Smoking cessation affects the natural history of COPD

Association of lifestyle factors with mortality risk in people with chronic obstructive pulmonary disease: a prospective cohort study

Background

Which lifestyle will benefit patients with chronic obstructive pulmonary disease (COPD) has becoming a hot topic in recent years. However, there are currently no recommendations. Life's Essential 8 (LE8) includes 8 metrics (BMI, non-HDL cholesterol, blood pressure, blood glucose, physical activity, diet, sleep duration, and nicotine exposure), which are considered the foundation of maintaining a healthy life. Here, we aimed to explore the relationship between LE8 and mortality risk in patients with chronic obstructive pulmonary disease (COPD), which may provide advice on how to live better for these patients.

Methods

Participants were from the National Health and Nutrition Examination Survey 2003-2018 at baseline linked to the 2019 National Death Index records. Cox proportional hazards regression models were used to explore the relationship between the LE8 score and mortality risk. All analyses were adjusted for survey design and weighting variables.

Results

We included 1,593 participants with COPD, representing 9,208,187 US patients. During a median follow-up of 5.8 years, compared with patients with low LE8 scores, those with moderate and high score presented decreased all-cause mortality (both log-rank p < 0.05) and increased 10-year survival rates (63.6, 72.4 and 89.9%, respectively). Patients in the high (HR 0.19, 95% CI 0.09-0.40) and moderate (HR 0.61, 95% CI 0.43-0.86) score groups had a lower risk of all-cause mortality after adjusted for confounders. Similar results were observed in high (HR 0.53, 95% CI 0.32-0.88) and moderate (HR 0.68, 95% CI 0.50-0.91) HB score groups. Among the 8 metrics, physical activity, sleep health, nicotine exposure and blood glucose were important contributors to decreased mortality risk. And there were approximately linear dose-response relationships between LE8 and HB score with all-cause mortality risk.

Conclusion

The LE8 score was inversely associated with all-cause mortality risk of patients with COPD. Changing lifestyles to improve LE8 scores may be an effective strategy to benefit these patients.

Effects of smoking cessation on individuals with COPD: a systematic review and meta-analysis

Objective

Despite smoking being a significant risk factor in the occurrence and progression of chronic obstructive pulmonary disease (COPD), no comprehensive analysis has been conducted to determine the potential benefits of smoking cessation for patients with established COPD or identify specific indicators that may be improved. The aim of our meta-analysis was to elucidate the positive impact of smoking cessation on COPD.

Methods

We conducted a comprehensive search of PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wan Fang and VIP databases to identify studies that met our eligibility criteria from inception up to 1, May 2024. Data were extracted independently by two authors and pooled using a random-effects model. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS).

Results

Preliminary screening of publications gave a total of 13,460 documents after which the repetitive and non-compliant studies were removed. Eventually, 11 studies were included for follow-up analysis. The pooled results showed that cessation of smoking produced significant improvements in forced expiratory volume in one second (FEV1)% predicted (MD = 6.72, 95% CI, 4.55-8.89, P < 0.001; I2 = 53%), FEV1/forced vital capacity (FVC) (MD = 6.82, 95% CI, 5.09-8.54, P < 0.001; I2 = 0%), modified Medical Research Council (mMRC) (MD = -0.49, 95% CI, -0.95--0.02, P = 0.040; I2 = 73%), 6-minute walk test (6-MWT) (MD = 64.46, 95% CI 14.60-114.32, P = 0.010; I2 = 94%), partial oxygen pressure (MD = 1.96, 95% CI, 1.03-2.89, P < 0.001; I2 = 0%), mortality (RR = 0.75, 95% CI, 0.56-1.00, P = 0.05; I2 = 44%).

Conclusion

Our meta-analysis presented suggestive evidence that smoking cessation offered significant benefits to COPD patients, notably in the improvement of specific key indicators of pulmonary function (FEV1% predicted, FEV1/FVC), alleviating symptoms, enhancing exercise tolerance, and could reduce mortality.

PROSPERO registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42022384123.

Chronic Obstructive Pulmonary Disease: Lifestyle Impact

Respiratory infections, a global health priority according to the World Health Organization, cause around 7.5 million deaths annually, constituting 14% of global mortality. Beyond severe health implications, these diseases exacerbate social disparities and impose a substantial economic burden. Chronic obstructive pulmonary disease (COPD) combines chronic bronchitis (airway inflammation) and emphysema (air sac destruction) caused by prolonged exposure to irritants, and poor lifestyle choices lead to airway blockage and breathing difficulties. Lifestyle choices significantly influence health trajectories, evidenced by a consistent increase in "positive comfort" over time. A Chinese study highlights the correlation between adopting a healthy lifestyle and increased life expectancy. European health initiatives address these challenges, emphasizing early detection through large-scale health camps to identify new cases and assess severity. Exacerbation and infections are primary triggers, with bacteria and viruses requiring antibiotic interventions. Awareness campaigns targeting causes, symptoms, and prevention, including childhood infection initiatives with influenza and pneumococcal vaccinations, are crucial. Motivating smoking cessation and encouraging whole grain, fruit, and vegetable consumption mitigate lung oxidative damage. Promoting physical activity and addressing environmental pollution contribute to overall lung health. Timely nutritional evaluations for newly diagnosed cases manage obesity and malnutrition and prevent further lung function deterioration. There is growing attention toward the influence of poor lifestyle choices like sedentary lifestyle, environmental exposure, and unhealthy dietary patterns on the increased risk of COPD development besides smoking. This essay explores these factors, recognizing the intricate interplay between lifestyle and COPD prevention and management.

Smoking cessation program preferences of individuals with chronic obstructive pulmonary disease: a qualitative study

AIM

To explore the views of tobacco-smoking chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO) patients on telehealth-based cessation programs and the role of e-cigarettes as an aid to quit smoking.

BACKGROUND

Tobacco smoking accelerates the progression of COPD. Traditional smoking cessation programs often do not entirely address the unique needs of COPD patients, leading to suboptimal effectiveness for this population. This research is aimed at describing the attitudes and preferences of COPD and ACO patients toward innovative, telehealth-based smoking cessation strategies and the potential application of e-cigarettes as a quitting aid.

METHODS

A qualitative exploratory approach was adopted in this study, employing both focus groups and individual interviews with English-speaking adults with diagnosed COPD or ACO. Participants included both current smokers (≥ 5 cigarettes/day) and recent ex-smokers (who quit < 12 months ago). Data were systematically coded with iterative reliability checks and subjected to thematic analysis to extract key themes.

FINDINGS

A total of 24 individuals participated in this study. The emergent themes were the perceived structure and elements of a successful smoking cessation program, the possible integration of telehealth with digital technologies, and the strategic use of e-cigarettes for smoking reduction or cessation. The participants stressed the importance of both social and professional support in facilitating smoking cessation, expressing a high value for insights provided by ex-smokers serving as mentors. A preference was observed for group settings; however, the need for individualized plans was also highlighted, considering the diverse motivations individuals had to quit smoking. The participants perceived online program delivery as potentially beneficial as it could provide immediate access to support during cravings or withdrawals and was accessible to remote users. Opinions on e-cigarettes were mixed; some participants saw them as a less harmful alternative to conventional smoking, while others were skeptical of their efficacy and safety and called for further research.

Evaluating the Impact of Tobacco Cessation Counseling on Oral Health-Related Quality of Life and Identifying Barriers to Quitting Among Tobacco Smokers

Introduction Tobacco addiction is widely recognized as the most significant menace to both systemic and oral diseases, resulting in around eight million fatalities worldwide annually. The current investigation was conducted to assess the influence of tobacco cessation counseling on the quality of life linked to oral health and to identify obstacles to quitting among those who use tobacco. Methods This observational, follow-up study was carried out among patients referred to the tobacco cessation unit for the cessation of their smoking tobacco habit. Data on the participants was collected in two phases. Oral health-related quality of life (OHRQoL) was assessed at baseline and again three months after quitting smoking habits in the second phase. The assessment of barriers to quitting was done by asking a few questions of all participants. A student t-test and a chi-square test were applied with a p-value <0.05 considering significance. Results The study comprised a total of 322 patients, ranging in age from 18 to 62, with a mean age of 32.58 ± 12.901 years. After three months of quitting tobacco, a comparison of the mean scores of the Oral Health Impact Profile (OHIP) domains revealed a significant reduction in the mean score across all domains. The reduction was statistically significant, with a p-value of 0.001. Upon investigating the association between obstacles to quitting tobacco and socioeconomic position, it was discovered that the expense of quitting aids or tobacco programs, as well as the likelihood of weight gain, were strongly linked to the socioeconomic status of the individuals involved in the study. Conclusion Based on the results, the present study concluded that oral health-related quality of life significantly improved after quitting.

