Pulmonary Disease Research Articles

Classification of Chronic Obstructive Pulmonary Disease (COPD) Through Respiratory Pattern Analysis

Background: This study proposes a classification system for predicting chronic obstructive pulmonary disease (COPD) patients and non-patients based on image and text data. Method: This study measured the respiratory volume based on thermal images, stored the respiratory data, and derived features related to respiratory patterns, including the total respiratory volume, average distance between expirations, average distance between inspirations, and total respiratory rate. The data for each feature were stored in text format. The four features saved as text were scaled using Z-score normalization and expressed as scores through weighted summation. These scores were compared to a threshold based on the ROC curve values, classifying participants as patients if the score exceeded the threshold and as non-patients if it fell below. Results: The proposed method achieved an accuracy of 82.5%. To validate the proposed approach, precision, recall, and F1-score were utilized, confirming the high classification performance of the model. The results of this study demonstrate the potential for future applications in non-contact medical examinations and diagnoses of respiratory diseases.

Heart failure with preserved ejection fraction: incidence and impact on mortality in patients with secondary tricuspid regurgitation

Abstract Introduction Secondary tricuspid regurgitation (STR) is a highly prevalent valve disease. STR and Heart Failure with preserved Ejection Fraction (HFpEF) share common features including exertional intolerance and high burden of atrial fibrillation (AF) and pulmonary hypertension (PH), making it challenging to disentangle HFpEF from TR. The incidence of clinically-recognized HFpEF in STR and its impact on mortality are not well established. Purposes To define the incidence of newly diagnosed HFpEF and its impact on mortality in a cohort of patients with significant STR and to evaluate the likelihood of a larger hidden burden of HFpEF. Methods Patients with a first diagnosis of ≥moderate-severe STR between 2004-2019 at our institution were retrospectively included. Patients with left ventricle ejection fraction <50%, left-sided valve diseases, and intracardiac device leads were excluded. HFpEF was identified by manual chart review as well as by use of ICD codes. The estimated prevalence of HFpEF was evaluated using an H2FPEF score ≥6, which corresponds to a ≥90% probability of having HFpEF. Results Of 2118 patients (mean age 70 ± 14, 36% females), 1057 (50%) had systemic hypertension (HTN) and 1091 (51%) had AF, with median 2.3 years of follow-up. From this cohort, 536 (25%) patients were diagnosed with HFpEF based upon chart review during the follow up period, while ICD diagnosis was only present in fewer than 50% of these patients (254). High H2FPEF score was present in 880 patients (41.5%), of whom 383 received a chart diagnosis of HFpEF, while 153 patients with H2FPEF score <6 received a chart HFpEF diagnosis. The cumulative incidence of chart-based diagnosis of HFpEF was 20.8% (N=158) at 1-year and 38.6% (N=273) at 5-years in patients with an H2FPEF score ≥6 and 5.5%(N=60) at 1-year and 11.1%(N=111) at 5-years in those with a score <6 (Figure). In Cox regression analyses, the diagnosis of HFpEF during follow-up was associated with increased mortality (HR 2.14, CI 1.86-2.46, p < 0.001) after adjusting for age, sex, body mass index, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, diuretics, HTN, pulmonary hypertension, chronic kidney disease and AF. Conclusions The incidence of clinically documented HFpEF in a cohort of patients with significant STR at index evaluation is high (25%). Use of ICD code underestimates clinical recognition, with the actual burden of HFpEF probably being even greater, as indicated by an H2FPEF score ≥ 6. Among those with significant STR, HFpEF diagnosis is an independent risk factor for mortality.

Echocardiographic estimate of pulmonary capillary wedge pressure improves outcome prediction in chronic heart failure

Abstract Background An echocardiographic algorithm to estimate pulmonary capillary wedge pressure (ePCWP) and pulmonary vascular resistance (ePVR) has been recently validated versus right heart catheterization (1). Purpose The aim of this study was to assess the prognostic significance of these measures in heart failure (HF) patients. Methods Consecutive outpatients with HF and left ventricular ejection fraction (LVEF) <50% undergoing echocardiography were selected and followed-up for the composite endpoint of cardiac death or HF hospitalization. Results Out of 2,214 patients (71±12 years, 76% males, LVEF 35±9%), ePCWP (16±6 mmHg) was elevated (>15 mmHg) in 52% of cases and ePVR (1.7±0.7 WU) was elevated (>2 WU) in 25% of cases. Patients with increased ePCWP were older, had a higher NYHA class, more pronounced cardiac remodeling, systo/diastolic dysfunction, and neurohormonal activation, particularly when ePVR was also elevated (p<0.001). Over a median follow-up of 33 (17-48) months, both measures stratified patients for the risk of the primary endpoint (Log-Rank 152 for PCWP, and 44 for ePVR, p<0.001). At adjusted regression analysis, ePCWP (hazard ratio for 1 mmHg increase 1.03 [95%CI 1-01-1-05], p<0.001) but not ePVR (p=0.584) predicted the primary endpoint, even in the subpopulation of patients with atrial fibrillation (p=0.003). ePCWP outperformed current diastolic dysfunction grading (Δ C-statistics 0.068 [95% CI 0.045-0.093], p<0.001), and stratified patients’ risk across each diastolic dysfunction grade at univariate analysis (Grade I: p=0.002; Grade II-III: p<0.001; Indeterminate cases: p=0.010). The addition of ePCWP to a multivariable prognostic model, including patients’ age, NYHA class III-IV, chronic obstructive pulmonary disease, estimated glomerular filtration rate, NT-proBNP, and LVEF, improved the accuracy of risk prediction (Δ C-statistics 0.008 [95% CI 0.002-0.014], p=0.007). Conclusion The echocardiographic estimates of PCWP retained clinical and prognostic significance in a large contemporary cohort of patients with chronic HF and LVEF <50%. This algorithm could facilitate early identification of high-risk patients, possibly reducing the need of right heart catheterisation, and allowing a tailored therapeutic approach. Graphical abstract KM curves for the primary endpoint - AF

