Search Results (83)

Background/Objectives: Targeting individuals with certain characteristics provides improved precision in many healthcare applications. An alert mechanism for COPD exacerbations has recently been validated. It has been argued that its efficacy improves considerably with stratification. This paper provides an in-depth analysis of the cough data of the stratified cohort to identify options for and the feasibility of improved precision in the alert mechanism for the intended patient group. Methods: The alert system was extended using a system complementary to the existing one to accommodate observed rapid changes in cough trends. The designed system was tested in a post hoc analysis of the data. The trend data were inspected to consider their meaningfulness for patients and caregivers. Results: While stratification was effective in reducing misses, the augmented alert system improved the sensitivity and number of early alerts for the acute exacerbation of COPD (AE-COPD). The combination of stratification and the augmented mechanism led to sensitivity of 86%, with a false alert rate in the order of 1.5 per year in the target group. The alert system is rule-based, operating on interpretable signals that may provide patients or their caregivers with better insights into the respiratory condition. Conclusions: The augmented alert system operating based on cough trends has the promise of increased precision in detecting AE-COPD in the target group. Since the design and testing of the augmented system were based on the same data, the system needs to be validated. Signals within the alert system are potentially useful for improved self-management in the target group. Full article

Background and Objectives: Acute respiratory failure (ARF) represents an increasingly relevant clinical challenge in older subjects due to population aging and the high prevalence of cardiopulmonary comorbidities. Non-invasive ventilation (NIV), developed as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP), has become a first-line treatment in various forms of ARF, including acute cardiogenic pulmonary oedema (ACPE) and acute exacerbations of COPD (AECOPD), offering several clinical advantages. In this context, the limited evidence on the efficacy of NIV in older patients leaves considerable uncertainty as to whether it constitutes a valid therapeutic option or represents medical futility in these patients. Materials and Methods: This narrative review explores the use of NIV and its outcomes in four key clinical scenarios in the elderly: ARF due to ACPE, AECOPD, community-acquired pneumonia (CAP), and palliative/end-of-life care. Results: Strong evidence supports NIV use with improved outcomes in ACPE and AECOPD, even in older populations. Conversely, data on its use in pneumonia are inconclusive, with potential harm if applied inappropriately. In palliative care, NIV can help relieve symptoms, but if not used appropriately, it may extend suffering. Conclusions: Age alone does not appear to be a sufficient factor to determine whether or not to use NIV; it becomes relevant only when considered in conjunction with the purpose of its use and the patient’s clinical history and condition. Data remain limited and often conflicting, particularly when investigating the elderly population and patients with a “do not intubate” (DNI) order. There is a need for additional research on these patients, focusing on long-term outcomes and quality of life. Full article

Background: Intravenous magnesium sulfate (IV MgSO₄) may serve as an effective adjunct therapy to improve clinical outcomes in patients experiencing acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Methods: A comprehensive search was conducted on PubMed, Cochrane, and EMBASE from inception to April 2025 to find eligible studies comparing IV MgSO₄ plus standard treatment versus standard treatment alone. A random-effects meta-analysis was conducted using RevMan. Results: Nine studies (seven RCTs and two observational studies) met the inclusion criteria. Pooled analysis demonstrated that adjunctive IV MgSO₄ significantly improved peak expiratory flow rate at 45 min (MD = 18.50, 95% CI = 6.36 to 30.65) and significantly reduced hospital admission rates from the emergency department (OR = 0.45, 95% CI = 0.23 to 0.88). No significant differences were observed in the length of hospital stay (MD = −0.83, 95% CI = −2.99 to 1.33) and adverse events (OR = 0.79, 95% CI = 0.20 to 3.13; p = 0.73, I² = 25%) between the two groups. Conclusions: Adjunct MgSO₄ in AECOPD is associated with significant improvement in peak expiratory flow rate at 45 min and reduced hospitalization rates. Additional large-scale, multicenter randomized controlled trials are needed to validate and strengthen these findings. Full article

