Chronic Respiratory Symptoms Research Articles

Outpatient Diuretic Use and Respiratory Outcomes in Children with Bronchopulmonary Dysplasia During the First Three Years of Life.

Outpatient Diuretic Use and Respiratory Outcomes in Children with Bronchopulmonary Dysplasia During the First Three Years of Life.

Primary ciliary dyskinesia cases bronchoscopic sampling and TEM analysis: sampling & diagnosis in PCD

ABSTRACT Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous disorder characterized by impaired ciliary structure and function, leading to chronic respiratory symptoms and recurrent infections. Despite its clinical significance, PCD diagnosis remains challenging due to its variable presentation and the lack of a gold standard diagnostic test. Specific clinical criteria, including neonatal respiratory distress and laterality defects, aid in suspicion of PCD, but confirmatory diagnosis often requires a combination of tests. In this study, we aimed to assess the efficacy of bronchoscopic techniques in obtaining respiratory epithelial samples for transmission electron microscopy (TEM) analysis. We enrolled adults with bronchiectasis and suspected PCD who underwent fiberoptic bronchoscopy. Bronchial forceps and brush biopsies were obtained from specific bronchial segments under conscious sedation. Tissue samples were processed for TEM analysis to identify ultrastructural axonemal defects associated with PCD. Our study included 10 patients (3 females, 7 males) aged 19–38 years, with detailed demographics and clinical characteristics provided. Evaluation of tracheobronchial biopsy samples revealed higher histological scores for the presence of ciliated cells and transverse sections of cilia in pellets obtained from brush biopsies and fixative solutions of forceps biopsy compared to forceps biopsy tissue samples. Electron microscopic examination of ultra-thin sections demonstrated abundant ciliated cells and abnormal cilia structures, aiding in the diagnosis of PCD in pellets. PCD represents a significant etiology of bronchiectasis, emphasizing the need for accurate diagnosis and appropriate management strategies. Our findings highlight the importance of bronchoscopic techniques, including bronchial brushing alongside forceps biopsies, in enhancing diagnostic yield and guiding timely intervention to improve patient outcomes.

Multicystic Interstitial Lung Disease Due to a Novel Biallelic C-C Chemokine Receptor Type 2 Variant.

We are presenting two individuals with biallelic C-C chemokine receptor type 2 (CCR2) deficiency carrying the novel c.644C>T p.L215P variant, who presented with chronic respiratory symptoms during infancy and developed multiple diffuse cystic lesions during childhood. The patients were diagnosed by means of whole exome sequencing and functional validation of the variant was performed in primary patient cells. While size and extent of the cysts were stable over years, progressive lung function decline was noted in adolescence and adulthood respectively. The CCR2 p.L215P variant was found to be loss-of-expression and patient monocytes displayed a migration defect upon stimulation with the CCR2 ligand C-C motif ligand 2 (CCL2). With a follow-up of up to 25 years, this report expands our understanding of lung disease in CCR2 deficiency and offers another monogenic cause of cystic lung disease. Early genetic diagnosis of affected individuals might allow potentially curative treatment by haematopoietic stem cell transplantation.

Eosinophils in chronic obstructive pulmonary disease.

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung condition characterised by chronic respiratory symptoms, fixed airway obstruction and persistent inflammation that leads to a progressive airflow limitation. Although COPD has traditionally been linked to neutrophilic inflammation, recent studies have identified a subset of patients - approximately 20%-40% - with elevated eosinophil levels in blood and sputum. Emerging evidence suggests that eosinophilic inflammation has a pivotal role in a subset of COPD patients and may influence disease progression, exacerbation frequency and therapeutic responses. This narrative review provides a comprehensive analysis of the role of eosinophils in COPD with particular attention to their role as biomarkers in blood and sputum. We evaluate the prevalence of eosinophilic inflammation in COPD exanimating different thresholds used in blood and in sputum to define it. In addition, we focus on eosinophilic COPD phenotype as a treatable trait, emphasising recent evidence that supports the effectiveness of biological target therapy.

