Severe Chronic Obstructive Pulmonary Disease Research Articles

Electrocardiographic signs of cardiac ischemia at rest and during exercise in patients with COPD traveling to 3,100 m: data from a randomized trial of acetazolamide

IntroductionIn patients with chronic obstructive pulmonary disease (COPD), oxygen delivery to the heart may be impaired during travel at altitude. We assessed electrocardiogram (ECG)-derived signs of cardiac ischemia and the effects of preventive acetazolamide therapy in COPD patients traveling to high altitudes.MethodsPatients with COPD [Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) grades 2–3] and a predicted forced expiratory volume in 1 s (FEV1) of 66 ± 11% (mean ± SD), aged 57 ± 8 years, and living <1,000 m were included in this analysis of secondary outcomes from a randomized placebo-controlled double-blind trial (www.clinicaltrials.gov, NCT03156231). Exercise electrocardiograms were recorded at the National Center of Internal Medicine and Cardiology, Bishkek (760 m) and on the day of arrival at the Tuja Ashu high-altitude clinic (3,100 m), Kyrgyzstan. Acetazolamide (375 mg/day) or placebo was administered 24 h before the ascent and during the stay at 3,100 m. The incidence of a post-exercise ST elevation (STE) ≥0.3 mm in aVR (J + 80 ms) was the main outcome.ResultsAt 760 m, 3 of 49 (6%) patients randomized to placebo and 3 of 50 (6%) randomized to acetazolamide showed a post-exercise STE. At 3,100 m under placebo, two (4%) new STEs developed and one (2%) disappeared compared to 760 m (P = 0.564, McNemar’s test). At 3,100 m under acetazolamide, one (2%) new STE developed and two (4%) disappeared compared to 760 m (P = 0.564). No treatment effect was detected (P = 0.242, Fisher’s exact test). The mean difference (95% CI) in STE between post-peak exercise between 3,100 m and 760 m was 0.22 mm (0.06 to 0.39) and 0.09 mm (−0.06 to 0.24) under placebo and acetazolamide therapy [treatment effect, −0.13 mm (−0.35 to 0.08, P = 0.230)], respectively.ConclusionsIn lowlanders with moderate to severe COPD ascending to 3,100 m, no ECG-derived signs of cardiac ischemia emerged neither at rest nor post-exercise and this was not modified by preventive acetazolamide therapy.

A normal electrocardiogram indicates a better prognosis in patients with moderate to very severe chronic obstructive pulmonary disease

The role of electrocardiography (ECG) in predicting mortality in patients with chronic obstructive pulmonary disease (COPD) has not been sufficiently established. Research question: Is a normal ECG associated with a better prognosis than an abnormal ECG in patients with COPD? ECG parameters were assessed in patients enrolled in the Czech Multicenter Research Database of COPD. We assessed ECGs from baseline (August 2013) until December 31, 2019, or until death. The primary endpoint was 5-year overall survival depending on the ECG findings. A total of 300 subjects were enrolled in the study and 143 died during follow-up. This multicenter noninterventional observational prospective study revealed a significant difference in 5-year overall survival between COPD patients with normal ECGs and those with prognostically significant or other ECG abnormalities (76.8%, 38.2%, and 63.4%, respectively; P < 0.001). Patients with prognostically significant ECG abnormalities had a 2.537-fold greater mortality risk at 5 years than those with normal ECGs. In the COPD setting, patients with normal ECGs had a better prognosis than those with prognostically significant abnormalities suggesting that ECG may be a valuable tool for predicting mortality risk in these patients.

MRI-assessed Dynamic Hyperinflation Induced by Tachypnea in Chronic Obstructive Pulmonary Disease: The SPIROMICS-HF Study.

