CAT Score Research Articles

Prognostic and Diagnostic Value of Platelet Distribution Width in COPD Patients with Pulmonary Hypertension: A Retrospective Study.

The objective of the study was to investigate the value of platelet distribution width (PDW) as a prognostic biomarker by comparing PDW between COPD patients with pulmonary hypertension (PH) (PASP 50mmHg) and those without PH (PASP < 50mmHg) and to explore its diagnostic and predictive value in this population. A retrospective study of 270 COPD patients in Liaocheng People's Hospital (July 2018 to July 2019) was done by dividing them into two groups according to pulmonary artery systolic pressure (PASP): COPD-only (PASP <50mmHg) and COPD with PH (PASP ≥50mmHg). Routine blood tests, C-reactive protein, pulmonary function tests, echocardiography, Chronic Obstructive Pulmonary Disease Assessment Questionnaire (CAT), Clinical COPD Questionnaire were performed. PDW was higher in COPD with PH group than COPD-only group. After adjusting for confounders including age, smoking history, CAT scores, white blood cell count, PDW, and NT-proBNP in COPD with PH, PDW was positively correlated with various parameters. PDW can diagnose COPD with PH, also prognostic value and cardiovascular distinction in these patients. The study concluded that PDW is a prognostic marker, reflecting pulmonary and cardiovascular physiology in COPD patients with PH. It can be used for early diagnosis, risk stratification, and individualized management for this high-risk population.

Utility of Diaphragm Dome Height as a Marker of Operational Lung Volume Changes, Disease Burden and Exacerbations in Patients with Mild-to-Moderate COPD: An Observational Study Within the CanCOLD Cohort

BackgroundDynamic hyperinflation is central to dyspnoea, exercise limitation, and exacerbations in chronic obstructive pulmonary disease (COPD). While studied previously in moderate-severe COPD, the relevance of diaphragm dome height on clinically important outcomes has been under-investigated in mild-to-moderate COPD.MethodsCanadian Cohort Obstructive Lung Disease participants with spirometry-confirmed COPD, symptom-limited incremental cardiopulmonary exercise testing, and computed tomography image data were included. Base-to-apex left and right diaphragm dome height (DDH) was automatically segmented, with increased height implying less flattening and thus less hyperinflation. Dynamic hyperinflation was defined as ≥150 mL reduction in inspiratory capacity (IC) from rest to peak-exercise. Cross-sectional linear regression models were fitted between left and right DDH (predictor variables) with peak IC (ICpeak), peak workload (Wpeak), FEV1, and CAT score (outcome variables), and in longitudinal (Anderson-Gill) models with “symptom-based” and “event-based” exacerbations. Results are reported as parameter estimates or hazard ratios with 95%CIs per interquartile range dome height increment.ResultsAmong 304 participants (mean age 64.7±10.3, 41.8% female, 44.4% with mild COPD), each left and right DDH increment, respectively, was associated with ICpeak(0.21[0.13,0.29]L, 0.13[0.07,0.19]L), Wpeak(9.54[5.03,14.04]W, 6.04[2.45,9.62]W), FEV1(0.17[0.10,0.25]L, 0.08[0.02,0.14]L), and CAT score (−1.36[−2.39,−0.33], −0.82[−1.63,0.00]). Left DDH alone was associated with both symptom-based (HR: 0.82[0.74,0.91]) and event-based (0.83[0.73,0.95]) exacerbations. Of 167/304 participants with confirmed dynamic hyperinflation (ΔIC=−0.47±0.25 L), left DDH alone was associated with all outcomes (ICpeak, Wpeak, FEV1, CAT, and symptom-based/event-based exacerbations).ConclusionsLeft DDH appears to be a clinically important marker for operational lung volume changes, lung function, exercise performance, disease burden, and exacerbations in mild-to-moderate COPD.

