Definition and Nomenclature of Chronic Obstructive Pulmonary Disease: Time for Its Revision

Childhood respiratory risk profiles associate with lung function and COPD among the old population

BACKGROUND

Childhood, often characterized by multiple concurrent risk factors, holds significant influence over long-term respiratory outcomes, with the intricate interplay among these factors representing an intriguing but underexplored avenue for research. We aimed to determine if respiratory risk factors during childhood affect lung function and chronic obstructive pulmonary disease (COPD) in old age.

METHODS

Participants were drawn from the Health and Retirement Study cohort. Latent class analysis (LCA) was applied with six variables used to develop the early-life respiratory risk profiles. Linear regressions and logistic regressions were used to assess the associations between childhood respiratory risk profiles and lung function, including peak expiratory flow (PEF) value, PEF value <80% of the predicted value and COPD.

RESULTS

A total of 12,296 participants (5017 males and 7279 females) with an average age of 68 years were recruited. We identified six distinct childhood respiratory risk profiles: (1) 'Asthma and respiratory disorders in early childhood' (n = 241, 1.96%), (2) 'Unexposed or least exposed' (n = 3874, 31.51%), (3) 'Smokers at home' (n = 7609, 61.88%), (4) 'Ear problems and respiratory disorders in early childhood' (n = 162, 1.32%), (5) 'Allergic conditions and respiratory disorders in early childhood' (n = 220, 1.79%) and (6) 'Allergic conditions and respiratory disorders in later childhood' (n = 190, 1.55%). Profile 2 served as the reference. The highest reduction of PEF was seen for profile 1 (-30.07 L/min), followed by profile 6 (-22.24 L/min) and profile 5 (-18.47 L/min). Profile 6, profile 3 and profile 1 related to 1.98-, 1.52- and 1.66-fold increased risks of diminished PEF values, respectively. The highest risk of COPD was observed in profile 5 (aOR = 4.16, 95% CI: 3.75-4.57), followed by profile 6 (aOR = 4.10, 3.69-4.51), profile 4 (aOR = 3.70, 3.25-4.15), profile 1 (aOR = 3.46, 3.07-3.85) and profile 3 (aOR = 1.41, 1.25-1.57).

CONCLUSIONS

People exposed to early-life respiratory challenges experienced larger declines in lung function and increased risks of COPD later in life. Our findings underscore the importance of early-life respiratory health in shaping lung function trajectories.

The value of extra-diaphragmatic inspiratory muscle surface electromyography during postural control tasks in patients with chronic obstructive pulmonary disease

Concurrent dysfunctions in postural control and diaphragm are observed in patients with chronic obstructive pulmonary disease (COPD). Measuring diaphragm activation traditionally involves transesophageal diaphragm electromyography (EMGdi), which is costly and relatively invasive. Extra-diaphragmatic inspiratory muscle surface electromyography may serve as a useful physiological marker for EMGdi. This study compared EMGdi amplitude with surface EMG amplitude of other inspiratory muscles, including sternocleidomastoid (sEMGscm), scalene (sEMGscal), and parasternal intercostal muscles (sEMGic) during postural control tasks in nine patients with COPD (5 males; age: 65 ± 6 years; forced expiratory volume in the first second: 60 ± 27 % predicted). Simultaneous recordings of EMGdi, sEMGscm, sEMGscal, and sEMGic amplitudes were obtained during six postural control tasks involving upright standing with ballistic arm movements under different conditions of support surface (stable/foam), arm movement frequency (single/repetitive), and breathing modes (normal/breath-hold at end-expiration). EMG amplitudes were normalized to each muscle's maximum voluntary contraction. A linear mixed model with Bonferroni-Holm post-hoc tests and Bland-Altman analyses were performed. There was a significant EMG-by-task interaction (p = 0.0223). The amplitude of EMGdi was significantly lower than sEMGic across all tasks (p < 0.0001 to 0.0007), while no significant differences were observed between EMGdi and sEMGscm or EMGdi and sEMGscal after Bonferroni-Holm correction (p = 0.019-0.858). Bland-Altman analyses indicated reasonable agreement between EMGdi and both sEMGscm and sEMGscal (mean biases: 1.8 % and -3.7 %), while sEMGic had a significantly higher overall bias of -20.7 %. These findings suggest that both sEMGscal and sEMGscm can serve as useful physiological markers for EMGdi in postural control assessments in patients with COPD. NEW & NOTEWORTHY. This study highlights the potential of extra-diaphragmatic inspiratory muscle surface electromyography as a physiological marker for transesophageal diaphragm electromyography during postural control tasks in patients with COPD, thereby reducing the need for costly and invasive measurements.

ASK1 inhibition by selonsertib attenuates elastase-induced emphysema in mice

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with its most severe form being pulmonary emphysema, for which no effective treatment currently exists. Apoptosis signal-regulating kinase 1 (ASK1) has been implicated in lung inflammation and injury. Here, we investigated the experimental treatment of elastase-induced emphysema in mice with selonsertib, an ASK1 inhibitor. Animals received intratracheal elastase and were subsequently treated with intranasal selonsertib at different doses. On day 21, bronchoalveolar lavage fluid and lung tissues were collected for histological and biochemical analyses. Results showed that elastase-instilled mice developed pulmonary emphysema, whereas treatment with selonsertib at a dose of 2 mg/kg significantly reduced mean alveolar diameter. Moreover, higher doses of selonsertib were effective in reducing inflammatory cytokines (CX3CL1, IL-6, CCL2, and IL-1β), reactive oxygen species, and apoptosis. These findings suggest that ASK1 plays a critical role in the development of elastase-induced emphysema in mice and could be a target for COPD treatment.

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prognostic risk profiling in COPD using Global Initiative for Chronic Obstructive Lung Disease 2023 ABE and comorbidity assessment: evidence from a register-based COPD cohort

Background

While the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 ABE classification system guides initial chronic obstructive pulmonary disease (COPD) treatment, patient heterogeneity and comorbidities complicate management. We investigated how the GOLD 2023 ABE classification and aligned comorbidity profiles affect patient outcomes in real-world Asian populations with COPD.

Methods

We conducted a register-based cohort study of 38 928 patients from multiple institutions across Taiwan (from April 2017 to December 2021). We classified patients by GOLD 2023 ABE categories. Data included demographics, Charlson comorbidity index (CCI)-defined comorbidities, treatment, symptoms, questionnaires, spirometry, and outcomes.

Results

Among COPD patients, 89.2% were males, and the median age was 71 years. Groups A comprised 30.2%, group B 46.4%, and group E 23.5% of patients. Among these, 28.3% of group A patients used inhaled corticosteroid-containing inhalers. Group E had the highest rates of GOLD 4 airway obstruction (11.8%), CCI score ≥4 (15.6%), and five-year mortality rate (22.6%). Group E demonstrated the highest risk of all-cause mortality (hazard ratio (HR) = 1.727; 95% confidence interval (CI) = 1.605-1.858) and moderate-to-severe exacerbation (HR = 2.127; 95% CI = 1.942-2.330) vs. group A. Key comorbidities, acute myocardial infarction (HR = 1.257; 95% CI = 1.057-1.430), congestive heart failure (HR = 1.836; 95% CI = 1.707-1.909), and pulmonary disease (HR = 1.071; 95% CI = 1.011-1.129), were associated with higher mortality. Acute myocardial infarction (HR = 1.251; 95% CI = 1.031-1.444), congestive heart failure (HR = 1.193; 95% CI = 1.089-1.285), and pulmonary disease (HR = 1.491; 95% CI = 1.405-1.550) were also associated with higher exacerbations, with patterns varying across GOLD groups.

Conclusions

In this large registry-based cohort, group E patients demonstrated the highest mortality and exacerbation risks. Cardiovascular and pulmonary comorbidities increased adverse outcome risks across all GOLD categories. Systematic comorbidity screening should be integrated into routine COPD care. Findings support personalised treatment approaches based on GOLD classification and comorbidity profiles.

Comparative Efficacy of Nutritional Supplements in Modulating Lung Function and Exercise Capacity in COPD Patients: A Network Meta-Analysis

Objective

To compare the effects of nutritional supplements on lung function and exercise tolerance in chronic obstructive pulmonary disease (COPD).

Methods

We searched PubMed, Embase, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) on nutritional supplements in COPD patients, with the search ending December 31, 2023. Two authors independently screened studies, extracted data, and assessed quality using the Cochrane risk of bias tool. Data were analyzed using RevMan 5.4 and R 4.2.3.

Results

Forty-eight studies with 2481 COPD patients were included. Network meta-analysis showed six supplements significantly improved the 6-minute walk distance (6MWD) (all p<0.05), with the top three being: Coenzyme Q10+ Creatine [MD=63, 95% CI (36, 90)], L-carnitine [MD=53, 95% CI (24, 82)], and anabolic steroids [MD=44, 95% CI (7.1, 82)]. Four supplements improved FEV1%(all p<0.05): nanocurcumin [MD=13, 95% CI (7.7, 18)], Vitamin D [MD=7.5, 95% CI (5.1, 9.9)], probiotics [MD=7.1, 95% CI (5.2, 9.1)] and BSO [MD=4.9, 95% CI (1.6, 8.3)]. In pairwise comparisons, nanocurcumin outperformed BSO and Probiotics. Nanocurcumin [MD=12, 95% CI (4.6, 19), p<0.05] improved FEV1/FVC, and nitrate [MD=26, 95% CI (9.7, 42), p<0.05] was effective for the Incremental Shuttle Walk Test (ISWT). Traditional Chinese Medicine (TCM) products [MD=-1.3, 95% CI (-1.9, -0.67)], melatonin (MLT) [MD=-0.9, 95% CI (-1.6, -0.21)] and Calcitriol [MD=-0.66, 95% CI (-0.93, -0.39)] improved the modified Medical Research Council(mMRC) dyspnea score (all p<0.05), with comparable efficacy among them.

