Chronic Obstructive Pulmonary Disease Cases Research Articles

The DOSE index in chronic obstructive pulmonary disease: evaluating healthcare costs

Background and objectivesThe DOSE index, which incorporates Dyspnea, Obstruction, Smoking, and Exacerbations, is a widely used tool for assessing the severity and prognosis of Chronic Obstructive Pulmonary Disease (COPD). In addition to risk assessment, it has potential clinical utility in predicting healthcare costs, which are primarily driven by exacerbations. While several indices, such as the BODE (Body-mass index, Obstruction, Dyspnea, Exercise) and ADO (Age, Dyspnea, Obstruction) indices, exist for risk prediction, there is a lack of dedicated tools for forecasting healthcare costs. This study explores the potential of the DOSE index compared to other indices, including BODE, ADO, and the Charlson Comorbidity Index (CCI), for this purpose.Materials and methodsThis cross-sectional retrospective study analyzed data from 396 COPD cases. We examined associations between the DOSE index, BODE index, ADO index, CCI, and healthcare costs, including hospitalizations and emergency room treatments. Healthcare costs were categorized as direct medical expenses.ResultsSignificant associations were observed between the DOSE index and various healthcare parameters. DOSE quartiles showed strong correlations with outpatient visits (p = 0.013) and outpatient medical expenses (p = 0.011). In addition, hospitalization frequency, duration, and associated costs were significantly correlated with higher DOSE quartiles (p < 0.001). A significant difference was found when comparing DOSE quartiles between patients with high (CCI ≥ 3) and low (CCI < 3) comorbidity scores (p = 0.018). The DOSE index outperformed other indices, likely due to its inclusion of exacerbations, a key driver of healthcare costs.ConclusionThe DOSE index demonstrates potential in predicting healthcare costs, particularly due to its inclusion of exacerbation frequency. This study highlights the importance of considering exacerbations alongside traditional risk factors for more accurate cost forecasting in COPD management. Our findings suggest that the DOSE index may be a valuable tool in both clinical and economic assessments of COPD patients, though further research is warranted to validate these findings in larger datasets.

Wearable device-measured bouted and sporadic physical activity patterns and incident COPD: A prospective cohort study from UK Biobank

ObjectivesModerate-to-vigorous physical activity (MVPA) is associated with a reduced risk of chronic obstructive pulmonary disease (COPD), but the optimal accumulation patterns are unclear. We aimed to investigate the associations between accelerometer-measured bouted and sporadic MVPA and incident COPD in the UK Biobank. Study designProspective cohort study. MethodsWe included 94161 COPD-free participants (median age of 61.74 years at baseline) from the UK Biobank who wore a wrist accelerometer. A random forest classifier was used to differentiate sporadic and bouted MVPA. Multivariable Cox proportional hazard models and restricted cubic splines were used to examine the MVPA-COPD associations. ResultsDuring a median follow-up of 7.95 years, 1380 incident COPD cases were identified. Bouted MVPA was inversely associated with COPD incidence in an L-shaped manner, with hazard ratios of 0.62 (95 % CI: 0.52–0.75) for intermediate vs lowest quintile and 0.43 (95 % CI: 0.34–0.55) for highest vs lowest quintile. In those with insufficient bouted MVPA, sporadic MVPA had a U-shaped association with incident COPD, with hazard ratios of 0.82 (95 %: CI: 0.67–0.99) for intermediate vs lowest quintile and 1.11 (95 % CI: 0.88–1.39) for highest vs lowest quintile. ConclusionsBouted MVPA is a key factor in reducing COPD incidence, while modest sporadic MVPA may offer protection when bouted MVPA is insufficient.

Partial correlation network analysis identifies coordinated gene expression within a regional cluster of COPD genome-wide association signals.

