Sea buckthorn extract mitigates chronic obstructive pulmonary disease by suppression of ferroptosis via scavenging ROS and blocking p53/MAPK pathways.

ETHNOPHARMACOLOGICAL RELEVANCE: Sea buckthorn (Hippophae rhamnoides), a traditional Tibetan medicinal herb, exhibits protective effects against cardiovascular and respiratory diseases. Although Sea buckthorn extract (SBE) has been confirmed to alleviate airway inflammation in mice, its therapeutic effect and underlying mechanism on chronic obstructive pulmonary disease (COPD) requires further clarification. AIM OF THE STUDY: To elucidate the alleviative effect and molecular mechanism of SBE on lipopolysaccharides (LPS)/porcine pancreatic elastase (PPE)-induced COPD by blocking ferroptosis. METHODS: The anti-ferroptotic effects of SBE were evaluated in human BEAS-2B bronchial epithelial cells using CCK8, RT-qPCR, western blotting, and transmission electron microscopy. Transwell was employed to detect chemotaxis of neutrophils. COPD model was induced by intranasally administration of LPS/PPE in mice and measured by alterations of histopathology, inflammation, and ferroptosis. RNA-sequencing, western blotting, antioxidant examination, flow cytometry, DARTS, CETSA, and molecular docking were then used to investigate its anti-ferroptotic mechanisms. RESULTS: In vitro, SBE not only suppressed erastin- or RSL3-induced ferroptosis by suppressing lipid peroxides (LPOs) production and glutathione (GSH) depletion, but also suppressed ferroptosis-induced chemotactic migration of neutrophils via reducing mRNA expression of chemokines. In vivo, SBE ameliorated LPS/PPE-induced COPD phenotypes, and inhibited the generation of LPOs, cytokines, and chemokines. RNA-sequencing showed that p53 pathway and mitogen-activated protein kinases (MAPK) pathway were implicated in SBE-mediated anti-ferroptotic action. SBE repressed erastin- or LPS/PPE-induced overactivation of p53 and MAPK pathway, thereby decreasing expression of diamine acetyltransferase 1 (SAT1) and arachidonate 15-lipoxygenase (ALOX15), and increasing expression of glutathione peroxidase 4 (GPX4) and solute carrier family 7 member 11 (SLC7A11). Mechanistically, erastin-induced elevation of reactive oxygen species (ROS) was reduced by SBE through directly scavenging free radicals, thereby contributing to its inhibition of p53 and MAPK pathways. CETSA, DARTS, and molecular docking further showed that ROS-generating enzyme nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 4 (NOX4) may be the target of SBE. Overexpression of NOX4 partially impaired the anti-ferroptotic activity of SBE. CONCLUSION: Our results demonstrated that SBE mitigated COPD by suppressing p53 and MAPK pro-ferroptosis pathways via directly scavenging ROS and blocking NOX4. These findings also supported the clinical application of Sea buckthorn in COPD therapy.

Bilateral lung volume reduction surgery outperforms the unilateral approach in functional improvement.

OBJECTIVES: Lung volume reduction surgery is an established treatment approach for patients with severe pulmonary emphysema, enhancing lung function and quality of life in selected patients. Functional benefits and outcomes after uni- versus bilateral lung volume reduction remain a topic to debate. METHODS: A retrospective analysis of patients undergoing lung volume reduction surgery from January 2018 to October 2022 was conducted. After encouraging initial results, the standard unilateral lung volume reduction surgery approach was switched to bilateral. This study aimed to assess the impact on functional outcomes at three and six months post-surgery compared to preoperative levels for the uni- versus bilateral approach. RESULTS: A total of 83 patients were included (43 bilateral, 40 unilateral). Baseline demographic and functional parameters were comparable between groups. The most common complication was prolonged air leak occurring in 19 patients (11 in unilateral group, 8 in bilateral group). Two patients died perioperatively (2.4%). Overall, lung volume reduction surgery improved Forced Expiratory Volume in 1 second by 8.3% after 3 and 12.5% 6 months postoperatively compared to baseline. Bilateral surgery presented significantly superior Forced Expiratory Volume in 1 second improvement than unilateral approach at both 3 (29.2% versus 2.9%; p = 0.0010) and 6 months (21.5% versus 3%; p = 0.0310) postoperatively. Additionally, it reduced hyperinflation (residual volume) by 23.1% after 3 months and 17.5% after 6 months, compared to reductions of 16% and 9.1% in the unilateral group. CONCLUSIONS: Bilateral approach resulted in better functional outcomes 3 and 6 months postoperatively compared to unilateral surgery.

