COPD: Journal of Chronic Obstructive Pulmonary Disease最新文献

Background: Chronic obstructive pulmonary disease (COPD) affects over 300 million people and is the third leading cause of death. People with COPD spend a large amount of their day sedentary, which is associated with reduced life expectancy.

Methods: A systematic search was conducted across electronic databases, including Medline, CINAHL, PsycINFO, and Cochrane Library. Due to the heterogeneity of study design and siting of the activity monitor, a narrative synthesis was conducted.

Results: 1086 studies were identified; six met inclusion criteria, and two reported a decreased sedentary time. Nordic walking reduced sedentary time by 128 minutes/day compared to baseline, significantly more than the control group (p < 0.01). Another study using a behaviour change intervention reduced sedentary behaviour by 64 minutes/day compared to baseline, significantly more than the control group (p = 0.018). Both studies were conducted for over 12 weeks, with a multi-modal approach incorporating behaviour change techniques, goal setting, education, self-monitoring and feedback. No studies focusing on reducing sedentary behaviour alone reported significant changes.

Conclusions: Few interventional studies have focused on reducing sedentary behaviour in people with COPD. Interventions that have effectively reduced sedentary time primarily focused on physical activity and adopted a multi-modal strategy. This suggests that future interventions could consider a multi-modal approach, which includes behaviour change and the incorporation of enjoyable light physical activities into daily living. We cannot conclude from the available evidence that solely targeting sedentary time will reduce sedentary behaviour. Longer interventions may reduce sedentary behaviour, but there is a lack of studies on both short- and long-term approaches.PROSPERO registration number CRD 42024510434.

Purpose: This study investigated whether total serum IgE (T-IgE) can serve as a biomarker to guide personalized inhaled corticosteroid (ICS) therapy in patients with stable chronic obstructive pulmonary disease (COPD).

Methods: We conducted retrospective (n = 1236) and prospective (n = 540) cohort studies of stable COPD patients. Participants were stratified by baseline T-IgE levels (cutoffs: 100 and 76 IU/mL). Propensity-score matching (PSM) was used to balance confounding factors, and a multivariate negative binomial regression model was constructed to evaluate the effects of ICS on the risks of exacerbations. Additionally, the stability of total serum IgE and its correlation with pulmonary function were analyzed.

Results: In the subgroup with T-IgE ≥ 100 IU/mL, COPD patients had a significantly increased risk of exacerbations, with incidence rate ratios (IRRs) of 1.60 (95% CI 1.11-2.29) for moderate exacerbations, 1.37 (1.03-1.82) for moderate or severe exacerbations, and 1.15 (1.00-1.31) for all exacerbations. In this subgroup, ICS treatment significantly reduced the risk of the aforementioned exacerbations, with corresponding IRRs of 0.62 (0.42-0.91), 0.73 (0.53-1.00), and 0.84 (0.72-0.99). In contrast, in the T-IgE < 100 IU/mL subgroup, the benefits of ICS treatment were not statistically significant. Furthermore, total serum IgE demonstrated better stability than blood eosinophil counts and was negatively correlated with pulmonary function indices. Consistent results were obtained using a cutoff value of 76 IU/mL.

Conclusion: The total serum IgE level is closely related to exacerbations of COPD. Patients with high IgE levels can experience a reduced exacerbation rate when treated with ICS.