Which is a real valuable screening tool for lung cancer and measure thoracic diseases, chest radiography or low-dose computed tomography?: A review on the current status of Japan and other countries

Chest radiography (CR) has been used as a screening tool for lung cancer and the use of low-dose computed tomography (LDCT) is not recommended in Japan. We need to reconsider whether CR really contributes to the early detection of lung cancer. In addition, we have not well discussed about other major thoracic disease detection by CR and LDCT compared with lung cancer despite of its high frequency. We review the usefulness of CR and LDCT as veridical screening tools for lung cancer and other thoracic diseases. In the case of lung cancer, many studies showed that LDCT has capability of early detection and improving outcomes compared with CR. Recent large randomized trial also supports former results. In the case of chronic obstructive pulmonary disease (COPD), LDCT contributes to early detection and leads to the implementation of smoking cessation treatments. In the case of pulmonary infections, LDCT can reveal tiny inflammatory changes that are not observed on CR, though many of these cases improve spontaneously. Therefore, LDCT screening for pulmonary infections may be less useful. CR screening is more suitable for the detection of pulmonary infections. In the case of cardiovascular disease (CVD), CR may be a better screening tool for detecting cardiomegaly, whereas LDCT may be a more useful tool for detecting vascular changes. Therefore, the current status of thoracic disease screening is that LDCT may be a better screening tool for detecting lung cancer, COPD, and vascular changes. CR may be a suitable screening tool for pulmonary infections and cardiomegaly.

Comparative analysis between PUMA and CAPTURE questionnaires for chronic obstructive pulmonary disease (COPD) screening in smokers

Chronic obstructive pulmonary disease (COPD) presents a significant global challenge, impacting health systems, economies, and societies. Its prevalence is anticipated to rise owing to an aging demographic. Although the PUMA and CAPTURE questionnaires are available for COPD screening, their comparative effectiveness has not been studied in Indonesia. The aim of this study was to evaluate the effectiveness of the PUMA and CAPTURE questionnaires as screening tools for COPD among smokers. A cross-sectional study was conducted at Universitas Sumatera Utara Hospital and H. Adam Malik General Hospital, Medan, Indonesia, from December 2022 to February 2023. Smokers aged over 40 or above with a history of smoking more than 100 cigarettes in their lifetime and no previous COPD diagnosis were included in the study. To collect the responses to PUMA and CAPTURE questionnaire, face-to-face interviews were conducted, followed by a spirometry test. A total of 76 smokers were included in the study; the predominant age group was 51-60 years (36.8%), with the majority being male (81.6%). Most participants began smoking at ages 15-20 years (65.8%) and had been smoking for 20-30 years (36.8%) at a moderate intensity (44.8%). Spirometry tests indicated obstructive patterns in 50 participants, with 17 classified as severe obstruction. At a cut-off score of ≥6, the PUMA questionnaire yielded a sensitivity of 72.55% and a specificity of 84%. In contrast, the CAPTURE questionnaire, with a cut-off score of ≥4, exhibited a sensitivity of 70.83% and a specificity of 64.29%. These results imply that the PUMA questionnaire could be more efficient in COPD screening compared to the CAPTURE questionnaire.

Impact of smoking reduction on lung cancer risk in patients with COPD who smoked fewer than 30 pack-years: a nationwide population-based cohort study

BACKGROUND

The effects of smoking reduction on the incidence of lung cancer in patients with chronic obstructive pulmonary disease (COPD) are not well known. This study aimed to investigate the effects of changes in smoking habits after COPD diagnosis on lung cancer development in patients who smoked less than 30 pack-years.

METHODS

This nationwide retrospective cohort study included 16,832 patients with COPD who smoked less than 30 pack-years at the time of COPD diagnosis. Based on changes in smoking habits in the health screening examination data, smokers were categorized into three groups: quitters, reducers, and sustainers. The primary outcome was the risk of lung cancer development, which was estimated using the Cox proportional hazards model. We also modelled the amount of smoking reduction as a continuous variable.

RESULTS

During a median follow-up of 4 years, the cumulative incidence of lung cancer was the highest among sustainers, followed by reducers and quitters. Compared with sustainers, reducers (adjusted HR 0.74, 95% CI:0.56-0.98) and quitters (adjusted HR 0.78, 95% CI:0.64-0.96) had a significantly lower risk of lung cancer. Incidence of lung cancer showed a decreasing trend with a decreasing amount of smoking (P for linearity < 0.01).

CONCLUSIONS

In patients with COPD who smoked less than 30 pack-years, smoking reduction and cessation lowered the risk of lung cancer.

The memory of airway epithelium damage in smokers and COPD patients

Chronic obstructive pulmonary disease (COPD), a devastating and irreversible lung disease, causes structural and functional defects in the bronchial epithelium, the (ir)reversibility of which remains unexplored in vitro. This study aimed to investigate the persistence of COPD-related epithelial defects in long-term airway epithelial cultures derived from non-smokers, smokers, and COPD patients. Barrier function, polarity, cell commitment, epithelial-to-mesenchymal transition, and inflammation were evaluated and compared with native epithelium characteristics. The role of inflammation was explored using cytokines. We show that barrier dysfunction, compromised polarity, and lineage abnormalities observed in smokers and COPD persisted for up to 10 wk. Goblet cell hyperplasia was associated with recent cigarette smoke exposure. Conversely, increased IL-8/CXCL-8 release and abnormal epithelial-to-mesenchymal transition diminished over time. These ex vivo observations matched surgical samples' abnormalities. Cytokine treatment induced COPD-like changes in control cultures and reactivated epithelial-to-mesenchymal transition in COPD cells. In conclusion, these findings suggest that the airway epithelium of smokers and COPD patients retains a multidimensional memory of its original state and previous cigarette smoke-induced injuries, maintaining these abnormalities for extended periods.

Lipid mediators of inhalation exposure-induced pulmonary toxicity and inflammation

Many inhalation exposures induce pulmonary inflammation contributing to disease progression. Inflammatory processes are actively regulated via mediators including bioactive lipids. Bioactive lipids are potent signaling molecules involved in both pro-inflammatory and resolution processes through receptor interactions. The formation and clearance of lipid signaling mediators are controlled by multiple metabolic enzymes. An imbalance of these lipids can result in exacerbated and sustained inflammatory processes which may result in pulmonary damage and disease. Dysregulation of pulmonary bioactive lipids contribute to inflammation and pulmonary toxicity following exposures. For example, inhalation of cigarette smoke induces activation of pro-inflammatory bioactive lipids such as sphingolipids, and ceramides contributing to chronic obstructive pulmonary disease. Additionally, exposure to silver nanoparticles causes dysregulation of inflammatory resolution lipids. As inflammation is a common consequence resulting from inhaled exposures and a component of numerous diseases it represents a broadly applicable target for therapeutic intervention. With new appreciation for bioactive lipids, technological advances to reliably identify and quantify lipids have occurred. In this review, we will summarize, integrate, and discuss findings from recent studies investigating the impact of inhaled exposures on pro-inflammatory and resolution lipids within the lung and their contribution to disease. Throughout the review current knowledge gaps in our understanding of bioactive lipids and their contribution to pulmonary effects of inhaled exposures will be presented. New methods being employed to detect and quantify disruption of pulmonary lipid levels following inhalation exposures will be highlighted. Lastly, we will describe how lipid dysregulation could potentially be addressed by therapeutic strategies to address inflammation.

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

Background

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

Methods

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

Result

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

Discussion

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

Clinical Use of an Exposure, Symptom, and Spirometry Algorithm to Stratify Smokers into COPD Risk Phenotypes: A Case Finding Study Combined with Smoking Cessation Counseling

Background

Chronic obstructive pulmonary disease (COPD) case-finding aims to detect airflow obstruction in symptomatic smokers and ex-smokers. We used a clinical algorithm including smoking, symptoms, and spirometry to classify smokers into COPD risk phenotypes. In addition, we evaluated the acceptability and effectiveness of including smoking cessation advice in the case-finding intervention.