Chronic obstructive pulmonary disease (COPD) is a complex disease influenced by well-established environmental exposures (most notably, cigarette smoking) and incompletely defined genetic factors. The chromosome 4q region harbors multiple genetic risk loci for COPD, including signals near HHIP, FAM13A, GSTCD, TET2, and BTC. Leveraging RNA-Seq data from lung tissue in COPD cases and controls, we estimated the co-expression network for genes in the 4q region bounded by HHIP and BTC (~70MB), through partial correlations informed by protein-protein interactions. We identified several co-expressed gene pairs based on partial correlations, including NPNT-HHIP, BTC-NPNT and FAM13A-TET2, which were replicated in independent lung tissue cohorts. Upon clustering the co-expression network, we observed that four genes previously associated to COPD: BTC, HHIP, NPNT and PPM1K appeared in the same network community. Finally, we discovered a sub-network of genes differentially co-expressed between COPD vs controls (including FAM13A, PPA2, PPM1K and TET2). Many of these genes were previously implicated in cell-based knock-out experiments, including the knocking out of SPP1 which belongs to the same genomic region and could be a potential local key regulatory gene. These analyses identify chromosome 4q as a region enriched for COPD genetic susceptibility and differential co-expression.

Informing community pharmacists on COPD case-finding methods: A scoping review.

Early detection of chronic obstructive pulmonary disease (COPD) is a strategy to address the increasing human and economic costs of this condition. This study aimed to inform pharmacists' case-finding strategies by providing an overview of case-finding approaches by health care practitioners. A scoping review was conducted based on the Joanna Briggs Institute and the PRISMA Extension for Scoping Reviews (PRISMA ScR) guidelines. Included studies were analyzed under the following themes: population characteristics, inclusion and exclusion criteria, setting, case-finding strategies and yield, health care practitioners involved, interprofessional collaboration and the provision of preventive services. Studies were then characterized by highest yields (the weighted average of each approach expressed as a percentage of the total number of new COPD cases divided by the total number of patients screened using the same approach). The screening process produced 170 eligible studies. Twenty case-finding approaches with average yields of new COPD cases ranging from 3.8% to 29% were identified. The approach with the highest yield involved the use of a questionnaire, peak flow meter and pre-post spirometry. In 14 of these approaches, the process was initiated with the use of questionnaires. In many of the studies, case-finding was targeted at high-risk and/or symptomatic patients. Characteristics of studies with the highest case-finding yields included provider education/training, patient education, active screening, multistep approaches to case-finding, provider engagement, diagnostic criteria by guidelines and engagement of other health care practitioners. In our scoping review of case-finding methods for patients with COPD, we found the greatest yield from pre-post spirometry following initial screening with a peak flow meter and questionnaire. Pharmacists and health researchers can use these approaches to identify high-risk patients for interventions.

The role of transthoracic echocardiography in evaluating right ventricular parameters in chronic obstructive pulmonary disease

BackgroundCardiac symptoms are a characteristic feature of chronic obstructive pulmonary disease (COPD), a disorder with lately achieved recognition as a systemic illness according to established standards. The research’s objective was aimed at investigating the transthoracic echocardiography role in assessing right ventricular (RV) dysfunction among individuals diagnosed with COPD, as well as to examine the potential correlation between blood pro B-type natriuretic peptide (BNP) concentrations + and this diagnostic procedure.MethodsArterial blood gasses, spirometry, echocardiography, and serum pro BNP were done for 80 COPD patients and 20 healthy smokers, and some echocardiographic parameters were correlated with degree of airflow limitation.Results77.5% of COPD cases exhibited pulmonary hypertension (PHTN), and on classifying our COPD patients, it was found that 65% of patients in group II had PHTN and 90% of patients in group III had PHTN. Systolic pulmonary artery pressure (SPAP), mean pulmonary arterial pressure (MPAP), right ventricular mid diameter (RVMD), right ventricular basal diameter (RVBD), right ventricular longitudinal diameter (RVLD), right ventricular outflow tract (RVOT) above pulmonary and aortic valve, and tricuspid annular plane systolic excursion (TAPSE) along with RVEF exhibited a significant variance among all groups. A negative correlation was observed among forced expiratory volume (FEV) 1% and (RVMD as well as RVBD) and between Pro BNP and (TAPSE and RVEF).ConclusionsPHTN was found in 77.5% of COPD patients and is negatively correlated with FEV1%. Serum pro BNP level exhibits a negative correlation with FEV1% in stable COPD patients.

Validation of diagnostic coding for chronic obstructive pulmonary disease in an electronic health record system in Hong Kong.

