Persistent Airflow Limitation Research Articles

Bhramari Pranayama and Thoracic Mobility Exercises for Moderate Chronic Obstructive Pulmonary Disease (COPD): A Case Study

Chronic obstructive pulmonary disease (COPD) is a global health issue and a significant cause of morbidity, disability, and mortality due to persistent respiratory symptoms and airflow limitations. COPD is diagnosed through pulmonary function testing, particularly spirometry, which measures the post bronchodilator FEV1/FVC ratio. The purpose of this study was to determine the effectiveness of Bhramari pranayama combined with thoracic mobility exercises on increasing exercise/activity tolerance in patient with moderate COPD. This case study is about a 60-year-old male with COPD who presented with breathlessness, cough, and mMRC grade 2 dyspnoea. His FEV1 was 58%, FVC was 75%, and FEV1/FVC (post bronchodilator) was 63%. The patient was given Bhramari pranayama and thoracic mobility exercise for a period of 4 days. After 4 days, there was improvement in dyspnoea severity, exercise capacity, thoracic expansion, FEV1, FVC, FEV1/FVC, and CAT questionnaire score. Hence, we concluded that Bhramari Pranayama and thoracic mobility exercises are effective in increasing exercise/activity tolerance in patient with moderate COPD.

Early-life house dust mite aeroallergen exposure augments cigarette smoke-induced myeloid inflammation and emphysema in mice

BackgroundLongitudinal studies have identified childhood asthma as a risk factor for obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO) where persistent airflow limitation can develop more aggressively. However, a causal link between childhood asthma and COPD/ACO remains to be established. Our study aimed to model the natural history of childhood asthma and COPD and to investigate the cellular/molecular mechanisms that drive disease progression.MethodsAllergic airways disease was established in three-week-old young C57BL/6 mice using house dust mite (HDM) extract. Mice were subsequently exposed to cigarette smoke (CS) and HDM for 8 weeks. Airspace enlargement (emphysema) was measured by the mean linear intercept method. Flow cytometry was utilised to phenotype lung immune cells. Bulk RNA-sequencing was performed on lung tissue. Volatile organic compounds (VOCs) in bronchoalveolar lavage-fluid were analysed to screen for disease-specific biomarkers.ResultsChronic CS exposure induced emphysema that was significantly augmented by HDM challenge. Increased emphysematous changes were associated with more abundant immune cell lung infiltration consisting of neutrophils, interstitial macrophages, eosinophils and lymphocytes. Transcriptomic analyses identified a gene signature where disease-specific changes induced by HDM or CS alone were conserved in the HDM-CS group, and further revealed an enrichment of Mmp12, Il33 and Il13, and gene expression consistent with greater expansion of alternatively activated macrophages. VOC analysis also identified four compounds increased by CS exposure that were paradoxically reduced in the HDM-CS group.ConclusionsEarly-life allergic airways disease worsened emphysematous lung pathology in CS-exposed mice and markedly alters the lung transcriptome.

Mitochondrial Dysfunction in Chronic Obstructive Pulmonary Disease: Unraveling the Molecular Nexus.

Chronic obstructive pulmonary disease (COPD) is a prevalent and debilitating respiratory disorder characterized by persistent airflow limitation and chronic inflammation. In recent years, the role of mitochondrial dysfunction in COPD pathogenesis has emerged as a focal point of investigation. This review endeavors to unravel the molecular nexus between mitochondrial dysfunction and COPD, delving into the intricate interplay of oxidative stress, bioenergetic impairment, mitochondrial genetics, and downstream cellular consequences. Oxidative stress, a consequence of mitochondrial dysfunction, is explored as a driving force behind inflammation, exacerbating the intricate cascade of events leading to COPD progression. Bioenergetic impairment sheds light on the systemic consequences of mitochondrial dysfunction, impacting cellular functions and contributing to the overall energy imbalance observed in COPD patients. This review navigates through the genetic landscape, elucidating the role of mitochondrial DNA mutations, variations, and haplogroups in COPD susceptibility and severity. Cellular consequences, including apoptosis, autophagy, and cellular senescence, are examined, providing insights into the intricate mechanisms by which mitochondrial dysfunction influences COPD pathology. Therapeutic implications, spanning antioxidant strategies, mitochondria-targeted compounds, and lifestyle modifications, are discussed in the context of translational research. Important future directions include identifying novel biomarkers, advancing mitochondria-targeted therapies, and embracing patient-centric approaches to redefine COPD management. This abstract provides a comprehensive overview of our review, offering a roadmap for understanding and addressing the molecular nexus between mitochondrial dysfunction and COPD, with potential implications for precision medicine and improved patient outcomes.