Purpose To assess the repeatability of real-time cine pulmonary MRI measures of metronome-paced tachypnea (MPT)-induced dynamic hyperinflation and its relationship with chronic obstructive pulmonary disease (COPD) severity. Materials and Methods SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) (ClinicalTrials.gov identifier no. NCT01969344) is a multicenter prospective cohort study that recruited individuals with COPD with 20 or more pack-years smoking history and controls aged 40-80 years. SPIROMICS-HF is a cross-sectional study evaluating cardiopulmonary interactions in COPD from December 2019 to April 2024. Two-dimensional coronal real-time cine pulmonary MRI (3.2 frames/sec) was performed during MPT twice. Lung masks and lung MR images from an independent study were used for transfer learning to segment real-time cine pulmonary MR images. Dynamic hyperinflation was evaluated as the increase in end-expiratory lung volume (EELV) during tidal breathing to the end of MPT. Repeatability was assessed with intraclass correlation coefficients, and multivariable associations with COPD severity were examined. Results Of the 70 participants (mean age, 67 years ± 10 [SD]; 37 male, 33 female) included in the study, 59% had COPD. The transfer learning model achieved high accuracy in lung segmentation (Dice similarity coefficient, 0.94 ± 0.03). There was good scan-rescan agreement for EELV and dynamic hyperinflation (intraclass correlation coefficient, 0.99 and 0.87, respectively). Dynamic hyperinflation was associated with COPD severity (P trend = .01, with a mean difference between severe COPD and controls of 0.24 L). Conclusion A transfer learning model yielded reproducible quantification of MPT-induced dynamic hyperinflation at real-time cine pulmonary MRI, with greater dynamic hyperinflation in participants with more severe COPD. Keywords: Chronic Obstructive Pulmonary Disease, MR Imaging, Pulmonary, Lung, Technology Assessment Supplemental material is available for this article. ClinicalTrials.gov identifier: NCT01969344 © RSNA, 2025.

Effect of Triple Therapy on Cardiovascular and Severe Cardiopulmonary Events in Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis of a Randomized, Double-Blind, Phase 3 Clinical Trial (ETHOS).

Rationale: Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of cardiovascular and cardiopulmonary events. In the phase III, 52-week ETHOS trial (NCT02465567), triple therapy with budesonide/glycopyrrolate/formoterol fumarate (BGF) reduced rates of moderate/severe exacerbations and all-cause mortality compared with dual therapy with glycopyrrolate/formoterol fumarate (GFF) or budesonide/formoterol fumarate (BFF). However, the effect of BGF on cardiovascular events versus GFF remains unevaluated. Furthermore, the effect of BGF on time to first severe exacerbation has not been reported. Objectives: To assess the effects of BGF 320/18/9.6 μg (BGF 320) and other inhaled corticosteroid-containing arms on cardiovascular and severe cardiopulmonary endpoints versus GFF in patients with COPD from the ETHOS trial. Methods: Patients with moderate to very severe COPD and a history of exacerbations were randomized to twice-daily BGF 320, BGF 160/18/9.6 μg, BFF 320/9.6 μg, or GFF 18/9.6 μg (GFF). Time to first severe COPD exacerbation was a prespecified endpoint; post hoc cardiovascular and severe cardiopulmonary endpoints included time to first major adverse cardiac event, time to first cardiovascular adverse event (AE) of special interest, time to first cardiac AE, and time to the composite endpoint of first severe cardiopulmonary event. Measurements and Main Results: BGF 320 reduced the rate of first occurrence (hazard ratio [95% confidence interval]) of cardiovascular and severe cardiopulmonary events versus GFF, including for time to first cardiovascular adverse event of special interest (0.63 [0.48, 0.82]), cardiac AE (0.60 [0.48, 0.76]), and severe cardiopulmonary event (0.80 [0.67, 0.95]). Conclusions: BGF had a benefit on cardiovascular endpoints and severe cardiopulmonary events versus GFF in patients with moderate to very severe COPD.

Effect of Precise Pulmonary Rehabilitation Nursing Intervention Combined With Simultaneous Inhalation Therapy and Noninvasive Ventilation for Chronic Obstructive Pulmonary Disease Patients With Chronic Hypercapnic Respiratory Failure.

