Obstructive Lung Disease Research Articles

Primary care need and engagement by people with criminal legal involvement: Descriptive and associational analysis using retrospective data on the entire population ever detained in one southeastern U.S. county jail 2014-2020.

More than 7 million people are released each year from U.S. jails or prisons, many with chronic diseases that would benefit from primary care in their returning communities. The objective of this study was to provide an in-depth, payer-agnostic description and associational analysis of primary care need and utilization by all individuals ever detained in one county detention facility over a 7-year period. Detention records 2014-2020 were merged with data from an electronic health record with excellent coverage of local primary care, emergency, and hospital services. We found low primary care participation for the group as a whole, with under three quarters of those with serious chronic diseases ever seeing a primary care provider over a 7-year period and less than half ever having a year with more than one visit. Multivariable regression models estimated associations between individual characteristics (demographic, detention-related, and clinical) and ever having access to primary care (logistic) and the number of primary care visits (zero-inflated negative binomial). We found that having more jail bookings was associated with fewer primary care visits, but not one-time access, even controlling for time out of community, age, insurance, and other demographic characteristics. This finding was driven by subgroups with chronic disease such as hypertension, obstructive lung disease, and diabetes, who most need regular primary care. Being Black retained an independent effect, even controlling for bookings and other variables, and was also associated with fewer primary care visits, though not one-time access. To promote primary care utilization among individuals who have the combined challenges of repeated jail involvement and chronic disease, it is crucial to focus on engagement, as much as formal access. Access to health insurance alone will not resolve the problem; Medicaid expansion should be coupled with specialized, tailored support to promote engagement in primary care.

Socioeconomic status and emergency department visits in adults with a history of severe childhood asthma: a register-based study

ABSTRACT Background and Objective Our knowledge of socioeconomic status (SES) and emergency department (ED) visits in adults with a history of severe childhood asthma is limited. Our aim was, therefore, to investigate these variables in individuals with a history of severe childhood asthma compared to a control population. Methods The Kongsberg cohort comprises Danish individuals with a history of severe childhood asthma and a previous 4-month stay at an asthma care facility in Kongsberg, Norway, between 1950 and 1979. The cohort was compared 1:1 to sex and age matched controls with no previous diagnosis of or treatment for obstructive airway disease (OAD). Data from the national Danish health registries were used for comparing cases and controls. Results A total of 1394 adults from the Kongsberg cohort were alive and residing in Denmark (mean age 63 years, 43% females) at the index date (June 2022). A Charlson comorbidity index score of ≥1 was higher in the study cohort compared to controls (7% versus 3%) (p < 0.01). Cases had a 1.5-fold increased likelihood of having a high educational level (p < 0.001) compared to controls. Compared to the controls, cases had a higher risk of all-cause ED visits, with individuals having lower educational levels showing the highest proportion of ED visits. Furthermore, 31.2% and 22.9%, respectively, of cases and controls with high educational levels had had ED visits. Compared to controls, logistic regression analysis revealed a 1.7-fold higher risk of all-cause ED visits in cases (p < 0.001). Conclusions In adults with a history of severe childhood asthma, educational level, comorbidity burden, and risk of ED visit were higher compared to matched controls with no history of obstructive airway disease.

Similarities of metabolomic disturbances in prematurity-associated obstructive lung disease to chronic obstructive pulmonary disease

