Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation最新文献

Background: The incidence of infections caused by nontuberculous mycobacteria (NTM) are steadily increasing worldwide, and the most common site of infection is the lung. Clinical characteristics of individuals with NTM pulmonary disease (NTM-PD) demonstrate pronounced geographical heterogeneity. In the United States, NTM-PD has an affinity for postmenopausal White females, many of whom are never-smokers, whereas in Asia, NTM-PD is more common in males with post-tuberculosis lung disease. While these geographical differences are known on the global scale, it remains unclear whether radiographic sex-associated differences in NTM-PD are present within the U.S. cohort.

Objective/method: In this single center, cross-sectional retrospective study of our patient registry, we sought to assess this knowledge gap by comparing radiographic and clinical features of individuals with NTM-PD by sex.

Results: We observed a significant preponderance of cavitary disease in men, while women commonly presented with bilateral apical fibrosis, increased nodules and tree-in-bud patterns in the lower lobes, and an increased risk of refractory disease and concomitant co-infection.

Conclusion: Results from this study demonstrate several sex-associated differences in the radiographic phenotype of NTM-PD and may be the result of differences in pre-existing risk factors that contribute to the development of NTM-PD. Future studies will be required to better assess the broad applicability of these findings to centers from other geographic regions where the underlying etiology of disease may vary.

Objectives: This meta-analysis assessed the effects of aerobic exercise on the function, prognosis, quality of life, and psychological outcome of patients with chronic obstructive pulmonary disease (COPD).

Methods: The Cochrane Library, Scopus, PubMed, and Web of Science were searched from the inception to June 20, 2025, to identify eligible studies. A random-effects model was employed for meta-analysis.

Results: Twenty randomized controlled trials with 1003 participants were included. The risk of bias was high in most studies, particularly because blinding was not feasible. For most outcomes, we observed high heterogeneity among studies. The meta-analysis indicated that compared to the control group, patients with COPD undergoing exercise training had a significantly increased 6MWT (WMD 42.44 m), FEV1 (WMD 0.08 L), FEV1/FVC (WMD 5.42%), and SpO2 (WMD 1.56%), which suggests that aerobic exercise can improve the functional capacity and respiratory reserve of patients with COPD. On the other hand, the results revealed that compared to the control group, aerobic exercise markedly decreased the SGRQ symptom score (SMD -1.13), SGRQ total score (SMD -1.44), mMRC score for dyspnea (SMD -0.81), and HADS-anxiety score (SMD -1.17), but its effect on the HADS-depression score (SMD -0.25) did not meet the threshold of statistical significance. Subgroup analysis unveiled that aerobic exercise can offer greater benefits in the long term, and those with FEV1 and FEV1/FVC of more than 50% can benefit more from aerobic exercise.

Conclusion: Aerobic exercise may improve the functional capacity, symptoms, respiratory reserve, quality of life, and psychological outcomes of patients with COPD.

Background: Chronic obstructive pulmonary disease (COPD) phenotyping is an approach for developing tailored therapies. The eosinophilic phenotype is associated with exacerbation risk and response to specific treatments. This study evaluates the relationship between sputum and blood eosinophilia, hypothesizing that sputum eosinophil percentage (SpE%) better reflects disease severity and exacerbation risk than blood eosinophil counts (BEC).

Methods: This was a single-center, prospective observational cohort with 107 participants aged 40-80 with clinically diagnosed COPD. Participants completed spirometry, a 6-minute walk test, and questionnaires, and blood and sputum samples were provided at baseline and 3 months. BEC and SpE% were measured via routine complete blood counts and flow cytometric analyses (fluorescence-activated cell sorting [FACS]). Eosinophilic phenotype thresholds were defined as BEC≥300 cells/μL and SpE%≥2%, and associations with clinical characteristics and outcomes were investigated.

Results: Adequate sputum specimens were obtained less frequently than blood (60.7% versus 98%). SpE% showed poor repeatability (interclass coefficient 0.36) and poor correlation with FACS (Spearman's 𝜌=0.008, p=0.58). Conversely, BEC showed higher repeatability (𝜌=0.67, p<0.01) and better correlation with FACS (𝜌=0.74, p<0.01). More participants were classified as eosinophilic COPD by sputum (33.3%) than by blood (19.6%). BEC values were poorly correlated with SpE% (𝜌=0.13, P=0.39), and sputum and blood-based diagnostic criteria showed poor agreement (64.5%, Cohen's 𝜅 0.10). High SpE%, but not high BEC, was associated with lower forced expiratory volume in 1 second percentage predicted.

Conclusions: In stable COPD patients, BEC and SpE% did not correlate well, and blood- and sputum-based diagnostic criteria identified different individuals. Defining eosinophilic COPD requires a better understanding of the bio-compartment sampled, testing methods, and cut-off values used.