Chronic obstructive pulmonary disease (COPD) is a progressive heterogeneous pulmonary disorder with an increasing high prevalence, particularly in the older. The objective of this study is to assess the effect of noninvasive ventilation combined with simultaneous nebulization during precise pulmonary rehabilitation nursing intervention in COPD patients with chronic hypercapnic respiratory failure, compared to pulmonary rehabilitation nursing alone. In total, 240 elderly COPD patients with chronic hypercapnic respiratory failure were randomized controlled into either a precise pulmonary rehabilitation nursing model group (control group) or noninvasive ventilation coupled with simultaneous nebulization during pulmonary rehabilitation nursing (intervention group). For our evaluation, we considered general information, pulmonary function, exercise endurance, mental health, blood gas, inflammation, COPD severity, life quality, and overall efficacy of subjects before and on the 5-, 30-, 90-day intervention. The total effective rates were 95% and 77.5% in the intervention and control group, respectively. In detail, the intervention group showed statistically significant improvements in lung function, exercise endurance, psychological health, blood gas inflammation, overall severity, and quality of life outcomes, especially on the 90-day intervention (p < 0.001). The complex COPD patients with chronic hypercapnic respiratory failure may confer more gains from precise pulmonary rehabilitation nursing intervention combined with simultaneous inhalation therapy and noninvasive ventilation.

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

Speckle tracking echocardiographic abnormalities in chronic obstructive pulmonary disease: insights from a systematic review and meta-analysis

Abstract Background Speckle tracking echocardiography (STE) is the most effective tool to describe the cyclic deformation of the myocardium offering a better insight into myocardial dysfunction and providing valuable prognostic information.1 Chronic obstructive pulmonary disease (COPD) has a direct impact on heart and pulmonary vasculature. Subclinical ventricular dysfunction is present in COPD even before conventional echocardiography can detect it.2,3 Purpose We conducted a systematic review and meta-analysis of the available literature on STE parameters to evaluate subclinical right and left ventricular dysfunction in COPD. Methods A systematic search was performed in the PubMed, Scopus, Cochrane Library, and ScienceDirect databases from 2011 to March 2023. Two independent investigators reviewed the results. The study findings are presented under PRISMA recommendations. To search the databases, search phrases and Boolean operators were employed. Boolean operators, such as "AND","OR," and "NOT" are used to combine or exclude search words. A comprehensive search was conducted using keywords and the studies that measured the STE parameters in COPD patients with no cardiac comorbidities were included in a meta-analysis, and pooled measures were obtained. The risk of bias was assessed using the STROBE Quality Assessment Tool. Results Eleven studies were included in the meta-analysis. The STROBE score among the 11 articles ranged between 18 to 21. A total of 742 subjects with COPD were studied out of which 74.4% were male and 25.6% were female. The average age among the studies was 64.20 ± 7.15 years. The meta-analysis was conducted in two stages. At first, the meta-analysis was conducted among the 742 COPD cases. A second-stage meta-analysis was performed with a case-control study design of 507 COPD cases and 259 healthy control groups. STE revealed that LV global longitudinal strain (GLS) and RV free wall strain (FWS) parameters in COPD patients (mean effect size: - 17.055 with a 95% CI: -18.395 to -15.715; mean effect size: -19.098 with a 95% CI: -20.064 to -18.131). STE parameters in COPD patients with a mean effect size = 2.100, 95% CI: 1.612 to 2.588 were significantly reduced compared to the control group. Egger’s test results showed that publication bias was not a concern for these studies [p = 0.282]. The average RVFWS and RV GLS were -18.59 ± 4.07 and -17.48 ± 3.65 respectively. The average LV GLS was -17.43 ± 3.03. The average values of STE parameters were significantly lower in COPD patients compared to healthy controls, and these values decreased even more with the progression of COPD severity. Additionally, the presence of STE abnormalities was associated with poorer outcomes in COPD patients. Conclusions Speckle tracking echocardiographic abnormalities are quite prevalent and portends poor prognosis in COPD patients. STE helps identify subclinical LV and RV dysfunction before conventional echocardiographic abnormalities are evident.