Background: Idiopathic pulmonary fibrosis (IPF) and emphysema often coexist in patients with lung cancer (LC), forming a syndrome with combined pulmonary fibrosis and emphysema (CPFE). The three share the pathogenic mechanisms of smoking, chronic inflammation, and oxidative stress. The clinical management of CPFE patients is challenging, but its impact on tumor characteristics, acute exacerbation (AE), and prognosis is still controversial. The purpose of this study was to clarify the effect of CPFE on tumor biological behavior, AE risk, and survival outcome in patients with IPF-LC so as to optimize individualized treatment strategies. Methods: This was a retrospective and single-center study. Newly diagnosed LC patients with IPF, COPD, and normal lungs were recruited in the west China hospital. Patients with IPF were further categorized into CPFE-LC and isolated IPF-LC groups based on the presence of emphysema. Clinical and tumor features, lung function parameters, and prognosis were obtained and compared. Results: Patients with IPF and LC were more common in older men and heavy smokers. IPF-associated tumors had a higher proportion of carrying EGFR wild-type, occurring in the lower lobe of the lung and developing adenocarcinoma and squamous cell carcinoma. Among IPF-LC patients, 68.2% (103/151) met CPFE criteria. Pulmonary function tests demonstrated preserved VC% but significantly reduced FEV1/FVC in CPFE versus non-emphysema IPF (76.3% vs. 80.7%, p = 0.004), alongside elevated CPI and impaired DLCO. CPI ≥ 40 (HR = 2.087, 95%CI: 1.715–6.089, p = 0.012), combined with COPD (HR = 2.281, 95%CI: 1.139–4.569, p = 0.040), isolated IPF (HR = 5.703, 95%CI: 2.516–12.925, p < 0.001), and CPFE (HR = 6.275, 95%CI: 3.379–11.652, p < 0.001), were independent prognostic risk factors in LC patients. The incidence of treatment-induced AEs (49.5% vs. 29.2%, p = 0.038) and AE-related mortality (28.0% vs. 11.8%, p = 0.045) were significantly higher in the CPFE group than in the isolated IPF group. Logistic regression analysis showed that CPFE (OR: 3.494, 95%CI: 2.014–6.063, p = 0.001) was independently associated with the risk of AE-related mortality in patients with LC and IPF. Conclusions: Compared to LC patients with solely IPF, the presence of emphysema had no significant impact on overall survival, but CPFE increased the risk of treatment-triggered AE and was associated with AE-related mortality. In patients with LC, CPFE with AEs had a worse prognosis than IPF with AEs. Full article

Background and Objectives: Vitamin D deficiency is linked to adverse outcomes in chronic obstructive pulmonary disease (COPD). Limited data exist on how vitamin D levels vary by disease severity during acute exacerbations of COPD (AECOPDs). This study aimed to determine whether the vitamin D status during AECOPDs—alongside inflammatory and hematological biomarkers—is associated with COPD severity. Materials and Methods: This observational study included 105 AECOPD hospitalized patients, stratified according to GOLD stages 1–2, 3, and 4. Blood samples were collected to measure serum vitamin D—as 25-hydroxyvitamin D [25(OH)D], acute phase reactants, serum calcium, and selected hematological parameters. Inter-group differences were evaluated using Kruskal–Wallis tests, with Spearman correlations applied for intra-strata associations. ROC analysis and logistic regression assessed the discriminatory power of significant biomarkers. Results: C-reactive protein (CRP) and fibrinogen concentrations were elevated across all COPD stages, whereas calcium and vitamin D remained consistently below normal. Interleukin (IL)-6 and 25(OH)D levels varied significantly with COPD stage (p = 0.033 and p = 0.047, respectively), with a marked drop from GOLD stage 3 to stage 4. High-IL-6 patients revealed significantly elevated CRP (p = 0.045), erythrocyte sedimentation rate (ESR) (p = 0.032), fibrinogen (p = 0.011), and procalcitonin (p = 0.044). The strongest correlations were seen between CRP, ESR, and fibrinogen (r_s ≥ 0.58, p ≤ 0.05), indicating a coordinated acute-phase response that weakened with advancing disease. Serum 25(OH)D was a significant independent predictor of COPD severity (AUC = 0.631, p = 0.048), while IL-6 had a weaker predictive value, losing significance in the combined regression model. Conclusions: Vitamin D deficiency is more pronounced in very severe COPD, serving as a potential clinical indicator of disease severity during exacerbation episodes. Full article

