COPD: Journal of Chronic Obstructive Pulmonary Disease最新文献

Chronic obstructive pulmonary disease (COPD) may be complicated by pulmonary hypertension (PH). We aimed to understand the impact of PH on in-hospital mortality and quantify the 30-day readmission rate among patients with COPD. For this cross-sectional study, we used the Nationwide Readmissions Database from 2017-2020 to identify adults ≥18 years with COPD. Patients were stratified according to PH diagnosis. Baseline characteristics between groups were compared using the Pearson chi-square test and two-sample t-test. Predictors of in-hospital mortality were determined using multivariate logistic regression analysis adjusted for demographics and confounders. The 30-day readmission rate and prevalence of PH subgroups by baseline COPD status were also obtained. There were 766,561 (7.43%) patients with concomitant PH and COPD among 10,312,543 patients with COPD. Patients with PH and COPD were older, female, and more often had a length of stay ≥7 days (all p < 0.001). Patients with PH suffered more from in-hospital mortality than those without PH (5.84% versus 3.94%, p < 0.001). PH predicted in-hospital mortality (adjusted odds ratio [aOR]: 1.22 [1.21-1.24], p < 0.001). COVID-19 (aOR: 6.20 [6.11-6.30]), metastatic cancer (aOR: 3.28 [3.23-3.32]), and moderate/severe liver disease (aOR: 3.09 [3.04-3.15]) were the strongest positive predictors of in-hospital mortality (all p < 0.001) in all patients with COPD. The 30-day readmission rate for the entire cohort was approximately 16%. Most patients had PH coded as unspecified/other.PH was associated with increased in-hospital mortality among patients with COPD, highlighting a high-risk group for targeted interventions to reduce morbidity and mortality.

Introduction: Chronic obstructive pulmonary disease (COPD) shows rising incidence worldwide. Progressive decline in lung function is characteristic for the disease and results in various signature COPD symptoms. A significant part of COPD-associated morbidity and mortality is due to acute exacerbations, which often require hospital usage, thus disproportionately impacting healthcare expenses. Novel digital health technologies allowing remote patient monitoring are desirable to improve COPD management by tailoring treatment- and follow-up strategies.

Methods: We here tested the feasibility and biomarker potential of smartphone-enabled cough monitoring during and after AECOPD in hospitalized patients. The study was designed as a single-center, prospective, longitudinal, observational cohort study and enrolled 23 subjects. A contact-free, near real-time, smartphone-enabled cough detection system was used for automated cough detection and quantification based on audio recordings. Cough counts were correlated to various clinical and biochemical markers.

Results: Cough levels were highest at study enrollment (approx. 15 coughs per hour) and gradually declined over time toward recovery (to below 5 coughs per hour) (incidence rate ratio (IRR): 0.97 [0.95-0.98], p < 0.001). There was a high degree of intra- and inter-patient variation of cough frequency and evolution. In addition, cough counts underlay significant diurnal regulation, with higher counts during daytime. Cough counts were inversely associated with oxygen saturation (IRR: 0.9 [0.87-0.95], p < 0.001) and correlated positively with body temperature (IRR: 2.00 [1.47-2.73], p < 0.001).

Discussion: Automated, contact-free, smartphone-enabled cough detection was feasible in COPD patients hospitalized for AECOPD. Cough counts declined over time and were associated with relevant clinical and biochemical markers. Our approach enables telemonitoring of AECOPD in near real-time and warrants further development to possibly establish cough count as an early digital biomarker for emerging AECOPD, allowing swift intervention and associated cost reductions.

