COPD Patients Research Articles

BackgroundCOPD is driven by the inhalation of noxious particles. A significant component of particulate matter is carbon, which is taken up by alveolar macrophages. We compared alveolar macrophage carbon levels in COPD patients to smokers and assessed the relationship of carbon load with macrophage size and phenotype.MethodsLung tissue from COPD patients (n=28) and smokers (n=15) was stained for alveolar macrophages. The area of carbon deposits within macrophages and macrophage size were measured. The effect of carbon exposure on macrophage size, phenotype marker expression (real-time PCR) and pro-inflammatory cytokine production (tumour necrosis factor-α (TNF-α) and CXCL8 by ELISA) was assessed in vitro using monocyte-derived macrophages (MDMs) from healthy donors.ResultsCarbon area (µm2) and percentage carbon area were significantly increased in COPD compared to smokers (5.0 µm2versus 1.3 µm2, p=0.04; 4.2% versus 0.74%, p=0.04). Carbon area and percentage carbon area were negatively correlated with forced expiratory volume in 1 s % (r= −0.43, p=0.001 and r= −0.49, p=0.004, respectively). Alveolar macrophages containing carbon were significantly larger than carbon negative macrophages (16.1 µm versus 14.2 µm, p<0.0001, respectively). MDMs treated in vitro with carbon were significantly larger (19% at 62 µg·mL−1) than controls and had significantly increased expression of macrophage phenotype markers CD206, CD80 and CD38 and released greater levels of TNF-α and CXCL8.ConclusionsAlveolar macrophage carbon was increased in COPD patients compared to smokers and negatively correlated with lung function. Carbon skews macrophages to a phenotype of increased size and differential expression of macrophage phenotype genes. Alveolar macrophage carbon exposure may be a significant driver of macrophage dysfunction in COPD.

Abstract Background Although noninvasive ventilation (NIV) is regarded as a first-line treatment for patients experiencing respiratory failure brought on by an acute exacerbation of chronic obstructive pulmonary disease, its failure rate ranges from 5 to 40%. Compared to a physical examination and chest radiography, combined lung ultrasound (LU) which performed swiftly and conveniently at bedside in critically has a greater diagnosis accuracy. In patients with hypoxemic respiratory failure admitted to a respiratory intensive care unit, the HACOR score is used to predict NIV failure. The study's goal was to use the US diaphragm thickness (Tdi) to predict NIV failure in patients with AECOPD by comparing it to the HACOR score. Methods In our study, we recruited 60 COPD patients who were divided into group A: patients with noninvasive ventilation (NIV) failure and group B: patients with successful noninvasive ventilation (NIV). All patients were subjected to the following baseline assessment including full clinical examination and routine laboratory workup including ABG on admission. The APACHE II scores were calculated on admission, and HACOR score was used in 1, 6, 12, 24, and 48 h after starting NIV. US assessment of the diaphragm was performed on admission and before starting NIV. Patients were followed until ICU discharge or death. Results The cut-off value of Tdi (%) was 29% to predict noninvasive MV failure with sensitivity 91.7% and specificity 69.4%. The cut-off value of HACOR 6 h was 15 to predict noninvasive MV failure with sensitivity 91.7% and specificity 72.2%. Conclusion Tdi and HACOR score are good predictors for noninvasive MV failure in patients with AECOPD.

Analysis of Exhaled Breath and Serum Markers Following a Single Bout of Exercise in COPD Patients - a Case-Control Study.

Bimetallic nanoclusters and dual-amplification tactic: an ultrasensitive electrochemiluminescence biosensor for miRNA-21 detection.

Development of a questionnaire on supportive care needs of patients with COPD combined with respiratory failure on noninvasive ventilators and evaluating its reliability and validity.

