International Journal of Chronic Obstructive Pulmonary Disease最新文献

Purpose: Elevated red blood cell distribution width (RDW) and decreased hematocrit (HCT) levels are associated with poor prognosis in chronic obstructive pulmonary disease (COPD) patients, but their significance in intensive care unit (ICU) patients with acute exacerbation of COPD (AECOPD) remains uncertain. The RDW/HCT ratio may offer a more comprehensive assessment compared to individual markers, potentially enhancing prognostic accuracy. Furthermore, the utility of RDW/HCT in improving traditional ICU scoring systems remains unexplored.

Patients and methods: The optimal RDW/HCT ratio cutoff was identified via ROC curve analysis, guiding classification into high and low ratio groups. Univariate and multivariate logistic regression analyses, Kaplan-Meier survival curves, and propensity score matching (PSM) were performed to evaluate the association between RDW/HCT ratio and 28-day all-cause mortality. The predictive value of RDW/HCT ratio compared to traditional ICU scoring systems was assessed using the area under the curve (AUC). Additionally, the eICU database was utilized to validate the robustness of the association between RDW/HCT and mortality in patients with AECOPD.

Results: 624 patients were included, with 361 in the low RDW/HCT ratio group and 263 in the high ratio group. PSM yielded 145 matched pairs of patients with balanced baseline characteristics. Multivariate logistic regression analysis revealed that patients with RDW/HCT ratio ≥ 0.473 had significantly higher 28-day all-cause mortality compared to those with RDW/HCT ratio < 0.473 (p < 0.001). Combining RDW/HCT ratio with SOFA score improved the diagnostic accuracy significantly (p=0.029).

Conclusion: The RDW/HCT ratio is an independent predictor of 28-day all-cause mortality in AECOPD patients in the ICU. It can be used for a preliminary assessment before a systematic evaluation of the patient, indicating its potential value in early assessment of disease severity. In a comprehensive evaluation, combining the RDW/HCT ratio with the SOFA score can further enhance predictive accuracy.

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory condition often complicated by cardiovascular disease (CVD) due to shared inflammatory pathways. This review explores the cardiovascular impacts of emerging anti-inflammatory therapies in COPD. Phosphodiesterase (PDE) inhibitors may offer anti-inflammatory effects with improved lung function but pose potential risks for arrhythmias when PDE3 is inhibited although PDE4 inhibitors reduce cardiovascular events by improving endothelial function and reducing thrombosis. Similarly, p38 mitogen-activated protein kinase (MAPK) and phosphoinositide 3-kinase (PI3K) inhibitors target COPD-related inflammation and may benefit COPD patients with CVD. p38 MAPK inhibitors reduce cardiac fibrosis, enhance contractility and lower the risk of arrhythmia. PI3K inhibitors target the PI3K/Akt pathway, which drives atherosclerosis and cardiac fibrosis, and thus potentially mitigate both plaque instability and fibrosis. Biologic therapies, including monoclonal antibodies that inhibit IL-5, IL-13/IL-4, thymic stromal lymphopoietin, IL-33, and IL-17A, show promise in reducing exacerbations but require close cardiovascular monitoring due to their immunomodulatory effects. Single-target inhibitors of neutrophil elastase or matrix metalloproteinases show limited efficacy in COPD but may aid cardiovascular patients by stabilizing atherosclerotic plaques through promoting vascular smooth muscle cell proliferation. However, their tendency to degrade the extracellular matrix and attract immune cells may heighten plaque rupture risk, contraindicating use in CVD. Alpha-1 antitrypsin replacement therapy holds promise, potentially reducing COPD exacerbations and providing cardiovascular protection, especially in myocardial injury. Understanding the influence of these innovative therapies on CVD is vital, making it imperative to examine these molecules in COPD patients with CVD at an early stage.

Objective: To assess the incidence and risk factors of tuberculosis-associated obstructive pulmonary disease (TOPD) in individuals with treatment-naive pulmonary tuberculosis (PTB) and develop a predictive model to enhance its management.

Methods: The incidence of TOPD among patients with treatment-naive PTB in Xinjiang, China, was followed up for one year. Patient characteristics, such as demographics, medical histories, laboratory test results, lung radiological evidence, and pulmonary function, were collected upon hospital admission and throughout follow-up visits. Risk factors associated with TOPD were evaluated by multivariate logistic regression analysis, and then a predictive model was established using LASSO regression.

Results: Of the 159 included patients, 69 (43.4%) developed TOPD during the follow-up period. Multivariate regression analysis identified age, body mass index, ESR, and symptom duration as significant risk factors. Subsequently, a model formula was derived from these factors to predict TOPD. Utilizing a cut-off value of 0.435, the model demonstrated a sensitivity of 89% and a specificity of 83%.

Conclusion: In Xinjiang, the prevalence of TOPD appears notably high among treatment-naive PTB patients. Our findings, such as the risk factors and predictive model, may facilitate the early detection and improved interventions for TOPD among patients with PTB, potentially leading to better patient outcomes.