[Clinical-demographic characteristics of tracheostomized patients with chronic obstructive pulmonary disease] / Características clínico-demográficas de pacientes traqueostomizados con enfermedad pulmonar obstructiva crónica.

Tracheostomy (TQT) has emerged as a valuable alternative for patients with orotracheal intubation, especially those under prolonged mechanical ventilation (VMP), as in the case of chronic obstructive pulmonary disease (COPD). This population presents additional challenges, and the available information regarding their progression in specialized centers is limited in Argentina.A descriptive, retrospective, and cross-sectional study was conducted at Santa Catalina Neurorehabilitation Clinic between August 2015 and December 2018. Patients with COPD referred to the Intensive Care Unit (ICU), tracheostomized, and subsequently referred to the Center for Ventilation Disconnection and Rehabilitation (CDVMR) were included. Cases with missing data or derived from other CDVMRs were excluded. Clinical records and interviews were employed to collect demographic and progression data.Out of the 27 COPD patients included (4.9% of 555), the majority were males (63%) with an average age of 68.1 years. Most were admitted with AVMi, and 11 (45.8%) were successfully disconnected, while 11 (40.7%) were decannulated. Survival and home discharge were more frequent in decannulated patients (81.8% were discharged) compared to non-decannulated ones (50% deceased, and none were discharged).COPD patients undergoing TQT and VMP, who succeed in being decannulated, seem to have better prospects for survival and home discharge compared to those who do not have the cannula removed. There is a suggestion for the need for additional analytical studies to confirm these findings and improve the understanding of this specific population.

La traqueostomía (TQT) es una una alternativa valiosa para pacientes con intubación orotraqueal, especialmente aquellos bajo ventilación mecánica prolongada (VMP), como en el caso de la enfermedad pulmonar obstructiva crónica (EPOC). Esta población presenta desafíos adicionales,  la información disponible sobre su evolución en centros especializados es limitada en Argentina.Se realizó un estudio descriptivo, retrospectivo y transversal en  Santa Catalina Neurorehabilitación Clínica entre agosto de 2015 y diciembre de 2018. Se incluyeron pacientes EPOC derivados a la unidad de terapia intensiva (UTI), traqueostomizados y posteriormente remitidos al Centro de Desvinculación de Ventilación Mecánica y Rehabilitación (CDVMR). Se excluyeron casos con datos faltantes o derivados de otros CDVMR. Se emplearon registros clínicos y entrevistas para recolectar datos demográficos y de evolución.De los 27 pacientes con EPOC incluidos (4.9% de 555), la mayoría eran hombres (63%) con una edad promedio de 68.1 años. La mayoría ingresó con AVMi, y se logró desvincular a 11 (45.8%) y decanular a 11 (40.7%) pacientes. La sobrevida y el alta domiciliaria fueron más frecuentes en pacientes decanulados (81.8% recibieron el alta) en comparación con los no decanulados (50% fallecieron y ninguno recibió el alta).Los pacientes EPOC sometidos a TQT y VMP, que logran ser decanulados, parecerían tener mejores perspectivas de sobrevida y alta domiciliaria en comparación con aquellos que no se les retira la cánula. Se sugiere la necesidad de estudios analíticos adicionales para confirmar estos hallazgos y mejorar la comprensión de esta población específica.

Predictive Value of CCQ and its Subdomains for Hospitalized Exacerbations in Chronic Obstructive Pulmonary Disease: A 3-Year Observational Prospective Study.