Associations between sedentary behaviour and sarcopenia among patients aged 40 and older with chronic obstructive pulmonary disease: a cross-sectional study

BackgroundPatients with chronic obstructive pulmonary disease (COPD) and sarcopenia experience poorer clinical prognosis. Although sedentary behaviour (SB) is common risk factor for COPD, its relationship with sarcopenia in this specific population remains unclear.MethodsThis is a cross-sectional survey of participants aged 40 and above with COPD, involving 27 communities and 2 hospitals’ outpatient departments. The definition of sarcopenia was in accordance with the Asian Expert Consensus Criteria for sarcopenia. SB and physical activity (PA) were evaluated using the short form of the international physical activity questionnaires (IPAQ-SF). SB was categorized into 4 categories: less than 4 h/day, 4 to 6 h/day, 6 to 8 h/day, and 8 h or more per day. PA was classified into light-intensity and moderate-to-vigorous intensity physical activity (LPA and MVPA). Multiple logistic regression and restricted cubic spline (RCS) were performed to investigate the rates of association between sarcopenia and SB. Subgroups was analysed by gender.ResultsA total of 414 COPD patients with complete information were included in this trial. The overall prevalence of sarcopenia was 22.9%. Participants with sarcopenia had longer of SB (P = 0.008) and less MVPA (P < 0.001) compared to those without sarcopenia. After adjustment for confounders, SB showed a significant association with sarcopenia (adjusted β = 1.47, 95% CI = 1.28–1.68). The participants who spent 6 or more hours on SB had a greater odds ratio for sarcopenia (= 6-8 h: adjusted OR = 2.97, 95% CI = 1.14–7.70; > 8 h: OR = 9.14, 95% CI = 3.59–23.22) than the participants who spent less than 4 h. The results of RCS indicated that when SB exceeded 5.7 h/day, a trend towards a significant increasing prevalence of sarcopenia was observed with increased SB. This trend was also observed across genders, differing only in the threshold values (male: SB = 5.7 h; female: SB = 8.0 h).ConclusionSB was an independent determinant of sarcopenia, independent of MVPA, and the prevalence of sarcopenia increases as SB increases within a certain range. This study advocated for the integration of SB in the self-management strategies for patients with COPD. Regardless of their engagement in MVPA, it was crucial to regulate SB.

P-762. Prevalence and/or Recurrence of Non-Tubercular Mycobacterial Pulmonary Disease in Structural and Airway Lung Disease

Abstract Background Nontuberculous mycobacterial pulmonary disease (NTM-PD) frequently remains undetected, especially among patients with preexisting respiratory conditions who are prone to develop the disease. This study aims to explore the prevalence, species diversity, and outcomes of NTM-PD in India, an uncharted topic. Methods We conducted a prospective observational study, enrolling 69 patients with symptomatic chronic respiratory diseases or a history of Tuberculosis (TB). These patients underwent thorough clinical assessment, chest computed tomography scans, and either a single bronchoscopic sample or three sputum samples for microbiological analysis, along with relevant biochemical investigations. Diagnosis of NTM-PD followed the ATS 2020 diagnostic criteria. The growth of the organism was compared using patented indigenous media with or without p-nitrobenzoic acid. Results The prevalence of NTM-PD was 17.4%, with TB affecting 31.9% of cases. Baseline clinical symptoms and their duration showed no statistically significant differences, except NTM-PD patients with hemoptysis had significantly shorter symptom durations than other groups. Isolation rates were notably higher with the patented indigenous media compared to the mycobacterial growth indicator tube for both NTM (100% vs. 33.3%, p &amp;lt; 0.001) and Mycobacterium tuberculosis (M.Tb) (57.1% vs. 47.6%, p &amp;lt; 0.001). NTM-PD patients exhibited a significantly higher proportion of fibro-cavitary disease compared to other groups when comparing radiological findings. After monitoring NTM-PD patients following treatment, one patient (20%) experienced a recurrence of symptoms within six months, rest continue to be under follow-up. Conclusion In a high-burden TB setting, clinical suspicion and effort to look for NTM-PD is often low. Our study highlights the high prevalence of NTM-PD in individuals with chronic lung conditions/past history of TB. Patients with NTM-PD show higher rates of fibro-cavitary disease, possibly allowing the NTM to form biofilms and hence lead to relapses. Diagnosis of NTM-PD is thus important, to ensure desired treatment for the recommended duration and a thorough and prolonged post-treatment monitoring due to higher relapse risk. Disclosures All Authors: No reported disclosures

ESR Essentials: imaging of common paediatric pulmonary diseases-practice recommendations by the European Society of Paediatric Radiology.

