International Journal of Chronic Obstructive Pulmonary Disease最新文献

We report the first successful case of volume reduction of a giant emphysematous bulla (GEB) using the latest shape-sensing robotic-assisted bronchoscopy (ssRAB). The patient was a 70-year-old male with chronic obstructive pulmonary disease (COPD) who developed GEB. He had previously undergone endobronchial valve (EBV) removal due to pneumonia caused by long-term implantation of EBVs for bulla volume reduction after a left emphysematous bulla rupture and subsequent pneumothorax. The patient visited our hospital for gradually worsening shortness of breath over two months. Chest radiography and computed tomography (CT) showed a GEB compressing 60% of the right lung volume, with the largest part filling the entire cross-section of the right lower lung. Under general anesthesia and with the assistance of ssRAB, we precisely punctured the bulla, safely aspirated the gas within the bulla, and injected medical adhesive to close the bulla. Postoperatively, the patient's shortness of breath improved significantly, and a CT follow-up six months later showed that the bulla had reduced to about half of its original size. Our experience indicates the feasibility and potential benefits of the novel ssRAB for volume reduction of GEB. The long-term efficacy and safety of using ssRAB to reduce GEB need to be evaluated by larger-scale studies.

Introduction and objectives: Chronic obstructive pulmonary disease (COPD) is associated with peripheral muscle weakness, dyspnoea and decreased exercise tolerance. Eccentric aerobic exercise (ECC), characterised by contractions during muscle stretching, is becoming an alternative to concentric aerobic exercise (CON) in this population, due to its reduced cardiorespiratory demand. The main objective of this systematic review, following the PRISMA criteria, is to determine the benefits of ECC versus CON on exercise tolerance in people with COPD.

Methods: A literature search was conducted in PubMed, Cochrane, Google Scholar and PEDro databases until March 2025. Only randomised controlled trials published in the last 10 years and with exercise tolerance and functional outcomes analysed were included.

Results: Six randomised controlled trials were included (n=154), with good methodological quality (PEDro 6-7) and moderate certainty of evidence. The ECC showed benefits compared to CON in improvement of quadriceps strength (-0.15 [-0.51, 0.22] p=0.43); reduction of dyspnoea (-0.74 [-1.15, -0.34] p <0.001) and lower limb fatigue (-2.29, p < 0.001), a higher work rate (-0.48 [-1.07, 0.12] p =0.12), improvements in Timed Up and Go (TUG) (-2.03 [-2.90, -0.16] p< 0.001) and decrease heart rate (-14.37 [-18.24, -10.50] p < 0.01), suggesting increased cardiorespiratory efficiency. In contrast, the CON showed an improvement in endurance time (1.05 [0.45, 1.64] p<0.01) and oxygen saturation (1.79 [0.62, -2.97] p < 0.01) (IC 95%).

Conclusion: ECC is presented as an effective and safe strategy to improve exercise tolerance in people with COPD in terms of saturation, dyspnoea, fatigue and heart rate, while CON improves endurance time. However, further studies are required to confirm its long-term functional benefits and its applicability in other pathologies and also treatment protocols are needed to standardize the use of eccentric exercise.

Background: Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are two common chronic respiratory diseases. Their co-existence forms overlap syndrome (OVS), a distinct clinical entity that imposes a dual burden on patients due to its unique pathophysiological mechanisms and significant clinical implications.

Purpose: This narrative review describes the consequences of OVS by tracing its pathophysiological from molecular mechanisms to clinical phenotypes, including non-cardiovascular complications. The primary aim is to synthesize this knowledge into a conceptual framework to guide future therapeutic development.

Methods: We searched electronic databases including Pubmed, Web of Science and Google Scholar for relevant studies and academic articles discussing OSA-COPD overlap.

Results: OVS demonstrates a high population prevalence, with distribution influenced by factors such as gender, age, COPD-specific phenotypes, and OSA severity. Pathogenically, factors including smoking and obesity collectively contribute to significant airflow limitation (AFL) through impaired respiratory control, reduced ventilatory drive, and multi-level airway narrowing. The characteristic chronic hypoxia and persistent AFL drive disease progression by triggering systemic inflammation, oxidative stress, and autonomic dysfunction. Consequently, the clinical presentation of OVS is more complex and severe than that of either disease alone, characterized by profound hypoxemia and prevalent hypercapnia. Beyond the core respiratory impairments, which predispose patients to major cardiovascular events, OVS drives a range of extrapulmonary manifestations. These include metabolic derangements, hematological alterations, neuropsychiatric complications, Vitamin D Deficiency, osteoporosis, retinal vascular tortuosity, erectile dysfunction (ED), and postural control, potentially fueled by persistent systemic inflammation and chronic hypoxia. This multisystem involvement. This multisystem involvement collectively contributes to a significantly worsened clinical prognosis.

Conclusion: Understanding the progression from localized AFL to systemic injury is essential for clarifying the full burden of OVS, particularly as it relates to its various comorbidities. Current evidence offers a basis for improving early identification and diagnosis of both the primary condition and its associated comorbid states. Future research should prioritize the development of personalized management strategies that address the specific risks of different comorbidities.