BACKGROUND: The prediction capacity of the Clinical COPD Questionnaire (CCQ) and its functional, symptom, and mental subdomain for COPD hospitalized exacerbation were rarely studied. OBJECTIVE: To examine the prognostic capacity of the total CCQ and its three subdomains for 3-year COPD hospitalized exacerbations. METHODS: We analyzed the predictive ability of total CCQ score and its subdomains for hospitalized exacerbations in an observational cohort of 987 subjects with stable COPD from the RealDTC, an ongoing multicenter prospective study. Hospitalized exacerbations were prospectively collected every 6 month for a maximum of 3 years. RESULTS: The total CCQ and its functional and symptom domain, but not the mental domain, were significantly associated with 3-year hospitalized exacerbations by multivariate Cox regression analysis. The predictive capacity of functional domain was similar to that of the total CCQ, but significantly stronger than the symptom and mental domain by ROC analysis (P < 0.05). ROC curves also showed that the AUC of exacerbation history combined with CCQ functional domain was larger than that of exacerbation history alone (P < 0.0001). Additionally, the predictive value of multivariable models that contains CCQ functional domain was significantly better than the corresponding model without CCQ functional domain (P < 0.05). CONCLUSIONS: The total CCQ and its functional and symptom domain were independent risk factors of 3-year hospitalized exacerbations. The prognostic capacity of the functional domain was similar to that of total CCQ, and was significantly stronger than the symptom and mental domain. The CCQ functional domain was able to increase the predictive power of exacerbation history and other multivariable prediction models, indicating it may have an important role in the multivariable prediction tool for hospitalized exacerbation, and its combination with other clinical variables might be used as a low-cost approach for assessments of the disease severity and severe exacerbation in COPD patients in the future.

Relationships between life-space mobility, physical function, and empowerment in patients with chronic obstructive pulmonary disease.

[Purpose] This study aimed to elucidate the relationship between the Life-Space Assessment measure, which conceptualizes physical activity in terms of life-space, and indicators of empowerment, and physical function, in stable patients with chronic obstructive pulmonary disease. [Participants and Methods] This was a cross-sectional study. The participants were 25 stable outpatients with chronic obstructive pulmonary disease (22 males, mean age 75.6 ± 6.1 years). Measurements included the Life-Space Assessment; the Empowerment Scale for the Elderly; respiratory function; grip strength; weight-adjusted knee extension strength; and a six-minute walk test. Pearson's correlation coefficient and a multivariate analysis were used to examine the relationship between the Life-Space Assessment and each indicator, with the significance level set at 5%. [Results] The Life-Space Assessment score (83.4 ± 23.7 points) correlated with the percentage forced vital capacity and the six-minute walk distance. However, the Life-Space Assessment demonstrated no association with the Empowerment Scale for the Elderly (38.3 ± 7.0 points). [Conclusion]The results of this study suggest that physical function correlates with scores on the Life-Space Assessment in patients with stable chronic obstructive pulmonary disease.

RESP-FIT: A Technology-Enhanced Combined Inspiratory and Expiratory Muscle Strength Training Intervention for Adults With COPD.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease associated with respiratory muscle weakness and activity-limiting symptoms such as dyspnea. Respiratory muscle strength training (RMST) is an empirically validated therapy to increase respiratory muscle strength. The theoretically-informed, technology-enhanced RESP-FIT intervention for COPD is a 6-week combined inspiratory and expiratory muscle strength training program with symptom measurement in real time via ecological momentary assessment (EMA). Objectives: In addition to hypothesis generating purposes, the purpose of this randomized control pilot study was to explore whether observed effects (on symptoms, patient-reported outcomes, and respiratory muscle strength) support carrying out a future large-scale trial of RESP-FIT. Methods: Thirty adults with COPD were randomized to intervention (n=15) or control, with intervention group undergoing 6 weeks of mHealth-enhanced RMST. Daily symptom data were collected in real time over the 6-week intervention period using EMA. Results: Compared to the control group, participants in the intervention group reported decreased dyspnea and anxiety, increased happiness, and improved respiratory muscle strength (PIMax). However, reports of fatigue and sleep disturbance increased in the intervention group compared to the control group. Conclusion: Results support the hypothesis that the 6-week RESP-FIT program will improve respiratory muscle strength, emotional state (anxiety and happiness), and breathlessness in COPD but may contribute to fatigue, at least in the short-term. Future work is needed to determine efficacy of RESP-FIT, determine mechanisms of action on dyspnea and fatigue, and conduct within-subject comparisons of EMA data to explore individual or environmental fluctuations in COPD symptoms.