Electronic health record databases can facilitate epidemiology research regarding diseases such as chronic obstructive pulmonary disease (COPD), a common medical condition worldwide. We aimed to assess the validity of International Classification of Diseases, 9th Revision (ICD-9) code algorithms for identifying COPD in Hong Kong's territory-wide electronic health record system, the Clinical Data Analysis and Reporting System (CDARS). Adult patients diagnosed with COPD at all public hospitals in Hong Kong and specifically at Queen Mary Hospital from 2011 to 2020 were identified using the ICD-9 code 496 (Chronic airway obstruction, not elsewhere classified) within the CDARS. Two respiratory specialists reviewed clinical records and spirometry results to confirm the presence of COPD in a randomly selected group of cases. During the study period, 93 971 and 2479 patients had the diagnostic code for COPD at all public hospitals in Hong Kong and specifically at Queen Mary Hospital, respectively. Two hundred cases were randomly selected from Queen Mary Hospital for validation using medical records and spirometry results. The overall positive predictive value was 81.5% (95% confidence interval=76.1%-86.9%). We also developed an algorithm to identify COPD cases in our cohort. This study represents the first validation of ICD-9 coding for COPD in the CDARS. Our findings demonstrated that the ICD-9 code 496 is a reliable indicator for identifying COPD cases, supporting the use of the CDARS database for further clinical research concerning COPD.

Circulating metabolomics revealed novel associations between multiple ambient air pollutants exposure and chronic obstructive pulmonary disease incidence: Evidence from a prospective cohort study

The mechanisms underlying relationships between ambient air pollution and chronic obstructive pulmonary disease (COPD) risk remained largely uncertain. In this study, we aim to evaluate whether metabolic signature comprising multiple circulating metabolites can characterize metabolic response to the multiple air pollution; and to assess whether the identified metabolic signature contribute to COPD risk. A total of 227,962 participants with complete data were included from the UK biobank study. Concentrations of nitrogen dioxide (NO2), nitrogen oxides (NOx), and particulate matter (PM2.5 and PM10) were evaluated by land-use regression models. We newly computed an air pollution score to reflect joint exposure to multiple air pollutants. Circulating metabolome was quantified by nuclear magnetic resonance (NMR) spectroscopy. During a median of 12.78 years of follow-up, a total of 8685 incident COPD cases were documented. After multiple correction, the Cox regression models showed that 102 of 143 metabolites were significantly associated with COPD risk. Utilizing elastic net regularized regressions, we identified a metabolic signature comprising 106 metabolites (including lipid, fatty acids, glycolysis and amino acids et al.) were robustly related to air pollution score. In the multivariate-adjusted Cox regression models, the derived metabolic signature showed a positive correlation with incident COPD [HR per SD = 1.20 (95% CI: 1.17–1.22)]. Casual mediation analysis further noted that the constructed metabolic signature mediated 10.5 % (8.3%–13.1%) of the air pollution-COPD associations. Taken together, our findings identified a metabolic signature that captured metabolic response to various air pollutants exposure jointly, and predicted future COPD risk independent of known risk factors.

Decreased plasma docosahexaenoic acid concentration in chronic obstructive pulmonary disease patients with pulmonary Hypertension: Findings from human lipidomics and transcriptomics analysis

Oxylipins derived from polyunsaturated fatty acids (PUFAs) are important endogenous signaling molecules, but are little characterized in pulmonary hypertension (PH) due to chronic obstructive pulmonary disease (COPD). In this study, we identified novel plasma oxylipins associated with PH risk in COPD patients. The plasma oxylipin profiles of COPD patients without PH (COPD-noPH) or with PH (COPD-PH) were obtained from discovery and validation cohort, using the process of LC-MS/MS analysis. There was a significant decrease in the plasma levels of both free docosahexaenoic acid (DHA) and DHA-derived oxylipins in the COPD-PH group. The multivariable logistic regression model identified DHA and four DHA-derived oxylipins (13-HDHA, 10-HDHA, 8-HDHA and 16-HDHA) exhibited significant differences between the two groups after adjusting for sex, BMI, FEV1% predicted, and smoking status. The diagnostic value of these metabolites was further evaluated through ROC curve analysis. The transcriptome profiles in peripheral blood mononuclear cells (PBMCs) of COPD-PH patients and COPD-PH patients were detected through high-throughput sequencing. The enrichment analysis revealed that the upregulated differentially expressed genes (DEGs) were highly enriched in the interferon signaling pathway. In addition, DHA supplementation proved that DHA may inhibit the development of pH by reducing the secretion of interferons derived from PBMCs. This conjecture was further confirmed by the higher level of serum interferon-γ and interferon-α2 of COPD-PH patients than that of COPD-noPH patients. The present study highlights that decreased DHA and DHA-derived oxylipins levels are suggestive of a higher risk of pH development in COPD cases.

