We treated life-threatening tracheomalacia in a 76-year-old man with severe chronic obstructive pulmonary disease using translaryngeal shared-airway microsurgical techniques to enable tracheal stent placement. These techniques included suspension laryngoscopy, transnasal humidified rapid-insufflation ventilatory exchange using OptiFlow-THRIVE, flow-controlled ventilation using the TriTube™ and the Evone ventilator, and supraglottic jet ventilation. A smooth silicone tracheal stent was secured using the cervico-tracheal (Howard) suture. Total airflow rose from 4.28l/s preoperatively to 6.31l/s at 10 months. Forced vital capacity increased from 2.27l to 2.81l. The patient remains stable five years later and has the original stent in situ. This case emphasises the value of translaryngeal shared-airway microsurgery to safely manage patients with significant morbidity and life-threatening tracheal disease.

Chronic obstructive pulmonary disease (COPD) remains a major health burden with few effective therapies, particularly for emphysema. The gut-lung axis and microbial metabolites, such as short-chain fatty acids (SCFAs), have emerged as modulators of lung inflammation. We investigated the therapeutic effects of Lactobacillus fermentum HEM20792 (LF), identified through a colon mimetic personalized pharmaceutical meta-analytical screening (PMAS) platform using fecal samples from severe COPD patients. LF and Lactobacillus sakei HEM20224 (LS) were orally administered to smoke-exposed mice, followed by lung function testing, histopathology, RNA sequencing, single-cell transcriptomics, and fecal microbiome/SCFAs analyses. LF attenuated emphysematous changes, improved compliance, and reduced macrophage and IL-17+ lymphocyte infiltration. Single-cell analysis showed restoration of alveolar macrophages and reduction of pathogenic C1q+ macrophages, while transcriptomics revealed normalization of NF-κB and arachidonic acid pathways and attenuation of IL-17- and SPP1-associated signaling. LF also increased fecal SCFAs levels. These findings provide preclinical evidence for LF as a promising microbiome-based therapeutic candidate for COPD.

Acute deteriorations of respiratory symptoms in people with chronic obstructive pulmonary disease (COPD), known as exacerbations, worsen COPD severity (e.g., speed up lung function decline), and increase hospital admissions, healthcare costs, and mortality risk. The prevention, diagnosis, and treatment of exacerbations remain challenging due to the heterogeneous nature of these events. This complexity is further compounded by the high prevalence of multiple comorbidities and incompletely understood underlying mechanisms. Exacerbations of COPD and comorbidities are linked through bidirectional relationships, characterized by mutual adverse impacts, overlapping clinical manifestations, and increased susceptibility to the other condition. The identification and management of comorbidities are pivotal for effective disease management. Although current clinical frameworks, that is, models that integrate clinical features and biomarker-based identification of exacerbations to guide risk stratification and management, represent promising approaches to improve patient outcomes, multimorbidity is insufficiently incorporated. This narrative review provides an overview of the complex clinical associations of comorbidities in COPD, with a particular focus on exacerbations. It highlights differences in comorbidity prevalence among exacerbators, explores clinical interrelationships, and underscores the importance of multimorbidity-oriented management.

Introduction . Endoscopic lung volume reduction (ELVR) with endobronchial valves is a minimally invasive technique used in severe emphysema-dominant chronic obstructive pulmonary disease (COPD). The procedure improves respiratory mechanics and reduces dyspnea by inducing atelectasis in hyperinflated lung segments without thoracotomy. ELVR is applied as palliative therapy or as a bridge to lung transplantation and can substantially improve quality of life in carefully selected patients. Segmental endobronchial valve therapy is now an established option for lung volume reduction in patients with upper-lobe-predominant emphysema and limited exercise tolerance. Materials and methods . Case report. A 73-year-old patient with COPD, heterogeneous non-bullous emphysema, with severe upper-lobe predominance in the right lung, and grade 2 cor pulmonale had experienced multiple hospitalizations. ELVR was performed by placing endobronchial valves to achieve bronchial blockade of the right upper-lobe segments. Results and discussion . The therapeutic effect of endobronchial valve therapy in COPD is achieved by restricting airflow to severely emphysematous regions. In this patient, segmental blockade of the right upper lobe reduced the severity of respiratory insufficiency and produced a meaningful improvement in quality of life. Conclusion. Bronchoscopic lung-volume reduction with endobronchial valves is an effective approach for improving pulmonary function and exercise capacity in patients with severe COPD and upper-lobe-predominant emphysema.

