Pulmonary Disease Research Articles

Severity, mortality, and incidence of venous thromboembolism in COVID-19 patients

BackgroundCOVID-19 is a global pandemic that negatively affected the world economy and the health care resources. It is associated with great health impact, mortality, and long-term sequelae.MethodsHistory taking computed tomography of the chest and laboratory investigations including complete blood count, liver and kidney function tests, serum ferritin, C-reactive protein, and D-dimer were done.ResultsA total of 246 hospitalized COVID-19 patients were enrolled. Male predominance (67.1% of the total study population) was observed. The mean age was 57.26 ± 14.08 years. Moderate cases comprised 63.8% of the total study population, 22.4% were severe cases, and 13.8% were critical cases. The mortality rate was 8.13% and 6.1% developed venous thromboembolism.ConclusionAge, smoking, and the presence of previous pulmonary disease were among the most important factors affecting COVID-19 severity. The severity of the disease greatly influences the incidence of venous thromboembolism and the outcome of the disease.

Not just CTEPH: a narrative review on the spectrum approach to post pulmonary embolism conditions

Three mutually exclusive entities can underlie a post-pulmonary-embolism-syndrome (PPES): not obstructed post-pulmonary embolism syndrome (NOPPES), chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH). Cardiorespiratory impairment in CTEPH and CTEPD underlie respiratory and hemodynamic mechanisms, either at rest or at exercise. Gas exchange is affected by the space effect, the increased blood velocity and, possibly, intracardiac right to left shunts. As for hemodynamic effects, after a period of compensation, the RV dilates and fails, which results in retrograde and anterograde right heart failure. Little is known on the pathophysiology of NOPPES, which has been reported in a highly comorbid with lung and heart diseases, so that a “two hit” hypothesis can be put forward: it might be caused by the acute myocardial damage caused by pulmonary embolism in the context of preexisting cardiac and/or respiratory diseases. More than one third of PE survivors develops PPES, with only a small, but widely varying fraction (0.1-11%) represented by CTEPH. A value of ≈3% is a plausible estimate for the incidence of CTEPD. Growing evidence supports the role of CTEPD as a hemodynamic phenotype intermediate between NOPPES and CTEPH, but it still remains to be ascertained whether it constantly underlies exercise-induced pulmonary hypertension (ExPH) and if it is a precursor of CTEPH. CTEPD and CTEPH can undergo effective surgical or interventional treatment, while no dedicated strategy exists for NOPPES. Further research is needed to improve the understanding and the management of CTEPD and NOPPES.

Aerosol of Enoximone/Hydroxypropyl-β-Cyclodextrin Inclusion Complex, Biopharmaceutical Evidence for ARDS Applicability

Background: Phosphodiesterase (PDE) inhibitors are gaining interest in the context of pulmonary pathologies. In particular, the PDE3 inhibitor enoximone (ENXM) has shown potential relative to the cure of asthma, chronic obstructive pulmonary disease (COPD), and acute respiratory distress syndrome (ARDS). Despite its administration via inhalation being planned for use against COVID-19 related ARDS (C-ARDS), presently, no inhalable medicine containing ENXM is available. Objectives: This study aims to develop a new formulation suitable for pulmonary administration of ENXM. Methods: A solution for nebulization, based on the complex between ENXM and Hydroxypropyl-β-Cyclodextrin (HPβCD) (ENXM/HPβCD) is developed. The obtained solution is characterized in terms of aerodynamic distributions and biopharmaceutical features. Results: The evaluation of the aerosol droplets indicates a good bronchi–lung distribution of the drug. Biological evaluations of the air–liquid interface (ALI) in an in vitro lung cell model demonstrates that ENXM/HPβCD is capable of a local direct effect, increasing intracellular cyclic adenosine monophosphate (cAMP) levels and protecting from oxidative stress. Conclusions: This study offers a promising advance in the optimization of enoximone delivery to the lungs.