Association between socioeconomic status and risk of chronic obstructive pulmonary disease in China: a prospective cohort study

ObjectiveSocioeconomic status (SES) has been proven to be associated with chronic obstructive pulmonary disease (COPD) in Western populations, but the evidence is very limited in China. This study aimed to investigate the association between SES and the risk of COPD incident.MethodsThis study was based on the China Kadoorie Biobank (CKB) project in Wuzhong District, Suzhou. A total of 45,484 adults aged 30–79 were included in the analysis during 2004–2008. We used Cox proportional hazard models to investigate the association between SES and the risk of COPD. Household income, education, private property and consumption potential was used to measure SES. Incident COPD cases were ascertained using hospitalization records, death certificates, and active follow-up.ResultsA total of 524 COPD cases were identified during a median follow-up of 11.2 years. Household income was inversely associated with the risk of COPD (Ptrend<0.005). The adjusted hazard ratios (95% confidence intervals) for incident COPD were 0.88 (0.69–1.14), 0.77 (0.60–0.99), and 0.42 (0.31–0.57) for participants with annual household income of 10,000 ~ 19,999 yuan, 20,000 ~ 34,999 yuan and ≥ 35,000 yuan respectively, in comparison to participants with an annual household income < 10,000 yuan. Furthermore, we found that education level, refrigerator use, private toilet, private phone, and motor vehicle were adversely associated with COPD risk, while ownership of newly renovated flats was positively correlated with COPD incident.ConclusionsThis prospective study suggests that SES is associated with the risk of COPD in Chinese adults. Population-based COPD prevention strategies tailored for people with different SES could help reduce the burden of COPD in Chinese.

Air Pollution Metabolomic Signatures and Chronic Respiratory Diseases Risk: A Longitudinal Study

BackgroundThough evidence has documented the associations of ambient air pollution with chronic respiratory diseases (CRD) and lung function, the underlying metabolic mechanisms remain largely unclear. Research QuestionHow does the metabolomic signature for air pollution relate to CRD risk, respiratory symptoms, and lung function? Study Design and MethodsWe retrieved 171,132 participants free of chronic obstructive pulmonary disease (COPD) and asthma at baseline from the UK Biobank, who had data on air pollution and metabolomics. Exposures to air pollutants (particulate matter with diameter ≤2.5 μm [PM2.5], PM10, nitrogen oxide [NOX], and NO2) were assessed for 4 years before baseline considering residential address histories. We used 10-fold cross-validation elastic net regression to identify air pollution-associated metabolites. Multivariable Cox models were used to assess the associations between metabolomic signatures and CRD risk. Mediation and pathway analysis were conducted to explore the metabolic mechanism underlying the associations. ResultsDuring a median follow-up of 12.51 years, 8,951 and 5,980 incident COPD and asthma cases were recorded. In multivariable Cox regressions, air pollution was positively associated with CRD risk (for example, hazard ratios [HR] per interquartile range [IQR] increment in PM2.5: 1.09; 95% confidence interval [CI]: 1.06-1.13). We identified 103, 86, 85, and 90 metabolites in response to PM2.5, PM10, NOX, and NO2 exposure, respectively. The metabolomic signatures showed significant associations with CRD risk (HR per standard deviation (SD) increment in PM2.5-metabolomic signature: 1.11; 95% CI: 1.09-1.14). Mediation analysis showed that peripheral inflammatory and erythrocyte-related markers mediated the effects of metabolomic signatures on CRD risk. We identified 14 and 12 perturbed metabolic pathways (energy metabolism and amino acid metabolism pathways, etc.) for PM2.5 and NOX-metabolomic signatures. InterpretationOur study identifies metabolomic signatures for air pollution exposure. The metabolomic signatures showed significant associations with CRD risk, and inflammatory and erythrocyte-related markers partly mediated the metabolomic signatures-CRD links.

Prevalence of Chronic Obstructive Pulmonary Disease and Its Associated Risk Factors in Yunnan Province, China: A Population Based Cross-Sectional Study.

