Risk Of Exacerbations Research Articles

A machine learning framework for short-term prediction of chronic obstructive pulmonary disease exacerbations using personal air quality monitors and lifestyle data

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease with a variety of symptoms including, persistent coughing and mucus production, shortness of breath, wheezing, and chest tightness. As the disease advances, exacerbations, i.e. acute worsening of respiratory symptoms, may increase in frequency, leading to potentially life-threatening complications. Exposure to air pollutants may trigger COPD exacerbations. Literature predictive models for COPD exacerbations, while promising, may be constrained by their reliance on fixed air quality sensor data that may not fully capture individuals’ dynamic exposure to air pollution. To address this, we designed a machine learning (ML) framework that leverages data from personal air quality monitors, health records, lifestyle, and living condition information to build models that perform short-term prediction of COPD exacerbations. The framework employs (i) k-means clustering to uncover potentially distinct patient sub-types, (ii) supervised ML techniques (Logistic Regression, Random Forest, and eXtreme Gradient Boosting) to train and test predictive models for each patient sub-type and (iii) an explainable artificial intelligence technique (SHAP) to interpret the final models. The framework was tested on data collected in 101 COPD patients monitored for up to 6 months with occurrence of exacerbation in 10.7% of total samples. Two different patient sub-types have been identified, characterised by different disease severity. The best performing models were Random Forest in cluster 1, with area under the receiver operating characteristic curve (AUC) of 0.90, and area under the precision/recall curve (AUPRC) of 0.7; and Random Forest model in cluster 2, with AUC of 0.82 and AUPRC of 0.56. The model interpretability analysis identified previous symptoms and cumulative pollutant exposure as key predictors of exacerbations. The results of our study set a premise for a predictive framework in COPD exacerbations, particularly investigating the potential influence of environmental features. The SHAP analysis revealed that the contribution of environmental features is not uniform across all subjects. For instance, cumulative exposure to pollutants demonstrated greater predictive power in cluster 1. The SHAP analysis also shown that overall clinical factors and individual symptomatology play the most significant role in this setup to determine exacerbation risk.

Prognosis of OSA‐COPD overlap syndrome: A matter of concern

AbstractThe impact of obstructive sleep apnea (OSA)‐chronic obstructive pulmonary disease (COPD) overlap syndrome (OVS) should not be ignored. Increased upper airway resistance, systemic inflammatory response, and increased sympathetic nerve activity contributed to the adverse clinical outcomes in overlapping patients. Compared with COPD or OSA alone, those with OVS have more severe daytime hypoxemia and hypercapnia, leading to increased frequency and severity of COPD exacerbations. Consequently, patients with OVS experience increased rates of hospitalization and all‐cause mortality, alongside a markedly elevated risk of cardiovascular events. Continuous positive airway pressure (CPAP) as a treatment can improve oxygenation and lung function in patients with OVS and reduce the risk of COPD exacerbation and cardiovascular death. However, individual differences in treatment effectiveness suggest the need for individualized treatment regiments and compliance monitoring. In addition, the current research evidence on OVS is insufficient, and more large‐sample, multicenter studies are needed to evaluate disease prognosis in patients with different phenotypes and establish uniform evaluation and treatment guidelines to optimize the clinical management of patients with OVS.

Features of infl ammatory biomarkers in patients with occupational COPD and cardiovascular comorbidity

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with over 30% of these patients dying from cardiovascular diseases. Objective: to study the pathophysiological links between echocardiography, spirometry indicators, and inflammatory biomarkers in patients with various clinical phenotypes of occupational COPD with cardiovascular comorbidity. Material and methods. The study included 111 patients with occupational COPD and cardiovascular comorbidity. Based on spirometry results, patients were divided into 4 groups (clinical phenotypes). Clinical examinations, echocardiography, and serum concentrations of troponin I, endothelin-1 (E-1), endothelial synthase (ES), hyaluronic acid (HA), and myoglobin were performed. Results. The concentrations of troponin I, myoglobin, and E-1 were normal in all groups. HA concentration was highest among phenotype “E” patients (p = 0.0008). ES concentration in phenotype “E” was more than 2.5 times higher compared to other groups (p = 0.0022). Myoglobin concentration positively correlated with left ventricular myocardium thickness, ES, eosinophil levels, and coronary heart disease (p < 0.05), while ES concentration correlated positively with hypertension. HA concentration negatively correlated with spirometry and echocardiography indicators and positively correlated with eosinophil levels and exacerbations (p < 0.05). Conclusion. Further research is needed to identify biomarkers reflecting the risk of exacerbations in cardiovascular comorbidities in patients with occupational COPD

