Editorial: Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 Guidelines for COPD, Including COVID-19, Climate Change, and Air Pollution

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.

COPD risk due to extreme temperature exposure: combining epidemiological evidence with pathophysiological mechanisms

Climate change is amplifying the frequency and intensity of extreme temperature events, posing a significant risk for chronic obstructive pulmonary disease (COPD). This review synthesised epidemiological evidence linking extreme temperature to COPD morbidity and mortality, while elucidating synergistic interactions with other environmental exposures. Combining population-level findings with biomedical mechanistic insights, we proposed a framework illustrating how biomarkers bridge the gap between extreme temperature exposure and COPD, highlighting the pathophysiological mechanisms of prodromal symptoms, key pathogenic processes and early molecular events. The mechanisms and biomarkers identified in this study would provide critical information for elucidating the causal pathways through which extreme temperatures increase COPD risk, and thus inform preventive interventions. Future research should incorporate multi-omics techniques to explore the underlying mechanisms in greater depth, while validating the biomarkers through large-scale cohort studies.

Therapeutic strategies to reverse cigarette smoke-induced ion channel and mucociliary dysfunction in COPD airway epithelial cells

Cigarette smoke (CS) is a leading cause of chronic obstructive pulmonary disease (COPD). Here, we investigated whether the ion channel amplifier nesolicaftor rescues CS-induced mucociliary and ion channel dysfunction. As CS increases the expression of transforming growth factor-beta1 (TGF-β1), human bronchial epithelial cells (HBECs) from healthy donors were used for TGF-β1 and COPD donors (COPD-HBEC) for CS exposure experiments. CS and TGF-β1 induce mucociliary dysfunction by increasing MUC5AC and decreasing ion channel conductance important for mucus hydration. These include cystic fibrosis transmembrane conductance regulator (CFTR) and apical large-conductance, Ca2+-activated K+ (BK) channels. Nesolicaftor rescued CFTR and BK channel dysfunction, restored ciliary beat frequency (CBF), and decreased mucus viscosity and MUC5AC expression in CS-exposed COPD-HBEC. Nesolicaftor further reversed reductions in airway surface liquid (ASL) volumes, CBF, and CFTR and BK conductance, and blocked the increase in extracellular signal-regulated kinase (ERK) signaling in TGF-β1-exposed normal HBECs. Mechanistically, nesolicaftor increased, as expected, not only binding of PCBP1 to CFTR mRNA but also surprisingly to LRRC26 mRNA, which encodes the gamma subunit required for BK function. Similar to nesolicaftor, the angiotensin receptor blocker (ARB) losartan rescued TGF-β1-mediated decreases in PCBP1 binding to LRRC26 mRNA. In addition, the ARB telmisartan restored PCBP1 binding to CFTR and LRRC26 mRNAs to rescue CFTR and BK function in CS-exposed COPD-HBEC. Thus, nesolicaftor and ARBs act on the same target and were therefore neither additive nor synergistic in their actions. These data demonstrate that nesolicaftor and ARBs may provide benefits in COPD by improving ion channel function important for mucus hydration.NEW & NOTEWORTHY Cigarette smoke (CS) increases transforming growth factor-beta1 (TGF-β1) expression that causes mucociliary dysfunction by decreasing ion channel function. In our study, a CFTR amplifier (nesolicaftor) and angiotensin II receptor blockers (losartan and telmisartan) improve CS-induced ion channel dysfunction, by increasing binding of PCBP1 to CFTR and LRRC26 mRNAs. Therefore, nesolicaftor and ARBs, acting on the same target, may provide therapeutic benefits for treating smoking-related diseases.

Gene Expression Profiles Reveal Distinct Mechanisms Driving Chronic Obstructive Pulmonary Disease Exacerbations

Chronic obstructive pulmonary disease (COPD) exacerbations are major contributors to morbidity and mortality, highlighting the need to better understand their molecular mechanisms to improve prevention, diagnosis, and treatment. This study investigated differential gene expression profiles and key biological processes in COPD exacerbations categorized based on sputum microbiome profiling. An observational study was performed on a cohort of 16 COPD patients, who provided blood and sputum samples during exacerbations, along with five stable-state samples as controls. Exacerbations were classified using 16S rRNA sequencing to analyze the sputum microbiota and multiplex PCR to detect respiratory viruses. Blood transcriptomic profiling was conducted using Oxford Nanopore technology, followed by differential gene expression and pathway enrichment analyses. A total of 768 regulated genes were identified across the exacerbation groups, with 35 shared genes associated with neutrophil activation. Bacterial exacerbations activated pathways related to phagocytosis and toll-like receptor signaling, while viral exacerbations were linked to pro-inflammatory responses and mitochondrial damage. Exacerbations of unknown origin showed activation of pathways involved in protozoan defense and neutrophilic asthma. Biomarkers such as IFITM3 and ISG15 for bacterial exacerbations, DEFA3 for viral, and CD47 for unknown-origin exacerbations were identified. These findings highlight distinct transcriptomic profiles and biological pathways in COPD exacerbations, emphasizing the central role of neutrophil-driven inflammation and identifying potential biomarkers for improved differential diagnosis and personalized management.

