Mild Chronic Obstructive Pulmonary Disease Research Articles

Does mild chronic obstructive pulmonary disease need a standard pulmonary rehabilitation program? A case report

Background: Patients with mild chronic obstructive pulmonary disease (COPD) are usually not recommended for a standard pulmonary rehabilitation (PR)program based on the GOLD guideline in mild COPD GOLD A classification. Especially, the scientific evidence on exercise capacity that can be identified for recruitment in PR programs has been less reported. Thus, a preliminary case study to identify the exercise capacity under cardiopulmonary responses by aerobic exercise testing among patients in mild COPD GOLD A classification was the aim of this study. Objective: To evaluate the cardiopulmonary responses from exercise capacity testing in individual COPD patients with mild COPD GOLD A Classification. Materials and methods: Four participants with mild COPD GOLD A performed an exercise endurance capacity test at home using Spot Marching Exercise Test (SMT), marching on the spot with high hip and arm raising. The load of SMT was indicated by a controlled stepping rate at 70, 80, 90, 100, and 110 steps/min. Every participant performed Incremental SMT (ISMT) with every 3 min incremental load, and the Constant SMT (CSMT) at the peak load. Both exercise tests were terminated at symptom limit. Resting time between ISMT and CSMT was at least 30 minutes. Cardiopulmonary exercise responses, Borg perceived breathlessness (RPB) and exertion (RPE) were monitored every minute during the exercise test. The duration of exercises was recorded. Results: Peak exercise capacity using ISMT was low with the end exercise load at 70, 80, 80, and 90 steps/min which is equivalent to moderate to high intensity at 81%, 62%, 65% and 93% of age-predicted maximum heart rate (HRmax). The exercise test was stopped by breathlessness at RPB 7, 8, 6, and 5. Respiratory rates (RR) were 36, 26, 38, and 38 breaths/min. With CSMT, the results showed very short exercise duration 1.78, 4.60, 2.15, and 2.47 mins with RPB 7, 8, 5, and 5 and RR of 33, 27, 34, and 41 breaths/min respectively. Conclusion: This preliminary report reveals that all four mild COPD GOLD A show low exercise capacity and very poor exercise endurance that should identify the appropriated standard PR program in the future.

Muscle loss phenotype in COPD is associated with adverse outcomes in the UK Biobank

BackgroundChronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder with systemic consequences that can cause a muscle loss phenotype (MLP), which is characterized by the loss of muscle mass, muscle strength, or loss of both muscle and fat mass. There are limited data comparing the individual traits of MLP with clinical outcomes in a large unbiased cohort of COPD patients. Our aim was to determine the proportion of patients who met criteria for MLP in an unbiased sample of COPD patients at the population-level. We also determined if specific MLP features were associated with all-cause and COPD-related mortality.MethodsA retrospective population-based cohort analysis of the UK Biobank was performed. COPD was defined by a FEV1/FVC ratio < 0.7, physician established diagnosis of COPD, or those with a COPD-related hospitalization before baseline assessment. MLP included one or more of the following: 1) Low fat-free mass index (FFMI) on bioelectric impedance analysis (BIA) or 2) Appendicular skeletal muscle index (ASMI) on BIA, 3) Low muscle strength defined by handgrip strength (HGS), or 4) Low muscle and fat mass based on body mass index (BMI). Cox regression was used to determine the association between MLP and all-cause or COPD-related mortality. All models were adjusted for sex, age at assessment, ethnicity, BMI, alcohol use, smoking status, prior cancer diagnosis and FEV1/FVC ratio.ResultsThere were 55,782 subjects (56% male) with COPD followed for a median of 70.1 months with a mean(± SD) age at assessment of 59 ± 7.5 years, and FEV1% of 79.2 ± 18.5. Most subjects had mild (50.4%) or moderate (42.8%) COPD. Many patients had evidence of a MLP, which was present in 53.4% of COPD patients (34% by ASMI, 26% by HGS). Of the 5,608 deaths in patients diagnosed with COPD, 907 were COPD-related. After multivariate adjustment, COPD subjects with MLP had a 30% higher hazard-ratio for all-cause death and 70% higher hazard-ratio for COPD-related death.ConclusionsEvidence of MLP is common in a large population-based cohort of COPD and is associated with higher risk for all-cause and COPD-related mortality.