Tezepelumab: patient selection and place in therapy in severe asthma.

Asthma is a disease characterised by heterogeneous and multifaceted airway inflammation. Despite the availability of effective treatments, a substantial percentage of patients with the type 2 (T2)-high, but mainly the T2-low, phenotype complain of persistent symptoms, airflow limitation, and poor response to treatments. Currently available biologicals target T2 cytokines, but no monoclonal antibodies or other specific therapeutic options are available for non-T2 asthma. However, targeted therapy against alarmins is radically changing this perspective. The development of alarmin-targeted therapies, of which tezepelumab (TZP) is the first example, may offer broad action on inflammatory pathways as well as an enhanced therapeutic effect on epithelial dysfunction. In this regard, TZP demonstrated positive results not only in patients with severe T2 asthma but also those with non-allergic, non-eosinophilic disease. Therefore, it is necessary to identify clinical features of patients who can benefit from an upstream targeted therapy such as anti-thymic stromal lymphopoietin. The aims of this narrative review are to understand the role of alarmins in asthma pathogenesis and epithelial dysfunction, examine the rationale underlying the indication of TZP treatment in severe asthma, summarise the results of clinical studies, and recognise the specific characteristics of patients potentially eligible for TZP treatment.

Effects of Home-Based Pulmonary Training Program on Functional Exercise Capacity and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, characterized by persistent respiratory symptoms and airflow limitation. Despite the availability of various treatments, there is a growing interest in exploring more effective strategies to manage symptoms, enhance exercise capacity, and improve the quality of life for COPD patients. Pulmonary rehabilitation, including both supervised and home-based exercises, has emerged as a promising approach. Objective: The aim of this study was to evaluate the effectiveness of a combined approach of Active Cycle of Breathing Technique (ACBT) with a home-based exercise regimen in improving functional exercise capacity and quality of life in patients with COPD, compared to ACBT alone. Methods: This was a randomized controlled trial involving 44 COPD patients, divided into two groups: Group A received ACBT alone, while Group B participated in ACBT plus a home-based exercise program. The intervention lasted for four weeks. Outcome measures included the St. George’s Respiratory Questionnaire (SGRQ) for quality of life, the 30-second arm curl test for upper extremity function, and the 6-minute walk test (6MWT) for lower extremity function. Data were analyzed using SPSS version 25, with the Mann-Whitney and Wilcoxon tests for between-group and pre-post intervention comparisons, respectively. Results: Group B showed more significant improvements in exercise capacity and respiratory symptoms compared to Group A. Specifically, the 6MWT distances increased from an average of 365.60±57.81 meters to 370.40±54.29 meters in Group B, indicating enhanced lower extremity function. Similarly, the SGRQ scores, reflecting quality of life, demonstrated more substantial improvement in Group B, though specific numerical results for this and the 30-second arm curl test were not significantly different between groups. Conclusion: The study concludes that combining ACBT with a home-based exercise regimen significantly benefits COPD patients by improving functional exercise capacity and potentially enhancing the quality of life. This combined approach could serve as a viable addition to the COPD management strategy, emphasizing the importance of comprehensive, patient-centered care.

Adherence to Exercise among COPD (Chronic Obstructive Pulmonary Disease) Patient- Barriers and Facilitators

Chronic obstructive pulmonary disease is a common inflammatory lung disease characterized by persistent respiratory symptoms and airflow limitation. There is compelling evidence that regular exercise can lower the chance of developing several chronic diseases. Although it helps in reducing COPD symptoms and improve quality of life, which is highly beneficial for COPD patients, there are still several reasons for barriers to adherence to exercise in COPD patients which further affects their health. Most COPD patients are typically compelled to minimize exercise and adopt sedentary lifestyles due to decrease activity related dyspnea and exercise tolerance. Relevant literature was obtained from platforms such as Google Scholar and PubMed. For thorough retrieval, the Boolean logic operators “AND, OR NOT” were applied. All pertinent keywords, mesh terms, and other index terms were searched for in relation to “barriers,” “facilitators,” “chronic obstructive pulmonary disease” and “exercise” which were then utilized to build the search strategy. This review found that exercise improved dyspnea, quality of life, lessened depression, enhanced cognitive and neurobehavioral function in COPD patients, and shortened hospital stays and COPD exacerbations. Many factors act as barriers of adherence to exercise among COPD patients, such as self, environment, health and psychosocial. While numerous factors such as positive feedback, support from family, self-initiation, etc. act as a facilitator of adherence to exercise among COPD patients. Keywords: Chronic Obstructive Pulmonary Disease, barriers, facilitators, benefits of exercise.