Prematurity-associated lung disease (PLD) is a long-term consequence of preterm-birth. Since the underlying mechanisms of PLD remain poorly characterised, we compared the urinary metabolome between recently described spirometry phenotypes of PLD. Preterm- and term-born children aged 7–12 years, from the Respiratory Health Outcomes in Neonates (RHiNO) cohort, underwent spirometry and urine collection. The urinary metabolome was analysed by gas chromatography time-of-flight mass spectrometry. Preterm-born children were classified into phenotypes of prematurity-associated obstructive lung disease (POLD, Forced expiratory volume in 1 s (FEV1) < lower limit of normal (LLN), FEV1/Forced Vital Capacity (FVC) < LLN), prematurity-associated preserved ratio impaired spirometry (pPRISm, FEV1 < LLN, FEV1/FVC ≥ LLN) and Preterm/Term controls (FEV1 ≥ LLN). Metabolite set enrichment analysis was used to link significantly altered metabolites between the groups with metabolic pathways. Univariable and multivariable linear regression models examined associations between early and current life factors and significantly altered metabolites of interest. Urine from 197 preterm- and 94 term-born children was analysed. 23 and 25 were classified into POLD and pPRISm groups respectively. Of 242 identified metabolites, 49 metabolites were significantly altered in the POLD group compared with Preterm controls. Decreased capric acid (log2 fold change − 0.23; p = 0.003), caprylic acid (− 0.18; 0.003) and ceratinic acid (− 0.64; 0.014) in the POLD group, when compared to preterm controls, were linked with reduced β-oxidation of very long chain fatty acids (p = 0.004). Reduced alanine (log2 fold change − 0.21; p = 0.046), glutamic acid (− 0.24; 0.023), and pyroglutamic acid (− 0.17; 0.035) were linked with decreased glutathione metabolism (p = 0.008). These metabolites remained significantly associated with POLD in multivariable models adjusting for early/current life factors. The pPRISm urinary metabolome was minimally changed when compared with preterm-born controls. When compared to term-born subjects, alterations in tryptophan metabolism were implicated (p = 0.01). The urinary metabolome in POLD showed significantly altered β-oxidation of fatty acids and glutathione metabolism, implying alterations in cellular metabolism and oxidative stress. Similar findings have been noted in adults with chronic obstructive pulmonary disease. Given the similarity of findings between the POLD group and those reported for COPD, the POLD group should be considered at future risk of developing COPD.

Investigation of inert gas washout methods in a new numerical model based on an electrical analogy.

Inert gas washout methods have been shown to detect pathological changes in the small airways that occur in the early stages of obstructive lung diseases such as asthma and COPD. Numerical lung models support the analysis of characteristic washout curves, but are limited in their ability to simulate the complexity of lung anatomy over an appropriate time period. Therefore, the interpretation of patient-specific washout data remains a challenge. A new numerical lung model is presented in which electrical components describe the anatomical and physiological characteristics of the lung as well as gas-specific properties. To verify that the model is able to reproduce characteristic washout curves, the phase 3 slopes (S3) of helium washouts are simulated using simple asymmetric lung anatomies consisting of two parallel connected lung units with volume ratios of , , and and a total volume flow of 250 ml/s which are evaluated for asymmetries in both the convection- and diffusion-dominated zone of the lung. The results show that the model is able to reproduce the S3 for helium and thus the processes underlying the washout methods, so that electrical components can be used to model these methods. This approach could form the basis of a hardware-based real-time simulator.

Policy, system and service design influence on healthcare inequities for people with end-of-life chronic obstructive airways disease, their support people and health professionals

BackgroundPeople with end-of-life chronic obstructive pulmonary disease (COPD) experience debilitating physical limitations, with a high mortality rate. Our research has shown health system design and delivery leads to inequitable outcomes. Enabling people with end-of-life COPD, their support people, and health professionals to partner in setting the agenda for resource allocation may inform health service improvement.DesignQualitative methodology utilising focus groups including patients, family, friends, informal support people, health care workers and professionals.MethodsThe analysis, utilising critical theory and Actor-Network theory, positioned people with severe COPD, their support people and health professionals as experts in end-of-life care. Analyses triangulated these perspectives, and were reviewed by the research investigators and an expert reference group.ResultsParticipants (n=74) in seven focus groups reported their experiences of inequity within the healthcare system. Equity was an overarching phenomenon identified by participants, with three specific themes being described: policy design, system design, and service design.ConclusionExperiences of patients, their support people and health professionals as experts in end-of-life COPD care can inform health systems and health service design to address current inequities in funding and delivery of care for end-of-life COPD.

Predictors of Emergency Interventions in Acute Airway Obstructive Diseases: A Retrospective Single-Center Observational Study

Predictors of Emergency Interventions in Acute Airway Obstructive Diseases: A Retrospective Single-Center Observational Study

Out-of-Pocket Prescription Drug Savings for Medicare Beneficiaries with Asthma and COPD Under the Inflation Reduction Act.