Discriminative potential of exhaled breath condensate biomarkers with respect to chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) affecting 334 million people in the world remains a major cause of morbidity and mortality. Proper diagnosis of COPD is still a challenge and largely solely based on spirometric criteria. We aimed to investigate the potential of nitrosative/oxidative stress and related metabolic biomarkers in exhaled breath condensate (EBC) to discriminate COPD patients.MethodsThree hundred three participants were randomly selected from a 15,000-transit worker cohort within the Respiratory disease Occupational Biomonitoring Collaborative Project (ROBoCoP). COPD was defined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as post-bronchodilator ratio of Forced Expiratory Volume in 1st second to Forced Vital Capacity < 0.7 in spirometry validated by an experienced pulmonologist. Discriminative power of biomarker profiles in EBC was analyzed using linear discriminant analyses.ResultsAmongst 300 participants with validated spirometry, 50.3% were female, 52.3 years old in average, 36.0% were current smokers, 12.7% ex-smokers with mean tobacco exposure of 15.4 pack-years. Twenty-one participants (7.0%) were diagnosed as COPD, including 19 new diagnoses, 12 of which with a mild COPD stage (GOLD 1). Amongst 8 biomarkers measured in EBC, combination of 2 biomarkers, Lactate and Malondialdehyde (MDA) significantly discriminated COPD subjects from non-COPD, with a 71%-accuracy, area under the receiver curve of 0.78 (p-value < 0.001), and a negative predictive value of 96%.ConclusionsThese findings support the potential of biomarkers in EBC, in particular lactate and MDA, to discriminate COPD patients even at a mild or moderate stage. These EBC biomarkers present a non-invasive and drugless technique, which can improve COPD diagnosis in the future.

QUALITY OF LIFE IN PATIENTS WITH STABLE CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN A TERTIARY CARE CENTRE- A HOSPITAL-BASED STUDY

Background:Chronic obstructive pulmonary disease (COPD) is a major and increasing global health problem .Analyzing the mental, physical and social aspects of this disease is necessary to improve the quality of life (QOL) of COPD patients. Methodology: This study was carried out in 100 stable COPD patients.Detailed history ,general and systemic examination were done.Routine blood investigations, Chest x-ray and spirometry were done.Patients were asked to complete St. Georges Respiratory Questionnaire for COPD patients (SGRQ-C) (simple malayalam version) as honestly as they can.Statistical analysis:Descriptive statistical tools like mean, standard deviation, median was used. Result:A total of 100 COPD patientswith a mean age of 66.91 years and a standard deviation of 7.93 yearswere included in the study in which 95% were males. Study showedsignificant difference between the mild and moderate groups (p &lt;0.001), mild and severe groups (p &lt;0.001), mild and very severe groups (p &lt;0.001). No significant difference between moderate and severe groups, moderate and very severe groups and between severe and very severe groups was found.So we can conclude that the median SGRQ score in the mild COPD group was significantly less compared to all the other groups and that there was no significant difference between the other groups.

CT trachea surface roughness is associated with chronic obstructive pulmonary disease symptoms