Chronic obstructive pulmonary disease (COPD) is a significant disease impacting health and quality of life. Yunnan Province, a major tobacco producer, lacks comprehensive COPD studies. The purpose of this study is to describe the epidemic situation of COPD in Yunnan province and explore its influencing factors. This study is a cross-sectional research conducted in a representative sample of adults aged 20 and older from 13 prefectures and cities in Yunnan Province, China. COPD was diagnosed using post-bronchodilator pulmonary function tests. Demographics were analyzed with descriptive statistics. The influencing factors of COPD were examined by using the multivariate logistic regression models. Our study found that high-risk individuals for COPD accounted for 20.30% of the screened population aged 20 and above, with a COPD prevalence of 27.18% among this high-risk group. Male had a higher prevalence (33.01%) than did female (16.35%; p<0.001 for sex difference). Additionally, the proportion of severe and extremely severe COPD cases in Yunnan Province was higher than the national average and other provinces. After considering the potential confounding variables, male (OR=2.291, 95% CI: 1.584-3.313), age (OR=1.501, 95% CI: 1.338-1.685), underweight (OR=1.747, 95% CI: 1.225-2.491), previous smoking (OR=1.712, 95% CI: 1.182-2.478), passive smoking (OR=1.444, 95% CI: 1.159-1.800), and a history of respiratory system diseases in childhood (OR=2.010, 95% CI: 1.346-3.001) were significantly associated with an increased risk of COPD. Conversely, being overweight (OR=0.636, 95% CI: 0.489-0.828), and residing in high-altitude counties (OR=0.445, 95% CI: 0.263-0.754) were negatively correlated with the risk of COPD. There is significant prevalence of COPD (27.18%) among high-risk population aged 20 and above in Yunnan Province, China. Apart from male, smoking, BMI and other known risk factors for COPD. We found that high-altitude residence had a lower prevalence of COPD. There is no significant difference in COPD prevalence between Han and ethnic minority populations.

Micronutrient Level Among Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a serious health problem today. Every year there is an increase in the number of cases of COPD around the world, which is accompanied by a deterioration in the quality of life of patients, temporary loss of ability to work, and even death. Deficiencies of macro- and microelements are currently recognized by world medicine as a global problem. These conditions have a significant impact on the body, presenting an urgent need for the development of effective health strategies to address them. According to available data, nutritional deficiencies are quite common in patients with COPD. Numerous studies highlight the impact of micronutrient deficiencies on disease progression. Currently, the connection between bronchopulmonary diseases and low levels of vitamin D and magnesium in the body of patients is being actively studied. Insufficient outdoor activity, infrequent exposure to sunlight, poor diet, alcoholism, smoking, decreased ability of the skin to synthesize vitamin D in smokers, general exhaustion of the body, and the use of certain antibiotics can be the causes of low levels of vitamin D and magnesium. Many studies indicate that deficiencies of these elements may be associated with decreased lung function and increased exacerbations in COPD, which contributes to disease progression. Deficiency conditions, which often remain undiagnosed, can negatively affect the prognosis of the disease. This study identifies the incidence of low blood levels of vitamin D and magnesium and demonstrates the relationship between low levels of these elements and the severity of COPD

Correlation-based network integration of lung RNA sequencing and DNA methylation data in chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous, chronic inflammatory process of the lungs and, like other complex diseases, is caused by both genetic and environmental factors. Detailed understanding of the molecular mechanisms of complex diseases requires the study of the interplay among different biomolecular layers, and thus the integration of different omics data types. In this study, we investigated COPD-associated molecular mechanisms through a correlation-based network integration of lung tissue RNA-seq and DNA methylation data of COPD cases (n = 446) and controls (n = 346) derived from the Lung Tissue Research Consortium. First, we performed a SWIM-network based analysis to build separate correlation networks for RNA-seq and DNA methylation data for our case-control study population. Then, we developed a method to integrate the results into a coupled network of differentially expressed and differentially methylated genes to investigate their relationships across both molecular layers. The functional enrichment analysis of the nodes of the coupled network revealed a strikingly significant enrichment in Immune System components, both innate and adaptive, as well as immune-system component communication (interleukin and cytokine-cytokine signaling). Our analysis allowed us to reveal novel putative COPD-associated genes and to analyze their relationships, both at the transcriptomics and epigenomics levels, thus contributing to an improved understanding of COPD pathogenesis.