Etiology and epidemiology of acute exacerbations of chronic obstructive pulmonary disease in Eastern Nepal: a narrative review.

This narrative review aims to examine the etiology and epidemiology of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in Eastern Nepal. A systematic search was conducted to identify relevant studies published in English, focusing on combinations of keywords such as "acute exacerbation of chronic obstructive pulmonary disease," "AECOPD," "Nepal," "etiology," "epidemiology," "environmental exposure," "comorbidities," and "socioeconomic factors." Synthesizing findings from recent studies, it highlights the multifactorial nature of AECOPD, including the roles of respiratory infections, environmental exposures, and comorbidities. Key findings indicate that respiratory infections (both viral and bacterial) and non-infectious factors such as air pollution and biomass fuel combustion significantly contribute to AECOPD. Socio-economic factors, particularly among women using traditional biomass fuels and engaged in smoking, also play a critical role. The review emphasizes the need for targeted interventions and preventive strategies to manage AECOPD effectively in this region. Conclusions suggest that understanding local patterns of AECOPD etiology is crucial for developing region-specific interventions to reduce exposure to risk factors and manage comorbidities, thereby improving clinical outcomes and reducing healthcare utilization.

HMGB1 promotes M1 polarization of macrophages and induces COPD inflammation.

Chronic obstructive pulmonary disease (COPD) is a pervasive and incapacitating respiratory condition, distinguished by airway inflammation and the remodeling of the lower respiratory tract. Central to its pathogenesis is an intricate inflammatory process, wherein macrophages exert significant regulatory functions, and High mobility group box 1 (HMGB1) emerges as a pivotal inflammatory mediator potentially driving COPD progression. This study explores the hypothesis that HMGB1, within macrophages, modulates COPD through inflammatory mechanisms, focusing on its influence on macrophage polarization. Our investigation uncovered that HMGB1 is upregulated in the context of COPD, associated with an enhanced proinflammatory M1 macrophage polarization induced by cigarette smoke. This polarization is linked to suppressed cell proliferation and induced apoptosis, indicative of HMGB1's role in the disease's inflammatory trajectory. The study further implicates HMGB1 in the activation of the Nuclear factor kappa-B (NF-κB) signaling pathway and chemokine signaling within macrophages, which are likely to amplify the inflammatory response characteristic of COPD. The findings underscore HMGB1's critical involvement in COPD pathogenesis, presenting it as a significant target for therapeutic intervention aimed at modulating macrophage polarization and inflammation.

Interpretable machine learning uncovers epithelial transcriptional rewiring and a role for Gelsolin in COPD.

Transcriptomic analyses have advanced the understanding of complex disease pathophysiology including chronic obstructive pulmonary disease (COPD). However, identifying relevant biologic causative factors has been limited by the integration of high dimensionality data. COPD is characterized by lung destruction and inflammation with smoke exposure being a major risk factor. To define novel biological mechanisms in COPD, we utilized unsupervised and supervised interpretable machine learning analyses of single cell-RNA sequencing data from the gold standard mouse smoke exposure model to identify significant latent factors (context-specific co-expression modules) impacting pathophysiology. The machine learning transcriptomic signatures coupled to protein networks uncovered a reduction in network complexity and novel biological alterations in actin-associated gelsolin (GSN), which was transcriptionally linked to disease state. GSN was altered in airway epithelial cells in the mouse model and in human COPD. GSN was increased in plasma from COPD patients, and smoke exposure resulted in enhanced GSN release from airway cells from COPD patients. This method provides insights into rewiring of transcriptional networks that are associated with COPD pathogenesis and provide a novel analytical platform for other diseases.

