A Comparative Observational Study of the Diagnostic Utility of Impulse Oscillometry Versus Spirometry in Obstructive Airway Diseases.

Background Obstructive airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), significantly impact respiratory function, making accurate diagnosis and differentiation essential for proper management. While spirometry is the gold standard for assessing lung function, impulse oscillometry (IOS) has emerged as a complementary tool, especially when spirometry results are inconclusive. This study aimed to compare the diagnostic utility of IOS with spirometry in patients with obstructive airway diseases and evaluate the correlation between these two methods. Methods A comparative observational study was conducted over 18 months at a tertiary care hospital in central India, including 130 patients (65 with asthma and 65 with COPD). Diagnostic evaluations using spirometry and IOS were performed before and after bronchodilator administration. Spirometry parameters assessed were forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio, while IOS parameters evaluated included resistance at 5 Hz (R5), resistance at 20 Hz (R20), resonant frequency (Fres), reactance at 5 Hz (X5), and the area under the reactance curve (AX). Statistical analysis was conducted using IBM SPSS version 27.0 (IBM Corp., Armonk, USA) and GraphPad Prism version 7.0 (Dotmatics, Boston, USA). Results Significant differences were observed in spirometry parameters between asthma and COPD groups, with asthma patients showing better lung function (FEV1, FVC, and FEV1/FVC; p<0.05). No significant differences were found in IOS parameters between the groups except for a correlation between FEV1 (%) and IOS measurements in the asthma group. Spirometry demonstrated superior sensitivity in identifying airway obstruction compared to IOS. However, IOS was more effective in detecting peripheral airway obstruction in asthma patients, with 22 out of 65 (33.85%) asthma patients showing peripheral airway obstruction compared to six out of 65 (9.23%) COPD patients (p=0.001). Conclusion While spirometry remains the primary diagnostic tool for assessing obstructive airway diseases, IOS is a valuable adjunct, particularly for detecting peripheral airway involvement in asthma patients. Combining spirometry and IOS enhances diagnostic accuracy and provides a more comprehensive assessment of lung function in patients with asthma and COPD.

Association between measures of kidney function and preserved ratio impaired spirometry in diabetes: NHANES 2007-2012.

OBJECTIVES: This study aimed to examine the relationship between measures of kidney function and impaired lung function in individuals with diabetes and to assess all-cause mortality risk associated with having chronic kidney disease (CKD) and or impaired lung function. DESIGN: Cross-sectional and retrospective cohort study. SETTING: The National Health and Nutrition Examination Survey 2007-2012. PARTICIPANTS: A total of 10 809 participants aged over 20 years were included in this study: 9503 with normal spirometry, 951 with preserved ratio impaired spirometry (PRISm) and 355 with variable obstruction (VO). EXPOSURE AND OUTCOME MEASURES: Kidney function measures, including estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio (UACR), were considered exposure variables. PRISm and VO were outcome variables. PRISm was defined as a forced expiratory volume in 1 s (FEV1)<80% predicted and an FEV1/forced vital capacity (FVC) ratio≥0.7, while VO was defined as an FEV1/FVC ratio <0.7 prebronchodilator and ≥0.7 postbronchodilator. In the cross-sectional analysis, multivariate logistic regression models were used to assess the relationship between kidney function measures and spirometry findings. In the retrospective cohort analysis, Cox proportional hazards models were employed to evaluate the impact of having PRISm or VO, combined with CKD, on all-cause mortality. RESULTS: An increase in UACR was significantly associated with higher odds of PRISm (OR (95% CI)=1.10 (1.01, 1.21), p=0.03). Additionally, eGFR <60 was associated with the odds of variable obstructive lung function (OR (95% CI)=1.72 (1.07, 2.74), p=0.03) compared with eGFR >60. After adjustments, an increase in UACR was associated with higher odds of PRISm in individuals with diabetes (OR (95% CI)=1.21 (1.08, 1.36), p=0.002), and UACR ≥300 mg/g significantly increased odds of having PRISm in idividuals with diabetes (OR (95% CI)=2.34 (1.23, 4.47), p=0.01). During a mean follow-up of 12.3 years, 10 500 deaths occurred. In the diabetic group, compared with normal spirometry without CKD, those with both PRISm and CKD had a significantly increased risk of all-cause mortality (HR (95% CI)=3.46 (1.94, 6.16), p<0.0001). CONCLUSION: An elevated UACR and albuminuria were linked to a higher risk of PRISm. Our study emphasises that kidney and lung function are correlated. Further research is necessary to confirm our findings.

Dynamics of the airway microbiome in response to exposure to particulate matter 2.5 in patients with chronic obstructive pulmonary disease.

BACKGROUND: Particulate matter (PM) and air pollution have been suggested to be associated with chronic obstructive pulmonary disease (COPD), contributing significantly to global respiratory disease-related mortality. This study aimed to investigate whether seasonal exposure to PM influences dysbiosis in the respiratory microbiota of patients with COPD. METHODS: Sputum samples were collected four times over 1 year from 102 patients with COPD, and 16S rRNA sequencing was performed. The dynamics of the airway microbiota were analyzed depending on PM exposure levels and season. RESULTS: The PM-low exposure group had higher α-diversity compared to the PM-high exposure group, particularly noted in spring. Some bacterial groups, including seven species such as Treponema socranskii, were more abundant in the low exposure group. Additionally, the bacterial community structure in summer significantly differed from that in other seasons, with significantly increased α-diversity in this season. The difference in the airway microbiome due to PM exposure was prominent in patients with moderate COPD. CONCLUSIONS: PM exposure may influence changes in the sputum microbiome depending on exposure levels and seasonal variations. Our results suggest that airway microbiomes could vary with PM exposure according to seasonal trends.