Abstract Background Trachea structural abnormalities occur in patients with chronic obstructive pulmonary disease (COPD), yet there are few methods for quantifying the trachea surface topology. Purpose To develop a method to quantify trachea surface roughness on computed tomography (CT) imaging and investigate the association with airflow limitation and symptoms in COPD. Materials and Methods Participants from the multi-center prospective Canadian Cohort Obstructive Lung Disease study between 2009-2015 underwent CT imaging and analysis. Established CT measurements included: tracheal index (TI), defined as the smallest ratio of coronal-to-sagittal trachea diameter, low attenuation areas below -950HU (LAA950), and wall thickness (Pi10). Trachea surface roughness shape (SRS) was calculated as the percent fraction of the measurement box filled by the surface mesh. Multivariable regression models were used to determine association for CT measurements with forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), and medical research council dyspnea scale (MRC)≥3, adjusting for covariates. Results A total of 1253 participants (mean age, 66 ± 10 years; 727 men) from 9 centers were investigated: n = 267 never-smoker, and n = 369 ever-smoker, n = 352 mild COPD and n = 265 moderate-to-severe COPD. There were no differences between groups for age or race (p &amp;lt; 0.05). In models including SRS and TI, a 1-standard deviation (SD) increase in SRS was independently associated with a 0.11-SD decrease in FEV1 (β=-0.11/p &amp;lt; 0.001) and a 0.16-SD decrease in FEV1/FVC (β=-0.16/p &amp;lt; 0.001); a 1-point increase in SRS was associated with a 13% increased likelihood of MRC ≥ 3 (Odds Ratio [OR]=1.13/p = 0.003). In models including SRS, LAA950 and Pi10, a 1-SD increase in SRS was associated with a 0.21-SD decrease in FEV1 (β=-0.21, p &amp;lt; 0.001) and a 0.13-SD decrease in FEV1/FVC (β=-0.13, p &amp;lt; 0.001); a 1-point increase in SRS was associated with a 12% increased likelihood of MRC ≥ 3 (OR = 1.12, p = 0.006). Conclusion Increased trachea surface shape roughness is independently associated with worse airflow and increased symptom burden in COPD.

Haemodynamic compensations for exercise tissue oxygenation in early stages of COPD: an integrated cardiorespiratory assessment study

BackgroundCardiovascular comorbidities are increasingly being recognised in early stages of chronic obstructive pulmonary disease (COPD) yet complete cardiorespiratory functional assessments of individuals with mild COPD or presenting with COPD risk...

Association of Urinary Incontinency with COPD Severity: An Analytical Cross-sectional Study

Large number of patients suffers from urinary incontinence (UI) with COPD leading to urine leakage and affecting their quality of life. Objective: To determine the prevalence and association of UI among with the severity of COPD patients. Methods: The cross sectional study was conducted from February 2023 to June 2023 in Ghurki Teaching Trust Hospital, Shalimar Hospital and Gangaram Hospital. 230 male patients of age 45-65 years suffering with COPD were selected by using convenient sampling technique. The demographic data and International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) were used collected. SPSS version 26.0 along with Chi-square was used for analysis with p-value &lt;0.05. Results: The results showed that 36 (15.7%) suffering with mild COPD, 142 (61.7%) had moderate COPD and 52 (22.6%) had severe COPD in which 33 (14.3%) experience have no urine incontinency, 25 (10.9%) had urge Incontinence, 154 (67%) had stress Incontinence and 18 (7.8%) had mixed Incontinence. Additionally; moderate COPD had shown significant association with stress incontinency with Chi-square value of 188.58 and p-value =0.00 and with the leakage of urine on coughing/ sneezing, during any physical activity/ exercise and all the time with value of 143.37, p-value = 0.00. Conclusions: The study concluded that UI is highly prevalent in COPD patients as stress and urge incontinency is highly prevalent among moderate and severe patients respectively, associated with coughing/ sneezing and physical activity/ exercises. 

Alternative Splicing Is a Major Factor Shaping Transcriptome Diversity in Mild and Severe Chronic Obstructive Pulmonary Disease.