Chest imaging in children presents unique challenges due to varying requirements across age groups. For chest radiographs, achieving optimal images often involves careful positioning and immobilisation techniques. Antero-posterior projections are easier to obtain in younger children, while lateral decubitus radiographs are sometimes used when expiratory images are difficult to obtain and for free air exclusion. Chest CT protocols should be age-dependent to minimise radiation exposure and motion artefacts. MRI is primarily used in specialised centres to reduce radiation exposure, requiring specific expertise and sedation in younger children. Respiratory distress syndrome is a leading cause of morbidity in preterm neonates, diagnosed through characteristic radiographic findings and a history of prematurity. Bronchopulmonary dysplasia is the most common complication of extreme preterm birth and chronic oxygen therapy; imaging is used for predicting outcomes for the assessment of severe cases. Transient tachypnoea of the newborn and meconium aspiration syndrome are common in term infants, with specific imaging characteristics aiding in their differentiation. Congenital lung malformations present diagnostic and management challenges, with imaging playing a crucial role in diagnosis and surgical planning. Finally, imaging is essential in detecting complications from pneumonia in children, such as empyema and necrotic pneumonia, or in identifying foreign object aspiration. CLINICAL RELEVANCE STATEMENT: This review summarises current radiology practice of paediatric chest pathologies, aiding in the accurate diagnosis and management of neonatal and congenital pulmonary conditions and pneumonia complications, ultimately improving patient outcomes through precise imaging interpretation and targeted clinical intervention. KEY POINTS: Chest radiographs should be systematically assessed for pathology. Ensure accurate differential diagnosis of neonatal lung diseases by collecting information on gestational age, method of delivery, presenting symptoms, ventilation type, and fetal ultrasound findings. Radiographs and ultrasound are initial diagnostic tools for paediatric pulmonary disease; CT should be reserved for complex cases. Referral to paediatric hospital should be considered when the use of chest MRI is indicated.

P-686. Risk of COPD Exacerbations, Asthma Exacerbations, and Hospitalizations for Heart Failure after RSV Hospitalization Among US Adults Aged at Least 50 Years

Abstract Background Older adults and adults with comorbidities are at increased risk of severe respiratory syncytial virus (RSV) disease. Limited data are available on the long-term impact of RSV on comorbid diseases. This study evaluated the association between RSV hospitalization and the risk of future acute disease worsening in adults aged ≥ 50 years. Figure 1 Methods This retrospective cohort study analyzed Optum’s de-identified Clinformatics Data Mart Database (CDM) healthcare claims from October 2015 to June 2023. Adults aged ≥ 50 years with ≥ 12 months of continuous enrollment were assigned to cohorts based on RSV hospitalization (RSV cohort), influenza hospitalization (flu cohort), or not having a recent acute respiratory illness (ARI) (controls). Index date was the start of an ARI episode that included hospitalization and an RSV or influenza diagnosis for the RSV and flu cohorts, respectively. Controls were matched 5:1 with the RSV cohort. Outcomes included acute exacerbations of (AE) chronic obstructive pulmonary disease (COPD), AE asthma, and hospitalizations for heart failure (HHF), were measured during the follow-up period (Fig. 1), and analyzed as recurrent events. AE COPD, AE asthma, or HHF risks were compared between the RSV vs influenza and RSV vs control cohorts using the Andersen-Gill formulation of Cox proportional hazards models in the overall population and subgroups. Results The study included 14,759, 77,468, and 73,795 adults in the RSV, flu, and control cohorts, respectively (Table 1). Mean cumulative event counts were highest in the RSV cohort (Table 2). In adjusted analyses, adults with an RSV hospitalization had a higher risk of AE COPD (for those with COPD: hazard ratio [HR] = 1.15 vs flu cohort, p &amp;lt; 0.001; HR = 2.78 vs control cohort, p &amp;lt; 0.001), AE asthma (for those with asthma: HR = 1.53 vs flu cohort, p &amp;lt; 0.001; HR = 6.51 vs control cohort, p &amp;lt; 0.001), and HHF (for those with heart failure: HR = 1.08 vs flu cohort, p &amp;lt; 0.001; HR = 3.07 vs control cohort, p &amp;lt; 0.001) (Table 3). Conclusion Increased risk of AE COPD, AE asthma, and HHF was observed among adults with RSV hospitalization compared to influenza hospitalization and compared to adults without a recent ARI. These findings build on previous research demonstrating the importance of RSV prevention in older and comorbid adults. FUNDING: GSK (VEO-000616) Disclosures David Singer, PharmD, MS, GSK: employee|GSK: Stocks/Bonds (Public Company) Yan Wang, ScD, Analysis Group: Employee Aozhou Wu, PhD, Analysis Group: Employee Elizabeth M. La, PhD, GSK: employee|GSK: Stocks/Bonds (Private Company) Susan Gerber, MD, GSK: Employee Lydia Lee, PharmD, MS, GSK: Fellowship Sponsorship Hongjiao Liu, PhD, Analysis Group: Employee Keith A. Betts, PhD, Analysis Group: Employee

Moderate aortic stenosis and preserved ejection fraction are not benign combination

