BackgroundRespiratory syncytial virus (RSV) is a leading cause of hospitalizations among young children globally. However, the impact of RSV-associated hospitalization on subsequent wheezing episodes remains understudied in Europe. We assessed the incidence rate ratio (IRR) of wheezing in the first year after hospitalization in children hospitalized with RSV compared to those hospitalized without acute respiratory infections (ARI).MethodsWe conducted a prospective matched cohort study in hospitalized children aged ≤2 years across ten hospitals in Germany, Spain, Italy, France, and England from October 2020 to May 2023. We compared the incidence rates of caregiver-reported wheezing, medically attended wheezing, and wheezing requiring medication within 12 months post-discharge in children with laboratory-confirmed RSV to matched children admitted for non-ARI. Caregivers reported wheezing episodes through bi-monthly online questionnaires. Potential confounders were adjusted using propensity scores as covariates in generalized estimating equations.ResultsA total of 300 hospitalized children with RSV and 140 with non-ARI were included, with an average 89% completion rate for the bi-monthly questionnaires. Two-thirds (66%) of children admitted with RSV experienced caregiver-reported wheezing episodes, compared to only 26% of non-ARI children; with an IRR of 3.58 (95% CI 2.87–4.46). The adjusted IRRs for caregiver-reported wheezing episodes, medically attended wheezing episodes, and use of respiratory medication were 2.51 (95% CI 1.46–4.33), 2.29 (95% CI 1.50–3.52), and 2.91 (95% CI 1.90–4.47), respectively. These associations remained consistent after imputation for missing data.ConclusionHospitalization due to RSV in children aged ≤2 years is associated with a significantly increased risk of wheezing in the year following discharge, underscoring the long-term respiratory burden of RSV infection in early childhood.DisclosuresJoanne G. Wildenbeest, MD, PhD, Merck & Co., Inc.: Grant/Research Support|Merck & Co., Inc.: Presentation at sponsored symposium|Sanofi: Grant/Research Support|Sanofi: participation in advisory boards, speaker at a Sanofi sponsored symposium Louis J Bont, M.D., Merck: Advisor/Consultant|Merck: Grant/Research Support Rebecca Stellato, n/a, Merck & Co., Inc.: Grant/Research Support Johannes Liese, MD MSc, Sanofi: Grant/Research Support Egbert Herting, PhD, Chiesi: Grant/Research Support Renato Cutrera, MD, Merck & Co., Inc.: Grant/Research Support Christina Calvo, MD, PhD, Merck & Co., Inc.: Grant/Research Support Chiara Azzari, Merck & Co., Inc.: Grant/Research Support Federico Martinon-Torres, MD, PhD, Assoc. Prof, Astra Zeneca: Advisor/Consultant|Astra Zeneca: Board Member|Astra Zeneca: Grant/Research Support|Astra Zeneca: Honoraria|Astra Zeneca: trial fees as PI, paid to may institution|GSK: Advisor/Consultant|GSK: Board Member|GSK: Grant/Research Support|GSK: Honoraria|GSK: trial fees as PI, paid to may institution|Merck & Co., Inc.: Advisor/Consultant|Merck & Co., Inc.: Grant/Research Support|Merck & Co., Inc.: Honoraria|Merck & Co., Inc.: trial fees as PI, paid to may institution|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Moderna: trial fees as PI, paid to may institution|Pfizer: Advisor/Consultant|Pfizer: Board Member|Pfizer: Grant/Research Support|Pfizer: Honoraria|Pfizer: trial fees as PI, paid to may institution|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Board Member|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Honoraria|Sanofi Pasteur: trial fees as PI, paid to may institution|Seqirus: Advisor/Consultant|Seqirus: Grant/Research Support|Seqirus: trial fees as PI, paid to may institution Simon Drysdale, FRCPCH, MSD: Grant/Research Support Ralph Epaud, MD, ASTRA: Advisor/Consultant|ASTRA: Board Member|GSK: Advisor/Consultant|SANOFI: Board Member Madelyn Ruggieri, MS, Merck: employee of Merck Yoonyoung Choi, PhD, MS, RPh, Merck & Co., Inc.: Grant/Research Support|Merck & Co., Inc.: Employment|Merck & Co., Inc.: Stocks/Bonds (Private Company)