The role of alternative splicing in chronic obstructive pulmonary disease (COPD) is still largely unknown. We aimed to investigate the differences in alternatively splicing events between patients with mild-to-moderate and severe COPD compared with non-COPD control subjects and to identify splicing factors associated with aberrant alternative splicing in COPD. For this purpose, we performed genome-wide RNA-sequencing analysis of bronchial brushings from 23 patients with mild-to-moderate COPD, 121 with severe COPD, and 23 non-COPD control subjects. We found a significant difference in the frequency of alternative splicing events in patients with mild-to-moderate and severe COPD compared with non-COPD control subjects. There were from two to eight times (depending on event type) more differential alternative splicing events in the severe than in the mild-to-moderate stage. The severe COPD samples showed less intron retention and more exon skipping. It is interesting that the transcript levels of the top 10 differentially expressed splicing factors were significantly correlated with the percentage of many alternatively spliced transcripts in severe COPD. The aberrant alternative splicing in severe COPD was predicted to increase the overall protein-coding capacity of gene products. In conclusion, we observed large and significant differences in alternative splicing between bronchial samples of patients with COPD and control subjects, with more events observed in severe than in mild-to-moderate COPD. The changes in the expression of several splicing factors correlated with prevalence of alternative splicing in severe COPD. Alternative splicing can indirectly impact gene expression by changing the relative abundance of protein-coding isoforms potentially influencing pathophysiological changes. The results provide a better understanding of COPD-related alternative splicing changes.

Tiotropium reduces clinically important deterioration in patients with mild-to-moderate chronic obstructive pulmonary disease: A post hoc analysis of the Tie-COPD study

BackgroundClinically important deterioration (CID) is a composite endpoint used to holistically assess the complex progression of chronic obstructive pulmonary disease (COPD). Tiotropium improves lung function and reduces the rate of COPD exacerbations in patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 (mild) or 2 (moderate). However, whether tiotropium reduces CID risk in patients with mild-to-moderate COPD remains unclear. MethodsThis was a post hoc analysis of the 24-month Tie-COPD study comparing 18 μg tiotropium with placebo in patients with mild-to-moderate COPD. CID was defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 s, an increase of ≥2 unit in COPD Assessment Test (CAT) score, or moderate-to-severe exacerbation. The time to the first occurrence of one of these events was recorded as the time to the first CID. Subgroup analyses were conducted among patients stratified by CAT score, modified Medical Research Council (mMRC) dyspnea score, and GOLD stage at baseline. ResultsOf the 841 randomized patients, 771 were included in the full analysis set. Overall, 643 patients (83.4 %) experienced at least one CID event. Tiotropium significantly reduced the CID risk and delayed the time to first CID compared with placebo (adjusted hazard ratio = 0.58, 95 % confidence interval = 0.49–0.68, P < 0.001). Significant reductions in CID risk were also observed in various subgroups, including patients with a CAT score <10, mMRC score <2, and mild COPD. ConclusionsTiotropium reduced CID risk in patients with mild-to-moderate COPD, even in patients with fewer respiratory symptoms or mild disease, which highlights tiotropium's effectiveness in treating COPD patients with mild disease. Trial registrationThis study is registered at ClinicalTrials.gov (Tie-COPD, NCT01455129).

Inhomogeneity of ventilation in smokers and mild COPD assessed by the ratio of alveolar volume to total lung capacity

BackgroundPrevious studies have shown that the ratio between alveolar volume (VA) and total lung capacity (TLC) reflects ventilation heterogeneity in subjects with chronic obstructive pulmonary disease (COPD). However, the ratio and its correlation to respiratory symptoms had to our knowledge not previously been investigated in subjects with mild chronic airflow obstruction or without airflow obstruction (normal ratio FEV1/VC).The purpose of this study was to investigate potential connection between VA/TLC and respiratory symptoms, smoking habits and lung function parameters in subjects with normal spirometry and with mild chronic airflow obstruction. MethodsWe examined 450 subjects (82 non-smokers with normal spirometry, 298 subjects who smoked or had smoked earlier but had a normal spirometry and 70 subjects with chronical airflow obstruction) with routine lung function tests and a questionnaire regarding respiratory symptoms. ResultsThis study showed 31 out of 54 subjects with a low VA/TLC had a normal ratio FEV1/VC. Of these subjects, 58.1 % had respiratory symptoms, compared to the group with normal ratio for both VA/TLC and FEV1/VC where 35.8 % had respiratory symptoms (p-value 0.02). ConclusionThis study has shown that within the group of subjects with a normal ratio FEV1/VC, those with a decreased ratio VA/TLC had a higher prevalence of respiratory symptoms compared to subjects with a normal VA/TLC ratio. These findings indicate that including the ratio VA/TLC in the evaluation of a pulmonary function test assessment might increase the possibility to identify subjects with early or at risk of lung disease.