The Application of Self-Made Disseminating and Descending Breathing Exercises in Home Rehabilitation of Stable COPD

To investigate the clinical effects and application value of self-made disseminating and descending breathing exercises on home rehabilitation of patients with stable chronic obstructive pulmonary disease (COPD). Seeking to generate concepts for creating novel, convenient, and efficient COPD prognosis rehabilitation exercises aimed at enhancing the well-being and rehabilitation confidence of both COPD patients and their families. A total of 70 COPD patients admitted to our outpatient department from July 2019 to September 2021 were randomly divided into the exercise group (n = 35) and the control group (n = 35). The control group received routine breathing training, while the exercise group was treated with self-made disseminating and descending breathing exercises. The respiratory function, including pulmonary function (FVC, FEV1, FEV1/FVC) and respiratory muscle strength (MIP, MEP), exercise tolerance (6-min walking distance, 6MWT), Modified Medical Research Council Dyspnea Scale (mMRC, Borg), COPD quality of life score (CAT, SGRQ), anxiety and depression scores (HAMA, HAMD) were compared between the two groups after 12-week exercise. After 12-week training, the FEV1, MIP, and MEP in the exercise group were significantly higher than those in the control group (p < 0.001), and the 6MWT was significantly increased in the exercise group compared to the control group (p < 0.001); while the mMRC, Borg score, the scores of CAT, SGRQ, HAMA, and HAMD were found significantly lower than those in the control group (p < 0.001). The self-made disseminating and descending breathing exercises can improve respiratory function and reduce symptoms of dyspnea in COPD patients, while enhancing exercise tolerance and relieving anxiety and depression, and are worthy of clinical application.

Developing Linkages Between PROMIS Physical Function CAT and QuickDASH Scores in Hand Surgery: A Crosswalk Study.

There is no standardization within hand and upper-extremity surgery regarding which patient-reported outcome measures (PROMs) are collected and reported. This limits the ability to compare or combine cohorts that utilize different PROMs. The aim of this study was to develop a linkage model for the QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand) and PROMIS PF CAT (Patient-Reported Outcomes Measurement Information System Physical Function computerized adaptive testing) instruments to allow interconversion between these PROMs in a hand surgery population. A retrospective review was conducted to identify adults (≥18 years old) who had completed the QuickDASH and PROMIS PF CAT instruments at the same clinical encounter. Patients with shoulder pathology were excluded. The linear relationship between scores was evaluated with use of the Pearson correlation coefficient. Linking was performed with use of several common methods, and an optimal linkage model was recommended on the basis of a higher R2, strong intraclass correlation coefficient (ICC), and lower standard error (SE). The recommended model was further evaluated in subgroups based on age (<60 or ≥60 years), sex, etiology for presentation (traumatic versus atraumatic), and treatment type (operative versus nonoperative). A total of 15,019 patients (mean age, 49 years; 54% female; 86% White) were included. The mean QuickDASH score (and standard deviation) was 37 ± 22, and the mean PROMIS PF CAT score was 45 ± 10. There was a strong negative linear relationship between the QuickDASH and PROMIS PF CAT (r = -0.73). The circle-arc linkage model demonstrated good accuracy and reliability (R2 = 0.55; ICC = 0.71), and crosswalk tables were developed from this model. The subgroup analysis demonstrated age-related bias in the linkage model (root expected mean squared difference, 0.12). To address this, a separate crosswalk table was developed, which was dichotomized by age category. The QuickDASH and PROMIS PF CAT scores were successfully linked. Utilization of the developed crosswalks-one specific to patients <60 years old and another specific to patients ≥60 years old-will allow for score interconversion in future meta-analyses and multicenter hand surgery studies. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Procalcitonin-guided use of antibiotic in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease: a randomized clinical trial.