Comprehensive Management Algorithm for Mycobacterium avium Complex Pulmonary Disease in the Real-World Setting.

The management of Mycobacterium avium complex pulmonary disease (MAC-PD) is challenging because of limited efficacy and frequent adverse events associated with standard treatments. The 2020 guidelines from the American Thoracic Society, European Respiratory Society, European Society of Clinical Microbiology and Infectious Diseases, and Infectious Diseases Society of America provide recommendations, but real-world adherence is often hindered by these issues, leading many patients to be unable to complete standard therapy. This review proposes a comprehensive management algorithm for MAC-PD, emphasizing multidisciplinary approaches and integrating nonantimicrobial management before, during, and after drug treatment to enhance patient outcomes. When a patient presents with chronic respiratory symptoms suggestive of nontuberculous mycobacteria, clinicians should follow a guideline-based approach to diagnosis, as diagnostic delays are common because of nonspecific symptoms. Proper evaluation should determine the disease phenotype (existence of cavitary lesions), as it influences treatment choices. Airway clearance, nutritional support, and management of underlying conditions are essential nonantimicrobial components. Regular outpatient monitoring helps detect disease progression and optimize treatment. Treatment strategies vary based on disease severity. For noncavitary nodular bronchiectatic disease, a thrice-weekly regimen is preferred because of better tolerability. Severe cases or those with cavitary forms may require daily treatment with additional aminoglycosides. Amikacin liposome inhalation suspension is recommended for patients not responding to standard regimens after 6 months. Recent research addresses drug intolerance, suggesting alternatives such as a two-drug regimen without rifamycin in certain cases. Consultation with nontuberculous mycobacteria specialists is advised for complex cases, particularly those with macrolide resistance or requiring surgical intervention. The algorithm emphasizes shared decision making, patient education, and family support to improve adherence and outcomes.

Chronic Pulmonary and Systemic Inflammatory Manifestations Associated with Interstitial Lung Disease in Patients with Common Variable Immunodeficiency

Rationale Interstitial (diffuse) lung disease (ILD) in common variable immunodeficiency (CVID) patients significantly impacts their quality of life and survival. We aimed to identify phenotypic characteristics associated with ILD in a large U.S. cohort of CVID patients. Methods We conducted a cross-sectional analysis of 1,470 CVID cases in the USIDNET registry. The primary outcome was physician-diagnosed ILD. Clinical characteristics were compared using chi-square or Wilcoxon–Mann–Whitney tests. Logistic regression evaluated associations between respiratory comorbidities, immunological features, extrapulmonary autoimmunity, and ILD. Results There were 103 CVID patients with known ILD (7%). Their median age was 47 years (IQR 25) compared with 50 years (IQR 38) in the non-ILD group, with a similar sex distribution, predominantly female (62.1% vs. 61%). Most ILD patients were asymptomatic for chronic respiratory symptoms, but dyspnea (15.5% vs. 3.6%, p < 0.001) and weight loss (14.6% vs. 7.1%, p = 0.007) were the most frequent symptoms. ILD patients had lower serum IgA levels (7 mg/dL vs. 29 mg/dL, p < 0.001) and CD3+, CD4+, CD8+, and CD19+ lymphocyte counts (p < 0.01). Chronic respiratory comorbidities associated with ILD included lung granulomas/multiple nodules (OR 16.75, 95% CI 9.23-30.39, p < 0.0001) and bronchiectasis (OR 3.1, 95% CI 1.9-5.1, p < 0.0001) independent of age. In contrast, upper airway inflammatory conditions and lower airway diseases (e.g., asthma and COPD) were not significantly associated. CVID patients with extrapulmonary immune dysregulation, including hepatosplenomegaly (OR 6.29, 95% CI 4.16-9.51, p < 0.0001), cytopenias (OR 3.9, 95% CI 2.59-5.88, p < 0.0001), inflammatory GI disease (OR 1.76, 95% CI 1.18-2.65, p = 0.006), and autoimmune endocrine disorders (OR 1.69, 95% CI 1.06-2.69, p = 0.028) also had an increased likelihood of ILD. No significant associations were observed between ILD and autoimmune skin or rheumatologic diseases. Conclusions CVID patients with ILD feature a severe phenotype characterized by a higher frequency of bronchiectasis, lung granulomas/nodules, reduced IgA, and T and B cells, as well as non-pulmonary immune dysregulation, particularly hematologic, GI, and endocrine manifestations. These findings highlight the need for targeted monitoring of lung disease in patients with these complications. Despite limitations (risk of recall/selection/attrition bias), our study provides valuable clinical insights into ILD in CVID patients and motivates further research into this highly relevant clinical problem.