Oral Cyclosporine in Vernal Keratoconjunctivitis: Indications, Outcomes, and Effect on Corticosteroid Use.

The purpose of this study was to report the indications and outcomes of oral cyclosporine A (oCsA) use in vernal keratoconjunctivitis (VKC) and to assess its effect on corticosteroid use. This retrospective review of VKC cases included patients who were prescribed oCsA. Data on clinical characteristics, demographic profile, and treatment were collected. An acute episode was defined as one requiring oral/topical corticosteroids. The outcome measure was the difference in the number of acute episodes before and after oCsA use. The study included 27 cases (54 eyes) of VKC from 2016 to 2024. The median age was 20 years. Thirty eyes had sequelae due to VKC, the most common of which was limbal stem cell deficiency (46%). The median duration of follow-up was 11 months. Indications for oCsA were recalcitrant disease (23/27, 85%) and severe active allergy in steroid-induced glaucoma/steroid responders (4/27, 15%). None of the cases experienced progression of sequelae with oCsA use. Forty-two acute episodes were observed before oCsA initiation over 403 person-months, which reduced to 10 episodes over 250 person-months with oCsA use. Without oCsA use, the odds of developing an acute exacerbation of the ocular allergy were 2.6 times (95% confidence interval: 1.3-5.2) higher compared with that with oCsA usage. Oral cyclosporine reduces corticosteroid use in VKC and can be considered in recalcitrant disease or in eyes with steroid-induced glaucoma and active allergy. Oral cyclosporine significantly reduced the risk of acute exacerbations, proving to be an effective modality for controlling inflammation in VKC.

Exacerbation and Mortality Risk in Individuals with Bronchiectasis Post-COVID-19 Recovery

Exacerbation and Mortality Risk in Individuals with Bronchiectasis Post-COVID-19 Recovery

Impact of Triple Inhaler Therapy on COPD Patients with Non-Small Cell Lung Cancer After Radical Surgery: A Single-Centre Retrospective Analysis.

Background: Chronic obstructive pulmonary disease (COPD) is among the most relevant comorbidity associated with lung cancer. The advent of innovative triple treatment approaches for COPD has significantly improved patients' quality of life and outcomes. Few data are available regarding the impact of triple inhaler therapy on patients featuring COPD and lung cancer. Methods: We retrospectively evaluated the impact of triple inhale bronchodilators in a cohort of 56 patients with treated COPD who underwent lung surgery for primary cancer. Results: Triple bronchodilation can help to relieve the symptoms of the disease and improve lung function, allowing people with lung cancer to reduce the risk of serious exacerbations and improve their quality of life. Conclusions: Within the limits of the study, it should be underlined that bronchodilators can effectively affect the outcome and performance status after thoracic surgery.

Sputum Microbiota Correlates With Metabolome and Clinical Outcomes in Asthma-Bronchiectasis Overlap.

