COPD Patients Research Articles

Erdosteine in the treatment of acute and chronic diseases of the respiratory system: resolution of the scientific forum of experts “In the Spotlight”

Airway mucus hypersecretion is a pathophysiologic manifestation of acute and chronic airway inflammatory disease. Mucolytics can reduce mucus viscosity and promote mucus discharge and therefore can be considered pathogenetically based therapy.The purpose of this publication with the resolution of the scientific forum of experts was to discuss pharmacological features, efficacy, and safety of erdosteine.Results. Experts of thescientific forum not only reviewed the results of clinical trials, but also voted on the use of mucoactive drugs according to the principle of Delphi consensus. Comparison of the efficacy and safety of mucoactive drugs (erdosteine, acetylcysteine, carbocysteine, ambroxol) in patients with respiratory diseases by the experts during voting showed that the highest level of agreement among the experts was achieved for the drug Elmucin® (erdosteine) in terms of its mucolytic activity and other pharmacological features, as well as when discussing the safety of the compared drugs in the officially recommended doses. The highest level of agreement was also noted on the erdosteine efficacy in COPD patients in reducing the frequency and duration of disease exacerbations, as well as reducing the risk of hospitalization of COPD patients when used long-term as part of combination therapy. The demonstrated safety profile was the most beneficial among the reviewed mucoactive drugs.Conclusion. Elmucin® is a mucolytic with pleiotropic effects such as complex mucoactive action, potent antioxidant, anti-inflammatory and antibacterial activity with anti-adhesive effect for pathogens that determine its clinical efficacy in the treatment of acute and chronic airway diseases.

Assessing the impact of different types of masks on COPD patients: A randomized controlled trial

BackgroundWearing masks imposes an additional respiratory burden on COPD patients. This study aimed to investigate the impact of various mask types on physiological parameters and subjective feelings in COPD patients.MethodsThis randomized, open-label, parallel-controlled trial randomly assigned 129 COPD patients from 2 Chinese hospitals to the N95 mask group, the surgical mask group and the no mask group, who were required to complete a 6-minute rest (6MR) and a 6-minute walking test (6MWT) while wearing their designated masks, and were assessed for blood pressure, oxygen saturation, pulse rate, Borg score, RPE score, 6-minute walk distance (6MWD), and subjective feeling score. Data were analyzed using intention-to-treat analysis and per-protocol analysis.ResultsNo significant differences were observed in blood pressures, oxygen saturation, pulse rate, or the 6MWD among the three groups following a 6MR or 6MWT. Wearing N95 masks and surgical masks during the 6MWT significantly elevated perceived dyspnea (p<0.001) and exertion scores (p<0.001) in COPD patients. The differences in the 2 scores between the highest and lowest groups were 2 and 4 points, respectively.ConclusionWearing surgical masks or N95 masks for 6MR or 6MWT did not adversely affect physiological parameters in COPD patients. However, it significantly increased perceived dyspnea and exertion.

Medical hypnosis increases 6MWT distance in severe COPD patients: a case-control study

Medical hypnosis increases 6MWT distance in severe COPD patients: a case-control study

GATA2 downregulation contributes to pro-inflammatory phenotype and defective phagocytosis of pulmonary macrophages in chronic obstructive pulmonary disease.

Pulmonary macrophages from COPD patients are characterized by lower phagocytic and bactericidal activity whereas there is hypersecretion of pro-inflammatory cytokines. The prominent decline of GATA2 expression in pulmonary macrophages from COPD patients inspired us to figure out its role during COPD development. The expression levels of GATA2 were decreased in alveolar macrophages isolated from cigarette smoke (CS)-induced COPD mice and cigarette smoke extract (CSE)-treated macrophages. In vitro, both CSE and GATA2 knockdown via siRNAs elevated pro-inflammatory cytokines expression whereas inhibiting phagocytosis in macrophages. Integrated analysis of transcriptomics of GATA2-knockdown macrophages and the results of ChIP sequencing of GATA2 together with dual-luciferase reporter assay identified Abca1 and Pacsin1 as functional target genes of GATA2. Mechanistically, ABCA1 mediates the pro-inflammatory secretion phenotype and the dysfunction in early stage of phagocytosis of macrophages through TLR4/MyD88 and MEGF10/GULP1 pathways, respectively. PACSIN1/SUNJ1 partially mediates the disruption effects of GATA2 downregulation on maturation of phagolysosomes in macrophages. Together, our study suggests that GATA2 influences multiple functions of pulmonary macrophages by simultaneous transcriptional regulation of several target genes, contributing to the dysfunctions of pulmonary macrophages in response to CS, which provides an impetus for further investigations of GATA2 or other underappreciated transcription factors as regulatory hubs in COPD pathogenesis.

