COPD: Journal of Chronic Obstructive Pulmonary Disease最新文献

Background: Chronic obstructive pulmonary disease (COPD) and cardiovascular-kidney-metabolic (CKM) syndrome are major public health concerns, yet their interrelationship remains under-explored. This study investigates the impact of lung function and COPD on the prevalence and mortality of CKM syndrome using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

Methods: A cross-sectional analysis of 5569 adults was conducted, defining CKM stages per the 2023 American Heart Association framework. Lung function was assessed via prebronchodilator spirometry, with COPD classified using GOLD criteria. Advanced CKM syndrome (stages 3-4) was the primary outcome. Associations were evaluated using survey-weighted logistic regression, restricted cubic splines (RCS), and cox proportional hazards models.

Results: Among participants, 10.7% had advanced CKM syndrome. COPD was significantly associated with advanced CKM(adjusted OR = 1.52 [1.11, 2.09]), with escalating risks across GOLD stages (GOLD stage II: OR = 2.13 [1.21, 3.74]; GOLD stage III-IV: OR = 4.38 [1.06, 18.02]). Pre-COPD conditions, including preserved ratio impaired spirometry (PRISm) (OR = 2.62 [1.66, 4.14]) and chronic bronchitis (OR = 2.60 [1.50, 4.53]), also showed significant associations. COPD increased all-cause mortality (HR = 1.40 [1.04, 1.89]) and cardiovascular-related mortality (HR = 1.81 [1.04, 3.14]) in individuals aged ≥50 with advanced CKM.

Conclusion: COPD is strongly associated with advanced CKM syndrome and increased mortality. These findings highlight the systemic impact of lung health on CKM progression and outcomes, emphasizing the need for integrated screening and management strategies targeting both pulmonary and cardiometabolic health, especially in older adults.

Haemophilus influenzae (H. influenzae) and Moraxella catarrhalis (M. catarrhalis) are associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD); however, their role in the pathogenesis of COPD is unknown. We retrospectively analysed the clinical data of patients with AECOPD (modified British Medical Research Council scale score, Global Initiative for Chronic Obstructive Lung Disease [GOLD] classification, pre-admission antibiotic and inhalant usage, sputum culture and epidemic influenza virus antigen test) for association with admission frequency. Among 169 eligible patients, pathogens were and were not detected in 64 and 105, respectively. The GOLD classification grade was higher in the non-detection group with a prior antimicrobial administration rate of 21.9% than in the detection group. H. influenzae and M. catarrhalis, each identified in 24.6% of the total number of detected pathogens, were the most common infectious bacteria. The GOLD classification grade was higher in the re-hospitalisation group than in the one-time hospitalisation group (p < 0.01). Regarding type of pathogen, M. catarrhalis infection (n = 16) was more common in the re-hospitalisation group. History of M. catarrhalis, H. influenzae infection and GOLD grade ≥ III were risk factors for re-hospitalisation, with odds ratios of 92.7 (95% confidence interval [CI]: 3.68-2340.0, p < 0.01), 20.1 (CI: 1.48-274.0, p < 0.05) and 9.83 (CI: 2.33-41.4, p < 0.01), respectively. These bacterial infections and severe airway limitation were associated with increased AECOPD frequency. Routine microbial monitoring may be useful for AECOPD prevention, reducing medical burden and improving prognosis.

Background: Clinical trials have shown beneficial results from lung volume reduction with endobronchial coils in patients with emphysema, but comprehensive safety data are not yet available for a new coil type, Coil #4. The objective of this study is to generate real-world data (RWD) on the safety and efficacy of endobronchial Coil #2 and Coil #4.

Methods: This is a cohort study of prospectively collected data from the multicenter German Lung Emphysema Registry e.V. (LE-Registry) for patients with advanced lung emphysema undergoing lung volume reduction. All patients treated with Coil #2 or Coil #4 were evaluated at baseline and at 3 months for pulmonary function tests (FEV₁, FVC, RV, DLCO, pCO₂), exercise capacity, quality of life (mMRC, CAT, SGRQ), and adverse events. Descriptive statistics were used to analyze response rates and changes in clinical outcomes.

Results: Data from 73 patients (37 Coil #2, 36 Coil #4) enrolled between 2017 and 2024 were evaluated. At 3 months, outcome data were available for 32 Coil #2 and 26 Coil #4 patients. In the Coil #2 cohort significant improvements in RV and SGRQ were observed. The Coil #4 cohort shows significant improvements in FVC, RV, SGRQ, and CAT. Complications occurred in 37% of Coil #2 and 37% of Coil #4 patients, with 26% of patients treated with Coil #4 experiencing pneumothorax.

Conclusions: The outcomes observed in this RWD study are consistent with other published coil studies. The higher pneumothorax rate with Coil #4 is surprising and should be minimized by adapting the technique.

Trial registration: DRKS00021207 registered on 29/05/2020.