Influence and distinctions of particulate matter exposure across varying etiotypes in chronic obstructive pulmonary disease (COPD) mouse model.

BACKGROUND: Air pollution, notably particulate matter (PM), significantly impacts chronic respiratory disease such chronic obstructive pulmonary disease (COPD). Although asthma-COPD overlap (ACO), considered one of the COPD etiotype, is associated with greater severity in both symptoms and outcomes, effects of PM exposure remain unclear. Thus, this study aimed to evaluate impact of PM on chronic airway disease animal models. METHODS: We established two distinct COPD etiotypes, cigarette smoking-related COPD (COPD-C) and COPD with asthma (COPD-A), using porcine pancreatic elastase (PPE) for COPD-C and a combination of PPE with ovalbumin for COPD-A. To reflect smoking influence, cigarette smoking extract was administered to both disease models. To assess impact of PM exposure, bronchoalveolar lavage fluid (BALF), proinflammatory cytokines, lung histology, and cellular damage mechanisms were analyzed. RESULTS: In the COPD-A model, cell counts and type 2 cytokines were elevated in BALF independent of PM exposure. All models exhibited increased lung inflammation and emphysema due to PM exposure. Expression levels of apoptosis-related protein B-cell lymphoma protein 2 (Bcl-2) associated X (Bax) showed an inclination to increase with PM exposure. In the COPD-A model, decreased expression of basal nuclear factor erythroid-derived 2-like 2 (Nrf-2) and increased production of reactive oxygen species (ROS) due to PM exposure were noted. CONCLUSION: We developed two distinct models for the etiotypes of COPD and found increased vulnerability to cell damage in COPD-A after PM exposure. Moreover, the control group displayed escalated airway inflammation and emphysema due to PM exposure, substantiating the risk of respiratory diseases.

Does adherence to exacerbation action plans matter? Insights from two COPD self-management studies.

Introduction: Patients' adherence is essential for COPD self-management, as beneficial effects can only be expected in adherent patients. We explored associations between patients' adherence to COPD exacerbation action plans and health outcomes. Materials and methods: Pooled COPD self-treatment intervention group data from two RCTs were analysed, only including patients who had ≥1 COPD exacerbation or started ≥1 course of oral corticosteroids over one-year follow-up. Optimal adherence was defined as 'self-treatment initiated ≤1 day before or after exacerbation start', suboptimal adherence as 'self-treatment initiated 2 days before or after exacerbation start or no self-treatment initiated for a short (1-3 days) exacerbation', and significant delay or no treatment as 'self-treatment initiated >2 days after exacerbation start or no self-treatment initiated for a longer (>3 days) exacerbation'. Regression models were built for several health outcomes, with the number of COPD exacerbation days/patient/year being the primary outcome. Results: Patients with significant delay or no treatment (n = 46) had more exacerbation days/patient/year (33.3 (95 % CI 10.9; 55.6)) than optimal adherent patients (n = 38) (23.7 (95 % CI 1.7; 45.7)). The duration per COPD exacerbation was longer for patients with significant delay or no treatment (15.5 days) compared to optimal adherent patients (7.8 days). No differences in health outcomes were observed between optimal and suboptimal adherent patients. Conclusions: Being adherent to action plans is associated with better health outcomes than significant delayed treatment or no treatment at all. Interestingly, suboptimal adherence demonstrated health benefits comparable to optimal adherence. COPD self-management interventions should prioritise strategies to optimise patients' adherence to action plans.

Effects of Qingjin Huatan decoction on pulmonary function and inflammatory mediators in acute exacerbations of chronic obstructive pulmonary disease: a systematic review and meta-analysis.