Prevalence, risk factors, and comorbidities of type 2 diabetes among COPD patients at a Bhubaneswar secondary care hospital

Prevalence, risk factors, and comorbidities of type 2 diabetes among COPD patients at a Bhubaneswar secondary care hospital

Features of Intracellular Matrix State during Development and Formation of COPD Clinical Phenotypes

The objective: to evaluate state of extracellular matrix markers and their tissue inhibitors during development and formation of clinical phenotypes of COPD, in patients facing the high risk of developing exacerbations.Subjects and Methods. 96 COPD patients (73% men and 27% women) were examined. Patients were randomized into the following groups: Group 1 included 40 COPD patients with bronchitis phenotype; Group 2 included 38 patients with emphysema phenotype; and Control Group consisted of 18 practically healthy subjects. All patients underwent a comprehensive clinical and laboratory examination. Levels of matrix metalloproteinases (total MMP-9 and MMP-2) and their tissue inhibitors TIMMP1 and TIMMP2 were determined by ELISA.Results. The development of COPD, regardless of the clinical phenotype of the disease, is accompanied by pronounced expression of extracellular matrix markers MMP-9 and MMP-2. Regardless of the COPD clinical phenotype, elevated activity of metalloproteinases is accompanied by inhibition of production of TIMMP2 and dysfunction of the MMP-9/TIMMP1 antiprotease system. In COPD patients with MMP-2 level of 214 ng/ml, the formation of bronchitis phenotype can be predicted, while with MMP-2 level of 214 ng/ml or more, the formation of emphysema phenotype can be predicted.

Prevalence of systemic hypertension in COPD patients with GOLD stage 1 disease

Morbidity and death in COPD patients is greatly influenced by co morbidities. We aim to study the prevalence of systemic hypertension in the initial stages of COPD, i.e. in patients with GOLD stage 1 disease having a FEV1 greater than 80% of predicted value in PFT. We conducted a period prevalence study on patients with early stages of COPD. Patients were evaluated for systemic hypertension after being diagnosed with COPD by pulmonary function test. The study was conducted at Sri Venkateswaraa Medical College Hospital and Research Institute, Chennai. A total of 205 patients were identified with COPD meeting the necessary inclusion and exclusion criteria. 150 patients were male and 55 were female. Among them 53.6% patients were diagnosed with systemic hypertension. 20.9% of the hypertensive patients were having obesity. 95.4% of the patients with hypertension were tobacco smokers. 4.6% of the patients with hypertension were having a history of biomass fuel smoke exposure. Tobacco smoking, biomass fuel smoke exposure and obesity are important factors which influence lung function and many cardiovascular/cerebrovascular diseases. Patients in the early stages of COPD have a higher prevalence of systemic hypertension. Systemic hypertension must be identified and treated early to prevent long term cardiovascular/cerebrovascular complications in COPD patients.

Systemic pro-inflammatory response following bronchoscopic lung volume reduction using endobronchial valves

RationaleBronchoscopic lung volume reduction treatment using endobronchial valves (EBV) is an effective treatment for severe COPD patients by improving lung function and quality of life. However, little is known about its effects on systemic inflammation. Therefore, the aim of our study was to investigate whether EBV treatment impacts the inflammatory cytokine profile.MethodsThis study was a predefined substudy of the SoLVE trial (NCT03474471) that investigated the combination of EBV treatment with pulmonary rehabilitation (PR). The substudy included the collection of blood samples with assessment of 10 inflammatory markers prior to EBV treatment and 6 months after EBV or EBV+PR treatment.ResultsIn 66 patients, six months after treatment a pro-inflammatory cytokine profile was observed, with an increase in all pro-inflammatory markers and a decrease in the anti-inflammatory cytokine IL-10. The changes in plasma cytokine profile were not associated with changes in clinical outcomes such as lung function or exercise capacity.DiscussionIn conclusion, our study demonstrated an elevation in systemic pro-inflammatory cytokine levels following successful EBV-treatment, which was not associated with adverse clinical outcomes. It would be interesting to further explore, whether this increase is attributed to a foreign body response or if other factors contribute to this phenomenon.

