Identifying risk factors for COPD and adult-onset asthma: an umbrella review

RARB genetic variants might contribute to the risk of chronic obstructive pulmonary disease based on a case-control study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that severely impairs patients' respiratory function and quality of life. RARB is involved in COPD progression by affecting inflammatory reactions, cell proliferation, and apoptosis. The impact of single nucleotide polymorphisms (SNPs) within RARB on COPD susceptibility remains unclear. Here, we aimed to evaluate the association between RARB SNPs and COPD risk.

METHODS

A total of 270 COPD patients and 271 healthy controls were enrolled. The MassARRAY iPLEX platform tested the genotype of the SNPs. The association was analyzed using logistic regression analysis. The false-positive report probability (FPRP) analysis was performed to validate the significant findings. The relationship between SNPs and RARB expression was evaluated using the GTEx database.

RESULTS

Our study found a significant association between rs6799734 and COPD susceptibility (OR 1.88, p = 0.008, p (FDR) = 0.047). The stratified analysis revealed that this association was particularly pronounced among individuals aged ≤ 71 years (OR 2.34, p = 0.011, p (FDR) = 0.045), males (OR 2.60, p = 0.002, p (FDR) = 0.013), those with a BMI ≥ 24 (OR 3.95, p = 0.018, p (FDR) = 0.108), and smokers (OR 2.48, p = 0.020, p (FDR) = 0.120). Additionally, rs1286641 and rs1881706 showed significant associations with COPD risk in females and smokers. These associations were further validated by FPRP analysis. Preliminary mechanism studies indicated that rs1286641 and rs1881706 were related to RARB expression.

CONCLUSION

Our findings suggest a potential role of RARB SNPs in influencing COPD risk.

Influence of cigarette smoking on drugs' metabolism and effects: a systematic review

PURPOSE

Cigarette smoke continues to be widely used around the world and it contains several substances that can affect the pharmacokinetics and/or pharmacodynamics of medications, altering their safety and effectiveness. The aim of this systematic review was to summarize the scientific evidence regarding possible changes in the pharmacokinetics and/or pharmacodynamics of drugs induced by cigarette smoking, possible mechanisms of action and related effects.

METHODS

The systematic review was performed according to the PRISMA Statement and the protocol was registered on the PROSPERO platform (CRD42023477784). Pubmed, Scopus, Web of Science databases were used. We considered observational, semi-experimental or experimental studies written in English and published between January 1, 2000, and November 13, 2024, focused on smoking subjects (healthy volunteers or patients) receiving any kind of medication. Data regarding possible modifications in drugs' pharmacokinetics and/or pharmacodynamics induced by cigarette smoking were assessed. The quality of observational studies and experimental studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale and the Jadad Scale, respectively.

RESULTS

In total, 37 studies were included, and 31 of them showed relevant modifications in the pharmacokinetics or effects of the drugs in smokers compared to non-smokers. Most of the included studies (n = 20) investigated drugs for psychiatric or neurological disorders, showing a reduction in plasma concentration or an increase in drug clearance in smokers as well as antibiotics metronidazole and cycloserine. Besides, seven articles focused on anticancer drugs indicating an increase in drug metabolism. The remaining articles reported effects of smoking on the metabolism of other drugs, such as cardiovascular drugs, phosphodiesterase 5 inhibitors, local anesthetics and medications for musculoskeletal or chronic obstructive pulmonary diseases. Induction of the cytochrome enzyme CYP1A2 is the most common mechanism mediating the reduction of drug concentrations by cigarette smoking.

CONCLUSION

The results indicate an increased risk of therapeutic failure for smokers and represent further motivation to encourage smoking cessation or attention in formulating personalized therapy.

Risk relationship between six autoimmune diseases and malignancies: An umbrella review

BACKGROUND

The bidirectional relationship between autoimmune diseases and malignancy has been widely discussed. And the relationship between autoimmune diseases and the risk of malignancy varies. Here, we categorized and re-analyzed the evidence of the association between six autoimmune diseases and malignancy risk, in order to provide ideas for the prevention of malignancy in the long-term individualized management of patients with autoimmune diseases.

METHODS

We systematically searched the relevant literatures in PubMed, Web of Science and Cochrane Library to identify and re-analyze studies methodically on the association between six autoimmune diseases and their malignancy risk. Our results showed that.

RESULTS

We included 34 meta-analyses including systematic lupus erythematosus, rheumatoid arthritis, psoriasis, ankylosing spondylitis, primary Sjogren's syndrome, multiple sclerosis, totalling 742 studies. Our results showed that the remaining five AIDs, with the exception of MS, were positively associated with the risk of overall malignancy. Among them, patients with SLE had the highest risk of developing lymphomas, oropharyngeal cancer and non-Hodgkin's lymphoma, and the lowest risk of developing uterine cancer, melanoma and endometrial cancer. The RA patients had the highest risk of developing lymphomas, Hodgkin's lymphoma and non-Hodgkin's and the lowest risk of colon cancer. pSS patients had the highest risk of lymphoma. MS patients had the highest risk of lung cancer and the lowest risk of testicular cancer. AS patients had the highest risk of lymphoblastic leukemia. PsO patients had the highest risk of keratinocyte cancer.

CONCLUSION

Patients with systematic lupus erythematosus, rheumatoid arthritis, psoriasis, ankylosing spondylitis and primary Sjogren's syndrome lead to an increased risk of overall malignancy, whereas patients with MS lead to a decreased risk of overall malignancy. However, the risk relationship between the same AIDs and different malignancies varied.

High expression of ITGB3 ameliorates asthma by inhibiting epithelial-mesenchymal transformation through suppressing the activation of NF-kB pathway

Integrin β3 (ITGB3) has been identified as an asthma-associated gene; however, its molecular mechanisms remain poorly understood. Epithelial-mesenchymal transition (EMT) is a critical driver of airway remodeling in asthma, which underpins disease progression. This study aimed to elucidate the role of ITGB3 in asthma pathogenesis by investigating its regulation of EMT. Asthma models were established in vivo using C57BL/6 mice and in vitro with A549 cells, both exposed to house dust mite (HDM) extract. The effects of HDM and ITGB3 modulation on cellular viability, apoptosis, and inflammatory cytokines (IL-4, IL-5, IL-13) were assessed in cultured cells and murine lungs. EMT was evaluated via western blot analysis of E-cadherin, N-cadherin, and vimentin expression. The NF-κB pathway was examined by quantifying phosphorylated p65 and IkBa levels. Lung tissue pathology and ITGB3 expression were assessed using hematoxylin and eosin (H&E) staining and immunohistochemistry. Results demonstrated that HDM exposure reduced A549 cell viability, increased cytotoxicity, apoptosis, and pro-inflammatory cytokine production, while promoting EMT. ITGB3 knockdown exacerbated these effects, whereas ITGB3 overexpression mitigated them. Furthermore, HDM activated the NF-κB pathway, an effect reversed by ITGB3 overexpression. In HDM-challenged cells, NF-κB activation via an agonist counteracted the protective effects of ITGB3 overexpression on apoptosis, inflammation, and EMT. Notably, ITGB3 overexpression suppressed inflammation, EMT, and pathological remodeling in asthmatic mice. Collectively, our findings reveal that ITGB3 exerts protective effects in asthma by inhibiting EMT through suppression of the NF-κB signaling pathway, thereby identifying ITGB3 as a potential therapeutic target for asthma management.

Association of dietary calcium intake with chronic bronchitis and emphysema

OBJECTIVE

Chronic bronchitis and emphysema (CBE) are two main types of chronic obstructive pulmonary disease (COPD). We aimed to investigate the relationship between dietary calcium intake and the risk of CBE.

METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. The ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) < 0.7 was used to define airflow obstruction. Multivariate logistic regression was performed to assess the effects of dietary calcium intake on CBE and airflow obstruction. Dietary calcium intake was divided into quartiles, with the lowest quartile set as the reference group. Linear regression models were applied to explore the association between dietary calcium intake and lung function.

RESULTS

A total of 10,143 participants were enrolled in the study, including 594 CBE and 9549 non-CBE individuals. The average dietary calcium intake was 908.5 ± 636.1 mg/day in the CBE group and 951.9 ± 599.7 mg/day in the non-CBE group. When using the lowest quartile of dietary calcium intake as a reference, the second, third, and fourth quartiles reduced the risk of CBE by 0.803 [95% confidence interval (CI): 0.802-0.804; P < 0.001], 0.659 (95% CI: 0.659-0.660; P < 0.001) and 0.644 (95% CI: 0.643-0.644; P < 0.001) times, respectively. Increased dietary calcium intake was correlated with reduced risk of airflow obstruction. Dietary calcium intake positively predicts FEV1 (β = 0.225, P < 0.001) and FVC (β = 0.232, P < 0.001).