Background: Chronic obstructive pulmonary disease (COPD) remains underdiagnosed and undertreated. Because screening asymptomatic individuals for COPD is not recommended, several case-finding tools have been explored. The COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) questionnaire and peak expiratory flow (PEF) rate (CAPTURE tool) have been tested in the primary care setting, with disappointing results. We hypothesized that these tools could yield better results in a computed tomography lung screening (CTLS) program, where individuals have a history of cigarette smoking and higher prevalence of COPD.

Methods: We recruited 67 patients referred to a CTLS program at a single institution. Participants completed the CAPTURE and COPD Assessment Test (CAT) questionnaires. Spirometric testing was completed with a portable device and low-dose chest computed tomography (CT) was performed according to a standard protocol.

Results: The group's mean age was 66 ±7 years, 43% were male, with a 37 pack-year smoking history. Eighteen (27%) had COPD (forced expiratory volume in 1 second of 60 ±22% predicted) and a higher CAT score (12 [interquartile range (IQR) 6-15]) compared to the nonobstructed group (CAT=7 [IQR 3-10]), p<0.02. Combining the CAPTURE questionnaire with PEF generated the best COPD diagnostic criteria (sensitivity=0.82, specificity=0.73, area under the receiver operating curve [AUROC]=0.784), followed by combining the CAPTURE questionnaire and emphysema presence (sensitivity=0.73, specificity=0.71, AUROC=0.779). The CAPTURE questionnaire alone had a sensitivity=0.766, specificity=0.616, and AUROC=0.669.

Conclusions: The CAPTURE tool is an effective method to find COPD cases in lung cancer screenings. A CT diagnosis of emphysema can substitute peak flow in this population.

Background: Pulmonary function tests may predict future outcomes; however, they are not often performed in middle-aged individuals at risk for future airway obstruction. We examined whether smokers with low lung function (LLF) have an increased risk of developing health problems and mortality over time.

Methods: Current and ever smokers (n=830) from the Lovelace Cohort aged 40-60 years without baseline airway obstruction and with at least 2 spirometry measurements over 18 months were included. Participants were divided into high lung function (HLF) and LLF function tertiles based on forced expiratory volume in 1 second percentage predicted (FEV₁%pred). Lung function, health status, and comorbidities were compared at baseline and over 17 years; mortality at 17 years was also assessed. From these participants, 61 HLF (baseline FEV1%pred >99%) and 26 LLF (baseline FEV1%pred <88%) were examined at 17 years follow-up using logistic regression.

Results: Baseline demographic and clinical characteristics were generally similar between the LLF and HLF tertiles, except for age, sex, body mass index, and lung function. In the overall cohort (LLF, n=277; HLF, n=277), survival of the HLF versus LLF cohort showed a hazard ratio of 0.49 (p=0.02). At the 17-year follow-up, LLF was associated with increased prevalence of wheeze, cardiovascular diseases, chronic lung diseases, diabetes, and worse health status.

Conclusions: Smokers with LLF without airflow obstruction exhibited reduced survival and an increased risk for development of chronic morbidities. Thus, spirometry may be used to identify at-risk individuals, allowing for early preventative interventions that can improve long-term health outcomes. Take home message: Among ever smokers without airflow obstruction, LLF is associated with increased mortality and poor health status. Spirometry may identify at-risk patients, enabling early emphasis on interventions with the potential to improve long-term health outcomes.

Chronic obstructive pulmonary disease (COPD) among individuals living in rural areas is associated with worse health outcomes. New strategies are needed to study interventions and deliver proven therapies to people with COPD in rural areas. This statement from the COPD Foundation Medical and Scientific Advisory Committee highlights specific challenges in capturing the key characteristics of rural residents and identifies approaches to improve research for COPD in rural areas. Specifically, geographic isolation, access to specialist care, lack of broadband access, and complex tobacco and exposure histories are drivers of COPD health disparities in rural populations that are not captured by conventional definitions of rurality. To improve the design of research studies among people with COPD living in rural settings, certain actions are identified. These include the inclusion of specific covariates such as distance and travel time to health care services and multidimensional assessment tools for societal and individual health determinants in data collection; deploying qualitative and mixed-methods research designs to assess cultural differences driving health care access and health behaviors; decentralized carousel recruitment models in study design; and operationalizing research partnerships to improve support for primary care providers engaged in research. These approaches will permit robust assessment of the complex matrices driving disparate health outcomes among people with COPD in rural areas.

Background: Cathepsins, a family of lysosomal proteolytic enzymes, have been implicated in the pathogenesis of various complex diseases, including chronic obstructive pulmonary disease (COPD). However, the causal relationship between cathepsins and COPD remains unclear.