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.

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.

Ensifentrine in COPD patients taking long-acting bronchodilators: A pooled post-hoc analysis of the ENHANCE-1/2 studies.

The efficacy and safety of ensifentrine, a novel PDE3/PDE4 inhibitor, were previously evaluated in the ENHANCE-1 (NCT04535986) and ENHANCE-2 (NCT04542057) trials. Here, we present a pooled post-hoc subgroup analysis of patients according to background chronic obstructive pulmonary disease (COPD) maintenance medication regimens. This analysis aimed to explore the efficacy and safety of ensifentrine in patients receiving long-acting muscarinic antagonists (LAMA) or long-acting beta-agonists with inhaled corticosteroids (LABA + ICS). Eligible patients had moderate to severe COPD, were aged 40-80years, and were symptomatic at randomization. Patients were randomized 5:3, receiving twice-daily ensifentrine 3mg or placebo via standard jet nebulizer over 24weeks. The pooled post-hoc analysis included 485 LAMA patients and 272 LABA + ICS patients. Ensifentrine showed lung function improvement over placebo at week 12, including average FEV1 AUC0-12h in the LAMA (placebo-corrected least squares mean change from baseline [LSMC], 92mL; 95% CI, 54, 131; p < 0.001) and LABA + ICS subgroups (LSMC, 74mL; 95% CI, 27, 121; p = 0.002). Ensifentrine reduced the rate and risk of exacerbations in both LAMA (48% and 50%, respectively) and LABA + ICS (51% and 56%, respectively) subgroups. Ensifentrine-treated patients reported improvement in symptoms and quality of life over 24weeks. The safety profile of ensifentrine in each subgroup was similar to the profile in the pooled modified intention-to-treat population. Nebulized ensifentrine offers a novel non-steroidal anti-inflammatory and bronchodilator treatment added to existing LAMA or LABA + ICS treatment options in patients with moderate to severe, symptomatic COPD.

Association of Chronic Obstructive Pulmonary Disease and Mortality following Thoracic and Complex Endovascular Aortic Repair.

This study assessed the association between chronic obstructive pulmonary disease (COPD) severity and postoperative mortality among patients undergoing thoracic endovascular aortic repair (TEVAR) and complex endovascular aortic repair (CEVAR). A retrospective review of the Vascular Quality Initiative database identified elective TEVAR and CEVAR cases from 2013-2022 with endograft proximal landing zone ≥2 for thoracic or complex abdominal aortic disease. Symptomatic disease, ruptures, and urgent/emergent surgeries were excluded. Patients were stratified by COPD severity. The primary outcome was in-hospital mortality. Secondary outcomes included respiratory complications and 1-year mortality. Multivariable logistic regression was used for in-hospital mortality, respiratory complications, and 1-year mortality. Among 11,336 patients with TEVAR and CEVAR, 66% did not have COPD, 9% had COPD not on medications, 20% had COPD on medications, and 6% had COPD on home supplemental oxygen. In-hospital mortality was 2.3%, 3.7%, 3.2%, and 4.5% (P=.0004) respectively, and was not associated with increased odds of mortality. Respiratory complications occurred in 4.3%, 4.5%, 6.4%, and 7.3% (P<.0001) and was associated with increased odds for COPD on medications (OR 1.3) and COPD on home supplemental oxygen (OR 1.7). 1-year survival was 91%, 87%, 86%, and 80% and associated with increased risk for each COPD group (HR 1.4, HR 1.4, HR 1.9). Patients with COPD undergoing TEVAR and CEVAR, have increased rates of in-hospital mortality, respiratory complications, and 1-year mortality. COPD severity is independently associated with increased respiratory complications and 1-year mortality, which should be factored into preoperative decision making.