Nuts and bolts of lung ultrasound: utility, scanning techniques, protocols, and findings in common pathologies.

Point of Care ultrasound (POCUS) of the lungs, also known as lung ultrasound (LUS), has emerged as a technique that allows for the diagnosis of many respiratory pathologies with greater accuracy and speed compared to conventional techniques such as chest x-ray and auscultation. The goal of this narrative review is to provide a simple and practical approach to LUS for critical care, pulmonary, and anesthesia providers, as well as respiratory therapists and other health care providers to be able to implement this technique into their clinical practice. In this review, we will discuss the basic physics of LUS, provide a hands-on scanning technique, describe LUS findings seen in normal and pathological conditions (such as mainstem intubation, pneumothorax, atelectasis, pneumonia, aspiration, COPD exacerbation, cardiogenic pulmonary edema, ARDS, and pleural effusion) and also review the training necessary to achieve competence in LUS.

The critical roles of caveolin-1 in lung diseases.

Caveolin-1 (Cav-1), a structural and functional component in the caveolae, plays a critical role in transcytosis, endocytosis, and signal transduction. Cav-1 has been implicated in the mediation of cellular processes by interacting with a variety of signaling molecules. Cav-1 is widely expressed in the endothelial cells, smooth muscle cells, and fibroblasts in the various organs, including the lungs. The Cav-1-mediated internalization and regulation of signaling molecules participate in the physiological and pathological processes. Particularly, the MAPK, NF-κB, TGFß/Smad, and eNOS/NO signaling pathways have been involved in the regulatory effects of Cav-1 in lung diseases. The important effects of Cav-1 on the lungs indicate that Cav-1 can be a potential target for the treatment of lung diseases. A Cav-1 scaffolding domain peptide CSP7 targeting Cav-1 has been developed. In this article, we mainly discuss the structure of Cav-1 and its critical roles in lung diseases, such as pneumonia, acute lung injury (ALI), asthma, chronic obstructive pulmonary disease (COPD), pulmonary hypertension, pulmonary fibrosis, and lung cancer.

Socioeconomic status and emergency department visits in adults with a history of severe childhood asthma: a register-based study.

Background and Objective: Our knowledge of socioeconomic status (SES) and emergency department (ED) visits in adults with a history of severe childhood asthma is limited. Our aim was, therefore, to investigate these variables in individuals with a history of severe childhood asthma compared to a control population. Methods: The Kongsberg cohort comprises Danish individuals with a history of severe childhood asthma and a previous 4-month stay at an asthma care facility in Kongsberg, Norway, between 1950 and 1979. The cohort was compared 1:1 to sex and age matched controls with no previous diagnosis of or treatment for obstructive airway disease (OAD). Data from the national Danish health registries were used for comparing cases and controls. Results: A total of 1394 adults from the Kongsberg cohort were alive and residing in Denmark (mean age 63 years, 43% females) at the index date (June 2022). A Charlson comorbidity index score of ≥1 was higher in the study cohort compared to controls (7% versus 3%) (p < 0.01). Cases had a 1.5-fold increased likelihood of having a high educational level (p < 0.001) compared to controls. Compared to the controls, cases had a higher risk of all-cause ED visits, with individuals having lower educational levels showing the highest proportion of ED visits. Furthermore, 31.2% and 22.9%, respectively, of cases and controls with high educational levels had had ED visits. Compared to controls, logistic regression analysis revealed a 1.7-fold higher risk of all-cause ED visits in cases (p < 0.001). Conclusions: In adults with a history of severe childhood asthma, educational level, comorbidity burden, and risk of ED visit were higher compared to matched controls with no history of obstructive airway disease.

Peak Inspiratory Flow and Inhaler Prescription Strategies in a Specialized COPD Clinical Program: A Real-World Observational Study.