Abstract 7423: Modelling COPD to lung cancer progression using machine learning frameworks

Abstract Background: Chronic obstructive pulmonary disease (COPD) is a lung condition characterised by chronic respiratory symptoms due to abnormalities of the airways that causes persistent, often progressive airflow obstruction and independent risk factor for lung cancer. However, the mechanisms linking COPD to lung cancer remain poorly understood, particularly the role of mutual risk factors such as air pollution and smoking. Emerging evidence challenges that environmental carcinogens can be purely mutagenic, and suggests that chronic inflammation also facilitates cancer progression and can be compounded in genetically susceptible individuals. This study aimed to investigate any gene-environment interactions contributing to lung cancer development in patients with COPD. Methods: We used machine learning frameworks to solve this problem given the limitations of conventional methods on this high-dimensional and multi-modal data. Using germline SNPs, measurements of air pollution through PM 2.5, and clinical information from the UK Biobank, a cohort of 488, 377 participants, we created models to predict whether patients with COPD would get lung cancer. We tested multiple frameworks optimised for tabular data such as eXtreme Gradient Boosting (XGBoost) and TabNet, in addition to Elastic Net, to be able to independently capture different facets of the data and account for potential non-linear interactions not modelled in linear approaches. As a secondary aim, we focussed on COPD patients with at least a ten-year post-diagnosis survival, minimizing bias from mortality effects on cancer progression. Results: In (n=24, 094) individuals with COPD, 1, 312 progressed to develop lung cancer by the date of censorship. Patients progressing to lung cancer were significantly older at enrolment, had greater exposure to air pollution, and smoked more heavily (all p < 0.001). Using an 80:20 train-test split, XGBoost and Elastic Net models outperformed TabNet (p< 0.01 by DeLong’s test) in predicting lung cancer risk, with XGBoost achieving the highest ROC-AUC on the held-out test set (0.73, 95% CI: 0.72-0.75). Restricting the inclusion criteria to ten-year COPD survivors notably improved prediction accuracy (ROC-AUC = 0.87, 95% CI: 0.85-0.90) and identified SNPs related to lung function and inflammation (such as RAGE) as important risk factor of lung cancer in patients in COPD patients. Conclusions: This study demonstrates that integrating machine learning with epidemiological data enables high-accuracy modelling of lung cancer risk in patents with COPD, emphasizing a potential role of inflammation mediating PM 2.5 gene-environment interactions. These findings underscore the need for research on the biological mechanisms driving inflammation-associated cancer risk in COPD for patient stratification, as well as the potential for applying machine learning frameworks methods to other cancers to explore tumorigenic inflammation. Citation Format: Tej Pandya, Marcellus Augustine, Kevin Litchfield, Nuno Rocha Nene, Charles Swanton. Modelling COPD to lung cancer progression using machine learning frameworks [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 7423.