Factors Determining the Risk Level of Chronic Obstructive Lung Disease (COPD) in Smokers in Bandung City: A Secondary Data Analysis

Chronic obstructive pulmonary disease (COPD) is a major contributor to illness and death. COPD can result in the obstruction of airflow and disturbance of the respiratory system. These symptoms have a tendency to be enduring and progressively worse. In Indonesia, the number of persons affected by COPD is estimated to be 9.2 million, with smokers being the primary cause of COPD cases. Hence, the objective of this study was to determine the risk variables linked to the occurrence of COPD among smokers in Bandung City in 2022. This study employed a cross-sectional design, with a sample size of 189 smokers aged over 40 years in Bandung City. The participants were selected via total sampling. This study employed secondary research methodology, utilising chi-square and binary regression analysis for data analysis. The findings indicated that the prevalence of high-risk COPD cases in Bandung City in 2022 was 12.7%. An relationship was seen between age, smoking intensity, namely 20-30 packs of cigarettes per year, and level of physical activity. After controlling for age, physical activity, and degree of smoking, the primary cause of the increased risk of COPD was the consumption of 20-30 packs of cigarettes per year (PR= 11.34; 95% CI = 1.65 to 77.67). This study highlights the significance of lifestyle interventions, such as smoking cessation programmes and CERDIK's behaviours, in managing COPD.

Joint effect of long-term exposure to ambient air pollution on the prevalence of chronic obstructive pulmonary disease using the Korea National Health and Nutrition Examination Survey 2010–2019

BackgroundLittle is known about the relationship between long-term joint exposure to mixtures of air pollutants and the prevalence of chronic obstructive pulmonary disease (COPD). We aimed to assess the joint impact of long-term exposure to ambient air pollution on the prevalence of COPD in Korea, especially in areas with high levels of air pollution. MethodsWe included 22,387 participants who underwent spirometry tests in 2010–2019. The community multiscale air quality model was used to estimate the levels of ambient air pollution at residential addresses. The average exposure over the 5 years before the examination date was used to calculate the concentrations of air pollution. Forced expiratory volume in 1 s and forced vital capacity were used to define restrictive lung disease, COPD, and moderate-to-severe COPD. Quantile-based g-computation models were used to assess the joint impact of air pollution on COPD prevalence. ResultsA total of 2535 cases of restrictive lung disease, 2787 cases of COPD, and 1399 cases of moderate-to-severe COPD were identified. In the individual pollutant model, long-term exposure was significantly associated with both restrictive lung disease and COPD. In the mixture pollutant model, the odds ratios (ORs, 95% confidence intervals) for restrictive lung disease increased with each quartile increment in the 1- to 5-year average mixtures: 1.14 (1.02–1.28, 1 year), 1.25 (1.11–1.41, 2 years), 1.26 (1.11–1.42, 3 years), 1.32 (1.16–1.51, 4 years), and 1.37 (1.19–1.58, 5 years), respectively. The increase in ORs of restrictive lung disease accelerated over time. By contrast, the ORs of COPD showed a decreasing trend over time. ConclusionsLong-term exposure to air pollutants, both individually and jointly, was associated with an increased risk of developing COPD, particularly restrictive lung disease. Our findings highlight the importance of comprehensively assessing exposure to various air pollutants in relation to COPD.

Impact of electronic cigarette usage on the onset of respiratory symptoms and COPD among Chinese adults

