Central and Obstructive Sleep Apnea (CSA and OSA), Chronic Obstructive Pulmonary Disease (COPD), and Obesity Hypoventilation Syndrome (OHS) disrupt breathing patterns, posing significant health risks and reducing the quality of life. Bilevel Positive Airway Pressure (BiPAP) therapy offers adjustable inhalation and exhalation pressures, potentially enhancing treatment adaptability for the above diseases. This is the first-ever study that employs Computational Fluid Dynamics (CFD) to examine the biomechanical impacts of BiPAP under four settings: Inspiratory Positive Airway Pressure (IPAP)/Expiratory Positive Airway Pressure (EPAP) of 12/8, 16/6, and 18/8 cmH2O, compared to a without-BiPAP scenario of zero-gauge pressure. Utilizing a computed-tomography-based respiratory tract model from the nasal cavity extending to the 13th generation, we analyzed parameters such as static pressure, shear stress, and airway wall normal force across different airway regions. Our results indicate that BiPAP, particularly at higher IPAP settings, effectively increases static pressure, thereby improving airway patency and potentially reducing the risk of airway collapse in both CSA and OSA. Lower EPAP, on the other hand, helps reduce the work of breathing during exhalation, which is particularly useful for patients who have difficulty exhaling against higher pressures or need to exhale CO2 more effectively. This comparative analysis confirms that BiPAP not only maintains open airways but does so with an adjustable approach that can be used for the specific needs of patients with various respiratory dysfunctions, thereby offering a versatile and effective treatment option.

The integration of enhanced recovery after surgery (ERAS) protocols into the peri-operative management of video-assisted thoracic surgery (VATS) has facilitated rapid patient recovery, enabling discharge within 48 h. However, postoperative pulmonary complications (PPCs) postdischarge pose significant concerns for patient welfare. Despite the established utility of lung ultrasound (LUS) in diagnosing the causes of dyspnoea, the effectiveness of quantitative LUS in predicting PPCs after VATS remains uncertain.

To determine whether quantitative LUS performed 24 h after surgery can identify patients with a higher risk of developing PPCs within 30 days after discharge from hospital.

Single-centre prospective cohort study.

Academic tertiary care medical centre.

Adults scheduled for elective VATS under general anaesthesia from November 2022 to January 2023.

This primary aim was to verify the association between lung ultrasound score (LUSS) on postoperative day 1 (POD1) and PPCs. The secondary aim was to identify other relevant peri-operative factors closely related to PPCs and establish a model capable of predicting the risk of PPCs in patients undergoing fast-track VATS.

Of the 200 recruited patients, 182 completed the LUS examination and 30-day follow-up. Of these, 66 (36.2%) developed various types of PPCs. These patients had a higher LUSS on POD 1 ( P  < 0.001), and more subpleural consolidation areas compared to those without PPCs ( P  < 0.001). Receiver-operating characteristics (ROC) analysis identified the optimal LUSS cut-off value at 6 points for predicting the occurrence of PPCs, with an area under the curve (AUC) of 0.838 (95% CI, 0.768 to 0.909). Patients with PPCs had higher rates of immune system diseases and ARISCAT score, longer hospital stay and procalcitonin levels, increased frequency of lobar resection, longer durations of surgical and mechanical ventilation, and greater incidence of unplanned hospital readmissions within 30 days postdischarge, compared with those without PPCs (all P  < 0.001). Multivariable logistic regression analysis indicated that the comorbidity of immune system disease, along with postoperative 24 h LUSS, were independent risk factor for PPCs within 30 days after VATS.

LUSS on POD 1 emerged as an independent risk factor for PPCs in fast-track VATS patients and reliably predicted the occurrence of PPCs within 30 days of hospital discharge.

ClinicalTrials. gov No. ChiCTR2200065865.

Airway remodeling is a critical pathological process that influences the progression of chronic obstructive pulmonary disease(COPD). To better study small airway remodeling in COPD, we employed advanced techniques such as decellularized scaffolds, immunofluorescence, scanning electron microscopy, and proteomics to analyze morphological and compositional changes in the extracellular matrix (ECM). Our study revealed significant ultrastructural abnormalities in the decellularized scaffolds from the COPD group, including thinning of alveolar septa, enlargement of alveolar spaces, and fusion of multiple alveoli. Additionally, the ECM composition in the COPD group exhibited notable changes characterized by an increase in collagen fibers, type I and IV collagens, fibronectin, and laminin (p < .05), along with a decrease in elastin and glycosaminoglycans (p < .05). Proteomic analysis identified 70 differentially expressed proteins between the COPD group and the control group. These included 34 upregulated proteins such as Smarca2, Skt, Acvrl1, Myl2 (all with ratios >10.64), and 36 downregulated proteins such as Col6a6, Col6a5, and AnK3 (all with ratios <0.27). Pathway analysis indicated that activation of apoptosis (Enrichment Score, ES = 0.23) and epithelial-mesenchymal transition (ES = 0.38) genes and inhibition of collagen synthesis (ES = -0.43) and degradation (ES = -0.63) genes were observed in the COPD group. These findings enhance our understanding of the mechanisms underlying airway remodeling and provide a scientific basis for developing novel therapeutic strategies for COPD.

Hypoxemia is a common symptom among patients with chronic obstructive pulmonary disease (COPD). The constant flow oxygen system (CFOS) is often insufficient to correct this symptom. The automatically titrating oxygen system (ATOS), a new oxygen therapy mode, remains undetermined in its ability to improve exercise performance more effectively than CFOS in COPD patients. The main objective of this meta-analysis was to explore this issue.

We conducted a thorough search of randomized controlled trials (RCTs) in PubMed, Embase, Web of Science (from inception to 1 November 2024). Study selection, data extraction, and risk of bias assessment were performed independently by two authors. Data synthesis was conducted using Stata software (Version 17.0). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was utilized to rate evidence quality.

Five eligible studies (n = 120) were included. Compared to CFOS, ATOS was more effective in extending the distance (MD = 180.28 m, 95%CI:133.03 to 227.52) and duration (MD = 237.63 s, 95%CI: 181.18 to 294.07) of endurance shuttle walking test (ESWT). Besides, ATOS could better prolong the percentage time of sustaining targeted SpO2 (92%-96%) (MD = 29.43%,95%CI:21.15 to 37.71) and relieve dyspnea at isotime (MD = -1.65, 95%CI -3.19 to -0.11) during ESWT.

ATOS may have more advantages in improving exercise tolerance, sustaining targeted SpO2, and ameliorating dyspnea during exercise in COPD patients.

The review was registered with PROSPERO (The website is https://www.crd.york.ac.uk/prosp ero/, and the ID is CRD 42024574955) and we didn't make a protocol.

Chronic obstructive pulmonary disease (COPD) is a global health challenge with the high morbidity and mortality. Cordyceps militaris (CM) is a medicinal fungus that has been widely used in Asia for centuries. It has the effects of tonifying the lung and kidney, replenishing essence, resolving phlegm, and stopping bleeding. CM has been used clinically for alleviating COPD in China. However, the potential mechanism of CM in treating COPD remains indistinct.

This article aimed to evaluate the efficacy and investigate the underlying mechanism of CM in treatment of COPD.

The ingredients in CM were identified by LC Q/TOF-MS. The effect of CM in COPD was evaluated. Untargeted metabolomics assay and 16S rDNA sequencing were employed to examine the changes in metabolites and gut microbiota in COPD mice. Gut microbiota ablation experiment and quantification of short chain fatty acids (SCFAs) were integrated to elucidate the systematic mechanism of CM in treatment of COPD.