Impact of obesity on airway remodeling in asthma: pathophysiological insights and clinical implications.

The prevalence of obesity among asthma patients has surged in recent years, posing a significant risk factor for uncontrolled asthma. Beyond its impact on asthma severity and patients' quality of life, obesity is associated with reduced lung function, increased asthma exacerbations, hospitalizations, heightened airway hyperresponsiveness, and elevated asthma-related mortality. Obesity may lead to metabolic dysfunction and immune dysregulation, fostering chronic inflammation characterized by increased pro-inflammatory mediators and adipocytokines, elevated reactive oxygen species, and reduced antioxidant activity. This chronic inflammation holds the potential to induce airway remodeling in individuals with asthma and obesity. Airway remodeling encompasses structural and pathological changes, involving alterations in the airway's epithelial and subepithelial layers, hyperplasia and hypertrophy of airway smooth muscle, and changes in airway vascularity. In individuals with asthma and obesity, airway remodeling may underlie heightened airway hyperresponsiveness and increased asthma severity, ultimately contributing to the development of persistent airflow limitation, declining lung function, and a potential increase in asthma-related mortality. Despite efforts to address the impact of obesity on asthma outcomes, the intricate mechanisms linking obesity to asthma pathophysiology, particularly concerning airway remodeling, remain incompletely understood. This comprehensive review discusses current research investigating the influence of obesity on airway remodeling, to enhance our understanding of obesity's role in the context of asthma airway remodeling.

Deciphering the molecular regulatory of RAB32/GPRC5A axis in chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) is a significant public health problem characterized by persistent airflow limitation. Despite previous research into the pathogenesis of COPD, a comprehensive understanding of the cell-type-specific mechanisms in COPD remains lacking. Recent studies have implicated Rab GTPases in regulating chronic immune response and inflammation via multiple pathways. In this study, the molecular regulating mechanism of RAB32 in COPD was investigated by multiple bioinformatics mining and experimental verification.MethodsWe collected lung tissue surgical specimens from Zhongshan Hospital, Fudan University, and RT-qPCR and western blotting were used to detect the expression of Rabs in COPD lung tissues. Four COPD microarray datasets from the Gene Expression Omnibus (GEO) were analyzed. COPD-related epithelial cell scRNA-seq data was obtained from the GSE173896 dataset. Weighted gene co-expression network analysis (WGCNA), mfuzz cluster, and Spearman correlation analysis were combined to obtain the regulatory network of RAB32 in COPD. The slingshot algorithm was used to identify the regulatory molecule, and the co-localization of RAB32 and GPRC5A was observed with immunofluorescence.ResultsWGCNA identified 771 key module genes significantly associated with the occurrence of COPD, including five Rab genes. RAB32 was up-regulated in lung tissues from subjects with COPD as contrast to those without COPD on both mRNA and protein levels. Integrating the results of WGCNA, Mfuzz clusters, and Spearman analysis, nine potential interacting genes with RAB32 were identified. Among these genes, GPRC5A exhibited a similar molecular expression pattern to RAB32. Co-expression density analysis at the cell level demonstrated that the co-expression density of RAB32 and GPRC5A was higher in type I alveolar epithelial cells (AT1s) than in type II alveolar epithelial cells (AT2s). The immunofluorescence also confirmed the co-localization of RAB32 and GPRC5A, and the Pearson correlation analysis found the relationship between RAB32 and GPRC5A was significantly stronger in the COPD lungs (r = 0.65) compared to the non-COPD lungs (r = 0.33).ConclusionsOur study marked endeavor to delineate the molecular regulatory axis of RAB32 in COPD by employing diverse methods and identifying GPRC5A as a potential interacting molecule with RAB32. These findings offered novel perspectives on the mechanism of COPD.