Methods

Smoking, symptoms, and spirometry abnormalities (airflow obstruction: forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] <0.7 or preserved-ratio spirometry (FEV1<80% of predicted value and FEV1/FVC ratio ≥ 0.7)] were assessed in a group of 864 smokers aged ≥ 30 years. The combination of these parameters allowed the identification of 4 phenotypes: Phenotype A (no symptoms, normal spirometry; reference), Phenotype B (symptoms; normal spirometry; possible COPD), Phenotype C (no symptoms; abnormal spirometry; possible COPD), and Phenotype D (symptoms; abnormal spirometry; probable COPD). We assessed phenotype differences in clinical variables and modeled the trend from phenotype A to phenotype D. Smoking cessation advice based on spirometry was provided. Follow-up was done by telephone 3 months later.

Results

Using smokers without symptoms or abnormal spirometry (phenotype A; n=212 [24.5%]) as a reference, smokers were classified into possible COPD (phenotype B;n=332 [38.4%]; and C: n=81 [9.4%]) and probable COPD (phenotype D: n=239 [27.2%]). The trend from baseline phenotype A to probable COPD phenotype D was significant for the number of cigarettes/day and the number of years of smoking (p=0.0001). At follow-up, 58 (7.7%) of the respondents (n=749) reported that they had quit smoking.

Conclusions

Our clinical algorithm allowed us to classify smokers into COPD phenotypes whose manifestations were associated with smoking intensity and to significantly increase the number of smokers screened for COPD. Smoking cessation advice was well accepted, resulting in a low but clinically significant quit rate.

Lack of Clinical Control in COPD Patients Depending on the Target and the Therapeutic Option

Introduction

According to the Global Initiative for chronic obstructive lung disease (GOLD), when a treatment is not achieving an appropriate response it should be switched taking into account the predominant treatable trait to target (dyspnea or exacerbations). The objective of the present study was to investigate the lack of clinical control according to the target and medication groups.

Materials and Methods

This was a post-hoc analysis of the CLAVE study, an observational, cross-sectional, multicenter study which evaluated the clinical control, and related-factors, in a cohort of 4801 patients with severe chronic obstructive pulmonary disease (COPD). The primary endpoint was the percentage of uncontrolled patients defined as COPD Assessment Test (CAT) >16 or presence of exacerbations in the last 3 months despite receiving long-acting beta2-agonist (LABA) and/or long-acting antimuscarinic antagonist (LAMA) with or without inhaled corticosteroids (ICS). Secondary objectives included the description of sociodemographic and clinical characteristics of patients by therapeutic group and the identification of characteristics potentially associated with the lack of control of COPD including low adherence measured by the test to adherence to inhalers (TAI).

Results

In the dyspnea pathway, lack of clinical control was of 25.0% of patients receiving LABA or LAMA in monotherapy, 29.5% by those with LABA + LAMA, 38.3% with LABA + ICS and 37.0% with triple therapy (LABA + LAMA + ICS). In the exacerbation pathway, percentages were 87.1%, 76.7%, 83.3%, and 84.1%, respectively. Low physical activity and high Charlson comorbidity index were independent factor of non-control in all therapeutic groups. Additional factors were lower post-bronchodilator FEV1 and poor adherence to inhalers.

Conclusion

There are still room for improvement in COPD control. From the pharmacological perspective, every step in treatment have a pool of uncontrolled patients in which a step-up could be considered according to a trait to target strategy.

Mucus Hypersecretion in Chronic Obstructive Pulmonary Disease and Its Treatment

Most patients diagnosed with chronic obstructive pulmonary disease (COPD) present with hallmark features of airway mucus hypersecretion, including cough and expectoration. Airway mucus function as a native immune system of the lung that severs to trap particulate matter and pathogens and allows them to clear from the lung via cough and ciliary transport. Chronic mucus hypersecretion (CMH) is the main factor contributing to the increased risk of morbidity and mortality in specific subsets of COPD patients. It is, therefore, primarily important to develop medications that suppress mucus hypersecretions in these patients. Although there have been some advances in COPD treatment, more work remains to be done to better understand the mechanism underlying airway mucus hypersecretion and seek more effective treatments. This review article discusses the structure and significance of mucus in the lungs focusing on gel-forming mucins and the impacts of CMH in the lungs. Furthermore, we summarize the article with pharmacological and nonpharmacological treatments as well as novel and interventional procedures to control CMH in COPD patients.

Smoking cessation after diagnosis of COPD is associated with lower all-cause and cause-specific mortality: a nationwide population-based cohort study of South Korean men

BACKGROUND

The most effective way to halt the advancement of COPD is smoking cessation. However, limited data are available on the question of whether quitting smoking within two years after COPD diagnosis reduces the risk of mortality. The goal of our research was to analyze the relationship between quitting smoking after COPD diagnosis and the risks of all-cause and cause-specific mortality, using the Korean National Health Insurance Service (NHIS) database.

METHODS

This study included 1,740 male COPD patients aged 40 years or more who had been newly diagnosed within the 2003-2014 time period and had smoked prior to their COPD diagnosis. The patients were categorized into two groups according to their smoking status after COPD diagnosis: (i) persistent smokers (ii) quitters (smoking cessation within two years of COPD diagnosis). Multivariate Cox proportional hazard regression was performed to determine the adjusted hazard ratio (HR) and 95% confidence interval (CI) for both all-cause and cause-specific mortality.

RESULTS

Among 1,740 patients (mean age, 64.6 years; mean follow-up duration, 7.6 years), 30.5% stopped smoking after COPD diagnosis. Quitters gained a 17% risk reduction in all-cause mortality (aHR, 0.83; 95% CI, 0.69-1.00) and a 44% risk reduction in cardiovascular mortality (aHR, 0.56; 95% CI, 0.33-0.95) compared with persistent smokers.

CONCLUSION

Our study found that patients who quit smoking within two years after COPD diagnosis had lower risks of all-cause and cardiovascular mortality relative to persistent smokers. These results can be used to encourage newly diagnosed COPD patients to stop smoking.

Modelling 30-day hospital readmission after discharge for COPD patients based on electronic health records

Chronic Obstructive Pulmonary Disease (COPD) is the third most common chronic disease in China with frequent exacerbations, resulting in increased hospitalization and readmission rate. COPD readmission within 30 days after discharge is an important indicator of care transitions, patient's quality of life and disease management. Identifying risk factors and improving 30-day readmission prediction help inform appropriate interventions, reducing readmissions and financial burden. This study aimed to develop a 30-day readmission prediction model using decision tree by learning from the data extracted from the electronic health record of COPD patients in Macao. Health records data of COPD inpatients from Kiang Wu Hospital, Macao, from January 1, 2018, to December 31, 2019 were reviewed and analyzed. A total of 782 hospitalizations for AECOPD were enrolled, where the 30-day readmission rate was 26.5% (207). A balanced dataset was randomly generated, where male accounted for 69.1% and mean age was 80.73 years old. Age, length of stay, history of tobacco smoking, hemoglobin, systemic steroids use, antibiotics use and number of hospital admission due to COPD in last 12 months were found to be significant risk factors for 30-day readmission of CODP patients (P < 0.01). A data-driven decision tree-based modelling approach with Bayesian hyperparameter optimization was developed. The mean precision-recall and AUC value for the classifier were 73.85, 73.7 and 0.7506, showing a satisfying prediction performance. The number of hospital admission due to AECOPD in last 12 months, smoke status and patients' age were the top factors for 30-day readmission in Macao population.

The Role of Multidimensional Indices for Mortality Prediction in Chronic Obstructive Pulmonary Disease

(1) Background: Chronic obstructive pulmonary disease (COPD) is one of the most important respiratory diseases. It is characterised by a progressive course with individual differences in clinical presentation and prognosis. The use of multidimensional indices such as the BODE, eBODE, BODEX, CODEX, ADO, and Charlson Comorbidity Index has been proposed to predict the survival rate of COPD patients. However, there is limited research on the prognostic significance of these indices in predicting long-term survival rates in patients with COPD. The aim of this prospective cohort study was to investigate the prognostic value of the BODE, eBODE, BODEX, CODEX, ADO, COTE and Charlson Comorbidity Index in predicting 5- and 10-year survival in patients with COPD. (2) Methods: A total of 170 patients were included in the study and their clinical and functional characteristics of COPD progression, such as dyspnoea, body mass index and spirometry data, were evaluated. A Kaplan-Meier survival analysis was used to calculate 5- and 10-year survival rates. The predictive value of each index was assessed using Cox proportional hazards regression models. (3) Results: The 5-year survival rate was 62.35% and the 10-year survival rate was 34.70%. The BODE, eBODE, BODEX, CODEX, ADO, COTE and Charlson Comorbidity Index were all significantly associated with the 10-year survival rate of COPD patients (p < 0.05). The hazard ratios (HRs) for these indices were as follows: BODE (HR = 1.30, 95% confidence interval [CI] 1.21-1.39); eBODE (HR = 1.29, 95% CI 1.21-1.37); BODEX (HR = 1.48, 95% CI 1.35-1.63); CODEX (HR = 1.42, 95% CI 1.31-1.54); COTE (HR = 1.55, 95% CI 1.36-1.75); ADO (HR = 1.41, 95% CI 1.29-1.54); and Charlson Comorbidity Index (HR = 1.35, 95% CI 1.22-1.48). (4) Conclusions: The multidimensional indices are a useful clinical tool for assessing the course and prognosis of COPD. These indices can be used to identify patients at a high risk of mortality and guide the management of COPD patients.