High and rising prescription drug costs for asthma and chronic obstructive pulmonary disease (COPD) contribute to medication nonadherence and poor clinical outcomes. The recently enacted Inflation Reduction Act includes provisions that will cap out-of-pocket prescription drug spending at $2,000 per year and expand low-income subsidies. However, little is known about how these provisions will impact out-of-pocket drug spending for Medicare beneficiaries with asthma and COPD. To estimate the impact of the Inflation Reduction Act's out-of-pocket spending cap and expansion of low-income subsidies on Medicare beneficiaries with obstructive lung disease. We calculated the number of Medicare beneficiaries ≥ 65years with asthma and/or COPD and out-of-pocket prescription drug spending > $2,000/year, and then estimated their median annual out-of-pocket savings under the Inflation Reduction Act's spending cap. We then estimated the number of beneficiaries with incomes > 135% and ≤ 150% of the federal poverty level who would become newly eligible for low-income subsidies under this policy. Respondents to the 2016-2019 Medical Expenditure Panel Survey (MEPS). Annual out-of-pocket prescription drug spending. An annual estimated 5.2 million Medicare beneficiaries had asthma and/or COPD. Among them, 360,160 (SE ± 38,021) experienced out-of-pocket drug spending > $2,000/year, with median out-of-pocket costs of $3,003/year (IQR $2,360-$3,941). Therefore, median savings under the Inflation Reduction Act's spending cap would be $1,003/year (IQR $360-$1,941), including $738/year and $1,137/year for beneficiaries with asthma and COPD, respectively. Total annual estimated savings would be $504 million (SE ± $42M). In addition, 232,155 (SE ± 4,624) beneficiaries would newly qualify for low-income subsidies, which will further reduce prescription drug costs. The Inflation Reduction Act will have major implications on out-of-pocket prescription drug spending for Medicare beneficiaries with obstructive lung disease resulting in half-a-billion dollars in total out-of-pocket savings per year, which could ultimately have implications on medication adherence and clinical outcomes.

A Comparative Observational Study of the Diagnostic Utility of Impulse Oscillometry Versus Spirometry in Obstructive Airway Diseases.

Background Obstructive airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), significantly impact respiratory function, making accurate diagnosis and differentiation essential for proper management. While spirometry is the gold standard for assessing lung function, impulse oscillometry (IOS) has emerged as a complementary tool, especially when spirometry results are inconclusive. This study aimed to compare the diagnostic utility of IOS with spirometry in patients with obstructive airway diseases and evaluate the correlation between these two methods. Methods A comparative observational study was conducted over 18 months at a tertiary care hospital in central India, including 130 patients (65 with asthma and 65 with COPD). Diagnostic evaluations using spirometry and IOS were performed before and after bronchodilator administration. Spirometry parameters assessed were forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio, while IOS parameters evaluated included resistance at 5 Hz (R5), resistance at20Hz (R20), resonant frequency(Fres), reactance at 5 Hz (X5), and the area under the reactance curve (AX). Statistical analysis was conducted using IBM SPSS version 27.0 (IBM Corp., Armonk, USA) and GraphPad Prism version 7.0 (Dotmatics, Boston, USA). Results Significant differences were observed in spirometry parameters between asthma and COPD groups, with asthma patients showing better lung function (FEV1, FVC, and FEV1/FVC; p<0.05). No significant differences were found in IOS parameters between the groupsexcept for a correlation between FEV1 (%) and IOS measurements in the asthma group. Spirometry demonstrated superior sensitivity in identifying airway obstruction compared to IOS. However, IOS was more effective in detecting peripheral airway obstruction in asthma patients, with 22 out of 65 (33.85%) asthma patients showing peripheral airway obstruction compared to six out of 65 (9.23%) COPD patients (p=0.001). Conclusion While spirometry remains the primary diagnostic tool for assessing obstructive airway diseases, IOS is a valuable adjunct, particularly for detecting peripheral airway involvement in asthma patients. Combining spirometry and IOS enhances diagnostic accuracy and provides a more comprehensive assessment of lung function in patients with asthma and COPD.

Transcriptional profiles of peripheral eosinophils in chronic obstructive pulmonary disease and asthma-An exploratory study.