Abstract Background Degenerative aortic stenosis (AS) is the most common progressive valvular disease and it is followed by adaptive left ventricular (LV) hypertrophy. LV hypertrophy is a compensatory mechanism aimed at reducing wall stress it also alters myocardial perfusion and impairs function and is tightly associated with heart failure with perserved ejection fraction (HFpEF). The outcome in patients with AS depends on the condition of the left ventricle and the presence of symptoms as well as the degree of the stenosis. Current guidelines do not address whether aortic valve replacement should be recommended in patients with moderate aortic valve stenosis regardless of the presence of symptoms and LV dysfunction. Purpose This study aimed to evaluate the association between moderate AS, symptoms, and myocardial structure and function after adjustment for comorbidities. Methods We conducted a matched cohort analysis. 61 patients with moderate aortic stenosis (MAS), LV ejection fraction &amp;lt;50% and sinus rhytm were matched with 1 comparator by age, gender and presence of arterial hypertension, diabetes, coronary artery disease, chronic obstructive pulmonary disease and renal failure. Echocardiographic parameters and presence of any of three symptoms (dyspnoea, chest pain and syncope) were recorded at and compared between two groups. Results No significant difference was found between the two groups concerning the left ventricle (LV) and right ventricle (RV) size, LV ejection fraction RV systolic function, and, pulmonary artery pressure, although patients with MAS tend to have greater end systolic diameter (ESD) but not statistically significant (35.20±8.28mm vs 32.86±6.08; P=0.083), LV global longitudinal strain was less in the MAS patients (-14.29 ±5.37 % vs. -17.95±2.44 %; P = 0.003). The LV mass index (LVMi) was greater, (122.30±31.16g/m2 vs 103.81±27.07; P=0.001), The relative wall thickness (RWT) was greater in MAS patients but not statistically significant (0.43 ± 0.09 vs. 0.41 ± 0.07 cm; P = 0.079). Left atrial volume index (LAVi) was greater in MAS (44±15ml/m2 vs 39±15; P=0.047), E/E′ ratio was greater in MAS (14±6 vs 11±3; P&amp;lt;0.001). Symptoms occurred more frequently in patients with MAS (24.6 %; 15/61 patients) than in the control group (8.2%; 5/61 patients, P=0.013). Conclusions LVEF as a means of assessing systolic function is insufficient. Ventricular hypertrophy and dysfunction were more common in patients with MAS than in the matched control group as well as the presence of symptoms. Timing of valve intervention in patients with symptomatic moderate aortic stenosis should be optimized.

305. Hospitalized Patients with Community-Acquired Pneumonia and Structural Lung Disease: A Multicenter Analysis

Abstract Background Patients with structural lung disease (SLD) are more susceptible to community-acquired pneumonia (CAP) and are at higher risk for resistant organisms. CAP studies often exclude patients with SLD making it difficult to determine when to treat patients empirically with broad-spectrum antibiotics (BSA). Here, we describe the epidemiology of CAP in inpatients with moderate to severe SLD. Methods Between 1/2017 and 12/2023, we analyzed data from inpatients with CAP in 68 Michigan hospitals. SLD was defined as documented moderate or severe chronic obstructive pulmonary disease, bronchiectasis, pulmonary fibrosis, or interstitial lung disease. BSA use was defined as therapy covering methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas and was considered appropriate if recommended by IDSA/ATS CAP guidelines. General estimating equation models, adjusted for variables known to be associated with outcomes, were used to compare 30-day outcomes between SLD and non-SLD CAP inpatients. Logistic or Poisson models, as appropriate, were adjusted for variables known to be associated with the outcomes. Results Of 51,953 patients with CAP across 68 hospitals, 18.2% (n=9,447) had documented SLD. Compared to patients without SLD, patients with SLD were sicker at baseline (see Table 1 for details) and, despite lacking traditional risk factors, were more often found to have MRSA (1.4% vs. 0.8%, p&amp;lt; 0.01) or Pseudomonas aeruginosa (4.7% vs. 1.7% p&amp;lt; 0.01) in their respiratory cultures (Table 2). While 42.2% of patients with SLD (vs. 35.5% without SLD) received broad-spectrum antibiotics, only 16.1% (vs. 10% without SLD) of such therapy was recommended by guidelines. Compared to patients without SLD, those with SLD had higher odds of mortality (aOR=1.31, p&amp;lt; 0.01 ) and hospital readmission (aOR = 1.19, p&amp;lt; 0.01; Table 3). Conclusion Patients with CAP and underlying SLD had more severe disease and experienced worse clinical outcomes. Though they were more likely to grow MRSA or Pseudomonas than patients without SLD, patients with SLD were far more likely to have non-guideline concordant empiric BSA use. New models may be needed to identify the risk of resistant pathogens in SLD and support better selection of empiric therapy. Disclosures Elizabeth McLaughlin, MS, RN, Blue Cross Blue Shield of Michigan: Salary Support

P-682. The Risk of Cardiorespiratory Events for up to 180 days Following Respiratory Syncytial Virus (RSV) Infection Hospitalization: A Self-controlled Case Series Analysis