Biological and Genetic Mechanisms of COPD, Its Diagnosis, Treatment, and Relationship with Lung Cancer

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronic adult diseases, with significant worldwide morbidity and mortality. Although long-term tobacco smoking is a critical risk factor for this global health problem, its molecular mechanisms remain unclear. Several phenomena are thought to be involved in the evolution of emphysema, including airway inflammation, proteinase/anti-proteinase imbalance, oxidative stress, and genetic/epigenetic modifications. Furthermore, COPD is one main risk for lung cancer (LC), the deadliest form of human tumor; formation and chronic inflammation accompanying COPD can be a potential driver of malignancy maturation (0.8-1.7% of COPD cases develop cancer/per year). Recently, the development of more research based on COPD and lung cancer molecular analysis has provided new light for understanding their pathogenesis, improving the diagnosis and treatments, and elucidating many connections between these diseases. Our review emphasizes the biological factors involved in COPD and lung cancer, the advances in their molecular mechanisms' research, and the state of the art of diagnosis and treatments. This work combines many biological and genetic elements into a single whole and strongly links COPD with lung tumor features.

Attempts to quit smoking, use of smoking cessation methods, and associated characteristics among COPD patients

We explored past-year quit attempts, cessation methods used, and associations with sociodemographic, smoking, and health-related characteristics among smoking patients with chronic obstructive pulmonary disease (COPD) in Germany. Cross-sectional survey data of 509 past-year smokers (current smokers and ≤12 months abstinent) with COPD (ICD-10 code J44.x and FEV1/FVC <0.70) from 19 pulmonary primary care practices were used. Associations were explored between age, sex, educational qualification, lung function, urges to smoke, psychological distress, and (a) ≥1 past-year quit attempt (yes/no), (b) use of ≥1 evidence-based smoking cessation method (yes/no). Of all patients, 48.5% (n = 247, 95% confidence interval (CI) 44.2–52.9) reported ≥1 past-year quit attempt. Such an attempt was positively associated with the male sex (Odds Ratio (OR) = 1.50, 95% CI 1.01–2.24) and negatively associated with time spent with urges to smoke (OR = 0.69, 95% CI 0.52–0.91). During the most recent past-year quit attempt, one-third of the patients used ≥1 evidence-based smoking cessation method (31.2%, 95% CI 25.4–37.0), which was positively associated with the strength of urges to smoke (OR = 1.62, 95% CI 1.09–2.41). Combined behavioural and pharmacological treatments were used by 4.0% (n = 10, 95% CI 1.6–6.5). Electronic cigarettes were used most frequently (21.5%, 95% CI 16.3–26.6). Although a high proportion of COPD patients in German pulmonary primary care attempt to quit smoking, only a few of them use evidence-based methods as assistance for quitting.

Tobacco use profiles by respiratory disorder status for adults in the wave 1-wave 4 population assessment of tobacco and health (PATH) study

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Exclusive ENDS use is associated with a prior COPD diagnosis.

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Dual ENDS/cigarette use is associated with prior diagnoses of COPD and bronchitis.

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Analyses adjusted for behavioral health symptoms and other respiratory disorders.

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Complete tobacco cessation is most beneficial in reducing respiratory complications.

Limited evidence exists on the association between electronic nicotine delivery systems (ENDS) and chronic respiratory disorders. This study examines the association of combustible tobacco and ENDS use with chronic respiratory disorders among US adults. Public-use data from the Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013–2014), Wave 2 (2014–2015), Wave 3 (2015–2016), and Wave 4 (2016–2018) were pooled. Analyses focused on adults with W1–W4 respiratory disorder data and current tobacco use at W4, as well as youth entering the adult cohort at W2 through W4 (N = 26,072). We fit weighted multivariable logistic regression models for each respiratory outcome (asthma, COPD, bronchitis) using W4 longitudinal weights. Cigarette smokers (adjusted odds ratio [AOR] = 0.8, 95 % CI 0.7–0.9) were less likely to report an asthma diagnosis (p = 0.013). In contrast, ENDS users (AOR = 6.5, 95 % CI 3.7–11.5), cigarette smokers (AOR = 6.1, 95 % CI 4.0–9.1), dual users of cigarettes and ENDS (AOR = 5.4, 95 % CI 3.4–8.7), current users of non-cigarette combustible, smokeless, and polytobacco products (AOR = 4.4, 95 % CI 3.1–6.4), and former users of any product (AOR = 3.0, 95 % CI 1.9–4.7) had significantly elevated odds of reporting a diagnosis of COPD (p < 0.001). Similar patterns to COPD were observed for bronchitis (p < 0.001). Current and former tobacco use, including ENDS, were significantly associated with prevalence of self-reported COPD and bronchitis after controlling for demographic and psychosocial confounders.

Association between lung function impairment with urinary heavy metals in a community in Klang Valley, Malaysia

Lung function status can be directly or indirectly affected by exposure to pollutants in the environment. Urinary heavy metals may be an indirect indicator of lung function impairment that leads to various diseases such as chronic obstructive pulmonary disease (COPD). This study aimed to explore the prevalence of lung function impairment as well as its association with urinary heavy metal levels and other influencing factors among the community in Klang Valley, Malaysia. Urinary sampling was done during various community events in the housing areas of Klang Valley between March and October 2019. Only respondents who consented would undergo a lung function test. Urine samples were obtained and sent for Inductively Coupled Plasma Mass Spectrometry (ICP-MS) analysis for heavy metal cadmium (Cd) and lead (Pb) concentration. Of the 200 recruited respondents, 52% were male and their ages ranged from 18 years old to 74 years old with a mean age of 38.4 ± 14.05 years. Urinary samples show high urinary Cd level in 12% of the respondents (n = 24) whereas none recorded a high urinary Pb level. There was a positive correlation between the levels of urinary Cd and urinary Pb (r = 0.303; p = 0.001). Furthermore, a negative correlation was detected between urinary Cd level and forced vital capacity (FVC) (r =  - 0.202, p = 0.004), force expiratory volume at the first second (FEV1) (r =  - 0.225, p = 0.001), and also force expiratory flow between 25-75% of FVC (FEF 25-75%) (r =  - 0.187, p = 0.008). However, urinary Pb did not show any correlation with lung function parameters. Multiple linear regression analysis showed that urinary Cd had a significant negative effect on FVC (p = 0.025) and FEV1 (p = 0.004) based on the predicted value. Additionally, other factors such as education level (p = 0.013) also influenced lung function. However, no interaction was detected between heavy metals or other factors. In short, there was a significant negative linear relationship between urinary Cd and lung function, whereas urinary Pb was not associated with lung function. Beside acting as a biomarker for cadmium exposure level, urinary Cd may also be applied as indirect biomarker for asymptomatic chronic lung function deterioration among the healthy population.

Evaluation of chest radiography and low-dose computed tomography as valuable screening tools for thoracic diseases

BACKGROUND

Recent studies have shown that low-dose computed tomography (LDCT) is effective for the early detection of lung cancer. However, the utility of chest radiography (CR) and LDCT for other thoracic diseases has not been as well investigated as it has been for lung cancer. This study aimed to clarify the usefulness of the veridical method in the screening of various thoracic diseases.

METHODS

Among individuals who had received general health checkups over a 10-year period, those who had undergone both CR and LDCT were selected for analysis. The present study included 4317 individuals (3146 men and 1171 women). We investigated cases in which abnormal opacity was detected on CR and/or LDCT.

RESULTS

A total of 47 and 124 cases had abnormal opacity on CR and LDCT, respectively. Among these, 41 cases in which the abnormal opacity was identified by both methods contained 20 treated cases. Six cases had abnormalities only on CR, and none of the cases required further treatment. Eighty-three cases were identified using LDCT alone. Of these, many cases, especially those over the age of 50 years, were diagnosed with thoracic tumors and chronic obstructive pulmonary disease, which required early treatment. In contrast, many cases of pulmonary infections have improved spontaneously, without any treatment.