Profile of Sleep-related Breathing Disorders in Chronic Obstructive Pulmonary Disease-obstructive Sleep Apnea Overlap Syndrome

Introduction: Overlap syndrome (OS) is defined by the combined occurrence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD). Sleep-related breathing disorders (SRBDs) in OS can also manifest with central sleep apnea (CSA) and hypoventilation; besides OSA. Methods: This study was carried out to evaluate various SRBD in OS and its therapeutic implications patients having postbronchodilator obstruction in spirometry with respiratory symptoms were classified as COPD. Those found to have an apnea–hypopnea Index (AHI) &gt;5/h in polysomnography (PSG) were diagnosed as OS. All 37 patients diagnosed as OS underwent a subsequent positive airway pressure (PAP) titration. Results: On the evaluation of the SRBD, over half (51%) of the patients had OSA with no hypoventilation. More than one-third of the patients (35%) had associated hypoventilation with OSA, three patients had hypercapnic CSA, and two patients had hypocapnic CSA with Cheyne–Stokes breathing (CSA-CSB). The OSA group was easily titrated and corrected by CPAP therapy. OSA with hypoventilation group had underlying COPD with severe obstruction requiring bilevel PAP titration. Patients with CSA-CSB were elderly hypertensive patients with congestive heart failure who were corrected by PAP and optimization of cardiac medications. Patients with hypoventilation and hypercapnic CSA were most difficult to titrate and needed a backup rate along with PAP therapy for correction. On classifying patients on the basis of severity of OSA and COPD, there was no correlation found between AHI and forced expiratory volume 1 (FEV1). Patients with mild COPD with severe OSA were easily titrated with CPAP with a mean pressure of 8 cm H2 0. The most challenging cases were with severe COPD with severe OSA who required high pressures in both exhalation PAP and inspiratory PAP titration; two of such patients required backup rate by spontaneous/timed mode of PAP therapy. Conclusions: There are many profiles of SRBD in OS, and a detailed in-hospital PSG with a PAP titration can help in effectively managing the patients.

Pulmonary hypertension within individuals suffering from chronic obstructive pulmonary disease.

Objective: To establish the frequency in regards to pulmonary hypertension within individuals suffering from chronic obstructive pulmonary disease. Study Design: Cross-sectional study. Setting: Pulmonology Division of Jinnah Hospital Lahore. Period: January, 2023 to April, 2023. Material &amp; Methods: A total of 200 patients of both male and female patients with age from 40 to 70 years having chronic obstructive pulmonary disease were included by nonprobability consecutive sampling. Patients with history of other respiratory disease like interstitial lung disease, bronchiectasis, allergic broncho-pulmonary aspergillosis (ABPA), sarcoidosis, occupational lung diseases, asthma, ischemic heart disease, pulmonary hypertension, collagen vascular disease were factored out of the study. Cardiac echocardiography was performed in all the patients and pulmonary hypertension as assessed. Results: In this study, 87 (43.5%) were between 40-55 years of age while 113 (56.5%) were within the ages of 56-70, and thus the mean age was 57.28±8.44 years. 131 (65.5%) patients were male and 69 (34.5%) were females. 49 (24.5%), 103 (51.5%) and 48 (24%) patients had mild, moderate and severe COPD respectively. Pulmonary hypertension was found in 105 (52.5%) patients. Pulmonary hypertension is more prevalent in severe cases of COPD than mild and moderate patients with p-value = 0.0001. Conclusion: Patients with chronic obstructive lung disease have a high prevalence of pulmonary hypertension. This is shown to be more common within patients suffering from severe cases of COPD.