Effectiveness of recently-approved oral antiviral medications on the outcome of patients with mild-to-moderate COVID-19 and preexisting chronic obstructive pulmonary diseases

ABSTRACT Objectives This study assessed the effectiveness of the oral antiviral agents nirmatrelvir – ritonavir (NMV-r) and molnupiravir (MOV) for treating mild-to-moderate coronavirus disease 2019 (COVID-19) in patients with COPD. Methods This retrospective cohort study extracted data from the TriNetX platform and examined 94,984 COVID-19 patients with preexisting COPD from 1 January 2022, to 1 October 2023. Patients receiving NMV-r or MOV (study group) were compared with those not receiving oral antiviral agents (control group) after propensity score matching (PSM). Results After PSM, 7,944 patients were classified into the study and control groups. The primary composite outcome of all-cause hospitalization, or death in 30 days was reported in 458 (5.7%) patients in the study group and 566 (7.1%) patients in the control cohort, yielding a hazard ratio [HR] of 0.79 (95% confidence interval [CI]: 0.70–0.89; Table 2). Compared with the control group, the study group had a significantly lower risk of all-cause hospitalization (HR, 0.87; 95% CI: 0.76–0.99) and death (HR: 0.21, 95% CI: 0.13–0.35). Conclusions This study revealed that oral antivirals – NMV-r or MOV might improve clinical outcomes in patients with preexisting COPD and COVID-19. However, only a small proportion of preexisting COPD patients with COVID-19 received oral antiviral treatment.

Circadian pattern of blood pressure in patients with stable COPD

ObjectiveTo describe the circadian blood pressure (BP) pattern in stable COPD patients. MethodsWe included stable COPD patients from Internal Medicine Departments. Office BP and ambulatory BP monitoring were performed. Patients were classified as BP reducers (dipper or extreme dipper) or non-reducers (non-dipper or riser). ResultsWe included 43 patients (5 women, mean age 69.5 ± 9.5 years). Among them, 11 had sustained normotension, 13 sustained hypertension, 2 white coat hypertension, and 17 masked hypertension. Arterial stiffness was observed in 12 (27.9%) patients. Overall, 26 (60.5%) exhibited a non-reducer BP profile. Non-reducers had a higher frequency of previous major cardiovascular events (50% vs. 11.8%, p = 0.020) and long-acting muscarinic antagonist use (84.6% vs. 47.1%, p = 0.009). ConclusionsHypertension is often masked in COPD patients, who frequently display an altered circadian BP pattern. Longitudinal studies with larger samples are needed to evaluate the impact of these patterns on COPD progression.

Predictive Value of CCQ and its Subdomains for Hospitalized Exacerbations in Chronic Obstructive Pulmonary Disease: A 3-Year Observational Prospective Study.

The prediction capacity of the Clinical COPD Questionnaire (CCQ) and its functional, symptom, and mental subdomain for COPD hospitalized exacerbation were rarely studied. To examine the prognostic capacity of the total CCQ and its three subdomains for 3-year COPD hospitalized exacerbations. We analyzed the predictive ability of total CCQ score and its subdomains for hospitalized exacerbations in an observational cohort of 987 subjects with stable COPD from the RealDTC, an ongoing multicenter prospective study. Hospitalized exacerbations were prospectively collected every 6month for a maximum of 3years. The total CCQ and its functional and symptom domain, but not the mental domain, were significantly associated with 3-year hospitalized exacerbations by multivariate Cox regression analysis. The predictive capacity of functional domain was similar to that of the total CCQ, but significantly stronger than the symptom and mental domain by ROC analysis (P < 0.05). ROC curves also showed that the AUC of exacerbation history combined with CCQ functional domain was larger than that of exacerbation history alone (P < 0.0001). Additionally, the predictive value of multivariable models that contains CCQ functional domain was significantly better than the corresponding model without CCQ functional domain (P < 0.05). The total CCQ and its functional and symptom domain were independent risk factors of 3-year hospitalized exacerbations. The prognostic capacity of the functional domain was similar to that of total CCQ, and was significantly stronger than the symptom and mental domain. The CCQ functional domain was able to increase the predictive power of exacerbation history and other multivariable prediction models, indicating it may have an important role in the multivariable prediction tool for hospitalized exacerbation, and its combination with other clinical variables might be used as a low-cost approach for assessments of the disease severity and severe exacerbation in COPD patients in the future.

