International Journal of Chronic Obstructive Pulmonary Disease最新文献

Background/aim: Chronic obstructive pulmonary disease (COPD) is often complicated by sarcopenia, a condition of reduced muscle mass and function that adversely affects quality of life, lung function, and exacerbation rates. Ultrasonography could be an effective tool for detecting sarcopenia, notably by assessing diaphragmatic function, which may indicate muscle health in COPD patients. This study aims to evaluate the effectiveness of diaphragmatic ultrasound in detecting sarcopenia among COPD patients.

Materials and methods: Thirty-five patients with COPD, with a forced expiratory volume in one second (FEV1) between 30% and 80%, were consecutively enrolled in this cross-sectional and double-blind study. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle mass was assessed with bioelectrical impedance analysis (BIA), muscle strength was assessed using the handgrip test and physical performance was assessed using a 4-meter gait speed test. Pulmonary function tests (PFT) (including maximum inspiratory pressure-MIP and maximum expiratory pressure-MEP) were performed. Diaphragm excursion and thickness at residual volume, functional residual capacity, and total lung capacity were measured using ultrasound. The diaphragm thickening fraction was calculated during normal (TF) and deep breathing (TLC-TF).

Results: Seventeen of 35 patients (48.6%) were found to be sarcopenic. Diaphragm thickness did not show significant variation between the groups. Both TF (27.43%) and TLC-TF (39.7%) were found to be lower in the sarcopenic group (p<0.05). The diaphragmatic excursion in the sarcopenic group was found to be 1.38 cm (p=0.078). There was no difference in median MIP and MEP values between the groups.

Conclusion: Diaphragmatic TF may be a valuable tool for detecting sarcopenia in COPD patients, which may vary independently of PFTs. This study highlights TF as a potential auxiliary measure, but further research with larger sample sizes and additional parameters is needed to confirm its clinical utility.

Introduction: Chronic obstructive pulmonary disease (COPD) is a prevalent, incurable condition requiring lifelong management. Inadequate daily management exacerbates COPD, leading to increased healthcare utilization and reduced quality of life.

Methods: This study aimed to design and validate a 10-item COPD self-evaluation (COPD-ES) questionnaire and apply it in the education of stable COPD patients. Participants were recruited from the Third Xiangya Hospital of Central South University and randomly assigned to control and intervention groups. The intervention group received monthly disease education using the COPD-ES questionnaire during a 6 months observation period.

Results: Significant improvements in smoking cessation, medication adherence, and disease knowledge in the intervention group were found. The intervention also led to a reduction in COPD Assessment Test (CAT) scores, modified Medical Research Council (mMRC) grades and acute exacerbation frequency. The COPD group classification improved accordingly.

Conclusion: The study highlights the importance of patient-centered education with our COPD-ES questionnaire in improving COPD management outcomes.

Purpose: Chronic obstructive pulmonary disease (COPD) is a common disease with high prevalence, high mortality and high costs across the globe. Small airways are major sites contributing to airway resistance and the small airway disorder (SAD) is frequently implicated in early-stage COPD. Smoking is recognized as the leading cause of COPD and SAD. This study aimed to investigate the status quo and influencing factors of smoking cessation in patients with SAD or COPD, which is crucial for improving prevention and treatment of chronic airway diseases.

Patients and methods: In this multicenter, prospective cohort investigation, questionnaire survey and one-year follow-up study were conducted in SAD and COPD patients with smoking history. The rate of quitting intention, quitting attempt and recent smoking cessation of SAD or different stages of COPD and their influencing factors were recorded, compared and analyzed.

Results: A total of 386 valid questionnaires were collected. The rate of quitting intention was 91.7% (95% CI: 88.53-94.07%), and quitting attempt was 73.6% (95% CI: 68.96-77.73%). Regular bronchodilator use, alcohol abstinence, and the lower Fagerstrom Test for Nicotine Dependence (FTND) scores were associated with a higher intention to quit smoking. Further, inpatients with higher mMRC scores, non-smoking parents, engagement in pulmonary rehabilitation exercises, and receipt of medical advice to quit were more likely to attempt quitting smoking. In the one-year follow-up survey, the overall recent smoking cessation rate was 23.9%. The multivariate logistic regression analysis revealed that higher mMRC grade, carrying out pulmonary rehabilitation exercise and the quitting intention were positive factors for quitting smoking, while outpatients with lower educational level, higher FTND score and Tobacco Craving Questionnaire-Short Form (TCQ-SF) scores were negative influencing factors for recent smoking cessation.