Prevalence of respiratory symptoms and lung function impairments among woodworkers in Gondar City

Respiratory symptoms and lung function impairments are concerns in the woodworking industry. In Ethiopia, the woodwork industry has been growing; however, there is limited data on pulmonary function, respiratory symptoms, and risk factors among woodworkers. This study aimed to assess the prevalence of impaired lung function and respiratory symptoms and determine their associated risk factors among woodworkers in Gondar City, Ethiopia. A comparative cross-sectional study was conducted, involving 185 woodworkers and 176 controls. Spirometry was used for Lung function tests. The data were collected using a questionnaire in Kobo Toolbox software. Statistical analyses, including ANOVA, t-test, and logistic regression were done in SPSS version 26. Almost all participants (96.4%) were male. The proportions of obstructive, restrictive, and mixed lung function impairments in woodworkers and control groups were 7.6% vs. 2.8%, 4.86% vs. 3.98%, and 1.08% vs.0%, respectively. The proportion of chronic respiratory symptoms in woodworkers and control groups was 35.5% vs. 12.7% with the proportion of cough (19.9% Vs 6.6%), phlegm (21.1% Vs 5.8%), wheezing (9.4% Vs 3.9%), shortness of breath (19.9Vs 6.6%), and breathlessness (13.3% Vs 8.3%). In woodworkers, and pooled models, the absence of a local exhaust ventilation system, working more than eight hours per day, being unable to use filter masks, and being unable to do physical exercise were significantly associated with respiratory symptoms. Forced Expiratory Volume in 1 s/Forced Vital Capacity ratio (FEV1/FVC ratio) (P = 0.001) and Mid-Expiratory Flow between 25% and 75% (MEF25%-75%) significantly decreased with work experience (P = 0.001). Woodworkers had higher rates of obstructive, restrictive, and mixed lung function impairments and more respiratory symptoms. Prioritizing workplace ventilation and the use of respiratory protective devices is crucial for mitigating these risks.

The impact of cystic fibrosis transmembrane conductance regulator (CFTR) modulators on the pulmonary microbiota.

Cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy has significantly changed the course of the disease in people with cystic fibrosis (CF) (pwCF). The approved triple therapy of elexacaftor, tezacaftor and ivacaftor (ETI), commercially known as Trikafta, increases CFTR channel function, leading to improvements in sweat chloride concentration, exercise capacity, body mass index, lung function and chronic respiratory symptoms. Because of this, the majority of pwCF are living longer and having fewer CF exacerbations. However, colonization with the common CF respiratory pathogens persists and remains a major cause of morbidity and mortality. Here, we review the current literature on the effect of ETI on the respiratory microbiota and discuss the challenges in addressing CF lung infections in the era of these new life-extending therapies.

An update on diagnosis and treatments of childhood interstitial lung diseases.

Childhood interstitial lung diseases (chILDs) are rare and heterogeneous disorders associated with significant morbidity and mortality. The clinical presentation of chILD typically includes chronic or recurrent respiratory signs and symptoms with diffuse radiographic abnormalities on chest imaging. Diagnosis requires a structured, multi-step approach. Treatment options are limited, with disease-specific therapies available only in selected cases and management relying primarily on supportive care. Awareness of chILDs has been steadily increasing. New diagnoses, advanced diagnostic tests, and novel treatments are emerging each year, highlighting the importance of collaborative, multidisciplinary teams in providing comprehensive care for children and families affected by these complex conditions. On behalf of the European Respiratory Society Clinical Research Collaboration for chILD (ERS CRC chILD-EU), this review provides an updated overview of the diagnostic approach and management strategies for chILDs.