To investigate the microbiota and metabolome of patients with ABO compared with bronchiectasis and asthma, and determine the relevance with clinical characteristics, inflammatory endotype and exacerbation risks. In this prospective cohort study, patients underwent comprehensive assessments, including sputum differential cell count, and sputum collection at baseline. Sputum microbiota was profiled via 16S rRNA gene sequencing and metabolome via liquid chromatography/mass spectrometry. Shannon-Wiener Diversity Index (SWDI) was used to reflect dysbiosis. Patients were followed-up to record exacerbations. ABO patients were stratified by the SWDI and sputum eosinophilia to determine the exacerbation risks. Two hundred forty-seven patients were recruited, including 99 ABO (median age: 53.2 years, 65.7% female), 61 asthma (median age: 39.5 years, 50.8% female) and 87 bronchiectasis patients (median age: 52.3 years, 55.2% female). Both microbiota compositions and metabolites differed among asthma, ABO and bronchiectasis, and between eosinophilic and non-eosinophilic ABO at steady-state. Baseline SWDI of microbiota was highest in asthma, followed by ABO. Both Pseudomonadaceae and Rothia most effectively discriminated ABO from asthma and bronchiectasis. Pseudomonas exhibited a more pronounced negative correlation with other taxa in nonEos-ABO. ABO patients with low SWDI with sputum eosinophilia, or those with high SWDI without sputum eosinophilia, had a shorter time to the first exacerbation. Metabolomic compositions in Eos-ABO separated from nonEos-ABO. The relative abundance of Enterobacteriaceae correlated negatively with 15-hydroxylated eicosatetraenoic acid, whose concentrations were higher in Eos-ABO. Integrating microbiota and metabolome profiles, together with eosinophilic inflammatory endotyping, can inform exacerbation risk and personalized management of ABO.

Combination Inhaled Corticosteroid and Short-acting Beta2 Agonist (ICS-SABA) Use for Older Adults With Asthma

The first combination inhaled corticosteroid and short-acting beta2 agonist (ICS-SABA) was approved by the Food and Drug Administration (FDA) in 2023 for as-needed treatment or prevention of bronchoconstriction and to reduce the risk of asthma exacerbations in patients 18 years of age and older. The recently approved product contains an ICS-albuterol combination. The 2024 Global Initiative for Asthma (GINA) guidelines recommend as-needed ICS-formoterol as the preferred asthma reliever therapy; however, a GINA alternative recommendation is the use of ICS whenever an as-needed (SABA) is used. There is no difference in as-needed asthma treatment recommended by the GINA guidelines in older adults, and there has been minimal study in older adults. Because of limited guidance on the use of the ICS-SABA reliever inhaler in older adults, the purpose of this review is to evaluate the DENALI and MANDALA studies and the potential role of ICS-SABA in older adults. The mean ages in both studies were 50 years. The MANDALA primary outcome result was a statistically significant lower risk of severe exacerbations in the ICS-SABA reliever group compared with the as-needed albuterol (ALB) group at 24 weeks. In the MANDALA older adults subgroup analysis, there was not a statistically significant difference in the ICS-SABA reliever group compared with the as-needed ALB-alone group but the results favored ICS-SABA. The DENALI primary outcome results were a greater change from baseline in forced expiratory volume in the first second (FEV1) area under the curve averaged over 12 weeks with albuterol/budesonide (ALB-BUD) 180/160 ug compared with budesonide alone and placebo and a greater change from baseline in trough FEV1 with ALB-BUD 180/160 ug and 180/80 ug than ALB-alone and placebo. Because of minimal adverse effects in both trials and the benefits in preventing asthma exacerbations reported in the MANDALA trial, it is important to assess and recommend that older adults with asthma receive inhaled corticosteroid with their reliever asthma inhaler.

Prevalence and Clinical Outcomes of Eosinophilic COPD in a Saudi Population: A Retrospective Study

Abstract Objective: This study assessed the prevalence of eosinophilic chronic obstructive pulmonary disease (COPD) among a selected Saudi population and examined its correlation with baseline characteristics, clinical outcomes, exacerbation risk, and current management. Materials and Methods: This retrospective single-center study was conducted over a 2-year period. The patients were divided into two groups based on the blood eosinophil count at the time of diagnosis: eosinophilic COPD (≥300 cells/μl) and non-eosinophilic COPD (<300 cells/μl) groups. Results: Overall, 156 patients were included, of which 76 (48.7%) and 80 (51.3%) patients belonged to the eosinophilic and non-eosinophilic COPD groups, respectively. There were no significant differences between both groups regarding age, gender, smoking status, coexisting morbidities, FEV1, FEV1/FVC, and COPD severity (for all, P >0.05). Besides, there were no significant differences between both groups regarding the frequency and numbers of exacerbations, emergency room visits, in-patient hospitalizations, and intensive care unit admissions (for all, P >0.05). Among patients with eosinophilic COPD, 64 patients (84.2%) were correctly receiving the triple therapy of long-acting β2 agonists + long-acting muscarinic antagonist + inhaled corticosteroids, whereas 4 patients (5.26%) were incorrectly receiving the dual therapy of long-acting β2 agonists + inhaled corticosteroids. Univariate regression analyses revealed that heart failure, GOLD 3 severity, use of triple therapy, and use of non-invasive ventilation were significantly correlated with a higher risk of COPD exacerbation. Conversely, higher FEV1 was significantly correlated with lower risk of COPD exacerbation. The eosinophilic COPD phenotype was not found to be a significant independent variable of COPD exacerbation. Conclusion: This study found that among Saudi patients with COPD, there was no clinically important relationship between baseline blood eosinophil count and the rate of exacerbation.