Off-label drug prescribing in pediatric populations is a common practice worldwide due to the limited availability of approved formulations and clinical data for children. While often necessary, it raises concerns regarding safety, efficacy, and ethical considerations. Pharmacists play a key role in ensuring the safe use of off-label drugs; however, their perspectives in low-resource settings like Kosovo remain under-investigated. A cross-sectional, questionnaire-based survey was conducted among 296 community pharmacists across Kosovo between December 2024 and January 2025. The 27-item structured survey collected demographic data and assessed pharmacists' familiarity, practices, and perspectives on pediatric off-label use. Data were analyzed using IBM SPSS 22.0. Of the pharmacists surveyed, 49% reported moderate familiarity with pediatric off-label use, and 79% had not received formal training. Nearly all participants (99%) had encountered off-label prescriptions, most commonly involving anti-infectives and respiratory medications. Although 98% acknowledged that off-label use is sometimes necessary, many expressed concerns about safety and effectiveness. Only 21% had observed adverse drug reactions, while 96% reported no treatment failures. Communication with prescribers was rated as good by 49% of respondents, though 71% emphasized the need for stronger interdisciplinary collaboration. This study provides the first national insight into community pharmacists' perspectives on pediatric off-label prescribing in Kosovo. The findings highlight the urgent need for targeted pharmacist education, the development of standardized national guidelines, and enhanced collaboration between pharmacists and prescribers to improve medication safety in pediatric patients.

ObjectivePrevious studies have shown an association between polycystic ovary syndrome (PCOS) and the use of various medications. However, there is still a lack of systematic research exploring this relationship in depth. This study aims to identify and evaluate drugs that may influence the risk of PCOS using the US FDA Adverse Event Reporting System (FAERS) database.MethodsAdverse events (AEs) related to drug-induced PCOS were retrieved from the FAERS database (Q1–2014 to Q4 2024). Four statistical methods (ROR, PRR, BCPNN, and MGPS) were used for imbalance analysis to identify drugs significantly associated with PCOS risk. Additionally, a latency (TTO) analysis was conducted to assess the timing of onset and the risk characteristics of PCOS-related adverse reactions.ResultsThis study identified 18 drugs significantly associated with PCOS-related AEs from a total of 1,516 cases through imbalance analysis. These drugs span various categories, including respiratory, antipsychotic, and anticonvulsant medications. Among them, Mecasermin (ROR = 67.54) and Ciclesonide (ROR = 62.10) presented the highest risk, followed by Valproic acid (ROR = 20.78) and Olanzapine (ROR = 10.27). Adverse events were most commonly observed either after 360 days of medication use or within 30 days. The median time to onset for the top three drugs with the highest signal frequency was as follows: Olanzapine (155.5 days), Quetiapine (335 days), and Valproic acid (905 days).ConclusionThis study is the first large-scale, systematic exploration of drug signals related to PCOS using the FAERS database. The drugs identified are primarily associated with the nervous system, followed by respiratory system medications and other types of drugs. These findings provide new warning evidence and references for clinical drug safety, suggesting that enhanced monitoring of female patients should be implemented when prescribing such drugs.

Introduction . At the current stage of medical development, intraventricular hemorrhage (IVH) remains a pathology with a high mortality rate and disability of premature newborns. Therefore, the identification of risk factors for the development of IVH, the development of therapeutic and preventive measures is an important medical and socio-economic task. Objective — analysis and generalization of new scientific data on risk factors, pathogenesis and prevention of IVH in newborns. Materials and methods . A search and analysis of scientific papers was performed using the databases PubMed, Cochrane Library, RSCI. The selection of articles was carried out using the terms: intraventricular hemorrhage, premature newborns, risk factors, pathogenesis, prevention. The review includes 78 sources published from 2014 to 2025. Results and discussion. The article presents data on the etiological and pathogenetic mechanisms of the development of IVH in newborns. The consequences of IVH determine the need to develop effective prevention of this pathology in order to reduce morbidity and prevent complications. Conclusion . IVH is a condition that has arisen due to the structural features of the germ matrix in newborns. This is a disease, the risk factors for which are: intrauterine infections, placental abruption, prolonged labor, concomitant diseases of newborns. A multidisciplinary approach is important in prevention. Prevention should be aimed at reducing the number of premature births, the use of glucocorticosteroids during pregnancy. Timely surgical delivery is important to prevent asphyxia. After the birth of a child, it is necessary to follow a medical regime and adequately prescribe respiratory support and medications.