Purpose: Hip fractures are a major public health concern, especially among older adults. Chronic obstructive pulmonary disease (COPD) is a famous comorbidity that can increase post-fracture outcomes. This retrospective population-based cohort study evaluated the impact of COPD on mortality and contralateral hip fracture risk following pertrochanteric fracture.

Patients and methods: We included patients diagnosed with pertrochanteric fracture (ICD-10-CM S72.1) between January 1, 2016, and December 31, 2022, from Taiwan's National Health Insurance Research Database. Mortality risk was assessed using Cox proportional hazards models, adjusted for sex, age, and Charlson Comorbidity Index (CCI) score. Contralateral hip fracture risk was estimated using competing risk analysis with death as a competing event. Subgroup analyses were stratified by sex, age, and CCI group.

Results: After adjustment, COPD was significantly associated with higher 1-year mortality (AHR: 1.12, 95% CI: 1.06-1.19, p<0.0001). Conversely, COPD patients had a lower 1-year incidence of contralateral hip fracture compared with non-COPD patients (3.12% vs 4.40%; adjusted subdistribution HR: 0.70, 95% CI: 0.61-0.81, p<0.0001). Similar patterns were observed across all subgroups.

Conclusion: COPD is an independent predictor of increased 1-year mortality after pertrochanteric fracture. The observed reduction in contralateral fracture risk likely reflects the competing risk of early mortality. These findings suggest that elderly patients with COPD should pay more attention in post-hip fracture management with personalized rehabilitation strategies.

Background: Chronic Obstructive Pulmonary Disease (COPD) represents a leading cause of mortality worldwide, with systemic inflammation being a key pathological feature. The association between the emerging inflammatory marker monocyte to high-density lipoprotein cholesterol ratio (MHR) and the risk of all-cause mortality in COPD patients remains unclear.

Methods: Data from COPD patients in the 1999-2018 NHANES database were analyzed using Cox regression models to assess the association between MHR and all-cause mortality risk. Restricted cubic spline (RCS) modeling was used to explore nonlinear associations and identify inflection points. Time-dependent ROC curves were utilized to evaluate the predictive accuracy of MHR. Subgroup and sensitivity analyses were performed to ensure the robustness of the results.

Results: This study included 1768 COPD patients and observed 606 all-cause deaths during a mean follow-up of 92 months. After adjusting for confounding factors, MHR level was significantly and positively associated with all-cause mortality risk (HR = 2.10, 95% CI: 1.53-2.89). RCS analysis revealed a nonlinear relationship between MHR and all-cause mortality risk (non-linear P = 0.004). A turning point analysis indicated a threshold effect of MHR at 0.29: mortality risk increased significantly above this value (HR = 2.52, P < 0.001) and decreased significantly below it (HR = 0.02, P = 0.006). Sex-stratified analysis showed that the association between MHR and mortality risk tended to be linear in men, while it was nonlinear in women. Time-dependent ROC analysis showed AUC values for MHR at 12, 36, 72, and 120 months were 0.73, 0.79, 0.78, and 0.81, respectively.

Conclusion: Elevated MHR serves as an important risk marker for all-cause mortality in COPD patients. This association exhibits nonlinear characteristics with threshold effects, suggesting that MHR has potential value in prognostic assessment of COPD patients.

Purpose: Chronic obstructive pulmonary disease (COPD) patients are at increased risk of sepsis, a condition associated with high mortality. The anion gap (AG) is commonly used to assess acid-base disturbances, but its reliability declines in hypoalbuminemia. The albumin-corrected anion gap (ACAG) may provide greater accuracy, yet its prognostic value in COPD patients with sepsis, defined according to Sepsis-3 criteria, remains unclear.

Patients and methods: This retrospective cohort study analyzed 2072 ICU patients with COPD and sepsis from the Medical Information Mart for Intensive Care IV (MIMIC-IV). Cox regression models evaluated the association between ACAG and mortality, Kaplan-Meier curves illustrated survival differences, restricted cubic splines examined nonlinear relationships, and subgroup analyses assessed consistency across strata. Receiver operating characteristic (ROC) curves compared the predictive performance of ACAG, AG, and serum albumin.

Results: Elevated ACAG was independently associated with both short- and long-term mortality. In fully adjusted models, each 1 mmol/L increase in ACAG was linked to higher risk of 28-day mortality (HR 1.064, 95% CI 1.042-1.086, P < 0.001) and 365-day mortality (HR 1.065, 95% CI 1.043-1.087, P < 0.001). A threshold effect was observed at ≥19.25 mmol/L, above which mortality risk increased markedly (28-day HR 1.336, 95% CI 1.126-1.586, P = 0.001; 365-day HR 1.429, 95% CI 1.208-1.691, P < 0.001). Kaplan-Meier survival analysis confirmed significant differences (log-rank P < 0.0001), and ROC analysis demonstrated that ACAG provided superior discrimination compared with AG and albumin for both 28-day (AUC = 0.734) and 365-day mortality (AUC = 0.696). Associations were consistent across clinical subgroups without significant interactions.