To analyze the effect and safety of PCT-guided antibiotic therapy in patients with AECOPD. We conducted a multicenter, open-label, randomized controlled trial among patients hospitalized for AECOPD in six hospitals in China. Enrolled patients were randomly assigned to either the PCT-guided group or the Global Initiative for Chronic Obstructive Lung Disease（GOLD）strategy -guided group. The co-primary endpoints were antibiotic prescription rate for AECOPD within 30days after randomization (to demonstrate superiority) and treatment success rate at day 30 after randomization (to demonstrate noninferiority). For primary outcomes, χ2 test, corrected χ2 test, or Fisher's exact test was used to evaluate the differences between the intervention and control groups. 95% confidence intervals (95% CIs) were calculated for all the outcomes. secondary outcomes, including days of antibiotic use during hospitalization, length of hospital stay, and change in mMRC and CAT score, were compared using the Student's t-test, with corresponding differences and 95% CIs calculated. Intention to treat (ITT)population were those who received randomization, and Per-Protocol population were those who strictly adhere to the treatment plan. A total of 455 patients underwent randomization, with 229 in the PCT-guided group and 226 in the GOLD-guided group. The rate of antibiotic prescription for AECOPD by day 30 was significantly lower in the PCT-guided group than that in the GOLD-guided group (38% [88/229] vs 59% [134/226]; difference -21%; 95% confidence interval [CI], -30% to -12%; p<0.0001) in the ITT analysis. There was no significant difference in the clinical treatment success rate by day 30 between the two groups (97% [223/229] vs 94% [212/229]; difference 4%, 95% CI, 0 to 7%; p=0.06). Compared with the GOLD strategy, PCT-guided antibiotic therapy was significantly associated with lower antibiotic prescription rate during hospitalization (37% vs 59%, difference -22%, 95% CI, -31 to -13; p<0.0001), and fewer days of antibiotic use during hospitalization (2.63 ± 4.66 vs 4.86 ± 4.83, difference -2.23days, 95%CI, -1.35 to -3.11; p<0.0001). There were no significant differences between the two groups in length of hospital stay, subsequent exacerbation rate, hospital readmission rate, ICU admission, and 30-day mortality in the ITT analysis. The results in the PP analysis were consistent with that in the ITT analysis. Compared with the GOLD strategy, PCT-guided antibiotic therapy significantly reduced the rate of antibiotic prescription for patients with AECOPD, without negatively affecting the treatment success rate.

Clonal hematopoiesis of indeterminate potential: a risk factor for future exacerbation in patients with COPD

BackgroundThere is limited data regarding the clinical significance of clonal hematopoiesis of indeterminate potential (CHIP) in patients with COPD. We aimed to evaluate whether CHIP could serve as a biomarker for the long-term prognosis of patients with COPD.MethodsNext-generation sequencing was used to detect CHIP in peripheral blood mononuclear cell samples. Participants with COPD were enrolled in a prospective observational cohort between January 2013 and December 2023. We investigated the association of CHIP status with the risk of subsequent acute exacerbation and longitudinal changes in lung function, by using negative binomial regression and linear mixed regression models, respectively.ResultsAmong 125 patients with COPD, the CHIP-positive group was 32 (25.6%). Higher smoking intensity and CAT score were significantly associated with increased risk of positive CHIP status, especially in current smokers. Positive CHIP of specific genes was significantly associated with a higher risk of subsequent mild and total acute exacerbation. Positive CHIP of ASXL transcriptional regulator 1 (ASXL1) had a lower risk of subsequent total acute exacerbation (aOR, 0.19; 95% CI, 0.04–0.95). The CHIP status did not show a statistically significant association with longitudinal changes in lung function.ConclusionsIn patients with COPD, CHIP positivity was significantly associated with an increased risk of subsequent acute exacerbations, but not with longitudinal changes in lung function.

Real World Study on the Reasons for eScalation or de-Escalation of Inhaled ThEraPies in COPD Patients: the STEPINCOPD Multicenter Observational Study

Background There is limited data on the reasons for escalation or de-escalation of COPD inhaled therapies in routine clinical practice, especially after the follow-up pharmacological treatment guidance on the 2019 GOLD report and the 2020 ERS guideline on ICS withdrawal. Methods The STEPINCOPD study was a 12-week, two-visit, prospective observational study that aimed to describe the reasons for change of inhaled therapies, in accordance with GOLD recommendations 2021. Only patients that had a recent change in their inhaled medication were enrolled. Moreover, we investigated associations between physicians’ and patients’ characteristics and adherence to GOLD recommendations. Results 1429 patients were enrolled from 146 centers (138 private practice and 8 hospitals) throughout Greece. At enrollment, the most frequent reasons for treatment change were lack of clinical (78.9%) or spirometric (49.5%) response to previous treatment, change in CAT score (45.1%), and mMRC score (28.2%). At the follow-up visit, most common reasons were lack of clinical response to previous treatment (71.4%), COPD exacerbations (59.5%), changes in CAT score (52.4%), lack of spirometric response (42.9%) and lower respiratory tract infections (31%). We observed high adherence to the GOLD 2021 recommendations (81.6% at enrollment and 92.9% at follow-up). Physicians’ age and consideration of GOLD recommendations for prescription choice, as well as patients’ CAT score were significant predictors of adherence to GOLD. Conclusion The STEPINCOPD study highlights the reasons for inhaled treatment change in Greek physicians with high adherence to GOLD recommendations and provides insights for future research that may inform the development of decision support tools.