Drug-induced cough risk: A pharmacovigilance study of FDA adverse event reporting system database.

Background: Saharan dust intrusions (SDIs) are associated with poor air quality and adverse respiratory outcomes. However, their impact on real-world inhaler utilization remains insufficiently characterized. We aimed to examine the association between SDI and the dispensing of short-acting beta-agonists (SABA) and inhaled corticosteroid–long-acting beta-agonist (ICS–LABA) combinations in the Canary Islands, Spain. Methods: Pharmaceutical sales data for SABA and ICS–LABA were collected from 60 pharmacies in Santa Cruz de Tenerife (TF) and Las Palmas de Gran Canaria (GC) between June 2017 and May 2022. SDI days were identified based on daily PM10 concentrations > 40 µg/m3 from the regional air quality monitoring network. Linear regression models evaluated associations between drug dispensations and SDI presence, frequency, and intensity, adjusting for seasonality (winter vs. summer). Results: Over 60 months, SABA sales were 14.8% lower in TF compared with GC, while ICS–LABA sales were 10.9% higher. SDI presence was associated with significantly higher ICS–LABA dispensations in both provinces (+5.7% in TF, +10.2% in GC), whereas no association was found for SABA. ICS–LABA sales correlated weakly but significantly with both SDI frequency and PM10 levels. Seasonal analysis revealed stronger effects in winter, with ICS–LABA dispensations increasing by 14.3% (TF) and 9.6% (GC) during SDI months. For SABA, seasonal differences were independent of SDI exposure. Conclusions: SDIs in the Canary Islands are independently associated with increased dispensing of ICS–LABA maintenance therapy, particularly during winter months. Dispensing data offer a valuable population-level indicator of respiratory impact from natural airborne pollution and support the integration of environmental alerts into preventive respiratory care strategies.

Evaluating dextrorphan as a wastewater biomarker for cough suppressant use: A longitudinal study in China.

Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disease characterized by persistent airflow limitation and is a leading cause of mortality worldwide. Pre-COPD refers to a pre-disease state associated with an increased risk of COPD development. This study aims to evaluate the clinical characteristics of individuals with COPD, pre-COPD, and smokers with normal lung function in South Korea, and to provide an updated analysis of the Korea COPD subgroup study (KOCOSS) cohort data.Methods We analyzed data from 4,502 participants in the KOCOSS database collected between 2012 and 2025, including 4,197 with COPD, 126 with pre-COPD, and 179 smokers with normal lung function. Baseline characteristics were compared across these groups.Results Patients with COPD were more likely to be male, older, and had a lower body mass index than those with pre-COPD and smokers with normal lung function. Symptom burden, as assessed by the COPD Assessment Test and modified Medical Research Council dyspnea scale, was highest in patients with COPD, followed by pre- COPD and smokers with normal lung function. Patients with COPD had the highest overall use of respiratory medications (89.3%), including inhalers and other treatments, followed by pre-COPD individuals (61.5%) and smokers with normal lung function (47.4%). Hypertension was the most common comorbidity across all groups, with no significant differences in the prevalence of comorbidities.Conclusion This analysis of the KOCOSS cohort highlights the distinct clinical characteristics of individuals with COPD, pre-COPD, and smokers with normal lung function. Notably, individuals without spirometric COPD still showed substantial symptom burden and inhaler use.