Objective: Immune checkpoint inhibitors (ICIs) are front-line treatment options for NSCLC. ICI therapy is associated with a risk of immune-related adverse events (irAEs). Checkpoint inhibitor pneumonitis (CIP) is a potentially life-threatening irAE. Previous studies have demonstrated that asthma and interstitial lung disease are associated with an increased risk of CIP. We sought to determine whether chronic obstructive pulmonary disease (COPD) is associated with CIP. Methods: This retrospective study examines a cohort of ICI-treated NSCLC patients either with or without chemotherapy at the Anna and Peter Brojde Lung Cancer Centre, Jewish General Hospital in Montreal, Canada between 2014 and 2023. We explored associations between risk factors and CIP using the Mann–Whitney U test or Fisher’s exact test. Analysis of prognostic factors was performed using a logistic regression model. All statistical analyses were carried out using SPSS software, version 24.0 (SPSS, Chicago, IL, USA). p-values of 0.05 or less were considered significant. Results: Of the 327 selected patients on ICIs, 23 experienced an acute respiratory deterioration that was attributed to CIP, 87/327(26.6%) patients had a pre-existing diagnosis of COPD, and 11/87 (12.6%) COPD patients experienced CIP compared to 13/240 (5.5%) non-COPD patients (p = 0.061). There was no statistical or clinically meaningful correlation between COPD severity and CIP. The only variable significantly associated with CIP was a poor ECOG performance status. Among ECOG 1 patients, 18/91 (19.8%) experienced CIP compared to 5/226 (2.2%) of those with an ECOG of 0. A multivariate assessment involving all 327 patients revealed no significant factors affecting CIP development. Conclusions: Our single-institution study revealed that although there was a trend, the presence of COPD was not statistically associated with an increased risk of CIP. Additionally, neither FEV1 nor DLCO had a meaningful impact on the development of CIP in COPD patients. Given these findings, we emphasize the need for larger prospective studies to confirm these observations before drawing definitive clinical recommendations. Full article

Background: Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of intensive care unit (ICU) admissions and in-hospital mortality. Several hematological inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), derived NLR (dNLR), and systemic immune-inflammation index (SII), have been proposed as markers of disease severity and mortality. Methods: A retrospective study was conducted on 104 ICU patients with AECOPD over a two-year period. We collected and analyzed clinical, demographic, and laboratory data. The hematological indices of the two groups—survivors (n = 39) and non-survivors (n = 65)—were compared to assess differences. We used t-tests, ANOVA, chi-square tests, and Mann–Whitney U tests to compare the groups. The factors that independently predicted mortality were identified using multivariate logistic regression. We examined survival differences using Kaplan–Meier analysis, and ROC curves were utilized to evaluate the predictive power of each biomarker. Results: Mortality was substantially predicted by higher SII (OR: 1.92, 95% CI: 1.24–3.08, p = 0.002) and NLR (OR: 2.89, 95% CI: 1.72–4.82, p < 0.001). Patients with NLR > 8.0 and SII > 1800 had significantly lower survival rates (log-rank p < 0.001), according to Kaplan–Meier analysis. SII (AUC = 0.79) and NLR (AUC = 0.82) were the best predictors of death, according to ROC analysis. Conclusions: In ICU-admitted AECOPD patients, NLR, MLR, PLR, dNLR, and SII are independent predictors of mortality. Due to their ease of evaluation and predictive capabilities, they should be included in ICU risk models for early interventions. Full article