Respiratory symptoms and associated factors among workers in the marble factory in ethiopia: A comparative cross-sectional study

Occupational dust exposure is one of the major risk factors for respiratory health in many dust-generating work environments, including the marble industries. The objective of this study was to determine the prevalence of respiratory symptoms and associated factors among marble factories workers in Addis Ababa, Ethiopia, compared to non-dust exposed alcohol factory workers. A comparative cross-sectional study was conducted among randomly selected 246 marble factories workers and 246 alcohol factory workers. The respiratory symptoms were assessed by using the standardized questionnaires adopted from both British Medical Research Council (BMRC) Questionnaires and American Thoracic Society (ATS) questionnaires. The data were entered into Epi-data version 3.1 and analyzed using SPSS version 23. A Poisson regression analysis was performed to compare the prevalence of respiratory symptoms among marble factory workers and alcohol factory workers. A multivariable logistic regression analysis was done to identify factors that were significantly associated with respiratory symptoms. Statistical significance was determined at a p-value of less than 0.05. A Poisson regression analysis revealed that the prevalence of chronic respiratory symptoms was significantly higher among marble factory workers (42.1%) than among control workers (16.2%). Chronic Respiratory symptoms was significantly associated with age ≥ 40 years (Adjusted Odds Ratio [AOR] = 1.72, 95% CI:1.07–2.74), past history of respiratory illnesses (AOR = 5.07, 95% CI:3.23–7.96), not using respiratory protective Equipment (AOR = 2.16, 95% CI: 1.19–3.92), work experience ≥ 10 years (AOR = 2.04, 95% CI:1.12–3.70), and working hours ≥ 48 h per week (AOR = 2.19, 95%CI: 1.36–3.56). Thus, respiratory protection equipment and engineering control methods should be implemented to reduce workers’ exposure to marble dust in marble factories.

Nutritional Support of Chronic Obstructive Pulmonary Disease.

Background: COPD is a heterogenous disease of the respiratory tract caused by diverse genetic factors along with environmental and lifestyle-related effects such as industrial dust inhalation and, most frequently, cigarette smoking. These factors lead to airflow obstruction and chronic respiratory symptoms. Additionally, the increased risk of infections exacerbates airway inflammation in COPD patients. As a consequence of the complex pathomechanisms and difficulty in treatment, COPD is among the leading causes of mortality both in the western countries and in the developing world. Results: The management of COPD is still a challenge for the clinicians; however, alternative interventions such as smoking cessation and lifestyle changes from a sedentary life to moderate physical activity with special attention to the diet may ameliorate patients' health. Here, we reviewed the effects of different dietary components and supplements on the conditions of COPD. Conclusions: COPD patients are continuously exposed to heavy metals, which are commonly present in cigarette smoke and polluted air. Meanwhile, they often experience significant nutrient deficiencies, which affect the detoxification of these toxic metals. This in turn can further disrupt nutritional balance by interfering with the absorption, metabolism, and utilization of essential micronutrients. Therefore, awareness and deliberate efforts should be made to check levels of micronutrients, with special attention to ensuring adequate levels of antioxidants, vitamin D, vitamin K2, magnesium, and iron, as these may be particularly important in reducing the risk of COPD development and limiting disease severity.

Efficacy and safety of long-acting muscarinic antagonists in COPD: A meta-analysis and meta-regression with a focus on aging.

The increasing global elderly population, projected to reach 20% of individuals aged 65 and over by 2030, faces significant pulmonary challenges, including chronic obstructive pulmonary disease (COPD). Aging is associated with a natural decline in lung function and structural changes that exacerbate respiratory issues. COPD, characterized by chronic respiratory symptoms and airflow obstruction, presents a unique challenge in older patients due to the accelerated decline in lung function. Acetylcholine plays a pivotal role in airway dynamics through muscarinic acetylcholine receptors, particularly M3 subtype, which mediates bronchoconstriction. The efficacy of long-acting muscarinic antagonists (LAMA) may differ in older adults, with evidence suggesting that these patients can respond favorably to LAMA treatment. This study utilized meta-analysis and meta-regression to explore the efficacy and safety of LAMA in treating COPD, while considering aging as a potential modifier. A meta-analysis of Phase III randomized controlled trials highlighted significant improvements in trough forced expiratory volume in the 1st second when LAMA were compared to placebo (PCB). Furthermore, the meta-regression revealed a trend suggesting older adults may experience enhanced benefits from LAMA therapy, particularly with once-daily regimens. Safety outcomes, including serious adverse events (SAE), cardiovascular SAE, and mortality, were not modulated by age when comparing LABA to PCB. Overall, these findings support the use of LAMA in elderly COPD patients and underscore the need for tailored treatment strategies to improve clinical outcomes in this vulnerable population.