The role of eosinophilic inflammation in the pathogenesis of chronic obstructive pulmonary disease (COPD) remains ambiguous and likely differs from its role in asthma. The molecular processes underlying the differences between eosinophils from asthma and COPD have not been sufficiently studied. The objective of this study was to compare the transcriptomic profiles of blood eosinophils in COPD and asthma. Eosinophils were isolated from peripheral blood drawn from stable mild-to-moderate COPD and asthma patients. RNA was isolated from eosinophils and sequenced using an NGSelect RNA. The prepared libraries were sequenced on an Illumina platform. The study group included five patients with asthma and four patients with COPD. The RNA-Seq data analysis identified 26 differentially expressed genes between COPD and asthma (according to adjusted p-value). In total, 6 genes were upregulated (e.g. CCL3L1, CCL4L2, GPR82) and 20 were downregulated (e.g. JUN, IFITM3, DUSP1, GNG7) in peripheral eosinophils of COPD patients compared to asthma. The genes associated with signalling of IL-4 and IL-13 pathways were downregulated in COPD eosinophils compared to asthma. In conclusion, blood eosinophils from COPD and asthma patients present different transcriptomic profiles suggesting their different function in pathobiology of both obstructive airway diseases. These differences might indicate the direction of the search of targeted therapy in COPD.

Mitochondrial pyruvate carriers control airway basal progenitor cell function through glycolytic-epigenetic reprogramming

Basal cells (BCs) are the progenitor cells responsible for tracheal epithelium integrity. Here, we demonstrate that mitochondrial pyruvate carriers (MPCs) act as metabolic checkpoints that are essential for BC fate decision. Inhibition of MPCs enables long-term expansion of BCs from both mice and humans. Genetic inactivation of Mpc2 in mice leads to BC hyperplasia and reduced ciliated cells during homeostasis, as well as delayed epithelial regeneration and accumulation of intermediate cells following injury. Mechanistically, MPC2 links glycolysis to ATP citrate lyase (ACLY)-dependent cytosolic acetyl-coenzyme A (CoA) generation, which is required for the epigenetic control of differentiation-related gene transcription. Modulating this metabolic-epigenetic axis partially rescues Yes-associated protein (YAP)-dysfunction-induced changes in BCs. Importantly, exogenous citrate promotes the differentiation of BCs from chronic obstructive lung disease (COPD) patients. Thus, beyond demonstrating the role of pyruvate metabolism in BC fate decision, our study suggests that targeting pyruvate-citrate metabolism may serve as a potential strategy to rectify abnormal BC behavior in lung diseases.

Risk Factors for Postoperative Pneumonia in Esophageal Cancer Patients

Purpose Patients undergoing surgery for esophageal cancer (EC) frequently experience postoperative pneumonia (POP). POP promotes poor prognosis as well as increased medical costs and longer hospital stays. Therefore, it is desirable to prevent and strictly control high-risk cases to reduce the incidence of pneumonia. The present study aimed to determine the risk factors for POP in EC. Patients and Methods The subjects of this retrospective study were 151 patients with EC who underwent subtotal esophagectomy in our department between January 2012 and December 2021. Univariate and multivariate logistic regression analyses were used to evaluate the association between the incidence of POP and clinical factors. Results Among 151 patients, 33 cases (21.8%) developed POP. Multivariate analysis identified preoperative C-reactive protein-to-albumin ratio (CAR) ≥0.03 [odds ratio (OR), 2.69; P = 0.0352], chronic obstructive lung disease (COPD) (OR, 7.32; P = 0.0001), and diabetes mellitus (DM) (OR, 3.35; P = 0.0252) as independent risk factors for POP. In accordance with the number of risk factors, the incidence rate of POP drastically increased, and its rate in patients with 3 risk factors was 80%. Conclusion High CAR, COPD, and DM are independent risk factors for the development of POP in patients undergoing subtotal esophagectomy for EC. Clinicians should be aware of the risk factors for POP and consider more intensive preventive measures and postoperative management in patients with EC.

Diagnostic value of impulse oscillometry in chronic obstructive pulmonary disease: a multicentre, retrospective, observational study

ObjectivesDiagnosis and assessment of chronic obstructive pulmonary disease (COPD) rely extensively on spirometry, which necessitates patient cooperation. The clinical value of impulse oscillometry (IOS) as a non-volitional method in patients...