Polygenic Risk Score Added to Conventional Case Finding to Identify Undiagnosed Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is often undiagnosed. Although genetic risk plays a significant role in COPD susceptibility, its utility in guiding spirometry testing and identifying undiagnosed cases is unclear. To determine whether a COPD polygenic risk score (PRS) enhances the identification of undiagnosed COPD beyond a case-finding questionnaire (eg, the Lung Function Questionnaire) using conventional risk factors and respiratory symptoms. This cross-sectional analysis of participants 35 years or older who reported no history of physician-diagnosed COPD was conducted using data from 2 observational studies: the community-based Framingham Heart Study (FHS) and the COPD-enriched Genetic Epidemiology of COPD (COPDGene) study. Modified Lung Function Questionnaire (mLFQ) scores and COPD PRS. The primary outcome was spirometry-defined moderate to severe COPD (forced expiratory volume in the first second of expiration/forced vital capacity [FEV1/FVC] <0.7 and FEV1 [percent predicted] <80%). The performance of logistic models was assessed using the PRS, mLFQ score, and PRS plus mLFQ score for predicting spirometry-defined COPD. Among 3385 FHS participants (median age, 52.0 years; 45.9% male) and 4095 COPDGene participants (median age, 56.8 years; 55.5% male) who reported no history of COPD, 160 (4.7%) FHS and 775 (18.9%) COPDGene participants had spirometry-defined COPD. Adding the PRS to the mLFQ score significantly improved the area under the curve from 0.78 to 0.84 (P < .001) in FHS, 0.69 to 0.72 (P = .04) in COPDGene non-Hispanic African American, and 0.75 to 0.78 (P < .001) in COPDGene non-Hispanic White participants. At a risk threshold for spirometry referral of 10%, the addition of the PRS to the mLFQ score correctly reclassified 13.8% (95% CI, 6.6%-21.0%) of COPD cases in FHS, but not in COPDGene. A COPD PRS enhances the identification of undiagnosed COPD beyond a conventional case-finding approach in the general population. Further research is needed to assess its impact on COPD diagnosis and outcomes.

A comparative study of efficacy and safety of combination of Indacaterol and Tiotropium versus Conventional Combination Formoterol Budesonide &amp; Tiotropium in moderate to severe COPD.

Objective: To compare the efficacy and safety of indacaterol with tiotropium versus conventional formoterol/budesonide with tiotropium combination in patients with moderate to severe chronic obstructive pulmonary disease. Study Design: Randomized Controlled Trial. Setting: Department of Pulmonology, PIMS Hospital, Islamabad. Period: January to August 2019. Methods: This study has recruited 88 patients between the ages of 40 – 70 years with complaints of moderate to severe degrees of COPD. The population was randomized and divided into two groups. Group A patients were instructed to use indacaterol 150mcg and tiotropium 18mcg DPI once a day and Group B patients were instructed to use formoterol/budesonide (12/400) DPI twice daily along with tiotropium 18mcg DPI once daily. Patients were followed up for improvement in FEV 1 with spirometry at 4 weeks and 8 weeks. The efficacy of both treatments was ascertained by estimating percentage improvement in FEV1 from baseline at 4 and 8 weeks and compared in both groups. Results: In total, there were 88 participants divided into two equal groups. At 4 weeks after the initiation of therapy, the mean FEV1 in group A was 1.98 L ± 0.52 SD and it was 1.89 L ± 0.53 SD in group B (p=0.429). At 8 weeks after the initiation of therapy, the mean FEV1 in group A was 2.01 L ± 0.53 SD and it was 1.91 L ± 0.52 SD in group B (p=0.419). Among the age group 40- 55 years, at 4 weeks, the percentage improvement in FEV 1 from baseline was 16.65% ± 7.62 SD in group A and it was 6.04% ± 3.57 SD in group B (P=0.001). At 8 weeks, the percentage improvement in FEV 1 from baseline was 18.12% ± 7.56 SD in group A and it was 7.56% ± 3.47 SD in group B (P=0.001). Among the age group 56-70 years, at 4 weeks, the percentage improvement in FEV 1 from baseline was 15.56% ± 7.19 SD in group A and it was 7.25% ± 3.08 SD in group B (P=0.001). At 8 weeks, the percentage improvement in FEV 1 from baseline was 17.21% 7.13 SD in group A and it was 8.78% ± 3.17 SD in group B (P=0.001). Conclusion: The results indicate that the fixed dosage of indacaterol and tiotropium has provided a better prognosis in increasing FEV1 and improving lung function.