High energy, high protein omega-3 enriched oral nutrition supplement is appreciated in COPD patients and preferred by dietitians.

High energy, high protein omega-3 enriched oral nutrition supplement is appreciated in COPD patients and preferred by dietitians.

Correlation of Perceived Social Support with Medication Adherence and Quality of Life in Individuals with Chronic Obstructive Pulmonary Disease

Background/Purpose: It is known that declining social support increases the disease burden in individuals with chronic obstructive pulmonary disease. The association between perceived social support with medication adherence and quality of life in COPD patients is unclear. The aim of this study was to show the correlation of perceived social support with medication adherence and quality of life in individuals with chronic obstructive pulmonary disease. Methods: A descriptive and correlational study was conducted. A Patient Information Form, the Multi-Dimensional Scale of Perceived Social Support, the St. George Respiratory Questionnaire and the Medication Adherence Report Scale were used to collect data. A total of 221 patients with COPD were included in the study. Descriptive statistics, the Mann–Whitney U test, Kruskal-Wallis tests, and Spearman's correlation analysis were used to analyze the data. Results: Perceived social support was negatively correlated with the respiration score (r=-0.23, p≤0.01), and positively with medication adherence (r=0.17, p

Elevated Triglyceride-Glucose (TyG) Index Predicts Poor Clinical Outcomes in Critically Ill AECOPD Patients: A Retrospective Study.

The triglyceride-glucose (TyG) index is a surrogate biomarker of insulin resistance which has been widely used in intensive care unit (ICU) to predict prognosis. However, its role in critically ill acute exacerbation of COPD (AECOPD) patients remains largely unknown. A total of 645 AECOPD patients were induced in this retrospective cohort study, which extracted data from the eICU Collaborative Research Database (eICU-CRD). The TyG index was calculated as Ln (fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2). The primary endpoint includes in-hospital mortality and ICU mortality. The secondary endpoint was sepsis, acute kidney injury (AKI), and acute respiratory failure (ARF). Multivariable Cox regression analysis revealed that the TyG index was independently associated with an increased risk of in-hospital mortality (hazard ratio, HR: 1.45, 95% CI: 1.04-2.01, P = 0.028) and ICU mortality (HR: 2.13, 95% CI: 1.28-3.54, P = 0.004). Moreover, the TyG index was independently associated with an increased risk of sepsis (odds ratio, OR: 1.54, 95% CI: 1.24-1.93, P < 0.001), AKI (OR: 1.57, 95% CI: 1.26-2.02, P < 0.001) and ARF (OR: 1.50, 95% CI: 1.20-1.87, P < 0.001). Kaplan-Meier survival analysis revealed that higher TyG indexes were also related to increased in-hospital mortality and ICU mortality. In addition, the restricted cubic splines regression model demonstrated that the in-hospital mortality and ICU mortality increased linearly with increasing TyG index (P for non-linearity = 0.897, P for non-linearity = 0.897, respectively). Elevated TyG index was independently associated with an increased risk of poor clinical outcomes in critically ill AECOPD patients. A prospective study to define TyG as a biomarker for prognosis prediction in critically ill AECOPD patients is warranted.

Type 2 inflammation in COPD: is it just asthma?

COPD is a heterogeneous condition, with tobacco smoking being the main environmental risk factor. The presence of type 2 (T2) inflammation is a well-recognised feature of asthma; however, it is now apparent that a subset of COPD patients also displays evidence of T2 inflammation with respect to elevated eosinophil counts and altered gene and protein expression of several T2 inflammatory mediators. T2 inflammatory mediators represent an attractive therapeutic target in both COPD and asthma; however, the efficacy of pharmaceutical interventions varies between diseases. Furthermore, the nature of some shared clinical features also differs. We provide a narrative review of differences in the nature of T2 inflammation between COPD and asthma, which may partly explain phenotypic differences between diseases. We focus on evidence from studies of pulmonary histopathology, sputum and epithelial gene and protein expression, and response to pharmacological interventions targeted at T2 inflammation.