Inhaler personalisation based on peak inspiratory flow (PIF) among dry powder inhaler users: a pilot randomised control trial (RCT) in COPD.

Dry powder inhalers (DPIs) are commonly used among patients with Chronic Obstructive Pulmonary Disease (COPD). These inhalers are breath-actuated, and require patients to generate sufficient peak inspiratory flow (PIF) to disaggregate the drug powder into respirable fine particles and deliver it to the lower airway tracts. Inhaler personalisation based on PIF among DPI users has not been studied in Malaysia, thus we conducted the present pilot study to determine the feasibility of conducting such research among COPD patients. This was an open-label pilot randomised control trial, conducted from June 2021-January 2022 at the respiratory clinic of Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia. Measurement of PIF was performed with In-Check DIAL G16 among adult COPD patients treated with DPI and had suboptimal PIF. Eligible subjects were randomised using block randomisation into two groups, either the interventional group or the control group. Twenty-two COPD patients fulfilled the study criteria and were randomised to intervention (n = 11) and control (n = 11) groups. For the interventional group, there were statistically significant improvements between baseline and at 12 weeks for both FEV1 and CAT scores. The mean (% predicted) FEV1 were 54.6 ± 20.4% and 56.6 ± 19.8% (p = 0.026), pre-and post-intervention. The mean CAT score at baseline was 24.4 ± 5.8 and reduced to 19.6 ± 4.4 at 12 weeks (p = 0.012). For the control group, the mean (% predicted) FEV1 at baseline was 58.0 ± 21.9% and 56.5 ± 20.7% at 12 weeks, with no statistical significance difference (p = 0.143). However, there was a statistically significant difference in CAT scores at baseline and 12 weeks, with a mean of 26.5 ± 6.1 and 23.3 ± 5.6, respectively (p = 0.010). The findings from the present pilot RCT highlighted that inhaler personalisation based on PIF among COPD patients was feasible and practical.

Research of related factors of depression in COPD patients.

We aimed to investigate the related risk factors of depression in patients with chronic obstructive pulmonary disease (COPD) to detect depressed patients early and perform timely intervention to improve the disease prognosis of chronic obstructive pulmonary disease. This cross-sectional study included COPD patients who were discharged from the First People's Hospital of Hefei, China from October 2018 to October 2019, and all participants were diagnosed with COPD according to the Global Initiative for Chronic Obstructive Pulmonary Disease. There was no COPD exacerbation during follow-up 1 month after discharge. Psycho-cognitive disorders, psychiatric disorders or other conditions causing psychiatric symptoms were excluded. We divided stable patients with chronic obstructive pulmonary disease into depression group (HAM-D 24 ≥ 8) and non-depression group (<8), and compared the sociodemographic data, clinical characteristics and serum inflammatory parameters between the 2 groups. In this cross-sectional study, 100 eligible COPD patients were initially recruited, 64 of whom completed all the programs. Univariate logistic regression analysis, female, chronic obstructive pulmonary disease assessment test (CAT) score, serum interferon alpha-a (IFN-α) level, and low smoking index were associated with depression in patients with chronic obstructive pulmonary disease. Multivariate logistic regression analysis showed that high serum IFN-α level (OR = 1.099, 95% CI: 1.010-1.196; P = .028), high CAT score (OR = 1.250, 95% CI: 1.052-1.484; P = .011) and low smoking index (OR = 10.154, 95% CI: 1.886-54.664; P = .007) were significant risk factors for depression in patients with chronic obstructive pulmonary disease. Our findings suggest that high serum IFN-α levels, and high CAT scores are risk factors for comorbid depression in COPD patients. Continuous high-dose smoking may aggravate the primary disease and ultimately aggravate depression.