Age, period and cohort processes in chronic obstructive pulmonary disease related emergency department visit rate in Taiwan, 2001-2015.

Emergency room (ER) physicians must deal with patients with clinically suspected symptoms, such as dyspnea, cough, and increased sputum production, on the frontlines of medical care if patients present with severe chronic obstructive pulmonary disease (COPD). This study aims to investigate the longitudinal tendencies of COPD-related ER visits. A total of 360,313 patients were included in this study. The COPD-related ER visit rates between 2001 and 2015 were categorized using the International Classification of Disease (ICD) codes (496). The effects of age, period, and cohort on COPD-related ER visit rates were determined using an age-period-cohort (APC) model. Age was associated with a high risk of COPD in the pediatric and older populations. A significant increase was observed in the period effect, from 2001 to 2015. The cohort effect tended to oscillate from 1918 to 1973, and was reversed in the latest cohort. Furthermore, the COPD-related ER visit rate increased between 2001 and 2015 in both men and women. Age, period, and cohort were observed to increase COPD visit rates. The APC model can be used to determine trends in COPD-related ER visits.

Effect of exercise training on modulating the TH17/TREG imbalance in individuals with severe COPD: A randomized controlled trial.

Chronic obstructive pulmonary disease (COPD) induces an imbalance in T helper (Th) 17/regulatory T (Treg) cells that contributes to of the dysregulation of inflammation. Exercise training can modulate the immune response in healthy subjects. We aimed to evaluate the effects of exercise training on Th17/Treg responses and the differentiation of Treg phenotypes in individuals with COPD. This randomized controlled trial included 50 individuals with severe or very severe COPD who were allocated to the Exercise or Control groups. The Exercise group underwent eight weeks of aerobic and muscle strength training, whereas the Control group received usual care. The primary outcome was the change in the phenotypic characteristics of Tregs and Th17 profile differentiation in systemic inflammation. Exercise training increased the frequency of total and activated Tregs and decreased the frequency of Th17 cells in between-group comparisons. Additionally, Th17/Treg responses were moderately correlated with improvements in the six-minute walking test, muscle strength of the upper and lower limbs, and daily life physical activity levels. Exercise training improved functional exercise capacity, muscle strength, and physical fitness, which was associated with a decrease in the Th17 inflammatory response and an increase in Treg cell phenotypes immunosuppressive activity.

Systematic Review and Meta-Analysis of the Application of T-PEP in the Therapeutic Management of COPD Patients.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, characterized by chronic mucus hypersecretion (CMH) that exacerbates airway obstruction and accelerates disease progression. Effective airway clearance techniques are essential to improve respiratory function and reduce exacerbations. Temporary Positive Expiratory Pressure (T-PEP) is a novel airway clearance device that has shown promise in managing COPD. Objectives: This meta-analysis aimed to evaluate the efficacy of T-PEP in a standard pulmonary rehabilitation program. Methods: Following PRISMA guidelines, a comprehensive search of randomized controlled trials (RCTs) was conducted in the MEDLINE and PEDro databases. Data from 162 subjects, including those with severe COPD and bronchiectasis, were analyzed. Key outcomes assessed were changes in lung function (FVC, FEV1, TLC), inspiratory and expiratory pressures (MIP, MEP), gas exchange (PaO2, PaCO2), exercise capacity (6MWT), symptom severity (mMRC, CAT, BCSS), and exacerbation rates. Results: T-PEP significantly improved FVC, FEV1, TLC, MIP, MEP, and DLCO compared to baseline, with heterogeneity noted across studies. Improvements in gas exchange and physical capacity were observed, with PaO2 increasing and PaCO2 decreasing. T-PEP also reduced symptoms of cough and dyspnea, improving quality-of-life scores. Additionally, a notable reduction in acute exacerbations of COPD was seen after one month and three months of treatment. Conclusions: T-PEP therapy shows substantial benefits in improving lung function, exercise capacity, and quality of life while reducing exacerbation rates in COPD patients. Although promising, these findings require further confirmation through randomized clinical trials to establish the optimal application of T-PEP in various clinical settings and patient phenotypes.

Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Quality of life (QL) is an important criterion of the state of health and its changes. It allows to determine the course of the disease, the effectiveness of therapy, to provide patient’s ranging and grouping, to create a rehabilitation plan and monitore its implementation. Objective — to determine the quality of life of patients with exacerbation of chronic obstructive pulmonary disease (COPD), its correlations and to assess the dependence of these parameters on the patien’s body weight. Materials and methods. The study included 145 patients with exacerbation of COPD who were divided into groups according to body mass index (BMI): 42 patients with normal body weight (30 men and 12 women, median age 50 years), 41 patients (29 men and 12 women, median age 52 years) with overweight and 62 patients (37 men and 25 women, median age 52 years) with obesity (OB). A determination of blood leptin level was performed, along with a COPD assessment test (CAT), checked QL according to St. George Respiratory Questionnaire (SGRQ), and the severity of anxiety and depression according to the Hospital Anxiety Depression Scale (HADS). The results were analyzed statistically. Results and discussion. The final assessment of the QL of patients with exacerbation of COPD was 45.6 %. The component «symptoms» (60.2 [48.4; 73.6]) had the greatest impact on QL, a somewhat smaller impact on QL had components «activity» (47.7 [35.8; 66.2] %) and «psychosocial influence» (39.4 [26.4; 56.4] %). Among women, QL was slightly lower (62.8 vs 57.1%; 53.4 vs 44.8 %; 41.5 vs 36.5 %; 53.4 vs 41.7 %). The QL was significantly lower in patients-smokers (according to the «impact» component and the final QL score: 47.3 [40.1; 62.9] vs 32.8 [18.8; 42.6] %; 57.3 [43.0; 63.4] vs 39.3 [29.2; 47.2] %; both р = 0.01). According to the Kendall’s correlational analysis, QL significantly worsened in parallel with increasing BMI and blood leptin content, with an increase in the severity of COPD (by clinical group; CAT result; degree of respiratory insufficiency), with the development of arterial hypertension and deterioration of pressure control, with dependence on depression, with an increase in the size of the right lobe of the liver as seen on ultrasound and deterioration of velocity and volume parameters of external respiratory function. Correlations of total QL were distinguished in patients with different body weight. Conclusions. Exacerbation of COPD was accompanied by decrease of quality of life according to the SGRQ (45.6 %), due to the development of symptoms and limitation of physical activity. QL was significantly lower in smokers and patients with concomitant obesity. Deterioration of quality of life occurred in parallel with an increase of body weight and blood leptin level, depending of the severity of COPD, development of arterial hypertension and depression, accompanied by deterioration of the external respiratory function indicators.

Clinical benefit of chronic non-invasive ventilation in severe stable COPD: a matter of persistent hypercapnia improvement

PurposeIn patients with chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV), the relation between improvements in nocturnal transcutaneous partial pressure of CO2 (PtcCO2) and daytime arterial partial...

Healthcare Workers (HCWs)' Perceptions and Current Practice of Managing Cognitively Impaired Patients with Chronic Obstructive Pulmonary Disease (COPD).