Background: Health information literacy (HIL) is crucial to patients' quality of life with chronic obstructive pulmonary disease (COPD). However, individual differences in HIL among COPD patients remain underexplored.

Purpose: This study aimed to determine COPD patients' HIL profiles, investigate the factors influencing these profiles, and assess their association with quality of life (QoL).

Methods: Using convenience sampling, a cross-sectional study was conducted in hospitals across Hunan Province, China, from October 2023 to June 2024. Data were collected using a sociodemographic questionnaire, the Health Information Literacy Self-Assessment Questionnaire (HILSQ), the COPD Self-Management Scale, and the Chronic Obstructive Pulmonary Disease Assessment Test (CAT) Scale. Latent profile analysis (LPA) identified distinct HIL profiles. Multiple logistic regression determined predictors of profile classification. The DU3STEP method within the AUXILIARY option in Mplus version 8.3 was used to analyze the impact of HIL profiles on QoL.

Results: A total of 432 COPD patients were included. Three distinct HIL profiles were identified: low-level (33.5%), medium-level (54.2%), and high-level (12.3%). Older age and longer disease duration were significantly associated with the low-level group, while better self-management predicted membership in the high-level group. QoL significantly differed across the three profiles χ² = 313.119, p < 0.001), with the high-level group reporting the best outcomes.

Conclusions: Three distinct HIL profiles were identified among COPD patients, each characterized by differing levels of age, disease course, self-management, and QoL. Targeted interventions - such as tailored education and digital support - can help address the specific challenges faced by patients with lower HIL, thereby enhancing their capacity to manage their condition and improving overall health outcomes.

Rationale: The Predict&Prevent trial was designed to provide a definitive randomised clinical trial of a personalised early warning decision support system, COPDPredict™.

Methods: Adults with ≥1 AECOPD were randomly assigned in a 1:1 ratio to use of a personalised early warning decision support system (COPDPredict™) or standard self-management plans with rescue medication (RM) (control). The primary outcome was number of hospital admissions for AECOPD at 12 months post-randomisation (intention to treat).

Results: Ninety (11%) of 789 screened patients were enrolled. Admissions per participant due to AECOPD at 12 months was lower with COPDPredict™: Incidence rate ratio (IRR) 0.64 (95% CI 0.19-2.17, p = 0.478). Exploratory Bayesian analysis and sensitivity analyses saw similar results. No significant differences were seen in inpatient days, visits to accident and emergency visits, and number of exacerbations. COPD Assessment Test (CAT) score benefits occurred at 3 and 6 months with COPDPredict™ (adjusted mean difference -3.8 points, 95% confidence interval (CI) -6.3 to -1.2, p = 0.004 and -3.0 points, 95% CI -5.7 to -0.4, p = 0.025, respectively) but was non-significant at longer periods (p > 0.22). There was not enough evidence to indicate a statistically significant treatment effect on the other outcomes.

Conclusions: COPDPredict™ failed to show a reduction in severe AECOPD events resulting in hospitalisations, although the number of admissions per participant was lower among users. The quality of life data (CAT scores) suggests that 6 months usage of COPDPredict™ period may be helpful to patients, with benefits exceeding the minimum clinically important difference throughout that time.

Trial registration: NCT04136418.

Chronic obstructive pulmonary disease (COPD) induced malnutrition is a common and serious problem resulting in a higher risk of complications, exacerbations, and hospitalization. We developed an inpatient geriatric rehabilitation program for patients with severe COPD and malnutrition and demonstrated its feasibility. The aim of the current study was to explore its preliminary effects. A prospective case series was conducted, including a total of eight patients with severe COPD and low fat-free muscle mass index (FFMi). Our 6-10 weeks program consisted of anaerobic resistance training, based on the nonlinear periodized exercise (NLPE) principles, nutritional support, psychoeducation on physical energy management, combined with a restriction of physical activities. Overall activity level, as measured in metabolic equivalents (METs), remained consistently below 3 METs for all patients. Primary outcomes were changes body composition (FFMi, body mass index (BMI), and body weight), muscle function, and exercise performance from the start and end of the study. We used paired samples t-test or Wilcoxon signed-rank test to compare pre and postscores. Body composition and muscle function showed both significant and clinically relevant improvements after discharge of the program. Exercise performance showed a clinically relevant improvement. Additionally, ADL independence and health-related quality of life were improved. The patients in the current study had a clinical improved body composition, increased personal FFMi and exercise performance despite the absence of cardio-training and restrictions in functional walking distance. A cluster randomized controlled study will be necessary to show the definitive effect of the intervention.

Background: Severe emphysema, a major chronic obstructive pulmonary disease (COPD) phenotype characterized by hyperinflation, is associated with significant morbidity and mortality. Lung volume reduction (LVR) therapies, including surgical (LVRS) and bronchoscopic techniques (e.g. endobronchial valves (EBVs) and coils (ECs)), aim to reduce hyperinflation and improve outcomes, but their comparative efficacy and safety are unclear.