Background: The inflammatory response is the main pathophysiological basis of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and is a key factor leading to frequent exacerbations and disease progression. Suppressing the inflammatory response can improve pulmonary function, prognosis, and quality of life in AECOPD patients. Purpose: To evaluate the effect of Qingjin Huatan decoction (QHD) on pulmonary function and inflammatory mediators in AECOPD patients. Methods: Randomized controlled trials (RCTs) on the treatment of AECOPD with QHD were retrieved from eight Chinese and English electronic databases up to 31 May 2024. The quality of the studies was assessed using the Cochrane Risk of Bias Tool and the modified Jadad scale. Statistical analysis, sensitivity analysis, and publication bias assessment were performed using Stata 17.0 software. Results: A total of 40 RCTs involving 3,475 AECOPD patients were included. Compared to conventional treatment, QHD significantly improved pulmonary function, with increases in FEV1 (MD = 0.30, 95% CI: 0.26 to 0.34, p = 0.000), FVC (MD = 0.34, 95% CI: 0.27 to 0.41, p = 0.000), FEV1/FVC (MD = 6.07, 95% CI: 5.55 to 6.58, p = 0.000), and PaO2 (MD = 7.20, 95% CI: 4.94 to 9.47, p = 0.000), and a decrease in PaCO2 (MD = -5.37, 95% CI: 7.99 to -2.74, p = 0.000). QHD also significantly suppressed the expression of inflammatory mediators, including TNF-α (MD = -10.87, 95% CI: 12.51 to -9.23, p = 0.000), IL-1ß (MD = -13.63, 95% CI: -16.31 to -10.95, p = 0.000), IL-6 (MD = -7.58, 95% CI: -10.10 to -5.06, p = 0.000), IL-8 (MD = -9.45, 95% CI: -12.05 to -6.85, p = 0.000), CRP (MD = -5.62, 95% CI: -6.60 to -4.65, p = 0.000), and PCT (MD = -0.84, 95% CI: -1.07 to -0.62, p = 0.000). Additionally, QHD improved clinical efficacy (RR = 4.16, 95% CI: 3.26 to 5.30, p = 0.000) without increasing the incidence of adverse reactions (RR = 1.04, 95% CI: 0.68 to 1.61, p = 0.000). Conclusion: Existing evidence suggests that QHD can significantly improve pulmonary function, suppress the expression of inflammatory mediators, and enhance clinical efficacy in AECOPD patients, with a good safety profile. Given the limitations of this study, more high-quality studies are needed to provide reliable evidence. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=559436, identifier CRD42024559436.

Genome-Wide Association Analysis of Rapid Decline in Lung Function: Analysis From the Korean Genome and Epidemiology Study.

BACKGROUND: A rapid decline in forced expiratory volume in 1 second (FEV1) is considered an important phenotype of the development of chronic obstructive pulmonary disease (COPD). However, the associations between specific genetic variants (single-nucleotide polymorphisms; SNPs) and this phenotype remain uncertain. METHODS: We enrolled 6,516 individuals from the Korean Genome and Epidemiology Study (KoGES). A rapid decline in FEV1 was defined as an annual decrease of FEV1 ≥ 60 mL/year. A multivariable logistic regression model was used to assess the associations between SNP variants and the rapid decline in FEV1. Considering the significant impact of smoking on lung function, a subgroup analysis based on smoking history was also conducted. RESULTS: A genome-wide association analysis of the rapid decline in FEV1 identified 15 association signals (P < 5.0 × 10-8). Among the 15 nucleotide variants, rs9833533 and rs1496255 have been previously reported to be associated with lung function development. In the subgroup analysis, rs16951883 (adjusted odds ratio [aOR], 3.24; P = 5.87 × 10-8) was the most significant SNP associated with rapid decline in FEV1 among never smokers, followed by rs41476549, rs16840064, and rs1350110. Conversely, among ever smokers, rs10959478 (aOR, 4.74; P = 8.27 × 10-7) showed the highest significance, followed by rs6805861, rs9833533, and rs16906215. CONCLUSION: We identified 15 nucleotide variants linked to a rapid decline in FEV1, including two SNPs previously reported to be associated with lung function development. Additional SNPs, which were associated with COPD, may be found using novel phenotypes.

What happens between first symptoms and first acute exacerbation of COPD - observational study of routine data and patient survey.

Background: Chronic obstructive pulmonary disease affects nearly 400 million worldwide - over a million in the United Kingdom - and is the third leading cause of death. However, there is limited understanding of what prompts a diagnosis, how long this takes from symptom onset and the different approaches to clinical management by primary care professionals. Objectives: Map out the clinical management and National Health Service contacts from symptom presentation to chronic obstructive pulmonary disease diagnosis and first acute exacerbation of chronic obstructive pulmonary disease in three time periods; construct risk prediction for first acute exacerbation of chronic obstructive pulmonary disease. Design: Retrospective cohort study and cross-sectional survey. Setting: Primary care. Participants: Patients with incident chronic obstructive pulmonary disease aged > 35 years in England. Interventions: None. Main outcome measures: First acute exacerbation of chronic obstructive pulmonary disease. Data sources: Clinical Practice Research Datalink Aurum; new online survey. Results: Forty thousand five hundred and seventy-seven patients were diagnosed between April 2006 and March 2007 (cohort 1), 48,249 between April 2016 and March 2017 (cohort 2) and 4752 between March and August 2020 (cohort 3). The mean (standard deviation) age was 68.3 years (12.0); 47.3% were female. Around three-quarters were diagnosed in primary care, with a slight fall in cohort 3. Compliance with National Institute for Health and Care Excellence diagnostic guidelines was slightly higher in cohorts 2 and 3 for all patients; 35.8% (10.0% in the year before diagnosis) had all four elements met for all cohorts combined. Multilevel modelling showed considerable between-practice variation in spirometry. The survey on the charity website had 156 responses by chronic obstructive pulmonary disease patients. Many respondents had not heard of the condition, hoped the symptoms would go away and identified various healthcare-related barriers to earlier diagnosis. Clinical Practice Research Datalink analysis showed notable changes in post-diagnosis prescribing from cohort 1 to 2, such as increases in long-acting muscarinic antagonist (21.7-46.3%). Triple therapy rose from 2.9% in cohort 2 to 11.1% in cohort 3. Documented pulmonary rehabilitation rose from just 0.8% in cohort 1 to 13.7% in cohort 2 and 20.9% in cohort 3. For all patients combined, the median time to first acute exacerbation of chronic obstructive pulmonary disease in patients who had one was 1.4 years in cohorts 1 and 2. Acute exacerbation of chronic obstructive pulmonary disease prediction models identified some consistent predictors, such as age, deprivation, severity, comorbidities, post-diagnosis spirometry and annual review. Models without post-diagnosis general practitioner actions had a c-statistic of around 0.70; the highest c-statistic was 0.81, for cohort 2 with post-diagnosis general practitioner actions and 6-month follow-up. All models had good calibration. The three most important predictors in terms of their population attributable risks were being a current smoker and offered smoking cessation advice (32.8%), disease severity (30.6%) and deprivation (15.4%). The highest population attributable risks for variables with adjusted hazard ratios < 1 were chronic obstructive pulmonary disease review (-27.3%) and flu vaccination (-26.6%). Limitations: Symptom recording and chronic obstructive pulmonary disease diagnosis vary between practice; predicted forced expiratory volume in 1 second had many missing values. Conclusions: There has been some improvement over time in chronic obstructive pulmonary disease diagnosis and management, with large changes in prescribing, though patient and system barriers to further improvement exist. Data available to general practitioners cannot generate risk prediction models with sufficient accuracy. Future work: It will be important to expand the COVID-era cohort with longer follow-up and augment general practitioner data for better prediction. Study registration: This study is registered as Researchregistry.com: researchregistry4762. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/72) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 43. See the NIHR Funding and Awards website for further award information.