Impact of seasonal biometeorological conditions and particulate matter on asthma and COPD hospital admissions

Climate change and air pollution are pressing public health concerns, necessitating monitoring of their impact, particularly on respiratory diseases like obstructive lung diseases. This retrospective study analyzed medical records of patients hospitalized at the Warmia and Mazury Centre for Pulmonary Diseases in Olsztyn, Poland (2012-2021) for asthma and chronic obstructive pulmonary disease (COPD) exacerbations. Data included meteorological factors such as temperature, humidity, wind speed, precipitation, and levels of PM2.5 and PM10. The Humidex was utilized to assess thermal discomfort, considering various meteorological and thermal seasons. Findings indicated seasonal variability in asthma and COPD exacerbations. During winter, poorer air quality due to higher PM2.5 and PM10 levels correlated with increased exacerbations (r = 0.283, p < 0.05; r = 0.491, p < 0.001). In summer, discomfort from meteorological conditions led to more hospital admissions. Humidex values strongly correlated with admissions for obstructive diseases (R2 = 0.956 for asthma; R2 = 0.659 for COPD), with July and August showing statistically higher admission rates (p < 0.05). The study highlights the significant impact of air pollution and meteorological conditions on exacerbations of asthma and COPD, with Humidex serving as a valuable predictor during summer months.

Path analysis of illness perception, medication beliefs, family support on inhaler adherence in elderly COPD patients: Based on triadic reciprocal determinism

OBJECTIVE

This study aimed to explore the pathways through which personal factors (demographic characteristics, illness perception, medication beliefs) and environmental factors (family support) influence adherence to inhaler therapy among Chinese elderly patients with chronic obstructive pulmonary disease (COPD) based on the triadic reciprocal determinism.

METHODS

A cross-sectional survey was conducted from June 2022 to December 2023 using the Test of Adherence to Inhalers (TAI), the Beliefs about Medicines Questionnaire (BMQ), the Brief Illness Perception Questionnaire (B-IPQ) and the Family Support Scale to investigate 305 elderly COPD patients (mean age 70.96 years, 213 males) from the Department of Respiratory Medicine of a comprehensive hospital in Anhui, China mainland. Path analysis was performed using AMOS 22.0.

RESULTS

Path analysis showed that illness perception, necessity beliefs, concerns beliefs and family support all had direct effects on inhaler adherence, while age had an indirect effect on adherence. Additionally, necessity beliefs and concerns beliefs exhibited significant mediating effects between illness perception and inhaler adherence. Family support respectively mediated the relationships between necessity beliefs, concerns beliefs and inhaler adherence.

CONCLUSION

A multidimensional approach targeting cognitive, belief and family factors holds promise for substantially improving inhaler adherence among elderly COPD populations.

PRACTICE IMPLICATIONS

This study provided new perspectives for improving inhaler adherence in COPD patients. Healthcare providers should emphasize improving patients' illness perception and medication beliefs, considering the important impact of family support on inhaler adherence.

Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease

Historically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference.

Editorial: Climate Change and the Spread of Vector-Borne Diseases, Including Dengue, Malaria, Lyme Disease, and West Nile Virus Infection

The major health threats from climate change include increasing temperatures, air pollution, extreme weather events, changes in the spread of infectious diseases, antimicrobial resistance, emerging pathogens, and an increase in vector-borne disease. Between October and December 2023, in 200 medical journal, epidemiologists, clinicians, healthcare policymakers, and journal editors published an emergency call to action to health professionals, the United Nations, and political leaders on climate change and its effects on the ecosystem and human health. Also, in December 2023, the Intergovernmental Panel on Climate Change (IPCC) published its sixth Assessment Report (AR6) that summarizes current knowledge, impacts, and health risks from climate change, as well as suggestions for mitigation and adaptation. For over a decade, the IPCC has reported that the prevalence of vector-borne diseases has increased and highlighted the importance of monitoring dengue, malaria, Lyme disease, West Nile virus infection, and other vector-borne diseases. This editorial aims to provide an update on the association between climate change and the spread of vector-borne diseases and highlights the urgent need for public health and disease prevention and treatment strategies to control the rise in vector-borne diseases.