BACKGROUND: COPD inhaler regimens should be appropriate for the patient's peak inspiratory flow (PIF) and should ideally consist of single or similar device(s). RESEARCH QUESTIONS: In a subspecialized COPD clinic: 1: What is the prevalence of patients with suboptimal PIF and with inappropriate device(s) for measured PIF? 2: Are there patient-related risk factors associated with suboptimal PIF? 3: What is the prevalence of patients with non-single inhaler therapy (SIT)/non-similar devices? 4: Does point-of-care PIF affect clinical decision-making? STUDY DESIGN AND METHODS: In this single-center real-world observational study, PIF was measured systematically at every outpatient visit in a subspecialized COPD clinic and point-of-care results were provided to the clinician. Co-primary outcomes were the prevalence of outpatients with suboptimal PIF and with inappropriate devices for measured PIF. Secondary outcomes were patient-related risk factors associated with suboptimal PIF, the prevalence of non-SIT/non-similar devices, the prevalence of regimens consisting of either inappropriate device(s) for measured PIF and/or non-SIT/non-similar devices, and the effect of point-of-care PIF on clinical decision-making. RESULTS: Suboptimal PIF was identified in 45 of 161 participants (28%) and inappropriate device(s) for measured PIF were identified in 18 (11.2%) participants. Significant associations were observed between suboptimal PIF and age (1.09 [1.04,1.15]), female sex (10.30 [4.45,27.10]), height (0.92 [0.88,0.96]), BMI (0.90 [0.84,0.96]) and FEV1 (0.09 [0.03,0.26]). Following adjustment for age and sex, the association between suboptimal PIF and BMI, but not height, remained significant. Non-SIT and/or non-similar devices were identified in 50 (31.1%) participants. Regimens consisting of either inappropriate device(s) for measured PIF and/or non-SIT/non-similar devices were observed in fifty-nine (36.6%) participants. Inhaler prescription changes were observed in this latter group (3.39 [1.76,6.64]), as well as in patients with suboptimal PIF already on SIT/similar regimens (2.93 [1.07,7.92]). INTERPRETATION: Suboptimal PIF and inappropriate devices for measured PIF are highly prevalent in outpatients from a subspecialized COPD clinic. Female sex, reduced FEV1 and low BMI are important, readily identifiable risk factors for suboptimal PIF and point-of-care PIF can inform clinical decision-making.

The effect of telemedicine employing telemonitoring instruments on readmissions of patients with heart failure and/or COPD: a systematic review.

Background: Hospital readmissions pose a challenge for modern healthcare systems. Our aim was to assess the efficacy of telemedicine incorporating telemonitoring of patients' vital signs in decreasing readmissions with a focus on a specific patient population particularly prone to rehospitalization: patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) through a comparative effectiveness systematic review. Methods: Three major electronic databases, including PubMed, Scopus, and ProQuest's ABI/INFORM, were searched for English-language articles published between 2012 and 2023. The studies included in the review employed telemedicine incorporating telemonitoring technologies and quantified the effect on hospital readmissions in the HF and/or COPD populations. Results: Thirty scientific articles referencing twenty-nine clinical studies were identified (total of 4,326 patients) and were assessed for risk of bias using the RoB2 (nine moderate risk, six serious risk) and ROBINS-I tools (two moderate risk, two serious risk), and the Newcastle-Ottawa Scale (three good-quality, four fair-quality, two poor-quality). Regarding the primary outcome of our study which was readmissions: the readmission-related outcome most studied was all-cause readmissions followed by HF and acute exacerbation of COPD readmissions. Fourteen studies suggested that telemedicine using telemonitoring decreases the readmission-related burden, while most of the remaining studies suggested that it had a neutral effect on hospital readmissions. Examination of prospective studies focusing on all-cause readmission resulted in the observation of a clearer association in the reduction of all-cause readmissions in patients with COPD compared to patients with HF (100% vs. 8%). Conclusions: This systematic review suggests that current telemedicine interventions employing telemonitoring instruments can decrease the readmission rates of patients with COPD, but most likely do not impact the readmission-related burden of the HF population. Implementation of novel telemonitoring technologies and conduct of more high-quality studies as well as studies of populations with ≥2 chronic disease are necessary to draw definitive conclusions. Systematic Review Registration: This study is registered at the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), identifier (INPLASY202460097).

