COPD: Journal of Chronic Obstructive Pulmonary Disease最新文献

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.

Objective: To assess the feasibility and acceptability of a nurse-led COllective PErson-centred dialogue (COPE-Dialogue) intervention developed though co-production focusing on nutritional and physical activity support to hospitalised patients with Chronic obstructive pulmonary disease.

Methods: A non-randomised feasibility study according to the Medical Research Council framework for developing and testing a complex intervention. The intervention consisted of a dialogue tool with three components related to nutrition and physical activity: (1) A needs assessment, (2) Recommendations for support (3) Transitional information. Data from patients and nurses was collected from January through March 2024. Recruitment, fidelity, and acceptability were measured with qualitative and quantitative approaches including progression criteria. Qualitative content analysis and descriptive statistic were applied in the analysis.

Results: Recruitment was feasible, with 77% patients participating. Fidelity was high for the needs assessment and recommendations. Transitional information needs modification and should be combined with a relational contact. Patients and nurses found the dialogue tool acceptable and meaningful but faced time constraints.

Conclusions: The dialogue tool was feasible regarding recruitment and fidelity. The tool was acceptable and meaningful to both patients and nurses, while modification is required in the transitional information. However, there is a need to strengthen the quality of the fundamental care within nutritional and physical activity combined with clinical management support.

Background: Despite limited breakthroughs in COPD pharmacotherapy, recent trials have shown promising results for biologics in COPD patients. However, robust evidence synthesis in this area is currently lacking.

Methods: We conducted a systematic review of MEDLINE, EMBASE, and Cochrane CENTRAL from inception to July 17, 2024, to identify randomized trials of biologic medications in patients with COPD. We performed a random effects frequentist network meta-analysis and present the results using relative risk (RR) and 95% confidence intervals (CI). We used the GRADE framework to rate the certainty of the evidence. Outcomes of interest included exacerbations, change in FEV1, change in quality of life, and serious adverse events.

Results: Dupilumab reduced exacerbations as compared to placebo (RR 0.68 [95% CI 0.59 to 0.79]) (high certainty). Benralizumab (RR 0.89 [95% CI 0.78 to 1]), itepekimab (RR 0.81 [95% CI 0.61 to 1.07]) and tezepelumab (RR 0.83 [95% CI 0.61 to 1.12]) may reduce exacerbations as compared to placebo (all low certainty). Dupilumab probably reduced exacerbations more than mepolizumab (RR 0.74 [95% CI 0.62 to 0.89]) (moderate certainty). Dupilumab may reduce exacerbations more than tezepelumab (RR 0.82 [95% CI 1.14]) (low certainty). For all patients, no treatment improved FEV1 above the pre-specified minimal clinically important difference (MCID) of 0.1 L. Dupilumab probably has no meaningful effect on FEV1 compared to placebo (MD 0.07 [95% CI 0.02 to 0.13]) (moderate certainty). However, in the subgroup of patients with blood eosinophils ≥300/mcL, both tezepelumab (MD 0.15 [95% CI 0.05 to 0.26]) and dupilumab (MD 0.13 [95% CI 0.06 to 0.19]) probably improved FEV1 above the MCID.

Conclusion: Dupilumab is effective at improving patient-relevant outcomes in COPD with higher eosinophil levels. Other biological therapies, including tezepelumab, have no important effect on patient-relevant outcomes.

Objective: To investigate whether chronic obstructive pulmonary disease (COPD) and asthma increase the risk of gallstones based on the National Health and Nutrition Examination Survey (NHANES) and Mendelian randomization (MR).

Methods: Data from the NHANES 2017-2023 were included in the cross-sectional study. Diagnoses of COPD, asthma and gallstones were obtained from self-report questionnaires. Multivariate logistic regression, subgroup analyses and interaction tests were applied to explore these associations. Data for MR analysis were obtained from the Finnish cohort and the Integrative Epidemiology Unit (IEU). The inverse variance weighting (IVW) estimate was applied as the main approach to determine the causality of associations.

Results: A total of 8,728 participants were enrolled in the cross-sectional study. Both COPD (OR 1,842, 95% CI 1.144, 2.968, p = 0.015) and asthma (OR 1.434, 95% CI 1.093, 1.883, p = 0.012) were associated with increased gallstone risk before and after covariate adjustments, and diabetes history may interact with the COPD-gallstone association (p = 0.020). In MR analysis, although a causal association was observed between COPD and gallstones (OR 1.216, 95% CI 1.023, 1.445; p = 0.026), leave-one-out analysis suggested that the causal association disappeared without serpin family A member 1 (SERPINA1). No causal association was observed between asthma and gallstones (OR 1.016, 95% CI 0.932, 1.108; p = 0.718).

Conclusions: Although both COPD and asthma were positively associated with gallstones based on NHANES, the COPD-gallstone association was largely driven by SERPINA1, and no causality was observed in asthma-gallstone association. The available evidence provided limited support for causal associations between obstructive lung diseases and gallstones.

Chronic obstructive pulmonary disease (COPD) is characterized by restricted airflow that leads to significant respiratory difficulties. This progressive disease often results in diminished pulmonary function and the onset of additional respiratory conditions. Autophagy, a critical cellular homeostasis mechanism, plays a significant role in the exacerbation of COPD. In this study, we utilized various bioinformatics tools to identify autophagy-related genes activated by smoking in individuals with COPD. Furthermore, we explored the immune landscape of COPD through these genes, analyzing cell communication patterns using scRNA-seq data. This analysis focused on key pathways between epithelial cells and other cellular subpopulations with different autophagy scores, essential for understanding the initiation and progression of COPD.