Conclusion: Elevated ACAG was an independent predictor of 28-day and 365-day all-cause mortality in critically ill patients with COPD and sepsis. An inflection point of approximately 19.25 mmol/L identified a clinically meaningful threshold for risk stratification. As a simple and widely accessible parameter, ACAG may facilitate threshold-based triage and individualized management in this high-risk population, though external validation in multicenter prospective cohorts is warranted.

Objective: The Rome classification was introduced to assess the severity of acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) based on easily measurable variables. However, its validation for global use has not yet reached a sufficient level. This study aims to evaluate the validity of the Rome criteria in determining the severity and prognosis of COPD AE in Turkey.

Methods: This multicenter study, conducted for the first time in Turkey and for the fourth time worldwide, included 750 patients diagnosed with AE-COPD who presented to emergency departments and outpatient clinics. According to the Rome criteria, patients were classified into three groups: mild, moderate, and severe AE-COPD.

Results: The study included 99 (13.2%) patients in the mild, 479 (63.9%) in the moderate, and 172 (22.9%) in the severe group. Emergency visits, hospitalizations, and ICU admissions in the past year were more frequent in the moderate and severe groups (p < 0.001 for all comparisons). Regarding outcomes of emergency or outpatient visits, most mild exacerbation cases were discharged (p < 0.001), while most moderate and severe exacerbations required hospitalization (p < 0.001). Compared to the moderate group, the severe exacerbation group had a higher risk of ICU admission (p < 0.001), NIV (p < 0.001), IMV (p < 0.001), in-hospital mortality (p < 0.001), and 30-day mortality (p = 0.015). No significant differences were found in 90-day mortality or 30 and 90-day readmission rates (p = 0.258, p = 0.712, p = 0.681, respectively). Survival analysis revealed no significant difference between the moderate and severe groups (p = 0.764).

Conclusion: The findings suggest that the Rome criteria can be successfully used to assess exacerbation severity in AE-COPD patients presenting to secondary and tertiary care hospitals in Turkey.

Objective: This retrospective study aimed to evaluate a health management model based on traditional Chinese medicine (TCM) constitution identification in Chronic Obstructive Pulmonary Disease (COPD) patients.

Methods: This retrospective case-control study selected 108 COPD patients from the Respiratory Department of our hospital, divided into an observation group (n=54, receiving TCM constitution-based health management) and a control group (n=54, receiving routine health guidance). Primary outcome measures included COPD Assessment Test (CAT) scores and Forced Expiratory Volume in one second (FEV1).

Results: After 6 months, the observation group showed improvements in CAT scores (baseline: 24.93±2.61 to 6 months: 22.31±2.12, p<0.001) and FEV1 values (baseline: 1.34±0.71 L to 6 months: 1.79±0.73 L, p<0.001). After propensity score matching, clinical response rates remained higher in the observation group (CAT: 48.8% vs 18.6%; FEV1: 72.1% vs 7.0%, both p<0.001). However, significant baseline differences existed between groups, with the observation group being younger, having shorter disease duration, and better baseline lung function (all GOLD II vs 55.6% GOLD III in controls).

Conclusion: This retrospective study provides preliminary evidence suggesting potential value of TCM constitution-based health management in COPD patients. However, significant baseline differences and methodological limitations necessitate cautious interpretation. Well-designed prospective randomized controlled trials with matched cohorts are essential to establish efficacy definitively.

Background: The neutrophil-to-lymphocyte ratio (NLR) and serum albumin (ALB) are associated with the development and progression of chronic obstructive pulmonary disease (COPD). However, the relationship between NLR/ALB and COPD remains to be fully elucidated.

Objective: The primary objective of this study was to investigate the potential correlation between NLR/ALB and COPD, with the aim of identifying a potential biomarker that could serve as a rapid assessment for COPD.

Methods: We performed a retrospective analysis involving 39,055 participants extracted from the National Health and Nutrition Examination Survey (NHANES) dataset, which covered the period from 1999 to 2018. We utilized weighted multivariable logistic regression models to evaluate the association between NLR/ALB and COPD. Additionally, a restricted cubic spline (RCS) model was applied to investigate the potential non-linear relationship between NLR/ALB and the risk of COPD.

Results: Weighted multivariate logistic regression revealed a significant link between ln-transformed NLR/ALB and heightened COPD risk [odds ratio (OR): 1.35, 95% confidence interval (CI): 1.17-1.55; P<0.001)]. When ln-transformed NLR/ALB was converted into categorial variables (quartiles, Q), compared to the first quartile (Q1) of ln-transformed NLR/ALB, COPD risk for the greatest Q4 group was significantly higher. Meanwhile, a nonlinear association between ln-transformed NLR/ALB was observed. Subgroup and sensitivity analyses further validated the robustness and consistency of these findings.

Conclusion: Elevated NLR/ALB is associated with an increased risk of COPD, showing nonlinear patterns and threshold effects. NLR/ALB may serve as a potential biomarker for the occurrence of COPD.