Non-adherence to inhaled medication poses a significant clinical and economic burden on patients with respiratory diseases. This narrative review provides an overview of key aspects of hair analysis, in general and specific for inhaled medications, and explores the potential of hair analysis as a novel tool to monitor adherence to inhaled medications. PubMed searches were conducted to explore four aspects: (1) mechanisms of (inhaled) drug's systemic absorption and deposition in hair; (2) quantification of drugs in hair; (3) factors impacting (inhaled) drug hair concentrations; and (4) clinical studies assessing inhaled medication adherence through hair analysis. Systemic absorption, deposition, quantification, and interpretation of drug concentrations in hair are complex phenomena and are influenced by various factors. Analysing drug concentrations in hair segments provides insights into adherence variability over up to 3 months. While studies suggest effective incorporation of several inhaled drugs into hair, inter-individual variability is influenced by external (e.g. UV-exposure), drug- (e.g. lipophilicity) and patient-specific (e.g. hair colour) factors, not just by adherence. The impact of these confounding factors on absolute hair concentrations is still unclear. Intra-individual variability unrelated to adherence appears, however, minimal. Although hair analysis shows promise as a novel objective bioanalytical method for assessing long-term inhaled medication adherence, until further analytical refinement, clinical validation and a clearer understanding of confounding factors, it should not be relied upon as the sole measure of adherence.

Although spirometry is the gold standard for diagnosing COPD, it is underused in clinical practice. Which factors are associated with timely spirometry (at chronic treatment initiation) in a clinically relevant population of people starting chronic treatment for respiratory symptoms? Is this diagnostic test associated with lower mortality risk? Incident adult users of chronic respiratory medication were identified in Belgian nationwide data. The odds on timely spirometry were examined by multivariable logistic regression and impact on survival by using multivariable Cox regression analysis. In those patients not receiving timely spirometry, factors related to further delay in spirometry were analyzed with a multivariable Fine-Gray subdistribution hazard regression. Among 146,205 chronic treatment initiators, 20.9% had spirometry at treatment initiation, and 13.8% received spirometry during follow-up. Although primary care physicians prescribed 81.1% of initiated treatments, general practitioners performed only 5.1% of all spirometry tests. People who received spirometry at treatment initiation had a 34% lower mortality risk (adjusted hazard ratio, 0.66; 95% CI, 0.63-0.70) and had less use of short-acting bronchodilators. Smoking, respiratory morbidities, and congestive heart failure increased chance of spirometry use. In contrast, female sex, age < 60 years or > 80 years, cognitive impairment, and frailty lowered the chance of spirometry use, both at initiation and during follow-up. Low socioeconomic status, depression/anxiety, and antibiotic use were associated with a lower chance of spirometry use at treatment initiation, whereas during follow-up, antibiotic use was associated with a higher chance of spirometry over time. In addition, anemia and cachexia were associated with a lower chance of spirometry use during follow-up. Only 1 in 3 initiators of chronic treatment for obstructive lung disease underwent spirometry. Spirometry was particularly underused in primary care. Especially (never-smoking) female participants and vulnerable patients may be at increased risk for underdiagnosis and suboptimal treatment. Importantly, spirometry at treatment initiation was significantly associated with better prognosis, possibly through better-tailored care.

Respiratory Distress Observation Scale and Medication Administration.

EPH19 Changes in Respiratory Medication and Antibiotic Use Among Asthma and COPD Individuals During the Pandemic