Morphometric analysis of airways in pre-COPD and mild COPD lungs using continuous surface representations of the bronchial lumen.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a prevalent respiratory disease that presents a high rate of underdiagnosis during onset and early stages. Studies have shown that in mild COPD patients, remodeling of the small airways occurs concurrently with morphological changes in the proximal airways. Despite this evidence, the geometrical study of the airway tree from computed tomography (CT) lung images remains underexplored due to poor representations and limited tools to characterize the airway structure. Methods: We perform a comprehensive morphometric study of the proximal airways based on geometrical measures associated with the different airway generations. To this end, we leverage the geometric flexibility of the Snakes IsoGeometric Analysis method to accurately represent and characterize the airway luminal surface and volume informed by CT images of the respiratory tree. Based on this framework, we study the airway geometry of smoking pre-COPD and mild COPD individuals. Results: Our results show a significant difference between groups in airway volume, length, luminal eccentricity, minimum radius, and surface-area-to-volume ratio in the most distal airways. Discussion: Our findings suggest a higher degree of airway narrowing and collapse in COPD patients when compared to pre-COPD patients. We envision that our work has the potential to deliver a comprehensive tool for assessing morphological changes in airway geometry that take place in the early stages of COPD.

Urine Albumin/Creatinine Ratio and Serum Uric Acid as Predictors of Severity in Patients with Chronic Obstructive Pulmonary Disease

Background and Objective: As a global healthcare issue, Chronic Obstructive Pulmonary Disease (COPD) is mainly associated with smoking. Nonetheless, environmental and occupational issues are also linked to its development. The present study aimed to assess the urine albumin-to-creatinine ratio (ACR) and serum uric acid (SUA) levels as predictors of disease severity in COPD patients. Materials and Methods: This cross-sectional study was conducted on 67 patients diagnosed with COPD using the Global Initiative for Obstructive Lung Disease diagnostic criteria. The participants were patients who were either referred to the subspecialty clinic of the pulmonology and spirometry unit of Hamadan Shahid Beheshti Hospital or were hospitalized in the pulmonology ward. Blood and urine samples were taken from the COPD patients, and the serum uric acid, urine albumin, and urine creatinine levels were assessed and recorded in a checklist. The data were analyzed in SPSS software (version 23) at a significance level of 0.05. Results: In terms of gender, 5.7% of the participants were male and 34.3% were female. The mean age of patients was 61.77 years. The stages of disease severity in the patients were as follows: 20.89%, 22.38%, 5.73%, and 2.98% of cases had very severe, severe, moderate, and mild COPD, respectively. The regression analysis results demonstrated that SUA levels could significantly predict the FEV1 in COPD patients; nonetheless, urine ACR could not predict the FEV1 scores. Conclusion: As evidenced by the result of the present study, the FEV1 in COPD patients and disease severity could be predicted by the SUA levels. Therefore, it is recommended to consider monitoring and assessing non-pulmonary factors, especially SUA levels, in the treatment of COPD patients.

Beta-blockers reduce severe exacerbation in patients with mild chronic obstructive pulmonary disease with atrial fibrillation: a population-based cohort study

Background and objectiveBeta-blockers (BBs) decrease mortality and acute exacerbation (AE) rates in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular disease; however, information on their effects in patients with...

Primary care patients with mild or stable chronic obstructive pulmonary disease need more support in disease management: a secondary analysis of a cluster randomized controlled trial