The Effect of the Severity of Chronic Obstructive Pulmonary Disease on the Pituitary Gonadal Axis

This study aims to investigate the levels of anabolic hormone implicated in specific clinical symptoms of chronic obstructive pulmonary disease (COPD) in relation to disease severity. Sixty-four male patients with COPD for at least two years were included. COPD diagnosed was based on pulmonary function tests, with severity classified using the CAT score and mMRC breathlessness scale. Levels of various hormones including TSH T3 T4, FSH, LH, testesterone, prolactin, progesterone and CRP were measured. Arterial blood gases were also analyzed. Patients were categorized according to GOLD stages. LH, FSH levels decreased during exacerbation, with a significant positive correlation between LH and low arterial oxygen levels. lower testosterone levels were statistically significant in severe COPD patients with FEV1 &lt; 50%. A decrease in LH, testosterone FSH, TSH, progesterone and prolactin was observed with low blood oxygen levels, indicating dysfunction in the hypothalamic-pituitary-gonadal axis. However,stastistical significance varied.In conclusion, hormonal changes occur in male COPD patients, particulary related to disease severity. Testesterone levels correlate significantly with COPD severity. LH decrease during pronounced hypoxemia period was notable. Further research is necessary to evaluate the safety and efficacy of testosterone supplementation in COPD patients.

Evaluation of CAT Score in a Cross-Sectional Study of Construction Site Workers with COPD

Evaluation of CAT Score in a Cross-Sectional Study of Construction Site Workers with COPD

Psychometric properties of computerized adaptive testing for chronic obstructive pulmonary disease patient-reported outcome measurement

BackgroundComputerized adaptive testing (CAT) is an effective way to reduce time, repetitious redundancy, and respond burden, and has been used to measure outcomes in many diseases. This study aimed to develop and validate a comprehensive disease-specific CAT for chronic obstructive pulmonary disease (COPD) patient-reported outcome measurement.MethodsThe discrimination and difficulty of the items from the modified patient-reported outcome scale for COPD (mCOPD-PRO) were analyzed using item response theory. Then the initial item, item selection method, ability estimation method, and stopping criteria were further set based on Concerto platform to form the CAT. Finally, the reliability and validity were validated.ResultsThe item discrimination ranged from 1.05 to 2.71, and the item difficulty ranged from − 3.08 to 3.65. The measurement reliability of the CAT ranged from 0.910 to 0.922 using random method, while that ranged from 0.910 to 0.924 using maximum Fisher information (MFI) method. The content validity was good. The correlation coefficient between theta of the CAT and COPD assessment test and modified Medical Research Council dyspnea scale scores using random method was 0.628 and 0.540 (P < 0.001; P < 0.001) respectively, while that using MFI method was 0.347 and 0.328 (P = 0.007; P = 0.010) respectively. About 11 items (reducing by 59.3%) on average were tested using random method, while about seven items (reducing by 74.1%) on average using MFI method. The correlation coefficient between theta of the CAT and mCOPD-PRO total scores using random method was 0.919 (P < 0.001), while that using MFI method was 0.760 (P < 0.001).ConclusionsThe comprehensive disease-specific CAT for COPD patient-reported outcome measurement is well developed with good psychometric properties, which can provide an efficient, accurate, and user-friendly measurement for patient-reported outcome of COPD.

Impact of pulmonary rehabilitation on exercise capacity, health-related quality of life, and cardiopulmonary function in lung surgery patients: a retrospective propensity score-matched analysis.

Pulmonary rehabilitation is considered beneficial for patients undergoing lung surgery, yet its specific impacts on exercise capacity, health-related quality of life (HRQL), and cardiopulmonary function require further elucidation. This study aimed to evaluate the effect of PR on these outcomes in patients undergoing lung surgery using a retrospective propensity score-matched analysis. We retrospectively analyzed 420 patients with non-small cell lung cancer (NSCLC) who underwent lung surgery from January 2022 to May 2024. Among these, 84 patients received PR while 336 did not (control group). Propensity score matching (PSM) at a 1:1 ratio yielded 46 patients in each group. Baseline characteristics, spirometry, cardiopulmonary exercise testing, respiratory muscle strength, HRQL, and muscle measurements were assessed pre-and post-surgery. Before PSM, significant differences existed between groups, with the PR group being older and having different pulmonary function baselines. After PSM, groups were well-balanced. Postoperatively, the PR group showed significant improvements in FEV1/FVC (64.17% vs. 50.87%, p < 0.001), FEV1 (2.31 L/min vs. 1.75 L/min, p < 0.001), and predicted FVC percentage (88.75% vs. 68.30%, p < 0.001). Cardiovascular responses showed a lower CI during exercise in the PR group post-PSM (6.24 L/min/m2 vs. 7.87 L/min/m2, p < 0.001). In terms of exercise capacity, the PR group had higher maximal WR percentage (104.76% vs. 90.00%, p = 0.017) and peak VO2 (1150.70 mL/min vs. 1004.74 mL/min, p = 0.009). PR also resulted in less leg soreness and lower total CAT scores postoperatively. Muscle measurements indicated significantly smaller reductions in ΔHUESMCSA and percentage change in the PR group. Pulmonary rehabilitation significantly enhances exercise capacity, HRQL, and cardiopulmonary function in patients undergoing lung surgery. It also mitigates postoperative muscle loss, underscoring its importance in the postoperative management of lung surgery patients.