Background: Alcohol intolerance, characterized by adverse reactions following alcohol consumption, can occur due to interactions between alcohol and certain medications. Despite its clinical significance, evidence for alcohol intolerance induced by commonly prescribed drugs remains limited. This study aimed to identify signals for drug-associated alcohol intolerance using the United States Food and Drug Administration (USFDA) Adverse Event Reporting System (AERS). Methods: A disproportionality analysis was conducted on the USFDA AERS spanning the first quarter of 2004 to the second quarter of 2024. Cases were identified using the Preferred Term "alcohol intolerance". Duplicate reports were excluded, and only drugs classified as primary suspects were analyzed. The key disproportionality measures included frequentists (reporting odds ratio [ROR]) and Bayesian methods. Top 10 drugs associated with alcohol intolerance were identified using volcano plot. Subgroup analyses by age and gender were performed, and clinical outcomes were evaluated. Results: Among 29 153 222 reports, 406 cases of drug-associated alcohol intolerance were identified, predominantly in adults aged 18 to 65 years. Multiple drug classes demonstrated significant signals including antimicrobials (metronidazole [ROR: 27.4], cefoperazone [ROR: 290.6]), and ketoconazole [ROR: 27.6]), respiratory medications (salmeterol [ROR: 6], mometasone [ROR: 6], and dupilumab [ROR: 6.1]), and psychoanaleptics (bupropion [ROR: 8.1] and several selective serotonin reuptake inhibitors). The Volcano plot analysis highlighted 10 drugs with particularly strong associations, including cefoperazone, spiramycin, metronidazole, and dupilumab. Outcomes included hospitalization (16%), disability (6.4%), and death (1.7%). Conclusion: This study highlights significant associations between several medications and alcohol intolerance, emphasizing the need for further research to confirm these findings and inform clinical guidelines to optimize patient safety.

Respiratory support for neonates is key for reducing mortality; however, the capabilities of countries in sub-Saharan Africa (SSA) are not exactly known. Our aim was to assess the availability of respiratory support systems and medications for neonates in a sample of hospitals in SSA. A survey was conducted among neonatal providers attending an annual neonatal conference in Tanzania. One response per healthcare facility was invited. A total of 47 institutions completed the survey. Continuous positive airway pressure (CPAP) was used in almost all (96.6%) tertiary hospitals and in 88.9% of frontline hospitals. Continuous oxygen saturation monitoring is available in less than 50% of healthcare facilities; the ability to blend oxygen for all infants is available in 22% of facilities. Although the availability of CPAP is high, this sample may not be representative of all hospitals. Monitoring oxygen saturation and the ability to blend oxygen are suboptimal.

Prescribing of inhalers for asthma and chronic obstructive pulmonary disease is complicated due to multiple treatment pathways, diverse products, and variability in patients’ needs and usage habits. Factors such as social deprivation, air quality, and differences in access to primary care influence both demand on respiratory medications and the rate and manner in which they are prescribed. Inhaler prescribing metrics are valuable for analysing temporal and geographic prescribing patterns across socio-economic groups, whether to identify areas with higher disease incidence or to assess problematic prescribing practices. Using data from OpenPrescribing.net, we estimate prescription items dispensed for different inhaler drugs in England at Lower Layer Super Output Area or ‘neighbourhood’ level. Generating metrics at small-area level enables analysis of the interactions between individuals, their environment, and the localised health system within which they are being treated. This approach complements a patient-centred clinical model that considers individual patient needs. To explore changes pre- and post- the March 2020 COVID-19 lockdown, we profile prescribing temporally and by neighbourhood-level deprivation, measured by the Index of Multiple Deprivation. We develop and apply seven prescribing measures informed by national clinical guidelines which facilitate contextual comparison of prescribing behaviour between neighbourhoods. We find inequalities in prescribing behaviour, with the most deprived neighbourhoods associated with higher rates of emergency or ’rescue’ inhaler prescribing - a pattern that was interrupted during the March 2020 lockdown. Additionally, we find an increase in the prescribing of less environmentally friendly inhalers, contrary to national prescribing guidelines. This trend persisted until early 2022, when the trend began to reverse. Whilst many complex factors influence prescribing behaviour and safety, area-level deprivation appears to be an important dimension.

