More to Explore: Further Definition of Risk Factors for COPD - Differential Gender Difference, Modest Elevation in PM2.5, and e-Cigarette Use

Length of stay and comorbidity prevalence among individuals with chronic obstructive pulmonary disease in a tertiary care healthcare center in Saudi Arabia; A cross-sectional study

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality, morbidity, and high healthcare costs. While previous studies have addressed the burden of COPD at the national level, there is a lack of current data examining the prevalence of COPD with comorbidities as a predictor for hospital length of stay (LOS). This study aimed to investigate the average LOS and its predictors among patients with COPD admitted to a tertiary healthcare center. A cross-sectional study was conducted in a tertiary care healthcare center in Saudi Arabia between 2017 and 2022. Adult patients with a primary COPD diagnosis admitted at least once to the medical department during the study period were identified. Data on the demographics and co-existing comorbidities were extracted from the electronic medical records of each patient. The main outcome was the LOS among admitted patients. Linear regression analysis was conducted to examine COPD predictors among the demographic and clinical variables. This study involved 629 patients diagnosed with COPD, primarily females, with a mean age of 74 years. The median length of hospital stay was 5 days, and hypertension was the most common comorbidity among the participants (78.8%). The hospital LOS of male patients was expected to be 1.30 days longer than that of female patients (95% confidence interval, 0.15-2.77), and the hospital LOS of patients with cancer was expected to be 3 days longer than that of patients without cancer (B coefficient, 2.73; 95% confidence interval, 0.78-5.37). Male sex and cancer were strong predictors of prolonged hospitalization among patients with COPD. These findings highlight the need for healthcare providers to observe the presence of these comorbidities when managing COPD in patients to reduce their hospital stay.

Chronic airway inflammatory diseases and e-cigarette use: a review of health risks and mechanisms

Chronic airway inflammatory diseases, which primarily include chronic obstructive pulmonary disease (COPD), asthma, allergic rhinitis, and chronic sinusitis, continue to have a high global prevalence, highlighting their significant public health impact. Concurrently, the use of e-cigarettes (tobacco e-cigarettes) has been rising worldwide, with many users perceiving them as a safer alternative to traditional cigarettes. However, accumulating evidence from international studies suggests that e-cigarettes pose substantial health risks. This review aims to explore recent research on the relationship between e-cigarette use and chronic airway inflammatory diseases. The findings indicate that e-cigarette usage increases the risk of developing these conditions. Specifically, studies have shown that e-cigarettes exacerbate airway inflammatory responses, elevate levels of type 2 inflammatory cytokines such as IL-4, IL-5, and IL-13, increase cellular oxidative stress, and impair lung function. These mechanisms may collectively contribute to an increased risk of chronic airway inflammatory diseases potentially associated with e-cigarette use.

Beyond self-reports: serum cotinine reveals sex-and age-related differences of smoking on all-cause and disease-specific mortality

Background

It is well-known that sex and age play critical roles in smoking-related diseases and mortality. However, quantification of the extent of smoking requires self-reports in these studies, which may yield only partially accurate results. This study investigated sex-and age-related differences in the association between smoking and all-cause, cardiovascular disease, and cancer mortality by measuring serum cotinine levels.

Methods

Participants aged 20-85 years from the US National Health and Nutrition Examination Survey (1999-2018) were included. All-cause and disease-specific mortality data were obtained from publicly available user-linked mortality files. Multivariate Cox regression was performed to identify serum cotinine as an independent risk factor of mortality. Subgroup and interaction analyses were performed to investigate these sex and age differences. Smooth curve fitting was conducted to discover potential nonlinear relationships and threshold saturation effects.

Results

Sex was significantly associated with all-cause and cancer mortality. Threshold saturation effects were observed in all-cause mortality among both males and females, cancer mortality among females, and cardiovascular disease mortality among males. Age markedly associated with all-cause and cardiovascular disease mortality. Threshold saturation effects were found in cardiovascular disease mortality among younger adults and cancer mortality among the all-age population.

Conclusion

These findings suggest that there are threshold saturation effects between smoking and mortality, and sex and age differences in smoking-related mortality are inconsistent in different diseases.

Real-World Evaluation of an EHR-Enabled Chronic Obstructive Pulmonary Disease Assessment Test

Purpose

The Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) measures COPD's impact on well-being and daily activities and is a recommended assessment by the Global Initiative for Obstructive Lung Disease (GOLD). Our research objective was to describe a real-world CAT implementation, including the association of CAT scores with subsequent treatment and clinical outcomes.

Patients and Methods

A retrospective, observational, comparative cohort study was conducted among adults with COPD who received care from M Health Fairview, a US healthcare delivery system. Eligible patients had an initial electronic health record (EHR) enabled CAT administration (index) between 8/2017 and 12/2021. Patients were grouped by score (<10 [low impact]; 11-20 [moderate]; and 21-40 [high]). Demographics, comorbidities, provider specialty, and exacerbation history were derived from EHR data in the 12 months preceding index.

Results

Of 11,194 eligible individuals, 821 (7.3%) were administered CAT (cases). Compared to individuals with no documented CAT scores (comparators), cases were older (66.7 vs 63.9 years; p < 0.05) and had higher rates of comorbidities (93.9% vs 79.2%, p < 0.05) and exacerbations (0.31 vs 0.14 PPPY). A total of 61.5% of pulmonologists and 11.5% of primary care providers (PCPs) administered the CAT at least once. Repeated use was more common among pulmonologists (55.7%) than PCPs (7.0%). Medication intensification was most common (28.1%) among individuals with high CAT scores, followed by moderate (21.6%), and low (10.0%). Post-index exacerbations were experienced by 24.2%, 17.4%, and 7.7% of patients with high, moderate, and low CAT scores.