Identification of the chronic obstructive pulmonary disease (COPD) phenotype allows selection of the most appropriate drug for each patient. Blood eosinophilia, as a surrogate marker for airway eosinophilia, has been associated with a phenotype of COPD exacerbators. Thus, blood eosinophilia and/or sputum eosinophilia enable healthcare providers to assess disease severity and guide treatment decisions in COPD patients. Understanding these factors can aid in effective COPD management and improve patient outcomes. A prospective observational study was conducted at a tertiary care hospital. A total of 140 diagnosed COPD patients who met the eligibility criteria and attended the Department of Tuberculosis and Respiratory Diseases were included in the study. All recruited patients underwent a thorough clinical assessment, including detailed history taking (with emphasis on exacerbations), physical examination, complete blood count, including absolute eosinophil count (AEC), sputum cytology, and chest X-ray. Eosinophilia was defined as an AEC>150 cells/µL and/or sputum eosinophilia ≥2%. If sputum cytology showed <2% eosinophils and <60% neutrophils, the sample was considered paucicellular, and those patients were excluded from statistical analysis. Appropriate statistical tests were applied to derive inferences. Of the 140 enrolled COPD patients, 83 (59.3%) had stable COPD and 57 (40.7%) were experiencing acute exacerbation. Blood eosinophilia (AEC>150 cells/µL) was present in 76 (54.3%) patients. After excluding sputum samples with paucicellularity (n=69), sputum eosinophilia (≥2%) was present in 41 (57.7%) of the remaining 71 patients. A statistically significant association was observed between blood eosinophilia and a history of exacerbations (p<0.001). Similarly, sputum eosinophilia was significantly associated with a history of COPD exacerbations (p=0.008). COPD severity (GOLD stage) was significantly associated with blood eosinophilia (p=0.044). However, no statistically significant correlation was found between sputum eosinophilia and blood eosinophilia (p=0.5). Measurement of blood and sputum eosinophils facilitates phenotyping of COPD patients and enhances precision in treatment without delay. The use of inhaled corticosteroids targets eosinophilic inflammation in patients with COPD exacerbations. Therefore, we recommend measuring blood eosinophil counts in all patients at the time of COPD diagnosis.

Introduction: Chronic obstructive pulmonary disease (COPD) is associated with substantial symptom burden and functional limitations, which may co-occur with psychological distress. This pilot study aimed to assess depressive symptoms, anxiety, insomnia, and sexual quality of life in patients with COPD living in the Podlaskie Voivodeship. Materials and Methods: This cross-sectional pilot study included 47 patients with COPD, including outpatients (n = 11) and inpatients (n = 36), recruited at the University Teaching Hospital in Bialystok between February and August 2025. The original survey questionnaire, Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Generalized Anxiety Disorder-7 (GAD-7), Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), and Sexual Quality of Life (SQoL) questionnaires were used. Results: In the study sample, median scores indicated a considerable burden of depressive symptoms (BDI Me = 16), anxiety (HAM-A Me = 27; GAD-7 Me = 15), and insomnia (AIS Me = 9; ISI Me = 14), alongside reduced sexual quality of life (SQoL Me = 46). Age in the total sample correlated positively with depressive symptoms, anxiety, and sleep difficulties, and negatively with SQoL; however, these relationships were not consistently maintained in age-stratified analyses. Crude inpatient-outpatient differences were substantial, but supplementary adjusted models showed that subjective symptom severity was the most consistent predictor across outcomes, whereas the independent role of hospitalization status was attenuated. Strong associations were observed between depression, anxiety, insomnia, and sexual quality of life. Conclusions: This pilot study indicates a substantial within-sample psychological burden in patients with COPD and suggests that these outcomes are closely associated with subjective symptom burden. Given the small sample size, marked group imbalance, cross-sectional design, and lack of objective COPD severity measures, the findings should be interpreted as exploratory and require confirmation in larger multicenter studies.

