Chronic Respiratory Disease最新文献

Inhaled therapies remain the cornerstone in managing chronic airway diseases, offering direct treatment delivery to the lungs with minimal systemic adverse effects. With advancements in respiratory care, digital inhalers have emerged as a transformative innovation. Their functions extend beyond delivering inhaled medication, providing deeper insights into patients' medication use behaviour and intervening through complementary platform features and integrated data analytics. However, despite being available for over two decades, the widespread adoption of digital inhaler platforms remains limited due to uncertainties regarding their cost-effectiveness, feasibility in real-world settings, and concerns regarding sustainability. Identifying patient groups that could benefit most from these technologies and designing strategies for effective deployment across diverse healthcare contexts is important. To achieve this, bridging the gap between innovation and accessibility is required so that digital inhaler platforms evolve into inclusive, patient-centred tools rather than niche technologies. This narrative review provides a summary of the evolution and current landscape of digital inhaler technology, its impact on clinical outcomes in chronic airway disease, and key challenges that stakeholders should address for the successful integration of these tools into respiratory care. We also propose key components of a patient-centred digital inhaler adherence support model that prioritises accessibility and efficacy.

BackgroundChronic obstructive pulmonary disease (COPD) is a heterogeneous and chronic condition characterized by irreversible airflow obstruction. Health literacy may influence the use of complementary and alternative medicine (CAM). This study aims to investigate the role of health literacy in the use of CAM among COPD patients.MethodsThis cross-sectional study was conducted at Ankara University School of Medicine, Department of Chest Diseases, involving patients with COPD between August 2024 and June 2025. Clinical COPD Questionnaire (CCQ) and Health Literacy Scale-Short Form (HLS-SF) were used to assess disease severity and health literacy, respectively.ResultsAmong 190 patients, inadequate and limited health literacy was more common among CAM users compared to non-users (n = 54/89, 61% vs n = 37/101, 37%, respectively, p = 0.007). CAM users were also more likely to have insufficient social support (n = 24/89, 25%, p = 0.047), cough (n = 79/89, 89%, p = 0.049), history of ICU admission (n = 19/89, 21%, p = 0.02), use of long-term oxygen therapy and noninvasive ventilation (n = 50/89, 56% p = <0.001; n = 26/89, 30%, p = <0.001, respectively), had higher rates of GOLD E classification (47/89, 55%, p = <0.001), and had higher median CCQ total scores as 2.78 [Interquantiler Range (IQR): 1.4-4.1, p = 0.002]. Inadequate and limited health literacy was significant predictors of CAM use (OR: 3.78; 95% CI: 1.25-11.4, p = 0.018; OR: 6.78, 95% CI: 1.63-28.0, p = 0.008, respectively), as well as GOLD E classification (OR: 2.71, 95% CI: 1.14-6.45, p = 0.024) and insufficient social support (OR: 2.56, 95% CI: 1.00-6.50, p = 0.048) after adjusting for age, sex, education, and comorbidities.DiscussionThis study revealed the association between COPD symptom severity and frequent exacerbation, insufficient social support, along with lower health literacy and the use of CAM.

Background: The efficacy and safety of ensifentrine, a novel PDE3/PDE4 inhibitor, were previously evaluated in the ENHANCE-1 (NCT04535986) and ENHANCE-2 (NCT04542057) trials. Here, we present a pooled post-hoc subgroup analysis of patients according to background chronic obstructive pulmonary disease (COPD) maintenance medication regimens.

Objective: This analysis aimed to explore the efficacy and safety of ensifentrine in patients receiving long-acting muscarinic antagonists (LAMA) or long-acting beta-agonists with inhaled corticosteroids (LABA + ICS).

Methods: Eligible patients had moderate to severe COPD, were aged 40-80 years, and were symptomatic at randomization. Patients were randomized 5:3, receiving twice-daily ensifentrine 3 mg or placebo via standard jet nebulizer over 24 weeks.

Results: The pooled post-hoc analysis included 485 LAMA patients and 272 LABA + ICS patients. Ensifentrine showed lung function improvement over placebo at week 12, including average FEV₁ AUC_0-12 h in the LAMA (placebo-corrected least squares mean change from baseline [LSMC], 92 mL; 95% CI, 54, 131; p < 0.001) and LABA + ICS subgroups (LSMC, 74 mL; 95% CI, 27, 121; p = 0.002). Ensifentrine reduced the rate and risk of exacerbations in both LAMA (48% and 50%, respectively) and LABA + ICS (51% and 56%, respectively) subgroups. Ensifentrine-treated patients reported improvement in symptoms and quality of life over 24 weeks. The safety profile of ensifentrine in each subgroup was similar to the profile in the pooled modified intention-to-treat population.

Conclusions: Nebulized ensifentrine offers a novel non-steroidal anti-inflammatory and bronchodilator treatment added to existing LAMA or LABA + ICS treatment options in patients with moderate to severe, symptomatic COPD.