Methods: This study employed Mendelian randomization (MR) to investigate the potential causal effects of cathepsin levels on COPD risk. This MR analysis utilized genetic data from individuals of European ancestry in the INTERVAL study and FinnGen consortium. Specifically, summary-level genetic data for 9 cathepsins (B, E, F, G, H, O, L2, S, and Z) were obtained from the INTERVAL study, while COPD summary statistics were sourced from the FinnGen consortium. We conducted comprehensive MR analyses, including univariable MR, reverse MR, multivariable MR (MVMR), and MR least absolute shrinkage and selection operator, to assess causal relationships between cathepsin levels and COPD risk.

Results: Univariable MR analysis revealed no significant causal relationships (forward or reverse) between the 9 cathepsins and COPD risk. However, MVMR analysis identified cathepsins O and S as having direct causal effects on COPD. For cathepsins O and S, odds ratio was estimated as 1.130 (p=0.022, 95% confidence interval [CI] = 1.018-1.255) and 1.068 (p=0.025, 95% CI = 1.008-1.132), respectively. Furthermore, these 2 cathepsins were independent risk factors for COPD after adjusting for smoking.

Conclusions: To our knowledge, this is the first MR study to systematically evaluate the causal role of cathepsins in COPD. Further research, particularly clinical trials, is warranted to validate these associations and explore the therapeutic potential of targeting cathepsins in COPD management.

Rationale: Chronic lung diseases, including chronic obstructive pulmonary disease (COPD) and bronchiectasis (BE), may differ by sex in symptom onset, diagnostic delays, and disease burden. This study examined health care experiences and symptom burden among individuals with self-reported COPD, BE, or nontuberculous mycobacteria (NTM).

Methods: This cross-sectional study analyzed data from an online survey of U.S. and international participants with self-reported COPD, BE, or NTM, recruited via COPD Foundation social media. The questionnaire, developed with input from COPD Foundation leadership, physician-researchers, and patient stakeholders, assessed health care experiences, disease burden, and symptoms. A subset of women answered menopause-related questions. Descriptive statistics were compared by sex and disease group: COPD (with/without BE or NTM) and BE (with/without NTM). T-tests assessed continuous variables; Chi-square or Fisher's exact tests analyzed categorical variables.

Results: Among 632 respondents (mean age 70±9 years, 74% women), 68% reported COPD and 32% BE. Women with COPD were younger (p=0.048) and sought care sooner after symptom onset (p<0.010) than men. More women with COPD did not have their diagnosis explained by a health care provider (p=0.038) and reported diagnosis-related anxiety, depression, or fear (p=0.007). Among participants with BE, men were more likely to receive a confirmed diagnosis sooner (p=0.038) and during hospitalization (p=0.024). Disease management burden, pulmonologist visit frequency, Chronic Airways Assessment Test scores, numbers of comorbidities, and financial burden were similar across groups. Over 75% of women were postmenopausal, and one-third reported worsened pulmonary symptoms postmenopause.

Conclusions: Differences in diagnostic delays and symptom burden highlight the need for further research into health care disparities to improve pulmonary care and outcomes.

Purpose: Chronic obstructive pulmonary disease (COPD) remains a challenging condition to manage due to its variability in clinical presentation and progression. While disease control is a well-defined concept in asthma, its relevance in COPD is less clear. This study aimed to evaluate the clinical utility of a COPD control framework, developed in Spain, in Portuguese outpatients by analyzing exacerbation rates among controlled and uncontrolled patients.

Methods: This prospective, observational study enrolled 133 COPD outpatients, evaluated at baseline (V0), 6 months (V1), and one year (V2). Patients were classified as controlled or uncontrolled based on criteria assessing clinical stability and disease impact, incorporating dyspnea severity, rescue medication use, physical activity, sputum color, and recent exacerbation history. Patients classified as controlled and uncontrolled were compared regarding the occurrence of an exacerbation (hospitalization, emergency visit, or ambulatory exacerbation) during follow-up.

Results: At baseline, 33.1% of patients were classified as controlled. This proportion increased to 46.2% at V1 but decreased to 31.6% at V2. Notably, only 12% remained consistently controlled throughout follow-up. There was a consistent trend of higher exacerbation rates among those previously uncontrolled. Only the difference in emergency visits at 12 months reached statistical significance (27.1% versus 7.8% in controlled patients, p=0.023).

Conclusion: This study provides the first independent validation of COPD control criteria in a Portuguese cohort. Although the control framework proved feasible for clinical application, its predictive value for exacerbations was low in this severe-disease cohort. Future research should expand on these findings in diverse populations to optimize COPD management strategies.