Chronic obstructive pulmonary disease is often caused by smoking and affects over 1 million people in the United Kingdom. While there are well-established treatments, less is known on where and when patients get the diagnosis, how general practitioners investigate their symptoms and to what extent the first major flare-up ('acute exacerbation') can be predicted and prevented. Using a research database of general practitioner consultation records linked to hospital admissions and the national death register, we described patient characteristics, general practitioner actions before and following diagnosis, and, with statistical models, predictors of the first exacerbation. We looked at three time periods according to the date of diagnosis: April 2006­March 2007 (cohort 1), April 2016­March 2017 (cohort 2) and March­August 2020 (cohort 3). We sent patients a questionnaire asking about their experiences of developing symptoms, seeking medical help and getting diagnosed. We analysed records of over 70,000 patients in total. The majority were diagnosed by their general practitioner. In cohorts 2 and 3, general practitioners did the recommended tests more than in cohort 1, though in the year before diagnosis, only 10% of patients had all four done. Our survey found that many people were unaware of chronic obstructive pulmonary disease and its symptoms before their diagnosis but also that some felt they were not taken seriously by the medical team and that their diagnosis was delayed. There were improvements over time in prescribing. Most patients were offered the flu jab. Older patients, current smokers and those with other conditions such as heart failure had higher risk of an acute exacerbation. The statistical models did not perform well enough to be used to guide decision-making. Despite some improvements over time, there remain opportunities for better recognition of the condition among patients and general practitioners alike. Future work should more fully assess the impact of COVID-19.

The effects of music therapy on patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis.

BACKGROUND: Inconsistent findings concerning the effects of music therapy on patients with chronic obstructive pulmonary disease (COPD) have been reported. OBJECTIVE: To systematically evaluate the effects of music therapy on patients with COPD. METHODS: Database search was conducted in Cochrane Library, Web of Science, PubMed, Embase, CINAHL, CNKI, CBM, WanFang Data, and VIP databases, from database inception to June 2024. Two researchers independently reviewed and assessed the methodological quality of the included studies using the Version 2 of the Cochrane tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the overall quality. Review Manager (v 5.4) software was used for the meta-analysis. RESULTS: Eleven studies with 947 patients were included. Standardized mean differences (SMD) and 95% confidence intervals (CI) were observed in favor of music therapy for quality of life (SMD = 0.92, 95% CI [0.39, 1.46]) and exercise endurance (SMD = 0.77, 95% CI [0.05, 1.49]). Meanwhile, the results of subgroup analyses indicated that passive music therapy had significant effects on quality of life (SMD = -0.83, 95% CI [-1.23, -0.44]), anxiety (SMD = -0.67, 95% CI [-1.11, -0.24]) and exercise endurance (SMD = 1.54, 95% CI [0.55, 2.54]). When intervention duration was more than 3 months, music therapy could significantly improve quality of life (SMD = -1.32, 95% CI [-2.17, -0.47]), reduce depression (SMD = -3.94, 95% CI [-5.20, -2.67]) and increase exercise endurance (SMD = 0.96, 95% CI [0.41, 1.51]). CONCLUSION: Music therapy is effective for quality of life and exercise endurance of patients with COPD; however, its impact on dyspnea, anxiety, and depression is still uncertain. More high-quality randomized control trials are warranted to confirm these conclusions.

[Real-life utilization of fixed triple therapy in COPD: The Trilife study. Beclomethasone/formoterol/glycopyrronium triple fixed-dose therapy in extra-fine particles]. / Utilisation en vie réelle d'une triple thérapie fixe dans la BPCO : étude Trilife. Triple association fixe béclometasone/formotérol/glycopyrronium en particules extra-fines.