Attenuation of Pulmonary Damage Associated with COPD in a Cadmium-Exposed Model Due to the Administration of a siRNA Targeting PAD4

Chronic obstructive pulmonary disease (COPD), characterised by persistent airflow limitation during breathing, is considered to be the third leading cause of death worldwide. Among the mechanisms involved in this pathology is the excessive generation of neutrophil extracellular traps (NETs), which can induce an unwanted inflammatory response. These traps have been reported to be generated by the enzyme peptidyl arginine deiminase 4 (PAD4). The aim of this work is therefore to evaluate the effect of the administration of a siRNA targeting PAD4 on lung damage in a COPD animal model. Wistar rats weighing 300–350 g were administered cadmium chloride (5 mg/kg i.p.) every 24 h. Then, following one week of the administration of cadmium chloride, the PAD4-targeted siRNA was administered, and at the second week, lung function was measured, as were lung and heart weights, as well as PAD4 expression by RT-PCR. Our results showed that cadmium administration generated a COPD model, which increased PAD4 expression and decreased lung and heart weights and respiratory function. SiRNA administration partially reversed the changes associated with the COPD model. In conclusion, our results suggest that administration of an siRNA targeting PAD4 could improve respiratory function by decreasing lung and heart damage.

CD4+ T cell-derived IFN-γ and LIGHT synergistically upregulate chemokine production from airway smooth muscle cells.

Airway smooth muscle (ASM) remodeling in asthmatic airways may contribute to persistent airflow limitation and airway hyperresponsiveness. CD4+ T cells infiltrate the ASM layer where they may induce a proliferative and secretory ASM cell phenotype. We studied the interaction between activated CD4+ T cells and ASM cells in co-culture invitro and investigated the effects of CD4+ T cells on chemokine production by ASM cells. CD4+ T cells induced marked upregulation of C-X-C motif chemokine ligands (CXCL) 9, 10, and 11 in ASM cells. Blockade of the IFN-γ receptor on ASM cells prevented this upregulation. Furthermore, T cell-derived IFN-γ and LIGHT (lymphotoxin, exhibits inducible expression and competes with HSV glycoprotein D for binding to herpesvirus entry mediator, a receptor expressed on T lymphocytes) synergize in a dose-dependent manner to coordinately enhance CXCL9, 10, and 11 expression. The synergistic property of LIGHT was mediated exclusively through the lymphotoxin-β receptor (LTBR), but not herpes virus entry mediator (HVEM). Disruption of LTBR signaling in ASM cells reduced CXCL9, 10, and 11 production and ASM cell-mediated CD4+ T cell chemotaxis. We conclude that the LIGHT-LTBR signaling axis acts together with IFN-γ to regulate chemokines that mediate lymphocyte infiltration in asthmatics.

The role of pulmonary vascular endothelium in chronic obstructive pulmonary disease (COPD): Does endothelium play a role in the onset and progression of COPD?

Chronic obstructive pulmonary disease (COPD) is an inflammatory lung pathology characterized by persistent airflow limitation and is the third leading cause of death globally. COPD pathophysiology includes both environmental and host risk factors and the presence of comorbidities contributes to its harmful outcome. Cardiovascular disease (CVD) is closely related to COPD and their coexistence is associated with worse outcomes than either condition alone. COPD impairs the cardiovascular system favoring mostly endothelial dysfunction that is a significant COPD prognostic factor at different stages of the disease. The mechanisms promoting endothelial dysfunction in the systemic and/or pulmonary circulation of COPD patients are different and include systemic inflammation, alteration of adhesion and pro-inflammatory molecules, oxidative stress, cellular senescence, and apoptosis. Nevertheless, the role of endothelium in the onset and progression of COPD and CVD is not yet fully understood. Hence, the purpose of this narrative review is to analyze the literature and provide evidence supporting the importance of endothelial dysfunction in COPD.