ObjectivesDiabetes is a common comorbidity in COPD population. This study aimed to explore the impacts of T2DM on clinical characteristics and outcomes of patients with exacerbation of COPD, as well as develop a specified prognostic model for these patients.MethodsAECOPD patients were enrolled from a prospective, noninterventional, multicenter cohort study. Propensity score matching with a 1:2 ratio was performed to compare the characteristics and prognosis between patients with and without T2DM. Predictors for short-term mortality were determined by logistic regression analysis and a prediction nomogram were established and further validated in another cohort.ResultsA total of 1804 AECOPD patients with T2DM and 3608 matched patients without T2DM were included. AECOPD patients with T2DM presented with worse disease profile and prognosis. Eight independent predictors for short-term mortality were determined, including advanced age, disturbance of consciousness, chronic cardiac disease, low blood pressure, high heart rate, elevated neutrophil, urea nitrogen and random blood glucose. A prognostic nomogram was established with an AUC of 0.878 (95%CI: 0.842-0.915) in derivation cohort and 0.834 (95% CI: 0.767-0.901) in validation cohort, which was superior to DECAF (0.647 [95%CI: 0.535-0.760]) and BAP-65 score (0.758 [95%CI: 0.666-0.850]). The calibration curve and decision curve analysis also indicated its accuracy and applicability. Besides, a web calculator based on the nomogram was constructed to simplify the use of prognostic nomogram in clinical practice.ConclusionsComorbid diabetes is significantly associated with severe disease profile and worse prognosis in AECOPD population. Our nomogram may help to facilitate early risk assessment and proper decision-making among patients with AECOPD and T2DM.

A 57-year-old female presented with a chief complaint of cough, with productive yellow sputum particularly severe in the morning. Bronchoscopy revealed inflammatory changes in both main bronchi, with abundant white purulent secretions and necrotic material adhering to the luminal surface. Histopathological examination showed chronic inflammatory changes in the mucosal tissue, with mild hyperplasia of the local squamous epithelium and evidence of keratinization in the surrounding area, consistent with a diagnosis of tracheal mucosal keratosis. The patient was treated with anti-infection therapy, combined with symptomatic supportive treatments such as cough suppression, expectorants, and bronchodilation, resulting in an improvement of symptoms. Analysis of previous literature revealed that although this condition lacks specific clinical manifestations and signs, it exhibits a typical pattern of tracheal wall lesions, and bronchoscopy and histopathological examination have high diagnostic value for this disease. Due to impaired airway mucosal barrier function, the patient is prone to bacterial infection or colonization in the airways. Symptomatic supportive treatment based on the actual condition can effectively alleviate the patient's clinical symptoms. Currently, there is no definitive curative treatment for tracheal mucosal keratosis. However, treatments such as high-frequency electrocautery, carbon dioxide cryotherapy, and repeated lavage with epidermal growth factors may be helpful in curing this condition.

Introduction: Pulmonary rehabilitation (PR) services are increasingly using alternative programme delivery modes, for example telerehabilitation strategies including videoconferencing, to improve patient choice and accessibility. Although telerehabilitation results in improvements in core outcomes, the effect on knowledge attainment is not known. Aim: To observe the real-world responses of patients choosing to undergo videoconference PR to a matched control group choosing to undergo in-person PR, in terms of knowledge attainment. Methods: Using propensity score matching, 25 people with COPD who completed videoconference PR were matched 1:1 with a control group of 25 people with COPD who completed in-person PR. Knowledge attainment was measured using the Lung Information Needs Questionnaire (LINQ). Results: There was a statistically and clinically significant improvement in LINQ score in both groups (mean (95%CI): videoconference -3.2 (-4.7 to -1.6); in-person -3.0 (-4.5 to -1.4)), with no significant between-group difference (mean (95%CI): 0.2 (-2.0 to -2.4)). 76% and 80% of participants achieved the minimal important difference of the LINQ in the videoconference and in-person PR groups respectively. Conclusion: In conclusion, this real-world service evaluation indicates that videoconference PR may be associated with similar improvements in knowledge attainment as in-person PR, but this requires corroboration due to the small sample size.

Objectives: To assess real-world survival and healthcare resource utilization (HCRU) in US patients with non-cystic fibrosis bronchiectasis (NCFBE).

Methods: This retrospective analysis, using data from the STATinMED RWD Insights database from Jan 2015-Oct 2022, included adults with NCFBE (from Jan 2015-Oct 2021) and non-NCFBE comparators (from Jan 2015-Aug 2020); baseline characteristics were balanced by inverse probability treatment weighting. Outcomes included survival through end of study. HCRU was assessed over 12 months.

Results: 117,718 patients with NCFBE and 306,678 comparators were included. Patients with NCFBE had a 77% higher risk of death than comparators (hazard ratio [HR] 1.77 [95% CI 1.74-1.80]). Risk of death was higher among patients aged ≥65 years (vs 18-34 years; HR 11.03 [95% CI 10.36-11.74]), among Black patients (vs White; HR 1.53 [95% CI 1.50-1.55]), and among patients with comorbid COPD (HR 1.42 [95% CI 1.40-1.44]). Patients with NCFBE incurred higher all-cause and respiratory-related HCRU than comparators for outpatient office, outpatient hospital, emergency department (ED), inpatient and respiratory-related pulmonologist visits (all p < .0001); HCRU increased with exacerbations.