INTRODUCTION: The Trilife study describes the real-life use, in France, of the beclomethasone/formoterol/glycopyrronium triple fixed-dose combination in solution for inhalation, which is indicated as continuous treatment for moderate-to-severe chronic obstructive pulmonary disease. METHODS: This prospective, non-interventional, multicentric study, involving hospital and office-based pulmonologists, evaluates the proportion of patients for whom the triple fixed combination was prescribed in compliance with the indication and dosage specified in the summary of product characteristics (SPC). Patients were followed for six months. RESULTS: In a population of 346 patients, the prescription was compliant with the SPC for 75.1% of patients (95% confidence interval: [70.6; 79.7]). The only variable associated with compliance with SPC in multivariate analyses was smoking (P=0.019). The results also show improved patient adherence to treatment and improved clinical status in terms of moderate or severe exacerbations, dyspnea, quality of life and satisfaction with treatment. CONCLUSION: Three quarters of the fixed triple combination prescriptions by French pulmonologists comply with the indication and dosage specified in the summary of product characteristics.

Inhaler personalisation based on peak inspiratory flow (PIF) among dry powder inhaler users: a pilot randomised control trial (RCT) in COPD.

Background: Dry powder inhalers (DPIs) are commonly used among patients with Chronic Obstructive Pulmonary Disease (COPD). These inhalers are breath-actuated, and require patients to generate sufficient peak inspiratory flow (PIF) to disaggregate the drug powder into respirable fine particles and deliver it to the lower airway tracts. Inhaler personalisation based on PIF among DPI users has not been studied in Malaysia, thus we conducted the present pilot study to determine the feasibility of conducting such research among COPD patients. Methods: This was an open-label pilot randomised control trial, conducted from June 2021-January 2022 at the respiratory clinic of Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia. Measurement of PIF was performed with In-Check DIAL G16 among adult COPD patients treated with DPI and had suboptimal PIF. Eligible subjects were randomised using block randomisation into two groups, either the interventional group or the control group. Results: Twenty-two COPD patients fulfilled the study criteria and were randomised to intervention (n = 11) and control (n = 11) groups. For the interventional group, there were statistically significant improvements between baseline and at 12 weeks for both FEV1 and CAT scores. The mean (% predicted) FEV1 were 54.6 ± 20.4% and 56.6 ± 19.8% (p = 0.026), pre-and post-intervention. The mean CAT score at baseline was 24.4 ± 5.8 and reduced to 19.6 ± 4.4 at 12 weeks (p = 0.012). For the control group, the mean (% predicted) FEV1 at baseline was 58.0 ± 21.9% and 56.5 ± 20.7% at 12 weeks, with no statistical significance difference (p = 0.143). However, there was a statistically significant difference in CAT scores at baseline and 12 weeks, with a mean of 26.5 ± 6.1 and 23.3 ± 5.6, respectively (p = 0.010). Conclusion: The findings from the present pilot RCT highlighted that inhaler personalisation based on PIF among COPD patients was feasible and practical.

Frequency of Asymptomatic Deep Vein Thrombosis in Hospitalized Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD).

INTRODUCTION: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are always associated with high mortality. Because of the presence of some concomitant risk factors such as immobilization and bronchial superinfection, patients who are admitted for acute exacerbations of COPD are generally considered to be at moderate risk for the development of venous thromboembolism. Thromboembolism is a cause of unexplained dyspnea, exacerbations, and mortality in COPD. This study aims to determine the frequency of asymptomatic deep vein thrombosis (DVT) in patients with acute exacerbations of COPD presented at a tertiary care hospital. METHODS: This is a descriptive cross-sectional study conducted at the Department of Chest Medicine, Jinnah Postgraduate Medical Center (JPMC), Karachi. A duplex ultrasound study of both lower limbs was performed by a sonologist to assess asymptomatic DVT in patients with acute exacerbations of COPD. RESULTS: The mean age of the sample was 59.64 ± 9.711 years. Out of 106 patients, 95 (90%) were male and 11 (10%) were female. Asymptomatic DVT was found in 16 (15%) patients with acute exacerbations of COPD. Male patients exhibited a higher incidence of DVT, with 12 cases versus four in females, a statistically significant finding (p=0.03). Additionally, DVT was significantly more prevalent among patients with restricted mobility, with all 16 cases occurring in this group (p=0.006). Age did not show a statistically significant difference in DVT occurrence between patients above and below 59 years. CONCLUSIONS: Deep venous thrombosis is a common occurrence in COPD exacerbations. It is a risk factor for pulmonary embolism that carries a high mortality. All patients with COPD exacerbations may need to be assessed for thromboembolic events. COPD morbidity and mortality are continually rising despite efforts to recognize new phenotypes and treatments. The cause may be the association of unrecognized and untreated thromboembolism. Prompt diagnosis and treatment with anticoagulants in COPD patients may lead to a better prognosis.