To facilitate shared decision-making in Chronic obstructive pulmonary disease (COPD), the Assessment of the Burden of COPD (ABC) tool was developed. An integral part of the ABC tool is the ABC scale, a questionnaire to determine COPD burden. The psychometric evidence of the ABC scale is limited. If the data would fit the Rasch model, more accurate scoring would be possible. This would improve the use of the ABC tool. Therefore, the aim of this study is to validate the ABC scale using the Rasch model. We conducted a secondary analysis based on data collected in a pragmatic RCT using Rasch model theory. The ordering of thresholds, reliability and targeting were analysed, and we tested unidimensionality, local independence of items (LD), fit of the data with the model and measurement invariance between groups (DIF). We analysed 551 samples from 176 patients. The analyses confirmed that the ABC scale is a reliable instrument. However, initial analysis showed a poor fit of the data to the Rasch model. After recoding the response options and analysing the fit of the data for the subdomains of the ABC scale, we found ordered thresholds and a good overall model fit. This analysis indicates that the ABC scale assessed three distinct sub-domains: symptoms, physical functioning, and emotional health. We conclude that the ABC scale is a valid instrument to assess COPD burden. While the scale is considered suitable for use in clinical practice and research, we suggest rewording the response options to ensure uniform understanding by respondents.

The used data were derived from a previously conducted trial (NTR3788).

Chronic obstructive pulmonary disease (COPD) is a major public health issue in China, but comprehensive studies on its long-term trends, risk factors, and future projections are limited. This study aimed to assess the COPD burden in China from 1990 to 2021, analyze risk factor contributions across demographic subgroups, and project future trends through 2030 to inform public health interventions. Data from the Global Burden of Disease Study 2021 were analyzed for incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Joinpoint regression was used to calculate age-standardized rates, population attributable fractions (PAFs) assessed risk factor contributions, and ARIMA modeling projected future trends. From 1990 to 2021, the age-standardized incidence, prevalence, mortality, and DALYs rates of COPD showed a declining trend, while the absolute burden increased due to population growth and aging. Men had a higher overall disease burden, but since 2015, women have shown higher age-standardized prevalence. The highest burden was observed in the ≥80 age group, with a worrying rise in age-standardized mortality in the 20-24 age group. Smoking was a major risk factor for men, while ambient particulate matter pollution had a greater impact on women and younger adults (30-34 years). Projections suggest a decreasing trend for most age groups, while the 30-39 and ≥80 age groups will experience an increase in age-standardized incidence rates. These findings highlight the need for targeted public health strategies focusing on tobacco control, air pollution, and climate-related exposures, with emphasis on age and sex differences.

Purpose: The study aims to improve the knowledge on the associations between comorbidities, symptom burden, inflammatory biomarkers and lung function deterioration in chronic obstructive pulmonary disease (COPD).

Materials and methods: Of the 572 COPD subjects initially included in the 2014-2016 Tools for Identifying Exacerbations in COPD study in Sweden, 228 had lung function data at the 7-year follow-up. Symptom burden was assessed by the modified British Medical Research Council scale of dyspnoea (mMRC), the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ). Relative lung function decline was assessed as decline in forced expiratory volume in one second (FEV₁) from baseline/year.

Results: Lower baseline symptom burden (mMRC, CAT and CCQ), higher FEV₁ and FEV₁% predicted, higher forced vital capacity (FVC) and having atrial fibrillation were associated with larger absolute FEV₁ decline. Associations were found for having atrial fibrillation at baseline and larger relative FEV₁ decline (Beta = -1.60, p = 0.005). Increased symptom burden (value at follow-up minus value at baseline), assessed by mMRC, CAT and CCQ, was positively associated with both larger absolute FEV₁ decline (mMRC: Beta = 6.4, p = 0.009; CAT: Beta = 1.63, p = 0.002; CCQ: Beta = 10.6, p < 0.001) and larger relative FEV₁ decline (mMRC: Beta = 0.44, p = 0.003; CAT: Beta = 0.13, p < 0.002; CCQ: Beta = 0.82, p < 0.001). Moreover, an increase in C-reactive protein (CRP) levels at follow-up was related to larger, both absolute and relative, FEV₁ decline (Beta = 1.14, p = 0.031 and Beta = 0.07, p = 0.019, respectively).

Conclusions: Changes in systemic inflammation and symptom burden between two visits were positively associated with a 7-year lung function decline.

