International Journal of Chronic Obstructive Pulmonary Disease最新文献

Background: Chronic obstructive pulmonary disease (COPD) complicated by hypertension imposes a substantial global health burden, with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) significantly increasing 1-year readmission risk. This study aimed to develop and validate an interpretable machine learning (ML) model that predicts 1-year readmission risk in AECOPD patients complicated by hypertension using real-world data.

Methods: This retrospective cohort study enrolled 2042 patients with AECOPD complicated by hypertension from the First Affiliated Hospital of Shihezi University between 2015 and 2024. The data were split into training and test sets at a 7:3 ratio. Feature selection was performed based on machine learning methods. Eight ML models were trained and tested to construct predictive models. Model performance was evaluated by the area under the receiver operating characteristic curve (AUC), accuracy, recall, specificity, and F1-score. The Shapley additive explanation method (SHAP) was used to rank the feature importance and explain the final model. An online risk prediction tool was developed based on the optimal model to facilitate clinical application.

Results: The 1-year readmission rate of patients with AECOPD complicated by hypertension was 37.5%. Seven independent predictors, including times of inhospitalization, procalcitonin, total protein, international normalized ratio (INR), prothrombin time, D-dimer, and hypoproteinemia, were identified as the most valuable features for establishing the models. The AdaBoost model showed optimal performance, with an AUC of 0.884 in the test set and an average AUC of 0.889 in 5-fold cross-validation. SHAP analysis confirmed that times of inhospitalization were the strongest predictor, followed by INR and total protein. An online calculator was deployed (https://fast.statsape.com/tool/detail?id=17) for clinical use.

Conclusion: This study developed an interpretable AdaBoost-based online calculator for 1-year readmission risk assessment in AECOPD patients by hypertension. The tool highlight the importance of addressing hypercoagulability and nutritional status to reduce readmission risk. Further external multi-center validation is needed to enhance its generalizability.

Purpose: Respiratory muscle weakness is common in chronic obstructive pulmonary disease (COPD), potentially carrying prognostic information beyond airflow limitation; however, clinical testing remains variably standardized, and its independent association with survival is uncertain. We evaluated whether respiratory muscle strength is associated with survival in patients with COPD, and summarized implementation-relevant evidence for other indices.

Methods: We systematically searched PubMed/MEDLINE, CENTRAL, and Web of Science from January 1, 1990 to September 30, 2025, screened observational cohorts and baseline-prognosis analyses in patients with COPD, appraised risk of bias, and meta-analyzed time-to-event estimates using random-effects where ≥2 comparable studies were available. Eligible studies enrolled patients with COPD with observational cohorts or baseline-prognosis analyses reporting all-cause mortality as outcome.

Results: Of the six eligible studies, two permitted pooling for inspiratory strength versus all-cause mortality. Lower inspiratory strength was associated with higher mortality (pooled hazard ratio 0.97, 95% confidence interval 0.95-0.99; I²=58%). In severity-restricted cohorts, frequently reported cut-offs were maximal inspiratory strength (MIP) ≤55 cmH₂O and maximal expiratory strength (MEP) ≤80 cmH₂O; all-cause mortality in these groups was approximately 46.6-54.4% at 42-60 months. However, in broader-severity samples, 2-year and 12-45-month mortality rates were 9.4-14.7% and 8.4-33.6%, respectively. Peak inspiratory flow rate (PIFR) <60 L/min repeatedly aligned with exacerbations and 90-day readmission. Conversely, the prognostic signal for MEP was directionally inconsistent, and sniff nasal inspiratory pressure associations frequently attenuated after adjustment.

Conclusion: MIP shows a consistent directional association with survival in patients with COPD, although magnitude estimates vary with measurement protocols and confounder control. We propose a minimum reporting set (posture, starting lung volume, trials/repeatability, device/calibration, cmH₂O units, and prespecified confounders) and immediate clinical actions: standardized MIP during stable visits for risk stratification and PIFR screening to guide inhaler selection.

Background: Chronic obstructive pulmonary disease (COPD) is a major global cause of death, imposing substantial socioeconomic and healthcare burdens. This meta-analysis synthesizes evidence on all-cause and cause-specific mortality risks in COPD populations to identify high-risk subgroups and guide precision management strategies.

Methods: We searched PubMed, Embase, Web of Science, and Cochrane Library for cohort studies reporting death risks in COPD from database inception to April 10, 2025. Study screening, data extraction, and quality assessment were independently performed by two investigators. Meta-analyses pooled risks for all-cause and cause-specific mortality. Sensitivity analyses tested robustness; publication bias was assessed via funnel plots and Egger's test.

