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

Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) affects approximately 38.7% of individuals globally and potentially leads to cirrhosis and hepatocellular carcinoma. This study aims to investigate the prevalence, characteristics, and impact of MAFLD on the frequency of exacerbations in chronic obstructive pulmonary disease (COPD) patients in Vietnam.

Methods: This cross-sectional descriptive study involved stable COPD patients, and using FibroScan to detect fatty liver while applying the 2020 Asian Pacific Association for the Study of the Liver criteria for a MAFLD diagnosis.

Results: Of the 168 COPD patients, 48.8% were diagnosed with MAFLD. Patients with MAFLD had significantly worse lung function, with a lower forced expiratory volume in 1 second (57.2% versus 67.0%, p=0.002) and forced vital capacity (80.8% versus 88.1%, p=0.009), compared to those without MAFLD. The frequency of exacerbations was higher in the MAFLD group, with 46.3% experiencing ≥2 exacerbations in the previous year, compared to 30.2% in the non-MAFLD group (p=0.032). Elevated controlled attenuation parameter (CAP) scores (>289dB/m) were strongly associated with frequent exacerbations in the previous year (odds ratio [OR] 5.64, p=0.001). MAFLD was also identified as an independent factor increasing the risk of exacerbation (OR 3.64, p=0.014).

Conclusion: Nearly half of the COPD patients were diagnosed with MAFLD. MAFLD is associated with worse lung function and an increased frequency of exacerbations in the past year. Elevated CAP scores were found to be a significant risk factor for frequent exacerbations in the past year. MAFLD is an independent risk factor for exacerbations in COPD patients.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by progressive airway inflammation and compromised immune defense, often worsened by reduced secretory immunoglobulin A (sIgA) levels. This decline in sIgA is linked to diminished polymeric immunoglobulin receptor (pIgR) activity, which impairs mucosal immunity. MicroRNA-144 (miR-144), a microRNA implicated in inflammation, may contribute to pIgR suppression, though this pathway in COPD remains poorly understood.

Methods: Human bronchial epithelial cells were exposed to cigarette smoke extract (CSE) to mimic COPD conditions, and were subsequently divided into control and CSE-treated groups. miR-144 was either inhibited or overexpressed in these cells via transient transfection. Expression levels of miR-144, transforming growth factor beta-induced factor homeobox 1 (TGIF-1), transforming growth factor beta (TGF-β), and pIgR were analyzed using quantitative real-time polymerase chain reaction and Western blot. Additionally, a TGF-β inhibitor was applied to assess TGF-β's role in miR-144-mediated regulation of pIgR.

Results: CSE treatment significantly upregulated miR-144 and TGIF-1 while reducing TGF-β and pIgR expression. miR-144 inhibition restored TGF-β and pIgR levels, while miR-144 overexpression reduced them further, indicating miR-144's direct influence on this regulatory pathway. TGF-β inhibition enhanced the reduction of pIgR under miR-144 overexpression, underscoring TGF-β's key role in pIgR regulation.

Conclusion: miR-144 mediates immune suppression in COPD by downregulating pIgR through the TGF-β pathway, suggesting that miR-144 could serve as a therapeutic target to restore airway immune function and mitigate disease progression in COPD.

Rationale: Alpha-1 antitrypsin deficiency (AATD) is the most common genetic cause of chronic obstructive pulmonary disease (COPD), but considerable phenotypic variability exists among affected individuals who share disease-causing variants. Therefore, a multicenter longitudinal cohort study of 270 adult participants with PiZZ AATD will be established with a goal of examining how computed tomography (CT) imaging and serum and airway biomarkers can be used to explain differences in phenotypic manifestations and outcomes.

Methods: Study visits at enrollment, 18 months, and 36 months will obtain spirometry, patient-reported outcomes, and biosampling from blood, nasal mucosa, and sputum. Chest CT image acquisition will be utilized for whole lung and lobar estimations of emphysema based on lung density and to test novel measurements of airway remodeling and lung tissue mechanics. Dried blood spot cards will be collected if the participant experiences an acute exacerbation of COPD during the study. Genetic analysis will be performed with complete SERPINA1 sequencing, and peripheral blood mononuclear cells will be isolated to generate a repository of inducible pluripotent stem cells.