"Rescue packs" for COPD exacerbations, consisting of a course of antibiotics and steroids, have become part of self-management strategies for many patients living with COPD. Currently, in the UK, rescue packs are guideline-recommended but not routinely offered on hospital discharge. They are, however, commonly prescribed by primary care teams. This study examined hospital-based respiratory clinicians' views on offering patients rescue packs following hospitalisation for COPD exacerbations. We conducted 24 individual and joint semi-structured interviews via telephone or videocall with 30 clinicians (respiratory consultants, respiratory registrars and specialist nurses) in 20 UK hospitals to understand variation in practice around, and views on, offering rescue packs to discharged COPD patients. Interview data were analysed using the constant comparative method. Clinicians' views on offering rescue packs were a mixture of concerns and recognition of potential benefits. Concerns included antimicrobial resistance, individual overuse of antibiotics, and potential side effects of steroids, especially in patients with poorer understanding of their own condition, with lower self-management skills, or who found it difficult to access primary care. Recognised benefits included the potential to prevent future exacerbations, empowering patients by supporting COPD self-management, and circumventing the difficulties of securing an urgent primary care appointment. There was a consensus that supporting patients in self-management of COPD was key to effective care. Given the increasing role of self-management for patients living with COPD, it is vital to ensure that patients are able to appropriately use rescue packs.

In Italy, long-acting bronchodilator (LABA/LAMA) fixed-dose combinations are widely used for treating chronic obstructive pulmonary disease (COPD). These medications are available in various inhaler devices, but clinical guidelines do not recommend a specific device, leaving the choice to clinicians based on patient needs. To date, no studies have directly compared the effectiveness and safety of different LABA/LAMA devices. This retrospective observational study evaluated the utilization, effectiveness, and safety of LABA/LAMA inhaler devices in COPD patients in the Lazio region, representing about 10% of Italy's population. Patients aged 45 and older who initiated LABA/LAMA treatment between January 2017 and December 2019 were included. The devices analyzed were dry powder inhalers (DPI) capsule/strip (DPI-t, reference group), DPI with a reservoir (DPI-r), and soft mist inhalers (SMI). The study identified 12,346 eligible patients, with over 80% having prior COPD drug use. Of these, 53.2% used DPI-t, 19.7% DPI-r, and 27.1% SMI. No significant differences in severe exacerbations, mortality, pneumonia, or cerebro-cardiovascular events were observed among the devices. Hazard ratios for key outcomes (e.g., severe exacerbations, mortality) showed overlapping confidence intervals across device types, suggesting no device offered superior effectiveness or safety. This is the first study to assess LABA/LAMA device use in real-world clinical practice for COPD. Findings suggest therapeutic equivalence among devices, supporting flexibility in prescribing. Further research is needed to inform cost-effective prescribing policies for LABA/LAMA therapies.

Purpose: Validation of an alert mechanism for COPD exacerbations based on coughing detected by a stationary unobtrusive nighttime monitor.

Methods: This prospective double-blind longitudinal study of cough monitoring included 40 chronic obstructive pulmonary disease (COPD) patients. Participants underwent cough monitoring and completed a daily questionnaire for 12 weeks. If no exacerbation occurred within that period patients were asked to continue being monitored for a further 12 weeks. The automated system identified deteriorating trends in cough based on a personalized cough classifier and the alerts were compared with patient reported exacerbation onsets.

Results: Thirty-eight patients [median age 72 (range 57-84)], median FEV-1% predicted 43% (range 20-106%) completed the study and had 41 exacerbations over a total of 3981 days. For 32 patients, the cough monitor data allowed classifier personalization, trend analysis, and alert generation. Based on the trend data, it is estimated that ∼30% of exacerbations are not associated with an increase in cough. The alert mechanism flagged 59% of the exacerbations. For the cases with alerts preceding the onset, the associated lead time was 4 days or more.

Conclusion: Though based on a single variable only, the cough-based alert system captured more than half of the exacerbations in a passive, free-living scenario. No adherence issues were reported, and patients confirmed the unobtrusive and hassle-free nature of the approach.