A comprehensive review of Mycoplasma pneumoniae infection in chronic lung diseases: recent advances in understanding asthma, COPD, and bronchiectasis.

This review summarizes the research progress over the past 30 years on the relationship between Mycoplasma pneumoniae infection and chronic respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis. Mycoplasma pneumoniae is a common cause of community-acquired pneumonia, particularly in children and young adults. Key findings from recent studies indicate that M. pneumoniae infection is associated with a higher risk of asthma exacerbations and may contribute to the development of bronchiectasis in susceptible individuals. Additionally, emerging evidence suggests that M. pneumoniae-induced immune dysregulation plays a crucial role in the pathogenesis of chronic lung diseases. This review aims to summarize the current understanding of the potential links between M. pneumoniae pneumonia and various chronic respiratory conditions, including asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis. We discuss the epidemiological data, pathogenic mechanisms, clinical manifestations, and long-term consequences of M. pneumoniae-related respiratory illnesses. Additionally, we highlight the challenges in diagnosis and treatment, as well as future research directions in this field.

Suboptimal Peak Inspiratory Flow in Patients Hospitalized for COPD Exacerbation: Prevalence and Predictive Factors.

Introduction: Despite the importance of an adequate peak inspiratory flow (PIF) during inhaled therapy in patients with COPD, the available evidence in patients with severe exacerbations and their evolution after admission is limited. We conducted this study to evaluate the PIF during an exacerbation, its variability, and predictors of suboptimal PIF. Material and Methods: A prospective study that included patients admitted for COPD exacerbation. Clinical, demographic, and functional variables were recorded. Using the In-Check DIAL G16®, PIF without resistance (PIF-nr) and that obtained by simulating the resistance of the patients' usual inhalers (PIF) were determined within the first 48 hours of admission and prior to discharge; also assessed during a stable phase in a subgroup of patients. The results were compared and, through a multivariate study, the factors related to a suboptimal PIF were analyzed. Results: A total of 137 patients were included; 27% were women and the mean age was 69.4 ± 9.8 years. Moreover, 30.8% of the participants with dry powder inhalers had a suboptimal PIF at admission and it was independently associated with female sex (odds ratio [OR] = 8.635; 95% confidence interval [CI] [2.007, 37.152]; p < 0.01) and forced expiratory volume in the 1st second (FEV1) (OR = 0.997; 95% CI: [0.995, 0.999]; p = 0.04). At discharge, suboptimal PIF reduced to 17% (p < 0.01). PIF-nr increased from the time of admission to the stable phase. Conclusion: One third of COPD patients admitted with a severe exacerbation had a suboptimal PIF, being female sex and lower FEV1 independent predictors. PIF-nr improved progressively after the exacerbation.

[Efficacy and toxicity of short-course corticosteroid therapy in chronic bronchial diseases]. / Efficacité et toxicité de la corticothérapie en cures courtes dans les pathologies bronchiques chroniques.

Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) are characterized by airway inflammation. While corticosteroids (CS) are frequently prescribed during exacerbations of these conditions, their repeated use is associated with numerous side effects. The aim of this review is to synthesize the recent literature on the indications, benefits, and risks of short-term CS therapy for these two diseases. French guidelines recommend short-term CS as a first-line treatment during asthma exacerbation (0,5 to 1mg/kg/day, not exceeding 60mg/day, for at least 5 to 7 days) or as a second-line treatment for COPD exacerbation (5 days, 30 to 40mg/day). However, these recommendations are not without limitations; they are primarily based on studies conducted in hospital settings, raising questions about the generalizability of their results to primary care, and as they employ a "one size fits all" strategy, they do not take into account the phenotypic heterogeneity of different patients. Moreover, repeated short-term CS courses generate side effects that even at low doses can appear early in young asthma patients, and they can exacerbate pre-existing comorbidities in COPD patients. The concept of a threshold dose should be employed in routine practice in view of accurately assessing the risk of side effects. In the near future, it will be important to consider recently published data supporting the use of predictive biomarkers for responses to CS, particularly in COPD cases.