Background: Understanding patients' perceptions of their illness may be more beneficial for healthcare providers in maintaining vigilance than merely focusing on the clinical status of patients. As patients' perceptions can significantly influence their behavior, it is possible that health care providers who are aware of patients' thoughts in advance may help improve their intervention programs, such as increased treatment adherence. However, current research offers limited insight into the subjective perceptions of disease among patients with Chronic Obstructive Pulmonary Disease (COPD). This study aims to deeply explore COPD patients' illness perception and coping behaviors.

Methods: A descriptive qualitative approach was used, conducting semi-structured in-depth interviews with 32 COPD patients, and verbatim data recording. Data analysis was based on thematic analysis methods proposed by Braun and Clarke.

Results: Through data analysis, we identified three themes to describe participants' perceptions and coping behaviors related to COPD: inadequate knowledge regarding the disease, improper self-management of the disease, and diverse impacts resulting from the disease.

Conclusion: Illness perception is crucial for COPD patients. Participants' descriptions underscored their perceptions of the disease as well as the various challenges and consequences they face when dealing with it. To enhance care for individuals with COPD, researchers and healthcare professionals should increase awareness about the disease among patients, understanding their coping strategies, beliefs, and recognizing its significant impacts.

Purpose: Although low-carbohydrate and low-fat diets improve weight loss, cardiovascular disease, and diabetes, the relationship between these dietary patterns, highlighting macronutrient sources, and chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to assess the association between low-carbohydrate diets (LCDs) and low-fat diets (LFDs) and the odds of COPD and mortality among people with COPD in the National Health and Nutrition Examination Survey.

Patients and methods: Clinical data were extracted from the 2007-2008, 2009-2010, and 2011-2012 National Health and Nutrition Examination Survey (NHANES) cycles that met the inclusion criteria. Multivariable logistic regression was used to evaluate the associations between LCD and LFD scores and COPD, and multivariable Cox proportional hazards regression and restricted cubic spline (RCS) regression were used to assess the relationship between all-cause mortality and LCD and LFD scores.

Results: Comparing extreme tertiles, multivariable-adjusted odds ratio (OR) were 1 (reference), 1.09 (95% CI, 0.77-1.55), 1.84 (95% CI, 1.09-3.09) (P = 0.045 for trend) for unhealthy LFD scores. After multivariate adjustment, a per 5-point increase in unhealthy LCD score was associated with a 21% higher risk of total mortality (hazard ratio, 1.21; 95% CI, 1.03-1.43); while a per 5-point increase in healthy LFD scores was associated with a 21% lower risk of total mortality (HR, 0.79; 95% CI, 0.67-0.94).

Conclusion: Higher unhealthy LFD score was associated with an increased odds of COPD. Unhealthy LCD scores were significantly associated with higher total mortality, whereas healthy LFD scores were associated with lower total mortality in patients with COPD.

Objective: To compare clinical characteristics and outcomes of hospitalized acute exacerbations of COPD (AECOPD)s secondary to SARS-CoV-2 versus other respiratory viruses amongst a highly vaccinated population in the Omicron era.

Design: Retrospective cohort study; analysis of hospital medical records and linked pathology and radiology reports.

Setting: Tertiary health network in Victoria, Australia; January 2022-August 2022.

Main outcome measures: Key clinical information including comorbidities, vaccination status, treatments administered and outcomes such as hospital length of stay, ICU admission, non-invasive ventilation usage and inpatient mortality.

Results: One hundred ninety-nine viral AECOPDs - 125 SARS-CoV-2 and 74 other viruses were identified. Of the SARS-CoV-2 group. 13.6% were unvaccinated, 17.6% partially and 68.0% fully vaccinated. The SARS-CoV-2 group were older (77.2 vs 68.9, p < 0.00001) with more comorbidities (1[1-2] vs 1[0-2], p = 0.008) and lower candidacy for full resuscitation (25.6% vs 56.8%, p < 0.0001). Mortality tended to be higher among SARS-CoV2 admission (9.6% v 2.7%, p = 0.066) but rates of ICU admission (10.4% v 13.5%, p = 0.507), length of hospitalisation (5[3-8] vs 5[3-9], p = 0.9) and readmission within 30 days (25% vs 33.3%, p = 0.184) were similar.

Conclusion: In a highly vaccinated population in the Omicron era, COPD patients requiring hospitalisation with SARS-CoV-2 are older with more comorbidities than those admitted with other respiratory viruses. Length of hospitalisation and ICU utilisation was similar. Inpatient mortality may be higher.

Background: More studies have focused on the clinical value of the measurement of the neutrophil-to-lymphocyte ratio (NLR) in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study aims to assess the stability of NLR in hospitalized AECOPD patients and its relationship with clinical prognosis.

Methods: This retrospective observational study recruited patients hospitalized with AECOPD from January 2020 to December 2023. Using receiver operating characteristic curves, we determined the optimal NLR cutoff, categorizing NLR stability into four groups: persistent high (NLR ≥ 3.8), increased (NLR < 3.8 at admission but ≥ 3.8 at discharge), decreased (NLR ≥ 3.8 at admission but < 3.8 at discharge), and persistent low (NLR < 3.8). Adverse hospital outcomes included hospital mortality, transfer to the intensive care unit (ICU), invasive mechanical ventilation (IMV), and length of hospital stay (LOS) ≥ 14 days. The associations between NLR stability and these outcomes were analyzed using multivariable logistic regression and Cox hazard analysis.