Conclusion: Patients with SAD and COPD generally had a high willingness to quit smoking, but a significant reduction in the success rate of smoking cessation. Factors influencing smoking cessation included the severity of the illness, nicotine dependence, patient self-control, lifestyle and environment.

Background: The STAR staging standard has been demonstrated to have good performance in distinguishing mortality among patients at different stages. However, the effectiveness of STAR and GOLD staging in distinguishing disease severity in high-risk and COPD patients remained unclear.

Methods: Based on Enjoying Breathing Program data through June 2023, a total of 7.924 high-risk and COPD patients were included. STAR and GOLD severity stages were based on FEV1/FVC (0.6-0.7, 0.5-0.6, 0.4-0.5, and <0.4 for stage 1 to 4 in STAR) and the proportion of predicted FEV1 value (≥80%, 50%-80%, 30%-50%, and <30% for stage 1 to 4 in GOLD), respectively. The cox regression model was used to assess the risk of medical visit due to severe respiratory symptoms according to STAR and GOLD.

Results: The current study included 1603 high-risk individuals and 6321 COPD patients. The proportions of STAR 1-4 in COPD patients were 37.1%, 33.2%, 20.5%, and 9.2%, respectively. In COPD patients only, GOLD stage distinguished disease severity well, but there was no difference in the risk of exacerbation between the different STAR stage groups. In addition, in COPD patients, by considering of GOLD and STAR together, GOLD 3 and 4 can provide more information about the exacerbation based on each STAR level, and STAR 1 and 2 can provide more information about the exacerbation in GOLD 2-4. COPD patients with GOLD 4 and STAR 2 (HR=4.08, 95% CI: 2.75-6.04) had the highest risk of exacerbation, followed by COPD patients with GOLD 4 and STAR 1 (HR=3.94, 95% CI: 2.49-6.23).

Conclusion: In COPD patients, GOLD performs better than STAR in predicting exacerbation risk. In addition, the combination of GOLD and STAR can provide more information, especially for COPD patients with GOLD 4 and STAR 1-2, which should be paid more attention in treatment and disease management.

Objective: To investigate the effectiveness of 12-weeks hybrid virtual coaching on health-related quality-of-life (HrQoL) in patients with stable COPD.

Methods: We equipped all patients with a CAir Desk for telemonitoring, the intervention group additionally received hybrid virtual coaching through the built-in smartphone. The multimodal intervention based on the Living well with COPD programme, containing educational content, physical activity coaching, and home-based exercises. Primary outcome was HrQoL as measured by the SGRQ. Secondary outcomes were symptom burden, physical activity, functional exercise capacity, and lung function. Between-group differences were calculated using linear regression models, controlling for baseline differences.

Results: We included 30 participants with COPD (13/17 women/men; 63 [9] years; FEV₁ 54 [22] % predicted), 24 (80%) completed the study. SGRQ improved in both groups (intervention: -4.5 [20.1]; control: -2.7 [7.4] points) without statistically significant or clinically relevant between-group differences (B = -2.5 points, 95% CI = -24.3, 19.3, p = 0.81). Physical activity increased only in the intervention group (313 [1561] vs -364 [2399] steps) without statistically significant but clinically relevant between-group difference (B = 2147 steps, 95% CI = -86, 4395, p = 0.06). Symptom burden decreased in both groups (-4.2 [6.7] vs -1.0 [2.8] points) without statistically significant but clinically relevant between-group difference (B = -3.0 points, 95% CI = -10.8, 5.0, p = 0.43).

Conclusion: Twelve-weeks hybrid virtual coaching did not improve HrQoL more than telemonitoring only in patients with stable COPD. The intervention group improved their physical activity and symptom burden clinically relevant more than the control group.