Tuberculosis-associated respiratory impairment and disability in children, adolescents and adults: protocol for a systematic review and individual participant data meta-analysis

BackgroundApproximately 2% of the global population has survived tuberculosis (TB). Increasing evidence indicates that a significant proportion of pulmonary TB survivors develop TB-associated respiratory impairment and disability—commonly referred to as...

Association of circadian syndrome and lung health: A population-based cohort study.

Association of circadian syndrome and lung health: A population-based cohort study.

Exploring the impact of climate change on respiratory health in Nigeria: a scoping review of current research, government policies and programs

Climate change significantly impacts health globally, especially in densely populated, rapidly industrialising and ecologically diverse countries like Nigeria. We analysed climate change policies, studies, programs, and events at the national and subnational levels in Nigeria and explored their effects on public and respiratory health. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) checklist, we searched PubMed, African Journals Online (AJoL), Google Scholar and government data repositories on January 10, 2024. We synthesised results using an adapted sector-level framework based on the World Health Organization (WHO) guidelines. Our searches returned 262 items, of which 32, including research studies, reports and grey documents, were retained for synthesis. Although some policies and programmes, like the Climate Change Act and Nigerian Climate and Health Observatory, exist, implementation is limited across many settings. Key reported respiratory pollutants in Nigeria include particulate matter (PM2.5, PM10), gaseous emissions (CO, SO₂, NOx), agricultural by-products (NH₃, H₂S), greenhouse gases (CH₄, CO₂), and microbial contaminants, which collectively increase the risk of respiratory inflammation, infections, and exacerbations of chronic respiratory symptoms and diseases. Our findings underscore a clear link between climate change and worsening respiratory health in many Nigerian settings. The current policies and programmes’ have limited impact, calling for comprehensive reforms, including improved enforcement and targeted action against major pollution sources, recognition of environmental rights, and stronger public health initiatives and community action.

Effectiveness of Crocodile Breathing Technique on reducing dyspnea, rate of perceived exertion in patient with Chronic Obstructive Pulmonary Disease: A Case Report

ABSTRACT Global Initiative for Chronic Obstructive Lung Disease 2023 defines COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration, and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction. We present the case of a 54-year-old male patient who presented with complaints of breathlessness and cough dry in nature diagnosed with Chronic Obstructive Pulmonary disease. The patient was subsequently referred for chest physiotherapy department to address these Breathlessness. As physiotherapists, we employed breathing exercises, and Crocodile Breathing Technique. This case ensures the significance of chest Crocodile Breathing Technique for patients with COPD. Outcome measures included the Modified Medical Research Council dyspnea grading scale, Borg-20 scale for rate of perceived exertion, the Functional Independence Measure score. Following the Physiotherapy management program, improvements were observed in all outcome measures. These findings indicate that Breathing exercise along with Crocodile Breathing Technique can give benefit to the patients suffering from Chronic obstructive pulmonary disease by reducing Breathlessness and enhancing functional independence.