Respiratory support is frequently needed for babies admitted to the neonatal intensive care unit. Among them, preterm babies are most likely to have issues of respiratory distress, and they may need invasive or non-invasive breathing support. Providing respiratory support, keeping the oxygen saturation (SpO2) in the target range (TR) and preventing abnormal high and low oxygen levels should be the aim of providing respiratory therapy. Usually, this control is achieved by manual adjustment of FiO2 (fraction of inspired oxygen) by bedside staff nurses to keep SpO2 in TR. However, the latest ventilators have automated oxygen control devices that adjust the FiO2 to keep SpO2 in TR. This study protocol is prepared to assess the effectiveness of automated versus manual oxygen control in keeping SpO2 in TR. This is a single-centre, non-blinded, randomised crossover trial that aims to recruit 26 preterm babies who may need invasive or non-invasive respiratory support. The 12-hour periods of automated oxygen control by ventilator will be compared with 12 hours of manual oxygen control by bedside staff nurse. The primary outcome will compare both interventions and will assess their efficacy to keep SpO2 in TR. Secondary outcomes will compare abnormal high and low SpO2 levels, and number and duration of fluctuations in both interventions. Median FiO2 values and median number of manual adjustments of FiO2 will also be compared. Secondary outcomes will also look for the impact of sedative and respiratory stimulant medications on target oxygen saturation. The ethics review committee at Aga Khan University Hospital Karachi has given ethical approval for this trial (approval number: 2024-10189-30775). Results from this trial will be published in journals. NCT06622161.

Laryngeal clefts are congenital malformations that can result in chronic microaspiration and subsequent lung disease. Type 1 laryngeal clefts can result in subtle presentation and whether or not to repair them remains controversial. In this retrospective cohort study, we describe the pulmonary symptoms and radiographic findings in children before and after type 1 laryngeal cleft repair. Twenty-year single institution retrospective cohort study. Retrospective chart review of pediatric patients who underwent type 1 laryngeal cleft endoscopic CO2-laser repair between August 2003 and August 2022. Data collected included history of respiratory illness, pulmonary symptoms, medications pre-repair, and radiographic findings pre- and post-repair. Pre- and post-repair chest x-ray (CXR) findings were compared. 325 pediatric patients (200 male and 125 female; median age at repair 2.6 years) required surgical repair between 2003 and 2022. Nearly all (99%) patients presented with respiratory symptoms, nearly half (44%) had a history of pneumonia, and 71% were prescribed at least one pulmonary medication. Median age at laryngeal cleft repair was higher in patients with a history of pneumonia (3.0 years, range 0.5-16.4) compared to patients without pneumonia (2.3 years, range 0.3-16.5), p < 0.001. Abnormal CXR findings were common (80%), with atelectasis (56%) and bronchial wall thickening (59%) being most prevalent. Atelectasis and bronchial wall thickening were significantly less frequent in the post-repair CXRs. Pulmonary symptoms and abnormal CXR findings are common in patients with type 1 laryngeal cleft, and those who do not respond properly to medical management should be considered for endoscopic repair.

Introduction: The comprehensive educational component of pulmonary rehabilitation (PR) is an important component of chronic obstructive pulmonary disease (COPD) self-management. However, depending on circumstances PR may not be convenient or appropriate for an individual patient and thus these patients do not access the educational component of PR. Background: COPD, due to its symptoms imposes a significant burden on the affected person in terms of quality of life and effects on daily activities [1]. Self-management is a term applied to educational programmes aimed at teaching the skills needed to perform medical regimens specific to the disease in order for patients to control their disease and lead more functional lives [2]. A patient with COPD has to become a partner and an active participant in their own care [3]. Method: 73 patients who did not complete PR were identified on the Respiratory Integrated Care (RIC) patient database. Reasons included that they did not fit the criteria or they declined or did not attend the programme. An invitation letter about the COPD Self-Management Day was sent to the 73 patients. 18 patients responded. Of these 4 patients responded that they were unable to attend at this time but would like to attend in the future. 11 patients attended on the day. A clinical specialist physiotherapist and clinical nurse specialists (CNS) working in RIC delivered self-management educational talks. These included: what is COPD?, Inhalers and Respiratory medications, Techniques to deal with shortness of breath, Chest clearance, Exercise and Self-management planning. Results: Patients completed an anonymous satisfaction survey at the end of the day. 100% of patients agreed that they had a better understanding of COPD, felt more confident and motivated to manage their COPD and would recommend the day to others. 90% of patients reported that they had a better understanding of Inhalers and Respiratory medications, Techniques to deal with shortness of breath, Chest clearance and Exercise. 80% of patients reported that they had a better understanding of self-management. 9 patients had their inhaler technique corrected, 2 patients were linked back into the CNS clinic, 2 patients now agreed to referral to PR and 1 patient had new equipment ordered. Conclusion: The COPD Self-Management Education Day was effective in improving patient’s knowledge and confidence to cope on a day to day basis with their disease. Notably, patients had their inhaler technique corrected and were linked into RIC services. There is a need for the COPD Self-Management Education Day and it will be repeated at regular intervals in Dublin North Central RIC.