Conclusion

Nutritional supplements improve lung function and exercise endurance in COPD. Coenzyme Q10+Creatine is most effective for endurance, while Nanocurcumin has the greatest impact on lung function.

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

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

Plasma proteins and different onset subtype of COPD: Proteome-wide Mendelian randomization study and co-localization analyses

Several studies have reported a strong association between plasma proteins and chronic obstructive pulmonary disease (COPD). However, the directionality and causality of the association and whether proteins effected COPD remain unclear. Therefore, we used Proteome-wide Mendelian randomization (MR) study and co-localization analyses to estimate the casual relationship between them. Summary-level data of 2923 plasma protein levels were extracted from a large-scale protein quantitative trait loci study including 54,219 individuals by the UK Biobank Pharma Proteomics Project. The outcome data for COPD and its subtypes were sourced from the FinnGen study. MR analysis was conducted to estimate the associations between protein and COPD and its subtypes risk. Additionally, phenome-wide MR analysis, and candidate drug prediction were employed to identify potential causal circulating proteins and novel drug targets. STROBE MR guidelines are followed for the study. We assessed the effect of 1929 plasma proteins on COPD. We found that Seven proteins, 4 proteins, and 3 proteins were associated with overall COPD, early-onset COPD, and later-onset COPD risk, respectively. MHC class I polypeptide-related sequence B_A (MICB_MICA) and tyrosine-protein kinase receptor tie-1 (TIE-1) would increase 8% and 27% COPD risk (MICB_MICA: odds ratios [OR], 1.08; 95% CI, 1.05-1.10; PFDR = 2.53 × 10-5; TIE-1: OR, 1.27; 95% CI, 1.13-1.43; PFDR = .012). There was negative association of Septin-8 and Butyrophilin subfamily 1 member A1 (BTN1A1) with overall COPD risk (Septin-8: OR, 0.68; 95% CI, 0.57-0.79; PFDR = 8.00 × 10-4 BTN1A1: OR, 0.82; 95% CI, 0.75-0.90; PFDR = .010). There was a protective effect of BTN1A1 on early COPD incidence (OR, 0.72; 95% CI, 0.63-0.83; PFDR = .002). However, there was no evidence indicating a shared causal variant between the other proteins and COPD and its subtypes in these regions (all posterior probability.H4 < .8). The study revealed the causal relationship between several plasma proteins and COPD and its subtypes, providing new theoretical support for understanding COPD.

Gender, tobacco and chronic obstructive pulmonary disease: analysis of the 2020 National Health Interview Survey

RATIONALE

Recent studies describe an increasing prevalence of chronic obstructive pulmonary disease (COPD) and higher COPD exacerbation rates among women compared with men despite lower average cigarette use, which has raised the question of whether women are more susceptible to the effects of tobacco smoke. We examined associations between gender, cigarette smoking and COPD in a national dataset.

METHODS

We used cross-sectional data for US respondents aged ≥40 years from the 2020 National Health Interview Survey (NHIS). Weighted multivariable logistic regressions assessed the relationship between gender and respondent-reported physician-diagnosed COPD, adjusting for tobacco use and sociodemographic covariates. Additional analyses were performed to determine if the relationship between cigarette smoking and COPD was modified by gender.

RESULTS

Women had a higher COPD prevalence (7.8%) than men (6.5%) despite lower cigarette smoke exposure. Women were less likely to have ever smoked, and among respondents who had smoked, women had a lower average pack-year history compared with men. In multivariable regressions, female gender was associated with a higher risk of COPD (adjusted risk ratio 1.47, 95% CI 1.30 to 1.65) and the relative risk was similar for respondents both with and without a history of smoking. Moreover, there was no significant interaction between gender and smoking status or gender and pack-year exposure relating to COPD prevalence.

CONCLUSIONS

Among adults aged ≥40 years, women had a roughly 50% greater risk of COPD than men. Higher susceptibility to cigarette smoking in women did not explain the difference.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effect of Qingjin Huatan decoction on pulmonary function and inflammatory mediators in stable chronic obstructive pulmonary disease: A systematic review and meta-analysis

BACKGROUND

The inflammatory response is the main pathophysiological basis of stable chronic obstructive pulmonary disease (COPD). It is a key factor that leads to frequent exacerbations and disease progression. Suppressing the inflammatory response can improve pulmonary function, prognosis, and quality of life in stable COPD patients.

OBJECTIVE

To evaluate the effect of Qingjin Huatan decoction (QJHTD) on pulmonary function and inflammatory mediators in stable COPD patients.

METHODS

Randomized controlled trials (RCTs) on the treatment of stable COPD with QJHTD were retrieved from nine Chinese and English electronic databases up to June 30, 2024. The quality of the studies was assessed using the Cochrane Risk of Bias Tool and the modified Jadad scale. Statistical analysis, sensitivity analysis, and publication bias assessment were performed using Stata 17.0 software.

RESULTS

A total of 16 RCTs involving 1,228 stable COPD patients were included. Compared to standard treatment, QJHTD significantly improved pulmonary function, with increases in FEV1 (MD = 0.32, 95% CI [0.25, 0.38], p = 0.000), FVC (MD = 0.30, 95% CI [0.22, 0.37], p = 0.000), FEV1/FVC (MD = 5.58, 95% CI [4.81, 6.34], p = 0.000), and PaO2 (MD = 9.62, 95% CI [6.17, 13.08], p = 0.000), and a decrease in PaCO2 (MD = -9.12, 95% CI [-11.96, -6.28], p = 0.000). QJHTD also significantly suppressed the expression of inflammatory mediators, including TNF-α (MD = -7.47, 95% CI [-10.59, -4.34], p = 0.000), IL-6 (MD = -4.33, 95% CI [-6.17, -2.48], p = 0.000), and hs-CRP (MD = -9.11, 95% CI [-11.02, -7.20], p = 0.000). Additionally, QJHTD improved clinical efficacy (RR = 4.60, 95% CI [3.09, 6.86], p = 0.000) without increasing the incidence of adverse reactions (RR = 1.60, 95% CI [0.69, 2.46], p = 0.42).

CONCLUSION

The current evidence suggests that QJHTD, as an adjunct therapy to standard treatment, may significantly improve pulmonary function, reduce inflammatory mediators, and enhance clinical efficacy in patients with stable COPD, with a favorable safety profile. However, these findings should be interpreted with caution due to several limitations, including small sample sizes, high heterogeneity among studies, and methodological weaknesses such as lack of blinding. More rigorously designed, high-quality, multicenter trials are needed to confirm these results.

Increasing Quality and Quantity of Life in Individuals with Chronic Obstructive Pulmonary Disease: A Narrative Review with an Emphasis on Pulmonary Rehabilitation

Goals of medical management of individuals with chronic obstructive pulmonary disease (COPD) should be to live better and live longer-in other words, improve health-related quality of life (HRQL) and survival. This narrative review summarizes the literature in these areas, with an emphasis on pulmonary rehabilitation (PR). Treatments that increase HRQL include pharmacologic agents, exercise training, physical activity promotion, lung volume reduction, PR, self-management training, and supplemental oxygen. Additionally, anything that reduces the frequency or impact of exacerbations substantially increases HRQL. With respect to survival in COPD, the list of beneficial interventions for this outcome is considerably more limited. Supplemental oxygen therapy for hypoxemic patients, smoking cessation interventions, influenza vaccination, and lung volume reduction procedures have the strongest evidence in survival benefit. PR, especially when provided following discharge for exacerbations, may improve survival. A nihilistic view of COPD treatment is unwarranted, as multiple interventions are available that improve HRQL, and likely increase survival for selected patients.

Assessing the Causal Relationship between Chronic Obstructive Pulmonary Disease and Tuberculosis: A Mendelian Randomization Study

Background

Chronic obstructive pulmonary disease (COPD) and tuberculosis are both significant global public health challenges. The co-occurrence of these two diseases is frequently observed in clinical settings. However, their causal relationship remains unclear.

Methods

We utilized genome-wide association study (GWAS) datasets to conduct bidirectional two-sample Mendelian randomization and multivariable Mendelian randomization analyses. We first analyzed COPD data from the FinnGen consortium (n = 193,638) and tuberculosis data from a genetic association study (n = 484,598). In the second phase, we stratified COPD patients by age into the EARLY COPD group (Event_Age < 65) and the LATER COPD group (Event_Age ≥ 65) to explore their causal relationships with tuberculosis separately. We then validated these results using tuberculosis data from MRC-IEU (n = 462,933). Finally, smoking and COPD-related SNPs as instrumental variables were analyzed by multivariable Mendelian randomization to further investigate the association between COPD and tuberculosis. Multiple methods were used in the Mendelian analyses to ensure a comprehensive and rigorous investigation.