This study aimed to evaluate the impact of rehabilitation on readmission rates among older patients requiring nursing care following with COPD following hospitalization for lower respiratory tract infection, focusing on whether initiating rehabilitation within two months post-discharge reduces readmissions. We conducted a retrospective observational study using insurance claim data in Kobe City, Japan, with a population of approximately 1.5 million. We included Patients with COPD aged 65 or older with certified care-need levels under Long-term Care Insurance system in Japan, hospitalized for lower respiratory tract infections and survived alive. Patients were classified based on their functional capacity in Activities of Daily Living (ADL). We used the extended Cox model to consider rehabilitation as time-varying exposure and assess the hazard ratios for readmission, adjusting for ADL. The ADL level was adjusted as a confounder. The survival probabilities were estimated among patients who experienced rehabilitation within two months and those who did not experience rehabilitation. Among 745 patients, 479 received rehabilitation within two months post-discharge, 105 received it later, and 161 did not receive rehabilitation. Participation in rehabilitation was associated with an increased hazard ratio for readmission (HR: 1.63, 95% CI: 1.19, 2.24), compared to those without it. The estimated survival curve of patients receiving rehabilitation within two months overlapped with that of those who did not receive rehabilitation. Rehabilitation following exacerbation in older patients with COPD who have disability may increase the risk of readmission after discharge. Healthcare providers should consider that patients with COPD with severe disability and complex needs may require staged, individualized rehabilitation.

In 2019, the U.S. Food and Drug Administration (FDA) issued a warning regarding the risk of serious respiratory depression in patients using gabapentin or pregabalin who have respiratory risk factors, including those with chronic obstructive pulmonary disorder (COPD). With the overall prescribing of gabapentinoids continuing to grow, there is the potential for inappropriate prescribing in this patient population. Data from the National Ambulatory Medical Care Survey (NAMCS) from 2013 to 2018, with the exception of 2017, was used to assess prevalence and predictors of gabapentinoid prescribing in patients with COPD. The data consists of 1,131 unweighted visits, representing approximately 53.6 million ambulatory care visits nationally. Of these visits, 146 patients (10.8%) with a COPD diagnosis were also prescribed a gabapentinoid, which represents more than a million office visits annually when weighted. Patients with an increased risk of receiving gabapentinoids were those with concomitant diabetes mellitus, concurrent opioid use, and those currently using tobacco. Due to increased risk of serious respiratory depression caused by gabapentinoids, prescribers should take caution when prescribing to individuals with COPD and other respiratory risk factors. Based on the reviewed prescribing patterns, more education is needed to inform providers about the risks associated with concomitant COPD and gabapentinoid use.

Background: Oxidative/anti-oxidative stress unbalance is one of the mechanisms of chronic obstructive pulmonary disease (COPD). Anion has been shown to be effective to eliminate reactive oxygen species, yet it is unknown if inhalation of anion (IA) can be beneficial for COPD intervention.

Methods: COPD model mice were established by cigarette smoke (CS) exposure in combination with tracheal instillation of LPS, and treated with various dosages of IA for 120 days. Pulmonary function, inflammatory mediators, anti-oxidatives and collagen deposition level were measured to evaluate the therapeutic effects of IA in COPD model mice. The pathological morphology and structure of lung, liver, renal, spleen, heart, and brain were analyzed to assess the safety of IA.

Results: IA improved COPD mice pulmonary function, reversed the decrease in SOD in blood serum and lung tissue, and increased the anti-oxidative stress protein NQO1 expression. IA could also decrease the collagen deposition and Smad2/3 phosphorylation in COPD mice lung. Additionally, IA did not affect the pathological structure and the index of major body organs.

Conclusions: This preclinical study demonstrated that IA is beneficial for COPD treatment, likely by increasing the anti-oxidative capacity and inhibiting Smad2/3 activation in lung tissue.

