with solid fuel exposure were 69% more likely to have COPD (adjusted odds ratio 1.69, 95% CI 1.41–2.04) than those without such exposure. In addition, we found a positive association between small airway dysfunction and solid fuel exposure (OR 1.35, 95% CI 1.18–1.53).

Conclusions: This study confirmed the substantial burden of COPD among never-smokers and also defined the risk factors for COPD in never-smokers. Furthermore, we found a positive association between solid fuel exposure and COPD or small airway dysfunction.

Hypermethylation of the Nrf2 Promoter Induces Ferroptosis by Inhibiting the Nrf2-GPX4 Axis in COPD

Background

Nuclear factor E2-related factor 2 (Nrf2) is involved in oxidative stress and lung inflammation and regulates the etiology of chronic obstructive pulmonary disease (COPD). Ferroptosis is characterized by the accumulation of lipid reactive oxygen species (ROS) via ferrous ion-dependent Fenton reactions and is involved in COPD. However, the role of Nrf2 in ferroptosis and its epigenetic regulation in the pathogenesis of COPD remain unclear.

Methods

Ferroptosis was detected by 4-HNE, MDA, C11BODIPY, DCFH-DA, Peals’ staining and CCK-8 assays. qPCR and Western blotting were performed to examine the Nrf2 levels in peripheral lung tissues, primary epithelial cells collected from patients with COPD and subjects with normal pulmonary function (never-smoker [control-NS]; smoker [control-S]), and cigarette smoke extract (CSE)-treated human bronchial epithelial (HBE) cells. ELISA was used to quantify IL-8 and IL-1β levels. Methylation of the Nrf2 promoter was analyzed by bisulfite sequencing and pyrosequencing.

Results

Ferroptosis was involved in COPD and glutathione peroxidase 4 (GPX4) expression was downregulated in the COPD group. Reactive oxygen species (ROS), lipid peroxides and MDA were increased, but GPX4 and SOD were exhausted in CSE-treated HBE cells. The production of IL-1β and IL-8 was promoted in HBE cells in response to CSE but could be reversed by the ferroptosis inhibitor fer-1. The Nrf2 level was significantly decreased in the COPD group compared with the control-S and control-NS groups. Increased Nrf2 expression enhanced GPX4 and SOD levels and inhibited ferroptosis and proinflammatory cytokines in the supernatant. Inhibition of GPX4 reversed the effect of Nrf2 overexpression and promoted ferroptosis. Two specific CpG sites within the Nrf2 promoter were hypermethylated in the COPD group. Similarly, CSE-treated HBE cells exhibited hypermethylation of the Nrf2 gene.

Conclusion

Nrf2 expression was downregulated in the lungs of COPD patients due to hypermethylation of the Nrf2 promoter, inhibiting Nrf2/GPX4 and ferroptosis, which is related to the initiation and progression of COPD. Targeting Nrf2/GPX4 may inhibit ferroptosis, which could provide strategies to delay or treat COPD.

Transient Ascaris suum larval migration induces intractable chronic pulmonary disease and anemia in mice

Ascariasis is one of the most common infections in the world and associated with significant global morbidity. Ascaris larval migration through the host’s lungs is essential for larval development but leads to an exaggerated type-2 host immune response manifesting clinically as acute allergic airway disease. However, whether Ascaris larval migration can subsequently lead to chronic lung diseases remains unknown. Here, we demonstrate that a single episode of Ascaris larval migration through the host lungs induces a chronic pulmonary syndrome of type-2 inflammatory pathology and emphysema accompanied by pulmonary hemorrhage and chronic anemia in a mouse model. Our results reveal that a single episode of Ascaris larval migration through the host lungs leads to permanent lung damage with systemic effects. Remote episodes of ascariasis may drive non-communicable lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), and chronic anemia in parasite endemic regions.