Abstract Background Beyond the burden of acute respiratory infection, RSV can cause cardiorespiratory disease exacerbations and trigger cardiovascular events in adults. Information on these associations is limited, particularly following the acute illness phase. We evaluated the risk of common cardiorespiratory events during and following RSV hospitalization in adults. Methods We conducted a self-controlled case series analysis using data from administrative claims and electronic health records from Optum’s de-identified Market Clarity database. Adults (≥18 years) with 6 months of baseline continuous enrollment and an RSV-related hospitalization (RSV diagnosis or RSV+ test in the inpatient setting) from 01Jan17–30Jun23 (observation period) were included. Patients with the first admission for chronic obstructive pulmonary disease exacerbations (COPD-E), myocardial infarction (MI), stroke, congestive heart failure exacerbations (CHF-E), and arrhythmias during this period were identified using diagnosis codes. The risk period was defined as 0–180 days after RSV infection, including subintervals of risk periods and pre-risk periods. The remaining time outside of the 180-day risk period and the 21-day pre-risk period during the observation period formed the control period. Conditional Poisson regression adjusting for time-varying age (5-year intervals) was performed to determine the incidence rate ratio (IRR) for each event following RSV infection. Results Among 8,181 adults hospitalized with RSV, 3,494 had COPD-E 1,601 MI, 1,175 stoke, 2,879 CHF-E, and 4,083 arrhythmias during the entire observation period. The IRR during days 1–21 compared to the control period following RSV infection was 16.0 (95% CI 13.9, 18.4), 8.8 (95% CI 7.1,11.0), 9.9 (95% CI 7.9, 12.4), 9.5 (95% CI 8.1, 11.2), and 12.8 (95% CI 11.3, 14.4), respectively, for COPD-E, MI, stroke, CHF-E, and arrhythmias. IRRs were elevated for all outcomes for 42 days and attenuated over time but remained elevated for up to 180 days for stroke and CHF-E. Conclusion There is an increased risk of acute cardiorespiratory events and exacerbations following RSV infection. These cardiorespiratory events should be considered as part of the burden of RSV infection when evaluating RSV preventive interventions. Disclosures Caihua Liang, MD, PhD, Pfizer: Stocks/Bonds (Private Company) Jennifer Judy, MS, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Negar Aliabadi, MD, MS, Pfizer Inc: employment|Pfizer Inc: Stocks/Bonds (Public Company) Reiko Sato, PhD, Pfizer Inc: employee|Pfizer Inc: Stocks/Bonds (Private Company) Erica Chilson, PharmD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds (Public Company) Xin Zhao, MS, Pfizer: Xin Zhao is an employee of Genesis Research Group which received compensation from Pfizer for conducting this study. Bradford D. Gessner, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Elizabeth Begier, MD, M.P.H., Pfizer Vaccines: Employee|Pfizer Vaccines: Stocks/Bonds (Private Company)

Combining Hyperpolarized 129Xe MR Imaging and Spectroscopy to Non-Invasively Estimate Pulmonary Vascular Resistance.

Hyperpolarized 129Xe MRI/MRS enables quantitative mapping of function in lung airspaces, membrane tissue, and red blood cells (RBCs) within the pulmonary capillaries. The RBC signal also exhibits cardiogenic oscillations that are reduced in pre-capillary pulmonary hypertension (PH). This effect is obscured in patients with concomitant defects in transfer from airspaces to RBCs, which increase RBC oscillation amplitudes. Here, we provide a framework for interpreting RBC oscillations and show their relationship to pulsatile blood flow, capillary blood volume, capillary compliance, and impedance of the capillary and venous circulation. This framework was first applied to characterize RBC oscillations in a cohort of subjects with pulmonary disease but no known PH (n=129). 129Xe MRI of RBC transfer was used to estimate capillary blood volume, and as it decreased, RBC oscillations sharply increased (r2adj=0.53), consistent with model predictions. Model-derived fit parameters were then used to estimate the distribution of pulmonary vascular resistance (PVR) across arterial, capillary, and venous circulation, and to correct oscillations for RBC transfer defects. 70% of PVR was estimated to arise from pulmonary arteries, 11% from capillaries, and 19% from veins. When tested in a second cohort of subjects who underwent 129Xe MRI/MRS and right heart catheterization (n=40), oscillations corrected for capillary blood volume correlated moderately with PVR (r2=0.27, p=0.0014). For every 1.96 WU increase in PVR, corrected oscillations decreased by 1 absolute percentage point. This work demonstrates that, although 129Xe-RBC oscillations are only indirectly sensitive to pre-capillary obstruction, corrected oscillations below 7.5% were 100% specific for elevated PVR.

Comparing spirometry, impulse oscillometry with computed tomography for assessing small airway dysfunction in subjects with and without chronic obstructive pulmonary disease