Results

In the initial analysis phase utilizing the inverse variance weighting (IVW) method, tuberculosis showed no significant contribution to the incidence of COPD (IVW odds ratio (OR) = 0.9961; 95% confidence interval (CI) = 0.9828-1.0095; P = 0.564). Conversely, COPD appeared to significantly increase the risk of developing tuberculosis (IVW OR = 1.0008; 95% CI = 1.0001-1.0014; P = 0.015), particularly in patients under 65 (IVW OR = 1.0008; P = 0.011).

Conclusion

This Mendelian randomization analysis found that COPD may increase the risk of tuberculosis, while tuberculosis does not increase the risk of COPD, suggesting the necessity of enhancing prevention and screening efforts for tuberculosis among COPD patients, especially younger individuals.

Body Mass Index and Lung Function in Hospitalized Severe AECOPD Patients: Investigating Nonlinear Associations and the Role of Hemoglobin

Background

Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity and mortality. Patients hospitalized with severe acute exacerbations of COPD (AECOPD) represent a high-risk group with poor outcomes and accelerated lung function decline. Body mass index (BMI) shows inconsistent associations with lung function across populations, and its role in AECOPD remains unclear. Understanding this relationship may improve clinical management. Hemoglobin (Hb), essential for oxygen transport, may further influence this association through physiological mechanisms. This study aimed to explore the relationship between BMI and lung function in hospitalized patients with severe AECOPD and to assess whether BMI influences length of hospital stay (LOHS), while evaluating the potential modifying role of Hb.

Methods

A retrospective, single-center cross-sectional study was conducted among 579 patients hospitalized for severe AECOPD from 2021 to 2023. Data on BMI, lung function, Hb levels, and LOHS were collected. Nonlinear and threshold effect analyses were used to explore associations between BMI and lung function or LOHS. Subgroup analyses assessed the modifying effect of Hb.

Results

BMI exhibited a nonlinear positive association with FEV1, FVC, FEV1% predicted, and FVC% predicted. Thresholds were identified at 25.39 kg/m² for FEV1, 26.23 kg/m² for FEV1% predicted, 21.67 kg/m² for FVC, and 22.19 kg/m² for FVC% predicted. The association was more pronounced in patients with higher Hb levels. No significant association was found between BMI and LOHS, suggesting that other factors such as infection severity, comorbidities, or treatment strategies may may exert greater influence.

Conclusion

A nonlinear, inverse L-shaped association was observed between BMI and lung function, further modified by Hb levels. These findings highlight the importance of individualized treatment and stratification strategies in severe AECOPD. Future longitudinal studies are needed to validate these observations.

Diffusing capacity and alveolar attachments to small airways in smokers with and without COPD

The number of alveolar attachments to the small airways correlates with D LCO in smokers, both with and without COPD. Early smoking-related lung pathology is reflected in impaired D LCO. https://bit.ly/4fY3QUr.

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

INTRODUCTION

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Analysis of risk factors and development of predictive model for acute myocardial injury in patients with acute exacerbation of chronic obstructive pulmonary disease

Background

Acute myocardial injury (AMI) is a common complication in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), often leading to a worse prognosis. Identifying modifiable risk factors for AMI in AECOPD is essential for improving outcomes, but these factors remain unclear. This study aims to explore the risk factors of AMI in AECOPD patients and identify those at high risk.

Methods

In this study, 437 inpatients with AECOPD were enrolled from the Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, between January 2018 and October 2023. The AECOPD patients were divided into non-myocardial injury (non-MI) and AMI groups. Demographic information, clinical characteristics, electrocardiogram (ECG), and laboratory tests were collected. Univariate logistic regression analysis and the least absolute shrinkage and selection operator (LASSO) were used to identify essential variables for multivariable logistic regression, which was then used to develop a nomogram. The nomogram was internally validated using the bootstrap method. The receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow test, and decision curve analysis (DCA) were employed to evaluate this nomogram's discrimination, calibration, and clinical usefulness.

Results

Compared with the non-MI group, the AMI group had an older age, a faster heart rate, a more severe Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade, and a higher prevalence of hypercapnic respiratory failure (HRF), hypertension, arrhythmia, ischemic ECG changes, cardiac medications usage, serum electrolyte imbalances, and even acute kidney injury. Additionally, this group demonstrated significantly higher admission rates to the respiratory intensive care unit (RICU) and in-hospital mortality. High-sensitivity cardiac troponin I (hs-TnI) levels were positively correlated with the risks of in-hospital mortality, RICU admission, and HRF (P<0.001). Furthermore, the AMI group showed elevated levels of inflammatory markers, such as the systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and neutrophil-to-lymphocyte ratio (NLR) (P<0.001). Conversely, hemoglobin, serum albumin, calcium ions, and chloride ions were significantly lower in this group (P<0.001). Multivariate logistic regression analysis identified seven independent risk factors for AMI in AECOPD patients: cardiac medications usage, ischemic ECG changes, age, HRF, heart rate, blood urea nitrogen (BUN), and serum calcium. The nomogram model achieved an area under the ROC curve (AUC) of 0.8882 [95% confidence interval (CI): 0.8525-0.9238] and demonstrated good internal validation (bootstrapped AUC =0.8885). The Hosmer-Lemeshow test had a nonsignificant P value of 0.16. Moreover, the DCA curves show that the model provided valuable clinical utility.

Conclusions

Age, use of cardiac medications, ischemic ECG changes, HRF, heart rate, BUN, and serum calcium ions were independently associated with AMI in AECOPD patients. A clinical risk assessment model of AMI was developed based on independent risk factors.

Identifying pyroptosis-related prognostic genes in the co-occurrence of lung adenocarcinoma and COPD via bioinformatics analysis

Studies have indicated a complex association between chronic obstructive pulmonary disease (COPD) and lung adenocarcinoma (LUAD). However, the underlying mechanisms of their coexistence are still not fully understood. Thus, this study evaluated the possible mechanisms and biomarkers of COPD and LUAD by analyzing public RNA sequencing databases via bioinformatics analysis. This study obtained the LUAD datasets (TCGA-LUAD, GSE118370, and GSE30219) and the COPD dataset (GSE11784 and GSE39874) from TCGA and GEO databases, respectively. The differentially expressed genes (DEGs) were analyzed using the DESeq2 and limma packages. These DEGs were then intersected with pyroptosis-related genes (PRGs) to produce PRDEGs, which were examined via GO analysis and KEGG enrichment analyses. Simultaneously, a prognostic model was developed using PRDEGs by the TCGA-LUAD dataset to generate diagnostic PRDEGs (DPRDEGs). The STING database was employed to develop a protein-protein interaction (PPI) network for DPRDEGs. Transcription factors-associated with DPRDEGs were also identified in the ChIPBase and hTFtarget databases. The comparative toxicogenomics database (CTD) was employed to detect possible drugs or small molecules that interacted with DPRDEGs, and results were illustrated using Cytoscape. Moreover, this study developed a prognostic model using multivariate analysis and simultaneously conducted a prognostic analysis. The results were further validated by immunohistochemistry (IHC), western blotting (WB), and qPCR of clinical specimens. A total of 273 DEGs were identified, and 12 PRDEGs were detected after intersecting with PRGs. Inflammation and infectious diseases were the primary enriched regions for these PRDEGs, as indicated by GO and KEGG enrichment analyses. The study identified six DPRDEGs (BNIP3, FTO, NEK7, POLR2H, S100A12, and TLR4) via prognosis modeling of PRDEGs. The expression of these DPRDEGs in COPD and LUAD was verified through IHC, WB, and qPCR examinations. Based on multifactorial prognosis modeling, among six, FTO, POLR2H, S100A12, and TLR4 revealed enhanced prognostic predictive effects. This study demonstrated that COPD and LUAD have common pathogenic mechanisms. The identified DPRDEGs and predictive models offer new perspectives for understanding and addressing COPD and LUAD.

Phenotypes of Exacerbations in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with an important public health challenge and a major burden on health-care resources, having a progressive character with constant deterioration of lung function. During the course of the disease, patients experience acute episodes of exacerbation, which are characterized by worsening symptoms, and require additional treatment during these exacerbating episodes. Given the heterogeneity of exacerbations, their phenotyping is of great interest in order to administer the most effective treatment with the aim of reducing mortality and preventing future exacerbation episodes. The lack of specific biomarkers for the diagnosis of acute exacerbations of COPD maintains researchers' interest in trying to identify such a biomarker. In this review, we explore the different phenotypes of COPD exacerbation, and we also evaluated the ability of various biomarkers to establish the etiology of exacerbations in association with clinical manifestations. Furthermore, we addressed the main therapeutic measures necessary according to each phenotype. Overall, phenotyping exacerbations allows for an individualized approach to these patients, thus avoiding the side effects of some treatments.