Ascariasis is the most common helminth infection and leads to significant global morbidity. Transient Ascaris larval migration through the host’s lungs is essential for larval development but leads to an exaggerated type-2 host immune response. Our work demonstrates that transient Ascaris spp. larval migration through the lungs has significant long-term consequences including changes in lung structure and function as well as vascular damage causing chronic lung disease and anemia. We propose that Ascaris spp. larval migration through the host lungs is a risk factor for the development of chronic lung disease and anemia in parasite-endemic regions globally.

Long-term neurodevelopment outcomes of hand, foot and mouth disease inpatients infected with EV-A71 or CV-A16, a retrospective cohort study

Hand, foot and mouth disease (HFMD) is a common infectious disease in western Asia area and the full range of the long-term sequelae of HFMD remains poorly described. We conducted a retrospective hospital-based cohort study of HFMD patients with central nervous system (CNS) complications caused by EV-A71 or CV-A16 between 2010 and 2016. Patients were classified into three groups, including CNS only, autonomic nervous system (ANS) dysregulation, and cardiorespiratory failure. Neurologic examination, neurodevelopmental assessments, Magnetic Resonance Imaging (MRI) and lung function, were performed at follow up. Of the 176 patients followed up, 24 suffered CNS only, 133 ANS dysregulation, and 19 cardiorespiratory failure. Median follow-up period was 4.3 years (range [1.4-8.3]). The rate of neurological abnormalities was 25% (43 of 171) at discharge and 10% (17 of 171) at follow-up. The rates of poor outcome were significantly different between the three groups of complications in motor (28%, 38%, 71%) domain (p=0.020), but not for cognitive (20%, 24%, 35%), language (25%, 36%, 41%) and adaptive (24%, 16%, 26%) domains (p = 0.537, p = 0.551, p = 0.403). For children with ventilated during hospitalization, 41% patients (14 of 34) had an obstructive ventilatory defect, and one patient with scoliosis had mixed ventilatory dysfunction. Persistent abnormalities on brain MRI were 0% (0 of 7), 9% (2 of 23) and 57% (4 of 7) in CNS, ANS and cardiorespiratory failure group separately. Patients with HFMD may have abnormalities in neurological, motor, language, cognition, adaptive behaviour and respiratory function. Long-term follow-up programmes for children's neurodevelopmental and respiratory function may be warranted.

Genes, environment, and developmental timing: New insights from translational approaches to understand early origins of respiratory diseases

Over the past decade, "omics" approaches have advanced our understanding of the molecular programming of the airways in humans. Several studies have identified potential molecular mechanisms that contribute to early life epigenetic reprogramming, including DNA methylation, histone modifications, microRNAs, and the homeostasis of the respiratory mucosa (epithelial function and microbiota). Current evidence supports the notion that early infancy is characterized by heightened susceptibility to airway genetic reprogramming in response to the first exposures in life, some of which can have life-long consequences. Here, we summarize and analyze the latest insights from studies that support a novel epigenetic paradigm centered on human maturational and developmental programs including three cardinal elements: genes, environment, and developmental timing. The combination of these factors is likely responsible for the functional trajectory of the respiratory system at the molecular, functional, and clinical levels.

Machine Learning Methods for the Diagnosis of Chronic Obstructive Pulmonary Disease in Healthy Subjects: Retrospective Observational Cohort Study

BACKGROUND

Airflow limitation is a critical physiological feature in chronic obstructive pulmonary disease (COPD), for which long-term exposure to noxious substances, including tobacco smoke, is an established risk. However, not all long-term smokers develop COPD, meaning that other risk factors exist.

OBJECTIVE

This study aimed to predict the risk factors for COPD diagnosis using machine learning in an annual medical check-up database.