CONCLUSION

Increased intake of dietary calcium may contribute to higher lung function, a lower risk of CBE and airflow obstruction. Since the cross-sectional design makes it difficult to determine a causal relationship, further research is needed to confirm these findings and explore the underlying mechanisms.

Neuroticism and asthma: Mendelian randomization analysis reveals causal link with mood swings and BMI mediation

BACKGROUND

Neuroticism has been associated with asthma, but the nature of this relationship remains unclear due to limited understanding of the impact of psychological factors on asthma risk. While Neuroticism is known to affect various health outcomes, its specific role in respiratory conditions like asthma is not fully understood.

METHODS

We conducted Mendelian randomization (MR) analyses using genome-wide association studies (GWAS) to explore the causal link between 12 Neuroticism traits and asthma. Various MR approaches, including MR-PRESSO, were employed, with validation through independent GWAS and the FinnGen dataset.

RESULTS

MR-PRESSO revealed a significant causal relationship between mood swings and asthma (OR: 1.927, 95% CI: 1.641-2.263), surpassing the Bonferroni-corrected threshold (p < 4.167 × 10-³). Mood swings emerged as the only significant trait associated with asthma, with reverse MR analyses showing no causal links for other traits. Secondary analyses supported these findings. Multivariate analysis showed mood swings increased asthma risk, independent of smoking, BMI, and air pollution. Mediation analysis indicated that BMI partially mediates the mood swing-asthma relationship, accounting for 9.87% of the effect (95% CI: 4.54%-15.2%, p = 2.850 × 10-4).

CONCLUSION

Mood swings elevate asthma risk, with BMI partially mediating this effect, highlighting a potentially significant pathway through which psychological traits influence asthma.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Relationship of perfluoroalkyl chemicals with chronic obstructive pulmonary disease: A cross-sectional study

Perfluoroalkyl chemicals are one of the most stable substances in industry and have become ubiquitous contaminants owing to their persistence in the environment. This study enrolled 1,953 participants aged ≥40 years old using data from the National Health and Nutrition Examination Survey (NHANES). We selected four perfluoroalkyl chemicals with a detection frequency of more than 80%, including perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), perfluorooctanoic acid (PFOA), and perfluorooctane sulfonic acid (PFOS). Multivariate logistic regression was performed to determine the relationship of serum perfluoroalkyl chemicals with COPD and airflow limitation. We evaluated the interaction between perfluoroalkyl chemicals and lung function using multivariate linear regression analyses. Our results showed that the prevalence of COPD was not significantly related to serum PFHxS, PFNA, PFOA, and PFOS. Airflow limitation was positively linked with serum PFHxS, PFOA, and PFOS. However, these significant differences were not robust after adjustment of all confounders of interest. Serum PFHxS, PFOA, and PFOS were all positively related to the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). However, only PFOA remained significantly linked with the FEV1 and FVC after covariate adjustment. These results indicated that there was no significant interaction between exposure to perfluoroalkyl chemicals and the prevalence of COPD. Higher levels of serum PFOA appeared to be related to higher measures of FEV1 and FVC.

Impact of occupational exposures in patients with chronic obstructive pulmonary disease: current understanding and knowledge gaps

PURPOSE OF REVIEW

Chronic obstructive pulmonary disease (COPD) is thought of as a disease caused by tobacco exposure, but numerous occupational exposures have been identified as risk factors for development of disease and exacerbations, although these remain underappreciated and underdiagnosed. We highlight evidence of occupational exposures and how they relate to COPD, while also looking at gaps in how the changing workplace might affect the occupational COPD landscape.

RECENT FINDINGS

Historical exposures linked to COPD included inorganic dusts like coal and silica and organic dusts like cotton and wood. Other data associated agricultural exposures, cleaning agents, air pollution, and construction work with COPD. As the workplace has evolved to include more work from home and growing industries like ridesharing and delivery, items like radon and indoor and outdoor air quality must be factored into the equation as occupational exposures with the potential to cause COPD and increase its morbidity. Despite this, causal conclusions with many risk factors are challenging due to the complex interaction between patient susceptibilities and environmental factors, both occupation-related and nonoccupation related.

SUMMARY

Additional studies are needed, not only to better evaluate occupational exposures and COPD pathogenesis, but also to look at more solution-oriented areas like precision medicine and interventions targeting a healthier workplace.

Formaldehyde and asthma: a plausibility?

Formaldehyde (FA) is a ubiquitous indoor air pollutant emitted from construction, consumer, and combustion-related products, and ozone-initiated reactions with reactive organic volatiles. The derivation of an indoor air quality guideline for FA by World Health Organization in 2010 did not find convincing evidence for bronchoconstriction-related reactions as detrimental lung function. Causal relationship between FA and asthma has since been advocated in meta-analyses of selected observational studies. In this review, findings from controlled human and animal exposure studies of the airways, data of FA retention in the respiratory tract, and observational studies of reported asthma applied in meta-analyses are analyzed together for coherence of direct association between FA and asthma. New information from both human and animal exposure studies are evaluated together with existing literature and assessed across findings from observational studies and associated meta-analyses thereof. Retention of FA in the upper airways is > 90% in agreement with mice exposure studies that only extreme FA concentrations can surpass trachea, travel to the lower airways, and cause mild bronchoconstriction. However, taken together, detrimental lung function effects in controlled human exposure studies have not been observed, even at FA concentrations up 4 ppm (5 mg/m3), and in agreement with controlled mice exposure studies. Typical indoor FA concentrations in public buildings and homes are far below a threshold for sensory irritation in the upper airways, based on controlled human exposure studies, to induce sensory-irritative sensitization nor inflammatory epithelial damage in the airways. Analysis of the observational heterogeneous studies applied in the meta-analyses suffers from several concomitant multifactorial co-exposures, which invalidates a direct association with asthma, thus the outcome of meta-analyses. The evidence of a direct causal relationship between FA and asthma is insufficient from an experimental viewpoint that includes retention data in the upper airways and controlled animal and human exposure studies. Taken together, a coherence of controlled experimental findings with individual observational studies and associated meta-analyses, which suffer from caveats, is absent. Further, lack of identified evidence of FA-IgE sensitization in both experimental studies and observational studies agrees with indoor FA concentrations far below threshold for sensory irritation. The assessment of experimental data with uncontrolled observational studies in meta-analyses is incompatible with a direct causal relationship between FA and asthma or exacerbation thereof due to lack of coherence and plausibility.

Comprehensive bioinformatics analysis identifies metabolic and immune-related diagnostic biomarkers shared between diabetes and COPD using multi-omics and machine learning

Background

Diabetes and chronic obstructive pulmonary disease (COPD) are prominent global health challenges, each imposing significant burdens on affected individuals, healthcare systems, and society. However, the specific molecular mechanisms supporting their interrelationship have not been fully defined.

Methods

We identified the differentially expressed genes (DEGs) of COPD and diabetes from multi-center patient cohorts, respectively. Through cross-analysis, we identified the shared DEGs of COPD and diabetes, and investigated alterations of signaling pathways using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and gene set enrichment analysis (GSEA). By using weighted gene correlation network analysis (WGCNA), key gene modules for COPD and diabetes were identified, and various machine learning algorithms were employed to identify shared biomarkers. Using xCell, we investigated the relationship between shared biomarkers and immune infiltration in diabetes and COPD. Single-cell sequencing, clinical samples, and animal models were used to confirm the robustness of shared biomarkers.

Results

Cross-analysis identified 186 shared DEGs between diabetes and COPD patients. Functional enrichment results demonstrate that metabolic and immune-related pathways are common features altered in both diabetes and COPD patients. WGCNA identified 526 genes from key gene modules in COPD and diabetes. Multiple machine learning algorithms identified 4 shared biomarkers for COPD and diabetes, including CADPS, EDNRB, THBS4 and TMEM27. Finally, the 4 shared biomarkers were validated in single-cell sequencing data, clinical samples, and animal models, and their expression changes were consistent with the results of bioinformatic analysis.

Conclusions

Through comprehensive bioinformatics analysis, we revealed the potential connection between diabetes and COPD, providing a theoretical basis for exploring the common regulatory genes.