Predictive value of NLRC3 levels for pulmonary hypertension in patients with chronic obstructive pulmonary disease

Objectives: Chronic obstructive pulmonary disease (COPD) is a medical condition defined by persistent airflow limitation and respiratory symptoms caused by airway and/or alveolar abnormalities. Pulmonary hypertension (PH) is one of the cardiovascular comorbidities associated with COPD. We investigated the correlation of NLRC3 levels in patients with COPD with prognostic and surrogate parameters of PH on echocardiography and examined whether it could be used to predict PH in this patient population. Methods: A total of 80 patients diagnosed with COPD and 40 healthy volunteers as the control group were included in the study. The COPD group was further divided into two subgroups according to the systolic pulmonary artery pressure (sPAP) as follows: sPAP<35 mmHg and sPAP≥35 mmHg. The enzyme-linked immunosorbent assay (ELISA) method was used to determine the levels of NLRC3 in peripheral blood. Results: Patients with sPAP≥35 mmHg had a lower mean NLRC3 level than those with sPAP<35 mmHg (P=0.006). The NLRC3 levels showed a significant negative correlation with sPAP, tricuspid regurgitation velocity, right atrium, and pulmonary artery diameter. For NLRC3, the cut-off value was found to be 271,486 ng/L, with a sensitivity of 74%, and specificity of 63% in distinguishing patients with sPAP≥35 mmHg from all patients with sPAP<35 mmHg. Conclusions: Our study results suggest that NLRC3 levels measured from peripheral blood are predictive of PH in patients with COPD. Although the exact function of NLRC3 in the lungs, COPD, and PH have not been completely understood, we believe these findings will serve as a model for future studies.

Strategies implemented by informal caregivers to facilitate self-care in patients with chronic obstructive pulmonary disease (COPD): a scoping review protocol.

Chronic obstructive pulmonary disease (COPD) is a disease characterized by persistent respiratory symptoms and airflow limitation. COPD is a significant social and economic burden, and hospital admissions contribute to increased costs. Informal caregivers play a crucial role in supporting COPD patients in their self-care efforts. Therefore, understanding informal caregiver interventions to improve self-care may be helpful in reducing hospitalizations. This is the protocol for a scoping review that aims to map the literature on informal caregiver interventions to facilitate self-care in COPD patients. What are the strategies implemented by informal caregivers to facilitate self-care for patients with COPD? The review will adhere to the methodology outlined by the JBI. A comprehensive search strategy will be executed in PubMed, CINAHL, Embase, Web of Science, Scopus, Cochrane, and PsycINFO. Additionally, grey literature and relevant unpublished documents will be searched to minimize publication bias. Studies describing strategies/actions implemented by informal caregivers to promote self-care in COPD patients from all countries will be included. We will exclude abstracts, editorials, articles on paid caregivers and social and healthcare workers. Two independent reviewers will screen titles, abstracts, and full-text articles based on inclusion criteria. Key data from the selected studies will be extracted using a predefined data extraction table. The results will be aggregated into themes and described qualitatively, figures and graphs may also be presented. The results will be presented according to the PRISMA-ScR. Open Science Framework https://doi.org/10.17605/OSF.IO/4TWRM.

Clinical efficacy of a triple combination of budesonide/ glycopyrronium bromide/formoterol in the treatment of chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a chronic condition characterized by persistent airflow limitation, caused by chronic inflammation in response to exposure to inhaled damaging particles or gases. Exacerbations of COPD lead to the progression of symptoms, worsening lung function, reduced physical tolerance, and, as a result, contribute to an increase mortality. Therefore, the prevention of exacerbations is a primary objective in the management of COPD. The foundation of COPD therapy involves prescribing long-acting bronchodilators, and for some patients, the use of anti-inflammatory agents, such as inhaled corticosteroids (ICS). ICS are used in combination with long-acting beta2-agonists (LABA) or as part of triple therapy (ICS/LABA/ LAMA). The choice of triple therapy depends on the patient’s exacerbation history, severity of symptom, level of peripheral blood eosinophilia, risk of infectious complications, and the presence of a concomitant diagnosis of bronchial asthma. Triple therapy offers advantages in terms of improving lung function, disease symptoms, reducing exacerbation frequency, and significantly decreasing mortality compared to other inhaled therapy options for COPD. A significant advantage of this therapy has been shown in patients with eosinophilic COPD. Currently, three combined inhalation medications containing ICS/LABA/LAMA are available for COPD treatment in our country. This review provides basic information on the clinical efficacy and safety profile of one of them, budesonide/glycopyrronium bromide/formoterol, in patients with various COPD phenotypes.