Dysregulation of Airway and Systemic Interferon Responses Promote Asthma Exacerbations in Urban Children.

Determining why some upper respiratory illnesses provoke asthma exacerbations remains an unmet need. To identify transcriptome-wide gene expression changes associated with colds that progress to exacerbation. 208 urban children (6-17 years) with exacerbation-prone asthma were prospectively monitored for up to two cold illnesses. Exacerbation illnesses (Ex+), defined as colds leading to asthma exacerbations requiring systemic corticosteroids within 10 days, were compared to colds that resolved without exacerbation (Ex-). Peripheral blood and nasal lavage samples were collected at baseline and during colds for RNA sequencing. Interferon gene expression was compared between Ex+ and Ex- illnesses. Generalized additive modeling revealed interferon response kinetics. Multiple linear regression models compared interferon expression to clinical variables. 106 participants were evaluated during 154 colds. There was greater up-regulation of differentially expressed interferon genes during Ex+ illnesses compared to Ex-. Ex+ illnesses had greater average and steeper rise in interferon expression. Within three days of illness, interferon expression was positively associated with nasal rhinovirus quantity (nasal:adjustedR2=0.48, p=0.015; blood:adjustedR2=0.22, p=0.013) and interferon expression was negatively associated with FEV1 percent predicted (nasal:β=-0.010, p=0.048; blood:β=-0.008, p=0.023). Participants with lower baseline interferon expression had shorter time to exacerbation, higher risk for exacerbation with viral illnesses and greater increase in interferon expression during viral colds (nasal:β=-0.80, p<0.0001; blood:β=-0.75, p<0.0001). Dysregulated interferon responses are important contributors to asthma exacerbation risk in children. Low baseline interferon expression followed by greater up-regulation of interferon pathways in airway and blood during respiratory illnesses increased exacerbation risk. Targeting this pathway in at-risk individuals holds promise for the personalized prevention of asthma exacerbations.

Data Insights on the Risks of Local Heat and Massage in Gouty Arthritis Treatment.

Gouty arthritis is a common inflammatory condition caused by the deposition of uric acid crystals in the joints, leading to intense pain, swelling, and functional impairment. Thermal therapies, including hot and cold fomentation, are often used as adjunctive treatments for managing inflammation and pain in various musculoskeletal conditions. However, the efficacy of these therapies in acute gout remains underexplored. This study aims to compare the effects of hot fomentation versus cold fomentation in patients experiencing acute gout flares, assessing pain reduction, swelling, joint mobility, and overall patient satisfaction. A randomized controlled trial was conducted with 2,400 patients diagnosed with acute gouty arthritis, divided into two equal groups: Group A received hot fomentation (38°C-42°C) and Group B received cold fomentation (5°C-10°C). Both interventions were applied twice daily for 20 min over 5 days, alongside standard gout care. Pain intensity was measured using the visual analog scale (VAS), while joint circumference, range of motion, and patient satisfaction were recorded at baseline, day 3, and day 5. Statistical analyses compared outcomes between the two groups. Cold fomentation significantly reduced pain intensity (VAS score reduction of 68% by day 5) compared to hot fomentation (26% reduction, P < 0.001). Joint swelling decreased by 25% in the cold group versus 5% in the hot group, with cold therapy also leading to greater improvements in joint mobility (average increase of 15° vs. 5°, P < 0.01). Notably, 35% of patients in the hot fomentation group experienced flare-ups, compared to only 2% in the cold fomentation group (P < 0.001). Patient satisfaction was also higher in the cold group, with 85% of participants reporting satisfaction versus 30% in the hot group. This study demonstrates that cold fomentation is significantly more effective than hot fomentation in managing acute gouty arthritis. Cold therapy provided superior pain relief, reduced swelling, improved joint mobility, and minimized the risk of symptom exacerbation. In contrast, hot fomentation often worsened symptoms, making it unsuitable for acute gout management. These findings suggest that cold fomentation should be the preferred thermal therapy for gout flare-ups, while heat applications should be avoided.