The Saudi Thoracic Society Evidence-based guidelines for the diagnosis and management of chronic obstructive pulmonary disease

The Saudi Thoracic Society (STS) developed an updated evidence-based guideline for diagnosing and managing chronic obstructive pulmonary disease (COPD) in Saudi Arabia. This guideline aims to provide a comprehensive and unbiased review of current evidence for assessing, diagnosing, and treating COPD. While epidemiological data on COPD in Saudi Arabia are limited, the STS panel believes that the prevalence is increasing due to rising rates of tobacco smoking. The key objectives of the guidelines are to facilitate accurate diagnosis of COPD, identify the risk for COPD exacerbations, and provide recommendations for relieving and reducing COPD symptoms in stable patients and during exacerbations. A unique aspect of this guideline is its simplified, practical approach to classifying patients into three classes based on symptom severity using the COPD Assessment Test and the risk of exacerbations and hospitalizations. The guideline provides the reader with an executive summary of recommended COPD treatments based on the best available evidence and also addresses other major aspects of COPD management and comorbidities. This guideline is primarily intended for use by internists and general practitioners in Saudi Arabia.

Adult Outcomes of Childhood Wheezing Phenotypes Are Associated with Early-Life Factors

Introduction: While the phenotypic diversity of childhood wheezing is well described, the subsequent life course of such phenotypes and their adult outcomes remain poorly understood. We hypothesized that different childhood wheezing phenotypes have varying longitudinal outcomes at age 26. We sought to identify factors associated with wheezing persistence, clinical remission, and new onset in adulthood. Methods: Participants were seen at birth and at 1, 2, 4, 10, 18, and 26 years in the Isle of Wight Birth Cohort (n = 1456). Information was collected prospectively on wheeze prevalence and phenotypic characteristics at each assessment. Wheeze phenotypes at 10 years were defined as participants wheezing (CW10) or not wheezing at 10 (CNW10). Multivariable regression analyses were undertaken to identify factors associated with wheezing persistence/remission in CW10 and wheeze development in CNW10 at age 26 years. Results: Childhood wheezing phenotypes showed different subsequent outcomes and associated risk factors. Adult wheeze developed in 17.8% of CNW10. Factors independently associated with adult wheeze development in CNW10 included eczema at age 4 years, family history of rhinitis, and parental smoking at birth. Conversely, 56.1% of CW10 had remission of wheeze by 26 years. Factors predicting adult wheezing remission in CW10 included absence of both atopy at age 4 years and family history of rhinitis. Conclusion: Early-life factors influence adult outcomes for childhood wheezing phenotypes, both with respect to later development of adult wheezing in asymptomatic participants and of wheeze remission in childhood wheezers. This suggests potential areas that could be targeted by early-life interventions to alleviate adult disease burden.

A comprehensive review of ferroptosis in environmental pollutants-induced chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common chronic lung disease that impacts hundreds of millions of individuals worldwide. It is principally characterized by irreversible and progressive airflow limitation. Environmental pollutants, including cigarette smoke, air pollution, occupational pollutants, remain predominant risk factors for COPD and play remarkable roles in COPD progression. Despite the availability of treatments to alleviate symptoms of COPD, it continues to exert a serious health and socioeconomic burden. Ferroptosis, a unique form of iron-dependent cell death distinguished by lipid peroxidation, is implicated in various diseases. Recent studies, utilizing COPD patients samples, animal models, and Gene Expression Omnibus (GEO) database, have revealed that ferroptosis is involved in pathogenesis of COPD. Inhibiting ferroptosis signaling pathways halts the progression of COPD. This review consolidates current insights into the mechanisms of ferroptosis in environmental pollutants-induced COPD, which might offer a novel therapeutic strategy for COPD.

Area-level socioeconomic inequalities in mortality in China: a nationwide cohort study based on the ChinaHEART project

BACKGROUND

Socioeconomic status is a key social determinant of health. Compared with individual-level socioeconomic status, the association between area-level socioeconomic status and mortality has not been well investigated in China. We aimed to assess associations between area-level socioeconomic status and all-cause mortality and cause-specific mortality in China, as well as the interplay of area-level and individual-level socioeconomic status on mortality.

METHODS

In this nationwide cohort study, residents aged 35-75 years from 453 districts and counties were included in the China Health Evaluation and Risk Reduction Through Nationwide Teamwork (ChinaHEART) Study. The composite value of area-level socioeconomic status was generated from national census data and categorised into tertiles. Mortality rates and their 95% CIs were calculated using the Clopper-Pearson method. Cox frailty models were fitted to calculate adjusted hazard ratios and 95% CIs for area-level socioeconomic status with the risk of all-cause mortality and cause-specific mortality and their disparities across different population. We also assessed the roles of multiple individual factors as potential mediators.

FINDINGS

Between December, 2015, and December, 2022, 1 119 027 participants were included, for whom the mean age was 56·1 (SD 9·9) years and 672 385 (60·1%) were female. 24 426 (5·24 [95% CI 5·18-5·31] per 1000 person-years) deaths occurred during the median 4·5-year follow-up. Compared with high area-level socioeconomic status, low area-level socioeconomic status was significantly associated with an increased risk of all-cause (hazard ratio 1·11, 95% CI 1·07-1·16), cardiovascular disease (1·38, 1·29-1·48), and respiratory disease (1·44, 1·22-1·71) mortality. The stronger associations were observed in people older than 60 years, females, and participants with lower individual-level socioeconomic status. The individual-level socioeconomic, behavioural, and metabolic factors mediated 39·5% of the association between area-level socioeconomic status and mortality, of which individual-level socioeconomic status made the largest contribution.

INTERPRETATION

There are substantial area-level socioeconomic status-related inequalities in mortality in China. Individual-level socioeconomic, behavioural, and metabolic factors had mediating effects. Actions to improve area-level circumstances and individual factors are needed to improve health equity.

FUNDING

The Chinese Academy of Medical Sciences Innovation Fund for Medical Science, the National High Level Hospital Clinical Research Funding, the Ministry of Finance of China, and the National Health Commission of China.

TRANSLATION

For the Chinese translation of the abstract see Supplementary Materials section.

The impact of airborne particulate matter-based pollution on the cellular and molecular mechanisms in chronic obstructive pulmonary disease (COPD)

Inhalation of particulate matter (PM), one of the many components of air pollution, is associated with the development and exacerbation of chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD). COPD is one of the leading causes of global mortality and morbidity, with a paucity of therapeutic options and a significant contributor to global health expenditure. This review aims to provide a mechanistic understanding of the cellular and molecular pathways that lead to the development of COPD following chronic PM exposure. Our review describes how the inhalation of PM can lead to lung parenchymal destruction and cellular senescence due to chronic pulmonary inflammation and oxidative stress. Following inhalation of PM, significant increases in a range of pro-inflammatory cytokines, mediated by the nuclear factor kappa B pathway are reported. This review also highlights how the inhalation of PM can lead to deleterious chronic oxidative stress persisting in the lung post-exposure. Furthermore, our work summarises how PM inhalation can lead to airway remodelling, with increases in pro-fibrotic cytokines and collagen deposition, typical of COPD. This paper also accentuates the interconnection and possible synergism between the pathophysiological mechanisms leading to COPD. Our work emphasises the serious health consequences of PM exposure on respiratory health. Elucidation of the cellular and molecular mechanisms can provide insight into possible therapeutic options. Finally, this review should serve as a stark reminder of the need for genuine action on air pollution to decrease the associated health burden on our growing global population.

Association between advanced lung cancer inflammation index and unstable asthma: a population-based study from the NHANES 2007-2018

Background

Asthma exacerbation is associated with obesity and systemic inflammatory diseases, and advanced lung cancer inflammation index (ALI) is a novel biomarker of nutritional inflammation. The purpose of this study was to investigate the potential relationship between ALI and unstable asthma.

Methods

This cross-sectional study utilized data from the 2007-2018 National Health and Nutrition Examination Survey (NHANES). Asthma was assessed through self-reported questionnaires. Multifactorial logistic regression, subgroup analyses, interaction assessments, smoothed curve fitting, and threshold effect analysis models were conducted to investigate the association between ALI and unstable asthma.

Results

The study included 1,822 subjects with current asthma, and we found a linear positive association between ALI and unstable asthma, with higher levels of ALI significantly associated with an increased risk of asthma exacerbations in fully corrected models. However, the associations were not entirely consistent across subgroups. In subgroup analyses by body mass index (BMI) and race, unstable asthma and ALI were independently significant in the BMI (25-29.9) range and the Non-Hispanic White group. Interaction analysis suggested that BMI moderated the relationship between ALI and unstable asthma. Furthermore, smoothed curve fitting showed an inverted U-shaped relationship between log ALI and unstable asthma in subjects with a BMI <25 and male individuals, with inflection points observed at 1.53 and 2.13, respectively.