Background: The recently proposed Staging of Airflow Obstruction by Ratio (STAR) system classifies severity based on the FEV1/FVC ratio, potentially offering improved prognostic performance. This study aimed to evaluate the prognostic performance of STAR in patients hospitalized for COPD exacerbation. Methods: A retrospective observational single-center study was conducted including COPD patients who were discharged after hospitalization for a severe exacerbation at a university hospital. The clinical and spirometric data in a stable condition, GOLD classification, STAR system, and mortality outcomes were recorded. Results: A total of 197 patients (23% female) were included. The follow-up was performed for a minimum of 38 months or until death if it occurred earlier. During the study period, 91 patients died (46%). Patients were distributed according to the STAR classification as follows: 21% in STAR 1, 32% in STAR 2, 28% in STAR 3, and 19% in STAR 4. The agreement between STAR and GOLD was fair (Cohen’s kappa = 0.28), with a moderate correlation (Tau-b = 0.49, p &lt; 0.001). STAR grades 2 to 4 demonstrated progressively increasing mortality, while STAR grade 1 showed a mortality similar to grade 2. STAR showed a trend toward a superior discrimination for mortality than GOLD (AUC 0.63 [95%CI 0.55–0.71] vs. 0.55 [0.47–0.63]; p = 0.055), although BODEx remained the most accurate predictor (AUC = 0.70 [0.63–0.77]). Conclusions: The STAR system effectively stratified the mortality risk among hospitalized COPD patients across grades 2 to 4. However, STAR grade 1 failed to differentiate patients with a lower risk. Although STAR may underestimate severity in individual patients with relatively preserved ratios, its integration into clinical evaluation could enhance prognostic assessments.

The relationship between care dependency and self-efficacy in older adult patients with chronic obstructive pulmonary disease.

PA0328 is associated with virulence and immune evasion in carbapenem-resistant Pseudomonas aeruginosa.

Using machine learning models to predict the risk of mild cognitive impairment for COPD patients: A multi-cohort study

Background/Objective: Single-inhaler triple therapy (SITT) with budesonide/formoterol/glycopyrronium (B/F/G) is an option for COPD patients with frequent exacerbations. We evaluated its long-term efficacy in real life on emergency room visits/hospitalizations (primary endpoints), lung function, oral corticosteroid (OC), antibiotics and salbutamol (SABA) prescriptions (secondary endpoints). Methods: The aim of this single-center, retrospective observational study was to evaluate, in 65 COPD patients with recurrent exacerbations, the effects of B/F/G treatment after 18–24 months compared to therapies with LABA/LAMA, ICS/LABA, ICS/LABA + LAMA or other SITT taken in the previous 18–24 months. Results: After 22.8 ± 4.6 months, 20.12 ± 4.24 B/F/G packages were prescribed, while packs of other therapies given in the 23.35 ± 4.7 months (p = 0.587) before using B/F/G were 15.58 ± 9.8 (p = 0.0009). Emergency room visits (0.34 ± 0.56) and hospitalizations (0.52 ± 0.81) during about 2 years of B/F/G therapy were lower compared to the ones during pre-B/F/G treatments (0.65 ± 1.2, p = 0.015 and 0.83 ± 1.25, p = 0.019, respectively). After B/F/G treatment, the mean FEV1% value (48.5 ± 16.7%) was higher compared to that measured after the therapies taken before switching to B/F/G (45 ± 15.3%; p = 0.013). Conversely, there were no differences in FVC% values. OCs (2.96 ± 2.6) and SABA (1.41 ± 2.06) packages prescribed during B/F/G were lower than those observed during pre-B/F/G treatments (3.86 ± 2.35, p = 0.026 and 2.48 ± 4.57, p = 0.046, respectively). No differences in antibiotic prescriptions were observed during both therapies. Conclusions: Our real-life evaluation highlighted that B/F/G treatment may be effective, even in the long term, in reducing exacerbations, OC and SABA consumption and in improving lung function in COPD patients with high persistence/adherence to B/F/G compared to other non-persistent inhaled therapies previously taken. Optimizing treatment adherence should be one important goal of COPD patients’ management to maximize the therapy benefits.