The role of tissue oxygenation in obesity-related cardiometabolic complications

AbstractObesity is a complex, multifactorial, chronic disease that acts as a gateway to a range of other diseases. Evidence from recent studies suggests that changes in oxygen availability in the microenvironment of metabolic organs may exert an important role in the development of obesity-related cardiometabolic complications. In this review, we will first discuss results from observational and controlled laboratory studies that examined the relationship between reduced oxygen availability and obesity-related metabolic derangements. Next, the effects of alterations in oxygen partial pressure (pO2) in the adipose tissue, skeletal muscle and the liver microenvironment on physiological processes in these key metabolic organs will be addressed, and how this might relate to cardiometabolic complications. Since many obesity-related chronic diseases, including type 2 diabetes mellitus, cardiovascular diseases, chronic kidney disease, chronic obstructive pulmonary disease and obstructive sleep apnea, are characterized by changes in pO2 in the tissue microenvironment, a better understanding of the metabolic impact of altered tissue oxygenation can provide valuable insights into the complex interplay between environmental and biological factors involved in the pathophysiology of metabolic impairments. This may ultimately contribute to the development of novel strategies to prevent and treat obesity-related cardiometabolic diseases.

Long-term self-reported attendance in exercise training or lung choir and status of quality of life following initial pulmonary rehabilitation for COPD

BackgroundBoth adherence rates to pulmonary rehabilitation (PR) programmes and long-term attendance in exercise training after PR remain a challenge. In our previous randomised controlled trial (RCT), effects were positively associated with a dose-response pattern, regardless of whether PR contained conventional physical exercise training (PExT) or Singing for Lung Health (SLH) as a training modality within a 10 weeks’ PR programme for chronic obstructive pulmonary disease (COPD). However, long-term status of this RCT cohort remains unknown. In this study, we investigated whether current status (=attendance in supervised exercise training or a lung choir and scoring in quality of life (QoL)) was related to initial PR completion, randomisation, or adherence.MethodsWe collected data via telephone, using a researcher-developed questionnaire on current self-reported attendance in supervised exercise training or a lung choir and on perceived benefits of the initial RCT intervention. Additionally, we used COPD-validated questionnaires (primarily: QoL (measure: St George's Respiratory Questionnaire; SGRQ).ResultsIn 2023 (i.e., mean/median 4.7 years after initial PR), surviving participants were contacted (n = 196; 73% of 270), and 160 (82% of 196) were included. Out of the included participants, 30 (19%) had not completed initial PR. Compared to the initial PR-completers, non-completers reported less current attendance in exercise training or lung choir (24% vs. 46%, p = 0.03) but SGRQ scores were comparable. Yet, those who attended exercise training or lung choir at present (n = 66/160; 41% out of 160) reported better QoL score than those with no current attendance (SGRQ; Attending: 39.9 ± 15.4; Not attending: 43.1 ± 16.7; p = 0.02). Neither having had SLH instead of PExT, nor adherence level during initial PR, was related to current attendance or to QoL scores.ConclusionThis study indicates that long-term self-reported attendance and current QoL scores are positively related to initial completion of a PR programme. Surprisingly, neither initial PR content (PExT or SLH) nor initial PR adherence was related to long-term outcomes. We suggest that future PR programmes include special attention to those who do not complete PR to support long-term attendance and QoL status.

Predictive values of serum amyloid A, toll‐like receptor 4, and sTREM‐1 for ventilator‐associated pneumonia in elderly patients undergoing abdominal surgery with tracheal intubation and general anesthesia