Dietary sodium intake restriction in patients with heart failure: an overview of systematic reviews.

This study aimed to identify, assess, and summarize systematic reviews on dietary sodium intake restrictions for patients with heart failure. Literature searches were conducted on Pubmed, CINAHL, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure, and the Wanfang Database up to January 2024. The methodological quality of the included reviews was assessed using the quality assessment tool from the Australian JBI Center for Evidence-Based Healthcare (2016). The results of systematic reviews and meta-analyses were synthesized and presented according to different outcome indicators. Nine systematic reviews were included in this study. The current evidence does not support the fact that dietary sodium intake restrictions for patients with heart failure have a positive impact on mortality rates, rehospitalization rates, and quality of life. Conversely, strict dietary sodium intake restrictions (≤ 2000mg/day) may increase the risk of death, rehospitalization, and symptom exacerbation. Dietary sodium intake restriction may not have a positive impact on clinical outcomes in patients with heart failure. Nevertheless, more evidence is required to explore the differences in the impact of various levels of dietary sodium restriction on the outcomes and symptom management indicators of patients with heart failure.

Comparative Effectiveness of Fluticasone Furoate/Umeclidinium/Vilanterol and Budesonide/Glycopyrrolate/Formoterol Fumarate among US Patients with Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is associated with exacerbations which can reduce quality of life and increase mortality. Single-inhaler triple therapy (SITT) is recommended for maintenance treatment of COPD among patients experiencing exacerbations despite dual-therapy use. This real-world comparative effectiveness study compared the impact of SITTs, fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI), and budesonide/glycopyrrolate/formoterol fumarate (BUD/GLY/FORM), on COPD exacerbations and mortality. Medicare Fee-for-Service (FFS) patients with COPD initiated on FF/UMEC/VI or BUD/GLY/FORM were identified from the Komodo Research healthcare claims dataset (01/01/2016-12/31/2023). Overlap weighting based on high-dimensional propensity scores evaluated from patient characteristics was used to adjust for baseline confounding. Primary outcome was annualized rate of moderate-severe COPD exacerbations (per patient-year; PPY) compared using rate ratios (RRs) with 95% confidence intervals (CIs) from weighted Poisson regression models. Secondary and exploratory outcomes were risk of moderate-severe COPD exacerbations and all-cause mortality, respectively, evaluated using Kaplan-Meier analysis and hazard ratios (HR) with 95% CIs from Cox proportional hazard models. A secondary analysis was conducted among a mutually exclusive population with Medicare Advantage, Medicaid, or commercial insurance. Overall, 32,312 FF/UMEC/VI and 12,230 BUD/GLY/FORM Medicare FFS patients were included. After weighting, median follow-up was 9months. Compared with BUD/GLY/FORM, FF/UMEC/VI users had a 12% lower rate of annualized moderate-severe COPD exacerbations [0.80 and 0.91 PPY; RR (95% CI): 0.88 (0.85-0.92); P<0.001] and a 10% lower risk of moderate-severe exacerbations at 12months post-initiation [HR (95% CI): 0.90 (0.87-0.93); P<0.001], driven by moderate exacerbations. FF/UMEC/VI compared with BUD/GLY/FORM users had 11% lower risk of all-cause mortality at 12months post-initiation [5.6% vs. 6.4%; HR (95% CI): 0.89 (0.80-0.98); P=0.020]. Results were consistent among patients with Medicare Advantage, Medicaid, or commercial insurance. In this real-world comparative effectiveness study, FF/UMEC/VI was associated with significantly lower rate and risk of COPD exacerbations than BUD/GLY/FORM.