A Review Study of Pranavaha Srotas Vikara With Special Reference to Chronic Obstructive Pulmonary Disease (COPD)

Abstract: Ayurvedic literature refers to the expression "Srotomayam Hi Shariram" which means "the living body is a system of channels consisting of several channels built as an internal transport system to perform various tasks. Srotas are macro channels and pathways in the living body covering visible and invisible organs, molecules, atoms and subatomic layers. Pranavaha Srotas is one of these channels that mediate Pranavayu. In Ayurveda, respiratory diseases are due to binding of Pranavaha Srotas, causing cough, breathing problems and disturbance of the breathing rhythm. COPD is the second largest common lung disease in India after pulmonary tuberculosis. It is common in middle-aged patients and rarely in patients under 35 years of age. COPD is the leading cause of death and morbidity worldwide. It is characterized by progressive and persistent airflow limitation.

ERS 2023 Abstract Highlights

The following highlights spotlight selected abstracts presented at the European Respiratory Society (ERS) International Congress 2023. They cover key topics, including persistent airflow limitation in paediatric severe asthma, pulmonary rehabilitation, health-related quality of life, chronic cough and obstructive sleep apnoea, paediatric lung transplantation, dead space ventilation in acute respiratory distress syndrome, and virtual wards for remote patient monitoring.

Eosinophil values in exacerbation and stable chronic obstructive pulmonary disease and its relationship to maintenance therapy in stable chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) is characterised by persistent and progressive airflow limitations. The study aimed to determine the relationship between eosinophil values in patients with stable and exacerbated COPD, and the relationship of eosinophil values with two drug regimens used as maintenance therapy in stable COPD. This cross-sectional study and the variables used in this study were eosinophil counts in stable and exacerbated COPD patients. Eighty-three patients with stable and exacerbated COPD were included. Stable COPD (63.9%) was predominant, with the highest degree of symptoms in group A 18 patients (34%) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2; 35 patients (66%). The degree of COPD exacerbation was dominated by Type II COPD 15 patients (50%). Eosinophil counts in patients with stable COPD were less than 100cells/mm3 37 patients (44.6%), while in patients with COPD exacerbation, it was greater than 100cells/mm3 with a total of 30 patients (36.1%). Long acting muscarinic antagonist class of drugs was the most used treatment as maintenance therapy in stable COPD 34 patients (64.2%). The eosinophil counts in patients with COPD exacerbation were significantly higher than those in patients with stable COPD. The provision of maintenance therapy in the long acting β-2 agonist + inhaled glucocorticosteroid group of stable COPD patients was generally provided to COPD patients with eosinophil values greater than 100cells/mm3, and the provision of long-term maintenance therapy in stable COPD patients was generally given to COPD patients with eosinophil values less than 100cells/mm3.

Value of Adding Nebulized Magnesium Sulphate to Rescue Medications in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Patients Admitted to Emergency Room

Abstract Introduction Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases, Nebulized magnesium is attractive as a therapeutic option because it is easily administered, relatively cheap and has minimal side effects. In light of some evidence for an effect when nebulized in severe exacerbations of asthma, the similarities between asthma and chronic obstructive pulmonary disease (COPD) (especially with regard to bronchodilator therapy) and the practical advantages of administration via nebuliser, we sought to focus on the nebulized route of delivery in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Objective The aim of this work was to evaluate the effect of administration of nebulized magnesium sulphate in the management of acute exacerbations of chronic obstructive pulmonary disease. Patient and methods The study was conducted upon 100 patients with acute exacerbation of COPD randomly divided into two groups, 50 patients for each group who admitted to emergency room with acute exacerbation of Chronic Obstructive Pulmonary Disease in Mansoura chest diseases hospital From January 2019 to June 2019, All patients randomly divided into two groups, Patients of group A: included 50 patients received 2.5 mg salbutamol (2.5 ml), mixed with 500 mg isotonic magnesium sulphate(5 ml), Patients of group B: included 50 patients received 2.5 mg salbutamol mixed with 2.5 ml isotonic saline. Treatment for all patients were given via nebulizer. Results There were no significant differences between group I who received nebulized magnesium sulphate + salbutamol and group II who received nebulized salbutamol regarding pulmonary functions (FEV1, FVC and FEV1/FVC), before and after treatment. After treatment there is a significant increase in O2 saturation, PO2 and Serum Mg(more in group I who received nebulized magnesium sulphate + salbutamol than group II who received nebulized salbutamol) and no significant difference between the two groups as regard PH, PCO2, HCO3, and CRP. There is significant change in pulmonary functions ( FEV1, FVC and FEV1/FVC), PO2, and O2 Saturation after treatment and no significant change in PH, PCO2, HCO3, serum Mg and CRP, in patients received salbutamol nebulizer. There is significant change in pulmonary functions ( FEV1, FVC and FEV1/FVC), PO2, O2 Saturation and serum Mg after treatment and no significant change in PH, PCO2, HCO3, and CRP in patients received Magnesium sulphate + salbutamol nebulizer. Conclusion Adding nebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has no effect on FEV1, FVC&FEV1/FVC. Nebulized magnesium sulphate+ salbutamol provides nearly equal response to nebulized salbutamol in the treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in adults. So we do not recommend routine using of nebulizeld magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD.