A total of 22 ingredients were identified in CM. CM alleviated COPD significantly by improving lung function and inhibiting pulmonary inflammation. Subsequently, 11 differential metabolites regulated by CM were mainly associated with amino acid metabolism. CM ameliorated the dysbiosis of intestinal microbiota in COPD mice, which contributed to the treatment of COPD. Moreover, CM increased the contents of SCFAs, including acetate, propionate, butyrate and isobutyrate. Spearman correlation indicated a close relationship among pulmonary function, differential metabolites, and gut microbiota.

This study revealed that CM alleviated COPD by regulating amino acid metabolism, ameliorating the imbalance of gut microbiota and increasing the SCFAs. These findings not only establish a foundation for the research of CM but also provide a basis for new treatment strategies of COPD.

We aimed to identify the preoperative risk factors for hypoxemia during one-lung ventilation (OLV) in patients who underwent thoracoscopic radical resection for lung cancer and to establish a prediction model.

This retrospective study included 268 patients who underwent video-assisted thoracoscopic surgery (VATS) radical resection for lung cancer at Yunnan Cancer Hospital from October 2021 to June 2022. Logistic regression analysis was performed to identify independent preoperative risk factors for hypoxemia during OLV. A prediction model was established, and its predictive efficacy was evaluated with the consistency index (C-index) and the area under the receiver operating characteristic curve (AUC).

The multivariate analysis demonstrated that the ratio of dependent lung FLV to total lung FLV (odds ratio [OR] 0.8434; 95% confidence interval [CI] 0.7281-0.9623), dependent lung HU value (OR 0.9676; 95% CI 0.9419-0.9895), dependent lung LAV% (OR 1.1838; 95% CI 1.0856-1.3138), and DLCO% pred (OR 0.9632; 95% CI 0.9353-0.9864) were independent preoperative risk factors affecting OLV hypoxemia. The prediction model that was constructed by this indicator was internally validated, with a C-index of 0.963, an AUC of 0.96 (95% CI 0.94-0.99) for the training set, and an AUC of 0.92 (95% CI 0.83-1) for the test set.

CT-based quantitative indicators of the dependent lung are strong predictors of hypoxemia during OLV for lung cancer patients. This prediction model helps anesthesiologists to intuitively and accurately identify patients who may experience hypoxemia during OLV before surgery and develop individualized management strategies.

Vowel-based voice analysis is gaining attention as a potential non-invasive tool for COPD classification, offering insights into phonatory function. The growing need for voice data has necessitated the adoption of various techniques, including segmentation, to augment existing datasets for training comprehensive Machine Learning (ML) modelsThis study aims to investigate the possible effects of segmentation of the utterance of vowel "a" on the performance of ML classifiers CatBoost (CB), Random Forest (RF), and Support Vector Machine (SVM). This research involves training individual ML models using three distinct dataset constructions: full-sequence, segment-wise, and group-wise, derived from the utterance of the vowel "a" which consists of 1058 recordings belonging to 48 participants. This approach comprehensively analyzes how each data categorization impacts the model's performance and results. A nested cross-validation (nCV) approach was implemented with grid search for hyperparameter optimization. This rigorous methodology was employed to minimize overfitting risks and maximize model performance. Compared to the full-sequence dataset, the findings indicate that the second segment yielded higher results within the four-segment category. Specifically, the CB model achieved superior accuracy, attaining 97.8% and 84.6% on the validation and test sets, respectively. The same category for the CB model also demonstrated the best balance regarding true positive rate (TPR) and true negative rate (TNR), making it the most clinically effective choice. These findings suggest that time-sensitive properties in vowel production are important for COPD classification and that segmentation can aid in capturing these properties. Despite these promising results, the dataset size and demographic homogeneity limit generalizability, highlighting areas for future research.Trial registration The study is registered on clinicaltrials.gov with ID: NCT06160674.

This study aims to provide a reference for clinical treatment selection by comparing noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC) oxygen therapy in patients with chronic obstructive pulmonary disease (COPD) complicated by community-acquired pneumonia (CAP). From January 2022 to December 2023, 63 patients with COPD and CAP treated at our hospital were enrolled. Patients were allocated to either the NIV group (33 patients) or the HFNC group (30 patients), in addition to receiving conventional treatments. The groups were compared across various parameters including respiratory rate (RR), peripheral oxygen saturation (SpO2), arterial oxygen partial pressure (PaO2), oxygenation index (PaO2/fraction of inspiration O2 [FiO2]), rates of complications, tracheal intubation, mortality, total hospital stay, and hospital costs at 1, 3, and 7 days post-treatment. After 1, 3, and 7 days of treatment, both groups exhibited significant improvements in RR, SpO2, PaO2, and PaO2/FiO2 from baseline (P < .05). The improvements increased over time. However, no significant differences were observed between the NIV and HFNC groups in RR, SpO2, PaO2, and PaO2/FiO2 at the measured time points (P > .05); the HFNC group experienced lower rates of complications such as facial injuries, dry nose and mouth, and bloating (P < .05). No significant differences were found in tracheal intubation rates, mortality rates, total hospital stay, and total hospital costs between the groups (P > .05). Both NIV and HFNC effectively improve respiratory and circulatory parameters in patients with COPD and CAP, with similar efficacy rates. While there were no significant differences in tracheal intubation rates, mortality rates, total hospital duration, and costs, HFNC was associated with fewer complications and greater patient comfort, rendering it a more favorable clinical option.

Sarcoidosis is a systemic granulomatous disease that may differ in clinical presentation, organ involvement and severity among different populations. The primary objective was to evaluate demographic characteristics, disease stage, diagnostic work-up and treatment of patients with sarcoidosis. The sarcoidosis registry was founded in 2022 at the Medical University of Vienna and is intended to record patients from all over Austria who were diagnosed with sarcoidosis. All relevant information was collected at the time of the initial presentation and then on an ongoing basis every 6 months thereafter. Data was available for 199 sarcoidosis patients who were treated at the Medical University of Vienna between 2022 and 2023. The mean age of all patients was 52 ± 13 years. At 57.5%, women were significantly more represented than men were. Of these patients, 44.5% were smokers, and significantly more of them were men (63.8%). Chest X-ray revealed sarcoidosis in lung stages 1, 2, 3 and 4 in 34. 5%, 46%, 9.5% and 6% respectively. Overall, 37.5% (male: 33 (38.8%)) of all patients received oral corticosteroid therapy (OCS) during their illness, the mean duration of treatment with OCS (years, median, IQR) was 5 (3; 7.5). Most patients who received OCS for their disease were in pulmonary stage 4 with 81.8%. Patients were on average overweight with a mean BMI of 28.3 kg/m2 (± 6.5). This study is the first characterization of sarcoidosis patients in Austria.

Chronic obstructive pulmonary disease (COPD), a chronic respiratory condition with airflow limitation, is the fourth leading global cause of death. Biomarkers are key for classifying COPD, detecting exacerbations, guiding treatment, and prognosis. This article uses bibliometrics and visualization to analyze COPD biomarker research trends, providing insights for future studies.

This study adopts a range of literature analysis tools, including HistCite, VOSviewer, and CiteSpace, to systematically analyze literature on COPD biomarkers within the Web of Science Core Collection database from 2005 to 2024.