Clinical characteristics, use and switch of drugs for obstructive airway diseases among patients with COPD experiencing an exacerbation: a retrospective analysis of Italian administrative healthcare data.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) represents an important health challenge, despite being preventable and manageable thanks to up-to-date recommendations. In Italy, the pharmaceutical care of COPD patients is still ill-timed and inaccurate. This study aimed to describe the treatment of COPD patients in Italy and possible switches following an exacerbation. METHODS: This observational retrospective analysis of Italian administrative healthcare data from the Fondazione Ricerca e Salute (ReS) database identified patients aged ≥ 45 years with COPD in 2019 and 2020. At least 6 years of look-back period and absence of concomitant asthma were required. COPD patients were categorized by treatment (SI-single/MI-multiple inhalers, TT-triple therapy, DT-dual therapy, other respiratory treatments, untreated) at index date (first dispensation during accrual period). Occurrence of moderate/severe exacerbation during one-year preceding index date and treatments during one-year preceding the exacerbation (possible switch) were evaluated. RESULTS: From ~ 4.7 million beneficiaries of the Italian National Health Service in 2019 and 2020, respectively, 105,828 and 103,729 (43 and 41 × 1,000 inhabitants aged ≥ 45 years) were identified as having COPD. Of 2019/2020 patients: 3.4%/5.2% received SI-TT, 20.7%/17.5% MI-TT, 35.9%/38.1% DT, 33.0%/33.1% other treatments, and 7.0%/6.0% were untreated. Males were prevalent and median age was > 73 years for all groups. Of 2019/2020 cohorts, heart failure and coronary artery disease affected 24/20%, 18/17%, and 11%/16% patients with SI-TT, MI-TT, DT, and other treatments, respectively. A previous moderate/severe exacerbation (2019/2020 patients) occurred to 60.5%/56.6%, 39.9%/37.4%, 30.8%/29.2% and 31.9%/29.7% patients treated with SI-TT, MI-TT, DT, and other treatments, respectively. Of 2019/2020 patients experiencing moderate/severe exacerbation: 6.0%/7.0% receiving DT, 5.1%/7.0% receiving other treatments and 4.5%/10.0% untreated, switched to SI-TT; 23.7%/16.9% receiving DT, 21.4%/17.7% receiving other treatments and 15.4%/12.0% untreated, switched to MI-TT. CONCLUSIONS: COPD patients receiving TT were older and had more comorbidities, especially cardiovascular diseases, than patients receiving DT or other treatments. The limited number of patients switching after exacerbation suggests that many COPD patients may be inappropriately treated. Ensuring early and adequate treatment, combination of in-hospital and outpatient management, and integration of specialist and primary care is pivotal for the appropriate clinical management of COPD patients.

The efficacy and safety of herbal formulas for adults with pulmonary hypertension combined with chronic obstructive pulmonary disease: a systematic review and meta-analysis involving 1,865 participants.

Background: There is currently no effective treatment for the majority of patients with chronic obstructive pulmonary disease combined with pulmonary hypertension (COPD-PH). Numerous clinical trials have demonstrated the use of traditional Chinese medicine (TCM) herbal formulas in combination with routine western pharmacotherapy (WP) for the treatment of COPD-PH, with positive results. This meta-analysis was designed to evaluate the efficacy and safety of TCM herbal formulas in the treatment of COPD-PH. Methods: A systematic literature search was conducted using Web of Science, PubMed, Chinese National Knowledge Infrastructure (CNKI), WanFang, and Chinese Science and Technology Journal (VIP) from database inception until October 2023. The primary outcome was pulmonary artery pressure parameters, including pulmonary artery systolic pressure (PASP) and mean pulmonary artery pressure (mPAP). Secondary outcomes included pulmonary ventilation function parameters, such as forced expiratory volume in one second (FEV1) and the ratio of FEV1 to forced vital capacity (FEV1/FVC%), as well as functional capacity assessments measured by the six-minute walk distance (6MWD). Reviewer Manager software was used for both random-effects and fixed-effects meta-analyses. We registered the protocol for this study with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY, registry number: INPLASY2022100041). Results: Twenty randomized control trials with a total of 1,865 patients were included in the meta-analysis. The results of our meta-analysis revealed that TCM herbal formulas in combination with basic WP significantly reduced pulmonary artery pressure in patients with COPD-PH, including PASP [mean difference (MD) =-4.50 mmHg, 95% confidence interval (CI): -6.04, -2.95] and mPAP (MD =-4.47 mmHg, 95% CI: -5.07, -3.88). Additionally, pulmonary ventilation function and 6MWD (MD =48.13 m, 95% CI: 39.92, 56.34) were also improved in COPD-PH patients. Pulmonary ventilation function was reflected by FEV1 (MD =0.83 L, 95% CI: 0.35, 1.30) and FEV1/FVC% (MD =4.76, 95% CI: 3.75, 5.77). A total of six studies reported adverse events in detail, and all claimed that no adverse events were observed in COPD-PH patients using TCM herbal formulas. Conclusions: The combination of TCM herbal formulas and basic WP might be more effective in improving the quality of life and exercise capacity of patients with COPD-PH than basic WP alone. However, the firm conclusions of our study were hampered by the low quality of the evidence.

Treatment of chronic obstructive pulmonary disease by traditional Chinese medicine Morin monomer regulated by autophagy.