Identifying abnormal exertional breathlessness in COPD: comparing mMRC and CAT with CPET

Chronic obstructive pulmonary disease (COPD) management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale and/or COPD Assessment Test (CAT). What is the ability of mMRC and CAT to detect abnormally high exertional breathlessness on incremental cardiopulmonary cycle exercise testing (CPET) in people with COPD? Analysis of people aged ≥40 years with post-bronchodilator FEV1/FVC<0.70 and ≥10 smoking pack-years from the Canadian Cohort Obstructive Lung Disease study. Abnormal exertional breathlessness was defined as a breathlessness (Borg 0-10) intensity rating > upper limit of normal (ULN) at the symptom-limited peak of CPET using normative reference equations. We included 318 people with COPD (40% women), age 66.5±9.3 years (mean±SD), FEV1 79.5±19.0%predicted; 26% had abnormally low exercise capacity (V'O2peak <lower limit of normal). Abnormally high exertional breathlessness was present in 24%, including 9% and 11% of people with mMRC=0 and CAT<10, respectively. A mMRC≥2 and CAT≥10 was most specific (95%) to detect abnormal exertional breathlessness, but had low sensitivity of only 12%. Accuracy for all scale cut-offs or combinations was <65%. Compared with 'true negatives', people with abnormal exertional breathlessness but low mMRC and/or CAT scores ('false negatives') had worse self-reported and physiological outcomes during CPET, were more likely to have physician-diagnosed COPD, but were not more likely to have any respiratory medication (37% versus 30%; mean difference 6.1%; 95% confidence interval -7.2 to 19.4; p=0.36). In COPD, mMRC and CAT have low concordance with CPET and fail to identify many people with abnormally high exertional breathlessness.

A Comparison of GOLD and STAR Severity Stages in Individuals with Chronic Obstructive Pulmonary Disease Undergoing Pulmonary Rehabilitation.

BackgroundAlongside the recognized Global Initiative for Obstructive Lung Disease (GOLD) classification, the STaging of Airflow obstruction by Ratio (STAR) severity scheme has been proposed for categorizing chronic obstructive pulmonary disease (COPD). Study QuestionWhat is the agreement and utility of the GOLD and STAR classifications in severe COPD patients entering the rehabilitation setting? Study Design and MethodsMedical records were reviewed in this multicenter retrospective study, examining key functional variables and their changes in a large cohort of COPD patients undergoing pulmonary rehabilitation (PR). ResultsA total of 1,516 participants (33.7% females, median age 72.0 years) were included in the analysis. Compared to GOLD, the use of the STAR classification resulted in a different disease severity category for 53.4% of patients. An unweighted Cohen’s κ of 0.25 and a Bangdiwala B value of 0.24 revealed a fair agreement between the two classifications. Higher weighted agreement measures (0.47 and 0.78, respectively) suggested that discrepancies between the classifications mainly occurred for contiguous stages. GOLD demonstrated superior discrimination between stages for chronic respiratory failure, while STAR exhibited better performance in detecting hyperinflation. In terms of their application within PR settings, GOLD exhibited superior performance compared to STAR in identifying the minimal clinically important difference (MCID) in 6-minute walking distance and modified Medical Research Council (mMRC) score. Accordingly, GOLD but not STAR acted as an independent predictor for achieving a MCID in mMRC (OR: 1.48; 95% CI: 1.12-1.94; P=0.005) and also independently predicted changes in Braden score (β=0.154; P=0.004). Interpretation.STAR shows a more uniform gradation of disease severity and enhanced performance in detecting hyperinflation but our preliminary findings do not endorse its utilization in the rehabilitation setting.

Development and Validation of a Clinical Prediction Model for Paclitaxel Hypersensitivity Reaction on the Basis of Real-World Data: Pac-HSR Score.