A total of 1835 papers or reviews related to COPD biomarkers are included in this study. Since 2003, the number of publications in this field has been on an upward trajectory. The United States being most influential in this field (n = 415, TLCS = 2319). Prominent institutions such as the University of British Columbia consistently deliver high-quality research results. Tal-Singer R, Sin DD, and Vestbo J have made significant contributions to COPD biomarker research. The journal American Journal of Respiratory and Critical Care Medicine is the most authoritative choice for researchers in the field.This research has long focused on biomarkers associated with the inflammatory response (C-reactive protein, eosinophils, etc.), pulmonary function, induced sputum, and computed tomography. Looking ahead, biomarkers such as microRNA, exosomes, DNA methylation, and microbiomics are likely to become popular topics, particularly regarding their roles in the prognosis and mechanisms of COPD.

Bibliometric analysis suggests that future research on COPD biomarkers will focus on advanced fields, such as microRNA, exosomes, DNA methylation, and microbiomics.

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic respiratory illness. Pentraxin-3 (PTX3) is abnormally elevated in the plasma of patients with acute exacerbation of COPD. However, the role and significance of PTX3 in the clinical diagnosis of COPD remain unclear.

This study was to explore the functional role of plasma PTX3 in COPD and its relationship with lung function metrics and influence on the severity of the disease.

We prospectively recruited 170 patients with stable-stage COPD admitted to our hospital between June 2020 and May 2023 and healthy study participants as study participants. Based on their smoking history, all participants were classified into those with a history of smoking and those without a smoking history.

Stable-stage smoking-related COPD patients exhibited lower values for FEV1(% predicted) and reduced FEV1/FVC ratios, with increased values for smoking index, red cell distribution width, fibrinogen, d-dimer, white blood cell counts, neutrophil to lymphocyte ratio (NLR), Medical Research Council (mMRC) scores, COPD assessment test (CAT) score, and plasma PTX3 level. There was a positive correlation of PTX3 levels with mMRC and CAT scores and a negative correlation with FEV1 % predicted and FEV1/FVC. Increased smoking index and plasma PTX3 and NLR were independent risk factors for exacerbation in stable smoking-related COPD patients. The area under the curve (AUC) for plasma PTX3 in predicting severe COPD was 0.831.

A plasma PTX3 level > 246.2 ng/mL could be a valuable indicator for predicting exacerbations in patients with stable-stage smoking-associated COPD exacerbation.

Recent treatment guidelines for COPD have replaced the long-acting beta2-agonist (LABA) and inhaled corticosteroid (ICS) combination with single-inhaler triple therapy that adds a long-acting muscarinic antagonist (LAMA). However, the corresponding trials reported numerically higher incidences of cardiovascular adverse events with triple therapy compared with LABA-ICS.

Does single-inhaler triple therapy increase the incidence of major adverse cardiovascular events, compared with LABA-ICS, in a real-world clinical practice setting?

We identified a cohort of patients with COPD aged ≥ 40 years treated during 2017-2021 from the UK's Clinical Practice Research Datalink. Among LAMA-naive patients, initiators of single-inhaler triple therapy were matched 1:1 to LABA-ICS users on time-conditional propensity scores. They were compared on the incidence of major adverse cardiovascular events (MACEs), defined as hospitalization for myocardial infarction or stroke, or all-cause-mortality, over 1 year.

The cohort included 10,255 initiators of triple therapy and 10,255 matched users of LABA-ICS. The incidence rate of MACEs was 11.3 per 100 per year with triple therapy compared with 8.8 per 100 per year for LABA-ICS. The corresponding adjusted hazard ratio (HR) of MACEs with triple therapy was 1.28 (95% CI, 1.05-1.55), relative to LABA-ICS; however, the increase was mainly in the first 4 months (HR, 1.41; 95% CI, 1.14-1.74). The HR of all-cause death was 1.31 (95% CI, 1.06-1.62), whereas for acute myocardial infarction and stroke hospitalization it was 1.00 (95% CI, 0.56-1.79) and 1.06 (95% CI, 0.48-2.36), respectively, with triple therapy, relative to LABA-ICS.

In a real-world setting of COPD treatment, patients who initiated single-inhaler triple therapy had an increased incidence of MACEs compared with similar patients treated with an LABA-ICS inhaler. This small increase was due to the all-cause mortality component, occurring mainly in the first 4 months after treatment initiation.

Background: Identifying persons with COPD at high risk for hospital readmission provides opportunities for efficient and appropriate care to lower readmission risk. This study examined 30-d and 60-d hospital readmission prediction of the COPD-readmission (CORE) score and a newly developed CORE+ score. The relationship between CORE and CORE+ scores and ICU admission, endotracheal intubation, and in-hospital noninvasive ventilation (NIV) use was explored. Methods: A retrospective cohort study evaluated participants with spirometry-confirmed COPD from 2 Midwestern academic hospitals. The CORE score variables included eosinophil blood count, FEV1/FVC (<0.70) and FEV1 (≤40% of predicted), triple inhaler therapy, previous hospitalization, and presence of neuromuscular disease. Out-of-hospital NIV use and Charlson comorbidity index were added to compose the CORE+ score. Researchers assessed associations between variables and outcomes with chi-square test or Fisher exact test, compared results of CORE and CORE+ scores with Wilcoxon signed-rank test, assessed each score's 30-d and 60-d readmission predictive power with multiple logistic regression, and evaluated predictive accuracy with AUC of receiver operating characteristic using alpha < 0.05. Results: Of 391 participants, the study found a 22% 30-d, all-cause readmission rate and a 16% 60-d, all-cause readmission rate. CORE+ score had better predictive accuracy than the CORE score for 30-d readmission (area under the curve 0.81 [95% CI 0.76-0.86]; AUC 0.73 [95% CI 0.66-0.79], P < .001) and 60-d readmission (AUC 0.77 [95% CI 0.71-0.83]; AUC 0.75 [95% CI 0.69-0.81], P < .001). Participants who used in-hospital NIV had higher median CORE+ scores (P = < .001). Conclusions: CORE and CORE+ scores demonstrated good to very good predictive accuracy for 30-d and 60-d readmission, respectively. Moreover, this study demonstrated a linear relationship between in-hospital NIV use and CORE+ score.

Emergency room (ER) physicians must deal with patients with clinically suspected symptoms, such as dyspnea, cough, and increased sputum production, on the frontlines of medical care if patients present with severe chronic obstructive pulmonary disease (COPD). This study aims to investigate the longitudinal tendencies of COPD-related ER visits.

A total of 360,313 patients were included in this study. The COPD-related ER visit rates between 2001 and 2015 were categorized using the International Classification of Disease (ICD) codes (496). The effects of age, period, and cohort on COPD-related ER visit rates were determined using an age-period-cohort (APC) model.

Age was associated with a high risk of COPD in the pediatric and older populations. A significant increase was observed in the period effect, from 2001 to 2015. The cohort effect tended to oscillate from 1918 to 1973, and was reversed in the latest cohort. Furthermore, the COPD-related ER visit rate increased between 2001 and 2015 in both men and women.

Age, period, and cohort were observed to increase COPD visit rates. The APC model can be used to determine trends in COPD-related ER visits.

Fatigue is a common symptom in patients with chronic obstructive pulmonary disease (COPD). Published studies of fatigue among patients with COPD have presented diverse findings that may reflect variations in research methods as well as actual population differences.

To estimate the worldwide prevalence of fatigue in patients with COPD and its associated epidemiological characteristics.

The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and China Biology Medicine disc (CBM) databases were searched for articles from their inception date through August 2024. The pooled prevalence of fatigue in patients with COPD and 95 % confidence interval (CI) were calculated using a random-effects model with Stata 15.0 software. Agency for Healthcare and Research and Quality (AHRQ) indicators and the Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the included studies.