Purpose: Ambulatory Care Sensitive Conditions (ACSCs) refer to hospital encounters that could potentially be prevented with improved primary care. Chronic Obstructive Pulmonary Disease (COPD) as one of the typical ACSCs, and its hospitalization is considered potentially preventable through the quality primary care. However, the literature on factors influencing Potentially Preventable Hospitalization (PPH) has rarely been conducted from the patient perspective, especially in China. Our study aims to explore the factors influencing PPH for COPD patients.

Patients and methods: This was a qualitative study. Twenty participants hospitalized by COPD were recruited from the healthcare institutions in China. The semi-structured interviews were conducted from July to August 2022. The data were gathered and analyzed systematically using thematic analysis.

Results: Patients' experiences for PPH generated two main themes: environmental characteristics and personal characteristics. Sub-themes included accessibility of healthcare resources, medical services capability, healthcare insurance policy, working environment, disease cognition, health awareness, disease burden, income constrain, disease perception, negative emotions, and comorbidity.

Conclusion: Environmental characteristics and personal characteristics are factors associated with PPH for COPD patients. It is important to enhance the medical service ability, improve the accessibility of healthcare resources and the health literacy of patients.

Background: We evaluated the inhaled corticosteroid/long-acting muscarinic antagonist/long-acting β₂-agonist (ICS/LAMA/LABA) triple therapy with budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) versus dual LAMA/LABA and ICS/LABA therapies in patients with chronic obstructive pulmonary disease (COPD) and phenotypic features of asthma (bronchodilator reversibility and elevated blood eosinophils), but no asthma diagnosis, for whom treatment guidelines are limited.

Patients and methods: KRONOS (NCT02497001) and ETHOS (NCT02465567) enrolled patients with moderate-to-very-severe COPD, no current asthma diagnosis, and either ≥0 (KRONOS) or ≥1 (ETHOS) moderate/severe exacerbations in the prior year. This pooled post hoc analysis evaluated trough forced expiratory volume in 1 second (FEV₁) and FEV₁ area under the curve from hours 0 to 4 (AUC_0-4) change from baseline over 12-24 weeks, moderate/severe exacerbation rates, and St George's Respiratory Questionnaire (SGRQ) total score over 24 weeks with ICS/LAMA/LABA (BGF 320/14.4/10 µg), LAMA/LABA (glycopyrronium/formoterol fumarate dihydrate [GFF] 14.4/10 µg), and ICS/LABA (budesonide/formoterol fumarate dihydrate [BFF] 320/10 µg) in patients with phenotypic features of asthma defined as reversibility to salbutamol and blood eosinophils ≥300 cells/mm³. Analyses were not adjusted for multiplicity.

Results: BGF improved trough FEV₁ and FEV₁ AUC_0-4 versus GFF (least squares mean [LSM] difference [95% confidence interval (CI)] 125 [39-211] and 153 [59-247] mL) and BFF (LSM difference [95% CI] 118 [30-207] and 146 [49-243] mL). Exacerbation rates were estimated to be lower with BGF versus GFF and BFF (respective rate ratios [95% CI] 0.28 [0.19-0.43] and 0.69 [0.45-1.05]) and SGRQ total score was estimated to be improved with BGF versus GFF and BFF (respective LSM differences [95% CI] -5.18 [-8.11 to -2.24] and -1.09 [-4.08 to 1.91]).

Conclusion: BGF was estimated to have benefits on lung function, exacerbations, and health-related quality of life versus dual therapies in patients with COPD and phenotypic features of asthma.

Trial registration: ClinicalTrials.gov NCT02497001 and NCT02465567.

Background: Chronic obstructive pulmonary disease (COPD) is a major global health concern, and while traditional pulmonary function tests are effective, recent radiomics advancements offer enhanced evaluation by providing detailed insights into the heterogeneous lung changes.

Purpose: To develop and validate a radiomics nomogram based on clinical and whole-lung computed tomography (CT) radiomics features to stratify COPD severity.