Background/Objectives: Chronic obstructive pulmonary disease (COPD) coexists with lung cancer in 40-70% of cases and increases perioperative risk, particularly in patients with severely impaired pulmonary function. Preoperative pulmonary rehabilitation (PR) has been proposed as a perioperative optimization strategy; however, its effect on hospital length of stay (LOS) in patients with advanced COPD remains unclear. This study aimed to compare postoperative complications, intensive care unit (ICU) utilization, and hospital LOS between patients with lower and higher baseline forced expiratory volume in one second (FEV1), and to evaluate the role of preoperative PR as a risk-adaptive perioperative strategy in high-risk COPD patients undergoing lung cancer surgery. Methods: This retrospective cohort study comprises patients with spirometry-confirmed COPD and non-small cell lung cancer (NSCLC) who underwent elective lung resection at a tertiary care center between March 2019 and June 2020. Disease severity was classified using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) framework: GOLD 1-2 (FEV1 ≥ 50% predicted) and GOLD 3-4 (FEV1 < 50% predicted). Patients in the GOLD 3-4 group received a uniform 15-day hospital-based preoperative PR program prior to surgery. Primary outcomes were ICU stay, postoperative complications, and hospital LOS. Factors independently associated with prolonged hospital stay were examined using an exploratory multivariable linear regression model. Results: Among 63 patients (95.2% male; median age 64 years), those with GOLD 3-4 COPD had significantly lower baseline FEV1 values and longer COPD duration compared with the GOLD 1-2 group. Despite a higher perioperative risk profile, postoperative complication rates (28.6% overall; p = 0.237) and ICU utilization were comparable between groups. Median postoperative hospital LOS was significantly longer in patients with GOLD 3-4 COPD (15 [IQR 6] vs. 11 [IQR 4] days; p < 0.001). In the exploratory regression analysis, lower predicted FEV1 percent (p = 0.003) and older age were independently associated with prolonged hospital stay, whereas PR was not an independent determinant of LOS. Conclusions: In patients with lung cancer and severe COPD (GOLD 3-4) who received preoperative PR, postoperative complication rates and ICU utilization were comparable to those observed in patients with less severe disease. Prolonged hospital stay in the high-risk group was independently associated with lower FEV1 and older age, reflecting underlying disease severity. Prospective controlled studies stratified by COPD severity are needed to establish the independent contribution of preoperative PR in this population.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality worldwide. Immunoglobulin free Light Chains (IgLCs) have been implicated in various inflammatory diseases; however, their role in COPD risk stratification remains unclear. Aim: To assess the correlation between IgLC levels and COPD severity and to evaluate their potential role in disease monitoring. Materials and Methods: This cross-sectional observational study was conducted at Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India, between March and December 2018. A total of 120 stable COPD patients aged over 40 years (post-bronchodilator FEV1 /FVC &lt;70%) with no exacerbations in the preceding three months were included. COPD severity was staged according to the GOLD (Global Initiative for Chronic Obstructive Pulmonary Disease) criteria using spirometry. Venous blood samples were analysed for serum κ and λ free light chains using immunoturbidimetry, along with standard biochemical parameters. Demographic and exposure-related data, including age, sex, Body Mass Index (BMI), smoking status, biomass exposure, and history of tuberculosis, were recorded. Associations between IgLC levels, COPD severity, lung function (FEV1 %), and biochemical parameters were analysed using Pearson’s correlation, Analysis of Variance (ANOVA), and Chi-square tests. A p-value &lt;0.05 was considered statistically significant. Results: The study included 120 COPD patients, comprising 45 (37.5%) males and 75 (62.5%) females, with a mean age of 59.2±10.6 years. The distribution across COPD stages was as follows: 20 (16.7%) in Stage I, 32 (26.7%) in Stage II, 40 (33.3%) in Stage III, and 28 (23.3%) in Stage IV. No significant differences were observed across disease stages with respect to sex, smoking status, biomass exposure, or history of tuberculosis (p-value &gt;0.05). Pulmonary function (FEV1 %) declined significantly with increasing COPD severity, from 82.10±1.21% in Stage I to 26.21±2.45% in Stage IV (F=308.166, p-value &lt;0.0001). Serum κ and λ free light chain levels increased progressively with disease severity (κ: 2.94±0.57 g/L to 5.50±0.81 g/L, F=87.318, p-value &lt;0.0001; λ: 1.50±0.26 g/L to 2.80±0.53 g/L, F=43.616, p-value &lt;0.0001), whereas the κ:λ ratio remained stable across all stages (p-value=1.000). Conclusion: Elevated IgLC levels showed a strong correlation with worsening COPD severity, declining lung function, and reduced BMI. Despite increases in individual κ and λ light chain concentrations, the κ:λ ratio remained stable across disease stages.