Results: Among 841 patients hospitalized for AECOPD, the mean age was 72.1±9.5 years, with 644 males (76.6%) and 197 females (23.4%). The proportions and distribution for groups: persistent high, decreased, increased, and persistent low groups were 109 (12.9%), 175 (20.8%), 216 (25.7%), and 341 (40.5%), respectively. The persistent high group had the worst outcomes, including higher IMV use, ICU transfer, LOS > 14 days, and hospital cost, compared to the persistent low group. Compared to the persistent high group, the persistent low group (HR: 0.13; 95% CI: 0.10-0.24) and the decreased group (HR: 0.40; 95% CI: 0.22-0.73) are statistically significant for the risk of death, while the increased group (HR: 0.63; 95% CI: 0.37-1.04) does not show a statistically significant difference.

Conclusion: AECOPD patients who have persistent low NLR group face a low risk of adverse hospital outcomes and mortality after 6 months after discharge. The stability of NLR may serve as a novel biomarker for identifying AECOPD patients at increased risk of poor hospital outcomes.

Chronic obstructive pulmonary disease (COPD) is one of the most common clinical respiratory illnesses, defined by permanent pathological deterioration that leads to respiratory failure. Regarding COPD treatment, oxygen therapy is very important. Non-invasive positive pressure ventilation (NPPV) is a technique for non-invasive mechanical ventilation that enables patients to get positive pressure support without the need of an artificial airway. Instead, it merely employs the mask by covering the mouth and nose, or simply the nose of patients. NPPV has been shown to be beneficial for COPD patients experiencing respiratory failure. High-flow nasal cannula (HFNC) oxygen therapy shows some advantages, including the reduction of anatomical dead space, the prompt correction of low oxygen levels as well as the improvement of patients' tolerance. Owing to its continuous progress, ventilation technology strongly improves COPD treatment. In this study, the authors analyze the application of NPPV and HFNC in COPD so as to provide recommendations for mechanical ventilation treatment.

Background and purpose: Chronic obstructive pulmonary disease (COPD) is a common and progressive disease that is influenced by both genetic and environmental factors, and genetic factors are important determinants of COPD. This study focuses on screening the best predictive models for assessing COPD-associated SNPs and then using the best models to predict potential risk factors for COPD.

Methods: Healthy subjects (n=290) and COPD patients (n=233) were included in this study, the Agena MassARRAY platform was applied to genotype the subjects for SNPs. The selected sample loci were first screened by logistic regression analysis, based on which the key SNPs were further screened by LASSO regression, RFE algorithm and Random Forest algorithm, and the ROC curves were plotted to assess the discriminative performance of the models to screen the best prediction model. Finally, the best prediction model was used for the prediction of risk factors for COPD.

Results: One-way logistic regression analysis screened 44 candidate SNPs from 146 SNPs, on the basis of which 44 SNPs were screened or feature ranked using LASSO model, RFE-Caret, RFE-Lda, RFE-lr, RFE-nb, RFE-rf, RFE-treebag algorithms and random forest model, respectively, and obtained ROC curve values of 0.809, 0.769, 0.798, 0.743, 0.686, 0.766, 0.743, 0.719, respectively, so we selected the lasso model as the best model, and then constructed a column-line graph model for the 25 SNPs screened in it, and found that rs12479210 might be the potential risk factors for COPD.

Conclusion: The LASSO model is the best predictive model for COPD and rs12479210 may be a potential risk locus for COPD.

Purpose: Exacerbations of COPD (ECOPD) significantly impact disease progression and mortality. Visiting a respiratory specialist (RS) in proximity to the exacerbation may lead to prompt treatment and improved outcomes. We aimed to evaluate the association between an RS visit 30-days before admission and exacerbation outcomes.

Patients and methods: The prospective study included subjects that were hospitalized with ECOPD between 2017 and 2019 in 13 medical centers. Pre-admission, in-hospital, and 30-day outcomes were assessed and compared between patients with and without a 30-day RS visit, using propensity score matching. A sub-group analysis was performed based on the reason for the RS visit (emergent vs regular follow-up).

Results: Three hundred and forty-four subjects were included, and 105 (31%) had pre-admission RS visit (RS group). Before matching, indicators of severe COPD were prevalent in the RS group, while after matching there were no differences. RS visits were associated with pre-hospital initiation of short acting bronchodilators (50% vs 36%), antibiotics (30% vs 17%), and systemic steroids (38% vs 22%). The RS group had longer duration between first symptoms to hospital arrival (median 5 vs 3 days, p < 0.01) and shorter hospital length-of-stay (median 4 vs 5 days, p = 0.04). In-hospital and 30-days outcomes were similar between the groups. However, a non-emergent pre-hospital RS visit was associated with improved in-hospital and 30-day outcomes.

Conclusion: Routine RS visits could lead to correct and early treatment for ECOPD with a potential for improved outcomes. These findings highlight the need for available specialists and higher awareness.