Genotype-Guided Asthma Treatment Reduces Exacerbations in Children: Meta-Analysis of Two RCTs.

Long-acting beta2-agonists (LABA) in combination with inhaled corticosteroids (ICS) are commonly used to treat asthma, however, some children lack response to the addition of LABA. This might be partially due to the presence of the Arg16Gly polymorphism, encoded by rs1042713 G>A in the ADRB2 gene. Carrying the A allele (Arg16) at this variant has been associated with an increased risk of exacerbations despite LABA treatment. We investigated whether genotype-guided treatment improved asthma-related outcomes. We conducted an individual participant data meta-analysis of two randomised controlled trials: PUFFIN (Dutch and Swiss 6-18 year-olds) and PACT (English and Scottish 12-18 year-olds). Children with uncontrolled asthma despite ICS who required a step-up in treatment were included. Participants were randomised to genotype-guided treatment or the control group with a follow-up of at least 6 months. Genotype-guided treatment consisted of adding LABA for children with ADRB2 Gly16/Gly16, whilst children with ADRB2 Arg16/Arg16 or Arg16/Gly16 were treated with double dose ICS (PUFFIN) or add-on montelukast (PACT). The primary outcome was a change in asthma control; secondary outcomes included exacerbation rate and time to exacerbation. Repeated measures mixed models and Cox regression were used. Fifty-nine out of 102 (PUFFIN) and 59 out of 91 (PACT) children had at least one Arg (A allele). Amongst all 193 children, no difference was observed in asthma control between the study groups. However, genotype-guided treatment resulted in lower asthma exacerbation rates (-0.08 (95%CI -0.16 to -0.00, p = 0.04)) compared to the control group. Genotype-guided step-up treatment for children with uncontrolled asthma on ICS may lower asthma exacerbation rates and may be useful for personalising asthma care.

INDICATORS OF APOPTOTIC ACTIVITY IN PATIENTS WITH COMBINED STAGE II ESSENTIAL HYPERTENSION AND STAGE II-III CHRONIC OBSTRUCTIVE PULMONARY DISEASE BASED ON COMORBIDITY CLINICAL FEATURES

The purpose of the study is to improve the diagnosis, prognosis and treatment of chronic obstructive pulmonary disease stage II-III in combination with essential hypertension stage II based on the study of the clinical and pathogenetic role of apoptosis markers. Introduction. Chronic obstructive pulmonary disease (COPD) is a progressive, chronic condition characterized by recurrent exacerbations that are the primary reason for COPD patients to seek medical care, accounting for hospitalizations and contributing to mortality rates. Frequent exacerbations are associated with reduced quality of life and poorer prognoses. Each episode accelerates the progression of COPD, exacerbating respiratory failure and complicating its management. Severe exacerbations pose a significant threat to life and are a leading cause of fatal outcomes. Essential hypertension (EH), often observed in the course of COPD, depends on the severity of the pulmonary pathology and bronchial tree obstruction. In such cases, it is termed pulmonogenic hypertension, occurring in 18–30% of cases. Conversely, COPD may develop under pre-existing hypertensive disease or symptomatic arterial hypertension. The interplay of these conditions substantially influences their clinical course and outcomes. The study aims to enhance the diagnosis, prognosis, and treatment of stage II–III COPD combined with stage II essential hypertension by investigating the clinical and pathogenetic role of apoptosis markers. Materials and methods. The results of the study are based on the data of a comprehensive examination and dynamic observation of 121 patients of both sexes, aged from 30 to 67 years, who were examined over the period 2016-2018 years and underwent inpatient treatment at the Zaporizhzhya Regional Clinical Hospital. The patients were divided into 3 groups, comparable by age and sex: the main group included 40 patients with chronic obstructive pulmonary disease stage II-III (moderately severe course) in combination with essential hypertension stage II of various cardiovascular risk (average age 50.81±0.99 years); the 1st comparison group included 48 patients with chronic obstructive pulmonary disease stage II-III (average age 50.7±1.53 years); the 2nd comparison group consisted of 33 patients with essential hypertension stage II of various cardiovascular risk (average age 51.68±1.22 years). To determine the reference values ​​of the studied indicators, 20 healthy people were examined as a control group. Results. The analysis of the dynamics of cysteine proteases revealed a statistically significant increase in these apoptosis markers in patients with comorbid chronic obstructive pulmonary disease (COPD) and essential hypertension (EH). This elevation was associated with advancing age, longer disease duration, and greater severity of both COPD and EH. Regression analysis indicated a strong relationship between blood caspase-7 levels and future exacerbation risks, as measured by the SAT score. The relationship is best described by a quadratic regression model, with the following parameters: R = 0.73, R² = 0.53, normalized R² = 0.51, F = 39.56, p &lt; 0.001. Conclusion. Apoptotic processes play a significant role in the development of exacerbations in the comorbid course of chronic obstructive pulmonary disease and essential hypertension.