CONCLUSION

These results revealed that LDCT allowed early detection of thoracic tumors and chronic obstructive pulmonary disease, especially in individuals over the age of 50 years. CR is still a useful imaging modality for other thoracic diseases, especially in individuals under the age of 49 years.

Global disease burden of COPD from 1990 to 2019 and prediction of future disease burden trend in China

OBJECTIVES

This study aimed to assess and predict the disease burden attributable to chronic obstructive pulmonary disease (COPD) in a timely, comprehensive, and reliable manner, thereby mitigating the health hazards of COPD.

STUDY DESIGN AND METHODS

Data on the disease burden owing to COPD from 1990 to 2019 were extracted from the Global Burden of Disease (GBD) Study 2019. Linear regression analysis was used to calculate the estimated annual percentage change (EAPC) in the age-standardized rates. Non-parametric tests were used for subgroup analysis. The Bayesian age-period-cohot (BAPC) model integrated nested Laplace approximations to predict the disease burden over the next 25 years. Sensitivity analysis was performed using the Norpred APC model.

RESULTS

Globally, the COPD-related age-standardized incidence rate decreased from 216.48/100,000 in 1990 to 200.49/100,000 in 2019, with an EAPC of -0.33. But the number of new cases increased from 8,722,966 in 1990 to 16, 214, 828 in 2019. Trends in prevalence, deaths, and disability-adjusted life years (DALYs) were the same as incidence. There were significant differences in disease burden between the genders and all age groups (P < 0.05) in China. The projections suggested that the COPD-related number of new cases and deaths in China would increase by approximately 1.5 times over the next 25 years.

CONCLUSIONS

The number of incidence, prevalence, deaths, and DALYs had all increased in China in the past and would continue to grow over the next 25 years. Therefore, measures should be taken to target risk factors and high-risk groups.

Chronic Obstructive Pulmonary Disease-Related Mortality in Brazil, 2000-2019: A Multiple-Cause-of-Death Study

Chronic obstructive pulmonary disease (COPD) remains a compelling cause of morbidity and mortality; however, it is underestimated and undertreated in Brazil. Using multiple causes of death data from the Information System on Mortality, we evaluated, from 2000 to 2019, national proportional mortality; trends in mortality rates stratified by age, sex, and macro-region; and causes of death and seasonal variation, considering COPD as an underlying and associated cause of death. COPD occurred in 1,132,968 deaths, corresponding to a proportional mortality of 5.0% (5.2% and 4.7% among men and women), 67.6% as the underlying, and 32.4% as an associated cause of death. The standardized mortality rate decreased by 25.8% from 2000 to 2019, and the underlying, associated, male and female, Southeast, South, and Center-West region deaths revealed decreasing standardized mortality trends. The mean age at death increased from 73.2 (±12.5) to 76.0 (±12.0) years of age. Respiratory diseases were the leading underlying causes, totaling 69.8%, with COPD itself reported for 67.6% of deaths, followed by circulatory diseases (15.8%) and neoplasms (6.24%). Respiratory failure, pneumonia, septicemia, and hypertensive diseases were the major associated causes of death. Significant seasonal variations, with the highest proportional COPD mortality during winter, occurred in the southeast, south, and center-west regions. This study discloses the need and value to accurately document epidemiologic trends related to COPD in Brazil, provided its burden on mortality in older age as a significant cause of death, aiming at effective planning of mortality prevention and control.

Smoking Cessation therapy is a cost-effective intervention to avoid tooth loss in Brazilian subjects with periodontitis: an economic evaluation

Background

Smokers present a higher prevalence and severity of periodontitis and, consequently, higher prevalence of tooth loss. Smoking cessation improves the response to periodontal treatment and reduces tooth loss. So, the aim of this study was to evaluate the efficiency in resources allocation when implementing smoking cessation therapy vs. its non-implementation in smokers with periodontitis.

Methods

We adopted the Brazilian public system perspective to determine the incremental cost-effectiveness (cost per tooth loss avoided) and cost-utility (cost per oral-related quality-adjusted life-year ([QALY] gained) of implementing smoking cessation therapy. Base-case was defined as a 48 years-old male subject and horizon of 30 years. Effects and costs were combined in a decision analytic modeling framework to permit a quantitative approach aiming to estimate the value of the consequences of smoking cessation therapy adjusted for their probability of occurrence. Markov models were carried over annual cycles. Sensitivity analysis tested methodological assumptions.

Results

Implementing the therapy saved approximately US$ 100 over the time horizon accompanied by a slightly better effect, both in CEA and CUA. Considering uncertainties, the therapy could be cost-effective in the most part of simulated cases, even being cheaper and more effective in 35% of cases in which the oral-health related outcome is used as effect. Considering a willingness-to-pay of US$100 per health effect, smoking cessation therapy was cost-effective, respectively, in 72% and 99% of cases in cost-utility and cost-effectiveness analyses.

Conclusions

Implementation of smoking cessation therapy may be cost-effective, considering the avoidance of tooth loss and oral health-related consequences to patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01932-2.

Transcriptional Response of Mycobacterium tuberculosis to Cigarette Smoke Condensate

Smoking is known to be an added risk factor for tuberculosis (TB), with nearly a quarter of the TB cases attributed to cigarette smokers in the 22 countries with the highest TB burden. Many studies have indicated a link between risk of active TB and cigarette smoke. Smoking is also known to significantly decrease TB cure and treatment completion rate and increase mortality rates. Cigarette smoke contains thousands of volatile compounds including carcinogens, toxins, reactive solids, and oxidants in both particulate and gaseous phase. Yet, to date, limited studies have analyzed the impact of cigarette smoke components on Mycobacterium tuberculosis (Mtb), the causative agent of TB. Here we report the impact of cigarette smoke condensate (CSC) on survival, mutation frequency, and gene expression of Mtb in vitro. We show that exposure of virulent Mtb to cigarette smoke increases the mutation frequency of the pathogen and strongly induces the expression of the regulon controlled by SigH—a global transcriptional regulator of oxidative stress. SigH has previously been shown to be required for Mtb to respond to oxidative stress, survival, and granuloma formation in vivo. A high-SigH expression phenotype is known to be associated with greater virulence of Mtb. In patients with pulmonary TB who smoke, these changes may therefore play an important, yet unexplored, role in the treatment efficacy by potentially enhancing the virulence of tubercle bacilli.

Challenges in Diagnosing Occupational Chronic Obstructive Pulmonary Disease

Occupational chronic obstructive pulmonary disease (oCOPD) represents 15–20% of the global burden of this disease. Even if industrial bronchitis has long been known, new occupational hazards continue to emerge and enlarge the number of people exposed to risk. This review discusses the challenges related to the early detection of oCOPD, in the context of new exposures and of limited usage of methods for an efficient disease occupational screening. It underlines that a better translation into clinical practice of the new methods for lung function impairment measurements, imaging techniques, or the use of serum or exhaled breath inflammation biomarkers could add significant value in the early detection of oCOPD. Such an approach would increase the chance to stop exposure at an earlier moment and to prevent or at least slow down the further deterioration of the lung function as a result of exposure to occupational (inhaled) hazards.

Factors Associated With Smoking Behaviors Among Late Adolescents: A Cross-Sectional Study in Taiwan

ABSTRACT

This study examined factors associated with smoking behaviors among late adolescents in Taiwan. A cross-sectional survey was conducted with 377 adolescents from four high schools who answered self-report questionnaires. The results indicated that 10.8% (n = 41) of the participants were current smokers. Univariate analysis indicated that current smoking status was significantly associated with smoking social confidence, smoking social connection, friend smoking, and smoking policy in schools. Logistic regression showed smoking social confidence (adjusted odds ratio = 1.41, 95% CI [1.16, 1.72], p = .01) and friend smoking (adjusted odds ratio = 2.80, 95% CI [1.67, 4.70], p < .01) were significantly associated with being a current smoker. Health professionals should consider implementing school-based programs to reduce influence of friend smoking, through strategies for resisting peer pressure, to reduce smoking. Educating late adolescents on improving skills related to social confidence, such as increasing communication abilities, should also be a part of these programs.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Life Expectancy and Rate of Decline After Lung Volume Reduction Surgery

Lung volume reduction surgery (LVRS) patient selection guidelines are based on the National Emphysema Treatment Trial. Because of increased mortality and poor improvement in functional outcomes, patients with non-upper lobe emphysema and low baseline exercise capacity are determined as poor candidates for LVRS. In well-selected patients with heterogeneous emphysema, LVRS has a durable long-term outcome at up to 5-years of follow-up. Five-year survival rates in patients range between 63% and 78%. LVRS seems a durable alternative for end-stage heterogeneous emphysema in patients not eligible for lung transplantation. Future studies will help identify eligible patients with homogeneous emphysema for LVRS.