Conclusion

We found a linear positive association between ALI and unstable asthma, which remained constant in the fully adjusted model. These findings suggest that higher levels of ALI were significantly associated with an increased risk of asthma exacerbation, particularly in asthmatic populations with BMI in the 25-29.9 range. However, more prospective studies are required to confirm our findings.

Discovering the role of microRNAs and exosomal microRNAs in chest and pulmonary diseases: a spotlight on chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition and ranks as the fourth leading cause of mortality worldwide. Despite extensive research efforts, a reliable diagnostic or prognostic tool for COPD remains elusive. The identification of novel biomarkers may facilitate improved therapeutic strategies for patients suffering from this debilitating disease. MicroRNAs (miRNAs), which are small non-coding RNA molecules, have emerged as promising candidates for the prediction and diagnosis of COPD. Studies have demonstrated that dysregulation of miRNAs influences critical cellular and molecular pathways, including Notch, Wnt, hypoxia-inducible factor-1α, transforming growth factor, Kras, and Smad, which may contribute to the pathogenesis of COPD. Extracellular vesicles, particularly exosomes, merit further investigation due to their capacity to transport various biomolecules such as mRNAs, miRNAs, and proteins between cells. This intercellular communication can significantly impact the progression and severity of COPD by modulating signaling pathways in recipient cells. A deeper exploration of circulating miRNAs and the content of extracellular vesicles may lead to the discovery of novel diagnostic and prognostic biomarkers, ultimately enhancing the management of COPD. The current review focus on the pathogenic role of miRNAs and their exosomal counterparts in chest and respiratory diseases, centering COPD.

CLCA1 and BPIFB1 are potential novel biomarkers for asthma: an iTRAQ analysis

Background

Asthma is a chronic respiratory disease that affects billions of people. Due to its diverse phenotypes and endotypes with distinct pathophysiological mechanisms, significant challenges arise in its clinical diagnosis and treatment. The discovery of potential biomarkers of asthma has significant implications for its clinical classification and precise treatment. The purpose of this study is to identify potential biomarkers for asthma, providing a foundation for its diagnosis and treatment.

Methods

We constructed an ovalbumin (OVA)-sensitized asthmatic mice model and used isobaric Tags for Relative and Absolute Quantitation (iTRAQ) labeling and liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) technology to identify differentially expressed proteins (DEPs) in lung tissues. We then performed enrichment analyses of the DEPs using the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases, and constructed protein-protein interaction (PPI) networks.

Results

We identified 242 DEPs in the asthmatic mice model and showed that heat shock protein family A (Hsp70) member 5 (HSPA5) is a central protein in asthma. Consistent with our bioinformatics analysis, our western blot validation confirmed that the protein levels of arginase 1 (ARG1), chitinase-like protein 3 (CHIL3), chloride channel accessory 1 (CLCA1), and bactericidal/permeability-increasing protein (BPI) fold-containing family B member 1 (BPIFB1) were significantly increased in asthma group compared to the control group. Thus, we found that CLCA1 and BPIFB1 were the most promising potential biomarkers of asthma.

Conclusions

Our iTRAQ analysis and western blot verification of asthmatic mice showed that HSPA5 is a central protein in asthma, and CLCA1 and BPIFB1 are novel potential biomarkers that could play significant roles in the diagnosis and treatment of asthma.

Assessment of Metabolic Syndrome in Patients with Chronic Obstructive Pulmonary Disease: A 6-Month Follow-Up Study

BACKGROUND/OBJECTIVES

The association between chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS) is a common one, with long-term therapeutic and prognostic impact. In view of the high pulmonary and cardiovascular morbidity and mortality, self-management contributes to decreasing the risk of an acute cardiac event or pulmonary decompensation.

METHODS

We conducted a prospective cohort study on 100 patients admitted to Iasi Clinical Rehabilitation Hospital who were divided into two groups according to the presence (67 patients) or absence (33 patients) of MetS. All patients benefited from multidisciplinary counseling sessions on their active role in improving modifiable cardiovascular risk factors and thus increasing quality of life. The aim of this study was to examine the impact of metabolic syndrome on lung function and the role of self-management in a 6-month follow-up period. The demographic, anthropometric, cardiovascular risk factors, and respiratory function were analyzed at baseline and at 6 months.

RESULTS

The presence of MetS was associated with higher fasting blood glucose (p = 0.004) and triglycerides (p = 0.003) but not with higher levels of interleukins or TNF-alpha. At the 6-month follow-up, abdominal circumference, forced expiratory volume in one second (FEV1), dyspnea severity, and blood pressure values improved in male patients with COPD. Systolic and diastolic blood pressure decreased in the COPD group as a whole, but especially in male patients with and without associated MetS. BMI was positively correlated with FEV1 (r = 0.389, p = 0.001) and the FEV1/forced vital capacity (FVC) ratio (r = 0.508, p < 0.001) in all COPD patients and in the MetS subgroup. In the COPD group as a whole. the six-minute walk test (6MWT) results (m) were positively correlated with FEV1 and FVC. The correlation remained significant for FVC in COPD patients with and without MetS. An increase in BMI by one unit led to an increase in TG values by 3.358 mg/dL, and the presence of metabolic syndrome led to an increase in TG values by 17.433 mg/dL.

CONCLUSIONS

In our study, MetS is a common comorbidity in patients with COPD and is associated with higher BMI, fasting glucose, and triglycerides but not with the inflammatory parameters. A mixed pulmonary-cardiovascular rehabilitation intervention leads to improvement in various parameters in both female and male COPD patients.

Discordant definitions of small airway dysfunction between spirometry and parametric response mapping: the HRCT-based study

OBJECTIVES

To analyze the lung structure of small airway dysfunction (SAD) defined by spirometry and parametric response mapping (PRM) using high-resolution computed tomography (HRCT), and to analyze the predictive factors for SAD.

METHODS

A prospective study was conducted with 388 participants undergoing pulmonary function test (PFT) and inspiratory-expiratory chest CT scans. The clinical data and HRCT assessments of SAD patients defined by both methods were compared. A prediction model for SAD was constructed based on logistic regression.

RESULTS

SAD was defined in 122 individuals by spirometry and 158 by PRM. In HRCT visual assessment, emphysema, tree-in-bud sign, and bronchial wall thickening have higher incidence in SAD defined by each method. (p < 0.001). Quantitative CT showed that spirometry-SAD had thicker airway walls (p < 0.001), smaller lumens (p = 0.011), fewer bronchi (p < 0.001), while PRM-SAD had slender blood vessels. Predictive factors for spirometry-SAD were age, male gender, the volume percentage of emphysema in PRM (PRMEmph), tree-in-bud sign, bronchial wall thickening, bronchial count; for PRM-SAD were age, male gender, BMI, tree-in-bud sign, emphysema, the percentage of blood vessel volume with a cross-sectional area less than 1 mm2 (BV1/TBV). The area under curve (AUC) values for the fitted predictive models were 0.855 and 0.808 respectively.

CONCLUSIONS

Compared with PRM, SAD defined by spirometry is more closely related to airway morphology, while PRM is sensitive to early pulmonary dysfunction but may be interfered by pulmonary vessels. Models combining patient information and HRCT assessment have good predictive value for SAD.

CRITICAL RELEVANCE STATEMENT

HRCT reveals lung structural differences in small airway dysfunction defined by spirometry and parametric response mapping. This insight aids in understanding methodological differences and developing radiological tools for small airways that align with pathophysiology.

KEY POINTS

Spirometry-SAD shows thickened airway walls, narrowed lumen, and reduced branch count, which are closely related to airway morphology. PRM shows good sensitivity to early pulmonary dysfunction, although its assessment of SAD based on gas trapping may be affected by the density of pulmonary vessels and other lung structures. Combining patient information and HRCT features, the fitted model has good predictive performance for SAD defined by both spirometry and PRM (AUC values are 0.855 and 0.808, respectively).

Indoor air pollution and airway health

Because of the disproportionate amount of time that people spend indoors and the complexities of air pollutant exposures found there, indoor air pollution is a growing concern for airway health. Both infiltration of outdoor air pollution into the indoor space and indoor sources (such as smoke from tobacco products, cooking or heating practices and combustion of associated fuels, and household materials) contribute to unique exposure mixtures. Although there is substantial literature on the chemistry of indoor air pollution, research focused on health effects is only beginning to emerge and remains an important area of need to protect public health. We provide a review of emerging literature spanning the past 3 years and relating indoor air exposures to airway health, with a specific focus on the impact of either individual pollutant exposures or common combustion sources on the lower airways. Factors defining susceptibility and/or vulnerability are reviewed with consideration for priority populations and modifiable risk factors that may be targeted to advance health equity.