Rationale: Discovering the biological basis of progression in chronic obstructive pulmonary disease (COPD), especially of rapid decline (RD) in forced expiratory volume in 1 second, is essential to the development of precision therapies. Objectives: First, we sought to define baseline characteristics of RD (⩾100 ml/yr), relative to participants with stable-to-improved (S/I) status or with intermediate decline (D)-categories based on spirometric data from the Framingham Offspring cohort. Second, we sought to examine these categories as predictors of longitudinal COPD outcomes, adjusting for baseline characteristics. Methods: Among ever-smoking participants in the Subpopulations and Intermediate Outcomes in COPD Study (or, SPIROMICS) with two or more spirometric measurements over 8 years, we used linear regression to fit slopes of postbronchodilator change in forced expiratory volume in 1 second. We used ordinal regression, testing baseline characteristics as predictors of lung function change categories (S/I, D, and RD) and used those categories to assess associated clinical outcomes. Results: In this heavy-smoking cohort (⩾20 pack-years), the status of 747 participants was S/I (40%), and that of 336 participants was RD (18%). In adjusted models of baseline factors associated with trajectories of decline, steeper decline was associated with better initial lung function (all P < 0.001) and greater likelihood of baseline bronchodilator responsiveness (S/I, D, and RD: 32%, 37%, and 43%, respectively; P < 0.001); there was no association between RD and race, ethnicity, socioeconomic status, medical history, or respiratory medication use. Regarding clinical endpoints, RD was associated with greater symptom burden, worse health-related quality of life, and increased mortality, but not exacerbation frequency. Conclusions: Categorical definitions of S/I and RD highlight bronchodilator responsiveness and smoking as risks for adverse outcomes, including death. Contrasting these disease trajectories will support the future identification of the biological bases of COPD progression.

This study aimed to compare the accuracy of three newly proposed definitions of bronchopulmonary dysplasia (BPD) in predicting outcomes, and to investigate the impact of large airway versus parenchymal versus vascular BPD phenotypes on BPD outcomes.Retrospective chart review of 100 infants with severe BPD discharged from a Children's hospital between 2020 and 2021. Multivariable models evaluated the associations between BPD definitions and phenotypes with tracheostomy and death at 6 months and 1 year after NICU discharge. Secondary outcomes included the need for respiratory support, the use of pulmonary medications, and the need for long-term gastrostomy feeding.Neonatal research network (NRN) and BPD collaborative criteria best-predicted outcomes associated with tracheostomy and/or death (p < 0.001). Among the three BPD phenotypes, large airway disease was independently associated with death or tracheostomy (odds ratios [OR]: 10.5; 95% confidence interval [CI]: 1.6, 68.1). The combination of all three phenotypes was also associated with death or tracheostomy (OR: 9.8; 95% CI: 1.0, 93.5). Both NRN and BPD collaborative definitions showed an association with the need for respiratory support, medication use, and need for long-term gastrostomy tube feeding. Among the 29 infants for whom complete information was available, 18 (62%), 20 (69%), and 18 (62%) had parenchymal, central airway and pulmonary vascular phenotype, respectively.Our results indicate that newer definitions of BPD may better predict the severity of BPD and the need for long-term invasive ventilation support compared with the 2001 National Institute of Health definition of BPD phenotypes impacting mortality and short-term outcomes. These data may be useful for counseling families and developing phenotype-based individualized treatment plans. · The current definition of BPD has limitations.. · New definitions of BPD better predict outcomes.. · BPD phenotypes can better predict outcomes..