Asthma Exacerbation Risk in Pregnancy and Postpartum: Assessing the Impact of Gestational Diabetes Mellitus and Other Key Factors.

Asthma, affecting approximately 13% of pregnancies worldwide, and gestational diabetes mellitus (GDM), present in about 14%, are both associated with adverse maternal and perinatal outcomes. This study aims to address a lack of current knowledge about how GDM affects asthma during pregnancy. To determine whether GDM is associated with an increased risk of asthma exacerbations during pregnancy and the first year postpartum. This retrospective cohort study analyzed electronic health records of pregnant asthma patients from 2010-2023, excluding those with pre-existing diabetes mellitus or concurrent chronic lung diseases. Asthma exacerbations were defined by the need for an oral corticosteroid (OCS) prescription. Multivariable logistic regression and zero-inflated Poisson regression were used to adjust for age, race, body mass index (BMI), pre-pregnancy asthma exacerbation history, and insurance status. Among 10985 individuals, 1492 had GDM. Patients with GDM were older with higher BMIs. GDM was associated with increased asthma exacerbation risk during pregnancy (adjusted OR 1.36, 95% CI 1.10-1.67), but not postpartum. Stratified analyses of 4331 individuals with gestational blood glucose measurement showed that each doubling of blood glucose levels doubled the risk of asthma exacerbations during pregnancy (adjusted OR of 2.02, 95% CI 1.45-2.81). Other factors associated with asthma exacerbation included pre-pregnancy asthma exacerbations, older age, and Medicaid coverage. The association between GDM and increased risk of asthma exacerbations underscores the need for early, universal screening and effective interventions to improve blood glucose control in pregnant individuals with pre-existing asthma.

Prognostic Impact of Hospital Discharge After Heart Failure Admission Without Structured Heart Failure Follow-Up.

(1) Objective. The aim was to evaluate the risk of new exacerbations of heart failure (HF) in patients discharged from hospital emergency departments (EDs) without a structured HF follow-up. (2) Methods. This prospective, single-center cohort study included patients discharged from the ED following hospital admission for acute HF. The study analyzed the profile of patients seen in the ED and assessed their risk of new ED visits or HF-related hospitalizations within 12 months of discharge. (3) Results. A total of 779 patients were included, with a mean age of 82 ± 8 years; 471 were women (60.4%), and 674 (86.7%) had a history of prior HF episodes. Of these, 591 patients (76.1%) were referred to an unstructured HF follow-up in primary care (PC). Patients who experienced HF exacerbations within 12 months of ED discharge had a higher incidence of chronic kidney disease, elevated natriuretic peptide levels, and a higher number of prior HF exacerbations and were more likely to receive unstructured HF follow-up in PC. The presence of the last two factors was associated with the highest risk of HF exacerbation within 12 months of discharge (HR: 2.83; 95% CI: 1.60-5.03; p < 0.001). (4) Conclusions. Patients discharged from the ED after an HF episode and referred to PC without a structured HF follow-up have a high risk of ED revisits or rehospitalization for HF.

The Impact of COVID-19 Vaccination on Thyroid Disease in 7 Million Adult and 0.2 Million Adolescent Vaccine Recipients.