METHODS

In this retrospective observational cohort study (ARTDECO [Analysis of Risk Factors to Detect COPD]), annual medical check-up records for all Hitachi Ltd employees in Japan collected from April 1998 to March 2019 were analyzed. Employees who provided informed consent via an opt-out model were screened and those aged 30 to 75 years without a prior diagnosis of COPD/asthma or a history of cancer were included. The database included clinical measurements (eg, pulmonary function tests) and questionnaire responses. To predict the risk factors for COPD diagnosis within a 3-year period, the Gradient Boosting Decision Tree machine learning (XGBoost) method was applied as a primary approach, with logistic regression as a secondary method. A diagnosis of COPD was made when the ratio of the prebronchodilator forced expiratory volume in 1 second (FEV₁) to prebronchodilator forced vital capacity (FVC) was <0.7 during two consecutive examinations.

RESULTS

Of the 26,101 individuals screened, 1213 met the exclusion criteria, and thus, 24,815 individuals were included in the analysis. The top 10 predictors for COPD diagnosis were FEV₁/FVC, smoking status, allergic symptoms, cough, pack years, hemoglobin A_1c, serum albumin, mean corpuscular volume, percent predicted vital capacity, and percent predicted value of FEV₁. The areas under the receiver operating characteristic curves of the XGBoost model and the logistic regression model were 0.956 and 0.943, respectively.

CONCLUSIONS

Using a machine learning model in this longitudinal database, we identified a number of parameters as risk factors other than smoking exposure or lung function to support general practitioners and occupational health physicians to predict the development of COPD. Further research to confirm our results is warranted, as our analysis involved a database used only in Japan.

Early chronic obstructive pulmonary disease: A new perspective

Chronic obstructive pulmonary disease (COPD) is a respiratory disease with a high incidence, mortality, and disability rate. Because there are few symptoms in the early stages of COPD, diagnosis and treatment are seriously insufficient. It is necessary to find effective clues for early COPD diagnosis and provide appropriate interventions. Several studies suggest that small airway disease is the earliest stage of COPD because it is correlated with subsequent development of airflow obstruction. However, there are currently no globally accepted criteria for defining early COPD. This study mainly introduced risk factors, definition, diagnosis, and treatment of early COPD from a new perspective.

Childhood Origins of Adult Lung Disease as Opportunities for Prevention

Prenatal and childhood exposures have been shown to impact lung development, lung function trajectory, and incidence and prevalence of respiratory disease. Early life may serve as a window of susceptibility to such exposures, with the potential to influence lifelong respiratory health. Risk factors encountered in early life with potentially durable impact on lung health include prematurity, respiratory viral illness, allergen sensitization and exposure, tobacco use and exposure, indoor and outdoor pollution, diet, and obesity. These exposures vary in the extent to which they are modifiable, and interventions aimed at reducing harmful exposures range from individual-level behavior modification to policy initiatives implemented to promote population health. For many exposures, including tobacco-related exposures, multilevel interventions are needed. Future research is needed to provide insight as to early-life interventions to promote optimal lung growth and prevent development of chronic respiratory disease. Clinicians should play an active role, assisting individual patients in avoiding known detrimental exposures including maternal smoking during pregnancy and initiation of active smoking. Clinicians can be empowered by evidence to support policies promoting reduction of population-level risk factors, such as restriction on electronic cigarette sales and legislation to uphold air quality standards, to encourage attainment of maximal lung function and reduce risk of chronic lung disease.

The Prevalence of Chronic Obstructive Pulmonary Disease (COPD) and the Heterogeneity of Risk Factors in the Canadian Population: Results from the Canadian Obstructive Lung Disease (COLD) Study

Purpose

To determine the spirometric-based prevalence of COPD across different regions in Canada and to evaluate the site heterogeneity of risk factors.

Patients and Methods

In this cross-sectional, population-based study, random samples of non-institutionalized adults aged ≥40 years were generated by random digit dialling. Participants answered an interviewer-administered questionnaire and performed spirometry before and after bronchodilator administration. COPD was defined as post-bronchodilator FEV₁/FVC <0.70 (fixed ratio, FR) and as FEV₁/FVC <5th percentile (lower limits of normal, LLN). Separate logistic regression models were used to compute the risk (adjusted odds ratio, aOR) for COPD. I² and Tau² analyses were used to evaluate heterogeneity.