AbstractObjectivesThis study aimed to conduct a retrospective study to identify inflammatory biomarkers for predicting ventilator‐associated pneumonia in elderly patients.MethodsOur retrospective study included 265 elderly patients (age ≥60 years) undergoing abdominal surgery with tracheal intubation and general anesthesia, with 93 experiencing varying degrees of ventilator‐associated pneumonia during hospitalization, and 172 without. Serum concentrations of serum amyloid A (SAA), toll‐like receptor 4 (TLR4), and soluble myeloid triggering receptor 1 (sTREM‐1) were measured at 24 h post‐operation using enzyme‐linked immunosorbent assay. Comparisons of SAA, TLR4, and sTREM‐1 and other risk factors at 24 h post‐operation between elderly patients with and without ventilator‐associated pneumonia were performed.ResultsThe study revealed a 35.1% incidence of postoperative ventilator‐associated pneumonia among elderly patients. Upregulations of SAA, TLR4, and sTREM‐1 were observed in patients with ventilator‐associated pneumonia. Chronic obstructive pulmonary disease, smoking, and tracheal intubation were identified as independent risk factors. The joint prediction model was demonstrated with superior predictive accuracy (area under the curve = 0.89) compared to individual biomarkers. Correlations with procalcitonin further supported the predictive potential of SAA, TLR4, and sTREM‐1 in an inflammatory response.ConclusionsSAA, TLR4, and sTREM‐1, particularly when combined, serve as valuable prognostic indicators for postoperative ventilator‐associated pneumonia in elderly patients undergoing abdominal surgery with tracheal intubation and general anesthesia. The joint prediction model offered a promising tool for early risk assessment.

Risk Factors Associated with Exacerbation Frequency in Chronic Obstructive Pulmonary Disease

Risk Factors Associated with Exacerbation Frequency in Chronic Obstructive Pulmonary Disease

Medication adherence to inhalation therapy and the risk of COPD exacerbations: a systematic review with meta-analysis

BackgroundAssessing medication adherence is crucial in chronic obstructive pulmonary disease (COPD) management to prevent exacerbations. However, it is unclear whether this association between adherence and exacerbations is influenced by the...

Prospects of Natural Polymers based Nano-drug Delivery Systems in the Treatment of Pulmonary Disorders

Numerous lung conditions, including lung cancer, influenza, acute respiratory distress syndrome, chronic obstructive pulmonary disease [COPD], asthma, and pneumonia, present a great threat to people all over the world. A range of pharmaceutical drugs, peptides, antibodies, and genetic therapies have all been used to treat chronic lung illnesses. Unfortunately, the majority of chronic lung disorders cannot be fully cured by medication alone. At the moment, managing the symptoms is the only asthma treatment. This article provides a brief overview of the state-of-the-art understanding of the function of natural polymeric materials and emphasises recent developments in innovative drug delivery systems that may help treat a variety of lung diseases. Furthermore, the paper also discusses the latest application of natural polymeric materials for targeting gene delivery through different approaches.

Long-term efficacy of mepolizumab on eosinophilic granulomatosis with polyangiitis: a retrospective study

Aim: Eosinophilic granulomatosis with polyangiitis (EGPA) is a vasculitis characterized by eosinophilic inflammation. Patients with EGPA are treated with systemic glucocorticoids and immunosuppressive drugs to induce and maintain remission. However, most patients relapse after tapering glucocorticoids, and there are refractory cases with inadequate response to glucocorticoids. Mepolizumab, a humanized anti-IL-5 antibody, is approved for relapsing or refractory EGPA. Furthermore, recent studies have reported the efficacy of benralizumab, a humanized anti-IL-5 receptor α antibody, in EGPA. Here, we investigate the efficacy of biologics on consecutive cases of EGPA. Methods: We retrospectively collected patients with EGPA treated with mepolizumab in addition to glucocorticoids at the Department of Pulmonary Medicine in Kagoshima University Hospital and Imakiire General Hospital. In this study, we compared the effects of biologics on inflammatory parameters between pre- and post-treatment of biologics in patients with EGPA. Results: Ten patients were included in the study. All patients were treated with mepolizumab, and one was switched to benralizumab later. Treatment with biologics markedly reduced EGPA relapse from 70% (pre-treatment) to 20% (post-treatment), Birmingham Vasculitis Activity Score from 8.4 to 4.0, peripheral blood eosinophil counts from 470.3 /µL to 40.5 /µL, and glucocorticoid doses from 7.3 mg/dL to 1.6 mg/dL. In contrast, lung function and fractional exhaled nitric oxide levels were not affected by treatment with biologics. Furthermore, the duration of biologics was positively correlated with symptom improvement. Conclusions: Treatment with mepolizumab for EGPA was effective in glucocorticoid sparing, symptom reduction, and relapse prevention. Mepolizumab is expected to reduce the risk of glucocorticoid-related adverse events. Therefore, continued administration as well as early intervention with mepolizumab for EGPA might be important to conserve future medical resources and control the disease.