The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), known as overlap syndrome (OS), presents unique diagnostic and therapeutic challenges. Patients with overlap syndrome exhibit more severe hypoxemia, higher cardiovascular risk, and increased COPD exacerbations compared to those with either condition alone. While treatment with positive airway pressure (PAP) remains the cornerstone of OSA management, its role in patients with OS requires more sophisticated application, particularly in the presence of hypercapnia or poor PAP tolerance. The present review synthesizes current evidence on the pathophysiology, clinical presentation, and management of patients with overlap syndrome, emphasizing the limitations of standard care. Moreover, the utility of noninvasive ventilation, pharmacologic strategies beyond PAP, and tailored screening tools are explored. Finally, it highlights the need for a comprehensive, individualized approach to the management of patients with overlap syndrome and calls for further research to refine treatment algorithms and improve patient outcomes.

Patients hospitalized due to an exacerbation of chronic obstructive pulmonary disease (ECOPD) often exhibit increased sedentary behavior (SB), which may persist after discharge and negatively affect recovery. However, early determinants of SB during this period remain unclear. To identify the factors at hospital discharge that predict SB 30 days later in patients with ECOPD. This observational longitudinal study included patients hospitalized for ECOPD, assessed during the first week after discharge and reassessed 30 days later. Data collected included sociodemographic information (age, sex, name, telephone number, and address), anthropometric measurements (weight, height, and body mass index [BMI]), clinical history (previous hospitalizations, exacerbations, and smoking status), dyspnea (Medical Research Council scale, mMRC), health status (COPD Assessment Test, CAT), co-morbidities (Charlson Comorbidity Index), and exercise capacity (6-minute walk test, 6MWT). Physical activity and sedentary behavior-including SB, light (LPA), moderate (MPA), and vigorous (VPA) physical activity, step count, and sleep-were measured using a triaxial accelerometer worn for seven consecutive days. Accelerometer data were processed with ActiPASS software, and statistical analyses were performed in RStudio. Stepwise regression analysis was used to identify the discharge variables that could predict SB at 30 days. Forty-four patients (61% female; age 66 ± 8 years; FEV₁ 53 ± 13%; Charlson 1 [1-2]; hospital stay 5 [3-6] days) were included. At discharge, median mMRC was 3 (2-3), CAT 21 ± 8, 6MWT 274 ± 102 m, steps/day 3,148, SB 619 ± 226 min/day, and LPA 216 min/day. At 30 days, SB was 615 ± 166 min/day. Dyspnea (mMRC) and LPA at discharge explained SB at 30 days (R² = 0.31, p < 0.001). Higher levels of dyspnea and lower levels of LPA during the first week after discharge are the significant predictors of SB 30 days after hospitalization for ECOPD.

Hyperinflation in chronic obstructive pulmonary disease (COPD) patients worsens on exertion/exercise when breathing frequency increases. Fast breathing, paced at 40 breaths per minute using a metronome (metronome-paced tachypnea, MPT), induces dynamic hyperinflation (DH) and can be performed during MRI. MPT in combination with phase-resolved functional lung (PREFUL) MRI can be used to assess stress-driven ventilation dynamics globally and regionally. A 90 s time series of one coronal slice centered to the trachea was acquired for PREFUL MRI during 60 s of resting tidal breathing (RTB) and 30 s of MPT at 40 breaths per minute in COPD patients and healthy volunteers. MPT detected DH in 12 out of 15 COPD patients and in 1 out of 15 healthy controls. During MPT, the global fractional ventilation decreased by 20% in healthy subjects (p = 0.01) and by 48% in COPD patients (p < 0.001). The end-expiratory lung area remained stable in healthy subjects and increased significantly by 7% in COPD patients over the course of MPT (p = 0.004). Younger, healthy volunteers adapted to increase breathing frequency by reducing tidal volume (global fractional ventilation), while older healthy volunteers showed less tidal volume reduction (p = 0.036). The MPT-induced change of regional ventilation homogeneity (flow volume loop cross-correlation, FVL-CC_MPT/RTB) increased with age in healthy volunteers (p = 0.039) likely due to the development of compensatory dystelectasis in younger volunteers leading to reduced homogeneity during MPT. In the future, the MPT test during MR imaging may be used for COPD treatment analysis and disease monitoring.