Factors Influencing the Length of Hospital Stay Among Patients with Chronic Obstructive Pulmonary Disease (COPD) in Macao Population: A Retrospective Study of Inpatient Health Record

Purpose

This study aims to identify the effects of patient and clinical therapy factors on the length of hospital stay (LOS) for admission due to chronic obstructive pulmonary disease (COPD) in Macao.

Patients and Methods

Health record of patients with COPD admitted to Kiang Wu Hospital from January 2017 to December 2019 was retrospectively analyzed. Demographic information, blood test results, clinical therapies, and LOS were described and analyzed by multivariable regression.

Results

A total of 1116 admissions were included with the average LOS being 12.28 (±9.23) days. Among them, 735 (66.6%) were male with mean age 79.42 (±10.35) years old, 697 were current or previous smokers (62.5%), and 360 (32.2%) had 3 or more comorbidities. During hospitalization, the most common treatments received were oxygen therapy (n=991,88.8%), antibiotics (n=828,74.2%), and systemic steroids (n=596,53.4%); only 120 (10.8%) had pulmonary rehabilitation (PR) and 128 (11.5%) received noninvasive ventilation (NIV). Inhaled medications were used during nearly 95% of hospitalization cases, while 2 and 3 types of inhaled medications were used during 230 (20.6%) and 582 (52.2%) hospitalization cases, respectively. Patient factors including age (B=0.178, 95% CI:0.535–1.072), being female (B=−1.147, 95% CI:-0.138–0.056), being current (B=−0.086, 95% CI:-0.124–0.018) or previous smoker (B=0.072, 95% CI:0.004–0.087), having 1, 2, 3 and over 3 comorbidities (B=0.126, 95% CI:0.034–0.147; B=0.125, 95% CI:0.031–0.144; B=0.116, 95% CI:0.028–0.146, B=0.090, 95% CI:0.021–0.166) and having low hemoglobin level (B=−0.118, 95% CI:-0.629- −0.214) exhibited significant associations with LOS. The use of NIV (B=0.080, 95% CI:0.022–0.138), pulmonary rehabilitation (B=0.269, 95% CI:0.212–0.327), two and three types of inhaled medications (B=0.109, 95% CI:0.003–0.166, B=0.255, 95% CI:0.083–0.237) were significantly associated with longer LOS (P<0.05).

Conclusion

NIV, PR and combined inhaled medications, which are often used for AECOPD, are the main clinical therapies associated with longer LOS in Macao. Smoking cessation, early treatments of comorbidities may be crucial to avoiding AECOPD and reducing LOS and disease burden.

Common Mental Disorders, Functional Limitation and Diet Quality Trends and Related Factors among COPD Patients in Spain, 2006-2017: Evidence from Spanish National Health Surveys

Certain conditions such as common mental disorders (CMDs), functional limitation (FL) and poor diet quality may affect the lives of individuals who suffer from chronic obstructive pulmonary disease (COPD). This study sought to examine time trends in the prevalence of CMDs, FL and diet quality among male and female COPD patients living in Spain from 2006 to 2017 and to identify which factors were related to CMDs, FL and a poor/improvable diet quality in these patients. We performed a cross-sectional study among COPD patients aged ≥ 40 years old using data from the Spanish National Health Surveys conducted in 2006, 2011 and 2017, identifying a total of 2572 COPD patients. Binary logistic regressions were performed to determine the characteristics related to CMDs, FL and poor/improvable diet quality. Over the years of the study, the prevalence of FL among female COPD patients increased (p for trend <0.001). In addition, CMDs were associated to body mass index (BMI), educational level, physical activity, smoking status, occupation, chronic conditions and alcohol consumption; FL was related to age, living with a partner, educational level, physical activity and chronic conditions; and poor/improvable diet quality was associated to age, smoking status, BMI and physical activity.

Efficacy of Shenling Baizhu San on stable chronic obstructive pulmonary disease patients: A systematic review and meta-analysis

ETHNOPHARMACOLOGICAL RELEVANCE

Shenling Baizhu San (SBS) as a classic Chinese medicine prescription, has been extensively used in gastrointestinal diseases, such as ulcerative colitis and chronic diarrhea. In recent years, SBS has shown a beneficial effect on chronic obstructive pulmonary disease (COPD) patients. However, clinical trials had shown conflicting results of SBS on improving pulmonary function and other related indicators of patients with stable COPD. The efficacy of SBS on stable COPD patients has not been fully assessed.

AIM OF THE STUDY

To determine whether the SBS used in the treatment of gastrointestinal disease was effective to treat COPD, we assessed the clinical evidence and efficacy of SBS supplemental treatment on stable COPD patients by a systematic review and meta-analysis of clinical trials.

MATERIALS AND METHODS

Nine electronic databases were searched to include clinical trials (published until August 31, 2020) with SBS as a supplementation treatment on stable COPD. Mean difference (MD) was used to evaluate continuous variables, odds ratio (OR) was calculated to evaluate dichotomous. The Egger's test was applied for publication bias.

RESULTS

A total of 770 COPD participants from 11 trials that met the inclusion criteria were included. The meta-analysis showed that modified SBS could improve the exercise endurance, life quality scores of stable COPD patients, and also showed the potential benefits to pulmonary function of COPD patients than original SBS.

CONCLUSION

The methodological quality of included trials may limit the conclusions that indicate that modified SBS may have a promising treatment for improving FEV₁/FVC and MVV, increasing exercise endurance and life quality scores on stable COPD patients.

Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan

BACKGROUND

There is scarce knowledge on the prevalence of diseases caused by non-tuberculous mycobacteria (NTM) in Pakistan. In the absence of culture and identification, acid-fast bacilli (AFB) causing NTM disease are liable to be misinterpreted as tuberculosis (TB). Introduction of nucleic acid amplification testing for Mycobacterium tuberculosis complex (MTBC) offers improved diagnostic accuracy, compared with smear microscopy, and also assists in differentiating MTBC from other mycobacteria. This study aimed to investigate the prevalence of NTM among patients investigated for TB and describe NTM disease and treatment outcomes at a tertiary care hospital in Pakistan.

METHODS

This is a retrospective study, data on NTM isolates among culture-positive clinical samples over 4 years (2016-19) was retrieved from laboratory records. Information on clinical specimens processed, AFB smear results, and for the AFB positive isolates, results of species identification for MTBC, and for NTM isolates, results of species characterization and drug susceptibility testing was collected. Additional clinical data including patient characteristics, treatment regimens, and outcomes were collected for patients with NTM disease treated at Gulab Devi Hospital, Lahore.

RESULTS

During the study period, 12,561 clinical specimens were processed for mycobacterial culture and 3673 (29%) were reported positive for AFB. Among these 3482 (95%) were identified as MTBC and 191 (5%) as NTM. Among NTM, 169 (88%) were isolated from pulmonary and 22 (12%) from extrapulmonary specimens. Results of NTM speciation were available for 60 isolates and included 55% (n = 33) M. avium complex and 25% (n = 15) M. abscesses. Among these patients, complete clinical records were retrieved for 12 patients with pulmonary disease including nine infected with M. avium complex and three with M. abscessus. All 12 patients had a history of poor response to standard first-line anti-TB treatment. Ten patients were cured after 18 months of treatment, whereas, one with M. abscessus infection died and another was lost to follow up.

CONCLUSION

In TB endemic areas, NTM can be misdiagnosed as pulmonary TB leading to repeated failed anti-TB treatment and increased morbidity, emphasizing the need for improved diagnosis.

The Impact of Smoking on Early Postoperative Complications in Hand Surgery

PURPOSE

Smoking is a prevalent modifiable risk factor that has been associated with adverse postoperative outcomes across numerous surgical specialties. We examined the impact of smoking on 30-day complications in patients undergoing hand surgery procedures.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program data sets were queried for patients who underwent common hand surgery procedures from 2011 to 2016. Cohorts were divided into smoking and nonsmoking and compared in terms of demographic characteristics, comorbidities, and postoperative complications. Multivariable logistic regression models were used to control for demographic characteristics and comorbidities in assessing the association between smoking and postoperative infections as well as other major and minor complications.