Assessment of CMR Feature-Tracking Age- and Sex-Dependent Right Ventricular Strain in a Healthy Caucasian Cohort.

Right ventricular (RV) strain offers crucial diagnostic insights in cardiovascular and pulmonary disorders. Nonetheless, the absence of established reference values impedes its clinical implementation. Utilizing CMR-feature tracking, age- and gender-dependent RV strains were systematically assessed in 175 heart-healthy Caucasians, 97 females, median 32.5years. RV global longitudinal strain (GLS) was greater in females than males (median -26.8% (-28.3;-24.1) vs. -24.4 ± 3.0%; p < 0.001), whereby radial and circumferential strain remained comparable. Age subgroups exhibited increased RV-GLS for group B (30-50years) (-26.0 ± 3.1% vs. -24.4 ± 3.2%; p = 0.011) and group C (> 50years) (-26.7 ± 2.3% vs. -24.4 ± 3.2%; p < 0.001) compared to group A (< 30years). High intra-class correlation coefficients (ICC) were exhibited by intrarater variability (ICC = 0.86-0.95) and moderate levels for interrater variability (ICC = 0.50-0.73). CMR-feature tracking provides a fair quantification method of age- and gender-specific normal RV strain values, demonstrating that higher RV-GLS is linked to female gender and advancing age within a healthy Caucasian cohort.

G6pdN126D Variant Increases the Risk of Developing VEGFR (Vascular Endothelial Growth Factor Receptor) Blocker-Induced Pulmonary Vascular Disease.

G6PD (glucose-6-phosphate-dehydrogenase) is a key enzyme in the glycolytic pathway and has been implicated in the pathogenesis of cancer and pulmonary hypertension-associated vascular remodeling. Here, we investigated the role of an X-linked G6pd mutation (N126D polymorphism), which is known to increase the risk of cardiovascular disease in individuals from sub-Saharan Africa and many others with African ancestry, in the pathogenesis of pulmonary hypertension induced by a vascular endothelial cell growth factor receptor blocker used for treating cancer. CRISPR-Cas9 genome editing was used to generate the G6pd variant (N126D; G6pdN126D) in rats. A single dose of the vascular endothelial cell growth factor receptor blocker sugen-5416 (SU; 20 mg/kg in DMSO), which is currently in a Phase 2/3 clinical trial for cancer treatment, was subcutaneously injected into G6pdN126D rats and their wild-type littermates. After 8 weeks of normoxic conditions, right ventricular pressure and hypertrophy, pulmonary artery remodeling, the metabolic profile, and cytokine expression were assessed. Right ventricular pressure and pulmonary arterial wall thickness were increased in G6PDN126D+SU/normoxic rats. Simultaneously, levels of oxidized glutathione, inositol triphosphate, and intracellular Ca2+ were increased in the lungs of G6PDN126D+SU/normoxic rats, whereas nitric oxide was decreased. Also increased in G6PDN126D+SU/normoxic rats were pulmonary levels of plasminogen activator inhibitor-1, thrombin-antithrombin complex, and expression of proinflammatory cytokines CCL3 (chemokine [C-C motif] ligand), CCL5, and CCL7. Our results suggest G6PDN126D increases inositol triphosphate-Ca2+ signaling, inflammation, thrombosis, and hypertrophic pulmonary artery remodeling in SU-treated rats. This suggests an increased risk of vascular endothelial cell growth factor receptor blocker-induced pulmonary hypertension in those carrying this G6PD variant.

Chitinase 3-like-1 Inhibits Innate Antitumor and Tissue Remodeling Immune Responses by Regulating CD47-SIRPα- and CD24-Siglec10-Mediated Phagocytosis.