Results: Twenty-seven studies covering 286,314 showed COPD patients had significantly higher all-cause mortality versus non-COPD individuals (HR, 1.80; 95% CI: 1.40-2.30). Mortality risk exhibited a graded increase with COPD severity compared to non-COPD individuals: mild (HR, 1.32; 95% CI: 1.19-1.47), moderate (HR, 1.62; 95% CI: 1.45-1.81), severe (HR, 2.18; 95% CI: 1.59-2.99), and very severe (HR, 2.94; 95% CI: 1.78-4.85). When stratified by smoking status, COPD patients had consistently higher mortality than their non-COPD counterparts within each subgroup: never-smokers (HR, 1.41; 95% CI: 1.27-1.56), former smokers (HR, 1.37; 95% CI: 1.30-1.45), and current smokers (HR, 1.48; 95% CI: 1.25-1.76). The presence of comorbidities further amplified mortality risks in COPD patients versus non-COPD individuals, particularly in those with respiratory diseases (HR, 3.64; 95% CI: 3.10-4.27), cardiovascular diseases (HR, 1.29; 95% CI: 1.10-1.50), and all-cancers (HR, 1.69; 95% CI: 1.37-2.10), especially lung cancer (HR, 2.57; 95% CI: 2.04-3.24).

Conclusion: COPD patients have significantly higher death risks than non-COPD individuals, worsening with disease severity. Independent determinants of COPD-attributable mortality risk comprise smoking, coexisting respiratory diseases, cardiovascular diseases, and cancer (particularly lung cancer). These findings provide an evidence-based foundation for developing targeted intervention strategies to mitigate COPD-related mortality.

Background: Community-based management improve chronic disease outcomes, but their impact on disease perception and frailty in chronic obstructive pulmonary disease (COPD) patients remains underexplored.

Objective: To identify factors influencing disease perception in elderly COPD patients and assess the role of community-based management.

Methods: In this cross-sectional study, 223 COPD patients aged ≥60 years (diagnosed per the 2021 Guidelines for Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease) were randomly selected. Dyspnoea severity was graded via the mMRC scale; COPD severity incorporated spirometry (FEV1/FVC) and symptom burden (COPD Assessment Test). Participants completed the Brief Illness Perception Questionnaire (BIPQ), Tilburg Frailty Indicator (TFI), and a general information survey. Differences between community-managed (n=81) and non-community-managed (n=142) groups were compared. Pearson's correlation and multivariate linear regression analyses identified predictors of disease perception.

Results: Mean BIPQ score was 46.87±7.47 (moderate threat perception), and frailty score was 8.02±2.38. Disease perception positively correlated with total frailty and its subdomains (P<0.05). Community-managed patients had significantly lower BIPQ and TFI scores (P<0.05). Regression revealed disease duration (β=0.28), dyspnoea severity (β=0.22), and frailty (β=0.19) as positive predictors of disease perception; community management (β=-0.15) and older age (β=-0.12) were negative predictors (P<0.05). The model explained 46.0% of variance (R²=0.46, F=18.03, P<0.001).

Conclusion: Elderly patients with COPD demonstrated strong links between disease perception and frailty. Community-based management considerably reduced these scores, indicating its potential to improve patient outcomes.

Background and aims: COPD patients are prioritized for influenza and pneumococcal vaccines, yet vaccination rates remain low, indicating vaccine hesitancy. This study aimed to investigate the vaccination rates and the underlying determinants of vaccine hesitancy, as the primary behavioral driver of low coverage, among patients hospitalized for Acute Exacerbation of COPD (AECOPD).

Methods: From September 2022 to October 2023, 536 patients hospitalized due to AECOPD from eight hospitals in China were surveyed on their vaccination status (influenza or pneumococcal). Data on vaccination status and a structured 3C model (confidence, complacency, convenience) questionnaire were collected. Logistic regression identified factors associated with vaccination behavior, while structural equation modeling (SEM) elucidated the pathways through which the 3C components directly influence vaccine hesitancy.

Results: The overall vaccination rate was 16.8% (90/536). Key factors associated with the vaccination behavior included high CAT score (aOR=5.64), pulmonary infection (aOR=2.28), former smoking (aOR=0.35), regular inhaled medication (aOR=0.47), high mMRC score (aOR=0.29), and bronchiectasis (aOR=0.40). Critically, the SEM analysis revealed that vaccine hesitancy was primarily driven by complacency, manifesting as a "lack of perceived need" (78%). This complacency was significantly influenced by a lack of confidence in vaccine safety and effectiveness, and compounded by convenience barriers like geographical inaccessibility and financial costs. The 3C model analysis quantified these relationships, with convenience (path coefficient=0.896) and confidence (0.375) positively impacting vaccination, while complacency showed a slight negative effect (-0.002).