Effects of Oral Doxofylline and Procaterol on Chronic Obstructive Pulmonary Disease: A Randomized Crossover Study

Background: Oral bronchodilators may serve as an adjunctive therapy in patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the effects of oral doxofylline and oral procaterol on lung function and clinical symptoms in COPD patients. Methods: A crossover randomized controlled trial was conducted in patients with clinically stable COPD. Participants first received either doxofylline or procaterol for 4 weeks, followed by a 1-week washout period. Assessments included the modified Medical Research Council (mMRC) dyspnea scale, COPD assessment test (CAT) scores, and 6-minute walking distance (6MWD). Pulmonary function was evaluated using spirometry with bronchodilator (BD) testing and all adverse events were recorded. Results: Twenty patients were randomly assigned to begin treatment with either doxofylline or procaterol. Their mean age was 71.7 ± 9.4 years. After four weeks of treatment, the doxofylline group showed significantly greater improvement in pulmonary function parameters (post-BD peak expiratory flow and post-BD forced expiratory flow 25-75) compared to the procaterol group. However, there were no significant differences in mMRC scores, CAT scores, or 6MWD between the two groups. More neurological adverse events were observed in the doxofylline group compared to the procaterol group (35% vs. 5%, p = 0.044). Conclusions: Doxofylline improved pulmonary function in COPD patients but did not provide superior functional performance compared to procaterol. Neurological adverse events were more frequently associated with doxofylline. Doxofylline may serve as an adjunctive therapy to enhance pulmonary function in COPD patients, but caution is advised due to its potential side effects.

Predictive value of neutrophil-lymphocyte ratio for all-cause mortality in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) involves inflammation as a key factor influencing its pathology and progression. This meta-analysis sought to assess the prognostic importance of the neutrophil-to-lymphocyte ratio (NLR) in individuals diagnosed with COPD.

METHODS

Comprehensive searches were carried out in PubMed, Embase, Web of Science, and the Cochrane Library up to March 2025. All-cause mortality-related data were collected and analyzed. Outcomes were evaluated using odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Following a thorough review of the literature and a rigorous screening process, a total of 24 studies including 18,597 patients were selected for this meta-analysis. The cut-off range of NLR in all included literatures was 1.3 to 16.83. Analysis of categorical variables showed that COPD patients with elevated NLR levels faced a significantly higher all-cause mortality risk compared to those with lower NLR levels (OR: 1.03, 95% CI: 1.01-1.06, P = 0.009, I² = 89%). For continuous variables, deceased COPD patients exhibited significantly elevated NLR levels compared to survivors (SMD: 1.23, 95% CI: 0.90-1.57, P < 0.00001, I² = 97%). The subgroup analysis highlighted study design and the timing of NLR measurement as potential contributors to heterogeneity. Subgroup analysis showed that NLR had a better predictive value for disease in AECOPD subgroups.

CONCLUSION

This meta-analysis demonstrates a correlation between increased NLR levels and heightened all-cause mortality risk in COPD patients. Nevertheless, given the inherent limitations of this study, additional multi-center, prospective clinical trials are essential to confirm these findings.

Maternal smoking around birth as a risk factor for offspring chronic obstructive pulmonary disease: Evidence from Mendelian randomization

INTRODUCTION

Previous observational studies suggested that exposure of the fetus to maternal smoking during pregnancy may increase the likelihood of chronic obstructive pulmonary disease (COPD). Hence, following the STROBE-MR guidelines, we carried out a two-sample MR analysis to explore the association between maternal smoking around birth and offspring COPD.

METHODS

We used independent single nucleotide polymorphisms (SNPs) related to maternal smoking around birth, obtained from genome-wide association study summary data, as instrumental variables (IVs). The dataset included 121634 controls and 276098 cases. The selected outcome was chronic obstructive pulmonary disease (COPD) in offspring, with 454945 controls and 13530 cases. We performed analyses using inverse variance weighting (IVW), weighted median, and MR-Egger regression methods. Multivariate MR included maternal illnesses (high blood pressure and heart disease) as covariates to address potential mediators. Sensitivity analysis was conducted using leave-one-out analysis, Cochran's Q test, and MR-Egger intercept test.

RESULTS

In the univariate MR analysis, it was found that maternal smoking around birth significantly increased the likelihood of offspring COPD (IVW, OR=35.13; 95% CI: 10.18-121.20; p<0.001). Furthermore, after adjusting the variates for maternal illnesses, the relationship between maternal smoking around birth and offspring COPD remained statistically significant (adjusted odds ratio, AOR= 62.11; 95% CI: 16.60-232.46; p<0.001).

CONCLUSIONS

The study provides MR evidence of a potential association between maternal smoking around birth and increased COPD risk in offspring.

Molecular Hydrogen in the Treatment of Respiratory Diseases

Molecular hydrogen is gaining increasing attention as an antioxidant, anti-inflammatory, and antiapoptotic agent. Once considered an inert gas, it reveals current therapeutic potential among others in inflammatory diseases, cancer, and sports medicine, among others. The present review aims to provide a consistent summary of the findings of the last twenty years on the use of molecular hydrogen in major respiratory diseases, including allergies, asthma, COPD, pulmonary fibrosis, lung injury of various origins, as well as cancer and infections of the respiratory tract. In addition, the basic mechanisms through which molecular hydrogen exercises its biological activity on the respiratory system are described.

Real-World Effectiveness of Single-Inhaler Triple Treatment Through Assorted Respiratory Outcomes When Switched From Multiple-Inhaler Triple Therapies (RESTART): A Prospective Cohort Study of Korean Patients With COPD

Purpose

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterized by persistent airflow limitation, leading to significant morbidity and mortality. Despite the effectiveness of multiple inhaler triple therapy (MITT), its complexity often results in poor adherence and suboptimal outcomes. Transitioning to single inhaler triple therapy (SITT) may enhance adherence, leading to improved clinical outcomes and quality of life of patients. The Real-World Effectiveness of Single Inhaler Triple Treatment through Assorted Respiratory Outcomes when Switched from Multiple Inhaler Triple Therapies (RESTART) study aimed to evaluate the clinical benefits of switching from MITT to SITT using fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) in a real-world Korean setting.

Patients and Methods

This prospective, multicenter, observational study enrolled 107 patients, aged 40 and older, with diagnosed COPD, all previously on MITT. The patients were transitioned to once-daily FF/UMEC/VI administered via the ELLIPTA inhaler. The primary outcome was a change in the COPD Assessment Test (CAT) score after 24 weeks. The secondary outcomes included changes in lung function, exacerbation rates, Modified Medical Research Council Dyspnea Scale scores, and Treatment Satisfaction-Visual Analysis Scale (TS-VAS) scores.

Results

A total of 91 patients completed the 24-week observation. CAT scores significantly improved (mean change = 1.40 points, P = 0.007). Lung function also improved, with a mean increase in the FEV1/FVC ratio (mean change = 4.31%, P = 0.005). Exacerbation rates decreased significantly (incidence rate ratio = 0.45, P = 0.016). Treatment satisfaction increased, with a mean TS-VAS score rise of 1.71 points (P < 0.001).

Conclusion

The transition from MITT to SITT significantly improved COPD symptom management, pulmonary function, exacerbation rate, and treatment satisfaction in Korean cohort. Using a single inhaler to simplify therapy might increase patient compliance and improve clinical outcomes of COPD management.

A survey and analysis of inhalation medication adherence among 977 COPD patients in a region of northern China

OBJECTIVE

Inhalation therapy is recommended by the World Health Organization as the first-line treatment for chronic obstructive pulmonary disease (COPD) due to its rapid onset of action, good safety profile, ease of use, and portability. High medication adherence in COPD patients is crucial for enhancing disease management. The aim of this study was to assess the level of disease control, adherence to inhaled medication therapy, and potential factors influencing treatment adherence among COPD patients.

METHODS

A paper-based questionnaire was used to survey COPD patients who were outpatients or inpatients at the First Affiliated Hospital of Harbin Medical University between January 2019 and October 2023. Patients were included if they had been diagnosed with stable COPD for more than 12 months, were prescribed inhaled medications for post-consultation or post-discharge management, and had used these medications for at least 8 weeks with follow-up review. Questionnaires were administered at the time of consultation and at the 8-week follow-up to comprehensively evaluate patients' adherence to inhaled medications based on their medication administration methods, frequency, and other relevant factors. Categorical data were described using frequencies and percentages, and comparisons between groups were conducted using the chi-square test. For the analysis of risk factors, binary logistic regression analysis was employed. To avoid collinearity among variables, a stepwise regression method was utilized for variable selection. A P-value < 0.05 was considered statistically significant.

RESULTS

A total of 977 patients were included, with an average age of 63 ± 9 years. Among them, 40.9% of the patients demonstrated high adherence to inhaled medication therapy. Patients who were under 70 years old (P = 0.03), had a higher annual household income (P = 0.04), had family supervision (P = 0.01), and had medical insurance (P = 0.02) exhibited higher adherence to inhaled medication therapy.

CONCLUSION

Among the surveyed patients, those who were under 70 years old (OR = 5.1, CI = 1.13-23.11) and had family supervision (OR = 3.26, CI = 1.3-8.21) demonstrated better medication adherence. This suggests that physicians could potentially improve patient medication adherence, optimize disease control, and enhance the overall quality of life for these patients by considering targeted interventions, such as identifying and educating elderly patients, intensifying tailored promotional activities, and encouraging family members to supervise medication use.