Innate immune responses such as phagocytosis are critically linked to the generation of adaptive immune responses against the neoantigens in cancer and the efferocytosis that is essential for homeostasis in diseases characterized by lung injury, inflammation, and remodeling as in chronic obstructive pulmonary disease (COPD). Chitinase 3-like-1 (CHI3L1) is induced in many cancers where it inhibits adaptive immune responses by stimulating immune checkpoint molecules (ICPs) and portends a poor prognosis. CHI3L1 is also induced in COPD where it regulates epithelial cell death. In this study, we demonstrate that pulmonary melanoma metastasis inhibits macrophage phagocytosis by stimulating the CD47-SIRPα and CD24-Siglec10 phagocytosis checkpoint pathways while inhibiting macrophage "eat me" signals from calreticulin and HMGB1. We also demonstrate that these effects on macrophage phagocytosis are associated with CHI3L1 stimulation of the SHP-1 and SHP-2 phosphatases and inhibition of the accumulation and phosphorylation of cytoskeleton-regulating nonmuscle myosin IIa. This inhibition of innate immune responses such as phagocytosis provides a mechanistic explanation for the ability of CHI3L1 to stimulate ICPs and inhibit adaptive immune responses in cancer and diseases such as COPD. The ability of CHI3L1 to simultaneously inhibit innate immune responses, stimulate ICPs, inhibit T cell costimulation, and regulate a number of other oncogenic and inflammation pathways suggests that CHI3L1-targeted therapeutics are promising interventions in cancer, COPD, and other disorders.

Progress in the Application of Bronchoscopic Cryotherapy in Pediatric Pulmonary Diseases

Cryotherapy in interventional bronchoscopy is a new treatment modality which has recently been made available for the pediatric airway. Lack of experience and safety concerns have led to hesitant adaptation. The aim of this work was to elaborate on the application progress of cryotherapy in pediatric pulmonary diseases and also to assess indications, success rates, and complications of airway cryotherapy in children. In summary, cryotherapy via flexible bronchoscopy is a safe and feasible method. The application scope in pediatrics is similar to that in adults, and it is mainly used in airway obstructive diseases. However, it is primarily caused by benign conditions, and the interventional treatment mainly seeks to provide long-lasting symptomatic alleviation. Thus, prevention, treatment, and prognosis of long-term complications are issues that should be carefully considered in pediatric applications.

WISP1 and Macrophage Migration Inhibitory Factor in Respiratory Inflammation: Novel Insights and Therapeutic Potentials for Asthma and COPD

Recent advancements highlight the intricate interplay between the extracellular matrix (ECM) and immune responses, notably in respiratory diseases such as asthma and Chronic Obstructive Pulmonary Disease (COPD). The ECM, a dynamic structural framework within tissues, orches-trates a plethora of cellular processes, including immune cell behavior and tissue repair mecha-nisms. WNT1-inducible-signaling pathway protein 1 (WISP1), a key ECM regulator, controls immune cell behavior, cytokine production, and tissue repair by modulating integrins, PI3K, Akt, β-catenin, and mTOR signaling pathways. WISP1 also induces macrophage migration inhibitory factor (MIF) expression via Src kinases and epidermal growth factor receptor (EGFR) activation. MIF, through its wide range of activities, enhances inflammation and tissue restructuring. Rec-ognized for its versatile roles in regulating the immune system, MIF interacts with multiple immune components, such as the NLRP3 inflammasome, thereby sustaining inflammatory pro-cesses. The WISP1–MIF axis potentially unveils complex molecular mechanisms governing im-mune responses and inflammation. Understanding the intricate roles of WISP1 and MIF in the pathogenesis of chronic respiratory diseases such as asthma and COPD could lead to the identi-fication of novel targets for therapeutic intervention to alleviate disease severity and enhance patient outcomes.

An Italian Delphi Consensus on the Triple inhalation Therapy in Chronic Obstructive Pulmonary Disease.