Asthma Inception: Epidemiologic Risk Factors and Natural History Across the Life Course

Asthma is a descriptive label for an obstructive inflammatory disease in the lower airways manifesting with symptoms including breathlessness, cough, difficulty in breathing, and wheezing. From a clinician's point of view, asthma symptoms can commence at any age, although most patients with asthma-regardless of their age of onset-seem to have had some form of airway problems during childhood. Asthma inception and related pathophysiologic processes are therefore very likely to occur early in life, further evidenced by recent lung physiologic and mechanistic research. Herein, we present state-of-the-art updates on the role of genetics and epigenetics, early viral and bacterial infections, immune response, and pathophysiology, as well as lifestyle and environmental exposures, in asthma across the life course. We conclude that early environmental insults in genetically vulnerable individuals inducing abnormal, pre-asthmatic airway responses are key events in asthma inception, and we highlight disease heterogeneity across ages and the potential shortsightedness of treating all patients with asthma using the same treatments. Although there are no interventions that, at present, can modify long-term outcomes, a precision-medicine approach should be implemented to optimize treatment and tailor follow-up for all patients with asthma.

Associations of sugary beverage consumption with chronic obstructive pulmonary disease, asthma, and asthma-chronic obstructive pulmonary disease overlap syndrome: a prospective cohort study

BACKGROUND

The associations between specific types of sugary beverages and major chronic respiratory diseases remain relatively unexplored.

OBJECTIVES

This study aimed to investigate the associations of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and natural juices (NJs) with chronic obstructive pulmonary disease (COPD), asthma, and asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS).

METHODS

This prospective cohort study included 210,339 participants from the UK Biobank. Sugary beverage intake was measured in units (glasses/cans/cartons/250 mL) through 24-h dietary questionnaires. Logistic regression and Cox proportional hazards models were used to analyze the prevalence and incidence, respectively. Quantile G-computation was used to estimate the joint associations and relative contributions of the 3 types of sugary beverages.

RESULTS

Over a median follow-up of 11.6 y, 3491 participants developed COPD, 4645 asthma, and 523 ACOS. In prevalence analysis, certain categories of SSB and NJ consumption were associated with increased asthma prevalence, while high ASB consumption (>2 units/d) was linked to higher risks of all 3 outcomes. In incidence analysis, high SSB consumption (>2 units/d) was associated with incident COPD (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.19, 1.98) and asthma (HR: 1.22; 95% CI: 0.98, 1.52). Dose‒response relationships were observed for ASB consumption with all 3 outcomes (continuous HR: 1.98; 95% CI: 1.36, 2.87, for COPD; continuous HR: 1.65; 95% CI: 1.24, 2.20, for asthma; and continuous HR: 2.84; 95% CI: 1.20, 6.72, for ACOS). Moderate NJ consumption (>0-1 unit/d) was inversely associated with COPD (HR: 0.89; 95% CI: 0.82, 0.97), particularly grapefruit and orange juice. Joint exposure to these beverages (per unit increase) was associated with COPD (HR: 1.15; 95% CI: 1.02, 1.29) and asthma (HR: 1.16; 95% CI: 1.06, 1.27), with ASBs having greater positive weights than SSBs.

CONCLUSIONS

Consumption of SSBs and ASBs was associated with increased risks of COPD, asthma, and potentially ACOS, whereas moderate NJ consumption was associated with reduced risk of COPD, depending on the juice type.

The Current Molecular and Cellular Landscape of Chronic Obstructive Pulmonary Disease (COPD): A Review of Therapies and Efforts towards Personalized Treatment

Chronic obstructive pulmonary disease (COPD) ranks as the third leading cause of global illness and mortality. It is commonly triggered by exposure to respiratory irritants like cigarette smoke or biofuel pollutants. This multifaceted condition manifests through an array of symptoms and lung irregularities, characterized by chronic inflammation and reduced lung function. Present therapies primarily rely on maintenance medications to alleviate symptoms, but fall short in impeding disease advancement. COPD's diverse nature, influenced by various phenotypes, complicates diagnosis, necessitating precise molecular characterization. Omics-driven methodologies, including biomarker identification and therapeutic target exploration, offer a promising avenue for addressing COPD's complexity. This analysis underscores the critical necessity of improving molecular profiling to deepen our comprehension of COPD and identify potential therapeutic targets. Moreover, it advocates for tailoring treatment strategies to individual phenotypes. Through comprehensive exploration-based molecular characterization and the adoption of personalized methodologies, innovative treatments may emerge that are capable of altering the trajectory of COPD, instilling optimism for efficacious disease-modifying interventions.

Exploring the Exposome Spectrum: Unveiling Endogenous and Exogenous Factors in Non-Communicable Chronic Diseases

The exposome encompasses all endogenous and exogenous exposure individuals encounter throughout their lives, including biological, chemical, physical, psychological, relational, and socioeconomic factors. It examines the duration and intensity of these types of exposure and their complex interactions over time. This interdisciplinary approach involves various scientific disciplines, particularly toxicology, to understand the long-term effects of toxic exposure on health. Factors like air pollution, racial background, and socioeconomic status significantly contribute to diseases such as metabolic, cardiovascular, neurodegenerative diseases, infertility, and cancer. Advanced analytical methods measure contaminants in biofluids, food, air, water, and soil, but often overlook the cumulative risk of multiple chemicals. An exposome analysis necessitates sophisticated tools and methodologies to understand health interactions and integrate findings into precision medicine for better disease diagnosis and treatment. Chronic exposure to environmental and biological stimuli can lead to persistent low-grade inflammation, which is a key factor in chronic non-communicable diseases (NCDs), such as obesity, cardiometabolic disorders, cancer, respiratory diseases, autoimmune conditions, and depression. These NCDs are influenced by smoking, unhealthy diets, physical inactivity, and alcohol abuse, all shaped by genetic, environmental, and social factors. Dietary patterns, especially ultra-processed foods, can exacerbate inflammation and alter gut microbiota. This study investigates the exposome's role in the prevention, development, and progression of NCDs, focusing on endogenous and exogenous factors.

Spatial patterns and sociodemographic predictors of chronic obstructive pulmonary disease in Florida

Background

Chronic obstructive pulmonary disease (COPD) is a chronic, inflammatory respiratory disease that obstructs airflow and decreases lung function and is a leading cause death globally. In the United States (US), the prevalence among adults is 6.2%, but increases with age to 12.8% among those 65 years or older. Florida has one of the largest populations of older adults in the US, accounting for 4.5 million adults 65 years or older. This makes Florida an ideal geographic location for investigating COPD as disease prevalence increases with age. Understanding the geographic disparities in COPD and potential associations between its disparities and environmental factors as well as population characteristics is useful in guiding intervention strategies. Thus, the objectives of this study are to investigate county-level geographic disparities of COPD prevalence in Florida and identify county-level socio-demographic predictors of COPD prevalence.

Methods

This ecological study was performed in Florida using data obtained from the US Census Bureau, Florida Health CHARTS, and County Health Rankings and Roadmaps. County-level COPD prevalence for 2019 was age-standardized using the direct method and 2020 US population as the standard population. High-prevalence spatial clusters of COPD were identified using Tango's flexible spatial scan statistics. Predictors of county-level COPD prevalence were investigated using multivariable ordinary least squares model built using backwards elimination approach. Multicollinearity of regression coefficients was assessed using variance inflation factor. Shapiro-Wilks, Breusch Pagan, and robust Lagrange Multiplier tests were used to assess for normality, homoskedasticity, and spatial autocorrelation of model residuals, respectively.

Results

County-level age-adjusted COPD prevalence ranged from 4.7% (Miami-Dade) to 16.9% (Baker and Bradford) with a median prevalence of 9.6%. A total of 6 high-prevalence clusters with prevalence ratios >1.2 were identified. The primary cluster, which was also the largest geographic cluster that included 13 counties, stretched from Nassau County in north-central Florida to Charlotte County in south-central Florida. However, cluster 2 had the highest prevalence ratio (1.68) and included 10 counties in north-central Florida. Together, the primary cluster and cluster 2 covered most of the counties in north-central Florida. Significant predictors of county-level COPD prevalence were county-level percentage of residents with asthma and the percentage of current smokers.

Conclusions

There is evidence of spatial clusters of COPD prevalence in Florida. These patterns are explained, in part, by differences in distribution of some health behaviors (smoking) and co-morbidities (asthma). This information is important for guiding intervention efforts to address the condition, reduce health disparities, and improve population health.