The 25 included studies involved 6830 patients. The meta-analysis results showed a 59 % (95 % CI: 52%-66 %) pooled prevalence of fatigue in patients with COPD. Subgroup analysis indicated that the prevalence varied significantly by region, setting, assessment tool, and publication year.

Fatigue is a common symptom among patients with COPD worldwide. To reduce the negative effects of fatigue in these patients, clinicians should actively explore the mechanisms of fatigue occurrence and its risk factors to provide a basis for further research.

The use of laboratory animals is essential to understand the mechanisms underlying COPD and to discover and evaluate new drugs. However, the complex changes associated with the disease in humans are difficult to fully replicate in animal models.

This review examines the most recent literature on animal models of COPD and their implications for drug discovery and development.

Recent advances in animal models include the introduction of transgenic mice with an increased propensity to develop COPD-associated features, such as emphysema, and animals exposed to relevant environmental agents other than cigarette smoke, in particular biomass smoke and other air pollutants. Other animal species, including zebrafish, pigs, ferrets and non-human primates, are also increasingly being used to gain insights into human COPD. Furthermore, three-dimensional organoids and humanized mouse models are emerging as technologies for evaluating novel therapeutics in more human-like models. However, despite these advances, no model has yet fully captured the heterogeneity and progression of COPD as observed in humans. Therefore, further research is needed to develop improved models incorporating humanized elements in experimental animals, that may better predict therapeutic responses in clinic settings and accelerate the development of new treatments for this debilitating disease.

Exacerbations of chronic obstructive pulmonary disease (COPD-E) have been associated with levels of air pollution. The occurrence of COPD-E is associated with increased mortality in this population.

To determine the association between long-term exposure to PM2.5 and NO2, and the frequency of COPD-E in patients belonging to AIREPOC, an institutional integrated care program for COPD in Bogota, Colombia.

Retrospective cohort study included patients with COPD living in Bogotá, between 2018 and 2021, who received health care in the AIREPOC program. Each patient´s home address was geolocated. Information from local air quality network stations was used to estimate daily and annual mean PM2.5 and NO2 exposure level for each patient using the inverse distance squared weighted regression (IDWR) method. The effect of PM2.5 and NO2 concentrations categorized at 15 µg/m3 and 25 µg/m3 respectively on the frequency of COPD-E was estimated using a zero-truncated negative binomial model adjusted for potential confounders. Goodness-of-fit was assessed by residuals.

During the observation period, 580 COPD-E occurred in 722 patients. Significant associations were found between COPD-E and NO2 concentrations ≥25 µg/m3 (incidence density ratio, RDI: 1.29, 95% CI: 1.02-1.67) after adjustment for sun exposure, COPD severity, depression, and ambient humidity. No association was found between the frequency of COPD-E and PM2.5 concentrations ≥15µg/m3.

Prolonged exposure to high levels of NO2 increases the frequency of COPD exacerbations in patients residing in Bogotá. These results highlight the importance of strengthening air quality control measures and educating people with COPD to know and interpret the local air quality indices and to follow the recommendations derived from its alterations.

COPD is a healthcare problem. However, the underlying mechanism remains unclear. Our study aimed to explore the key genes involved in immune infiltration in COPD using bioinformatic tools.

In this study, scRNA-seq analysis was utilized to explore specific marker genes of each immune cell subtype in COPD. TSNE analysis was used to evaluate the relationship between each immune cell cluster. Lasso regression identified 21 genes as characteristics of COPD modulated by the single-cell NK cell subpopulation. The "limma" package was used for differentially expressed analysis. The pseudotime analysis reveals the continuous changes of NK cells along their developmental trajectory. Further, we constructed a hub gene network to examine the correlation between hub genes and immune factors, transcriptional regulation factors, and potential therapeutic drugs. GO and KEGG enrichment analysis revealed the biological functions of the hub genes. RT-qPCR was used for validation of the five hub in COPD patients.

NK cell subtypes are closely related to other immune cell subtypes and considered as the most important immune cells in the immune microenvironment of COPD patients. LASSO regression identified 21 genes as NK cells-characteristic genes for COPD. The GSE57148 as the training set has a AUC of 0.9489 and GSE8581 as the validation set has a AUC of 0.7303. The GO semantic similarity further confirmed five NK cell-related hub genes, C1orf56, S100A6, IGFBP7, ANXA1, and PTPN7. RT-qPCR experiment revealed that the mRNA expression of five hub genes in the normal group was lower than that in the disease group. We also found that five hub genes correlated with immune cell infiltration. The potential therapeutic agents for COPD may be zalcitabine, PP-2, PD-98059, and TGX-221 based on the CMap database prediction.

We proposed that peripheral NK cells may play a role in the pathogenesis of COPD through bioinformatic analysis. These hub genes may provide insights into mechanistic research and new targets for new therapies in patients with COPD.

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide, primarily due to persistent airflow limitation from tobacco and biomass smoke exposure. While inhaled corticosteroids (ICS) combined with long-acting bronchodilators, namely long-acting β2-adrenoreceptor agonists (LABA) and long-acting muscarinic antagonists (LAMA), are recommended for symptom control and exacerbation reduction, their effect on mortality remains uncertain. Recent randomized controlled trials (RCTs) suggest potential mortality benefits with triple ICS/LABA/LAMA therapy, though findings are not definitive.

We conducted a systematic review and network meta-analysis (NMA) to evaluate the impact of ICS-containing therapies on all-cause mortality in COPD. Searches were performed across ClinicalTrials.gov, Cochrane Library, EMBASE, MEDLINE, and SCOPUS, focusing on RCTs measuring mortality as an efficacy outcome.

A total of 42,784 COPD patients from five high-quality studies were included. Pairwise meta-analysis showed a significant reduction in all-cause mortality with ICS-containing therapies (RR 0.80, 95% CI 0.68-0.95), particularly with ICS/LABA and ICS/LABA/LAMA combinations. The NMA ranked ICS/LABA/LAMA as the most effective treatment (SUCRA 0.89).

This study provides compelling evidence that ICS-containing therapies, particularly triple therapy, significantly reduce all-cause mortality in COPD patients. Future research should identify patient subgroups most likely to benefit while minimizing adverse effects.

PROSPERO registration ID: CRD42024607568.

Astragaloside II (AST II) is one of the principal bioactive components of Astragalus mongholicus Bunge, exhibiting multiple pharmacological properties. However, the therapeutic efficacy of AST II in Chronic Obstructive Pulmonary Disease (COPD) remains to be fully elucidated. The study explored the effects and mechanisms of AST II in a COPD model induced by exposure to cigarette smoke (CS) and lipopolysaccharide (LPS) in mice.

An animal model of COPD was established by intratracheal instillation of LPS and cigarette smoking in mice. Serum samples were collected to determine inflammatory cell infiltration and cytokine levels. Lung tissues were collected for histological, immunofluorescence and Western blot analysis. The RAW264.7 macrophage cell line was employed to investigate the molecular mechanism of AST II in vitro.

Lung dysfunction, histopathological damage, inflammatory infiltration, and pro-inflammatory factors secretion in COPD mice induced by CS and LPS were mitigated by AST II. AST II exerted an anti-inflammatory effect by enhancing the activation of the mammalian target of rapamycin complex 1 (mTORC1)/glycogen synthase kinase-3β (GSK-3β) signaling pathway, which promoted the binding of CREB-binding protein (CBP) to CREB, thereby antagonizing the binding to nuclear factor-κB (NF-κB) and inhibiting its transcriptional activity. However, AST II did not demonstrate a protective effect against LPS-induced inflammatory damage to RAW264.7 cells when mTORC1 was inhibited by rapamycin.