Rationale: The incremental shuttle walk test (ISWT) correlates closely with peak oxygen uptake in COPD and relates to important outcomes such as mortality, response to treatment and hospital readmission. Despite this, there is limited data on the physiological determinants of ISWT distance (ISWD) in COPD. Methods: In this exploratory, prospective observational study, spirometry, lung volumes, diffusion capacity (DLCO) and oscillometry were performed in patients with confirmed COPD. Patients then completed two ISWT with the results of the best test, measured by distanced walked taken. The determinants of ISWD and dyspnoea measured by BORG score were evaluated. Results: 25 COPD patients, mean (SD) age 71 (8.82) years, 48% female with a mean (SD) FEV1 Z-score -2.54 (0.83) were recruited. Median (IQR) ISWD was 350 (210-440) metres (mean (SD) 66.4 (27.9)% predicted distance). Most patients (85%) stopped due to inability to maintain walking speed with submaximal mean heart rate of 77.3 (10.1)% predicted and BORG dyspnoea score of 'severe' (median 5/10 (IQR 4-5.5)). Inspiratory capacity to TLC ratio (IC/TLC) correlated strongly with ISWD, even when corrected for age and height (r_s = 0.59 p = 0.02). Oscillatory reactance (Xrs₅) and DLCO were also correlated with ISWD. There were no oscillometric or spirometric predictors of dyspnoea. Conclusion: Resting hyperinflation measured by IC/TLC, predicted ISWD despite submaximal dyspnoea, suggesting that hyperinflation may not be the mechanism that limits exercise performance, but rather reflects overall impairment in COPD.

Objective: To analyze the status of research on treating chronic obstructive pulmonary disease (COPD) combined with respiratory failure internationally to reveal its development trends through visualization methods and to provide a reference and suggestions for future research directions.

Methods: Literature on the treatment of COPD combined with respiratory failure published from the year of inception of the Web of Science database to December 31, 2023, was searched. CiteSpace 6.2.R7 software was used to visualize and analyze the published articles. A bibliometric analysis of the publications, keyword co-occurrence analysis, keyword clustering analysis, and keyword emergence analysis were performed to draw a correlation map and analyze the results.

Results: A total of 369 articles were analyzed. An overall increasing trend was observed in the number of publications. The network of researchers was relatively dense, and a core team was clearly observed. The researchers' affiliations were mainly European universities and hospitals, and close cooperation between institutions was observed. The keyword analysis obtained high-frequency keywords such as "noninvasive ventilation", "mechanical ventilation", and "positive pressure ventilation". The keyword clustering analysis revealed 10 clusters, and the keyword emergence analysis yielded 20 keywords.

Conclusions: The focus of attention internationally has been on respiratory failure classification and types of ventilation support, such as high-flow oxygenation and noninvasive positive pressure ventilation. Future directions should include clinical research on high-flow oxygen administration to improve patient prognosis and the application of extracorporeal carbon dioxide removal technology to enhance patients' quality of life.

COPD is a highly stigmatised condition. To develop effective measures to reduce COPD-related stigma, it is important to understand patients' experiences and identify contributing factors. This systematic review explores qualitative evidence regarding the features of COPD leading to stigmatisation and how it can potentially influence health outcomes. Electronic databases were searched to identify primary qualitative studies focussing on stigma-related experiences of adults with COPD, published between January 1988 to August 2024. Data were synthesised using framework synthesis. Twenty-nine studies with 427 participants were included in this review. Findings fit well into six themes identified from Jones et al.'s framework of stigma dimensions and provide rich description. Smoking habit was not the only factor of stigma but also factors that contributed to disability of individuals. Patients experience COPD-related stigma mainly from themselves and healthcare professionals. Potential consequences of stigma identified are mental distress, isolation, reduced help-seeking behaviour and non-compliance to management. Collective effort by society and healthcare systems will be necessary to alleviate the stigma associated with chronic symptoms and smoking behaviour of COPD and to promote the benefit of pulmonary rehabilitation and available mental health support.

Evidence on the risk of adverse respiratory outcomes associated with gabapentinoids in patients with chronic obstructive pulmonary disease (COPD) remains limited. Thus, we aimed to assess the risk of severe COPD exacerbation associated with gabapentinoids. We assembled a base cohort of patients aged ≥ 55 years newly diagnosed with COPD between 1993 and 2021 using the UK's Clinical Practice Research Datalink, linked to the Hospital Episode Statistics, and Office for National Statistics datasets. Using a time-conditional propensity score (TCPS)-matched, new-user design, patients prescribed gabapentinoids with an indication of epilepsy, neuropathic pain, or other chronic pain were matched 1:1 with non-users with the same indication on age, sex, calendar year, COPD duration, and TCPS. Cox proportional hazards models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CIs) of severe exacerbation associated with gabapentinoid use compared to non-use in the overall cohort, and by indication. The study cohort comprised 29,882 gabapentinoid users, including 1,256 with epilepsy, 19,155 patients with neuropathic pain, and 9,471 with other chronic pain matched 1:1 with non-users. Compared with non-use, gabapentinoid use was associated with an increased risk of severe exacerbation in the overall cohort (HR 1.43; 95% CI: 1.35-1.52), and among patients with epilepsy (HR 1.39; 95% CI: 1.11-1.74), neuropathic pain (HR 1.43; 95% CI: 1.32-1.54), and other chronic pain (HR 1.45; 95% CI: 1.31-1.60). These findings suggest that gabapentinoid use is associated with an increased risk of severe exacerbation among patients with COPD, consistent among patients with neuropathic pain, epilepsy, and other chronic pain.