Results: The cohort will be deeply characterized, including imaging, physiology, and symptomatology, cross-sectionally and longitudinally over a 3-year follow-up period. A validation cohort from Ireland will independently enroll patients with identical procedures.

Conclusion: This is the first cohort of AATD to incorporate such detailed metrics of disease, including quantitative emphysema measures, with the overarching goal of improving the understanding of disease heterogeneity in AATD and identifying factors associated with disease severity and progression.

The prevalence of chronic obstructive pulmonary disease (COPD) is higher in people with schizophrenia than in the general population, even after adjusting for smoking, but schizophrenia has not generally been considered in discussions of COPD multimorbidity. People with schizophrenia die prematurely, and COPD is an important but neglected cause of this mortality. People with schizophrenia have a higher prevalence of ever smoking tobacco than the general population. The link between COPD and schizophrenia may be partially explained by higher rates of smoking, but may also be syndemic, with shared genetic, socioeconomic, and environmental risk factors, and common pathophysiological mechanisms. People with a mental illness tend to receive medical care intermittently. There is often a lack of continuity of care, and primary and preventive services are infrequently used. Physical symptoms may be viewed as "psychosomatic," leading to underdiagnosis. People with schizophrenia are less likely to receive adequate general medical care, including investigation and treatment, in line with guidelines. Antipsychotic drugs are associated with adverse effects that may be problematic in people with COPD. The management and outcomes for people with schizophrenia and COPD could be improved by reducing stigma, developing integrated services, undertaking physical health checks that include asking about respiratory symptoms and arranging spirometry when indicated, care coordination that includes addressing physical health issues, vaccination, support with smoking cessation, exercise, and pulmonary rehabilitation.

Background: Chronic obstructive pulmonary disease (COPD) affects millions of people and is associated with significant morbidity and mortality. Patients experience a high symptom burden with impacts on quality of life, which have not been well quantified.

Methods: Phreesia's PatientInsightsquantitative survey was offered in January 2025 to patients with COPD during their check-in process for health care provider (HCP) visits. The survey comprised 28 questions. Survey question categories included COPD symptom experience and impact, and the treatment journey of patients with COPD. The survey also sought to identify potential communication gaps between patients and HCPs that might hinder effective COPD management.

Results: Of 1615 patients surveyed, most (59%) were female, and the majority identified as White (82%). A total of 39% of patients had experienced COPD for over 7 years at the time the survey was conducted, and 25% reported experiencing symptoms all 30 days in a typical month. A large proportion (64%) said that COPD had a moderate-to-great impact on their daily lives. Only 45% of patients had detailed discussions about their COPD with their HCPs. Among patients who had not tried/were currently not on any maintenance medications (n=339), the leading reasons included that their COPD was not severe enough, and that their HCP had not recommended it. Among patients who had tried maintenance medications, the majority (77%) indicated that they would be willing to try another therapy.

Conclusions: Improvements in patient-HCP communication are needed to achieve more effective, timely COPD management.

Background: Inhalation therapy is the cornerstone of chronic obstructive pulmonary disease (COPD) management. However, errors frequently occur since every type of inhalation device has different characteristics, complicating their use. The clinical pharmacist is an expert on these devices and can be involved in the care and education of inhaler use in patients with COPD.

Objective: The feasibility of a pharmaceutical care protocol specifically for patients with COPD in a rehabilitation hospital was assessed in a quality improvement study (mixed-methods).

Method: First, the clinical pharmacist had 6 contact moments with hospitalized patients between January and April 2022, which contained appropriateness evaluations and educational moments that were focused on inhalation techniques. Subsequently, a focus group discussion with all involved health care professionals (HCPs) took place to evaluate the preliminary results of the protocol's implementation.