Background and Objectives: Despite the significant impacts of cognitive impairment on patients with chronic obstructive pulmonary disease (COPD), there is limited information available on healthcare workers' (HCWs) perceptions, current practice, and barriers to managing COPD patients with cognitive impairment. Materials and Methods: A cross-sectional questionnaire was distributed to HCWs in Saudi Arabia between April and December 2023. The collected responses were analysed using descriptive statistics and logistic regression models. Results: A total of 890 participants, including nursing, physical, and respiratory therapists, completed the online questionnaire. Over two-thirds of the study participants indicated not having sufficient knowledge or adequate training in managing cognitive impairment in patients with COPD. The majority of HCWs perceive cognitive impairment to underdiagnose COPD (83%), underestimate COPD severity (81%), exacerbate COPD symptoms (80%), and interfere with self-management (81%) and pulmonary rehabilitation (81%). However, less than 45% (n = 394) reported having the potential to recognise signs of cognitive impairment during patient encounters. Logistic regression analysis revealed that male healthcare practitioners were more likely to recognise cognitive impairment than females (OR: 1.48; 95% CI: 1.13 to 1.95; p < 0.001). Physical and respiratory therapists were more likely to identify cognitive impairment compared to nurses. Additionally, having more years of experience (≥10 years, OR: 1.63; 95% CI: 1.02 to 2.61; p = 0.001) and adequate knowledge of cognitive impairment (OR: 6.23; 95% CI: 4.18 to 9.29; p = 0.001) were strongly associated with better recognition. Confidence in managing cognitively impaired COPD patients was low, attributed to poor training (64%), inadequate knowledge (64%), and the absence of standardised procedures (58%). Conclusions: HCWs agreed upon the negative impacts associated with cognitive impairment in patients with COPD. However, the potential of recognising signs of cognitive impairment and confidently dealing with the existence of cognitive impairment in COPD is not optimal, owing to poor training and limited knowledge. A focus should be given to managing comorbidities alongside COPD.

Prevalence and Clinical Outcomes of Eosinophilic COPD in a Saudi Population: A Retrospective Study

Abstract Objective: This study assessed the prevalence of eosinophilic chronic obstructive pulmonary disease (COPD) among a selected Saudi population and examined its correlation with baseline characteristics, clinical outcomes, exacerbation risk, and current management. Materials and Methods: This retrospective single-center study was conducted over a 2-year period. The patients were divided into two groups based on the blood eosinophil count at the time of diagnosis: eosinophilic COPD (≥300 cells/μl) and non-eosinophilic COPD (&lt;300 cells/μl) groups. Results: Overall, 156 patients were included, of which 76 (48.7%) and 80 (51.3%) patients belonged to the eosinophilic and non-eosinophilic COPD groups, respectively. There were no significant differences between both groups regarding age, gender, smoking status, coexisting morbidities, FEV1, FEV1/FVC, and COPD severity (for all, P &gt;0.05). Besides, there were no significant differences between both groups regarding the frequency and numbers of exacerbations, emergency room visits, in-patient hospitalizations, and intensive care unit admissions (for all, P &gt;0.05). Among patients with eosinophilic COPD, 64 patients (84.2%) were correctly receiving the triple therapy of long-acting β2 agonists + long-acting muscarinic antagonist + inhaled corticosteroids, whereas 4 patients (5.26%) were incorrectly receiving the dual therapy of long-acting β2 agonists + inhaled corticosteroids. Univariate regression analyses revealed that heart failure, GOLD 3 severity, use of triple therapy, and use of non-invasive ventilation were significantly correlated with a higher risk of COPD exacerbation. Conversely, higher FEV1 was significantly correlated with lower risk of COPD exacerbation. The eosinophilic COPD phenotype was not found to be a significant independent variable of COPD exacerbation. Conclusion: This study found that among Saudi patients with COPD, there was no clinically important relationship between baseline blood eosinophil count and the rate of exacerbation.