RESULTS

We identified a cohort of 48,370 patients in the National Surgical Quality Improvement Program who underwent certain outpatient and inpatient hospital facility-based hand surgery procedures from 2011 to 2016. Up to 22% of these patients reported active smoking. Compared with nonsmokers, smokers were more likely to be younger and male and to have a lower body mass index. In addition, they were more likely to have a higher American Society of Anesthesiologists classification and to report dyspnea and chronic obstructive pulmonary disease. Multivariable logistic regression identified an independent association between smoking and major complications. Smoking was not significantly associated with minor complications. When regrouped by complication type, smoking was associated with infectious and wound healing complications. In subgroup analysis, smokers undergoing elective hand surgery had increased odds of wound healing complications but not major, minor, or infectious complications.

CONCLUSIONS

Smokers may be at a significantly higher odds of certain complications compared with nonsmokers. For patients undergoing the elective procedures evaluated in this study, perioperative smoking may increase the risk of wound-healing complications.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Factors associated with poor oral health-related quality of life among non-institutionalized Brazilian older adults: Oral health and quality of life in older adults

AIMS

To investigate the factors associated with poor oral health-related quality of life (OHRQoL) in a sample of Brazilian older adults.

METHODS AND RESULTS

A cross-sectional study was conducted with 535 non-institutionalized elders aged 60 years or older from Piracicaba, São Paulo, Brazil. OHRQoL was measured using the Geriatric Oral Health Assessment Index (GOHAI). Data on sociodemographic characteristics, self-perceived general health status, and health-related behaviors were obtained through a structured questionnaire. Data on chronic diseases were obtained from health records. Associations between exploratory factors and low OHRQoL (% GOHAI score <30) were evaluated using multivariate Poisson regression models to estimate adjusted prevalence ratios (PRs) and confidence intervals. The mean OHRQoL score was 30 (± 4.4). In bivariate analysis, being not married, smoking, and self-rated "fair/poor" general health status were associated with lower OHRQoL. In the adjusted model, self-rated "fair/poor" general health (PR: 1.25; 95% CI: 1.05-1.48), presence of chronic diseases (PR: 1.88; 95% CI: 1.37-2.58), smoking (PR: 1.25; 95% CI: 1.02-1.53), and reason for last dental appointment (PR: 1.34; 95% CI: 1.13-1.59) were associated with poor OHRQoL.

CONCLUSION

Non-institutionalized older adults with a history of chronic diseases, who smoke, have a negative perception of their general health, and had the last dental appointment motivated by pain present significantly higher prevalence rates of poor OHRQoL.

COPD Management in Community Pharmacy Results in Improved Inhaler Use, Immunization Rate, COPD Action Plan Ownership, COPD Knowledge, and Reductions in Exacerbation Rates

Purpose

To evaluate the effectiveness of a pilot community pharmacy care model for patients with chronic obstructive pulmonary disease (COPD) to improve: 1) inhaler technique; 2) medication adherence; and 3) uptake of non-pharmacological treatment and prevention activities.

Patients and Methods

Forty "host" pharmacies in Sydney were invited to recruit eligible patients and to provide a counselling room/area in their pharmacy for service provision. Eligible patients were referred to two "consultant" pharmacists, specifically trained to deliver a specialized pharmacy COPD service which involved 3 in-pharmacy visits and 2 follow-up phone calls over a 6-month period. The service consisted of 1) inhaler technique assessment; 2) medication adherence assessment; and 3) referrals to the patient's general practitioner (GP) to facilitate the uptake of non-pharmacological resources as well as to review COPD medications/devices, as required. Pre-post analyses were conducted using paired Student's t-test and Wilcoxon Signed Rank Test for independent variables and chi-squared tests for proportional data.

Results

Nine "host" pharmacies recruited 40 patients, of whom 37 completed the baseline Visit and 27 completed all Visits. A total of 270 interventions were provided by the "consultant" pharmacists with most provided at Visit 1 (176). The most common interventions were addressing patient gaps in COPD knowledge and inhaler technique. A total of 119 referrals were made to GPs for various reasons, the most common being for a COPD action plan, pulmonary rehabilitation, or pneumonia vaccination. There were significant improvements pre-post intervention in inhaler use competence, COPD knowledge, immunization rate for pneumonia, exacerbation rate and COPD plan ownership.

Conclusion

In this pilot study, the specialized pharmacy-based COPD care model delivered by "consultant" pharmacists in community pharmacies provided significant health benefits for patients. Further research is needed to assess the model's effectiveness in a larger population as well as when measured against standard care.

Analysis of Risk Factors Affecting The Occurrence of Chronic Obstructive Pulmonary Disease in Indonesia

Background: Chronic obstructive pulmonary disease (COPD) is a lung disease caused by the occurrence of airflow limitation in the lungs and also causes 60% of all deaths in Indonesia. Purpose: This study aimed to analyze the risk factors that affect the incidence of COPD in Indonesia. Methods: This study was conducted in July–August 2019 in Indonesia as an analytic research study with a cross-sectional design, using data from the Indonesia Family Life Survey-5. The sample consisted of respondents aged >15 years, giving a total of 34,231 respondents. Data analysis was partially carried out using the chi-square test to analyze the relationships between the variables. Results: The majority of respondents were female, were aged <40 years, and had a low level of education. Risk factors for the development of COPD included, among others, an age of >40 years (p = 0.02; PR = 1.20; 95% CI = 1.02–1.41), male gender (p = 0.01; PR = 1.26; 95% CI = 1.07–1.49), smoking (p = 0.01; PR = 1.22 ; 95% CI = 1.03–1.44), first smoking age < 40 years (p = 0.02; PR = 1.22; 95% CI = 1.03–1.44), residence in urban areas (p = 0.01; PR = 1.43; 95% CI = 1.20–1.70), being underweight (p = 0.01; PR = 2.17; 95% CI = 1.76–2.66). Conclusions: The risk factors that affect the incidence of COPD include being aged >40 years, being male, smoking, taking up smoking when aged <40 years, urban residence, and being underweight.

Clinical Control Criteria to Determine Disease Control in Patients with Severe COPD: The CLAVE Study

Background

Clinical control in chronic obstructive pulmonary disease (COPD) has not been completely characterized. A proposal of clinical control criteria (CCC) has been recently defined and validated as a tool for determining control, but there is scarce information on patients with severe COPD.

Objective

To evaluate clinical control in severe COPD using the CCC.

Patients and Methods

The study design was observational, multicenter, cross-sectional study involving 4801 patients with severe COPD in Spain. Clinical control was defined according to clinical impact (dyspnea grade, use of rescue treatment in last week, sputum color, and daily physical activity) and stability (exacerbations in last 3 months and patient’s perception about health status). Clinical control of COPD was alternatively evaluated with the COPD assessment test (CAT) and the presence of exacerbations in the last 3 months.

Results

According to CCC, 61.0% of patients had low clinical impact, and 41.4% showed clinical stability. Overall, 29.9% of patients had both low clinical impact and stability (controlled), whereas 70.1% showed high clinical impact and/or no clinical stability (non-controlled). COPD control was also assessed by using only the definition of CAT≤16 and no exacerbations in the last 3 months. Results obtained with this definition were similar to those obtained by CCC, and the concordance between both definitions was high (Kappa index = 0.698).

Conclusion

By using the CCC, approximately only one third of patients with severe COPD were considered as controlled. Physical activity, adherence to inhalers, age, post-bronchodilator FEV₁, age-adjusted Charlson comorbidity index, and healthcare level were independent factors associated with COPD control.

Can self-management programmes change healthcare utilisation in COPD?: A systematic review and framework analysis

OBJECTIVE

The study aims to evaluate the ability of self-management programmes to change the healthcare-seeking behaviours of people with Chronic Obstructive Pulmonary Disease (COPD), and any associations between programme design and outcomes.

METHODS

A systematic search of the literature returned randomised controlled trials of SMPs for COPD. Change in healthcare utilisation was the primary outcome measure. Programme design was analysed using the Theoretical Domains Framework (TDF).

RESULTS

A total of 26 papers described 19 SMPs. The most common utilisation outcome was hospitalisation (n = 22). Of these, 5 showed a significant decrease. Two theoretical domains were evidenced in all programmes: skills and behavioural regulation. All programmes evidenced at least 5 domains. However, there was no clear association between TDF domains and utilisation. Overall, study quality was moderate to poor.

CONCLUSION

This review highlights the need for more alignment in the goals, design, and evaluation of SMPs. Specifically, the TDF could be used to guide programme design and evaluation in future.

PRACTICE IMPLICATIONS

Practices have a reasonable expectation that interventions they adopt will provide patient benefit and value for money. Better design and reporting of SMP trials would address their ability to do so.