Chronic Obstructive Pulmonary Disease (COPD) is a pulmonary condition characterized by airflow obstruction, which progresses with systemic alterations such as changes in muscle composition and metabolism, anticipating the activation of the inspiratory metaboreflex. This study aimed to analyze the acute effects of Inspiratory Muscle Training (IMT) on peripheral muscle metabolism in individuals with COPD, using near-infrared spectroscopy (NIRS). This randomized, blinded, crossover study included 29 individuals with COPD who underwent three distinct sessions: high-load IMT (IMT-Strength, 60% of maximal inspiratory pressure-MIP), low-load IMT (IMT-Endurance, 30% of MIP), and a sham protocol. Tissue oxygenation of the gastrocnemius muscle was assessed using NIRS before and after each protocol. Differences in mean final tissue oxygen saturation were observed only during the IMT-Endurance protocol. The oxygen desaturation time was shorter during the IMT-Strength protocol compared with the other groups. Although not statistically significant, patients with more severe COPD (GOLD 3-4) exhibited an oxygen desaturation rate higher during the strength IMT compared with the endurance and sham protocols. Acute high-intensity IMT may accentuate the reduction in peripheral perfusion, especially in patients with advanced COPD, suggesting possible metaboreflex activation. Conversely, endurance IMT may improve peripheral perfusion. These findings reinforce the need for careful and individualized prescription of IMT in the COPD population. Clinical Trials number: NCT06827379 https://clinicaltrials.gov/study/NCT06827379.

This secondary data analysis used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), logistic regression (Method 1), Xtreme Gradient Boosting (Method 2), and a 12-member expert panel (Method 3) to develop and validate a predictive model to identify patients undergoing thoracic surgery at risk for postoperative pneumonia (POP). Twenty-three covariates associated with POP were selected from the 2013-2022 ACS NSQIP dataset filtered for thoracic surgeries. Method 1 and Method 2 were assessed through area under the receiver operating characteristic curve (AUC ROC) using 10-fold cross-validation. Method 3 evaluated the 23 covariates for relevance to POP and relevant predictors were assessed through AUC ROC. Method 1 identified nine significant predictors (P < .05) with a 10-fold cross-validated AUC ROC = .72 (fair classifier). The significant preoperative predictors and their effect size were, sepsis (1.43), systemic inflammatory response syndrome (1.04), male gender (.77), bleeding disorder (.57), current smoker within 1 year (0.39), disseminated cancer (.39), hypoalbuminemia (.33), history of severe chronic obstructive pulmonary disease (.31), and anemia (.05). Method 2 achieved a 10-fold cross-validation AUC ROC = .75 (fair classifier). Method 3 had an AUC ROC = .6 (poor classifier). The nine significant predictors from Method 1 were used to develop a risk-based calculator.

Background: The high rate of underdiagnosed Chronic Obstructive Pulmonary Disease (COPD) in the Alto Minho region highlighted an urgent need for a comprehensive, community-centered approach to enhance early diagnosis, preventive care, and integrated follow-up for COPD patients. This project aligns with the United Nations Sustainable Development Goals (SDGs) for 2030, specifically SDG 3 (good health and well-being), SDG 10 (reduction of inequalities), and SDG 17 (partnerships for the goals), promoting health and well-being, reducing health disparities, and establishing effective partnerships for sustainable development. Approach: The Breathing Well, Living Better project, launched in 2014, is a collaborative effort among ULS Alto Minho, Universidade Nova de Lisboa, and Novartis, with the primary goal of strengthening early diagnosis, improving treatment adherence, and enhancing patients’ quality of life through a community-supported model of integrated care. This approach involves Family Health Units (USF) and Personalized Health Care Units (UCSP), supported by Community Health Units for continuous patient monitoring. The main components include: •Early diagnosis: Identification and outreach of at-risk patients for spirometry, with subsequent stratification into severity groups (A, B, E). •Community-based intervention: Promotion of preventive vaccination (influenza and pneumococcus) to reduce respiratory complications, encouragement of treatment adherence, education on the risks of fossil fuel use in home environments, and support for smoking cessation. •Respiratory physiotherapy: Referral for continued care when indicated, to improve lung function and quality of life for patients with severe COPD. Results: By the end of 2023, the project had invited 22,007 patients for spirometry, with a 91.92% completion rate. This effort led to the confirmation of 2,187 cases of COPD, reflecting a prevalence rate of 10.8% in the studied population. Among the diagnosed patients, severe cases were referred for specialized follow-up, while others continued care under the USF/UCSP management. The intervention demonstrated improved treatment adherence, increased vaccination rates, and a reduction in the number of exacerbations. Implications: The Breathing Well, Living Better project demonstrates an effective integrated care model for COPD, aligned with the UN SDGs. Focusing on prevention, therapeutic adherence, and community involvement, and supported by strategic partnerships, this model contributes to improved quality of life and reduced health disparities. Insights from this project highlight the importance of integrated, community-centered approaches for managing chronic respiratory diseases, with strong potential for replication in other regions to promote sustainable, long-term health improvements.