Relationship between Asthma and Allergic Rhinitis in Terms of Prevalence and Severity in East-Azerbaijan, Iran

Background: Asthma and Allergic rhinitis (AR) are frequently concurrent diseases. Epidemiological, immunological, and clinical studies reported increasing evidence of the links between AR and asthma. Epidemiologically, up to 40% of patients with AR also have asthma, and up to 80% of patients with asthma experience nasal symptoms. Furthermore, patients with AR are at three times the risk of developing asthma compared with those without AR. Method: This cross-sectional study was carried out during one year from all patients between 0-16 years who were referred to allergy and ENT clinics with symptoms of chronic cough (more than four weeks) or upper respiratory tract symptoms such as sneezing, runny nose, and nasal congestion. Data and diagnosis were classified according to the Global Initiative for Asthma (GINA) and the AR criteria and its Impact on Asthma guidelines (ARIA), respectively. Results: 190 (120 individuals with asthma and 70 individuals with AR) were enrolled in the study. The mean age of patients with asthma was 9.14±3.13, and 43.3% were female. The severity of asthma was classified as mild (20%), moderate (70.8%), and severe (9.2%). The mean age of patients with rhinitis was 10.13±3.45 years, and 35.7% were female. Rhinitis was classified as intermittent (40%) and persistent (60%). The prevalence of AR in the asthma group was 42 individuals (35%). Twenty-nine cases of them (24.2%) had intermittent AR, and 13 (10.8%) cases had persistent AR. The prevalence of asthma in AR was 18 cases (25.7%) 3 cases (4.3%) had mild asthma, 12 cases (17/1%) had moderate asthma, and 3 cases (4.3%) had severe asthma. A significant correlation was found (P<0.0001) between the severity of AR and asthma. Conclusion: Based on the findings of our study, there is a significant relationship between the severity of asthma and AR in patients with asthma and AR. The results show that asthma prevalence is high in patients with AR. Also, the frequency of AR in patients with asthma is significantly higher.

Endothelial dysfunction in chronic obstructive pulmonary disease: an update on mechanisms, assessment tools and treatment strategies.

Chronic obstructive pulmonary disease (COPD) is a complex condition marked by chronic respiratory symptoms, such as cough and dyspnoea, and persistent irreversible airway obstruction, punctuated by acute episodes of exacerbations. COPD is associated with a significant mortality risk and several comorbidities, including cardiovascular diseases. The link between COPD, acute exacerbations and cardiovascular diseases has been recently acknowledged under the unifying concept of cardiopulmonary risk. In this context, endothelial dysfunction (ED) has been identified as a key contributor to the systemic manifestations of COPD and an early event in atherogenesis, thus potentially linking respiratory diseases and cardiovascular risk. Assessing endothelial dysfunction could therefore provide valuable prognostic insights into COPD, while targeting it may emerge as a promising therapeutic approach. Nonetheless, several aspects such as clinical assessment options and potential treatment strategies are still under debate, despite an intense research activity in recent years and promising results coming from the field of pulmonary rehabilitation medicine, which seems to be highly beneficial for the improvement of ED in COPD patients. On these premises, this mini review aims to provide an updated overview of the pathophysiology of ED in the context of COPD, with a focus on its assessment and its potential as an attractive therapeutic target.

Current Smoker: A Clinical COPD Phenotype Affecting Disease Progression and Response to Therapy.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition of the lungs, characterized by chronic respiratory symptoms, primarily dyspnea, cough, and sputum production, due to airway and/or alveoli abnormalities that cause persistent, and often progressive, airflow obstruction. Although the underlying mechanisms responsible for COPD remain poorly understood, over the last several decades, clinical phenotypes and endotypes have been suggested. These include frequent exacerbator and eosinophilic groups that guide tailored therapies for patients with that clinical expression. In the developed world, smoking is the main known cause of COPD, responsible for ~80% of cases. Active smokers have more severe disease, with more rapid lung function decline and impaired quality of life, than former smokers. Unfortunately, smoking is still highly prevalent. Rates range between 3% and 37% globally, with factors including sex, age, race, education level, and geography influencing the rate of addiction. Importantly, several studies have shown that smoking detrimentally affects treatment efficacy of COPD medications; this is particularly true of inhaled corticosteroids and macrolides. In this review, we discuss the effects of smoking on the pathophysiology of COPD and the clinical impact of smoke exposure in patients with COPD. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).