The management of chronic obstructive pulmonary disease (COPD) lacks standardization due to the diverse clinical presentation, comorbidities, and limited acceptance of recommended approaches by physicians. To address this, a multicenter study was conducted among Italian respiratory physicians to assess consensus on COPD management and pharmacological treatment. The study employed the Delphi process using the Estimate-Talk-Estimate method, involving a scientific board and expert panel. During a 6-month period, the scientific board conducted the first Delphi round and identified 11 broad areas of COPD management to be evaluated while the second Delphi round translated all 11 items into statements. The statements were subsequently presented to the expert panel for independent rating on a nine-point scale. Consensus was considered achieved if the median score was 7 or higher. Consistently high levels of consensus were observed in the first rating, allowing the scientific board to finalize the statements without requiring further rounds. Topics generating substantial discussion included the pre-COPD phase, patient-reported outcomes, direct escalation from a single bronchodilator to triple therapy, and the role of adverse events, particularly pneumonia, in guiding triple therapy prescriptions. Notably, these topics exhibited higher standard deviations, indicating greater variation in expert opinions. The study emphasized the significance that Italian pulmonologists attribute to managing mortality, tailoring treatments, and addressing cardiovascular comorbidities in COPD patients. While unanimous consensus was not achieved for all statements, the results provide valuable insights to inform clinical decision-making among physicians and contribute to a better understanding of COPD management practices in Italy.

Evidence map of traditional Chinese exercises

ObjectiveThis study aimed to assess and visually depict the clinical evidence landscape of traditional Chinese exercises and identify any research gaps and future research needs.MethodsWe comprehensively searched seven Chinese and English databases to identify randomized controlled trials (RCTs) and systematic reviews (SRs) evaluating the effects of traditional Chinese exercises from their inception until May 2023. The quality of evidence was assessed via the GRADE approach, and the research topics, intervention effects, and strength of evidence were graphically displayed.ResultsThis evidence map includes 2,017 studies, comprising 1,822 RCTs and 195 SRs. These studies were conducted globally in various countries. Among the traditional Chinese exercises, Tai Chi and Baduanjin have received the most research attention, with a growing number of publications. When traditional Chinese exercises were compared with the control groups, 88.2% of the included SRs reported significantly positive effects, 4.1% reported unclear effects, and 7.7% reported no significant differences. The findings suggested that traditional Chinese exercises could benefit patients with osteoarthritis, osteoporosis, hypertension, coronary heart disease, diabetes, chronic obstructive pulmonary disease, stroke, Parkinson’s disease, anxiety, and depression. However, the overall quality of the evidence was suboptimal, with 11.3% rated as moderate, 45.6% as low, and 43.1% as critically low.ConclusionThis evidence map visually represents valuable information on traditional Chinese exercises. While most studies have reported significant benefits, the overall quality of evidence is low.

Burden of Herpes Zoster in Individuals with Chronic Conditions in the Republic of Korea: A Nationwide Population-Based Database Study

Abstract Background Chronic conditions (CC) may increase the risk of herpes zoster (HZ) infection, leading to a greater healthcare burden in these individuals compared to those without CCs. It is therefore clinically important to quantify HZ disease burden in individuals with and without CCs, given the rapidly ageing population in the Republic of Korea (ROK). Methods This retrospective cohort study examines the trends in incidence rates (IRs) and incidence rate ratios (IRRs) in individuals with CCs aged ≥18 years using the National Health Insurance Service National Sample Cohort (NHIS-NSC) database from 2010–2019. These patients were stratified by age groups, sex, HZ complications, and CCs. The annual average number of HZ patients, IRs and IRRs were calculated for individuals with and without CCs. Results In total, 729,347 patients with HZ were eligible for the study. HZ IRs were highest in patients with diabetes, followed by chronic obstructive pulmonary disease, chronic kidney disease, asthma, and chronic liver disease, with HZ IRRs following a similar trend. Overall, HZ IRs generally increased with age, typically peaking at 60–64 or 65–69 years and were similar for females and males. HZ IRs were highest among patients without complications, followed by HZ with other, cutaneous, ocular, and neurologic complications across all CCs. For each of the CCs, HZ IRs were consistently higher than that of the non-CC population regardless of sex. Conclusions The findings of this study reiterate the importance of HZ prevention for healthy ageing, especially for CCs populations at increased risk of HZ in the ROK.