The Effectiveness of Some Chronic Pulmonary Management Units for Patients with COPD and Asthma in Vietnam

Introduction: Asthma and chronic obstructive pulmonary diseases are chronic diseases and have high mortality rates in Vietnam and other countries. The chronic pulmonary disease Management Unit is a management model connecting inpatient and outpatient treatment for asthma and COPD patients. Patients receive long-term management and full consultation to share experiences and be provided with necessary information about the disease. The main purpose was to evaluate the effectiveness of the unit for patients with COPD and asthma in Vietnam. Material and Methods: A Combined cross-sectional study and retrospective longitudinal study were conducted on 310 COPD and asthma patients at Hai Duong, Bac Giang, Thai Nguyen. The questionnaires included 30 questions with two sections including sociodemographic data and using management and treatment services. Results: After 24 months of management and treatment, knowledge of the disease, medicine use, symptoms, range of activities, eating, sleeping status, and disease control of patients were improved better. For ACT score, the points increased by 2.1 points, 3.4 points, and 4 points, respectively. For the CAT score, the point reduced by 3.7 points, 6.4 points, and 9.1 points, respectively. Improved severe breathlessness efficiency index from 0.6% at 6 months to 9.5% after 24 months. Conclusion: Our findings suggest that the government needs to invest in facilities, equipment, and human resources to maintain and replicate the model nationwide to help patients receive timely management and treatment, contributing to reducing treatment costs and improving the quality of life for asthma and COPD patients.

The Real-World Efficacy of Fixed Triple Inhalation Therapy in the Treatment of Moderate COPD Patients (RATIONALE Study).

COPD affects more than 300 million people worldwide, requiring inhalation treatment. Novel triple formulations of ICS, LABAs and LAMAs are becoming the mainstay of treatment, however there is still a lack of clinical evidence for personalized therapy. RATIONALE was a non-interventional, prospective, 52 week study, assessing the effectiveness of beclometasone/formoterol/glycopyrronium-bromide (BDP/FF/G), in symptomatic COPD patients, with moderate airflow obstruction. The study included 4 visits, where data on demographic parameters, exacerbations, symptoms, quality of life (based on the EQ-5D-3L questionnaire) and lung function were collected. Data on adherence to treatment, based on prescriptions filled was collected from the database of the National Health Insurance Fund, with the patients' consent. The primary objective was the change of adherence to treatment during the study, compared to baseline. Altogether 613 patients had been enrolled. Their average age was 64.56 years and 50.5% were female. The average CAT score was 20.86, and most patients had suffered minimum one exacerbation (82.2%). Average FEV1 was 59.6%. Most patients had some limitation in one or more dimensions of EQ-5D-3L, with an average visual analogue scale score (VAS) of 60.31. After 12 months of treatment, adherence improved significantly - proportion of patients in the highest adherence group increased from 29.8% to 69.7% (p<0.001). The average CAT score improved by 7.02 points (95% CI 5.82-8.21, p<0.001). There was a significant improvement in all dimensions of EQ-5D-3L, with an average increase of 17.91 (95% CI 16.51-19.31, p< 0.001) points in the VAS score. Exacerbation frequency also decreased significantly. Although limitations of observational studies are present, we observed that early introduction of fixed triple combination results in a marked improvement in adherence to treatment, symptom scores, exacerbation frequency and quality of life. The optimal choice of treatment is crucial for reaching the highest possible adherence.

Switching to E-cigarettes as Harm Reduction Among Individuals With Chronic Disease Who Currently Smoke: Results of a Pilot Randomized Controlled Trial.