AST II exhibits potential therapeutic benefits as an alternative medication for COPD and other respiratory inflammatory conditions since it may reduce lung injury and inflammatory response in mice exposed to CS and LPS.

To investigate the associations of lung function with glaucoma and related traits, explore the interactions between glaucoma genetic risk and lung function, and assess the causal relationships using Mendelian randomization (MR).

This cross-sectional study involved 85,369 participants with lung function measurements at baseline from the UK Biobank. Associations between lung function parameters and glaucoma and related traits were tested by multivariable logistic and linear regression. Two-sample MR analyses were conducted using summary statistics from large genetic datasets.

Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC ratio were inversely associated with glaucoma, with the lowest quartiles conferring odds ratios (ORs) of 1.51 (95% confidence interval [CI], 1.31-1.74; P = 7.6 × 10-8), 1.58 (95% CI, 1.37-1.81; P = 4.7 × 10-10) and 1.20 (95% CI, 1.08-1.34; P = 0.002), respectively, compared with the highest quartiles (P trends < 0.001 observed for each). Similar associations were found for impaired lung function (FEV1 <80% Global Lung Initiative predicted FEV1: OR, 1.22, 95% CI, 1.11-1.33; P = 1.2 × 10-5; FEV1/FVC <0.7: OR, 1.13, 95% CI, 1.03-1.24; P = 0.01). Lower lung function was associated with lower intraocular pressure (IOP), thinner macular retinal nerve fiber layer thickness, and thinner ganglion cell-inner plexiform layer thickness. No interactions were observed between glaucoma genetic risk and lung function. MR analyses did not suggest causal relationships.

Lower FVC, FEV1, FEV1/FVC, and impaired lung function are potential biomarkers for glaucoma risk. These findings may facilitate clinical strategies for glaucoma management, particularly for individuals with impaired lung function.

The Glittre-ADL test is a comprehensive test to evaluate functional capacity in patients with chronic obstructive pulmonary disease (COPD).

The primary aim was to validate the Glittre-ADL test with and without the backpack performed in three laps as an alternative to five laps in people with COPD.

Forty-eight participants with mild to severe COPD (mean ± SD age: 71 ± 7 years; FEV1: 46 ± 17 %predicted) were recruited and performed two 6-min walk tests (visit 1); two Glittre-ADL tests with backpack (visit 2), and the Glittre-ADL test with and without the backpack, in random order (visit 3).

The Glittre-ADL tests were performed in five laps and symptoms, heart rate and oxygen saturation were recorded for three and five laps. The Glittre-ADL test performed in three laps provoked the same oxygen desaturation [mean ± SD oxygen saturation (SpO2): 90 ± 6 vs 90 ± 6, p = 0.249] and rate of perceived exertion (RPE) [RPE legs: 2.91 ± 2.23 vs 3.08 ± 2.56, p = 0.380; RPE arms: 1.91 ± 1.77 vs 2.16 ± 1.92, p = 0.306] to the Glittre-ADL test performed in five laps for both Glittre with the backpack and without the backpack SpO2 [mean ± SD: 90 ± 6 vs 90 ± 7, p = 0.249], and RPE [legs: 3.02 ± 2.28 vs 3.25 ± 2.37, p = 0.380; arms: 2.13 ± 1.91 vs 2.03 ± 1.84, p = 0.306]. The heart rate and dyspnoea were significantly lower for both Glittre-ADL tests performed in three laps.

The 3-lap Glittre-ADL test may be a more practical alternative to the 5-lap test, while still remaining a good test of functional capacity for activities of daily living.

Early randomized controlled trials (RCTs) of bronchoscopic lung volume reduction (BLVR) have shown clinically meaningful benefits in lung function, dyspnea, and quality of life in patients with severe emphysema. Safety outcome data obtained after BLVR in the United States are scarce outside the RCTs.

What is the rate of inpatient complications after BLVR in the real world in the United States?

We used the National Inpatient Sample database to identify in-hospital complications after BLVR from 2018 through 2020. Complications were defined as pneumothorax, COPD exacerbation, pneumonia, hemoptysis, acute respiratory failure, and valve removal. We also analyzed all-cause in-hospital mortality and length of stay (LOS).

We identified 467 admissions related to BLVR procedures. The number of procedures doubled between 2019 and 2020 (from 153 to 295 procedures). The median age was 67.9 years (interquartile range, 61.1-72.8 years), 210 patients (45.0%) were female, 401 patients (85.8%) were White, and Medicare was the primary expected payer for 72.8% of patients. Most procedures were performed in urban teaching hospitals (56.9%). The rate of pneumothorax was 26.3%, that of acute respiratory failure was 19.5%, that of COPD exacerbation was 8.8%, that of pneumonia was 7.3%, and that of hemoptysis was 5.3%. Chest tube placement was required in 84 of 123 patients (68.3%) with pneumothorax. The endobronchial valve had to be removed in 69 patients (14.8%). The median LOS was 2.8 days (interquartile range, 2.3-4.5 days). The number of in-hospital deaths was fewer than 11 (< 2.3%). Overall, the subgroup who experienced in-hospital complications did not differ significantly from the others in terms of comorbidities, demographics, and hospital characteristics.

We found that the real-world complication rate after BLVR was similar to the published complication rates from early randomized clinical trials. In-hospital mortality was low, suggesting that aside from the commonly anticipated complications, BLVR is a safe treatment option for severe emphysema.

Chronic Obstructive Pulmonary Disease (COPD) is associated with physical limitations and significant social, psychological, and behavioral challenges. This study investigates the relationship between fatigue levels and psychosocial adjustment in COPD patients, considering their sociodemographic characteristics.

A descriptive study was conducted with 160 COPD patients hospitalized in the Pulmonology Department of a university hospital. Data were collected via face-to-face interviews using a patient information form, the COPD and Asthma Fatigue Scale (CAFS), and the Psychosocial Adjustment to Illness Scale-Self-Report (PAIS-SR). Statistical analyses included Independent Sample t-test, One-Way ANOVA, Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation analysis, with significance set at p < 0.05.

The mean age of participants was 68.70 ± 9.41 years; 71.9% were male, and 67.9% had COPD for over six years. Most participants (74.4%) reported limitations in daily living activities due to the disease, and 91.9% reported having social support. Mean scores were 58.03 ± 15.80 on the CAFS and 64.19 ± 6.41 on the PAIS-SR. Significant differences were observed in fatigue and psychosocial adjustment scores based on gender, social support, and disease impact on daily activities (p < 0.05). A weak positive correlation was found between fatigue levels and psychosocial adjustment (p < 0.05).

COPD patients experience moderate-to-high fatigue levels and challenges in psychosocial adjustment, with fatigue negatively influencing adjustment. Interventions should focus on enhancing coping strategies, addressing psychosocial needs, and leveraging social support systems to improve patient outcomes.

To evaluate the efficacy and safety of pulmonary rehabilitation under the supervision of health professionals at the institute versus conventional exercise-based pulmonary rehabilitation at home in Chronic Obstructive Pulmonary Disease (COPD) patients.

Patients of COPD received pulmonary rehabilitation under the supervision of a professional at the institute (PI cohort, n = 115) or self-driven traditional Chinese methods-based pulmonary rehabilitation at home (CE cohort, n = 127) or did not receive any type of pulmonary rehabilitation (ME cohort, n = 155). All patients received inhaled pharmacological treatment for COPD.