Objective Patient education based on the patient’s individual needs and circumstances is known to be associated with positive changes in clinical outcomes in chronic obstructive pulmonary disease (COPD). We aimed to assess the levels of patients’ subjective needs for information about COPD before and after their general practitioners had taken part in a COPD education. Design A secondary analysis of a cluster randomized controlled trial Setting 22 PHCCs in Stockholm, Sweden Subjects Randomly selected primary care patients with COPD in GOLD stages 2 and 3 (n = 293) Outcome measures Scores in the Lung Information Needs Questionnaire (LINQ) at baseline and 18 months, spirometry results, and self-reported, descriptive patient data. Results GPs’ improved skills in COPD did not affect patients’ self-management skills over time. In general, patients’ information needs remained great in issues concerning diet, exercise and self-management. However, 43% of the patients reported reduced and 57% increased or unchanged information needs, over time. Reduced information needs were mainly associated with a high level of information needs at baseline (OR = 3.17 [95% CI 1.93–5.23], p < .01) and establishing contact with a physiotherapist (OR = 2.26 [95% CI 1.05–4.86], p = .038). Patients in a mild or stable phase of COPD with no recent exacerbations reported greater needs than those with unstable, deteriorated COPD. Conclusion Patients’ information needs are substantial in most areas of self-management of COPD, and seem to covary with the patient’s current clinical status. Care providers should thus continuously be vigilant about offering all patients with COPD support and education. Trial registration Clinicaltrials.gov, 10 August 2014, Identifier NCT02213809.

Association of mild chronic obstructive pulmonary disease with all-cause mortality: A systematic review and meta-analysis

BackgroundIt is unclear whether patients with Global Initiative for Chronic Obstructive Lung Disease stage 1 (mild) chronic obstructive pulmonary disease (COPD) have worse respiratory outcomes than individuals with normal spirometry. MethodsFor this systematic review and meta-analysis, we conducted a search of PubMed, Embase, and Web of Science for all literature published up to 1 March 2023. Studies comparing mortality between mild COPD and normal spirometry were included. A random-effects model was used to estimate the combined effect size and its 95% confidence interval (CI). The primary outcome was all-cause mortality. Respiratory disease-related mortality were examined as secondary outcomes. ResultsOf 5242 titles identified, 12 publications were included. Patients with mild COPD had a higher risk of all-cause mortality than individuals with normal spirometry (pre-bronchodilator: hazard ratio [HR] = 1.21, 95% CI: 1.11–1.32, I2 = 47.1%; post-bronchodilator: HR = 1.19, 95% CI: 1.02–1.39, I2 = 0.0%). Funnel plots showed a symmetrical distribution of studies and did not suggest publication bias. In jackknife sensitivity analyses, the increased risk of all-cause mortality remained consistent for mild COPD. When the meta-analysis was repeated and one study was omitted each time, the HR and corresponding 95% CI were >1. Patients with mild COPD also had a higher risk of respiratory disease-related mortality (HR = 1.71, 95% CI: 1.03–2.82, I2 = 0.0%). ConclusionsOur results suggest that mild COPD is associated with increased all-cause mortality and respiratory disease-related mortality compared with normal spirometry. Further research is required to determine whether early intervention and treatment are beneficial in mild COPD.

Association Between C-Reactive Protein and Albumin Ratios and Risk of Mortality in Patients with Chronic Obstructive Pulmonary Disease.

This study was to evaluate the association between C-reactive protein (CRP) to albumin (ALB) ratio (CAR) and the risk of mortality in patients with chronic obstructive pulmonary disease (COPD). In this retrospective cohort study, clinical data were extracted from the National Institutes of Health National Health and Nutrition Examination Survey (NHANES) database between 2007 and 2010. Cox proportional hazard regressions were performed to assess the association between CAR and 5-year mortality in COPD patients. Subgroup analyses were applied to identify the consistency of the association based on the severity of COPD, gender, body mass index (BMI), smoking status, cardiovascular disease (CVD), and chronic kidney disease (CKD), and diabetes. The area under the curve (AUC) of the receiver operator characteristic (ROC) curve analysis was used to evaluate the predictive performance of CAR. A total of 1210 COPD patients were included, of which 110 COPD patients (9.09%) had 5-year mortality. The mean follow-up was 57.76 (0.33) months. A higher CAR was associated with an increased risk of 5-year mortality in COPD patients [hazard ratio (HR): 1.94, 95% confidence interval (CI): 1.07 to 3.50, P =0.029)]. Subgroup analysis showed that the association between CAR and mortality was especially suitable for COPD patients with mild COPD, in COPD patients who were still smoking, in COPD patients with BMI <=29.9 kg/m2, in COPD patients who were without CVD, in COPD patients who were without diabetes, and COPD patients who were without CKD. The AUCs of CAR for predicting 1-year, 3-year, and 5-year mortality in COPD patients were 0.735, 0.615, and 0.608, respectively. CAR is strongly correlated with mortality in patients with COPD and CAR could be served as a prognostic biomarker for patients with COPD. This study may provide a promising prognostic biomarker for risk stratification and clinical management of patients with COPD.