The prevalence of dual usage and the relatively low cessation rate among e-cigarette (EC) users suggest that ECs have not demonstrated significant effectiveness as a smoking cessation tool. Furthermore, there has been a substantial increase in the prevalence of EC usage in recent years. Therefore, the objective of this study is to investigate the association between EC use and the incidence of respiratory symptoms and chronic obstructive pulmonary disease (COPD). A total of 10,326 participants aged between 20 and 55 years, without any respiratory diseases or COPD, were recruited for the study. These individuals attended employee physical examinations conducted at 16 public hospitals in Hebei province, China from 2015 to 2020. Logistic regression models were utilized to assess the association between EC use and the risk of respiratory symptoms and COPD using risk ratios along with their corresponding 95% confidence intervals. Restricted cubic spline functions were employed to investigate the dose–response non-linear relationship. The robustness of the logistic regression models was evaluated through subgroup analyses, and sensitivity analyses. During the 5-year follow-up period, a total of 1071 incident cases of respiratory symptoms and 146 incident cases of COPD were identified in this cohort study. After adjusting for relevant confounding factors, EC users demonstrated a respective increase in the risk of reporting respiratory symptoms and COPD by 28% and 8%. Furthermore, dual users who used both ECs and combustible cigarettes exhibited an elevated risk of incident respiratory symptoms and COPD by 41% and 18%, respectively, compared to those who had never used non-users of any cigarette products. The association between daily EC consumption and the development of respiratory symptoms, as well as COPD, demonstrated a significant J-shaped pattern. The potential adverse association between the consumption of ECs, particularly when used in combination with combustible cigarettes, and the development of respiratory symptoms and COPD necessitates careful consideration. Policymakers should approach ECs cautiously as a prospective smoking cessation tool.

The Level of Leptin in the Blood of Patients with Chronic Obstructive Pulmonary Disease and its Correlations with the Levels of Clinical, Functional and Anamnestic Indicators

Leptin, a hormone produced by white adipose tissue and recognised as an inflammatory biomarker, has an undefined role in the progression of chronic obstructive pulmonary disease (COPD). Objective — to evaluate the leptin level and its correlations with the levels of clinical, functional and anamnestic indicators in COPD patients. Materials and methods. This study employed a case-control design involving 42 patients experiencing acute exacerbation of COPD and 20 control subjects. The patients were examined according to the standard protocol. Additionally, the examination included ultrasonic scanning of the abdominal cavity, evaluation of the serum leptin level, scoring of the anxiety and depression and quality of life. Results and discussion. It was revealed that hyperleptinemia in the patients with acute exacerbation of COPD occurred significantly more frequently than in the healthy persons ((73.8 ± 6.8) vs (40.0 ± 11.0) %; р &lt; 0.05). Besides, the COPD patients manifested increased leptin levels much more frequently than normal levels ((73.8 ± 6.8) vs (26.2 ± 6.8) %; р &lt; 0.01). Hyperleptinemia was found to co-occur with severe COPD cases belonging to E clinical group ((51.6 ± 9.0) vs (18.2 ± 11.6) % in group with normal leptin level; р &lt; 0.05). Kendall correlation analysis established that elevated circulating leptin levels were associated with an increased body mass index (τ = 0.3; р = 0.02), female gender (τ = 0.3; р = 0.01), non-smoking history (τ = – 0.2; р = 0.03), stronger manifestation of such symptoms as shortness of breath (τ = 0.3; р=0.01), disturbed home (τ = 0.3; р = 0.002) and out-of-home activities (τ = 0.3; р = 0.02) and lack of energy (τ = 0.3; р = 0.01). It also correlated with increased severity of pulmonary insufficiency (τ = 0.3; р = 0.003) and decreased forced vital capacity (τ = – 0.2; р = 0.04), elevated systolic blood pressure (τ = 0.2; р = 0.02), elevated cholesterol (τ = 0.3; р = 0.01) and β-lipoproteins levels (τ = 0.2; р = 0.04), pronounced depression (τ = 0.3; р = 0.002) and lowered quality of life (τ = 0.3; р = 0.01). Сonclusions. COPD patients with elevated leptin levels manifest not only with an increased body weight, but also with arterial hypertension, disturbed lipid metabolism, more pronounced pulmonary insufficiency, depressive disorders and lowered life quality with more severe subjective respiratory symptoms.

Susceptible Young Adults and Development of Chronic Obstructive Pulmonary Disease Later in Life.