Before commencing inhaled pharmacological treatment with or without pulmonary rehabilitation (BT) COPD patients had 5 (5-4) / patient BODE (body-mass index, airflow obstruction, dyspnea, and exercise capacity) index score and 12 (13-12) / patient exacerbations (in 6-months) reported. After 6 months of inhaled pharmacological treatment for COPD with or without pulmonary rehabilitation (AT), a six-minute walking test was improved and the BODE index score and exacerbations during 6 months were decreased for patients of the PI cohort as compared to BT conditions and compared to those of the CE and ME cohorts in AT conditions (p < 0.05 for all). Patients of PI, CE, and ME cohorts had the risk of under treatment for <0.01 BODE index score, <1.32 BODE index score, and <3.14 BODE index score, respectively.

Chinese patients with COPD have worse clinical conditions. After 6 months of inhaled pharmacological treatment for COPD with pulmonary rehabilitations at institutes improves the conditions of COPD patients.

Introduction/Objective: the concept of clinical control of COPD is a measure proposed in the Spanish COPD Guidelines (GesEPOC), which aims to help clinicians assess the clinical status in order to adapt the treatment plan at follow-up. However, studies that have evaluated clinical practice reveal that the degree of control of COPD is not always assessed, which underlines the need to promote its assessment through a scoring system. To develop a scoring system that quantitatively assesses the validated criteria defining the degree of COPD control. Methods: this study used data from the EPOCONSUL audit in respiratory clinics across Spain. We included in this analysis all patients with a COPD clinical control grade estimated and reported by the physician at the visit, who had registered the criteria necessary to define the degree of clinical control validated and established in GesEPOC. Patients were randomly assigned to either the development or validation cohorts. The development cohort included 485 patients and the validation cohort included 341 patients. Score modelling was conducted using a multivariate logistic regression model, and calibration of the model and score was assessed using the Hosmer-Lemeshow goodness-of-fit test and GiViTi Calibration belts. The model and generated score's discrimination capacity were analyzed by calculating the Area Under the Curve (AUC). Results: the scoring system was developed using four criteria as predictors of poor clinical control of COPD reported by the treating physician:adjusted dyspnoea severity, use of rescue inhaler more than three times per week, walking less than 30 min per day, and COPD exacerbations in the last three months. The scoring system attributed scores from 0 to 8. Calibration was satisfactory in both development and validation cohorts, and the score's discrimination power, as indicated by the AUC, was 0.892. Conclusions: this scoring system provides an easy-to-use quantitative assessment of clinical control of COPD that we believe will help to measure COPD control and its evolution during patient follow-up. Future research will be needed to prospectively evaluate this score as a predictor of outcome.

Chronic obstructive pulmonary disease (COPD) affects breathing, speech production, and coughing. We evaluated a machine learning analysis of speech for classifying the disease severity of COPD.

In this single centre study, non-consecutive COPD patients were prospectively recruited for comparing their speech characteristics during and after an acute COPD exacerbation. We extracted a set of spectral, prosodic, and temporal variability features, which were used as input to a support vector machine (SVM). Our baseline for predicting patient state was an SVM model using self-reported BORG and COPD Assessment Test (CAT) scores.

In 50 COPD patients (52% males, 22% GOLD II, 44% GOLD III, 32% GOLD IV, all patients group E), speech analysis was superior in distinguishing during and after exacerbation status compared to BORG and CAT scores alone by achieving 84% accuracy in prediction. CAT scores correlated with reading rhythm, and BORG scales with stability in articulation. Pulmonary function testing (PFT) correlated with speech pause rate and speech rhythm variability.

Speech analysis may be a viable technology for classifying COPD status, opening up new opportunities for remote disease monitoring.

Chronic obstructive pulmonary disease (COPD) exacerbations frequently cause patient consultations in both out- and inpatient settings. Recent data suggest that only 40-60% of exacerbations are of bacterial origin and mandate antibiotic treatment. However, a reliable tool to justify prescribing antibiotics for COPD exacerbation is still lacking. This study was designed to explore the hypothesis that utilization of a novel decision-making tool called Prospector would lead to lower consumption of antibiotics and provide a more rational approach to managing COPD exacerbations versus standard therapy in patients with COPD. The study included 77 COPD patients who experienced a COPD exacerbation and were treated in outpatient settings. The Prospector group (PG) (n = 40) were treated by the study author using the Prospector calculator (a tool designed by the first author that translates: patient symptoms, exacerbation, and medical history of COPD into a decision on the use of antibiotics in COPD exacerbation treatment). Other primary care specialists treated the control group (CG) (n = 37) in the same outpatient clinic; antibiotic therapies were implemented at the physician's discretion, most often using Anthonisen's criteria. All other medications were administered at the physician's discretion. Safety endpoints were set as: death, hospitalization, and number of exacerbations. Antibiotics were administered in 32.8% and 81.2% of exacerbations in the PG and CG, respectively (p < 0.0001). A comparable percentage was verified positively in both PG patient subsets: those that did and did not receive antibiotics at visit 1 (94.7% and 94.9%, respectively). Twenty-eight patients in the PG and 37 in the CG were followed for up to 35 months. Failure to recover (defined as deterioration or lack of improvement) in 30 days following exacerbation was 10.7% in the PG and 47.2% in the CG. In the CG, the failure rate was significantly higher (p = 0.0043). Hospitalization rates in the PG and the CG were 42.9% and 94.4%, respectively. In the CG, the hospitalization rate was significantly higher (p < 0.0001). COPD hospitalization rates in the PG and the CG were 17.9% and 33.3%, respectively (p = 0.1643). This preliminary study suggests that using the Prospector calculator results in markedly reduced antibiotic prescription for COPD exacerbations. No new safety signals have been identified for the method.

Lipid Accumulation Product (LAP), which is derived from measurements of waist circumference and triglyceride (TG) levels, serves as a comprehensive indicator of lipid accumulation. Emerging research indicates that lipid accumulation dysfunction might significantly contribute to the pathogenesis of Chronic Obstructive Pulmonary Disease (COPD). Nevertheless, the investigation into the association between LAP and COPD risk is still insufficient, particularly in population-based research. This research intends to examine the possible correlation between LAP and the likelihood of developing COPD.

This study, designed as a cross-sectional analysis, made use of data gathered from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2017 to 2020, encompassing a total of 7,113 eligible participants. LAP, the exposure variable, was calculated using waist circumference and triglyceride concentration. COPD diagnosis was determined using participants' self-reported information. To explore the association between LAP and COPD, multivariate logistic regression models were applied, and smoothing curve fitting was employed to examine any potential nonlinear patterns. Further analysis included stratified subgroup evaluations to assess how variables such as sex, smoking habits, and alcohol intake might impact the relationship between LAP and COPD.

The findings indicated a significant increase in COPD risk with each one-unit rise in ln LAP, as evidenced by an Odds Ratio (OR) of 1.16 [95% Confidence Interval (CI): 1.04-1.30, p < 0.01]. Furthermore, a quartile-based analysis revealed that individuals in the highest ln LAP category had a considerably higher likelihood of developing COPD compared to those in the lowest category, with an OR of 1.35 (95% CI: 1.04-1.75, P for trend <0.01). Furthermore, the smoothing curve fitting identified a nonlinear and positive association between ln LAP and COPD, suggesting a steeper increase in risk as ln LAP values rise. Subgroup analysis suggested that this association remained fairly consistent across various demographic groups.

This study found a significant link between higher LAP levels and an elevated risk of COPD, with the association displaying a nonlinear pattern. As a marker of lipid accumulation abnormalities, LAP may serve as a valuable tool for assessing COPD risk and could inform strategies for early identification and targeted clinical management.