This study aimed to develop and validate the behavioral intention scale for pulmonary rehabilitation with traditional Chinese medicine in COPD patients (BISPTCM-PR-COPD), based on the extended theory of planned behavior. Following the COSMIN framework, the scale was developed through literature review, semi-structured interviews, and expert consultations. A preliminary item pool was refined using item analysis and content validity evaluation. Psychometric testing was conducted in 2 patient samples. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to determine the factor structure. Reliability was assessed via internal consistency, split-half reliability, and test–retest reliability (ICC). Convergent validity was examined using composite reliability (CR) and average variance extracted (AVE). The final scale contained 26 items across 5 dimensions: basic knowledge, attitudes, subjective norms, perceived behavioral control, and behavioral intention. EFA supported a 5-factor solution, explaining 68.9% of the variance. CFA demonstrated acceptable model fit (χ2/df = 2.259, RMSEA = 0.075, IFI = 0.941, TLI = 0.933, CFI = 0.941, GFI = 0.822). Reliability was strong, with Cronbach α = 0.951, split-half reliability = 0.883, and test–retest ICC = 0.927 (95% CI: 0.86–0.97). Content validity was satisfactory (S-CVI = 0.933). Convergent validity was supported, with CR values between 0.735 and 0.973 and AVE values between 0.362 and 0.901. Notably, the basic knowledge domain showed lower AVE (0.362), suggesting item heterogeneity. The BISPTCM-PR-COPD is a reliable and valid instrument for assessing COPD patients’ intentions to participate in TCM-based pulmonary rehabilitation. It can serve as both a research tool and a clinical screening instrument to identify low-scoring domains, thereby guiding targeted education and support strategies and facilitating more effective implementation of TCM pulmonary rehabilitation.

INTRODUCTIONSmall airway remodeling is a key pathological feature of COPD, yet its mechanisms remain unclear. TGF-β1 induces epithelial-mesenchymal transition (EMT), contributing to airway remodeling. Smad7 is a negative regulator of TGF-β signaling, but its role in COPD remains undefined. This study investigates whether Smad7 suppresses TGF-β1-induced EMT in COPD small airway remodeling.METHODSLung tissues from COPD patients (n=3 for each group) and mouse models (n=5 for each group) were analyzed for EMT markers and collagen deposition. BEAS-2B cells were exposed to cigarette smoke extract (CSE) to assess TGF-β1 secretion. EMT markers (E-Cadherin, N-Cadherin, and Vimentin) were evaluated using RT-qPCR, Western blot, and immunofluorescence staining. Morphological changes were examined, and Smad7 function was assessed via overexpression and knockdown experiments.RESULTSCOPD patients and mouse models showed increased EMT and collagen deposition. CSE exposure upregulated TGF-β1 in BEAS-2B cells, leading to decreased E-Cadherin and increased N-Cadherin and Vimentin. Morphological changes confirmed EMT induction. Overexpression of Smad7 reversed these effects, while its knockdown enhanced them.CONCLUSIONSSmoking promotes TGF-β1-induced small airway remodeling in COPD by driving EMT. Smad7 suppresses this process.

Background: Patients with chronic diseases face increased risks from vaccine-preventable diseases, including influenza and herpes zoster. The concurrent administration of influenza and herpes zoster vaccines presents an opportunity to improve vaccination coverage while reducing healthcare visits. Objective: To systematically review the literature on the safety, immunogenicity, and efficacy of concurrent administration of influenza and herpes zoster vaccines in patients with chronic diseases. Methods: A comprehensive literature review was conducted using PubMed, MEDLINE, and Cochrane databases, focusing on studies published between 2006-2023. Search terms included "influenza vaccine," "herpes zoster vaccine," "concurrent administration," "coadministration," and "chronic disease." Results: Multiple randomized controlled trials and observational studies demonstrate that concurrent administration of influenza and herpes zoster vaccines is safe and immunogenic in chronic disease populations. The Zoster-039 study (n=828) showed non-inferior immune responses when vaccines were given concomitantly versus separately. Safety profiles were comparable between concurrent and separate administration groups across multiple studies involving diabetic, cardiovascular, and COPD patients. Conclusions: Concurrent administration of influenza and herpes zoster vaccines is safe, immunogenic, and effective in chronic disease patients. Current evidence supports this practice as recommended by major health organizations, with potential benefits including improved vaccination coverage and reduced healthcare burden.