Background/Objectives: Hospitalizations for acute exacerbations in patients with chronic obstructive pulmonary disease (AECOPD) are connected with considerable mortality and morbidity and have a great impact on healthcare costs. We aimed to identify potentially important characteristics that distinguish patients with AECOPD that required hospitalization between those that did not. Methods: We performed a post hoc study of a previously conducted observational study assessing the discharge records of AECOPD patients who were either hospitalized or discharged directly from the emergency department (ED). Results: A total of N = 593 AECOPD patients (37.4% female) were included: N = 225 (37.9%) were hospitalized, while 368 (62.1%) were discharged from the ED. Patients had a mean age of 71 (±9.14) years. Further, 64.7% had arterial hypertension, and 60.4% of hospitalized and 42.1% of discharged patients had cardiovascular disease (excluding hypertension) (p < 0.001). In addition, 24% of hospitalized patients suffered from diabetes mellitus (vs. 16.8% of those discharged, p = 0.042). Patients that were discharged had a higher median eosinophil count than hospitalized patients (p < 0.001). Among the 368 patients discharged from the ED, 23.6% visited the ED due to AECOPD, and 50.6% were hospitalized in the subsequent three months. Patients that had at least one AECOPD in the subsequent three months had significantly lower initial eosinophil counts than those that did not (p = 0.015). Conclusions: Hospitalized AECOPD patients had a higher prevalence of pre-existing cardiovascular disease, diabetes mellitus and lower blood eosinophil counts. Patients that had subsequently visited ED in the following three months initially had lower blood eosinophil counts than those that did not make subsequent visits. Full article

While the impact of air pollution on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has been widely studied, its effect on hospitalization outcomes remains less explored. This study examines the influence of short-term air pollution exposure on adverse hospitalization outcomes—mortality, mechanical ventilation use, and prolonged hospitalization—in patients with non-infectious severe AECOPD in Novi Sad, Serbia. Using a five-year time-series analysis, concentrations of selected air pollutants (PM₁₀, PM_2.5, SO₂, and NO₂) and meteorological data were integrated with hospitalization outcomes. Distributed lag non-linear models (DLNMs) revealed significant associations between rising air pollutant levels and some unfavorable outcomes. Exposure to rising PM_2.5 (urban background) and SO₂ (urban traffic) concentrations were linked to higher risks of mechanical ventilation (cumulative OR 21.95 (95% CI 1.07–449.45) and 11.37 (95% CI 1.25–103.27), respectively) and prolonged non-infectious AECOPD hospitalization (cumulative RR 2.27 (95% CI 1.14–4.52) and 2.24 (95% CI 1.38–3.64), respectively). No cumulative lag effects on mortality were observed, though specific patterns emerged in individual lag models. These findings highlight the critical role of improving air quality in reducing some COPD-related hospitalization risks. Full article

COPD is a major public health problem due to its high morbidity and mortality. The evolution of COPD is marked by the occurrence of acute exacerbations (AECOPD). One of the major causes of AECOPD is non-adherence treatment. Telemedicine is an accessible educational tool that can help physicians to provide continuous, accessible educational support and monitoring for patients with COPD. Objectives: This study aimed to determine the impact of therapeutic education via phone-based telemedicine on ED visits and/or hospitalizations for AECOPD. Methods: This is a randomized controlled trial carried out in the emergency department (ED) of Fattouma Bourguiba Monastir over a period of 7 consecutive months, including patients admitted with a final diagnosis of AECOPD. Patients were randomly assigned to receive standard care (STD) or weekly phone-based telemonitoring (TLM). Outcomes (exacerbation and the need for hospitalization for AECOPD) were assessed at a 1-, 3-, and 6-month follow-up after being discharged from the hospital. Results: We included 163 patients (57 patients in the TLM group and 106 patients in the STD group). The mean age of the study population was 66.5 ± 12.5 years. The TLM group exhibited a significantly lower risk of ED visits for AECOPD compared to the STD group, with an odds ratio of 0.13 (95% CI: 0.04–0.40) and a p-value ≤ 0.001. Additionally, the TLM group had a notably lower hospitalization rate for AECOPD compared to the control group (15.8% vs. 44.3%, respectively), with an odds ratio of 0.23 (95% CI: 0.10–0.52) and a p-value < 0.001. The all-cause death rate was also lower in the TLM group at the 6-month follow-up. Conclusions: Telemedicine represents an innovative approach that could improve the management of patients with COPD. Full article