Marine-Derived Bioactive Compounds: A Promising Strategy for Ameliorating Skeletal Muscle Dysfunction in COPD

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by skeletal muscle dysfunction, a critical and severe extrapulmonary complication. This dysfunction contributes to reduced exercise capacity, increased frequency of acute exacerbations, and elevated mortality, serving as an independent risk factor for poor prognosis in COPD patients. Owing to the unique physicochemical conditions of the marine environment, marine-derived bioactive compounds exhibit potent anti-inflammatory and antioxidant properties, demonstrating therapeutic potential for ameliorating COPD skeletal muscle dysfunction. This review summarizes marine-derived bioactive compounds with promising efficacy against skeletal muscle dysfunction in COPD, including polysaccharides, lipids, polyphenols, peptides, and carotenoids. The discussed compounds have shown bioactivities in promoting skeletal muscle health and suppressing muscle atrophy, thereby providing potential strategies for the prevention and treatment of COPD skeletal muscle dysfunction. These findings may expand the therapeutic strategies for managing COPD skeletal muscle dysfunction.

Association between urinary exposures and the risk of chronic obstructive pulmonary disease in smokers: results from NHANES 2007-2016

Objective

This study aims to shed light on the connection of urinary exposures with risk of chronic obstructive pulmonary disease (COPD) among smokers, thereby providing scientific evidence for the prevention and intervention of COPD.

Methods

Data of the National Health and Nutrition Examination Survey (NHANES) 2007-2016 were utilized, including 3,973 smokers aged 20 or older. We employed the weighted multivariate logistic and weighted quantile sum (WQS) regression models to delve into the link of urinary concentrations of exposures to COPD risk. Additionally, restricted cubic spline regression was utilized to examine the dose-response relationship between biomarker concentrations and COPD risk. The stability of the associations across different participant characteristics was evaluated through subgroup and mediation analyses.

Results

Our study encompassed a total of 3,973 participants, of whom 472 were diagnosed with COPD. Regression analyses revealed the inverse association between urinary concentrations of benzophenone-3 (BP-3) and propyl paraben (PrP) and COPD risk. Higher quartiles of BP-3 and PrP exhibited lower COPD incidence [BP-3: odds ratio (OR) = 0.64, 95% confidence interval (95%CI) (0.47, 0.89), p = 0.007; PrP: OR = 0.56, 95%CI (0.36, 0.86), p = 0.008]. Significant synergistic interactions among urinary exposures were observed [WQS: 0.75, 95%CI (0.65, 0.88), p = 0.026], with BP-3 and PrP contributing 40.31 and 40.01% to the weighted analysis, respectively. Mediation analysis proved that inflammatory markers, such as white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR), significantly mediated the association between BP-3, PrP, and COPD risk (all p-values <0.05).

Conclusion

BP-3 and PrP in environmental exposure in smokers have an inverse correlation with COPD risk, with WBC and NLR partially mediating this association.

Effect of low-moderate intensity traditional Chinese exercises combined with acupuncture on patients with stable chronic obstructive pulmonary disease: study protocol for a randomized controlled trial

Background

Traditional Chinese exercises (TCEs), as a new technology for pulmonary rehabilitation, have been proven to be effective in patients with chronic obstructive pulmonary disease (COPD). However, further aggravation of dynamic hyperinflation manifested as exertional dyspnea during exercises may limit the partial therapeutic efficacy of TCEs on patients with COPD. Acupuncture therapy, internationally recognized as a complementary and alternative therapy, can effectively improve the degree of dyspnea, and it is expected to serve as an adjuvant therapy for exercise training in patients with COPD to fully realize the therapeutic efficacy of exercise training. Therefore, this study aims to explore the multidimensional and multi-system effects of the combination of pulmonary-based Qigong (PQ) exercise and acupuncture therapy on patients with COPD.

Methods

This protocol describes an assessor-blinded, data analyst-blinded, four-arm randomized controlled trial that aims to recruit 132 participants with stable COPD and randomly allocate them into pulmonary-based Qigong exercise group, acupuncture group, pulmonary-based Qigong exercise and acupuncture combined group, or control group at a 1:1:1:1 ratio. All participants will receive usual medical care and health education; those in the intervention groups will receive PQ exercise, acupuncture treatment, or a combination of both treatments three times per week for 8 weeks. The primary outcome will be the exercise endurance as assessed by a 6-min walk test. Secondary outcomes will include lung function, degree of dyspnea, diaphragmatic function, respiratory muscle strength, skeletal muscle structure, skeletal muscle function, psychological states, and quality of life. Exploratory outcomes will include the levels of inflammatory mediators. The frequency and severity of acute exacerbations of COPD will be recorded at baseline and 1 year after intervention.

Discussion

The findings of this study will clarify the effects of the combination of PQ exercise and acupuncture therapy on the multi-system function of patients with stable COPD to provide evidence for acupuncture as an adjuvant therapy for pulmonary rehabilitation.

Clinical trial registration

https://www.chictr.org.cn, ChiCTR2300076255.

A realist review of factors critical for the implementation of eHealth in chronic disease management

BACKGROUND

In Canada, chronic disease is responsible for 88% of deaths and $120 billion in cost each year. With 44% of Canadian adults living with at least one chronic condition, only 66% receive necessary care. Ehealth interventions are instrumental in chronic disease management (CDM), especially since the pandemic, as they provide accessible, cost-effective solutions for self-management. Despite its promise and accelerated use, its implementation remains challenging. This paper reports on a realist review of critical factors for the implementation of eHealth interventions relevant to conditions such as heart failure, chronic obstructive pulmonary disease, chronic kidney disease, and diabetes. The findings are presented in terms of context, mechanisms, and outcomes.

METHODS

A realist review of the primary literature was conducted by searching five databases: Medline, Embase, Cochrane, CINALH and PsycInfo. The initial search was run for a date spanning from the databases' inception to September 2018 and subsequently updated to dates spanning from October 2018 to May 2022. A systematic and iterative approach to data extraction was used. Thematic analysis was used to identify context-mechanism-outcome (CMO) configurations.

RESULTS

Among the 13,209 citations retrieved, 64 articles were included. This paper reports the top ten configurations found to facilitate or hinder eHealth implementation. Key themes related to context, such as team-based care, and action, including program use, perceived usefulness and motivation, are reported.

CONCLUSIONS

This study explores the role of context, mechanisms, and outcomes in ehealth implementation, highlighting the nonlinear relationships between these factors. Future implications include empirical testing CMOs as middle-range theories in real-world settings to determine causality.

TRIAL REGISTRATION

The review protocol was registered with PROSPERO (CRD42020208275) on 1 October 2020.

Integrated network pharmacology, molecular docking, and animal experiments to reveal the potential mechanism of hesperetin on COPD

Hesperetin (HE), a natural flavonoid exhibiting anti-inflammatory and antioxidant properties, holds significant potential in treating chronic obstructive pulmonary disease (COPD). Nonetheless, the precise mechanisms underlying its effects are yet to be fully elucidated. In this study, we aim to explore the role and potential mechanism of HE in treating COPD using network pharmacology, molecular docking and experimental validation. We screened for HE and COPD-related targets from public databases, and then imported potential targets into a STRING database to establish a protein-protein interaction network. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes enrichment analysis were performed to obtain key signaling pathways. We then predicted the binding interactions between HE and core targets using molecular docking. The animal model of COPD was established through lipopolysaccharide and cigarette smoke induction in mice to observe lung function, inflammatory factors, pathology, and the expression of related proteins. Network pharmacology findings unveiled that HE and COPD shared 105 common targets. MAPKs and NF-κB signaling pathways were selected for further validation. In animal experiment, HE enhanced lung function and histopathological morphology, while reducing inflammation levels. The results of Western blot tests indicated that HE treatment considerably inhibited the expression of MAPKs and NF-κB. HE effectively reduced lung inflammation and improved lung function in mice. This mechanism may be achieved by inhibition of MAPKs and NF-κB signaling pathways.

The effect of a post-bronchodilator FEV1/FVC < 0.7 on COPD diagnosis and treatment: a regression discontinuity design

BACKGROUND

Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the diagnosis of chronic obstructive pulmonary disease (COPD) only in patients with a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) less than 0.7. However the impact of this recommendation on clinical practice is unknown.

OBJECTIVE

To estimate the effect of a documented post-bronchodilator FEV1/FVC < 0.7 on the diagnosis and treatment of COPD.

DESIGN

We used a regression discontinuity design to measure the effect of a post-bronchodilator FEV1/FVC < 0.7 on COPD diagnosis and treatment.

PARTICIPANTS

Patients included in a national electronic health record database who were 18 years of age and older and had a clinical encounter between 2007 and 2022 in which a post-bronchodilator FEV1/FVC value was documented.

MAIN MEASURES

An encounter was associated with a COPD diagnosis if an international classification of disease code for COPD was assigned, and was associated with COPD treatment if a prescription for a medication commonly used to treat COPD was filled within 90 days.

RESULTS

Among 27,817 clinical encounters, involving 18,991 patients, a post-bronchodilator FEV1/FVC < 0.7 was present in 14,876 (53.4%). The presence of a documented post-bronchodilator FEV1/FVC < 0.7 increased the probability of a COPD diagnosis by 6.0% (95% confidence interval [CI] 1.1-10.9%) from 38.0% just above the 0.7 cutoff to 44.0% just below this cutoff. The presence of a documented post-bronchodilator FEV1/FVC < 0.7 had no effect on the probability of COPD treatment (-2.1%, 95% CI -7.2 to 3.0%).