Chronic obstructive pulmonary disease (COPD) is a leading cause of death with few effective therapies. While clinical staging distinguishes mild to very severe disease, recent molecular and single-cell studies have revealed that progression involves distinct reprogramming of cellular and immune pathways rather than a simple linear escalation of inflammation. Yet, most studies have analyzed COPD without stratifying by stage, obscuring mechanisms specific to disease severity. To address this, we investigated serum proteomic profiles from the UK Biobank and applied machine learning to identify stage-specific protein signatures across COPD progression. Integration with single-cell and bulk transcriptomic datasets revealed that in severe COPD, endothelial cells exhibit a senescent phenotype characterized by elevated interleukin-6 (IL6) expression. Endothelial-derived IL6 correlated with reduced type 1 helper T cell (Th1) abundance and impaired interferon-γ signaling, indicating suppression of Th1-mediated immunity. These findings position endothelial senescence-driven IL6 signaling as a key pathogenic mechanism and potential therapeutic target in late-stage COPD.

Psychological distress is a common comorbidity in chronic obstructive pulmonary disease (COPD), yet its relationship with disease severity remains incompletely understood. This study aimed to assess depression, anxiety, and stress using the Depression Anxiety Stress Scales-21 (DASS-21) and to examine their distribution across COPD severity stages. This multicenter, cross-sectional observational study included 285 clinically stable COPD patients enrolled between 2023 and 2025. COPD severity was classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Multinomial and binary logistic regression models were constructed to identify independent predictors of COPD severity and clinically significant psychological distress, adjusting for demographic and clinical covariates. Bayesian independent sample analyses and ANOVA effect size estimates were additionally performed. Smoking exposure was independently associated with advanced COPD stages (GOLD 4 vs. GOLD 1-3: aOR 1.05, p < 0.001), as was dyspnea severity (mMRC: aOR 14.66, p < 0.001). In multivariable models examining psychological outcomes, COPD severity was not independently associated with clinically significant depression (p = 0.899), anxiety (p = 0.460), or stress (p = 0.843). In contrast, symptom burden measured using the COPD Assessment Test (CAT) score was consistently associated with depression (aOR 1.133, p < 0.001), anxiety (aOR 1.179, p < 0.001), and stress (aOR 1.144, p < 0.001). ANOVA effect sizes across GOLD stages were small (η2 ≤ 0.047), and Bayesian analyses provided moderate to strong evidence supporting minimal differences in DASS-21-R scores between severity groups. Psychological distress is prevalent across all COPD severity stages and is not independently determined by airflow limitation. Symptom burden rather than spirometric severity appears to be more closely associated with emotional outcomes.

Giant bullous lung disease presents unique challenges in thoracic surgery due to the large size of bullae and compromised respiratory function. This case report highlights the successful use of awake uniportal video-assisted thoracoscopic surgery (A-UVATS) in a high-risk patient with severe chronic obstructive pulmonary disease and a giant multiseptated bulla occupying the entire left lower lobe. Instead of traditional general anaesthesia, regional techniques, including thoracic paravertebral block and dexmedetomidine sedation, were employed to ensure safety and comfort. The procedure resulted in significant clinical improvement, with minimal complications, aside from a transient air leak. Post-operative recovery was uneventful, and lung re-expansion was confirmed via imaging. This case highlights the feasibility and safety of A-UVATS bullectomy in carefully selected patients, offering improved recovery and reduced perioperative risks. More research is needed to develop standardised protocols and evaluate long-term outcomes of awake thoracic surgical approaches.