Patients and methods: One thousand ninety-nine patients with COPD (including 308, 132, and 659 in the training, internal and external validation sets, respectively), confirmed by pulmonary function test, were enrolled from two institutions. The whole-lung radiomics features were obtained after a fully automated segmentation. Thereafter, a clinical model, radiomics signature, and radiomics nomogram incorporating radiomics signature as well as independent clinical factors were constructed and validated. Additionally, receiver-operating characteristic (ROC) curve, area under the ROC curve (AUC), decision curve analysis (DCA), and the DeLong test were used for performance assessment and comparison.

Results: In comparison with clinical model, both radiomics signature and radiomics nomogram outperformed better on COPD severity (GOLD I-II and GOLD III-IV) in three sets. The AUC of radiomics nomogram integrating age, height and Radscore, was 0.865 (95% CI, 0.818-0.913), 0.851 (95% CI, 0.778-0.923), and 0.781 (95% CI, 0.740-0.823) in three sets, which was the highest among three models (0.857; 0.850; 0.774, respectively) but not significantly different (P > 0.05). Decision curve analysis demonstrated the superiority of the radiomics nomogram in terms of clinical usefulness.

Conclusion: The present work constructed and verified the novel, diagnostic radiomics nomogram for identifying the severity of COPD, showing the added value of chest CT to evaluate not only the pulmonary structure but also the lung function status.

Background: The risk of coronavirus (COVID-19) can be affected by the presence of certain chronic conditions. It is unknown if individuals with severe hereditary alpha-1-antitrypsin deficiency (AATD) faced an increased risk of severe COVID-19 infection during the pandemic and if COPD in this population affected the risk of severe COVID-19 outcomes.

Aim: Our aim was to investigate COVID-19 outcomes in individuals with severe AATD and to identify if COPD was a risk factor for severe disease.

Methods: Between 2021-2023 we interviewed 863 individuals with severe AATD (phenotype PiZZ) included in the Swedish National AATD Registry. Details on COVID-19 outcomes were collected. Cox regression models were used to assess risk of mild and severe COVID-19 by presence of COPD.

Results: Of 863 subjects with severe AATD, 231 reported COVID-19 infection (208 mild and 23 severe COVID-19). Subjects with severe COVID-19 were older, had lower FEV₁ values, were more likely ever-smokers and had more comorbidities compared to those with mild COVID-19. Subjects with COPD had over a 5-fold increased risk of severe COVID-19 compared to those without COPD (HR 5.43 (95% CI 1.61-18.27, p=0.006). After adjusting for potential confounders including smoking habits the risk remained significant (HR 3.72 (95% CI 1.04-13.23, p=0.043)).

Conclusion: Most patients with severe AATD exhibit mild symptoms of COVID-19 infection, managing them in the community. Patients who also have COPD are at increased risk of severe COVID-19 infection.

Purpose: Immune checkpoint inhibitors are a standard treatment option for many patients with cancer and are most frequently used to treat lung cancer. Chronic obstructive pulmonary disease (COPD) is the most common comorbidity of patients with lung cancer. As the cancer-specific survival of patients with lung cancer continues to increase with modern treatments, it is critical to optimize comorbidities to improve overall survival. This literature review aimed to summarize current research on the impact of COPD upon immunotherapy outcomes.

Methods: A comprehensive search was conducted in the PubMed database using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria focused on peer-reviewed articles published between 2010 and 2024 that addressed COPD, cancer, and immune checkpoint inhibitors. The study team screened the studies for relevance and then synthesized them narratively.

Results: This review identified 37 studies that met the inclusion criteria. Findings suggest that COPD is predictive of improved efficacy but slightly worse toxicity from immune checkpoint inhibitor therapy. The chronic inflammation of COPD leads to immune exhaustion including the overexpression of immune checkpoints on T-cells. Particularly within "hot" tumors that have higher concentrations of tumor-infiltrating lymphocytes, the COPD-related increase in programmed cell death protein 1 (PD-1) signaling likely creates sensitivity to immune checkpoint inhibitors. However, COPD can also lead to respiratory dysfunction, debility, and interstitial lung disease; each of which increases the severity of immune-related adverse events.

Conclusion: COPD is a critical comorbidity that has a significant impact on many patients with cancer who receive treatment with immune checkpoint inhibitors. Future research is needed to design interventions to optimize COPD care in this high-risk patient population.