Bone marrow mesenchymal stem cell (BMSC) therapy is a novel approach for treating COPD. However, the difficulty in engraftment and easy clearance of BMSCs in vivo has hindered their clinical application. Hence, exploring effective methods to improve the engraftment and differentiation rates of BMSCs in vivo is urgent.

We constructed BMSCs overexpressing Wnt3a by lentivirus infection and transplanted them into a COPD rat model. The damage level of COPD rat lung tissue was assessed by pathology analysis and inflammatory cytokines analysis. The engraftment of BMSC was detected by immunofluorescence staining. Statistical analysis was performed using GraphPad Prism 7.

We found that Wnt3a significantly enhanced the engraftment rate of BMSCs in the lungs of rats and further increased their differentiation rate into type II alveolar epithelial cells. We also assessed the expression of inflammatory factors in the lung tissues of COPD rats and discovered that Wnt3a reduced the levels of the inflammatory factors IL-6 and IL-1β while increasing the level of the anti-inflammatory factor IL-10. Our study demonstrates that Wnt3a can improve the engraftment and differentiation rates of BMSCs in the host and further alleviate COPD symptoms by regulating the secretion of inflammatory factors.

Constructing BMSCs overexpressing Wnt3a could serve as a new strategy for stem cell therapy in COPD.

Chronic obstructive pulmonary disease (COPD) is characterized by pulmonary and systemic inflammation. The peripheral blood (neutrophil + monocyte)/lymphocyte ratio (NMLR) can predict the clinical outcomes of several inflammatory diseases. However, its prognostic value in COPD remains unknown.

This retrospective study included 870 patients with COPD due to acute exacerbation, and the 5-year all-cause mortality of these patients was recorded. The Kaplan-Meier method was used to compare the mortality risk of these patients according to their NMLR value. Multivariable COX hazard regression and restricted cubic spline model were used to assess the relationship between the NMLR and 5-year all-cause mortality of patients with COPD.

The NMLR values of non-surviving patients with COPD were significantly increased compared to the survivors [3.88 (2.53-7.17) vs 2.95 (2.08-4.89), P=0.000]. The area under the NMLR receiver operating characteristic curve for predicting the 5-year all-cause mortality of COPD patients was 0.63. Kaplan-Meier survival curves showed that the 5-year all-cause mortality of COPD patients was significantly increased when the admission peripheral blood NMLR was ≥ 5.90 (27.3% vs 12.4%, P=0.000). The COX regression model showed that NMLR was an independent predictor of 5-year all-cause mortality in COPD patients (hazard ratio=1.84, 95% confidence interval: 1.28-2.64, P=0.001). Moreover, the restricted cubic spline model showed a non-linear relationship between NMLR and COPD death risk (Pnon-linear < 0.05).

The admission peripheral blood NMLR is a significant predictor of 5-year all-cause mortality in patients with COPD, and high NMLR values may indicate a poor clinical prognosis.

The current study was designed with the aim of conducting a systematic review and meta-analysis to determine the circulating levels of visfatin in patients with chronic obstructive pulmonary disease (COPD) compared to healthy individuals.

Until March 2024, we searched the Web of Science, PubMed/Medline, and Scopus databases. The analysis included case-control studies assessing the association between circulating visfatin and COPD. The random effects model was utilized to analyse the results with the help of Standard Mean of Differences (SMD) and 95% confidence interval (CI). The heterogeneity of the data was assessed using Cochrane Q and I2 values.

Seven studies were eligible to be included in the meta-analysis, with the COPD and healthy (control) groups having 265 and 244 subjects, respectively. The pooled results showed that although the circulating concentration of visfatin was lower in patients with COPD, no significant difference was observed (SMD: -0.48 mg/L; 95% CI: -1.67 to 0.70; p = 0.43). Subgroup analysis revealed that visfatin levels were significantly reduced in FEV1 less than 50% (p < 0.001) and in GOLD grade I-II (p < 0.05). Visfatin was shown to be significantly associated with IL-6 (p < 0.001) and TNF-α (p < 0.01) in the correlation meta-analysis. Meta-regression analysis revealed a significant correlation between the pooled SMD visfatin and pooled SMD age (p < 0.01), BMI (p < 0.001), FEV1 (p < 0.001), and IL-6 (p < 0.001).

The findings showed an insignificant decline in visfatin level among COPD patients, but additional research is necessary due to the heterogeneity in study results.

PROSPERO (CRD42023450851), https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023450851.

To explore the factors related to the progression of chronic obstructive pulmonary disease (COPD).

80 COPD patients treated between January 2020 and December 2022. The patients' pulmonary functions at their first hospital admission were categorized into four groups: Grade I, Grade II, Grade III and Grade IV. Each group was further divided into a progression group and a non-progression group based on the disease progression over one year or several years of follow-up. Patients with other respiratory diseases, malignant tumors, severe heart, kidney, liver dysfunctions, or immune deficiencies affecting the prognosis were excluded. General information, clinical data, treatment data, and statistical analysis of the patients.

In comparison with the non-progression group, the progression group had significantly higher age, smoking behavior, COPD history, hemoptysis history, CRP levels, IL-6 levels, and Pneumonia Severity Index (PSI) scores, exhibiting significantly lower FEV1, FEV1% predicted, PaO2, and PaCO2. More frequent use of antibiotics, corticosteroids, oxygen therapy, and mechanical ventilation were observed in the progression group than that in the non-progression group (P < 0.05). As a consequence, the progression group had a worse prognosis as indicated by higher hospitalization costs, longer hospital stay, and higher rate of acute exacerbations than the non-progression group (P < 0.05). Multifactorial logistic regression analysis showed that age ≥ 65 years, PSI score ≥ 130 points, and multidrug-resistant bacteria infection were independent risk factors for the progression of COPD (P < 0.05).

Older COPD patients, higher PSI score, and multidrug-resistant bacteria infection have a worse prognosis and need more intensive treatment and follow-up.

Pulmonary function tests offer crucial parameters for evaluating lung health and predicting clinical outcomes. Hyperlipidemia, a prevalent metabolic disorder, has been linked to declining pulmonary function. Statins are an essential therapy for lowering lipid levels in hyperlipidemia.

This study aims to investigate the therapeutic potential of statins in mitigating the decline in pulmonary function.

This is a retrospective cohort study.

Out of 8286 patients who underwent spirometry testing from January 2018 to December 2020, 492 patients were included in the final analysis. The relationship between statin usage, dosage, along with other biometric indices and spirometry parameters were evaluated. Multivariate logistic regression analyses were employed to assess the association between statin use and the decline in pulmonary function.

In patients with persistent hyperlipidemia, the use of statins was associated with a higher predicted percentage of forced expiratory volume in 1 second (FEV1) compared to non-users (84.0% vs 78.0%, p = 0.015). Logistic regression models further revealed that statin use independently prevented FEV1 decline, irrespective of dosage (adjusted OR 0.036, 95% CI: 0.002-0.618 in lower statins dose group and adjusted OR 0.170, 95% CI: 0.019-1.552 in higher statins dose group).

The findings suggested that statin usage, regardless of dosage, independently mitigated the decline in pulmonary function among patients with persistent hyperlipidemia. Early initiation of statin therapy may hold promise for individuals experiencing hyperlipidemia and declining pulmonary function.

With the evolution of chronic Chagas cardiomyopathy (CC) and the progression towards heart failure (HF), patients may show a decline in inspiratory muscle strength, lung function, and functional capacity.

We compared respiratory function and submaximal functional capacity in patients with CC with versus without HF.