Paclitaxel is effective chemotherapy against various cancers but can cause hypersensitivity reaction (HSR). This study aimed to identify predictors associated with paclitaxel HSR and develop a clinical prediction model to guide clinical decisions. Data were collected from the medical records database of Rajavithi Hospital. Patients with cancer treated with paclitaxel from 2015 to 2022 were included, and a multivariable logistic regression analysis identified predictors associated with paclitaxel HSR. The scoring system was transformed and calibrated on the basis of diagnostic parameters. Discrimination and calibration performances were assessed. Internal validation was conducted using bootstrap resampling with 1,000 replications. This study involved 3,708 patients with cancer, with an incidence of paclitaxel HSR of 10.11%. An 11-predictor-based Pac-HSR scoring system was developed, involving the following factors: younger age; poor Eastern Cooperative Oncology Group performance status; previous history of paclitaxel HSR; medication allergy history; chronic obstructive airway disease; lung and cervical cancers; high actual dose of paclitaxel; no diphenhydramine premedication; low hemoglobin level; high WBC count; and high absolute lymphocyte count. The C-statistics was 0.73 (95% CI, 0.70 to 0.76), indicating acceptable discrimination. The P value of the Hosmer-Lemeshow goodness-of-fit test was 0.751. The ratio of observed and expected values was 1.00, indicating good calibration. At a cutoff point of 8, specificity was 75.28% and sensitivity was 57.07%. Internal validation indicated good performance with minimal bias, and decision curve analysis demonstrated improved prediction with the use of this scoring system in clinical decision making. This study developed the 11-predictor-based Pac-HSR scoring system for predicting paclitaxel HSR in patients with cancer. High-risk patients identified by this score should be prioritized for close monitoring and early treatment prophylaxis.

Assessment of Bone Mineral Density in Chronic Obstructive Pulmonary Disease Patients

Background: Main co-morbidities of chronic obstructive pulmonary disease that restricts physical exercise is osteoporosis. In this study we assess chronic obstructive pulmonary disease patients for osteoporosis, osteopenia and determine correlation of body mass index, number of pack years, severity of chronic obstructive pulmonary disease with bone mineral density Method and patients: This cross-sectional study was carried out on 61 chronic obstructive pulmonary disease patients.. Dual energy x-ray absorptiometry was used to evaluate the bone mineral densities at lumbar spine. According to WHO guidelines, patients with a T score greater than -1 were classified as having normal bone density, those with a T score of (-1 )to (-2) as having osteopenia, and those with a T score of less than -2.5 as having osteoporotic bone density. Results: Sixty - one chronic obstructive pulmonary disease patients were included in this study, 11 patients (18%) had normal bone mineral density, fifty patients had abnormal bone mineral density .Also thirty - two patients had osteoporosis(52.5%) and 18 (29.5%) had osteopenia. .BMD correlated directly with BMI (P value=0.009) and inversely with number of pack years (P = 0.000), ,BMD correlated inversely with severity of COPD (P = 0.001) . Conclusion: Patients with chronic obstructive lung disease had a higher chance of osteoporotic fractures and decreased bone mineral density.A lower BMI, more pack years, and a rise in the severity of the condition raised chance of osteoporosis..

Roles of Glyco-redox in Epithelial Mesenchymal Transition and Mesenchymal Epithelial Transition, Cancer, and Various Diseases.

Reduction-oxidation (redox) regulation is an important biological phenomenon that provides a balance between antioxidants and the generation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) under pathophysiological conditions. Structural and functional changes in glycans are also important as post-translational modifications of proteins. The integration of glycobiology and redox biology, called Glyco-redox has provided new insights into the mechanisms of epithelial-mesenchymal transition (EMT)/mesenchymal-epithelial transition (MET), cancer, and various diseases including Alzheimer's disease (AD), chronic obstructive lung disease (COPD), type 2 diabetes, interstitial pneumonitis, and ulcerative colitis (UC), . Glycans are biosynthesized by specific glycosyltransferases and each glycosyltransferase is either directly or indirectly regulated by oxidative stress and redox regulation. A typical example of Glyco-redox is the role of N-glycan referred to as core fucose in superoxide dismutase 3 (SOD3). This glycan was found to be involved in the growth inhibition of cancer cell lines. The significance of Glyco-redox in EMT/MET, cancer and various diseases was found in major N-glycan branching glycosyltransferases GnT-III, GnT-IV, GnT-V, VI, GnT-IX, Fut8, and ST6Gal1. Herein, we summarize previous reports on the target proteins and how this relates to oxidative stress. We also discuss the products of these processes and their significance to cancer and various diseases.