Rationale: Chronic obstructive pulmonary disease (COPD) has its origin in early life, and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposes a predisease state termed "pre-COPD." Objectives: We tested the hypothesis that susceptible young adults identified with chronic bronchitis and subtle lung function impairment will develop COPD later in life. Methods: We followed random individuals without COPD ages 20-50 years from two population-based cohorts from different smoking eras-the Copenhagen General Population Study from 2003 (N = 5,497) and the Copenhagen City Heart Study from 1976-1978 (N = 2,609)-for 10 and 25 years, for the development of COPD (FEV1/FVC <0.70) and COPD GOLD Stages 2-4 (additionally, FEV1 <80% predicted). Measurements and Main Results: After 10 years, 28% developed COPD and 13% developed COPD GOLD Stages 2-4 in individuals susceptible to COPD, compared with 8% and 1% in those without any susceptibility to COPD. Correspondingly, after 25 years, 22% versus 13% developed COPD and 20% versus 8% developed COPD GOLD Stages 2-4. More than half of incident COPD cases developed from a susceptible state. Compared with those without susceptibility to COPD, multivariable-adjusted odds ratios in those susceptible to COPD were 3.42 (95% confidence interval: 2.78-4.21) for COPD and 10.1 (6.77-15.2) for COPD GOLD Stages 2-4 after 10 years and were 1.54 (1.23-1.93) and 2.12 (1.64-2.73) after 25 years. The ability of a COPD risk score-consisting of the state of susceptibility to COPD with smoking and asthma as risk factors-to predict COPD later in life was high. Conclusions: Our study suggests the existence of a predisease state of COPD, which can be used for early identification of susceptible individuals at risk for COPD later in life.

Peripheral Blood Mononuclear Cell Gene Expression Associated with Pulmonary Microvascular Perfusion: The Multi-Ethnic Study of Atherosclerosis Chronic Obstructive Pulmonary Disease.

Rationale: Chronic obstructive pulmonary disease (COPD) and emphysema are associated with endothelial damage and altered pulmonary microvascular perfusion. The molecular mechanisms underlying these changes are poorly understood in patients, in part because of the inaccessibility of the pulmonary vasculature. Peripheral blood mononuclear cells (PBMCs) interact with the pulmonary endothelium. Objectives: To test the association between gene expression in PBMCs and pulmonary microvascular perfusion in COPD. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited two independent samples of COPD cases and controls with ⩾10 pack-years of smoking history. In both samples, pulmonary microvascular blood flow, pulmonary microvascular blood volume, and mean transit time were assessed on contrast-enhanced magnetic resonance imaging, and PBMC gene expression was assessed by microarray. Additional replication was performed in a third sample with pulmonary microvascular blood volume measures on contrast-enhanced dual-energy computed tomography. Differential expression analyses were adjusted for age, gender, race/ethnicity, educational attainment, height, weight, smoking status, and pack-years of smoking. Results: The 79 participants in the discovery sample had a mean age of 69 ± 6 years, 44% were female, 25% were non-White, 34% were current smokers, and 66% had COPD. There were large PBMC gene expression signatures associated with pulmonary microvascular perfusion traits, with several replicated in the replication sets with magnetic resonance imaging (n = 47) or dual-energy contrast-enhanced computed tomography (n = 157) measures. Many of the identified genes are involved in inflammatory processes, including nuclear factor-κB and chemokine signaling pathways. Conclusions: PBMC gene expression in nuclear factor-κB, inflammatory, and chemokine signaling pathways was associated with pulmonary microvascular perfusion in COPD, potentially offering new targetable candidates for novel therapies.

Oxidative Damage and Telomere Length as Markers of Lung Cancer Development among Chronic Obstructive Pulmonary Disease (COPD) Smokers.

Lung cancer (LC) constitutes an important cause of death among patients with Chronic Obstructive Pulmonary Disease (COPD). Both diseases may share pathobiological mechanisms related to oxidative damage and cellular senescence. In this study, the potential value of leucocyte telomere length, a hallmark of aging, and 8-OHdG concentrations, indicative of oxidative DNA damage, as risk biomarkers of LC was evaluated in COPD patients three years prior to LC diagnosis. Relative telomere length measured using qPCR and serum levels of 8-OHdG were determined at the baseline in 99 COPD smokers (33 with LC and 66 age-matched COPD without LC as controls). Of these, 21 COPD with LC and 42 controls had the biomarkers measured 3 years before. Single nucleotide variants (SNVs) in TERT, RTEL, and NAF1 genes were also determined. COPD cases were evaluated, which showed greater telomere length (p < 0.001) and increased serum 8-OHdG levels (p = 0.004) three years prior to LC diagnosis compared to the controls. This relationship was confirmed at the time of LC diagnosis. No significant association was found between the studied SNVs in cases vs. controls. In conclusion, this preliminary study shows that longer leucocyte telomere length and increased 8-OHdG serum levels can be useful as early biomarkers of the risk for future lung cancer development among COPD patients.