Emerging reports have raised concerns regarding the potential link between COVID-19 vaccination and thyroid dysfunction, specifically thyroiditis. This study aimed to investigate the potential association between COVID-19 vaccination and the prevalence of thyroid diseases using data from a Korean national cohort. This study included 7,579,210 adult and 241,063 adolescent vaccine recipients. A self-controlled case series design was applied to estimate the incidence rate ratio (IRR) of thyroid disease during the 55-day post-vaccination period (first and second dose) compared to the baseline period (non-exposure period) using conditional Poisson regression. In the adult population, IRRs for hyperthyroidism, hypothyroidism, subacute thyroiditis, and thyroid eye disease were 0.98 (95% CI 0.89-1.09), 0.91 (95% CI 0.84-0.98), 1.27 (95% CI 0.94-1.72), and 0.68 (95% CI 0.50-0.93) after the first vaccine dose and 0.96 (95% CI 0.87-1.06), 0.93 (95% CI 0.87-0.99), 1.32 (95% CI 0.96-1.80), and 1.06 (95% CI 0.81-1.38) after the second vaccine dose. While the risk of hyperthyroidism recurrence did not increase after vaccination, we observed an increased risk of hypothyroidism exacerbation. Subgroup analyses based on age, sex, and vaccine type revealed no significant differences in the incidence of thyroid diseases. In adolescents aged 12-17 years, no increase in the risk of thyroid disease was observed after vaccination. This extensive national self-controlled case series analysis found an increased risk of exacerbation of hypothyroidism following COVID-19 vaccination. However, no significant association was observed between COVID-19 vaccination and an increased risk of most other thyroid diseases. These findings contribute to increasing evidence supporting the safety of COVID-19 vaccination in relation to thyroid health.

Baseline Characteristics of Dupilumab-Treated Patients with Asthma in the Real World: The RAPID Global Registry.

Patients with uncontrolled, moderate-to-severe asthma have a higher risk for exacerbations, negatively impacting lung function and quality of life. Dupilumab, a fully human monoclonal antibody, blocks interleukins 4 and 13, key and central drivers of type 2 inflammation. Dupilumab has been effective in the treatment of certain types of moderate-to-severe asthma across several clinical trials. We describe the characteristics of patients enrolled in RAPID, a global prospective registry, who initiated dupilumab (primary indication: asthma) in a real-world clinical setting. A total of 205 patients (aged≥12years) were enrolled between March 2020 and October 2021 and are included in this analysis. Data are shown as mean (SD) unless stated otherwise. Patients were aged 50.1 (17.4) years and were mostly female (65.4%) and white (74.1%). At enrollment, 24.4% reported being current/former smokers and 86.8% had moderate-to-severe asthma (Global Initiative for Asthma steps 3-5). A mean (SD) of 4.4 (6.4) severe asthma exacerbations were reported in the year before enrolling in the registry in 78 of 152 patients with available data. Patients had reduced lung function [pre-bronchodilator forced expiratory volume in 1s (FEV1): 2.3 (1.1) L; pre-bronchodilator percent predicted FEV1: 70.3 (20.3) %] and poor asthma control [6-item Asthma Control Questionnaire: 2.4 (1.2); Asthma Quality of Life Questionnaire: 4.1 (1.3)]. The median (Q1-Q3) blood eosinophil count was 305 (200-695) cells/µL and the mean (SD) fractional exhaled nitric oxide levels were 42 (35) ppb (range: 4-186ppb). Our findings suggest that most patients who enrolled in RAPID and initiated dupilumab in real-world clinical settings had a high disease burden, despite receiving current standard-of-care treatment at enrollment.

Prognosis of unipolar depression

Depression, a severe illness with variable outcomes, requires prompt intervention to mitigate the risk of exacerbation and suicide. This review finds that psychopharmacological treatment is critical in severe cases. In mild cases, medication's side effects frequently outweigh the benefits. Prioritising non-pharmacological strategies, especially psychotherapy, is essential for mild to moderate depression. Given its recurrent nature and the risk of lasting cognitive decline, maintenance treatment is vital to avert relapse, particularly for those with a history of multiple episodes.