Background: Chronic obstructive pulmonary disease (COPD) is a frequently occurring disorder. The aim of this study is to explore the mechanism of traditional Chinese medicine Morin monomer in the treatment of COPD via regulating autophagy based on the long non-coding RNA (lncRNA) H19/microRNA (miR)-194-5p/Sirtuin (SIRT)1 signal axis. Methods: The COPD rat model was constructed, and the lung tissues were collected. The pathological analysis was performed using hematoxylin-eosin (HE), Masson, and periodic acid-Schiff (PAS) staining. Autophagosomes were observed using transmission electron microscope. LncRNA H19, miR-194-5p, SIRT1 genes in the rat lung tissues were detected using reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR). The autophagy-related proteins including SIRT1, mammalian/mechanistic target of rapamycin (mTOR), phosphorylated (p)-mTOR, microtubule-associated protein light chain 3 (LC3), Beclin-1, autophagy-related (ATG)7, and p62 in each group were detected using Western blot. Results: The rats in the control group had normal lung structure. Alveolar enlargement and destruction could be found in the rat lung tissues in the model group, accompanied with obvious infiltration of inflammatory cells, thickened bronchial walls, enlarged alveolar septum, collagen fibers deposition, and goblet cells proliferation. In comparison with the model group, Morin treatment relieved the lung injuries, which was optimized in the moderate- and high-dose groups. The number of autophagosomes in the lung tissues of the model rats was dramatically increased compared with the normal rats. However, the number of autophagosomes in each Morin treatment group was obviously less than that in the model group. LncRNA H19 and SIRT1 expression was significantly increased in the model group, and miR-194-5p was significantly decreased (P<0.05). Morin and 3-methyladenine (3-MA) could obviously reduce the lncRNA H19 and SIRT1 expression, and increase the miR-194-5p expression (P<0.05). Relative to control rats, ATG7, Beclin-1, LC3II/I and SIRT1 levels in the model group increased obviously, while the expression of p62, and p-mTOR/mTOR decreased (P<0.05). Morin treatment reduced the expression of ATG7, Beclin-1, SIRT1, LC3II/I significantly, and increased the p-mTOR/mTOR and p62 expression (P<0.05). Conclusions: Morin decreased lncRNA H19 expression, resulting in upregulation of miR-194-5p expression, downregulation of SIRT1 expression, and increased of p-mTOR/mTOR expression. Furthermore, cell autophagy was inhibited, contributing to the COPD treatment.

Detection of chronic obstructive pulmonary disease with deep learning using inspiratory and expiratory chest computed tomography and clinical information.

Background: In recent years, more and more patients with chronic obstructive pulmonary disease (COPD) have remained undiagnosed despite having undergone medical examination. This study aimed to develop a convolutional neural network (CNN) model for automatically detecting COPD using double-phase (inspiratory and expiratory) chest computed tomography (CT) images and clinical information. Methods: A total of 2,047 participants, including never-smokers, ex-smokers, and current smokers, were prospectively recruited from three hospitals. The double-phase CT images and clinical information of each participant were collected for training the proposed CNN model which integrated a sequence of residual feature extracting blocks network (RFEBNet) for extracting CT image features and a fully connected feed-forward network (FCNet) for extracting clinical features. In addition, the RFEBNet utilizing double- or single-phase CT images and the FCNet using clinical information were conducted for comparison. Results: The proposed CNN model, which utilized double-phase CT images and clinical information, outperformed other models in detecting COPD with an area under the receiver operating characteristic curve (AUC) of 0.930 [95% confidence interval (CI): 0.913-0.951] on an internal test set (n=307). The AUC was higher than the RFEBNet using double-phase CT images (AUC =0.912, 95% CI: 0.891-0.932), single inspiratory CT images (AUC =0.888, 95% CI: 0.863-0.915), single expiratory CT images (AUC =0.897, 95% CI: 0.874-0.925), and FCNet using clinical information (AUC =0.805, 95% CI: 0.777-0.841). The proposed model also achieved the best performance on an external test (n=516) with an AUC of 0.896 (95% CI: 0.871-0.931). Conclusions: The proposed CNN model using double-phase CT images and clinical information can automatically detect COPD with high accuracy.

Correlation between handgrip strength and air trapping in patients with stable chronic obstructive pulmonary disease.

Background: Chronic obstructive pulmonary disease (COPD) often presents with dyspnea resulting from the condition of air trapping, assessed by lung volume measurement studies. This study aimed to investigate the relationship between handgrip strength (HGS) and air trapping in COPD patients. Methods: Cross-sectional research was conducted in COPD patients at Thammasat University Hospital, Thailand between May 2022 and December 2023. HGS was assessed using the Jamar® Smart Hand Dynamometer, and air trapping was measured using a body plethysmograph. Air trapping was defined as a ratio of residual volume (RV) to total lung capacity (TLC) greater than 40%. Receiver operator characteristic (ROC) curves, sensitivity, and specificity values were calculated to determine the optimal cutoff value of HGS for predicting air trapping. Results: A total of 72 patients (90.3% male) were included, with an average age of 72.4±9.7 years. The body mass index was 23.5±4.3 kg/m2. The smoking history was 23.2±14.8 pack-years. Common comorbidities included hypertension (36.1%) and diabetes (22.2%). Post-bronchodilator forced expiratory volume in 1 second (FEV1) was 72.1%±21.2%. Air trapping was found in 55.6%. A negative correlation was found between HGS and RV/TLC (R=-0.399, P=0.001). The best cutoff value for HGS to predict air trapping was 28.3 kg, with 71.9% sensitivity and 65.0% specificity. The area under the ROC curve for identifying air trapping was 0.681 (95% CI: 0.554 to 0.808, P=0.009). Conclusions: Air trapping is common in COPD patients, and HGS is significantly correlated with air trapping. Thus, HGS may serve as an alternative tool for assessing air trapping.