E-cigarettes (ECs) may be an effective harm reduction strategy for individuals with conditions like chronic obstructive pulmonary disease (COPD), asthma, coronary artery disease (CAD), and peripheral arterial disease who smoke combustible cigarettes (CCs). Our aim was to examine how individuals with chronic conditions transition from CCs to ECs and its impact on health outcomes. In a pilot randomized controlled trial (RCT), patients with COPD, asthma, and CAD/PAD who currently smoke CCs and have not used nicotine replacement therapy (NRT) or ECs in the past 14 days were randomized to receive ECs or combination NRT with behavioral counseling. Disease symptoms, acceptability/satisfaction (TSQM-9) and feasibility, and cigarettes per day (CPD), and/or EC use were collected at baseline, 3-, and 6 months. Descriptive statistics and a linear regression were conducted to explore changes in CPD and chronic condition-specific assessments (CAT, SAQ-7, and ACT) that assess COPD, asthma, and CAD/PAD symptom change. At 3 months, the EC group (n = 63, mean CPD = 9 ± 11) reduced their CPD by 54% versus 60% in the NRT group (n = 58, mean CPD = 7 ± 6), p = .56. At 6 months, 17.5% had switched completely to ECs while 23% quit smoking in the NRT arm. CAT scores showed a significant 6-point reduction in the EC arm (p = .03). Participants scored an average of 69 ± 27 for EC effectiveness, 87 ± 23 for convenience, and 75 ± 27 for overall satisfaction. This pilot study suggests that ECs may be a safer alternative for chronic condition patients using CCs and warrants further research on expected smoking cessation/reduction among individuals who use ECs. The findings from this pilot RCT hold significant implications for chronic conditions such as COPD, asthma, CAD, and peripheral arterial disease who smoke CCs. The observed reduction in CPD and improvement in respiratory symptoms suggest that switching to ECs appears feasible and acceptable among those with chronic diseases. These results suggest that ECs may offer an alternative for individuals struggling to quit CC smoking through existing pharmacotherapies. This study supports further exploration of switching to ECs as a harm reduction strategy among CC users who have been unsuccessful at quitting by other means.

Effect of a Combination of Lactiplantibacillus plantarum KC3 and Leonurus japonicus Extracts in Respiratory Discomfort: A Randomized, Double-Blind, Placebo-Controlled Trial.

The increased global prevalence of chronic respiratory diseases in recent years has caused a substantial public health burden. Lactiplantibacillus plantarum KC3 and Leonurus japonicus Houtt. (LJH) extracts can alleviate respiratory symptoms and improve lung function in vitro and in vivo. However, the clinical efficacy and safety profile of this combination in patients with respiratory diseases remain unclear. Therefore, this multicenter, randomized, double-blind, placebo-controlled clinical trial aimed to evaluate the efficacy and safety of L. plantarum KC3 and LJH extracts in adults with respiratory discomfort. This mixture was termed 'CKDB-315'. Participants, randomly assigned to the CKDB-315 or placebo groups, were treated for 12 weeks. Assessments included the St. George's Respiratory Questionnaire (SGRQ) and the Chronic Obstructive Pulmonary Disease Assessment Test (CAT). The CKDB-315 group showed considerably improved SGRQ and CAT scores compared with the placebo group. Secondary outcomes, including dyspnea, pulmonary function, total antioxidant status, and inflammatory cytokine levels, were consistent with the primary outcomes. Exploratory analyses of the gut microbiota and short-chain fatty acid contents revealed the potential mechanisms underlying the effects of CKDB-315. Finally, safety analysis indicated that CKDB-315 was well tolerated and caused few adverse events. Our findings indicate that CKDB-315 is a promising therapeutic option for respiratory discomfort in adults.

Comparison of Clinical Outcomes Between Acetylcysteine and Ambroxol in Post Acute Exacerbation of COPD Patients

Literature studies show that the use of acetylcysteine or ambroxol can accelerate improvement of clinical outcomes of post acute exacerbation chronic obstructive pulmonary disease (AECOPD) patients. This study aims to compare the clinical outcomes of acetylcysteine and ambroxol administration in post AECOPD patients. The study was cohort design, prospective, to comparison of clinical outcomes of acetylcysteine and ambroxol with post AECOPD outpatients  coming for clinical chekups in August 2023 at Respira Lung Hospital Yogyakarta. Clinical outcomes parameters were observed on day zero and thirty for CAT score and day zero and four for cough score. The patients were categorized into two groups: acetylcysteine group (n=30) and ambroxol group (n=30). There was no significant difference between two  groupsto change of CAT score and cough score (p&gt;0.05) post AECOPD. The acetylcysteine group compared to ambroxol, there was a mean decrease in morning cough score -1.10±1.11 vs -0.87±1.12 (p=0.228), night cough score -1.53±1.43 vs -1.13±1.31 (p=0.438), and CAT score -2.43±5.45 vs -2.90±3.41 (p=0.391). Providing additional therapy of acetylcysteine or ambroxol in this study did not significantly reducing cough scores and CAT scores in post AECOPD patients.