Ecuadorian Provinces with High Morbidity and Mortality Rates Due to Asthma among the Working-Age Population: An Ecological Study to Promote Respiratory Health

Asthma is a significant public health concern. This study identified the provinces with the highest morbidity and mortality rates due to asthma among the working-age population (15-69 years) in the Republic of Ecuador. The secondary objective was to explain the possible differences attributable to occupational exposure. This nationwide ecological study was conducted in 24 provinces between 2016 and 2019. Government databases were used as sources of information. Age-standardized rates were calculated for codes J45 and J46. The hospitalization morbidity rate for asthma decreased from 6.51 to 5.76 cases per 100,000 working-age population, and the mortality rate has consistently been low and stable from 0.14 to 0.15 deaths per 100,000 working-age population. Geographic differences between the provinces were evident. The risk of hospitalization and death due to asthma was higher in the Pacific coast (Manabí with 7.26 and 0.38, Esmeraldas with 6.24 and 0.43, Los Ríos with 4.16 and 0.40, El Oro with 7.98 and 0.21, Guayas with 4.42 and 0.17 and the Andean region (Azuay with 6.33 and 0.45, Cotopaxi (5.84 and 0.48)). The high rates observed in provinces with greater agricultural and industrial development could be national heterogeneity's main determinants and act as occupational risk factors. The contribution of occupational hazards in each province should be examined in depth through ad hoc studies. The findings presented here provide valuable information that should prompt further detailed studies, which will assist in designing public policies aimed at promoting and safeguarding the respiratory health of the population, particularly that of workers. We believe that this study will inspire the creation of regional networks for the research and surveillance of occupational health.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association Between Urinary Phthalate Metabolites and Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

Objective

To determine the association of urinary phthalate metabolites with chronic obstructive pulmonary disease (COPD), airflow obstruction, lung function and respiratory symptoms.

Methods

Our study included a total of 2023 individuals aged ≥ 40 years old in the National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression was conducted to explore the correlation of eleven urinary phthalate metabolites (MCNP, MCOP, MECPP, MnBP, MCPP, MEP, MEHHP, MEHP, MiBP, MEOHP, and MBzP) with COPD, airflow obstruction and respiratory symptoms. Linear regression analyses were used to evaluate the relationship between urinary phthalate metabolites and lung function.

Results

When compared to the first tertile, the third tertile of MEHHP was associated with the risk of COPD [OR: 2.779; 95% confidence interval (CI): 1.129-6.840; P = 0.026]. Stratified analysis showed that MEHHP increased the risk of COPD by 7.080 times in male participants. Both MCPP and MBzP were positively correlated with the risk of airflow obstruction. The third tertile of MBzP increased the risk of cough by 1.545 (95% CI: 1.030-2.317; P = 0.035) times. Both FEV1 and FVC were negatively associated with MEHHP, MECPP, MnBP, MEP, MiBP and MEOHP.

Conclusion

Higher levels of MEHHP are associated with increased risk of COPD, and lower measures of FEV1 and FVC. MBzP is positively related to airflow obstruction and cough.

Protective Effect of the Total Alkaloid Extract from Bulbus Fritillariae pallidiflorae in a Mouse Model of Cigarette Smoke-Induced Chronic Obstructive Pulmonary Disease

Purpose

In recent years, the incidence of chronic obstructive pulmonary disease (COPD) has been increasing year by year, but therapeutic drugs has no breakthrough. The total alkaloid extract from Bulbus Fritillariae pallidiflorae (BFP-TA) is widely used in treating lung diseases. Therefore, this study aimed to investigate the protective effect and mechanism of BFP-TA in COPD mice.

Methods

BFP-TA was prepared by macroporous adsorbent resin, and the material basis of BFP-TA was analyzed by HPLC-ELSD and UHPLC-MS/MS. Then, the COPD mouse model was induced by cigarette smoke (CS) for 12 weeks, administered at weeks 9-12. Subsequently, the body weight, lung-body ratio, pulmonary function, histopathology, and the levels of pro-inflammatory cytokines, matrix metalloproteinases (MMPs) and oxidative stress markers in the serum of mice were determined. The expressions of related protein of EMT and MAPK signaling pathways in the lung tissues of mice were detected by Western blot.

Results

The alkaloid relative content of BFP-TA is 64.28%, and nine alkaloids in BFP-TA were identified and quantified by UHPLC-MS/MS. Subsequently, the animal experiment showed that BFP-TA could improve pulmonary function, and alleviate inflammatory cell infiltration, pulmonary emphysema, and collagen fiber deposition in the lung of COPD mice. Furthermore, BFP-TA could decrease the levels of pro-inflammatory cytokines (TNF-α, IL-6 and IL-1β), MMPs (MMP-9 and MMP-12) and MDA, while increase the levels of TIMP-1 and SOD. Moreover, BFP-TA could decrease the protein expressions of collagen I, vimentin, α-SMA, MMP-9, MMP-9/TIMP-1, Bax, p-JNK/JNK, p-P38/P38, and p-ERK/ERK, while increase the level of E-cadherin.

Conclusion

This study is the first to demonstrate the protective effect of BFP-TA in CS-induced COPD mouse model. Furthermore, BFP-TA may improve airway remodeling by inhibiting the EMT process and potentially exert anti-inflammatory effect by inhibiting the MAPK signaling pathway.

Association between magnesium depletion score and chronic obstructive pulmonary disease risk: a secondary data analysis from NHANES

BACKGROUND AND OBJECTIVE

The association between magnesium depletion score (MDS) and the risk of chronic obstructive pulmonary disease (COPD) has not been examined to date. Meanwhile, the potential impact of dietary magnesium intake on this association remains unclear. This study aimed to investigate the influence of dietary magnesium intake on the association between MDS and COPD incidence.

METHODS

In this cross-sectional study using the National Health and Nutrition Examination Survey database, we analysed the relationship between MDS and COPD, while also exploring the role of dietary magnesium.

RESULTS

A total of 39 852 participants, including 1762 patients with COPD and 38 090 patients with non-COPD, were included in the analysis. After adjusting for confounding factors, our results demonstrated a significant association between higher MDS and increased COPD incidence (OR=1.48, 95% CI: 1.10 to 1.99). Furthermore, it was observed that dietary magnesium intake did not significantly impact this association.

CONCLUSION

This study highlights a significant positive correlation between MDS and the incidence of COPD. Nonetheless, no significant alteration in this association was observed with dietary magnesium intake.

Epidemiological characteristics of chronic non-communicable diseases in Dongfang, China, 2021: a cross-sectional survey

OBJECTIVES

The study aimed to understand the composition, epidemiological characteristics and disease burden of chronic non-communicable diseases and to evaluate the association between sociodemographic factors and chronic non-communicable diseases.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

Medical records of 196 761 residents were collected from Dongfang disease surveillance system from January to December 2021.

PRIMARY OUTCOME

Prevalence and disability burden were recorded. Logistic regression was used to investigate the relationship between sociodemography factors and diseases.

RESULTS

Cardiovascular diseases, chronic lower respiratory diseases and other upper respiratory tract diseases were the main chronic non-communicable diseases. In multivariable analysis, men were associated with increased risk of cardiovascular diseases (OR=1.210, 95% CI 1.162 to 1.261) and chronic lower respiratory diseases (OR=1.128, 95% CI 1.079 to 1.180). Older age was associated with increased risk of cardiovascular diseases (OR=83.952, 95% CI 58.954 to 119.550), whereas was associated with decreased risk of chronic lower respiratory diseases (OR=0.442, 95% CI 0.415 to 0.471) and other upper respiratory tract diseases (OR=0.450, 95% CI 0.411 to 0.493). The unemployed and poor household were associated with decreased risk of cardiovascular diseases (OR=0.463, 95% CI 0.412 to 0.521 and OR=0.390, 95% CI 0.342 to 0.444, respectively), whereas were associated with increased risk of chronic lower respiratory diseases (OR=12.219, 95% CI 6.343 to 23.539 and OR=10.954, 95% CI 5.666 to 21.177, respectively) and other upper respiratory tract diseases (OR=2.246, 95% CI 1.719 to 2.936 and OR=3.035, 95% CI 2.308 to 3.991, respectively). Gender and age moderated the association between personnel category and major diseases.

CONCLUSIONS

The spectrum and epidemiological characteristics of chronic diseases observed in Dongfang is good evidence for developing prevention guides and health policies for region.