An analysis of the regional heterogeneity in tissue elasticity in lung cancer patients with COPD.

Recent advancements in obtaining image-based biomarkers from CT images have enabled lung function characterization, which could aid in lung interventional planning. However, the regional heterogeneity in these biomarkers has not been well documented, yet it is critical to several procedures for lung cancer and COPD. The purpose of this paper is to analyze the interlobar and intralobar heterogeneity of tissue elasticity and study their relationship with COPD severity. We retrospectively analyzed a set of 23 lung cancer patients for this study, 14 of whom had COPD. For each patient, we employed a 5DCT scanning protocol to obtain end-exhalation and end-inhalation images and semi-automatically segmented the lobes. We calculated tissue elasticity using a biomechanical property estimation model. To obtain a measure of lobar elasticity, we calculated the mean of the voxel-wise elasticity values within each lobe. To analyze interlobar heterogeneity, we defined an index that represented the properties of the least elastic lobe as compared to the rest of the lobes, termed the Elasticity Heterogeneity Index (EHI). An index of 0 indicated total homogeneity, and higher indices indicated higher heterogeneity. Additionally, we measured intralobar heterogeneity by calculating the coefficient of variation of elasticity within each lobe. The mean EHI was 0.223 ± 0.183. The mean coefficient of variation of the elasticity distributions was 51.1% ± 16.6%. For mild COPD patients, the interlobar heterogeneity was low compared to the other categories. For moderate-to-severe COPD patients, the interlobar and intralobar heterogeneities were highest, showing significant differences from the other groups. We observed a high level of lung tissue heterogeneity to occur between and within the lobes in all COPD severity cases, especially in moderate-to-severe cases. Heterogeneity results demonstrate the value of a regional, function-guided approach like elasticity for procedures such as surgical decision making and treatment planning.

Topologic Parametric Response Mapping Identifies Tissue Subtypes Associated with Emphysema Progression

Small airways disease (SAD) and emphysema are significant components of chronic obstructive pulmonary disease (COPD), a heterogenous disease where predicting progression is difficult. SAD, a principal cause of airflow obstruction in mild COPD, has been identified as a precursor to emphysema. Parametric Response Mapping (PRM) of chest computed tomography (CT) can help distinguish SAD from emphysema. Specifically, topologic PRM can define local patterns of both diseases to characterize how and in whom COPD progresses. We aimed to determine if distribution of CT-based PRM of functional SAD (fSAD) is associated with emphysema progression. We analyzed paired inspiratory-expiratory chest CT scans at baseline and 5-year follow up in 1495 COPDGene subjects using topological analyses of PRM classifications. By spatially aligning temporal scans, we mapped local emphysema at year five to baseline lobar PRM-derived topological readouts. K-means clustering was applied to all observations. Subjects were subtyped based on predominant PRM cluster assignments and assessed using non-parametric statistical tests to determine differences in PRM values, pulmonary function metrics, and clinical measures. We identified distinct lobar imaging patterns and classified subjects into three radiologic subtypes: emphysema-dominant (ED), fSAD-dominant (FD), and fSAD-transition (FT: transition from healthy lung to fSAD). Relative to year five emphysema, FT showed rapid local emphysema progression (-57.5%±1.1) compared to FD (-49.9%±0.5) and ED (-33.1%±0.4). FT consisted primarily of at-risk subjects (roughly 60%) with normal spirometry. The FT subtype of COPD may allow earlier identification of individuals without spirometrically-defined COPD at-risk for developing emphysema.