This observational, cross-sectional study was carried out with CC patients divided into CCG, a group without HF (n = 28), and HFG, a group with HF (n = 27). Spirometry (percent predicted forced vital capacity (ppFVC), forced expiratory volume in one second of FVC (ppFEV1), forced expiratory flow between 25 % and 75 % of FVC (ppFEF25-75%), and maximum voluntary ventilation (ppMVV)) and submaximal functional capacity (six-minute step test: 6MST) were evaluated. Mann-Whitney (comparison of pulmonary function and functional capacity between groups) and linear regression (association between the presence of HF and other variables) were performed.

We included 55 participants, with median age of 67 years (56.25-71.75) and 54.55 % males. Dyslipidemia was the most recurrent comorbidity (49.09 %). HFG presented lower ppFVC (P = 0.000), ppFEV1 (P = 0.011), ppFEF25-75% (P = 0.017), and ppMVV (P = 0.003) than the CCG. The ppFVC (B = -18.95; P = 0.000), ppFEV1 (B = -16.29; P = 0.021), ppFEF25-75% (B = -19.57; P = 0.014), ppMVV (B = -16.59; P = 0.003), and 6MST (B = -17.13; P = 0.034) were negatively associated with the presence of HF.

Our data suggest that impaired lung function, compatible with a restrictive pulmonary pattern, is present among adults with CC and HF.

COPD is a chronic, heterogeneous inflammatory disorder of the airways with persistent and poorly reversible airflow limitation, causing symptoms such as cough, shortness of breath, and sputum production. Despite optimal treatment, some patients remain symptomatic due to the disease's heterogeneity, manifesting in various phenotypes. One notable phenotype involves eosinophilic inflammation, with a variable prevalence. Identifying eosinophilic phenotypes is crucial for tailored therapeutic strategies, as they respond favorably to corticosteroids and potentially biologics. Recent advances in both clinical trials and spontaneous research have helped understand the biological and clinical characteristics of this phenotype, although no universal consensus has been reached yet on the definition of the cut-off values of the eosinophil peripheral blood count. Moreover, there is evidence of novel emerging biomarkers which might go beyond the sole eosinophil count, while significant advancements in terms of pharmacological treatment have been made, with dupilumab being the first biological drug being licensed for COPD patients with elevated circulating eosinophils in the stable phase. In light of the above, although several papers have been written on the relationship between eosinophils and COPD, in the present work we endeavored to summarize and discuss the pivotal literature findings regarding the eosinophilic COPD in order to help define the biological and clinical features of this peculiar phenotype, with particular attention to the use of established and emerging biomarkers, as well as current and future therapeutic perspectives.

Tezepelumab is a human monoclonal antibody that blocks thymic stromal lymphopoietin, which has shown increased expression in patients with chronic obstructive pulmonary disease (COPD) compared with healthy individuals. We aimed to assess the efficacy and safety of tezepelumab in patients with moderate to very severe COPD despite receiving triple inhaled therapy.

COURSE was a double-blind, randomised, placebo-controlled, phase 2a trial across 90 sites in ten countries in Asia, Europe, and North America. Eligible participants were aged 40-80 years, had moderate to very severe airflow limitation, were receiving triple inhaled maintenance therapy, and had at least two moderate to severe COPD exacerbations in the 12 months before enrolment. Patients were randomly assigned (1:1) to receive tezepelumab 420 mg or placebo subcutaneously every 4 weeks for up to 52 weeks. Randomisation was stratified by geographical region and by number of exacerbations in the 12 months before enrolment. Participants, investigators, site staff, and the study sponsor were masked to treatment assignment. The primary endpoint was the annualised rate of moderate or severe COPD exacerbations over 52 weeks. A prespecified subgroup analysis assessed the primary endpoint in patients grouped by baseline blood eosinophil counts (BECs). Efficacy and safety were assessed in all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT04039113 (completed).

Between July 30, 2019, and Oct 4, 2022, 333 patients (mean age 67·2 years [SD 7·0]; 145 [44%] female and 188 [56%] male; 293 [88%] White, 34 [10%] Asian, and four [1%] Black or African American) were randomly assigned and treated with tezepelumab (n=165) or placebo (n=168). The annualised rate of moderate or severe COPD exacerbations over 52 weeks was 1·75 for tezepelumab versus 2·11 for placebo (rate ratio 0·83 [90% CI 0·64-1·06]; p=0·10 [one-sided]; the primary endpoint was not met). In prespecified subgroup analyses, the annualised rate of moderate or severe COPD exacerbations over 52 weeks was 2·04 with tezepelumab versus 1·71 with placebo (rate ratio 1·19 [95% CI 0·75-1·90]) in patients with a baseline BEC of less than 150 cells per μL, 1·64 versus 2·47 (0·66 [0·42-1·04]) in patients with a baseline BEC of 150 cells per μL to less than 300 cells per μL, and 1·20 versus 2·24 (0·54 [0·25-1·15]) in patients with a baseline BEC of 300 cells per μL or higher. Adverse events occurred in 133 (81%) of 165 patients in the tezepelumab group and 126 (75%) of 168 patients in the placebo group. Serious adverse events occurred in 49 (30%) patients in the tezepelumab group and 50 (30%) patients in the placebo group. Five patients died while receiving study treatment: two in the tezepelumab group and three in the placebo group. No deaths were determined to be causally related to study treatment by investigator assessment.

A significant reduction was not observed in the annualised rate of moderate or severe COPD exacerbations with tezepelumab versus placebo. Further studies are required to evaluate the efficacy of tezepelumab in patients with moderate to very severe COPD, particularly in patients with a baseline BEC of 150 cells per μL or higher. Tezepelumab was well tolerated, with no safety concerns identified.

AstraZeneca and Amgen.

Pulmonary embolism (PE) and acute exacerbation of chronic obstructive pulmonary disease (COPD) have similar clinical symptoms, making PE diagnosis challenging. Previous studies have shown that the prevalence of PE among COPD patients admitted with worsening respiratory symptoms was not negligible, but that systematic search for PE did not provide a clinical benefit. Predictive factors for PE remain unknown.

to identify predictive factors for PE among COPD patients with worsening respiratory symptoms.

We conducted an individual participant data meta-analysis which included the patients from the prospective PEP cohort and those randomized to the intervention arm in the SLICE trial which included a systematic search for PE in COPD patients admitted for worsening respiratory symptoms. Univariable and multivariable analysis were used to assess factors associated with the diagnosis of PE during the initial management.

Among 1110 COPD patients, PE was diagnosed in 61 (5.49 %; 95 %CI 4.15 %-6.84 %). In univariable analysis, BNP (Brain natriuretic peptide) (odds ratio [OR] 1.02 per 100 ng/L increase, 95 %CI 1.01-1.04), prothrombin time (OR 0.78, 95 %CI 0.65-0.94), fibrinogen (OR 0.80, 95 %CI 0.64-0.98), atrial fibrillation (OR 4.74, 95 %CI 1.84-10.80), respiratory rate ≥30 min (OR 2.34, 95 %CI 1.13-4.6) and recent medical immobilization (OR 1.79, 95 %CI 0.99-3.13]) were associated with the risk of PE diagnosed during the initial management. In multivariable analysis, respiratory rate ≥30 (OR 2.77, 95 %CI 1.08-6.71) was a predictive factor for PE, as well as BNP (OR 1.02, 95 %CI 1.00-1.05) with an area under the curve =0.64, negative predictive value =0.15 (95 %CI 0.09-0.23), sensitivity =0.78 (95 %CI 0.74-0.82) and specificity =0.46 (95 %CI 0.29-0.63).

Among patients with COPD admitted for worsening respiratory symptoms, respiratory rate and BNP levels are predictor of PE, but with limited discriminatory power.