Conclusion

In a real-world practice setting, few patients with COPD received a CAT, although pulmonologists demonstrated repeated use. Higher CAT scores were associated with COPD medication regimen intensification and exacerbations. Further investigation on how to incorporate the CAT into routine care and optimize its impact on medical decision making and evaluation is warranted.

In-silico discovery of common molecular signatures for which SARS-CoV-2 infections and lung diseases stimulate each other, and drug repurposing

COVID-19 caused by SARS-CoV-2 is a global health issue. It is yet a severe risk factor to the patients, who are also suffering from one or more chronic diseases including different lung diseases. In this study, we explored common molecular signatures for which SARS-CoV-2 infections and different lung diseases stimulate each other, and associated candidate drug molecules. We identified both SARS-CoV-2 infections and different lung diseases (Asthma, Tuberculosis, Cystic Fibrosis, Pneumonia, Emphysema, Bronchitis, IPF, ILD, and COPD) causing top-ranked 11 shared genes (STAT1, TLR4, CXCL10, CCL2, JUN, DDX58, IRF7, ICAM1, MX2, IRF9 and ISG15) as the hub of the shared differentially expressed genes (hub-sDEGs). The gene ontology (GO) and pathway enrichment analyses of hub-sDEGs revealed some crucial common pathogenetic processes of SARS-CoV-2 infections and different lung diseases. The regulatory network analysis of hub-sDEGs detected top-ranked 6 TFs proteins and 6 micro RNAs as the key transcriptional and post-transcriptional regulatory factors of hub-sDEGs, respectively. Then we proposed hub-sDEGs guided top-ranked three repurposable drug molecules (Entrectinib, Imatinib, and Nilotinib), for the treatment against COVID-19 with different lung diseases. This recommendation is based on the results obtained from molecular docking analysis using the AutoDock Vina and GLIDE module of Schrödinger. The selected drug molecules were optimized through density functional theory (DFT) and observing their good chemical stability. Finally, we explored the binding stability of the highest-ranked receptor protein RELA with top-ordered three drugs (Entrectinib, Imatinib, and Nilotinib) through 100 ns molecular dynamic (MD) simulations with YASARA and Desmond module of Schrödinger and observed their consistent performance. Therefore, the findings of this study might be useful resources for the diagnosis and therapies of COVID-19 patients who are also suffering from one or more lung diseases.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Relationship between dietary live microbe intake and the prevalence of COPD in adults: a cross-sectional study of NHANES 2013-2018

OBJECTIVE

To explore the potential association between dietary live microbes and the prevalence of Chronic Obstructive Pulmonary Diseases (COPD).

METHODS

In this cross-sectional study, data of 9791 participants aged 20 years or older in this study were collected from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2018. Participants in this study were classified into three groups according to the Sanders' dietary live microbe classification system: low, medium, and high dietary live microbe groups. COPD was defined by a combination of self-reported physician diagnoses and standardized medical status questionnaires. Logistic regression and subgroup analysis were used to assess whether dietary live microbes were associated with the risk of COPD.

RESULTS

Through full adjustment for confounders, participants in the high dietary live microbe group had a low prevalence of COPD in contrast to those in low dietary live microbe group (OR: 0.614, 95% CI: 0.474-0.795, and p < 0.001), but no significant association with COPD was detected in the medium and the low dietary live microbe groups. This inverse relationship between dietary live microbe intake and COPD prevalence was more inclined to occur in smokers, females, participants aged from 40 to 59 years old and non-obese participants.

CONCLUSION

A high dietary live microbe intake was associated with a low prevalence of COPD, and this negative correlation was detected especially in smokers, females, participants aged from 40 to 59 years old and non-obese participants.

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

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

Quercetin Improves Pulmonary Function and Prevents Emphysema Caused by Exposure to Cigarette Smoke in Male Mice

Chronic obstructive pulmonary disease (COPD) is the major cause of morbidity and mortality worldwide, and cigarette smoke is a key factor in the development of COPD. Thus, the development of effective therapies to prevent the advancement of COPD has become increasingly essential. We hypothesized that quercetin protects lungs in mice exposed to long-term cigarette smoke. Thirty-five C57BL/6 mice were exposed to cigarette smoke (12 cigarettes per day) for 60 days and pretreated with 10 mg/kg/day of quercetin via orogastric gavage. After the experimental protocol, the animals were euthanized and samples were collected for histopathological, antioxidant defense, oxidative stress and inflammatory analysis. The animals exposed to cigarette smoke showed an increase in respiratory rate and hematological parameters, cell influx into the airways, oxidative damage and inflammatory mediators, besides presenting with alterations in the pulmonary histoarchitecture. The animals receiving 10 mg/kg/day of quercetin that were exposed to cigarette smoke presented a reduction in cellular influx, less oxidative damage, reduction in cytokine levels, improvement in the histological pattern and improvement in pulmonary emphysema compared to the group that was only exposed to cigarette smoke. These results suggest that quercetin may be an agent in preventing pulmonary emphysema induced by cigarette smoke.