CONCLUSIONS

The presence of a documented post-bronchodilator FEV1/FVC < 0.7 had only a small effect on the diagnosis of COPD and no effect on corresponding treatment decisions.

Physiological effects and clinical evidence of high-flow nasal cannula during acute exacerbation in COPD patients: A narrative review

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. During severe exacerbations, COPD patients may develop acute respiratory failure (ARF), often necessitating hospital admission due to impaired gas exchange. In COPD patients, the diaphragm is subjected to an increased workload resulting from airflow limitations and geometric changes in the thorax due to pulmonary hyperinflation. Noninvasive ventilation (NIV) plays a crucial role in managing type II ARF by improving alveolar ventilation, reducing the work of breathing, minimizing the need for endotracheal intubation (ETI), and decreasing both hospital stays and mortality rates. Studies have shown that approximately 64% of patients with acute exacerbation of COPD (AECOPD) may fail NIV, primarily due to worsening respiratory function, interface intolerance, cardiovascular instability, or neurological deterioration. For patients intolerant to NIV, a trial with a high-flow nasal cannula (HFNC) is recommended. Recently, HFNC has gained popularity as a novel respiratory support system and is increasingly used in routine clinical practice for AECOPD patients. It delivers warmed, humidified, and oxygen-enriched air through a nasal cannula at flow rates of up to 60 L/min. This narrative review aims to describe the physiological effects of HFNC in the COPD population and provide an updated overview of HFNC's role in AECOPD patients requiring hospitalization.

Effects of whole-body vibration exercise on functional capacity, muscle strength, and quality of life in individuals with severe chronic obstructive pulmonary disease: a systematic review and meta-analysis

BACKGROUND

Whole body vibration (WBV) exercise is a therapy used for individuals with low tolerance to conventional exercises, such as patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess the impact of WBV exercise on the functional capacity, muscle strength, and health-related quality of life (HRQoL) in severe COPD patients.

METHODS

Studies published until March 2024 were reviewed, encompassing randomized clinical trials (RCTs) without temporal or linguistic constraints, comparing WBV exercise with other interventions. The PubMed/MEDLINE, Scopus, Cochrane Airways Trials Register, and CINAHL databases were queried. The Revised Cochrane risk-of-bias tool for randomized trials 2.0A was employed for quality assessment.

RESULTS

Among 351 screened studies, 7 met the criteria, totaling 356 participants (WBV group, n = 182; control group, n = 174). Meta-analysis revealed a significant mean difference of 41.36 m [95%CI (13.28-69.44); p = .004] in the 6-minute walk test distance favoring the WBV group for functional capacity. Lower limb muscle strength improved in 57.14% of included studies. HRQoL meta-analysis demonstrated a 1.13-point difference [95%CI -1.24-3.51; p = .35] favoring WBV, although group differences were not significant. A mean difference of 2.31 points favored the control group in health condition [95%CI (-1.32-5.94); p = .021].

CONCLUSION

WBV exercise is recognized as a promising therapeutic modality for severe COPD patients, notably enhancing functional capacity. Although heterogeneous study protocols weaken the evidence for clinically relevant outcomes, improvements in lower limb muscle strength and HRQoL were also observed, differences between groups were not significant.

Nomogram to predict progression from preserved ratio impaired spirometry to chronic obstructive pulmonary disease

Preserved Ratio Impaired Spirometry (PRISm) is a specific subtype of pre-chronic obstructive pulmonary disease (pre-COPD). People with PRISm are at risk of progression to chronic obstructive pulmonary disease (COPD). We developed a model to predict progression in subjects with PRISm. We screened 188 patients whose lung function transitioned from PRISm to COPD and 173 patients with PRISm who remained stable over two years. After excluding 78 patients due to incomplete clinical or laboratory data, a total of 283 patients were included in the final analysis. These patients were randomly divided into a training cohort (227 patients) and a validation cohort (56 patients) at a 8:2 ratio. LASSO regression and multivariate logistic regression were used to identify factors influencing progression. Among the 283 patients, 134 progressed to COPD. The model developed using six variables showed good performance, with areas under the receiver operating characteristic (ROC) curves of 0.87 in the training cohort and 0.79 in the validation cohort. The model demonstrated excellent calibration and was clinically meaningful, as shown by decision curve analysis (DCA) and clinical impact curve (CIC). We developed China's first prediction model for the progression of lung function from PRISm to COPD in a real-world population. This model is conducive to early identification of high-risk groups of pulmonary function deterioration, so as to provide timely intervention and delay the occurrence and progression of the disease.

Efficacy of remote respiratory rehabilitation in stable chronic obstructive pulmonary disease and factors affecting acute exacerbation

OBJECTIVES

To evaluate the effects of remote respiratory rehabilitation on patients with stable chronic obstructive pulmonary disease (COPD) and identify factors influencing acute exacerbation.

METHODS

This retrospective study included 60 stable COPD patients who visited the First Affiliated Hospital of Gannan Medical University between June 2020 and December 2021. Among them, 27 patients in the control group received routine health guidance, while 33 patients in the research group received WeChat app-based remote respiratory rehabilitation. The study comparatively analyzed pulmonary function (PF; forced vital capacity percentage [FVC%], forced expiratory volume in 1 second percentage [FEV1%], and FEV1/FVC), blood oxygen saturation (SaO2), dyspnea index (Borg Dyspnea Scale), 6-minute walking distance (6MWD), number of hospitalizations, frequency of acute exacerbations, and health-related quality of life (measured using the Chronic Respiratory Disease Questionnaire [CRQ]). Additionally, univariate and multivariate analyses were conducted to identify factors contributing to acute exacerbation in stable COPD patients.

RESULTS

Significant improvement in FVC%, FEV1%, FEV1/FVC, SaO2, 6MWD, and various CRQ scores were observed in the research group after treatment with higher values than the control group (all P<0.05). The Borg Dyspnea Scale scores were significantly lower in the research group than those of the control group (P<0.05). The research group had significantly fewer hospitalizations and acute exacerbations compared to the control group (P<0.05). Univariate analysis indicated that body mass index (BMI; P=0.042), smoking history (P=0.011), chronic respiratory failure (P=0.010), diabetes (P=0.024), hypertension (P=0.008), and treatment modality (P=0.006) were significantly associated with acute exacerbations in stable COPD patients. Multivariate analysis identified that hypertension (P=0.032) and treatment methods (P=0.022) were risk factors for acute exacerbation in stable COPD patients.

CONCLUSIONS

Remote respiratory rehabilitation significantly benefits stable COPD patients by improving respiratory function, exercise endurance, and quality of life. Moreover, hypertension and conventional health guidance interventions are closely associated with an increased risk of acute exacerbation in stable COPD patients.

Fungal microbiota in COPD patients during exacerbations

Acute exacerbations of chronic obstructive pulmonary disease (COPD) results in increased mortality and can be triggered by a range of factors, including microorganisms. Very little studies have examined the role of fungi and fungal diversity in COPD patients. The aim of the study was to determine the role of Candida in COPD during an exacerbation. Oral swabs, sputum, feces and whole blood samples were collected from the AECOPD patients and control group. Mycological and serological analysis were performed. Yeast were statistically significantly more often isolated from the AECOPD group (97.06%) than from the control group (26.32%). 7 species were isolated from the AECOPD, and 3 from the control group. Dominated Candida albicans followed by C. tropicalis. α-diversity was much greater in AECOPD patients than in controls. β-diversity was also assessed. A much higher level of antimycotic resistance was observed in isolates from the AECOPD group, which affects the effectiveness of therapy. Serological tests showed twice the frequency of positive results in the AECOPD group. The mycobiota of AECOPD patients is numerically and taxonomically richer than controls, including species less frequently recorded in humans. Our research confirms that fungal mycobiota may be a potential factor influencing the development of exacerbations and progression of COPD.

Association and risk of blood urea nitrogen-to-creatinine ratio with congestive heart failure in critically ill COPD patients

OBJECTIVE

Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity and death. The blood urea nitrogen-to-creatinine ratio (BCR) is recognized as a crucial marker to assess renal function and cardiovascular risk. Nevertheless, the effects of BCR on COPD patients suffering comorbid congestive heart failure (CHF) is not clarified. This study aims to elucidate the association between BCR and CHF risk in the COPD population.

METHODS

Data from COPD patients meeting the eligibility criteria were from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The cumulative incidence curve was utilized for examining the link of BCR to CHF. Kaplan-Meier (KM) analysis was carried out for evaluating the relation of BCR to in-hospital mortality(IHM). Multivariable Cox regression assisted in assessing the correlation of BCR with CHF risk. Restricted cubic splines (RCS) were leveraged for unraveling the association of BCR (as a continuous variable) with CHF.