Low-Dose Whole-Chest Dynamic CT for the Assessment of Large Airway Collapsibility in Patients with Suspected Tracheobronchial Instability.

Purpose To quantify tracheal collapsibility using low-dose four-dimensional (4D) CT and to compare visual and quantitative 4D CT-based assessments with assessments from paired inspiratory-expiratory CT, bronchoscopy, and spirometry. Materials and Methods The authors retrospectively analyzed 4D CT examinations (January 2016-December 2022) during shallow respiration in 52 patients (mean age, 66 years ± 12 [SD]; 27 female, 25 male), including 32 patients with chronic obstructive pulmonary disease (mean forced expiratory volume in 1 second percentage predicted [FEV1%], 50% ± 27), with suspected tracheal collapse. Paired CT data were available for 27 patients and bronchoscopy data for 46 patients. Images were reviewed by two radiologists in consensus, classifying patients into three groups: 50% or greater tracheal collapsibility, less than 50% collapsibility, or fixed stenosis. Changes in minimal tracheal lumen area, tracheal volume, and lung volume from inspiration to expiration were quantified using YACTA software. Tracheal collapsibility between groups was compared employing one-way analysis of variance (ANOVA). For related samples within one group, ANOVA with repeated measures was used. Spearman rank order correlation coefficient was calculated for collapsibility versus pulmonary function tests. Results At 4D CT, 25 of 52 (48%) patients had tracheal collapsibility of 50% or greater, 20 of 52 (38%) less than 50%, and seven of 52 (13%) had fixed stenosis. Visual assessment of 4D CT detected more patients with collapsibility of 50% or greater than paired CT, and concordance was 41% (P < .001). 4D CT helped identify more patients with tracheal collapsibility of 50% or greater than did bronchoscopy, and concordance was 74% (P = .39). Mean collapsibility of tracheal lumen area and volume at 4D CT were higher for 50% or greater visually assessed collapsibility (area: 53% ± 9 and lumen: 52% ± 10) compared with the less than 50% group (27% ± 9 and 26% ± 6, respectively) (P < .001), whereas both tracheal area and volume were stable for the fixed stenosis group (area: 16% ± 12 and lumen: 21% ± 11). Collapsibility of tracheal lumen area and volume did not correlate with FEV1% (rs = -0.002 to 0.01, P = .99-.96). Conclusion The study demonstrated that 4D CT is feasible and potentially more sensitive than paired CT for central airway collapse. Expectedly, FEV1% was not correlated with severity of tracheal collapsibility. Keywords: CT-Quantitative, Tracheobronchial Tree, Chronic Obstructive Pulmonary Disease, Imaging Postprocessing, Thorax Supplemental material is available for this article. © RSNA, 2024.

Elevated expression of NLRP3 promotes cigarette smoke-induced airway inflammation in chronic obstructive pulmonary disease.

Introduction: NOD-like receptor protein 3 (NLRP3) is implicated in chronic obstructive pulmonary disease (COPD) pathogenesis. Here, we explored the role of NLRP3 in cigarette smoke (CS)-induced airway inflammation in COPD. Material and methods: NLRP3 expression level was assessed with the microarray data in GEO datasets and validated in serum by ELISA from a case-control cohort. Male C57BL/6J mice were randomly divided into: saline, CS, MCC950 (a specific NLRP3 inhibitor, 10 mg/kg) and CS + MCC950 (5 mg/kg and 10 mg/kg) groups (n = 5 per group). All mice were exposed to CS or air for 4 weeks. Then, broncho-alveolar lavage (BAL) fluid and lung tissues were collected for cell counting, ELISA, HE staining and RNA sequencing with validation by real-time qPCR. Results: Compared to non-smokers, NLRP3 expression was significantly elevated in the lung tissues and sera of COPD smokers. CS remarkably induced airway inflammation in mice, characterized by an increase of inflammatory cells and proinflammatory cytokines in BAL fluid and HE inflammatory score, which were ameliorated by MCC950 treatment dose-dependently. Subsequently, 84 candidate genes were selected following RNA sequencing, and five hub genes (Mmp9, IL-1α, Cxcr2, Cxcl10, Ccr1) were then identified by PPI and MCODE analyses, which were confirmed by real-time qPCR. GO and KEGG analysis suggested that the five genes were enriched in a complicated network of inflammatory processes and signaling pathways. Conclusions: NLRP3 expression is elevated in lungs and sera of COPD smokers. Inhibition of NLRP3 significantly attenuates CS-induced airway inflammation in mice via inactivation of multiple hub genes and their related inflammatory processes and signaling pathways.