Total Antioxidant Status in Stable Chronic Obstructive Pulmonary Disease

Objective

This study evaluates the total antioxidant status (TAS) in plasma of stable chronic obstructive pulmonary disease (COPD) patients. Earlier studies of their relationship showed inconsistent findings.

Patients and Methods

We compared TAS between 90 COPD patients and 30 age- and sex-matched controls (mean age 67 ± 7.9, 87 males and 33 females) according to airway obstruction severity, gender, smoking status (current/ former/ non-smoker), smoking-dose, the number of exacerbations in the previous year, nutritional status and hypercapnia.

Results

There were no differences in pack-years between COPD and controls, neither in COPD groups. The median time from the last exacerbation was 5 months (interquartile range 3-8.3). TAS was significant higher in COPD than controls (1.68 [1.55-1.80] versus 1.59 [1.54-1.68], respectively; P = 0.03). TAS was significantly higher in COPD men than women (1.7 [1.6-1.8] versus 1.57 [1.5-1.7], respectively; P = 0.001). In COPD groups, there were no significant differences between the severity of airway obstruction and TAS. We found significant positive correlation between pack-years and TAS in all participants (Rho = 0.429, P = 0.004) and COPD patients (Rho = 0.359, P = 0.02), but not in controls. TAS was a significant predictor of COPD (β = 3.26; P = 0.04; OR = 26.01; 95% CI: 1.20 to 570.8). We failed to find significant differences between TAS and smoking status, frequency of exacerbations in the previous year, nutritional status and hypercapnia.

Conclusion

TAS was a significant predictor of COPD. TAS was a significantly higher in stable COPD than controls, higher in COPD men than women, but there was no significant correlation between TAS and the airway obstruction severity. Our results suggest that it could be appropriate to include the time from the last exacerbation in the oxidant-antioxidant balance analysis of COPD patients.

Clinical Application of Forced Oscillation Technique (FOT) in Early Detection of Airway Changes in Smokers

The forced oscillation technique (FOT) is a non-invasive method to assess airway function by emitting oscillatory signals into the respiratory tract during tidal ventilation. This opinion piece discusses the current use, trialled modification and future directions in utilizing FOT as a novel diagnostic tool for early detection of small airway changes in smokers. The published evidence to date has shown that FOT parameters could be a sensitive diagnostic tool to detect early respiratory changes in smokers. Multiple frequencies and the frequency dependence of resistance and reactance can provide the most valuable and early information regarding smoking induced changes in airways. Considering its non-invasiveness, lower level of discomfort to patients than spirometry, feasibility, and cost effectiveness, it could be the first-choice diagnostic technique for detection of early respiratory changes in smokers. The finding of FOT could further be supported and correlated with inflammatory markers.

Different Characteristics of Ex-Smokers and Current Smokers with COPD: A Cross-Sectional Study in China

PURPOSE

Chronic obstructive pulmonary disease (COPD), usually caused by tobacco smoking, is increased in China. Smoking cessation is the first step in COPD management. Data on predictors of smoking cessation are sparse in COPD patients in China. We aim to find the differences in the clinical characteristics between ex-smokers and current smokers with COPD to determine the factors related to smoking cessation.

PATIENTS AND METHODS

From outpatient departments of 12 hospitals in Hunan and Guangxi provinces, a total of 4331 patients were included. Information on demographic and sociological data, lung function, and modified Medical Research Council (mMRC) dyspnea scale scores were recorded. Patients were divided into an ex-smokers group and a current smokers group based on whether they gave up smoking. A logistic regression analysis was performed to analyze the factors associated with smoking cessation.

RESULTS

Of the total, the mean age was 62.9±8.5 years, and 47.3% were ex-smokers. Compared with the current smokers, the ex-smokers were older, and had heavier dyspnea, more severe airflow limitation, fewer pack-years, shorter smoking duration, and a higher proportion of Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups C and D. The logistic regression model showed that smoking cessation was negatively correlated with widowhood, years of smoking, and forced expiratory volume in 1 second (FEV1), but was positively correlated with age, education level, amount smoked, mMRC score, GOLD grades, and GOLD groups.

CONCLUSION

Among patients with COPD, more than half still smoked. In the group of patients who quit smoking, many of them quit rather late in age after they had significant symptoms. Several predictors of smoking cessation were identified, indicating that ex-smokers differ substantially from continuing smokers. This should be taken into account in smoking-cessation interventions.

Predicting the outcomes and costs for a cohort of 426 patients with Chronic Obstructive Pulmonary Disease (COPD) in Bulgaria through a Markov model

The aim was to estimate the economic burden, as well as rate of progression of COPD for a cohort of 426 patients for a 10-year period. A total of 426 patients from 19 regions with Chronic Obstructive Pulmonary Disease were enrolled in a representative, ambispective, national study for Bulgaria. Patients were recorded on disease stage, occupation, smoking habits and medication. Cost of treatment was calculated and a 10-year one-way Markov model was used by employing transition probabilities and quality of life data from available literature. Costs and outcomes were recorded and a cost-effectiveness acceptability curve (CEAC) was established.

Out of all patients included in the study 288 were non-smokers with a mortality percentage after 10 years of 42.7%. Smokers showed faster transition rate with 139 of them transitioning to more severe states and mortality was 54.6%. The incremental cost-effectiveness ratio (ICER) was 863.75 BGN. Patients who smoked had a lower quality of life – cumulatively for the 10-year period QALY = 623.51 for smokers vs. 1557.51 for non-smokers, but also lower costs for treatment (538 007.52 BGN vs. 1 344 757.95 BGN) accounted by the high transition rate and mortality amongst that group. Relatively few non-smokers transitioned from a less severe to a more severe state (6%), while most of the very severe stage patients experienced a lethal outcome within 10 years (81%).

Despite the higher costs associated with the disease, the Quality of Life and lower transition probability would enable patients to live a normal life. The ICER was well below the WHO threshold.

Update on the approach to smoking in patients with respiratory diseases

Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.

[COPD and smoking cessation: Patients' expectations and responses of health professionals]

The importance of smoking cessation in the management of COPD is well-established: the benefit of quitting smoking as regards morbidity and mortality outcomes in patients, is unquestioned. The smoking cessation in COPD patients is difficult: high levels of consumption, the duration of smoking, high dependence level, psychological co-morbidities such as anxiety and depression, lower socio-economic and intellectual level, constitute barriers. Studies have shown that patients often minimize the risks of smoking, that others do not believe in the benefits of quitting or doubt their ability to quit smoking. The patients' experience, and expectations with regard to smoking cessation are incompletely satisfied: are considered, the smoking characteristics of these patients, the understanding of the tobacco dependence, the beliefs and ideas of smokers, the knowledge of smoking cessation methods, the role of validated aids and alternative treatments, failure management. The answers of the health professionals can be in several directions: establishment of a better communication patient-doctor (empathy), more centered on the needs of the smoker, the role of the motivation and the place of the motivational interview, the understanding of the mechanisms of addiction, a better individualisation of therapeutics, the necessity of a extended follow-up, the contribution of modern technologies, the electronic cigarette, the smoking cessation in respiratory rehabilitation, guidelines that address smoking cessation treatment.

Forced oscillation technique for early detection of the effects of smoking and COPD: contribution of fractional-order modeling

Purpose

The aim of the present study was to evaluate the performance of the forced oscillation technique (FOT) for the early diagnosis of the effects of smoking and COPD. The contributions of the integer-order (InOr) and fractional-order (FrOr) models were also evaluated.

Patients and methods

In total, 120 subjects were analyzed: 40 controls, 40 smokers (20.3±9.3 pack-years) and 40 patients with mild COPD.

Results

Initially, it was observed that traditional FOT parameters and the InOr and FrOr models provided a consistent description of the COPD pathophysiology. Mild COPD introduced significant increases in the FrOr inertance, damping factor and hysteresivity (P<0.0001). These parameters were significantly correlated with the spirometric parameters of central and small airway obstruction (P<0.0001). The diagnostic accuracy analyses indicated that FOT parameters and InOr modeling may adequately identify these changes (area under the receiver operating characteristic curve – AUC >0.8). The use of FrOr modeling significantly improved this process (P<0.05), allowing the early diagnosis of smokers and patients with mild COPD with high accuracy (AUC >0.9).

Conclusion

FrOr modeling improves our knowledge of modifications that occur in the early stages of COPD. Additionally, the findings of the present study provide evidence that these models may play an important role in the early diagnosis of COPD, which is crucial for improving the clinical management of the disease.