Auricular Acupuncture as a Traditional Chinese Medicine Therapy for Chronic Obstructive Pulmonary Disease Combined with Sleep Disorders.

Chronic obstructive pulmonary disease (COPD) is a clinical syndrome characterized by persistent and irreversible airflow limitation and chronic respiratory symptoms. It has a wide spectrum of complications, and sleep disorders, as part of it, are common in severe cases, especially in elderly patients. Long-term lack of sleep may lead to the aggravation of the original disease, reducing patients' quality of life. Benzodiazepines are mainly used for symptomatic treatment of COPD combined with sleep disorders. However, such drugs have the side effect of respiratory central inhibition and could probably aggravate hypoxia symptoms. Auricular acupuncture is a special method of treating physical and psychosomatic dysfunctions by stimulating specific points in the ear. This article explains the specific methods of clinical operation of auricular acupuncture in detail, including assessment of patient eligibility, medical devices used, acupuncture points, course of treatment, post-treatment care, responses to emergencies, etc. The Pittsburgh sleep quality index (PSQI) and chronic obstructive pulmonary disease assessment scale (CAT) were used as the observational index of this method. So far, clinical reports have proved that auricular acupuncture has a definite curative effect in the treatment of COPD combined with sleep disorders, and its advantages of simple operation, few adverse reactions are worthy of further study and promotion, which provide a reference for the clinical treatment of such diseases.

The Effectiveness of Home-Based Inspiratory Muscle Training on Small Airway Function and Disease-Associated Symptoms in Patients with Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitations, occurring mainly in the small airways. Weakness in the respiratory muscles contributes to dyspnea and a decreased exercise capacity in COPD patients. This study aimed to investigate the effectiveness of home-based inspiratory muscle training (IMT) on small airway function and symptoms in COPD patients. This research adopted a non-randomized controlled-study quasi-experimental design. The IMT program consisted of two 15 min sessions·d-1, 5 d·wk-1, with 40% of the maximal inspiratory pressure (PImax) on each participant's assessment results and lasted for 12 weeks. Small airway function was assessed using plethysmography at baseline and after 12 weeks. The modified British Medical Research Council (mMRC), COPD assessment test (CAT), PImax, and 6 min walking distance (6MWD) were recorded at baseline as well as four, eight, and twelve weeks. Twenty-three participants with at least moderate COPD were enrolled in IMT (n = 16) or in the control group (n = 7) in this study. The study participants were mostly male (82.6%), and the average age was 68.29 ± 10.87 years, with a mean body mass index (BMI) of 23.54 ± 4.79. After 12 weeks, the ratios of the first second of forced expiration to the forced vital capacity (FEV1/FVC%) (B coefficient [95% Wald confidence interval] of 5.21 [0.46 to 9.96], p = 0.032), forced expiratory flow (FEF25-75%) (0.20 [0.04 to 0.35] L/s, p = 0.012), and FEF50% (0.26 [0.08 to 0.43] L/s, p = 0.004) in the IMT group were significantly better than in the control group. The IMT group showed significantly lower CAT scores at week 8 (-5.50 [-10.31 to -0.695] scores, p = 0.025) than the control group. The mMRC grade, CAT score, PImax, and 6MWD were significantly improved compared to their values at baseline in the IMT group. Home-based IMT effectively improved post-bronchodilator small airway function and disease-associated symptoms in COPD patients.