Integrated care in COPD.

Airway Candida diversity in COPD patients and its differential stimulatory effects on lung inflammation in mice

Background and AimsChronic obstructive pulmonary disease (COPD) patients with right ventricular (RV) dysfunction have poor prognoses, and early detection of RV dysfunction is beneficial. Therefore, we aimed to determine the association between CA125 levels and RV dysfunction in patients with COPD.MethodsWe enrolled 40 patients with stable COPD underwent echocardiography and the serum CA125 levels were measured.ResultsThe mean CA125 level was higher in COPD patients with RV dysfunction (17.28 ± 27.35 U/mL) than without (10.94 ± 10.62 U/mL); however, it was not statistically significant (p = 0.147). Additionally, tricuspid annular plane systolic excursion and pulmonary arterial pressure were not significantly different, while RV free wall strain (RVFWS) was decreased in the COPD patients with RV dysfunction when compared to the patients without RV dysfunction (p < 0.001). Moreover, the CA125 level was remarkably correlated with RVFWS (r = −0.497, p = 0.03) and FAC (r = 0.51, p = 0.025) in patients with RV dysfunction.ConclusionWe found that the CA125 level may not be beneficial in detecting RV dysfunction in stable COPD patients without exacerbation or hospitalization. However, further examinations with larger sample sizes are necessary to confirm our findings.

BackgroundChronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. Hemoglobin (HGB) abnormalities, including anemia and secondary polycythemia, are common comorbidities in COPD patients, yet their association with mortality remains less clear. This study aimed to investigate the relationship between HGB levels and all-cause mortality in COPD patients and to evaluate whether HGB could serve as a treatable trait in COPD.MethodsWe conducted a retrospective observational cohort study using data from the National Health and Nutrition Examination Survey (NHANES, 2013–2018). A total of 544 COPD patients were included. Multivariable Cox regression was conducted to assess HGB-mortality associations, adjusting for age, sex, BMI, smoking status, and comorbidities. Nonlinear relationships were examined using generalized additive models with threshold effect analysis. Stratified analyses were performed by sex, age, and comorbidity status.ResultsAmong 544 COPD patients, HGB levels demonstrated a significant nonlinear association with all-cause mortality, with a critical inflection point identified at 14.2 g/dL. Below this threshold, each 1g/dL in HGB was associated with reduced mortality (adjusted HR=0.73, 95% CI: 0.61–0.79, P<0.0001). Above 14.2g/dL, however, no significant association was observed (HR=1.24, 95% CI: 0.98–1.55, P=0.0775). Although stratified analyses suggested variation in HR across subgroups (including males, elderly >65 years, smokers, and those with cardiovascular disease), interaction tests did not reach statistical significance (all P-interaction >0.05), indicating no evidence of effect modification. Smoothing curves supported this nonlinear relationship, showing decreasing mortality risk with rising HGB until the threshold, beyond which risk stabilized with a slight non-significant upward trend.ConclusionThis study identifies a nonlinear relationship between HGB levels and mortality in COPD, establishing 14.2 g/dL as a critical threshold that supports anemia’s inclusion in the COPD “treatable traits” framework. Below this value, increasing HGB is associated with reduced mortality, whereas above it no further benefit is observed. Clinicians should prioritize HGB monitoring in high-risk subgroups (elderly males, smokers, and cardiac comorbidities).