RESULTS

Our study included 2,840 COPD patients in the intensive care unit for the first time, with hospital stays exceeding 24 h. The incidence of CHF was 57.18% among these patients. Cumulative incidence curve analysis demonstrated a notably increased CHF incidence in patients having higher BCR (18.889 < BCR ≤ 92.5) in contrast to those with lower BCR (2.877 ≤ BCR ≤ 18.889) (p < 0.0001). KM survival analysis indicated a markedly elevated IHM risk in patients with higher BCR in comparison to those with lower BCR (p < 0.0001). Multivariable Cox regression and RCS analysis further confirmed that higher BCR was linked to a risen likelihood of CHF [hazard ratio (HR) = 1.28, 95% confidence interval (CI, 1.15-1.44), p < 0.001]. Subgroup analysis revealed a higher risk of CHF [HR = 1.41, 95% CI (1.13-1.76), p = 0.002] in patients with diabetes than those without [HR = 1.24, 95% CI (1.08-1.41), p = 0.002].

CONCLUSION

Elevated BCR is an independent risk factor for CHF in critically ill COPD individuals and strongly related to a risen risk of CHF. The findings prove BCR as a reliable clinical predictor, facilitating risk stratification and personalized treatment for COPD patients with comorbid CHF.

Causal Associations Between Chronic Obstructive Pulmonary Disease and Common Comorbidities: Evidence from Comprehensive Genetic Methods

Background

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease with high morbidity and mortality worldwide. Observational studies have shown correlations between common extrapulmonary comorbidities and COPD, but the existence of correlations does not necessarily prove a causal association. Therefore, causal relationships between diseases need to be explored by means of causal inference methods.

Materials and Methods

Genetic correlation and two-sample Mendelian randomization (MR) analysis were explored to assess the causal relationship between exposures and outcomes with the genome-wide association studies (GWAS) dataset. Different sensitivity analyses were conducted to verify the robustness and consistency of results.

Results

The linkage disequilibrium score regression showed that cardiovascular disease (CVD), hypertension (HTN) and type 2 diabetes mellitus (T2DM) were significantly genetically associated with COPD. T2DM and HTN were found to have a positive causal effect on COPD. The odds ratio (OR) of T2DM on COPD was 1.111 (95% CI, 1.063-1.160; P<0.0001) and that of HTN on COPD was 1.125 (95% CI, 1.084-1.167; P < 0.0001). Similar results were verified by different MR methods. Furthermore, COPD had a positive causal effect on T2DM (OR 1.152 (95% CI, 1.064-1.246; P=0.0005)).

Conclusion

Our findings provided evidence for the causal association between HTN, T2DM and COPD, which would render new insights into the pathogenesis, prevention and intervention for COPD.

Identification and Experimental Validation of Biomarkers Related to MiR-125a-5p in Chronic Obstructive Pulmonary Disease

Purpose

The miR-125a-5p has been reported influence the development of lung cancer, however, the link between it and chronic obstructive pulmonary disease (COPD) is still not well understood. Hence, this study was designed to investigate the molecular pathway by which miR-125a-5p related biomarkers were involved in COPD.

Patients and Methods

The differentially expressed genes (DEGs) and module genes related to COPD in GSE100153 were screened out by differential analysis and weighted gene co-expression network analysis, respectively. Then, the target genes of miR-125a-5p obtained from miRWalk database were intersected with DEGs and module genes, followed by identification of biomarkers through SVM-RFE algorithms. Moreover, the gene set enrichment analysis, immune infiltration analysis, construction of regulatory network, single-cell analysis and Mendelian randomization (MR) analysis were performed. At last, the expression levels of the biomarkers were further validated in GSE100153 and GSE146560 as well as in qRT-PCR.

Results

A total of 10 genes were acquired by intersecting the 126 DEGs, the 3989 module genes, and 2329 target genes, of which PITHD1, CNTNAP2 and GUCD1 were identified as biomarkers. Enrichment analysis showed their roles in various cellular functions. In addition, significant associations were identified between 9 distinct cells and biomarkers. Subsequently, 5 TFs and 63 therapeutic agents were predicted as biomarkers. Moreover, GUCD1 and PITHD1 were significantly different between case and control in T cells and Alveolar cells. In COPD, GUCD1 and PITHD1 were significantly down-regulated in GSE100153 and GSE146560 datasets and confirmed by qRT-PCR.

Conclusion

In our study, PITHD1, CNTNAP2, and GUCD1 were recognized as biomarkers related to miR-125a-5p-related genes in COPD, providing new references for treatment of COPD.

Acupuncture improves the symptoms, gut microbiota, metabolomics, and inflammation of patients with chronic obstructive pulmonary disease: a multicenter, randomized, sham-controlled trial protocol

Background

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease. The occurrence of COPD is associated with gut microbiota, meticulous metabolism and inflammation. Acupuncture may be effective as an adjunctive therapy for COPD, but the available evidence is limited. This study aims to confirm whether acupuncture therapy has an adjunctive therapeutic effect on COPD and to investigate the relationship between the efficacy and the gut microbiota, metabolomics and inflammation.

Methods

This study is a multicenter randomized controlled trial. A total of 72 patients with stable COPD eligible will be randomized in a 1:1 ratio to receive either manual acupuncture (MA) or sham acupuncture (SA) without puncturing the skin. There will be no changes to the essential medicines used for all patients. The intervention will be 12 weeks, 3 times per week and follow-up will be 52 weeks. The primary outcome will be the change in COPD Assessment Test (CAT) score before and after treatment. Secondary outcomes will include modified Medical Research Council (mMRC), St. George's Respiratory Questionnaire (SGRQ), 6-min walk test (6MWT), and the number of moderate or severe acute exacerbations during follow-up. A total of 36 healthy volunteers will also be recruited as normal control. In addition, feces and blood will be collected from each participant to characterize the gut microbiota, metabolomics, immune cells and inflammatory cytokines. Differences between COPD patients and healthy participants will be observed, as well as changes before and after treatment in MA and SA groups. Ultimately, the correlation among gut microbiota, metabolomics, immune cells, inflammatory cytokines and clinical efficacy in COPD patients will be analyzed.

Discussion

This study will evaluate the efficacy and provide preliminary possible mechanisms of acupuncture as an adjunctive therapy in treating COPD. In addition, it will identify biomarkers of the gut microbiota, metabolites, immune cells, and inflammatory cytokines associated with therapeutic efficacy. The results of this study will be published in a peer-reviewed journal.

The relationship between genetic prediction of 486 blood metabolites and the risk of COPD: mendelian randomization study

Metabolic disorders are an important feature of chronic lung disease. Patients diagnosed with chronic obstructive pulmonary disease (COPD) have been found to experience metabolic disorders. Nonetheless, evidence on the causal role of circulating metabolites in promoting or preventing COPD is still lacking. Conducting a methodical examination on the causal connection between blood metabolites and COPD can aid in identifying fresh objectives for the screening and prevention of COPD. Therefore, we performed a two-sample Mendelian randomization (MR) analysis to evaluate the causal association between COPD and 486 blood metabolites.We used two-sample MR techniques and genome-wide association study (GWAS) data to evaluate the correlation between COPD and 486 serum metabolites. To evaluate the causal impact of serum metabolites on the risk of COPD, we predominantly employed inverse variance weighting (IVW) methodology. The MR-Egger regression test was employed to assess multiple validity, while the presence of heterogeneity was examined using the Cochran's Q test. To ensure the reliability of the findings, a leave-one-out analysis was conducted. The Bonferroni correction is used to adjust for multiple comparisons, ensuring rigorous validation of our results.After filtering by IVW and sensitivity analysis, we identified 10 known metabolites including fructose, margarate (17:0), guanosine, 2-stearoylglycerophosphocholine, hexadecanedioate, lactate, 5-oxoproline, paraxanthine, phenyllactate (PLA) and N-acetylglycine. Of these, fructose, margarate (17:0), guanosine, 2-stearoylglycerophosphocholine and hexadecanedioate are risk metabolites, and additionally, lactate, 5-oxoproline, paraxanthine phenyllactate(PLA) and N-acetylglycine are protective metabolites. In addition, the study identified five currently unknown chemical structures. Cochran's Q-test showed no significant heterogeneity, and MR Egger's intercept analysis confirmed the absence of horizontal multidirectionality. Leave-one-out analysis also proved the reliability of the MR analysis.We identified seven COPD-related risks and eight protective human serum metabolites. By combining genomics and metabolism, it provides new insights into the underlying mechanisms of COPD, with important implications for COPD screening and prevention.

Diagnosis of chronic obstructive pulmonary disease (COPD) in older patients : Consensus statement of the Working Group on Pneumology in Older Patients

Chronic obstructive pulmonary disease (COPD) is a frequent disease from which approximately 8% of individuals aged 40 years and above suffer. The prevalence increases up to fivefold as age advances. Following an introduction including the etiology, measurement, characteristic features and classification of COPD, this article presents the consensus recommendations of the German Working Group on Pneumology in Older Patients. These include statements on the screening for frailty, dysphagia, malnutrition and cognitive impairment. The results are summarized with the final conclusion that adequate treatment of COPD can also slow the progression of cognitive decline and could potentially prevent or delay the onset of dementia.