Effect of Lycopene on Lungs of COPD Patients

Effect of Lycopene on Lungs of COPD Patients

Differential proteins from EVs identification based on tandem mass tags analysis and effect of Treg-derived EVs on T-lymphocytes in COPD patients

BackgroundChronic obstructive pulmonary disease (COPD) is a widespread respiratory disease. This study examines extracellular vesicles (EVs) and proteins contained in EVs in COPD.MethodsBlood samples were collected from 40 COPD patients and 10 health controls. Cytokines including IFN-γ, TNF-α, IL-1β, IL-6, IL-8, and IL-17, were measured by ELISA. Small EVs samples were extracted from plasma and identified by transmission electron microscope (TEM), nanoparticle tracking analysis (NTA), and Western blot. Protein components contained in EVs were analyzed by Tandem Mass Tags (TMT) to identify differential proteins. Treg-derived EV was extracted and added to isolated CD8+, Treg, and Th17 subsets to assess its effect on T-lymphocytes.ResultsELISA revealed higher levels of all cytokines and flow cytometry suggested a higher proportion of Treg and Th17 cells in COPD patients. After identification, TMT analysis identified 207 unique protein components, including five potential COPD biomarkers: BTRC, TRIM28, CD209, NCOA3, and SSR3. Flow cytometry revealed that Treg-derived EVs inhibited differentiation into CD8+, CD4+, and Th17 cells.ConclusionThe study shows that cytokines, T-lymphocyte subsets differences in COPD and Treg-derived EVs influence T-lymphocyte differentiation. Identified biomarkers may assist in understanding COPD pathogenesis, prognosis, and therapy. The study contributes to COPD biomarker research.

Evaluating the mucolytic effectiveness of Ambroxol and N-Acetylcysteine in patients with Acute exacerbation of chronic obstructive pulmonary disease

IntroductionChronic obstructive pulmonary disease (COPD) is the third most fatal disease globally. Acute deterioration of the patient's respiratory symptoms is known as an acute exacerbation of COPD (AECOPD), that goes beyond usual variations and result in change in medications. Ambroxol (ABX) and N-acetylcysteine (NAC), are mainly used as mucolytics in the treatment of AECOPD. MethodologyThis prospective observational study examines effectiveness of ABX and NAC in COPD patients by assessing the quality of cough relief, peak expiratory flow rate (PEFR), length of hospital stay, quality of life (QOL) and reduction in symptoms of COPD. Leicester Cough Questionnaire (LCQ); Breathlessness, Cough and Sputum scale (BCSS)and St. George Respiratory Questionnaire (SGRQ) scales are used to evaluate patient condition before and after the treatment. ResultsThe mean duration of hospital stay for NAC and ABX were found to be 8 ± 3.6 and 9.9 ± 3.9 days, respectively. Lung function in both groups improved with a change in percentage mean score of PEFR. Reduction in symptoms of COPD was evident in both groups by decrease in mean BCSS score from admission to discharge. Our study also demonstrated better QOL in both groups using SGRQ. LCQ showed a mean increase in all domains: physical, psychological and social. ConclusionIt was concluded that both ABX and NAC leads to betterment in lung function, cough relief and control AECOPD. Hence, this study gives a signal to clinicians about these treatment options along with standard therapy of COPD for a better therapeutic outcome.

Observing the effect of timed incentive respiratory training combined with resistance exercise using elastic bands on pulmonary function rehabilitation in elderly COPD patients.

Observing the effect of timed incentive respiratory training combined with resistance exercise using elastic bands on pulmonary function rehabilitation in elderly COPD patients.

The need for a new classification system in chronic obstructive pulmonary disease.

The current classification fails to fully meet the needs of physicians and COPD patients in clinical practice. The future classification should aim to prevent the development of disease in high-risk groups, enable early diagnosis before irreversible damage occurs, identify subgroups, and provide pathophysiological insight to inspire drug development. It would be reasonable to thoroughly examine and assess the contributing factors such as an increase in the annual decline of (FEV1), bronchial hyperresponsiveness, variable obstruction, FEV1 % predicted, blood eosinophil count, preserved ratio impaired spirometry (PRISm), and the subgroups of group B as potential additions to the new classification.