Results

Out of 5176 (95%) participants, 4893 (47% male with mean age 56.6 years (95% confidence interval, 56.0-57.2)) had spirometry that satisfied ATS criteria. The population prevalence of COPD was 16.2% (95% CI, 14.5-17.8) by FR and 11.2% (95% CI, 9.7-12.6) by LLN. Male predominance in prevalence was shown by FR but not by LLN criteria. Patient characteristics associated with an increased risk of COPD included: age (OR 1.56; 95% CI 1.33-1.84); history of physician-diagnosed asthma (OR 3.30; 95% CI 2.42-4.49); and childhood hospitalization for respiratory illness (OR 1.81; 95% CI 1.17-2.80). In terms of smoking-related risk factors, current smoking status had the highest odds ratio (OR 3.49; 95% CI 2.55-4.80). Variance in prevalence among sites was significantly reduced by adjusting for risk factors in Tau² analyses. Higher odds of exposure for each risk factor was found in more severe COPD, suggesting that a higher risk could be linked to the development of severe disease.

Conclusion

This study reports the population prevalence of COPD in nine urban cities which collectively represent the majority of the Canadian population and demonstrates that heterogeneity in prevalence among sites is substantially explained by variation in associated risk factors for COPD.

Occupational exposures and exacerbations of asthma and COPD-A general population study

Purpose

Recent studies suggest that occupational inhalant exposures trigger exacerbations of asthma and chronic obstructive pulmonary disease, but findings are conflicting.

Methods

We included 7,768 individuals with self-reported asthma (n = 3,215) and/or spirometric airflow limitation (forced expiratory volume in 1 second (FEV₁)/ forced expiratory volume (FVC) <0.70) (n = 5,275) who participated in The Copenhagen City Heart Study or The Copenhagen General Population Study from 2001–2016. Occupational exposure was assigned by linking job codes with job exposure matrices, and exacerbations were defined by register data on oral corticosteroid treatment, emergency care unit assessment or hospital admission. Associations between occupational inhalant exposure each year of follow-up and exacerbation were assessed by Cox regression with time varying exposure and age as the underlying time scale.

Results

Participants were followed for a median of 4.6 years (interquartile range, IQR 5.4), during which 870 exacerbations occurred. Exacerbations were not associated with any of the selected exposures (high molecular weight sensitizers, low molecular weight sensitizers, irritants or low and high levels of mineral dust, biological dust, gases & fumes or the composite variable vapours, gases, dusts or fumes). Hazards ratios ranged from 0.8 (95% confidence interval: 0.7;1.0) to 1.2 (95% confidence interval: 0.9;1.7).

Conclusion

Exacerbations of obstructive airway disease were not associated with occupational inhalant exposures assigned by a job exposure matrix. Further studies with alternative exposure assessment are warranted.

Prevalence and Risk Factors for COPD at High Altitude: A Large Cross-Sectional Survey of Subjects Living Between 2,100-4,700 m Above Sea Level

Aim of Study: Four hundred million people live at high altitude worldwide. Prevalence and risk factors for COPD in these populations are poorly documented. We examined the prevalence and risk factors for COPD in residents living at an altitude of 2,100–4,700 m.

Methods: We performed a cross-sectional survey in Xinjiang and Tibet autonomous region. A multistage stratified sampling procedure was used to select a representative population aged 15 years or older from eight high altitude regions. All participants underwent pre- and post-bronchodilator measurement of forced expiratory volumes. COPD was diagnosed according to 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria.