Meta-Analysis of Randomized, Controlled Trials Assessing the Effectiveness and Safety of Biological Treatments in Chronic Obstructive Pulmonary Disease Patients

Anti-interleukin-5 (IL-5), anti-IL-5 receptor and anti-interleukin-4 (IL-4) have emerged as potential treatments for severe eosinophilic asthma, yet their role in treating chronic obstructive pulmonary disease (COPD) is unclear. A literature review was conducted up to May 31, 2024. Only randomized controlled trials (RCTs) assessing the clinical efficacy and adverse effects of biological treatment (anti-IL-5/ anti-IL-5 receptor /anti-IL-4) in COPD patients were included in this meta-analysis. Primary outcomes focused on COPD exacerbation risk, with secondary outcomes examining lung function, quality of life, and adverse events. Four articles comprising 6 RCTs were analyzed. Among 2837 patients receiving anti-IL-5/anti-IL-5 receptor therapies, 468 receiving anti-IL-4 therapies, and 1913 receiving placebo. Overall, biological treatment therapies collectively demonstrated a reduced risk of COPD exacerbation compared to placebo (rate ratio, 0.88; 95% CI, 0.80-0.97, I2 = 53%). Specifically, dupilumab statistically significant reduction in exacerbation risk (rate ratio 0.70, 95% CI 0.58-0.84). Benralizumab showed a borderline reduction in exacerbation risk (rate ratio, 0.92; 95% CI, 0.85-1.00, I2 = 0%, while Mepolizumab exhibited a trend towards lower exacerbation risk that did not reach statistical significance (rate ratio 0.90, 95% CI 0.77-1.06, I2 = 62%). Subgroup analysis showed that patients with COPD and eosinophils ≥300 per cubic millimeter who received biological treatment may experience a reduced risk of acute exacerbation. Changes in lung function from baseline did not significantly differ between biological therapies and placebo. Analysis of St. George's Respiratory Questionnaire (SGRQ) scores indicated significant improvements with biological therapies compared to placebo (mean difference -1.30, 95% CI -2.46 to -0.14, I2 = 28%). Biological therapies showed comparable risks of adverse events compared to placebo. This meta-analysis suggests that biological therapies may reduce the risk of acute exacerbations and improve quality of life in COPD patients compared to placebo. However, these therapies did not demonstrate significant improvements in pulmonary function. Future studies are needed to delineate the role of these biologic therapies in managing COPD exacerbations.

Clinical and Prognostic Differences in Mild to Moderate COPD With and Without Emphysema

BACKGROUND

The clinical and prognostic characteristics of mild-to-moderate COPD with and without emphysema remain inadequately investigated.

RESEARCH QUESTION

Do the clinical and prognostic characteristics differ between mild-to-moderate COPD with and without emphysema?

STUDY DESIGN AND METHODS

We obtained clinical data of 989 participants with mild-to-moderate COPD from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). They were categorized into two groups based on their baseline low-attention lung voxels with a density < -950 Hounsfield units of < 5% on CT scans: mild-to-moderate COPD with emphysema (EC) group and mild-to-moderate COPD without emphysema (NEC) group. Linear mixed-effects models were used to assess the differences in the decline of lung function, health-related quality of life, and quantitative CT indexes between these two groups. Zero-inflated negative binomial regressions were used to evaluate the rates of acute respiratory exacerbations between the groups.

RESULTS

Among participants with mild-to-moderate COPD, 428 (43.3%) exhibited emphysema on CT scans. The annual decline in FEV1 was -56.1 mL/y for the EC group and -46.9 mL/y for the NEC group, with a nonsignificant between-group difference of 9.1 mL/y (95% CI, -24.0 to 5.7 mL/y). The rate of emphysema progression in the EC group was significantly lower than in the NEC group (natural logarithm(%LAA-950), -0.173%; 95% CI, -0.252% to -0.094%). The EC group also showed a more pronounced annual increase in the St. George's Respiratory Questionnaire score (0.9 points) compared with the NEC group. The EC group had a higher rate of acute respiratory exacerbations (0.36 per person-year) than the NEC group (0.25 per person-year), with a rate ratio of 1.42 (95% CI, 1.27-1.54).

INTERPRETATION

The EC group did not have accelerated rates of decline in FEV1, but they experienced significantly worse health-related quality of life and a higher rate of acute respiratory exacerbations. The nonemphysema subtype demonstrated increased emphysema progression.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov; No.: NCT01969344; URL: www.

CLINICALTRIALS

gov.

Molecular Approaches to Treating Chronic Obstructive Pulmonary Disease: Current Perspectives and Future Directions

Chronic obstructive pulmonary disease (COPD) is a clinical syndrome that presents as airflow limitation with poor reversibility accompanied by dynamic hyperinflation of the lung. It is a complex disease with chronic inflammatory airway changes caused by exposure to noxious particles or gases, such as cigarette smoke. The disease involves persistent inflammation and oxidative stress, perpetuated by frequent exacerbations. The prevalence of COPD is on the rise, with the prediction that it will be the leading cause of morbidity and mortality over the next decade. Despite the global burden of COPD and its associated morbidity and mortality, treatment remains limited. Although the understanding of the pathogenesis of COPD has increased over the last two decades, molecular approaches to develop new therapies for the treatment of COPD have lagged. Here, we review the molecular approaches that have the potential for developing novel therapies for COPD.

Quantitative CT and COPD: cluster analysis reveals five distinct subtypes with varying exacerbation risks

BACKGROUND

The heterogeneity of chronic obstructive pulmonary disease (COPD) is increasingly recognized. To characterize the heterogeneity of COPD, we aimed to identify subtypes related to quantitative CT by using principal component analysis (PCA) and cluster analysis.

METHODS

The data of 1879 participants in the SPIROMICS study were obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center. A combination of PCA and k-means clustering was used to analyze the data from these participants in the SPIROMICS study. We randomly split the samples into training and validation sets. Clusters were evaluated for their relationship with acute exacerbation risk throughout the entire follow-up period. The results of the training set were confirmed in the validation set. To avoid sampling errors, we conducted 10 random sampling cycles. Normalized mutual information (NMI) was applied in every cycle to evaluate the stability of clustering.

RESULTS

We identified five clusters related to quantitative CT characterized as follows: (1) male-dominated low disease impact cluster, (2) obesity with relatively high symptom burden cluster, (3) airway wall lesion cluster, (4) lung upper region zone-predominant emphysema cluster, (5) severe emphysema cluster. There are significant differences in acute exacerbation risk among these five clusters.

CONCLUSIONS

Cluster analysis identified 5 clusters related to quantitative CT of all participants in the SPIROMICS cohort with significant differences in baseline characteristics and acute exacerbation risk. The stability of clustering results was validated through NMI in 10 sampling cycles. In addition, dimensionality reduction results showed high reproducibility in different studies.

Associations of Serum Legumain with Severity and Prognosis Among Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients

Background

A number of studies have demonstrated that legumain is engaged in the pulmonary diseases. Nevertheless, the role of legumain is indistinct in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The aim is to identify the correlation of serum legumain with AECOPD patients through a prospective cohort study.

Methods

All 202 patients with AECOPD were enrolled. Fasting venous blood was collected. Serum legumain was detected by ELISA.

Results

On admission, serum legumain concentration was gradually elevated in line with AECOPD severity scores. Additionally, serum legumain was closely associated with clinical characteristics. Linear regression analysis confirmed the positive relationships of serum legumain with COPD severity scores. Moreover, the poor prognoses were tracked in patients of AECOPD. Serum higher legumain at admission increased the risks of death and acute exacerbation during hospitalization.

Conclusion

Serum legumain at admission was positively correlated with the severity and adverse prognosis in AECOPD patients, indicating that legumain plays a vital role in the initiation and development of AECOPD. As a result, serum legumain can become a biomarker in the disease assessment and prognosis prediction for AECOPD.

Risk Factors of FEV₁/FVC Decline in COPD Patients

BACKGROUND

Factors influencing the decline in forced expiratory volume in one second (FEV₁)/forced vital capacity (FVC) for chronic obstructive pulmonary disease (COPD) progression remain uncertain. We aimed to identify risk factors associated with rapid FEV₁/FVC decline in patients with COPD.

METHODS

This multi-center observational study was conducted from January 2012 to December 2022. Eligible patients were monitored with symptoms, spirometric tests, and treatment patterns over 3 years. Rapid FEV₁/FVC decliners were defined as the quartile of patients exhibiting the highest annualized percentage decline in FEV₁/FVC.

RESULTS

Among 1,725 patients, 435 exhibited rapid FEV₁/FVC decline, with an annual change of -2.5%p (interquartile range, -3.5 to -2.0). Rapid FEV₁/FVC decliners exhibited lower body mass index (BMI), higher smoking rates, elevated post-bronchodilator (BD) FEV₁, higher post-BD FEV₁/FVC, and a lower prevalence of Staging of Airflow Obstruction by Ratio (STAR) stage IV. Rapid FEV₁/FVC decline was not linked to the annual exacerbation rate, but there was an association with symptom deterioration and FEV₁ decline. In multivariable analyses, low BMI, current smoking, increased modified Medical Research Council dyspnoea score, low post-BD FEV₁, low STAR stage, high forced mid-expiratory flow (FEF25-75%), accelerated FEV₁ decline, and not initiating dual BD therapy were identified as independent risk factors for rapid FEV₁/FVC decline.

CONCLUSION

We identified the risk factors for rapid FEV₁/FVC decline, including BMI, smoking, symptoms deterioration, FEV₁ decline, and adherence to standard inhaler treatment. Our findings underscore the potential benefits of maintaining consistent use of long-acting beta-agonist/long-acting muscarinic antagonist even in the presence of worsening symptoms, in attenuating FEV₁/FVC decline.