Combined Lifestyle Interventions in the Prevention and Management of Asthma and COPD: A Systematic Review

(1) Background: A healthy lifestyle has a protective role against the onset and management of asthma and chronic obstructive pulmonary disease (COPD). Therefore, combined lifestyle interventions (CLIs) are a potentially valuable prevention approach. This review aims to provide an overview of existing CLIs for the prevention and management of asthma or COPD. (2) Methods: A systematic literature search was conducted using PubMed, EMBASE, and PsycInfo. Studies were included if CLIs targeted at least two lifestyle factors. (3) Results: Among the 56 included studies, 9 addressed asthma and 47 addressed COPD management, with no studies focusing on prevention. For both conditions, the most prevalent combination of lifestyle targets was diet and physical activity (PA), often combined with smoking cessation in COPD. The studied CLIs led to improvements in quality of life, respiratory symptoms, body mass index/weight, and exercise capacity. Behavioural changes were only measured in a limited number of studies and mainly showed improvements in dietary intake and PA level. (4) Conclusions: CLIs are effective within asthma and COPD management. Next to optimising the content and implementation of CLIs, these positive results warrant paying more attention to CLIs for persons with an increased risk profile for these chronic respiratory diseases.

Urinary volatile organic compound metabolites and COPD among US adults: mixture, interaction and mediation analysis

BACKGROUND

Volatile organic compounds (VOCs) encompass hundreds of high production volume chemicals and have been reported to be associated with adverse respiratory outcomes such as chronic obstructive pulmonary disease (COPD). However, research on the combined toxic effects of exposure to various VOCs on COPD is lacking. We aimed to assess the effect of VOC metabolite mixture on COPD risk in a large population sample.

METHODS

We assessed the effect of VOC metabolite mixture on COPD risk in 5997 adults from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2020 (pre-pandemic) using multivariate logistic regression, Bayesian weighted quantile sum regression (BWQS), quantile-based g-Computation method (Qgcomp), and Bayesian kernel machine regression (BKMR). We explored whether these associations were mediated by white blood cell (WBC) count and total bilirubin.

RESULTS

In the logistic regression model, we observed a significantly increased risk of COPD associated with 9 VOC metabolites. Conversely, N-acetyl-S-(benzyl)-L-cysteine (BMA) and N-acetyl-S-(n-propyl)-L-cysteine (BPMA) showed insignificant negative correlations with COPD risk. The overall mixture exposure demonstrated a significant positive relationship with COPD in both the BWQS model (adjusted odds ratio (OR) = 1.30, 95% confidence interval (CI): 1.06, 1.58) and BKMR model, and with marginal significance in the Qgcomp model (adjusted OR = 1.22, 95% CI: 0.98, 1.52). All three models indicated a significant effect of the VOC metabolite mixture on COPD in non-current smokers. WBC count mediated 7.1% of the VOC mixture associated-COPD in non-current smokers.

CONCLUSIONS

Our findings provide novel evidence suggesting that VOCs may have adverse associations with COPD in the general population, with N, N- Dimethylformamide and 1,3-Butadiene contributing most. These findings underscore the significance of understanding the potential health risks associated with VOC mixture and emphasize the need for targeted interventions to mitigate the adverse effects on COPD risk.

Symptom-based drug prediction of lifestyle-related chronic diseases using unsupervised machine learning techniques

BACKGROUND AND OBJECTIVES

Lifestyle-related diseases (LSDs) impose a substantial economic burden on patients and health care services. LSDs are chronic in nature and can directly affect the heart and lungs. Therapeutic interventions only based on symptoms can be crucial for prompt treatment initiation in LSDs, as symptoms are the first information available to clinicians. So, this work aims to apply unsupervised machine learning (ML) techniques for developing models to predict drugs from symptoms for LSDs, with a specific focus on pulmonary and heart diseases.

METHODS

The drug-disease and disease-symptom associations of 143 LSDs, 1271 drugs, and 305 symptoms were used to compute direct associations between drugs and symptoms. ML models with four different algorithms - K-Means, Bisecting K-Means, Mean Shift, and Balanced Iterative Reducing and Clustering using Hierarchies (BIRCH) - were developed to cluster the drugs using symptoms as features. The optimal model was saved in a server for the development of a web application. A web application was developed to perform the prediction based on the optimal model.

RESULTS

The Bisecting K-means model showed the best performance with a silhouette coefficient of 0.647 and generated 138 drug clusters. The drugs within the optimal clusters showed good similarity based on i) gene ontology annotations of the gene targets, ii) chemical ontology annotations, and iii) maximum common substructure of the drugs. In the web application, the model also provides a confidence score for each predicted drug while predicting from a new set of input symptoms.

CONCLUSION

In summary, direct associations between drugs and symptoms were computed, and those were used to develop a symptom-based drug prediction tool for LSDs with unsupervised ML models. The ML-based prediction can provide a second opinion to clinicians to aid their decision-making for early treatment of LSD patients. The web application (URL - http://bicresources.jcbose.ac.in/ssaha4/sdldpred) can provide a simple interface for all end-users to perform the ML-based prediction.

Assessing the causal role of physical activity and leisure sedentary behaviours with chronic obstructive pulmonary disease: a Mendelian randomisation study

BACKGROUND

Observational studies show that patients with chronic obstructive pulmonary disease (COPD) tend to be sedentary during leisure time. Physical activity (PA) may reduce the risk of COPD, but the causal relationship is unclear. We used a Mendelian randomisation (MR) method to elucidate the association of leisure sedentary behaviours (LSB) and PA with lung function and COPD.

METHODS

Data on LSB (n=422 218), PA (n=608 595), COPD (n=299 929) and lung function (n=79 055) were obtained from the large-scale genome-wide association study. Causal inference used inverse variance-weighted, MR-Egger and weighted median. Sensitivity analysis was performed to assess heterogeneity and pleiotropy, and radial MR was used to distinguish outliers. The primary outcome was analysed by multifactorial MR adjusted for daily smoking.

RESULTS

The inverse variance weighted analysis indicated that increased moderate-to-vigorous PA (MVPA) is associated with higher levels of forced vital capacity (FVC) (beta=0.27, 95% CI 0.12 to 0.42; p=3.51×10-4). For each increment of 2.8 hours in television watching, the odds of COPD were 2.25 times greater (OR=2.25; 95% CI 1.84 to 2.75; p=2.38×10-15). For early-onset COPD, the odds were 2.11 times greater (OR=2.11; 95% CI 1.56 to 2.85; p=1.06×10-6), and for late-onset COPD, the odds were 2.16 times greater (OR=2.16; 95% CI 1.64 to 2.84; p=3.12×10-8). Similarly, the odds of hospitalisation for COPD were 2.02 times greater with increased television watching (OR=2.02; 95% CI 1.59 to 2.55; p=4.68×10-9). Television watching was associated with lower FVC (beta=-0.19, 95% CI -0.28 to -0.10; p=1.54×10-5) and forced expiratory volume in the 1 s (FEV1) (beta=-0.16, 95% CI -0.25 to -0.08; p=1.21×10-4) levels. The results remained significant after adjustment for smoking.

CONCLUSIONS

Our study suggests a potential association with LSB, particularly television watching, is associated with higher odds of COPD and lower indices of lung function as measured continuously, including FEV1 and FVC. Conversely, an increase in MVPA is associated with higher indices of lung function, particularly reflected in increased FVC levels.

Discriminative potential of exhaled breath condensate biomarkers with respect to chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) affecting 334 million people in the world remains a major cause of morbidity and mortality. Proper diagnosis of COPD is still a challenge and largely solely based on spirometric criteria. We aimed to investigate the potential of nitrosative/oxidative stress and related metabolic biomarkers in exhaled breath condensate (EBC) to discriminate COPD patients.

METHODS

Three hundred three participants were randomly selected from a 15,000-transit worker cohort within the Respiratory disease Occupational Biomonitoring Collaborative Project (ROBoCoP). COPD was defined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as post-bronchodilator ratio of Forced Expiratory Volume in 1st second to Forced Vital Capacity < 0.7 in spirometry validated by an experienced pulmonologist. Discriminative power of biomarker profiles in EBC was analyzed using linear discriminant analyses.

RESULTS

Amongst 300 participants with validated spirometry, 50.3% were female, 52.3 years old in average, 36.0% were current smokers, 12.7% ex-smokers with mean tobacco exposure of 15.4 pack-years. Twenty-one participants (7.0%) were diagnosed as COPD, including 19 new diagnoses, 12 of which with a mild COPD stage (GOLD 1). Amongst 8 biomarkers measured in EBC, combination of 2 biomarkers, Lactate and Malondialdehyde (MDA) significantly discriminated COPD subjects from non-COPD, with a 71%-accuracy, area under the receiver curve of 0.78 (p-value < 0.001), and a negative predictive value of 96%.

CONCLUSIONS

These findings support the potential of biomarkers in EBC, in particular lactate and MDA, to discriminate COPD patients even at a mild or moderate stage. These EBC biomarkers present a non-invasive and drugless technique, which can improve COPD diagnosis in the future.