Results: A total of 19 patients entered the study with the protocol resulting in a decrease of critical device errors (38.5% at baseline, to 7.7% at discharge). The HCPs concluded that it was feasible to implement the protocol given certain adjustments. A multidisciplinary collaboration between pharmacists and nurses is necessary to permit the practical implementation, as well as an individualization of the protocol based on the patient's needs. In patient follow-up, transmural care is essential including the HCPs in primary care, and the outpatient clinic.

Conclusion: The evaluation of the protocol by the involved HCPs emphasizes the importance of a clinical pharmacist in the care of patients with COPD as part of the multidisciplinary team, not only in the community or in an acute hospital setting, but also in a rehabilitation hospital.

Rationale: Studies have shown that digital inhalers, using remote monitoring data, can improve medication adherence and clinical outcomes, such as prediction of impending asthma exacerbations. There is limited research on the clinical utility of physiologic inhalation parameters and inhaler medication use data captured by a digital inhaler to identify impending acute exacerbations of chronic obstructive pulmonary disease (AECOPDs).

Objectives: The objective was to determine variation in digital inhaler-measured physiologic and inhaler use metrics in ambulatory chronic obstructive pulmonary disease (COPD) patients in advance of an AECOPD.

Methods: This phase 4, open-label, 3-month pilot study was conducted at 2 U.S. centers. Participants used the ProAir Digihaler for primary rescue medication during the study. Participants were contacted monthly for COPD disease assessments. Inhaler metric variations leading up to an AECOPD were evaluated.

Results: The ProAir Digihaler measured key inhalation metrics (mean [standard deviation]) including peak inspiratory flow (PIF) (67.6 [20.3]L/min), inhalation volume (1.40 [0.60]L), and recorded inhaler use from 9649 inhalations among 40 participants. Statistically significant reductions were observed in inhalation volume (1.4L versus 1.1L), inhalation duration (1875msec versus 1492.1msec), and time to peak (500msec versus 376.3msec) (p<0.02 for all comparisons) during the 14 days preceding an AECOPD. There were no significant changes observed in PIF (67.2 versus 63.3, p=0.1) and number of inhalations per day (2.7 versus 3.7, p=0.2).

Conclusion: Physiologic data captured by a digital inhaler may serve as a valuable remote patient monitoring tool to help support the identification of early or impending AECOPDs among ambulatory COPD patients and monitor COPD disease variability.

Background: The burden of chronic obstructive pulmonary disease (COPD) is well established, but opportunities for earlier diagnosis and improved management are still missed. Compared to the general COPD population, patients with a history of exacerbations and suboptimal treatment ("modifiable high-risk") are at greater risk of future exacerbations and adverse health outcomes. To date there is no systematic approach for identifying and treating this patient group.

Method: Two cluster randomized controlled trials (CRTs) in the United Kingdom and United States will assess the impact of a primary care-based quality improvement program (COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care [CONQUEST]), compared to routine care. In each trial, 126 primary care clusters will be randomized 1:1 to intervention or control arms. Three groups of modifiable high-risk patients will be identified using electronic medical records: undiagnosed with potential COPD, newly diagnosed COPD, and already diagnosed COPD. Eligible patients will be aged ≥40 years, have experienced ≥2 moderate/≥1 severe exacerbation(s) in the prior 24 months, including ≥1 in the last 12 months, and not be prescribed inhaled triple therapy. Patients in the undiagnosed group will also be required to have a positive smoking history. Primary trial outcomes will be the annual rate of exacerbations and the annual rate of major adverse cardiac or respiratory events, comparing the quality improvement program against routine care.

Discussion: These will be the first CRTs assessing such a comprehensive primary care-based COPD quality improvement program. Intention-to-treat analysis of trial outcomes after 24 months will inform its effectiveness in targeting the identification, assessment, treatment, and follow-up of patients with modifiable high-risk COPD.

Trial registration: UK trial: ISRCTN15819828; US trial: NCT05306743.