PurposeChronic obstructive pulmonary disease (COPD) is a common condition with respiratory obstructive impairment, and is often treated by primary care physicians. Because COPD is a high-risk factor for lung cancer, chest computed tomography (CT) is used to screen for early cancer detection. However, it is difficult for primary care physicians to conduct regular CT examinations. In the western Yokohama area, we have established a system of collaboration between primary care physicians and our hospital to manage COPD patients. We hypothesized that routine standard-dose CT examinations could detect lung cancer at early stage in COPD patients managed by primary care physicians via COPD coordinated system.Patients and MethodsFrom 114 COPD patients who visited Yokohama Seibu Hospital between January 2013 and March 2020 for the purpose of COPD consultation, we selected the 70 in whom either abnormal shadows had been detected or negative imaging findings confirmed on chest CT over a 5-year period.ResultsNodules were detected in 15 patients (21.4%) during the course of the study, with six of these founded to have lung cancer. Five of the six had were operable as early-stage cancer, and one had advanced small cell lung cancer and received chemotherapy. Detection of operable cases was difficult with chest X-rays.ConclusionRoutine chest CT may contribute to the early-stage detection of cancer in patients with COPD managed by primary care physicians in collaboration with hospitals.

BackgroundChronic obstructive pulmonary disease (COPD) is a heterogeneous inflammatory respiratory disorder characterized by persistent respiratory symptoms that negatively impact quality of life, reduce survival, and increase the risk of cardiovascular events. It is one of the leading causes of global morbidity and mortality.MethodsA retrospective cohort study was conducted in patients with a confirmed diagnosis of COPD based on spirometry (FEV1/FVC < 0.7), who received care between 2005 and 2020. Adults over 40 years of age were included. Clinical, sociodemographic, and treatment-related variables were collected. Five-year survival was estimated using Kaplan-Meier curves and stratified by age, sex, comorbidities, use of oxygen therapy, FEV1 ≤ 35%, and GOLD 2025 classification. The Log rank test was used to compare survival differences.ResultsA total of 350 COPD patients were included; the mean age was 75.3 years (SD 11.77); 82.3% were over 65 years old and 56.6% were male. Five-year survival was 89.7%. No differences were observed between sexes (p = 0.558). Survival was lower in those over 65 years (87.9% vs 98.5%; p = 0.015), in patients with heart failure (78.4% vs 91.1%; p = 0.014), those using oxygen therapy (82.2% vs 94.6%; p = 0.002), and those with FEV1 ≤ 35% (88.8% vs 96.5%; p = 0.035). A trend toward lower survival was found in GOLD group E (84.9%) compared to GOLD A (93.3%) and B (87.7%) (p = 0.186).ConclusionThe five-year survival rate in this cohort was 89.7%. Lower survival was observed in patients over 65 years of age, with heart failure, on home oxygen therapy, and with FEV1 ≤ 35%. A trend toward lower survival was identified in the GOLD group E.

This study investigated whether specific sulfatase modifying factor-1 (SUMF1) SNPs—previously linked to lung function—are associated with COPD progression and response to inhaled corticosteroid (ICS) treatment, specifically budesonide, given that SUMF1 expression is altered in COPD and its variants linked to increased disease risk. A subgroup of 165 COPD patients from the HISTORIC study were genotyped for two common SUMF1 SNPs, rs11915920 and rs793391. Patients first underwent a six-week run-in phase with open-label triple inhaled therapy (LAMA/LABA/ICS), then were randomized to receive either LAMA/LABA/placebo or LAMA/LABA/ICS for 12 months. Associations between SNPs, baseline characteristics, and response to ICS—based on FEV1 change over 12 months—were evaluated. Heterozygotes (TG) for the rs793391 polymorphism treated with LAMA/LABA/ICS showed a significant and clinically meaningful FEV1 improvement compared to the placebo group. This was supported by improved patient-reported outcomes, with lower SGRQ and CAT scores and a clinically relevant increase in General Health Questionnaire scores. These findings suggest that rs793391 may be linked to both COPD progression and ICS response and could contribute to more personalized treatment strategies in COPD.