Background/Objectives: The interpretation of evidence on the de-escalation of triple therapy with the withdrawal of inhaled corticosteroids (ICSs) to dual bronchodilator therapy with a long-acting muscarinic antagonist (LAMA) and a long-acting beta-agonist (LABA) in patients with chronic obstructive pulmonary disease (COPD) is conflicting. We evaluated the efficacy and safety of ICS discontinuation from LABA-LAMA-ICS triple therapy compared to its continuation. Methods: We searched PubMed, Embase, Scopus, Web Of Science, clinicaltrial.gov, and CENTRAL for RCTs and observational studies from inception to 22 March 2024, investigating the effect of triple therapy de-escalation with the withdrawal of ICSs to dual therapy on the risk of COPD exacerbation, pneumonia, and lung function. This study was registered with PROSPERO, CRD42024527942. Results: A total of 3335 studies was screened; 3 RCTs and 3 real-world non-interventional studies were identified as eligible. The analysis of the time to the first moderate or severe exacerbation showed a pooled HR of 0.96 (95% CI, 0.80–1.15; I² = 77%) for ICS withdrawal compared to triple therapy continuation. The analysis according eosinophil levels showed that COPD subjects with ≥300 eosinophils/µL had a significant increase in the incidence of moderate or severe exacerbations when de-escalated to LABA/LAMA (pooled HR: 1.35, 95% CI: 1.00–1.82; I²: 56%). ICS withdrawal did not significantly affect the risk of mortality and pneumonia. Conclusions: The de-escalation of triple therapy with ICS withdrawal does not affect the main outcomes evaluated (moderate or severe exacerbations, change in trough FEV₁). COPD patients with high blood eosinophils (≥2% or ≥300 cells/µL) are most likely to benefit from continuing triple therapy. Full article

To test the hypothesis that they serve as systemic biomarkers of chronic obstructive pulmonary disease (COPD), we profiled the mRNA expression of enzymes connected to systemic inflammation and GSH metabolism in peripheral blood mononuclear cells (PBMCs). These were taken from patients displaying acute exacerbation of COPD (AE-COPD) and stable COPD, and also from non-obstructive smokers and non-smokers. The expression of poly(ADP-ribose) polymerase-1 was increased, but that of histone deacetylase 2 was decreased in association with AE-COPD. The expression of modulatory subunit of glutamyl–cysteine ligase was higher and that of its catalytic subunit, together with the expression of dipeptidyl peptidase 4, was lower in COPD patients compared with non-obstructive smokers and non-smokers. Leukotriene A4 hydrolase saw increased expression in patients with COPD according to disease severity compared to non-obstructive individuals, whereas the expression of GSH peroxidase increased in non-obstructive smokers and COPD patients with the growing number of pack-years smoked. The results corroborate COPD and its acute exacerbation as a complex systemic disorder demonstrating distinct associations with the expression of enzymes linked to inflammation and the regulation of GSH metabolism. Full article