Conclusion: Low vaccination rates in AECOPD patients were mainly due to perceived lack of necessity, linked to vaccine hesitancy. This hesitancy was mainly driven by underestimation of disease severity. Integrated interventions are essential to improve vaccination uptake in this at-risk group.

Purpose: Emerging evidence indicates that psychological resources may influence clinical outcomes and disease burden in chronic obstructive pulmonary disease (COPD), but their interactions are still not well understood. This study examined how coping strategies and self-esteem are connected to psychological distress, symptom impact, and functional capacity in moderate and severe COPD.

Patients and methods: A cross-sectional study was conducted between December 2024 and July 2025 at a tertiary pulmonary center. Ninety-three patients with stable COPD were enrolled and classified into moderate (n = 43) and severe (n = 50) groups according to GOLD criteria. Assessments included spirometry, 6-minute walk test (6MWT), COPD Assessment Test (CAT), modified Medical Research Council (mMRC) scale, Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale (RSES), and the COPE inventory. Statistical analyses comprised group comparisons, correlation analyses with Benjamini-Hochberg correction, and multiple linear regression to identify independent predictors of coping styles.

Results: Severe COPD was associated with lower self-esteem (median RSES 18.5 vs 21, p < 0.0001), reduced 6MWT (203 m vs 300 m, p < 0.0001), higher anxiety (HADS-A 9.5 vs 7, p = 0.0001), and greater symptom burden (CAT 25 vs 19, p < 0.0001). These patients relied less on problem- (27 vs 31, p < 0.0001) and emotion-focused coping (23 vs 27, p < 0.0001), but more on avoidant coping (21 vs 19, p < 0.0001). Correlations showed that problem- and emotion-focused coping were linked to higher self-esteem and better 6MWT performance, whereas avoidant coping was related to greater dyspnea, higher CAT, and lower self-esteem. Regression analyses identified dyspnea severity (mMRC, p = 0.018) and lower FEV₁% (p = 0.0003) as predictors of avoidant coping, while self-esteem (p = 0.036) and 6MWT % (p = 0.015) predicted adaptive coping.

Conclusion: Severe COPD is associated with greater psychological distress, reduced self-esteem, and reliance on avoidant coping. In contrast, higher self-esteem and better functional capacity favor adaptive coping strategies.

Purpose: Improving physical activity (PA) is important in patients with chronic obstructive pulmonary disease (COPD). Goal setting can be a possible intervention to improve PA, but the increase in PA is not sustainable in the long term. We evaluated the effects of providing an individualized target step count, reflecting the disease condition of each patient, on PA and other factors, such as myokines, after six months in patients with COPD.

Patients and methods: We performed a randomized parallel group, open-label study (INTAR-Step study) between the target provision (intervention) group and the usual care (control) group and investigated differences in the proportion of subjects who achieved the target as a primary outcome and differences in changes in PA parameters and myokines as secondary outcomes. This study was registered with UMIN-CTR (UMIN000046390, January 13, 2022).

Results: A total of 73 subjects were analyzed (intervention, n=38; control, n=35). The proportion of participants in the intervention group who achieved their target step count did not show a significant increase relative to the control group (p=0.157). However, the change in step count, and change in duration of activity at ≥3.0 metabolic equivalents were significantly increased in the intervention group. The Changes in the Growth differentiation factor-15 (GDF-15), fatty acid-binding protein-3, and Irisin levels also increased in the intervention group. Furthermore, GDF-15 levels were significantly higher in subjects with increased step counts than in those with decreased step counts.

Conclusion: Providing individualized step targets did not increase the proportion of subjects who achieved their targets, but it increased their step counts after six months. GDF-15 may be involved in the increase in the step count.

Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by respiratory muscle dysfunction, particularly involving the diaphragm and intercostal muscles. This may limit the feasibility of traditional pulmonary function testing.

Purpose: To investigate the association between ultrasound-derived respiratory muscle parameters and COPD severity, and to evaluate the utility of respiratory muscle ultrasound for disease stratification.

Patients and methods: This single-center, prospective study was conducted at Zhejiang Hospital between January 2024 and June 2025, 78 COPD patients (35 mild-to-moderate, 43 severe) and 50 healthy volunteers were enrolled. Muscle thickness, thickening fraction, excursion, and shear-wave elasticity of the diaphragm and intercostal muscles were measured. Group comparisons and logistic regression analyses were performed. Repeatability was evaluated in the healthy cohort.