Background: Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a disorder linked to increased cardiovascular risk, often coexisting with coronary artery disease (CAD), yet angiographic data on coronary involvement in COPD remain limited. This study aimed to evaluate whether COPD is associated with a distinct angiographic pattern of CAD, focusing on vessel distribution. Methods: We retrospectively enrolled 94 patients who underwent coronary angiography between 2023 and 2024 for suspected or known CAD. Clinical data, comorbidities, laboratory testing, pulmonary function, electrocardiography, echocardiography, and angiography were collected. Participants were stratified into two groups: COPD (n = 47) and non-COPD (n = 47). Coronary vessels were classified by number, location, and diameter. The normality of continuous variables was assessed using the Shapiro-Wilk test. Non-normally distributed variables were compared using the Mann-Whitney U test, while Fisher's exact test was used for categorical comparisons. A multivariable logistic regression model was performed to identify independent predictors of left main coronary artery (LMCA) disease at the patient level. The primary endpoint was the association between COPD and CAD severity. Results: Baseline characteristics, including age, sex, BMI, and smoking history, were comparable between groups. The overall extent of CAD, expressed as the number of diseased vessels, did not differ significantly (p = 0.1436). However, vessel-based analysis revealed a distinct pattern: COPD patients showed a significantly higher prevalence of left main coronary artery (LMCA) disease compared to non-COPD patients (14% vs. 4.7%, p < 0.001). At the patient level, LMCA disease was present in 15/47 (31.9%) COPD patients compared with 6/47 (12.8%) non-COPD patients (p = 0.046). Multivariable logistic regression confirmed that COPD was an independent predictor of LMCA disease (OR = 3.56, 95% CI: 1.12-11.29, p = 0.031) after adjustment for age, sex, smoking, diabetes, and chronic kidney disease. Intermediate-caliber vessels were most frequently affected in both groups, while small-caliber branches were less commonly involved in COPD patients. Conclusions: COPD is an independent predictor of LMCA disease despite a similar overall angiographic extent of CAD. These findings suggest a distinct, high-risk coronary phenotype in COPD and highlight the need for enhanced cardiovascular vigilance and integrated cardiopulmonary management in this population.

BackgroundCardiovascular diseases are prevalent in individuals with chronic obstructive pulmonary disease (COPD), but current cardiovascular risk assessment models are not optimised for COPD. We aimed to develop a prediction model for the 10-year risk of major adverse cardiovascular and respiratory events (MACRE) in patients with COPD.MethodsWe used nationwide primary care electronic health records from individuals with COPD, aged ≥40 years in 2011 without prior myocardial infarction in the UK Optimum Patient Care Research Database. Practices were randomly divided at the practice level into derivation (80%) and validation (20%) datasets. The primary composite outcome (MACRE) consisted of myocardial infarction, coronary revascularization, heart failure, severe COPD exacerbation, and all-cause mortality. Multivariable Cox regression was used to derive the model using the derivation dataset, with the least absolute shrinkage and selection operator used for variable selection and shrinkage. Performance was evaluated using the validation dataset over prediction horizons of five and 10 years.ResultsAmong the 122,077 patients included (98,959 in the derivation set; whole cohort: 47.9% women and mean age 69.3 (SD 11.2) years), cardiometabolic risk factors were prevalent, and most had moderate (53.4%) or severe (24.7%) COPD. Over a median follow-up of 10.5 [interquartile range: 4.2–12.4] years, MACRE occurred in 50.2% of the validation set. Sixty-one predictor variables constituted the model, which demonstrated good-to-excellent discrimination and satisfactory calibration across prediction horizons (AUROC 0.78 at five years and 0.82 at 10 years, Brier score of 0.18 at five years and 0.16 at 10 years) in the validation set.ConclusionA model derived using electronic medical records predicts MACRE in COPD with high discrimination and satisfactory calibration across medium and longer-term prediction horizons. Its utility to inform trial enrolment and clinical decisions requires further study.