Conclusions: Patients with NCFBE have high mortality burden and incur high HCRU, both of which are further increased with exacerbations. Prevention and delay of exacerbations are key areas for improvement of disease management.

Objectives: This study aimed to identify educational needs of people with COPD or asthma referred for pulmonary rehabilitation and their significant others. Methods: In this cross-sectional study, information needs were assessed by the Lung Information Needs Questionnaire. Learning styles were assessed with a multiple-choice question (visual, aural, read/write and kinaesthetic - multiple choices were possible). Psychological profiles were assessed by an instrument distinguishing four profiles: fighter, analyst, optimist or sensitive. Results: 121 patients (57% female; age: 65 ± 10 years; 81% COPD) and 67 significant others (55% female; age: 61 ± 12 years) were included. Patients and their significant others had a variety of information needs. Patients and their significant others mostly preferred the aural (39% and 49%, respectively) and read/write learning styles (31% and 36%, respectively) as unimodal learners. 49% of patients and 51% of significant others preferred more than one learning style. Most prevalent psychological profiles were optimist in patients (36%) and fighter in significant others (59%). Discussion: The identified variety in educational needs among people with COPD or asthma and their significant others underlines the importance of addressing this diversity of individual needs in education. Learners should have the opportunity to choose among a variety of topics and have access to multiple learning styles. Furthermore, educational interventions should consider to incorporate different communication strategies.

BackgroundIdentifying clinical and socio-economic predictors of adverse health outcomes in chronic obstructive pulmonary disease (COPD) patients is imperative for reducing exacerbation and mortality rates.MethodsThe COPD Community Disease Management (COPD-CDM) clinical trial evaluated the efficacy of a disease management program among 1202 ambulatory COPD patients receiving recommended care. The study did not find disease management to be superior to recommended care only, in preventing COPD hospital admissions or mortality. This post-hoc analysis examined the association of clinical and socioeconomic parameters with the length of in-hospital stay and all-cause mortality by multivariable non-linear mixed and Cox proportional hazards models, adjusted for age, sex, study arm, recruitment and study period, and medical therapy.ResultsA one-point increment in the Modified Medical Research Council dyspnea scale was associated with a higher hazard for all-cause mortality, (Hazards Ratio [HR]:1.50, 95% confidence interval [CI]: 1.22-1.85); longer in-hospital stay for COPD or all causes; Rate Ratio (95% CI): 1.64 (1.36-1.98), and 1.36 ( 1.19-1.55), respectively. A 50 m increment in six-minute walking distance was associated with fewer days in-hospital for both COPD and all causes; Rate Ratio (95% CI); 0.94 (0.89-0.99) and 0.95 (0.92-0.99), respectively. Unemployment and lower educational attainment were associated with a longer in-hospital stay both for COPD and all causes.ConclusionsClinical and socioeconomic parameters were associated with the number of days in hospital for COPD and all-causes, and all-cause mortality in ambulatory COPD patients. Our findings support the importance of a multi-disciplinary pulmonary approach to improve clinical outcomes among COPD patients.

Background: The paradigm of bronchiectasis is shifting away from its exclusive characterization as a neutrophilic condition. Patients with bronchiectasis and high eosinophil levels have been found to have a specific phenotype, but the clinical effect of eosinopenia remains unclear.

Method: A retrospective, single-center, observational study was conducted at a tertiary medical center. Adult patients under follow-up for bronchiectasis from January 2007 to August 2020 were categorized by blood eosinophil count (BEC) as follows: eosinopenia (<100 cells/µL), normal (100-299 cells/µL), and eosinophilia (≥300 cells/µL). Data on the first hospitalization due to exacerbation and the community exacerbation rate in the first year of follow-up were analyzed. Mortality rates were assessed up to the end of follow-up on September 1, 2023.

Results: The cohort included 724 patients (100%), 61% female (n = 442), of mean age 61 ± 16 years. The median follow-up period was 7.5 years (IQR: 5.1-10.8). Eosinopenia was found in 14.7% (n = 107), normal BEC in 56.6% (n = 417), and eosinophilia in 28.7% (n = 200). Patients with eosinopenia had a higher hazard ratio for first hospitalization than the normal-count group (1.71, 95% CI 1.11-2.64, p = .01) and the highest mean exacerbation rate (p = .04). On multivariate analysis, eosinopenia was significantly associated with higher mortality (HR 2.15, 95% CI 1.42-3.24, p < .001) after adjusting for age and sex.

Conclusion: Eosinopenia in bronchiectasis emerged as a potential biomarker for adverse outcomes. Further study of its role in disease behavior may provide insights for the development of therapeutic strategies.