Methods: This network meta-analysis compared LVR therapies. We systematically evaluated LVRS, EBV, EC, intrabronchial valves (IBV), sealants (ELS), vapor ablation (BVA), or airway bypass stents (ABS) in adults with severe emphysema. The primary outcomes were early and overall mortality. The secondary outcomes included lung function (FEV1, RV reduction), exercise capacity (6MWD), quality of life (SGRQ), and adverse events. Bayesian analysis using R/BUGSNet was used to assess their effects and rankings.

Results: Twenty-six RCTs (4418 patients) were included. No LVR therapy significantly reduced mortality compared with standard medical care (SMC) (early mortality, 1.6%; overall mortality, 10.9%; and highest rates of LVRS). Compared with SMC, LVRS and EBV significantly improved FEV1, RV reduction, and the 6MWD; LVRS consistently ranked most effectively. After excluding the impact of collateral ventilation in the subgroup analysis, EC significantly improved the SGRQ and 6MWD, and a reduction in residual volume and IBV improved the SGRQ. LVRS, EBV, and EC had significantly higher adverse event rates than SMC did.

Conclusions: While no LVR therapy improved survival over SMC, LVRS and some bronchoscopic techniques (EBV, EC) significantly enhanced lung function, exercise capacity, and quality of life in severe emphysema patients. LVRS offers the greatest efficacy benefits but carries the highest risks. Bronchoscopic options (EBV, EC) provide safer and more effective alternatives, particularly for symptoms and functional improvement. Careful patient selection on the basis of fissure status and emphysema pattern is paramount.

Chronic Obstructive Pulmonary Disease (COPD) poses significant challenges, not only to patients but also to their caregivers, who often experience substantial unmet needs, stress, and emotional burdens. This scoping review synthesizes existing literature to understand the experiences, perspectives, and challenges faced by caregivers of COPD patients. A comprehensive search of multiple databases was conducted, focusing on studies addressing unmet needs, psychological experiences, and the day-to-day realities of caregivers. The review reveals that COPD caregivers frequently encounter inadequate support, insufficient information, and heightened emotional and physical strain. These factors contribute to negative mental health outcomes, including anxiety, depression, and caregiver burnout. Moreover, the review highlights the disparity in care and support services across different healthcare settings, with a particular emphasis on the need for targeted interventions that address the unique challenges of COPD caregiving. The findings underscore the importance of integrating caregivers' needs into COPD management plans and the development of policies that recognize and support their role. The review concludes with recommendations for future research to fill existing gaps in the literature and for healthcare providers to implement strategies that enhance caregiver well-being, thereby improving overall patient care.

Clear and effective treatment for pulmonary hypertension (PH) caused by chronic obstructive pulmonary disease (COPD) has not been established, and thus promptly identifying patients with PH is of particular importance. In this study, by comparing Angiopoietin-2 expression in patients with COPD and COPD-PH, we analysed the risk factors of PH and evaluated the predictive value of these in PH. Therefore, this prospective study selected COPD of patients as research subjects, which were divided into COPD and COPD-PH groups according to whether they were complicated with PH. Lung function, general laboratory index, N-terminal pro brain b-type natriuretic peptide (NT-proBNP), Angiopoietin-2, and other cytokines levels were compared between the two groups, and the risk factors of COPD-PH were explored through multivariate binary regression analysis. Lastly, receiver operating characteristic curve was used in evaluating the predictive value of risk factors for COPD-PH. The results show that the COPD-PH group has higher Angiopoietin-2, logistic analysis showed that Angiopoietin-2, NT-proBNP, age, and FEV1%pred were independent risk factors for COPD-PH and had high predictive value for COPD-PH. The AUROC for Angiopoietin-2 and NT-proBNP for predicting COPD-PH were 0.646 and 0.751. When Angiopoietin-2 ≥ 39.55 pg/ml, NT-proBNP ≥ 134.03 pg/ml, the sensitivity for COPD-PH prediction was 44.7 and 93.6%, respectively, and the specificity rates were 83.1 and 49.2%, respectively. When Angiopoietin-2 was combined with NT-proBNP, enhanced the AUROC to 0.766, exceeding Angiopoietin-2 alone, which may be useful in the prediction of COPD-PH.

Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by chronic inflammation of small airways and lung parenchyma, which manifests as irreversible and progressive airflow limitation. Inhalation of toxic particles is a major risk factor for the development of COPD. Due to long-term exposure to cigarettes, air pollutants, or occupational pollutants, the incidence of COPD continues to be stubbornly high. Although some treatments can improve symptoms, the remodeling of small airways in COPD cannot be reversed, which still brings heavy social and economic burdens. There is evidence that airway epithelial cells are actively involved in the development of COPD. Damage, fibrotic repair, and death of airway epithelial cells lead to chronic inflammation and dysfunction of small airways. This review article summarizes the pattern of airway epithelial cell death and its role in the progression of COPD. At the same time, the corresponding mechanism is discussed in depth.