Inhaled corticosteroid (ICS)-long-acting β-agonist (LABA) inhalers are generally considered therapeutically equivalent when treating chronic obstructive pulmonary disease (COPD). However, metered-dose inhalers in the class are associated with substantially higher greenhouse gas emissions than dry powder formulations, and studies have raised questions about potential intraclass differences in clinical outcomes among patients receiving ICS-LABAs. To analyze COPD exacerbations and pneumonia hospitalizations associated with once-daily fluticasone furoate-vilanterol dry powder inhalers, twice-daily fluticasone propionate-salmeterol dry powder inhalers, and twice-daily budesonide-formoterol metered-dose inhalers in adults with COPD. This cohort study was conducted using longitudinal commercial claims data of US adults aged 40 years or older with COPD. Patients were 1:1 pairwise propensity score matched into 3 cohorts: (1) new users receiving fluticasone furoate-vilanterol vs budesonide-formoterol between January 1, 2014, and February 29, 2024; (2) new users receiving fluticasone furoate-vilanterol vs fluticasone propionate-salmeterol between January 1, 2014, and February 29, 2024; and (3) new users receiving fluticasone propionate-salmeterol vs budesonide-formoterol between January 1, 2007, and February 29, 2024. Receipt of a once-daily fluticasone furoate-vilanterol dry powder inhaler (Breo Ellipta; GSK), twice-daily fluticasone propionate-salmeterol dry powder inhaler (Advair Diskus; GSK), or twice-daily budesonide-formoterol metered-dose inhaler (Symbicort; AstraZeneca). The primary outcomes were first moderate or severe COPD exacerbation and first pneumonia hospitalization. Hazard ratios and 95% CIs were estimated using Cox proportional hazards regression models. The cohorts included 38 070 matched pairs of patients receiving fluticasone furoate-vilanterol vs budesonide-formoterol (58.8% women; mean [SD] age, 71.0 [9.0] years), 20 471 matched pairs of patients receiving fluticasone furoate-vilanterol vs fluticasone propionate-salmeterol (58.3% women; mean [SD] age, 69.9 [9.2] years), and 55 627 matched pairs of patients receiving fluticasone propionate-salmeterol vs budesonide-formoterol (56.2% women; mean [SD] age, 68.3 [9.0] years). Patients receiving fluticasone furoate-vilanterol had a 9% lower risk of moderate or severe COPD exacerbations compared with those receiving budesonide-formoterol (hazard ratio [HR], 0.91 [95% CI, 0.88-0.94]; number needed to treat [NNT] = 40) and a 6% lower risk compared with those receiving fluticasone propionate-salmeterol (HR, 0.94 [95% CI, 0.89-0.98]; NNT = 40). The risk of moderate or severe COPD exacerbation was similar for patients receiving fluticasone propionate-salmeterol and budesonide-formoterol (HR, 0.98 [95% CI, 0.95-1.01]). No differences were observed in the risk of pneumonia hospitalization across the 3 cohorts (fluticasone furoate-vilanterol vs budesonide-formoterol: HR, 1.03 [95% CI, 0.96-1.11]; fluticasone furoate-vilanterol vs fluticasone propionate-salmeterol: HR, 0.93 [95% CI, 0.85-1.03]; and fluticasone propionate-salmeterol vs budesonide-formoterol: HR, 1.04 [95% CI, 0.98-1.10]). In this cohort study of new ICS-LABA users with COPD, once-daily dry powder fluticasone furoate-vilanterol inhalers were associated with slightly improved clinical outcomes compared with twice-daily metered-dose budesonide-formoterol inhalers and twice-daily dry powder fluticasone propionate-salmeterol inhalers. Further studies are needed to explore potential intraclass differences among inhalers used to treat COPD.