Obstructive Ventilatory Dysfunctions-Functional Assessment and Rehabilitation Program

BACKGROUND

Obstructive ventilatory dysfunctions have an increased incidence, and through functional assessment determined by the International Classification of Functioning, Disability and Health (ICF), appropriate treatment can be established.

AIMS

The objectives of our research are represented by the application of respiratory rehabilitation sessions according to the ICF in patients with obstructive ventilatory dysfunctions-with COPD or asthma, using a unique, international language and the evaluation of the results obtained before and after completion pulmonary rehabilitation.

METHODS

We conducted a randomized prospective study between November 2022-April 2023, which included 84 patients diagnosed with obstructive ventilatory dysfunctions and who performed respiratory rehabilitation. They were divided into two categories: category 1-C1 which included 43 patients with Chronic Obstructive Pulmonary Disease-COPD and category 2-C2 which included 41 patients diagnosed with asthma. The rehabilitation program lasted 8 weeks, with exercises performed from Monday to Friday, with a weekend break. Respiratory rehabilitation consisted of physical therapy, inspiratory and expiratory muscle training (IEMT), proper nutrition, and psychotherapy.

RESULTS

At the end of the program, most of the patients showed improvements in the ICF qualifiers, a fact that supported us that respiratory recovery is one of the basic therapies of patients with obstructive ventilatory dysfunctions.

CONCLUSIONS

The ICF allows the application of a personalized respiratory rehabilitation program. The ICF qualifiers are used for the functional assessment of patients and allow they to be included in individualized medical rehabilitation programs.

Common Pathogeneses Underlying Asthma and Chronic Obstructive Pulmonary Disease -Insights from Genetic Studies

Neither asthma nor chronic obstructive pulmonary disease (COPD) is a single disease consisting of a uniform pathogenesis; rather, they are both syndromes that result from a variety of basic distinct pathogeneses. Many of the basic pathogeneses overlap between the two diseases, and multiple basic pathogeneses are simultaneously involved at varying proportions in individual patients. The specific combination of different basic pathogeneses in each patient determines the phenotype of the patient, and it varies widely from patient to patient. For example, type 2 airway inflammation and neutrophilic airway inflammation may coexist in the same patient, and quite a few patients have clinical characteristics of both asthma and COPD. Even in the same patient, the contribution of each pathogenesis is expected to differ at different life stages (eg, childhood, adolescence, middle age, and older), during different seasons (eg, high seasons for hay fever and rhinovirus infection), and depending on the nature of treatments. This review describes several basic pathogeneses commonly involved in both asthma and COPD, including chronic non-type 2 inflammation, type 2 inflammation, viral infections, and lung development. Understanding of the basic molecular pathogeneses in individual patients, rather than the use of clinical diagnosis, such as asthma, COPD, or even asthma COPD overlap, will enable us to better deal with the diversity seen in disease states, and lead to optimal treatment practices tailored for each patient with less disease burden, such as drug-induced side effects, and improved prognosis. Furthermore, we can expect to focus on these molecular pathways as new drug discovery targets.

The Associations Between Serum Vitamins and Carotenoids with Chronic Obstructive Pulmonary Disease: Results from the NHANES

Purpose

Vitamins and carotenoids are essential in preventing and treating chronic obstructive pulmonary disease (COPD). This study investigated the associations between serum vitamins, carotenoids, and COPD in adults aged ≥ 40 years in the United States.

Methods

We selected 3487 participants aged ≥40 from the NHANES (2017-2018) and used demographic analysis, sensitivity tests, and different weighted multivariate regression models to investigate the relationship between serum vitamins, carotenoids, and COPD.

Results

Subjects in the highest tertile of serum vitamin C, vitamin E (α-tocopherol), α-carotene, trans-β-carotene, and cis-β-carotene had a 50%, 35%, 51%, 54%, and 51% lower risk of COPD than those in the lowest tertile (P for trend: P=0.0005, <0.0001, 0.0054, 0.0066, and 0.0049). Unfortunately, no significant correlation was found for serum vitamin D levels.

Conclusion

Our analysis of nationally representative data from 3487 participants showed that serum levels of vitamin C, vitamin E (α-tocopherol), α-carotene, and β-carotene were negatively associated with the incidence of COPD in adults over 40 years of age in the US The findings highlighted the importance of antioxidant vitamins and carotenoids in respiratory health, while the data showed no significant correlation between vitamin D (25-OHD) and the incidence of COPD.

Exploration of the Pathogenesis of Chronic Obstructive Pulmonary Disease Caused by Smoking-Based on Bioinformatics Analysis and In Vitro Experimental Evidence

This study was aimed at investigating the pathogenesis of chronic obstructive pulmonary disease (COPD) caused by smoking-based on bioinformatics analysis and in vitro experimental evidence. The GEO, GEO2R, TargetScan, miRDB, miRWalk, DAVID, and STRING databases were used for bioinformatics analysis. The mRNA expression and the protein levels were determined by real-time PCR and ELISA. After taking the intersection of the diversified results of the databases, four differentially expressed miRNAs (hsa-miR-146a, hsa-miR-708, hsa-miR-150, and hsa-miR-454) were screened out. Subsequently, a total of 57 target genes of the selected miRNAs were obtained. The results of DAVID analysis showed that the selected miRNAs participated in COPD pathogenesis through long-term potentiation, the TGF-β signaling pathway, the PI3K-Akt signaling pathway, etc. The results of STRING prediction showed that TP53, EP300, and MAPK1 were the key nodes of the PPI network. The results of the confirmatory experiment showed that, compared with the control group, the mRNA expression of ZEB1, MAPK1, EP300, and SP1 were up-regulated, while the expression of MYB was down-regulated and the protein levels of ZEB1, MAPK1, and EP300 were increased. Taken together, miRNAs (hsa-miR-146a, hsa-miR-708, hsa-miR-150, and hsa-miR-454) and their regulated target genes and downstream protein molecules (ZEB1, EP300, and MAPK1) may be closely related to the pathological process of COPD.

The impact of air pollution on asthma: clinical outcomes, current epidemiology, and health disparities

INTRODUCTION

Air pollution has been shown to have a significant impact on morbidity and mortality of respiratory illnesses including asthma.

AREAS COVERED

Outdoor air pollution consists of a mixture of individual pollutants including vehicle traffic and industrial pollution. Studies have implicated an array of individual components of air pollution, with PM2.5, NO2, SO2, and ozone being the most classically described, and newer literature implicating other pollutants such as black carbon and volatile organic compounds. Epidemiological and cohort studies have described incidence and prevalence of pollution-related asthma and investigated both acute and chronic air pollution exposure as they relate to asthma outcomes. There is an increasing body of literature tying disparities in pollution exposure to clinical outcomes. In this narrative review, we assessed the published research investigating the association of pollution with asthma outcomes, focusing on the adult population and health care disparities.

EXPERT OPINION

Pollution has multiple deleterious effects on respiratory health but there is a lack of data on individualized pollution monitoring, making it difficult to establish a temporal relationship between exposure and symptoms, thereby limiting our understanding of safe exposure levels. Future research should focus on more personalized monitoring and treatment plans for mitigating exposure.

Exhaled volatile organic compounds associated with risk factors for obstructive pulmonary diseases: a systematic review

Background

Asthma and COPD are among the most common respiratory diseases. To improve the early detection of exacerbations and the clinical course of asthma and COPD new biomarkers are needed. The development of noninvasive metabolomics of exhaled air into a point-of-care tool is an appealing option. However, risk factors for obstructive pulmonary diseases can potentially introduce confounding markers due to altered volatile organic compound (VOC) patterns being linked to these risk factors instead of the disease. We conducted a systematic review and presented a comprehensive list of VOCs associated with these risk factors.

Methods

A PRISMA-oriented systematic search was conducted across PubMed, Embase and Cochrane Libraries between 2000 and 2022. Full-length studies evaluating VOCs in exhaled breath were included. A narrative synthesis of the data was conducted, and the Newcastle-Ottawa Scale was used to assess the quality of included studies.

Results

The search yielded 2209 records and, based on the inclusion/exclusion criteria, 24 articles were included in the qualitative synthesis. In total, 232 individual VOCs associated with risk factors for obstructive pulmonary diseases were found; 58 compounds were reported more than once and 12 were reported as potential markers of asthma and/or COPD in other studies. Critical appraisal found that the identified studies were methodologically heterogeneous and had a variable risk of bias.

Conclusion

We identified a series of exhaled VOCs associated with risk factors for asthma and/or COPD. Identification of these VOCs is necessary for the further development of exhaled metabolites-based point-of-care tests in these obstructive pulmonary diseases.