BackgroundStudies on consistency among spirometry, impulse oscillometry (IOS), and histology for detecting small airway dysfunction (SAD) remain scarce. Considering invasiveness of lung histopathology, we aimed to compare spirometry and IOS with chest computed tomography (CT) for SAD detection, and evaluate clinical characteristics of subjects with SAD assessed by these three techniques.MethodsWe collected baseline data from the Early COPD (ECOPD) study. CT-defined SAD was defined as parametric response mapping quantifying SAD (PRMfSAD) ≥ 15%. Spirometry-defined SAD was defined as at least two of maximal mid-expiratory flow (MMEF), forced expiratory flow 50% (FEF50), and forced expiratory flow 75% (FEF75) less than 65% of predicted. IOS-defined SAD was defined as peripheral airway resistance R5 − R20 > 0.07 kPa/L/s. The consistency of spirometry, IOS and CT for diagnosing SAD was assessed using Kappa coefficient. Correlations among the three techniques-measured small airway function parameters were assessed by Spearman correlation analysis.Results2055 subjects were included in the final analysis. There was low agreement in SAD assessment between spirometry and CT (Kappa = 0.126, 95% confidence interval [CI]: 0.106 to 0.146, p < 0.001), between IOS and CT (Kappa = 0.266, 95% CI: 0.219 to 0.313, p < 0.001), as well as among spirometry, IOS, and CT (Kappa = 0.056, 95% CI: 0.029 to 0.082, p < 0.001). The correlation was moderate (|r|: 0.5 to 0.7, p < 0.05) between spirometry and CT-measured small airway function parameters, and weak (|r|< 0.4, p < 0.05) between IOS and CT-measured small airway function parameters. Only spirometry-defined SAD group had more lower lung function (FEV1/FVC: adjusted difference=-10.7%, 95% CI: -13.5% to -7.8%, p < 0.001) and increased airway wall thickness (Pi 10: adjusted difference = 0.3 mm, 95% CI: 0 to 0.6 mm, p = 0.046) than only CT-defined SAD group. Only IOS-defined SAD group had better lung function (FEV1/FVC: adjusted difference = 3.9%, 95% CI: 1.9 to 5.8%, p < 0.001), less emphysema (inspiratory LAA− 950: adjusted difference=-2.1%, 95% CI:-3.1% to -1.1%, P < 0.001; PRMEmph: adjusted difference=-2.3%, 95% CI: -3.2% to -1.4%, p < 0.001), and thicker airway wall (Pi 10: adjusted difference = 0.2 mm, 95% CI: 0.1 mm to 0.4 mm, p = 0.005) than only CT-defined SAD group.ConclusionsThere was low consistency in the assessment of SAD between spirometry and CT, between IOS and CT, as well as among spirometry, IOS, and CT.Clinical trial numberNot applicable.

Managing cognitive impairment in patients with chronic obstructive pulmonary disease (COPD) in Saudi Arabia: what are the current practices?

Objective Cognitive impairment is a common comorbidity, yet overlooked, in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the current practice and perceptions of physicians on recognising and managing cognitive impairment in patients with COPD in Saudi Arabia. This study aimed to investigate current practices and perceptions of physicians in Saudi Arabia regarding the recognition and management of cognitive impairment in COPD patients. Methods An online cross-sectional questionnaire was distributed between March and October 2023 to physicians in Saudi Arabia. The collected responses were analysed using descriptive statistics. Results A total of 808 physicians completed the online survey. Of whom, only 19% indicated receiving adequate training for managing cognitive impairment. Although the vast majority of physicians reported that cognitive impairment leads to underestimation of COPD severity (85%) and interferes with self-management (85%), only 11% agreed on the important role of screening. In addition, only half of the study participants aimed to identify possible cognitive impairment, with only 4% screening for cognitive impairment during patients’ assessment. The overall confidence level in recognising and managing cognitive impairment was relatively low. The most common barriers contributing to the suboptimal management of cognitive impairment in COPD were poor training (62%), the absence of standardised procedures (63%) and limited knowledge (58%) about cognitive impairment in COPD. Conclusion The current practice of recognising and managing cognitive impairment in Saudi Arabia is suboptimal. This is likely to be attributed to inadequate training, the absence of standardised procedures, and limited knowledge about cognitive impairment in COPD. Healthcare systems should provide more training and implement a holistic approach to detect and manage cognitive impairment during patients’ visits.

The relationship between fatigue levels and psychosocial adjustment in elderly individuals with chronic obstructive pulmonary disease: A descriptive study.

Chronic Obstructive Pulmonary Disease (COPD) is associated with physical limitations and significant social, psychological, and behavioral challenges. This study investigates the relationship between fatigue levels and psychosocial adjustment in COPD patients, considering their sociodemographic characteristics. A descriptive study was conducted with 160 COPD patients hospitalized in the Pulmonology Department of a university hospital. Data were collected via face-to-face interviews using a patient information form, the COPD and Asthma Fatigue Scale (CAFS), and the Psychosocial Adjustment to Illness Scale-Self-Report (PAIS-SR). Statistical analyses included Independent Sample t-test, One-Way ANOVA, Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation analysis, with significance set at p < 0.05. The mean age of participants was 68.70 ± 9.41years; 71.9% were male, and 67.9% had COPD for over six years. Most participants (74.4%) reported limitations in daily living activities due to the disease, and 91.9% reported having social support. Mean scores were 58.03 ± 15.80 on the CAFS and 64.19 ± 6.41 on the PAIS-SR. Significant differences were observed in fatigue and psychosocial adjustment scores based on gender, social support, and disease impact on daily activities (p < 0.05). A weak positive correlation was found between fatigue levels and psychosocial adjustment (p < 0.05). COPD patients experience moderate-to-high fatigue levels and challenges in psychosocial adjustment, with fatigue negatively influencing adjustment. Interventions should focus on enhancing coping strategies, addressing psychosocial needs, and leveraging social support systems to improve patient outcomes.