Results: All 128 participants completed the study. Ultrasound measurements demonstrated excellent repeatability (ICC coefficients 0.851-0.969). Gender (male vs female, OR = 4.934, P = 0.014), DE (OR=0.393, P=0.008), ICMTF (OR=10.053, P=0.025), and ICM-SWV (OR=6.419, P<0.001) were predictive of screening-positive COPD, with an area under the curve (AUC) of 0.908. Within COPD severity stratification, end-inspiratory diaphragmatic thickness (OR=0.041, P=0.014), diaphragmatic thickening fraction (DTF; OR=0.188, P=0.027), and ICM-SWV (OR=5.662, P=0.024) were identified as independent predictors, with an AUC of 0.959.

Conclusion: Respiratory muscle ultrasound offers reproducible and clinically informative parameters that support both COPD diagnosis and severity assessment, providing a potential complementary tool to pulmonary function testing in clinical practice.

Background: Body weight plays an intricate role in COPD, as obesity can impair lung function and thus might affect COPD categorization. We asked to which extent overweight/obesity affects conventional COPD scores taking into account lung function and potential restrictive patterns (PRISm, preserved ratio and impaired spirometry).

Methods: Patients of the COSYCONET cohort were included. Outcomes were the modified Medical Research Council (mMRC) questionnaire, the COPD Assessment Test (CAT), CAT question #4 (dyspnea upon exertion), the St George's Respiratory Questionnaire (SGRQ) and its domains, and the EQ-5D-VAS (EuroQoL-5-dimension) questionnaire for generic quality of life. Body mass index (BMI) was categorized into <25, ≥25 to <30, and ≥30 kg/m^2. The relationship between outcomes and predictors including airway obstruction, lung hyperinflation, air trapping and CO diffusing capacity was assessed by generalized linear models in a repeated measures design.

Results: Data from visits 1, 3, 4 and 5 were available in n=2478, 1855, 1291 and 944 patients, respectively, of whom 169, 132, 95 and 63 fulfilled the PRISm criterion. For mMRC, CAT total, CAT dyspnoea (#4), EQ-5D-VAS, SGRQ total, Activity and Impact, scores were higher in the upper two BMI categories compared to the lower one (p<0.05 each), without further significant dependence on PRISm or an interaction between BMI and PRISm. For SGRQ Symptoms, only the upper BMI category showed a significantly higher score. All scores depended (p<0.05 each) on lung function and exacerbation history in terms of GOLD group E.

Conclusion: For common indicators of the burden from COPD, BMI played a significant role by increasing these scores even if confounders were taken into account. Compared to the lowest BMI category, there was a continuous increase with overweight and obesity. Categorization into PRISm did not influence the relationship between BMI and symptom scores. The underlying mechanisms probably involve mechanical but also systemic factors. Based on this, COPD categorizations based on the scores studied probably should consider the effects of BMI.

Clinicaltrialsgov: NCT01245933.

Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by psychological distress, delayed symptom resolution, and poor quality of life (QoL). Anticipatory nursing interventions may offer a proactive strategy to address these multifaceted challenges, yet their clinical efficacy remains insufficiently established, particularly in resource-constrained settings where holistic care is often lacking.

Methods: This quasi-experimental study with historical controls included 369 COPD patients admitted between January 2023 and December 2024. Patients were divided into a control group (n = 186) receiving routine nursing care and an intervention group (n = 183) receiving structured, multidisciplinary anticipatory nursing interventions over a six-month period. The protocol comprised individualized care plans, proactive complication prevention, psychological support, and management of respiratory, circulatory, nutritional, and sleep needs. Outcomes included psychological status (SAS, SDS), symptom resolution time, QoL (GQOLI-74), and complications.

Results: All enrolled patients completed the study. Baseline demographic, clinical, and socioeconomic characteristics showed no significant differences between groups. Compared with routine care, anticipatory nursing significantly reduced post-intervention SAS and SDS scores (both p < 0.001), shortened symptom resolution times for dyspnea, cough, wheezing, and chest tightness (all p < 0.001), and improved all QoL domains (p < 0.001). The total complication rate was significantly lower in the intervention group (12.02% vs 33.33%, χ² = 23.83, p < 0.001).

Conclusion: Structured anticipatory nursing significantly improves psychological well-being, accelerates symptom resolution, enhances quality of life, and reduces complications in COPD patients. These findings support integrating proactive, holistic nursing strategies into standard COPD care, offering a viable model for improving outcomes even in settings with limited resources.