Background/Objectives: Thoraco-abdominal asynchrony (TAA) is a key mechanical consequence of severe chronic obstructive pulmonary disease (COPD), particularly during acute exacerbations (AECOPD), when dynamic hyperinflation and diaphragmatic dysfunction impair the coordination between rib cage and abdominal motion. Continuous, non-invasive monitoring of respiratory mechanics may provide valuable information on clinical evolution during hospitalization. This study aimed to evaluate Global Phase Delay (GPD) as a longitudinal marker of TAA in hospitalized AECOPD patients and to explore its ability to reflect disease severity and short-term clinical evolution using repeated measurements obtained with thoracic and abdominal respiratory belts using respiratory inductance plethysmography (RIP). Methods: We conducted an observational longitudinal study in hospitalized adults with AECOPD. Respiratory inductance plethysmography signals were recorded daily over four consecutive days using thoracic and abdominal RIP belts. Five-breath sequences were analyzed to derive GPD, phase angle, and loop rotation direction through automated MATLAB processing. Clinical data included demographics, lung function, blood gases, dyspnea severity, and need for intermediate respiratory care unit (IRCU) admission. Temporal changes in TAA indices and subgroup differences (FEV1 < 35%, IRCU admission) were assessed using repeated-measures ANOVA. Results: Twenty-one patients were included. On admission, mean absolute GPD was 49 ± 58°, with larger delays observed in patients with more severe airflow limitation and in those requiring IRCU support. During hospitalization, GPD showed a significant reduction over time (p < 0.05), particularly in these subgroups, indicating progressive improvement in thoraco-abdominal synchrony. Directional analysis of GPD revealed heterogeneous patterns consistent with different underlying mechanical behaviors. Conclusions: Serial assessment of TAA using respiratory bands and GPD provides clinically meaningful information on the evolution of respiratory mechanics during AECOPD hospitalization. This approach may support bedside monitoring and help track patient response to treatment, offering potential value for individualized respiratory management.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition whose clinical severity may be influenced by social factors. We aimed to identify distinct COPD clinical phenotypes and assess variation by social determinants of health. In this retrospective cohort study, we identified adults aged 50-80 years with a diagnosis of COPD (n=59 797) at a tertiary academic medical centre in North-Central Florida using codes from International Classification of Diseases. Latent class analysis defined COPD clinical phenotypes using indicators of clinical severity, including frequency of acute care encounters (urgent care, emergency department visits and hospitalisations), presence of COPD as the principal diagnosis, comorbidity burden and use of Global Initiative for Chronic Obstructive Lung Disease Group D medications. Kaplan-Meier survival curves and Cox proportional hazards models assessed mortality across phenotypes. Multinomial logistic regression models estimated associations between phenotype membership and race/ethnicity, income, rurality and smoking status, using the minimal phenotype as reference. Five clinical phenotypes were identified: minimal (20.9%), mild (35.2%), moderate (22.5%), severe (12.2%) and very severe (9.3%). The very severe phenotype had the highest mortality (adjusted HR 2.94; 95% CI 2.72 to 3.18). Odds of very severe COPD were higher among non-Hispanic Black (adjusted OR (aOR) 1.29; 95% CI 1.21 to 1.36) and Hispanic individuals (aOR 1.75; 95% CI 1.63 to 1.87), those in the lowest income communities (aOR 1.25; 95% CI 1.18 to 1.32), rural residents (aOR 1.80; 95% CI 1.68 to 1.92) and individuals who currently smoke (aOR 1.30; 95% CI 1.20 to 1.42). Most patients with COPD had mild disease; however, the very severe phenotype, which was associated with higher mortality, was more common among Black and Hispanic individuals, those residing in lower-income and rural areas and those who currently smoke. These clinical phenotypes highlight sociodemographic differences in COPD severity as reflected in healthcare utilisation and outcomes.

ABSTRACT Background: Chronic obstructive pulmonary disease is a leading cause of morbidity and mortality worldwide, characterized by progressive airflow limitation and respiratory symptoms. The disease burden continues to increase in developing regions, including Palestine, where challenges in healthcare infrastructure limit access to comprehensive management. To examine the effect of active-assisted range of motion exercises combined with standard care on dyspnea, cough, sputum production and pulmonary function among patients with severe chronic obstructive pulmonary disease at Nasser Hospital, Gaza. Methods: This quasi-experimental study will use a convenience sampling method among severe chronic obstructive pulmonary disease patients admitted to the male and female medical departments at Nasser Hospital in Khan Younis, Southern Gaza Strip. A power analysis has determined an effect size of 0.58, requiring a total sample of 158 participants (79 in each group) to achieve adequate statistical power. Participants diagnosed with severe chronic obstructive pulmonary disease will be allocated into two groups: (1) the intervention group, which will receive active-assisted range of motion exercises in addition to standard treatment, and (2) the control group, which will receive standard treatment only. Results: The study findings are expected to provide a promising results in advocating the utilisation of active-assisted range of motion exercises into pulmonary rehabilitation programs among patients with severe chronic obstructive pulmonary disease. Conclusion: This study findings will support integrating active-assisted range of motion exercises into severe chronic obstructive pulmonary disease pulmonary rehabilitation in resource-limited settings.