Results: Between June, 2015 and August 2016, 4,967 subjects were included. Median age was 38.0 years (range: 15–91 years; inter-quartile range: 28–49 years); 51.4% participants were female. Overall prevalence of spirometry-defined COPD was 8.2% (95% CI 7.4–8.9%): 9.3% in male (95% CI 8.2–10.4%), and 7.1% in female (95% CI 6.1–8.2%). By multivariable logistic regression analysis, COPD was significantly associated with being aged ≥40 years (odds ratio: 2.25 [95% CI 1.72–2.95], P < 0.0001), exposure to household air pollution (OR: 1.34 [95% CI 1.01–1.79], P = 0.043), and a history of tuberculosis (OR: 1.79 [95% CI 1.23–2.61], P = 0.030), while living at a higher altitude (OR: 0.45 [95% CI 0.33–0.61], P < 0.0001) and having a higher educational level (OR: 0.64 [95% CI 0.43–0.95], P = 0.025) were associated with a lower prevalence of COPD.

Conclusions: Our results show that the spirometry-defined COPD is a considerable health problem for residents living at high altitudes and COPD prevalence was inversely correlated with altitude. Preventing exposure to household air pollution and reducing the incidence of tuberculosis should be public health priorities for high altitude residents.

Development of the Advancing the Patient Experience in COPD Registry: A Modified Delphi Study

Background

Chronic obstructive pulmonary disease (COPD) is commonly managed by family physicians, but little is known about specifics of management and how this may be improved. The Advancing the Patient Experience in COPD (APEX COPD) registry will be the first U.S. primary care, health system-based registry following patients diagnosed with COPD longitudinally, using a standardized set of variables to investigate how patients are managed in real life and assess outcomes of various management strategies.

Objective

Gaining expert consensus on a standardized list of variables to capture in the APEX COPD registry.

Methods

A modified, Delphi process was used to reach consensus on which data to collect in the registry from electronic health records (EHRs), patient-reported information (PRI) and patient-reported outcomes (PRO), and by physicians during subsequent office visits. The Delphi panel comprised 14 primary care and specialty COPD experts from the United States and internationally. The process consisted of 3 iterative rounds. Responses were collected electronically.

Results

Of the initial 195 variables considered, consensus was reached to include up to 115 EHR variables, 34 PRI/PRO variables and 5 office-visit variables in the APEX COPD registry. These should include information on symptom burden, diagnosis, COPD exacerbations, lung function, quality of life, comorbidities, smoking status/history, treatment specifics (including side effects), inhaler management, and patient education/self-management.

Conclusion

COPD experts agreed upon the core variables to collect from EHR data and from patients to populate the APEX COPD registry. Data will eventually be integrated, standardized and stored in the APEX COPD database and used for approved COPD-related research.

Prevalence of COPD by age, sex, socioeconomic position and smoking status; a cross-sectional study

Purpose

The purpose of this study is to calculate gender and socioeconomic status (SES) inequalities in chronic obstructive pulmonary disease (COPD) in Greater Glasgow and Clyde and measure the proportion of inequalities explained by smoking.

Design/methodology/approach

Medical records until May 2016 were linked to mortality data to measure COPD prevalence. Population estimates for smoking status were calculated by merging three (2013–2015) Scottish Household Survey rounds. Poisson regression was carried out to analyse the relationship between SES and gender inequalities in COPD, and smoking.

Findings

Crude COPD prevalence for ages 16+ years was 3.29% and for ages 45 years+ was 6.26%, and higher in females than males. Adjusting for age and sex, prevalence of COPD in the most deprived quintile was 4.5 times of that in the least deprived. Adjustment for smoking explains almost half of the relative difference between Scottish Indicator for Multiple Deprivation (SIMD) 1 (least affluent quintile of deprivation) and SIMD 5 (most affluent quintile) and a fifth of the absolute difference. There is a higher risk of COPD among male non-smokers than female, but among smokers the risk is greater for females than males.

Research limitations/implications

Risk factors specific to respiratory health beyond smoking and common risk factors of morbidity more generally should be considered in understanding inequalities in COPD.