Optimising Outcomes For Those With Chronic Respiratory Disease: Detecting Frailty In The Respiratory OPD

Abstract Background Frailty is a treatable trait of relevance to people with various chronic respiratory diseases, especially those with severe COPD and/or lung transplantation. This has been recognised in the 2024 GOLD (Global initiative for chronic Obstructive Lung Disease) report and within recent European Respiratory Society guidelines. Central to optimisation of frailty management in those with chronic respiratory conditions is the identification of frail patients in the respiratory OPD (outpatients department) setting. This study aims to assess the prevalence of frailty among patients attending the respiratory OPD in our hospital. Methods A cross-sectional study was conducted over two respiratory clinics over a two-week period. Patients aged 65 and above were screened for frailty using the Clinical Frailty Scale (CFS). A CFS score was assigned to each patient by an assessing NCHD/consultant on the respiratory team. Statistical analysis was then performed to determine the prevalence of frailty amongst such patients. Frailty was defined as those having a CFS score of &amp;gt;5. Results A total of 25 patients were included in the study. Frailty (CFS score of &amp;gt;5) was identified in 56% of patients assessed, with 12% of patients being identified as having a CFS score of 7 (severely frail) or higher. Frailty had not previously been diagnosed by the respiratory team in those patients. Conclusion This study highlights a high prevalence of frailty among patients aged 65 or over in the respiratory OPD. Implementing systematic frailty screening in the respiratory OPD using the CFS can improve early identification of such patients, potentially enhancing management and clinical outcomes. The CFS is a quick and effective tool in identifying frailty. Integrating frailty assessments into routine clinical practice may help to ensure comprehensive care for this vulnerable population. We are currently looking at options for referral pathways to develop to improve management of frailty in this population.

Vacuna contra el virus de la influenza y exacerbaciones de EPOC, un estudio transversal

Background: Influenza (flu) is one of the most frequent infections associated with acute exacerbations of Chronic ObstructivePulmonary Disease (COPD). Objective: To determine the association between flu vaccine use and acute exacerbation ofCOPD and the cost of COPD exacerbations. Methods: Cross-sectional, multicenter study at two hospitals and three clinics inLima and Callao, Peru. All subjects had a COPD diagnosis based on The Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (e.g., age 3 40 years old, smoker or ex-smoker, spirometry test). Sociodemographic, clinical, and COPD-relatedvariables were collected using questionnaires and medical records. Multivariate analysis using multiple logistic regression wasperformed to measure the association between the use of the flu vaccine and acute exacerbations of COPD. Results: Onehundred twelve patients were included, with a median age of 70 years (interquartile range: 63.5-75.0 years). Of these, 37.5%were vaccinated against flu, and 51.79% had at least one COPD exacerbation. In the adjusted analysis, being vaccinated theprevious year with the flu vaccine was not significatively associated with fewer exacerbations (OR=0.49, 95% CI 0.15-1.57;p=0.230), whereas being vaccinated three consecutive previous years was associated with significative fewer exacerbations(OR=0.13, 95% CI 0.02-0.91; p=0.040). The mean cost of an inpatient COPD exacerbation was USD 7,150.70. Conclusions:This study did not show a statistically significant relationship between having flu vaccination the previous year and fewerCOPD exacerbations in Peruvian patients, which was the primary study objective; however, this shows a statistically significantrelationship between the use of three consecutive flu vaccines and fewer exacerbations.

The lung proteome in HIV-associated obstructive lung disease (OLD)

RationaleObstructive lung disease is increasingly common among persons living with HIV (PLWH). There are currently no validated biomarkers that identify individuals at risk of developing obstructive lung disease (OLD) and specific mechanisms contributing to HIV-associated OLD remain elusive, independent of smoking.ObjectivesWe sought to identify biomarkers and biological pathways associated with OLD using a broad proteomic approach.MethodsWe performed tandem mass tagging and mass spectrometry (MS) analysis on bronchoalveolar lavage fluid (BALF) samples from persons living with HIV with OLD (n=26) and without OLD (n=26). We combined untargeted MS with a targeted SomaScan aptamer-based approach. We used Pearson correlation tests to identify associations between each protein and lung function (FEV1pp). We adjusted for multiple comparisons using a false discovery rate (FDR) adjustment. Significant proteins were entered into a pathway overrepresentation analysis. Protein-driven endotypes were constructed using K-means clustering.Measurements and main resultsWe identified over 3800 proteins by MS and identified 254 proteins that correlated with FEV1pp when we combined the MS and SomaScan proteomes when adjusting for smoking status. Pathway analysis revealed cell adhesion molecules as significant.ConclusionsProtein expression differs in the lung of PWH and decreased lung function (FEV1pp). Pathway analysis reveals cell adhesion molecules having potentially important roles in this process.