Prevalence, mortality and risk factors for self-reported COPD among smokers and never smokers, NHANES 1999-2018.

Cigarette smoke is the main risk factor for chronic obstructive pulmonary disease (COPD), but 25% to 50% of cases occur in non-smokers. In the US, limited recent national data compare COPD prevalence between smokers and never smokers. Furthermore, our study seeks to explore the prevalence and mortality of self-reported COPD among smokers (including current smokers and ex-smokers) and never smokers in the US from 1999 to 2018, and to identify the risk factors and differences. This cross-sectional analysis used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Age-standardized prevalence of self-reported COPD among current smokers, ex-smokers, and never smokers was calculated using sample weights and 2010 US Census estimates. Risk factors were evaluated through weighted logistic regression models. Subsequently, participants who enrolled in the study cohort were followed until 31 December 2019, to determine all-cause mortality rates. Between 1999 and 2018, the weighted prevalence of COPD among current smokers, ex-smokers, and never smokers in the U.S. was 12.6%, 9.6%, and 4.1%, respectively. The mortality rates observed were 21.1% among current smokers with COPD, 29% among ex-smokers with COPD, and 12% among never smokers with COPD. Over this period, among the general population in the U.S., the proportion of current smokers has declined, the proportion of never smokers has increased, and the proportion of ex-smokers has remained relatively stable. From 1999 to 2018, COPD prevalence rose from 13.7% to 21.9% among current smokers, stayed at 10.1% among ex-smokers, and dropped from 4.9% to 3.3% among never smokers. Independent risk factors for COPD across all groups included being female, older, and lower income. In particular, US citizens and non-Hispanic Whites (among ex-smokers and never smokers) were at higher risk compared to their counterparts. The prevalence and all-cause mortality of COPD among current smokers and ex-smokers remain elevated. Although the prevalence of COPD among never smokers is gradually declining, it continues to be significant, thereby maintaining a substantial burden of disease. Furthermore, common independent risk factors for COPD across current smokers, ex-smokers, and never smokers include female gender, advanced age, lower income, and deviations from normal body weight whether overweight or underweight.

Effect of Perioperative Inhaled Tiotropium for patients with chronic Obstructive Pulmonary disease in Esophageal cancer surgery (EPITOPE): an open-label, randomized, parallel-group pilot study.

Chronic obstructive pulmonary disease (COPD) is a risk factor for pneumonia following esophagectomy. This study aimed to investigate the efficacy of perioperative inhaled tiotropium in patients with COPD undergoing esophagectomy. This open-label, randomized controlled trial randomly assigned 32 patients with COPD undergoing esophagectomy to conventional management or addition of tiotropium inhalation. The intervention group received tiotropium from two weeks before esophagectomy until the final evaluation one month after esophagectomy. The primary outcome was the incidence of pneumonia within 30 postoperative days. We also assessed the changes and the percentages from baseline in pulmonary function and walking distance of the incremental shuttle walking test to just before esophagectomy and final evaluation. Enrolled patients were randomly assigned to the control group (n = 18) and the intervention group (n = 14). Pneumonia was recorded in 4 (28.6%) and 5 (27.8%) patients in the intervention and control groups, respectively (risk difference: 0.8%, 95% confidence interval: - 30.6 to 32.2). The intervention group demonstrated a significant improvement in pulmonary function and walking distance preoperatively. Further, the pulmonary function test was significantly better preoperatively in the intervention group than in the control group. Postoperatively, pulmonary function deterioration was more significant in the control group than in the intervention group. Preoperative tiotropium inhalation significantly improved pulmonary function and exercise tolerance in patients with COPD undergoing esophagectomy. The perioperative tiotropium did not reduce pneumonia after esophagectomy, but it may contribute to patient recovery by reducing postoperative pulmonary function deterioration.