Adolescent Obesity and Charlson Comorbidity Index in Young Adults

Background: There is insufficient evidence regarding the independent risk of childhood/adolescent obesity for morbidity and mortality in adulthood. The objective of the present study was to evaluate the association of weight categories during adolescence with high-risk diseases determined by the Charlson Comorbidity Index in young adulthood. We also analyzed the association of weight categories with cumulative mortality at the age of 30. Methods: A retrospective cohort study, based on the central computerized database of a major health service organization, was conducted. The study population consisted of 80,853 adolescents. The study period was from 1 January 2007 to 31 December 2022 and was divided into the exposure period from 1 January 2007 to 31 December 2011 (ages 17–19) and the follow-up period from 1 January 2007 to 31 December 2022 (from the date of the defining BMI measurement up to the age of 30 years). Results: The five diseases with the highest cumulative incidence were chronic pulmonary disease (8.2%), mild liver disease (3.7%), cerebrovascular disease (2.8%), diabetes without end-organ damage (2.0%), and peptic disease (1.6%). When adjusted for socio-demographic variables and adult BMI, the relative risks with 95% confidence intervals for the increase in the Charlson Comorbidity Index were 1.11 (1.05–1.17), 1.17 (1.11–1.24), and 1.22 (1.09–1.35) for the “overweight”, “obesity”, and “class 2 obesity” categories, respectively, while the mortality for these categories were 1.60 (1.11–2.27), 1.71 (1.12–2.57), and 3.18 (1.48–6.35), respectively. Conclusions: Adolescent obesity is an independent risk factor for high-risk diseases and mortality in young adulthood. Interventions aimed at reducing the rate of adolescent overweight and obesity should be implemented as early as possible.

The Effects of Home High-Flow Nasal Cannula Oxygen Therapy on Clinical Outcomes in Patients with Severe COPD and Frequent Exacerbations

Background: Chronic Obstructive Pulmonary Disease (COPD) is a disease with high morbidity and mortality globally. Exacerbations of COPD are major contributors to disease progression and a decline in health-related quality of life (HRQoL). High-flow nasal cannula (HFNC) oxygen therapy is an innovative therapy that provides humidified and heated blended air and oxygen through a nasal cannula. There is some preliminary evidence supporting the effectiveness of HFNC in managing COPD exacerbations, but there are limited data on its effectiveness when used at home for patients with stable, severe COPD. The aim of the present study is to test the hypothesis that home HFNC can decrease the COPD exacerbations rate and hospital admissions and improve HRQoL measures in severe COPD patients with frequent COPD exacerbations. Methods: In a prospective proof-of-concept interventional multicenter study, 40 GOLD stage III and IV COPD patients with a high disease burden (≥2 exacerbations treated with antibiotics and/or corticosteroids) and ≥1 hospital admission in the last year were included. Patients were given instructions on the usage of HFNC by a ventilation practitioner during a group session. The flow rate was 25–30 L/min and FiO2 was 21–35%. Outcome measures included the COPD exacerbations rate, hospital admissions, in-hospital days, Medical Research Council dyspnea (MRC) score, Clinical COPD Questionnaire (CCQ) score, Hospital Anxiety Depression Scale (HADS) scores and capillary pCO2. Repeated analysis of variance (ANOVA) was used to analyze the data. Significant effects identified in the ANOVA were further examined using Student’s t-tests. Results: After 1 year, 27 patients could be evaluated. The COPD exacerbations rate decreased by 1.40 (mean difference ± SD: 1.40 ± 2.09; p = 0.002), hospital admissions decreased by 0.96 admissions per year (0.96 ± 1.37; p = 0.001), and in-hospital days decreased by 7.22 days (7.22 ± 9.26; p = 0.001). Capillary pCO2 decreased by 0.02 kPa (0.02 ± 0.52; p = 0.85). The CCQ score decreased by 0.06 (0.06 ± 0.96; p = 0.76). The MRC dyspnea score decreased by 0.04 (0.04 ± 0.80; p = 0.81). The HADS anxiety score decreased by 0.63 (0.63 ± 3.12; p = 0.31). And finally, the HADS depression score decreased by 0.32 (0.32 ± 3.48; p = 0.64). There was a significant difference between the normocapnic (capillary pCO2 &lt; 6.0 kPa) group and the hypercapnic group in terms of change in the CCQ score (−0.24 ± 0.55 and 0.49 ± 1.32 decrease, respectively, p = 0.05) and the HADS depression score (−0.76 ± 1.86 and 2.20 ± 4.75 decrease, respectively, p = 0.03) after 1 year of HFNC treatment. Conclusions: One-year-long HFNC therapy significantly decreased the COPD exacerbations rate, hospital admissions, and in-hospital days in severe COPD patients with a high disease burden and frequent COPD exacerbations irrespective of them having hypercapnia and with the HRQoL measures only improving in the hypercapnic group. This may imply that severe COPD patients with a high disease burden and frequent COPD exacerbations, irrespective being hypercapnic, are candidates for treatment with home HFNC oxygen therapy.

Chronic disease prevalence and preventive care among Ontario social housing residents compared with the general population: a population-based cohort study

BackgroundOlder adults living in social housing report poor health and access to healthcare services. This study aimed to estimate the prevalence of chronic diseases, influenza vaccination and cancer screenings among...