The Accuracy of PUMA Questionnaire in Combination With Peak Expiratory Flow Rate to Identify At-risk, Undiagnosed COPD Patients

IntroductionThe English PUMA questionnaire emerges as an effective COPD case-finding tool. We aimed to use the PUMA questionnaire in combination with peak expiratory flow rate (PEFR) to improve case-finding efficacy in Chinese population. MethodsThis cross-sectional, observational study included two stages: translating English to Chinese PUMA (C-PUMA) questionnaire with linguistic validation and psychometric evaluation, followed by clinical validation. Eligible participants (with age ≥40 years, respiratory symptoms, smoking history ≥10 pack-years) were enrolled and subjected to three questionnaires (C-PUMA, COPD assessment test [CAT], and generic health survey [SF-12V2]), PEFR measurement, and confirmatory spirometry. The C-PUMA score and PEFR were incorporated into a PUMA-PEFR prediction model applying binary logistic regression coefficients to estimate the probability of COPD (PCOPD). ResultsC-PUMA was finalized through standard forward–backward translation processes and confirmation of good readability, comprehensibility, and reliability. In clinical validation, 240 participants completed the study. 78/240 (32.5%) were diagnosed with COPD. C-PUMA exhibited significant validity (correlated with CAT or physical component scores of SF-12V2, both P<0.05, respectively). PUMA-PEFR model had higher diagnostic accuracy than C-PUMA alone (area under ROC curve, 0.893 vs. 0.749, P<0.05). The best cutoff values of C-PUMA and PUMA-PEFR model (PCOPD) were ≥6 and ≥0.39, accounting for a sensitivity/specificity/numbers needed to screen of 77%/64%/3 and 79%/88%/2, respectively. C-PUMA ≥5 detected more underdiagnosed patients, up to 11.5% (vs. C-PUMA ≥6). ConclusionC-PUMA is well-validated. The PUMA-PEFR model provides more accurate and cost-effective case-finding efficacy than C-PUMA alone in at-risk, undiagnosed COPD patients. These tools can be useful to detect COPD early.

The impact of traditional mind-body exercises on pulmonary function, exercise capacity, and quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic condition characterized primarily by airflow obstruction, significantly impacting patients' quality of life. Traditional mind-body exercises, as a non-pharmacological intervention for COPD, have become a new research focus. To assess the impact of traditional mind-body exercises (Tai Chi, Qigong, Yoga) on pulmonary function, exercise capacity, and quality of life in COPD patients. Additionally, to identify the most suitable form of traditional mind-body exercise for different indicators. Searches were conducted in databases such as Web of Science, PubMed, EBSCOhost, CNKI, etc., to collect randomized controlled trials (RCTs) evaluating the intervention of traditional mind-body exercises (Tai Chi, Yoga, Qigong) in COPD. The Cochrane evaluation tool was applied for methodological quality assessment of the included literature. Statistical analysis and sensitivity analysis were performed using Revman 5.4 software, while publication bias was assessed using R software. This study included 23 studies with a total of 1862 participants. Traditional mind-body exercises improved patients' FEV1% index (WMD = 4.61, 95%CI [2.99, 6.23]), 6-min walk distance (SMD = 0.83, 95%CI [0.55, 1.11]), and reduced patients' SGRQ score (SMD = -0.79, 95%CI [-1.20, -0.38]) and CAT score (SMD = -0.79, 95%CI [-1.20, -0.38]). Qigong showed the most significant improvement in FEV1% and 6MWT, while Tai Chi primarily improved 6MWT, and the effect of Yoga was not significant. Sensitivity analysis indicated stable and reliable research conclusions. Traditional mind-body exercises are effective rehabilitation methods for COPD patients, significantly improving pulmonary function, exercise capacity, and quality of life. They are suitable as complementary interventions for standard COPD treatment. [https://www.crd.york.ac.uk/prospero/display-record.php?ID=CRD42023495104], identifier [CRD42023495104].