Originality/value

Prevalence of COPD is higher than previously thought. Smoking explains less than half of inequalities in COPD. Gender inequalities in COPD are dependent on smoking status and the smoking indicator used.

Progress in the mechanism and targeted drug therapy for COPD

Chronic obstructive pulmonary disease (COPD) is emphysema and/or chronic bronchitis characterised by long-term breathing problems and poor airflow. The prevalence of COPD has increased over the last decade and the drugs most commonly used to treat it, such as glucocorticoids and bronchodilators, have significant therapeutic effects; however, they also cause side effects, including infection and immunosuppression. Here we reviewed the pathogenesis and progression of COPD and elaborated on the effects and mechanisms of newly developed molecular targeted COPD therapeutic drugs. Among these new drugs, we focussed on thioredoxin (Trx). Trx effectively prevents the progression of COPD by regulating redox status and protease/anti-protease balance, blocking the NF-κB and MAPK signalling pathways, suppressing the activation and migration of inflammatory cells and the production of cytokines, inhibiting the synthesis and the activation of adhesion factors and growth factors, and controlling the cAMP-PKA and PI3K/Akt signalling pathways. The mechanism by which Trx affects COPD is different from glucocorticoid-based mechanisms which regulate the inflammatory reaction in association with suppressing immune responses. In addition, Trx also improves the insensitivity of COPD to steroids by inhibiting the production and internalisation of macrophage migration inhibitory factor (MIF). Taken together, these findings suggest that Trx may be the ideal drug for treating COPD.

Diagnosis and Treatment of Early Chronic Obstructive Lung Disease (COPD)

Chronic obstructive lung disease (COPD) is responsible for substantial rates of mortality and economic burden, and is one of the most important public-health concerns. As the disease characteristics include irreversible airway obstruction and progressive lung function decline, there has been a great deal of interest in detection at the early stages of COPD during the “at risk” or undiagnosed preclinical stage to prevent the disease from progressing to the overt stage. Previous studies have used various definitions of early COPD, and the term mild COPD has also often been used. There has been a great deal of recent effort to establish a definition of early COPD, but comprehensive evaluation is still required, including identification of risk factors, various physiological and radiological tests, and clinical manifestations for diagnosis of early COPD, considering the heterogeneity of the disease. The treatment of early COPD should be considered from the perspective of prevention of disease progression and management of clinical deterioration. There has been a lack of studies on this topic as the definition of early COPD has been proposed only recently, and therefore further clinical studies are needed.

Lung ultrasound findings in pediatric community-acquired pneumonia requiring surgical procedures: a two-center prospective study

BACKGROUND

Lung ultrasound (US) in the evaluation of suspected pediatric pneumonia is increasingly used and has a recognized role in evaluating pleural effusions, although there are no detailed studies specifically addressing its use in the pediatric population.

OBJECTIVES

To define lung US findings of severe pediatric community-acquired pneumonia that required surgical procedures during admission.

MATERIALS AND METHODS

Our prospective case-control study compared lung US findings in patients ages 1 month to 17 years admitted with community-acquired pneumonia that required surgical procedures from findings those who did not. Lung US was performed at admission and always before surgical procedures. Medical treatment, laboratory and microbiological findings, chest X-ray, computed tomography scan and surgical procedures are described.

RESULTS

One hundred twenty-one children with community-acquired pneumonia were included; of these, 23 underwent surgical intervention. Compared with the control group, children requiring a surgical procedure had a significantly higher rate of large consolidations (52.2%; 95% confidence interval [CI]: 30.6% to 73.2%), larger and complicated pleural effusions (100%; 95% CI: 85.2% to 100%), and both liquid and air bronchograms (73.9%; 95% CI: 51.6% to 89.8%).

CONCLUSION

Larger consolidations, larger and more complicated pleural effusions, and liquid and air bronchograms were associated with surgical treatment.