Identification of patient demographic, clinical, and SARS-CoV-2 genomic factors associated with severe COVID-19 using supervised machine learning: a retrospective multicenter study

BackgroundDrivers of COVID-19 severity are multifactorial and include multidimensional and potentially interacting factors encompassing viral determinants and host-related factors (i.e., demographics, pre-existing conditions and/or genetics), thus complicating the prediction of clinical outcomes for different severe acute respiratory syndrome coronavirus (SARS-CoV-2) variants. Although millions of SARS-CoV-2 genomes have been publicly shared in global databases, linkages with detailed clinical data are scarce. Therefore, we aimed to establish a COVID-19 patient dataset with linked clinical and viral genomic data to then examine associations between SARS-CoV-2 genomic signatures and clinical disease phenotypes.MethodsA cohort of adult patients with laboratory confirmed SARS-CoV-2 from 11 participating healthcare institutions in the Greater Toronto Area (GTA) were recruited from March 2020 to April 2022. Supervised machine learning (ML) models were developed to predict hospitalization using SARS-CoV-2 lineage-specific genomic signatures, patient demographics, symptoms, and pre-existing comorbidities. The relative importance of these features was then evaluated.ResultsComplete clinical data and viral whole genome level information were obtained from 617 patients, 50.4% of whom were hospitalized. Notably, inpatients were older with a mean age of 66.67 years (SD ± 17.64 years), whereas outpatients had a mean age of 44.89 years (SD ± 16.00 years). SHapley Additive exPlanations (SHAP) analyses revealed that underlying vascular disease, underlying pulmonary disease, and fever were the most significant clinical features associated with hospitalization. In models built on the amino acid sequences of functional regions including spike, nucleocapsid, ORF3a, and ORF8 proteins, variants preceding the emergence of variants of concern (VOCs) or pre-VOC variants, were associated with hospitalization.ConclusionsViral genomic features have limited utility in predicting hospitalization across SARS-CoV-2 diversity. Combining clinical and viral genomic datasets provides perspective on patient specific and virus-related factors that impact COVID-19 disease severity. Overall, clinical features had greater discriminatory power than viral genomic features in predicting hospitalization.

Hearing loss and risk of major osteoporotic fracture: a population-based cohort study in the United Kingdom

SummaryUsing the UK Clinical Practice Research Datalink, our cohort study matched 237,297 individuals with hearing loss (HL) to 829,431 without HL. The study found an 8–10% higher risk of major osteoporotic fracture in individuals with HL compared to those without. Additionally, within the HL cohort, we identified risk factors for potential inclusion in fracture risk models.PurposeAssess association between hearing loss (HL) and major osteoporotic fracture (MOF; spine, wrist/forearm, shoulder/proximal humerus, hip) in individuals aged ≥ 60 years, and risk factors for MOF in individuals with HL.MethodsFrom the UK Clinical Practice Research Datalink, our cohort study matched individuals aged ≥ 60 years diagnosed with HL (READ/ICD-10 codes; 01January2001–31December2021; index event), without secondary osteoporosis causes, with up to five individuals without HL (birth, index year, sex, general practice). Incidence rates and Cox proportional hazard ratios (HL vs. no HL; stratified by low/high fracture risk) were calculated for MOF and hip fracture; multivariate logistic regression assessed risk factors for MOF and hip fracture (HL cohort).ResultsA total of 237,297 individuals with HL matched to 829,431 without HL, with a median age of 74 and 72 years, respectively. Compared with those without HL, individuals with HL had greater frailty (severe electronic frailty index, 5.9% vs. 2.7%), higher incidence of prior falls (14.1% vs. 10.6%), longer mean follow-up with higher incidence of MOF and hip fractures (5.1 vs. 4.4 years, 20.1 and 5.32 vs. 16.58 and 4.54 per 1000 person-years, respectively) and higher risk of MOF and hip fracture (adjusted HR, 1.10 and 1.08, respectively). Significant risk factors for MOF and hip fracture included age ≥ 70 years, fracture history, falls, osteoporosis diagnosis, chronic obstructive pulmonary disorder and cardiovascular disease (HL cohort).ConclusionIn individuals with HL, we observed an 8–10% higher risk of MOF and hip fracture versus individuals without HL and identified risk factors for potential inclusion in fracture risk models.

Interleukin-1 signaling and CD4+ T cells control B cell recruitment to the lungs in chronic beryllium disease

Chronic beryllium disease (CBD) is a debilitating pulmonary disorder that occurs due to persistent exposure to beryllium (Be) particles in the workplace. Be-exposure causes activation of the innate immune system, resulting in the secretion of interleukins and chemokines that drive the accumulation of B and T cells in the lungs. However, the mechanisms by which innate molecules influence the recruitment of B cells and B cell-mediated protection in CBD are poorly understood. In this study, we employed multiple approaches to examine the role of innate immune signaling and CD4+ T cells in B cell recruitment and function in the lungs. We show that the absence or blocking of IL-1R1 signaling prevents the recruitment of B cells to the lungs of BeO-exposed mice. Additionally, we show that B cell recruitment to the lungs depends on the chemokine receptor, CXCR5, and CD4+ T cells. In BeO-exposed mice, lung B cells down-regulate IgM but showed an increased IgD and CD44 surface expression. Further, RNA sequencing of pulmonary tissue-specific B cells in CBD revealed distinct gene signatures compared to splenic B cells, with increased expression of pathways involved in antigen presentation, tight junction interactions, and interferon signaling. Overall, our study shows that B cell recruitment and aggregate formation during CBD depend on sequential activation of innate and adaptive immune responses.