Background: Current management of COPD is predominantly focused on respiratory aspects. A multidimensional assessment including nutritional assessment, quality of life and disability provides a more reliable perspective of the true complexity of COPD patients. Methods: This was a prospective observational study of 120 elderly COPD patients at high risk of acute exacerbations. The Mini Nutritional Assessment (MNA) was administered in addition to the usual respiratory assessment. The primary outcome was a composite of moderate or severe acute exacerbations during 52 weeks of follow-up. Results: The median MNA Short Form (SF) score was 11 (8–12), 39 participants (32.50%) had a normal nutritional status, 57 (47.5%) were at risk of malnutrition and 24 (20%) were malnourished. Our multivariate linear regression models showed that the MNA score was associated with dyspnea and respiratory symptom severity, assessed by the Modified British Medical Research Council (mMRC) scale and the COPD Assessment Test (CAT) score, with spirometric variables, in particular with the severity of airflow limitation based on the value of FEV1, and with poorer QoL, as assessed by the EQ-5D-3 questionnaire. Competing risk analysis according to nutritional status based on the MNA Total Score showed that COPD participants “at risk of malnutrition” and “malnourished” had a higher risk of moderate to severe acute exacerbations with sub-hazard ratios of 3.08 (1.40–6.80), p = 0.015, and 4.64 (1.71–12.55), p = 0.0002, respectively. Conclusion: Our study confirms the importance of assessing nutritional status in elderly COPD patients and its prognostic value. Full article

Background/Objective: Systemic inflammation is common in chronic obstructive pulmonary disease (COPD), and evidence suggests that inflammatory biomarkers can predict acute exacerbations (AECOPDs). The aim of this study was to analyse whether C-reactive protein (CRP), fibrinogen, white blood cell count (WBC), or the blood cell indices PLR (platelet-to-lymphocyte ratio), SII (systemic immune inflammation index), SIRI (systemic inflammation response index), and AISI (aggregate index of systemic inflammation) can predict future AECOPDs. Methods: In the Tools Identifying Exacerbations (TIE) cohort study, participants with spirometry-confirmed COPD were recruited from primary and secondary care in three Swedish regions and assessed during a stable phase of COPD. AECOPD frequency during the three-year follow-up was reviewed in medical records. Associations were analysed via ordinal logistic regressions. Results: Of the 571 participants, 46% had ≥1 AECOPD during follow-up, and the mean ± SD AECOPD frequency was 0.63 ± 1.2/year. In unadjusted analyses, high levels of CRP (odds ratio 1.86, 95% CI 1.29–2.67), fibrinogen (2.09, 1.38–3.16), WBCs (2.18, 1.52–3.13), SII (1.52, 1.05–2.19), SIRI (1.76, 1.23–2.52), and AISI (1.99, 1.38–2.87) were associated with a higher AECOPD frequency. After adjustment for AECOPD history, age, sex, smoking, body mass index, COPD Assessment Test score, lung function, and inhaled corticosteroid use, associations remained for high levels of CRP (adjusted odds ratio of 1.64; 95% CI of 1.08–2.49), fibrinogen (1.55; 1.07–2.24), and WBC (1.65; 1.10–2.47). Conclusions: CRP, fibrinogen, and WBC, assessed during stable-phase COPD, enhanced AECOPD prediction, whereas PLR, SII, SIRI, and AISI did not. Full article

Background: Chronic obstructive pulmonary disease (COPD), characterized by high-energy metabolism, often leads to malnutrition and is linked to exacerbations. This study investigates the association of malnutrition-related body composition and handgrip strength changes with exacerbation frequencies in COPD patients. Methods: We analyzed 77 acute exacerbation COPD (AECOPD) patients and 82 stable COPD patients, categorized as frequent and infrequent exacerbators. Assessments included body composition, handgrip strength, nutritional risk, dyspnea scale, and COPD assessment. Results: Among AECOPD patients, there were 22 infrequent and 55 frequent exacerbators. Infrequent exacerbators showed better muscle parameters, extracellular water ratio, phase angle, and handgrip strength. Significant differences in intracellular water, total cellular water, protein, and body cell mass were observed between groups. Logistic regression indicated that extracellular water ratio (OR = 1.086) and phase angle (OR = 0.396) were independently associated with exacerbation risk. Thresholds for exacerbation risk were identified as 0.393 for extracellular water ratio and 4.85° for phase angle. In stable COPD, 13 frequent and 69 infrequent exacerbators were compared, showing no significant differences in weight, muscle, and adipose parameters, but significant differences in extracellular water ratio, phase angle, and handgrip strength. Conclusions: These findings suggest that increased exacerbations in COPD patients correlate with higher extracellular water ratios and lower phase angles. Full article