Search Results (432)

Background and Objectives: Emphysema and coronary artery calcium (CAC) share common lifestyle-related risk factors, yet their association in Chinese populations remains understudied. This study investigated how lifestyle factors influence the association between emphysema and CAC score in an urban Chinese general population. Methods: The study included 1000 participants from the Chinese Nelcin-B3 urban general population study originating in 2017 who underwent low-dose CT (LDCT) screening and comprehensive CT assessment. Emphysema was visually assessed by subtype and severity. CAC was measured using the Agatston method and categorized as 0, 1–100, and >100. Questionnaire-based lifestyle factors (smoking, BMI, diet, physical activity, alcohol consumption and environmental exposures) were categorized based on number of unfavorable behaviors. Multivariable multinomial logistic regression adjusted for age, sex, education and cardiovascular risk factors examined the associations between emphysema and CAC, with interactions and stratified analyses for lifestyle effects. Results: Emphysema was present in 62.3% of the participants, with centrilobular being the most common subtype (61.5%). Paraseptal emphysema was associated with both CAC 1–100 (OR: 2.07 [1.03–4.15]) and CAC > 100 (OR: 2.94 [1.26–6.84]). Severe emphysema was linked to CAC > 100 (OR: 3.50 [1.38–8.84]). These associations were stronger in the intermediate unhealthy lifestyle group for paraseptal (OR: 5.41 [1.70–17.22] and moderate and severe emphysema (OR: 9.64 [1.64–56.55]; OR: 3.73 [1.07–13.06]), respectively, but not significantly different. Conclusions: While paraseptal and severe emphysema are associated with higher CAC scores, there is no modifying effect of lifestyle factors. These findings suggest that cardiovascular risk assessment could be of importance in individuals with emphysema. Further longitudinal studies are needed to clarify the clinical implications. Full article

Background/Objectives: Subcutaneous emphysema is a rare but potentially life-threatening complication of dental procedures caused by the penetration of pressurized air into submucosal tissues and its spread through cervicofacial and mediastinal spaces. This review aimed to summarize all reported cases of subcutaneous emphysema following periodontal interventions and to identify procedure and device-related etiologic factors associated with its occurrence. Methods: A comprehensive literature search was conducted, and case reports published between 1957 and 2025 were included without language restrictions. Cases related to trauma, maxillofacial surgery, endodontic, restorative, or prosthetic procedures were excluded. Results: A total of 34 publications reporting 36 clinical casesmet the inclusion criteria. The median patient age was 48 years (range: 8–76), and 66.7% of cases occurred in female patients. Air-powder abrasive devices were the most frequently implicated etiologic factor (66.7%), followed by dental lasers (11.1%) and air-water syringes (8.3%). Mediastinal spread was reported in 41.7% of cases. Most patients received prophylactic antibiotic therapy, and the median resolution time was 5 days (range: 3–14). Conclusions: Subcutaneous emphysema following periodontal interventions is most frequently reported in association with the use of pressurized air-driven devices, particularly air-powder abrasive systems. Although the clinical course described in the included cases was generally benign, the observed patterns highlight the relevance of procedural and device-related factors in the development and extent of this complication. Full article

Chronic obstructive pulmonary disease (COPD) is a major contributor to global respiratory morbidity and exhibits substantial sex- and gender-related differences in incidence, phenotype, pathophysiology, and outcomes across the life course. Historically regarded as a predominantly male disease due to higher smoking rates, COPD is now increasingly recognized among women, reflecting changing exposure patterns and enhanced diagnostic attention. Moreover, evidence indicates that women may be more biologically susceptible to the harmful effects of tobacco smoke and often develop COPD at younger ages. Clinical manifestations also differ, with women more frequently reporting dyspnea, anxiety, and depression, whereas men may exhibit more cough and sputum production. Imaging studies suggest that airway-predominant disease is more common in women, while men are more likely to demonstrate emphysema-predominant patterns. Furthermore, women face an increased risk of exacerbation, yet they are more likely to experience underdiagnosis or misdiagnosis. Treatment responses and comorbidity patterns also show sex- and gender-related variations. Despite these differences, most clinical guidelines and therapeutic strategies do not differentiate by sex and gender, highlighting a gap in personalized COPD management. Overall, growing evidence underscores the importance of incorporating sex and gender as biological and sociocultural variables in COPD research, diagnosis, and treatment. Recognizing sex/gender-specific risk profiles, symptom patterns, and disease phenotypes may improve early detection and enable more targeted, effective interventions. This narrative synthesis, derived from a meticulous search in PubMed and the critical selection of 74 articles from the 448 identified originally, integrates evidence from guideline statements, registry studies, mechanistic and preclinical research, imaging and physiology investigations, systematic reviews, and randomized controlled trials that report sex- and gender-disaggregated data. Full article

Background: Following the earthquakes that occurred in Türkiye in 2023, the resulting demolition dust (DD) negatively impacted air quality and led to an increase in respiratory diseases. Although the harmful effects of crystalline and amorphous silica are known, the effects of hydrated cement dust (HCD), autoclaved aerated concrete dust (AACD), and DD on the lungs have not been sufficiently investigated. This rat study presents the first experimental data on the toxicity of these dusts. Methods: In the study, the structural properties of dust particles smaller than 5 µm were characterized using XRD analysis. Subsequently, 48 female rats were divided into four groups: HCD, AACD, DD, and control. The relevant dust suspensions were administered to the experimental groups, and physiological saline was administered to the control group intranasally a total of five times over a 15-day period, once every 3 days. Subsequently, bronchoalveolar lavage fluid, blood, and lung tissues were analyzed. Results: An increase in emphysema was observed in all exposure groups, and this increase was significant in the AAC and HC groups. Inflammation and alveolar wall thickness increased in the HC and DD groups. Goblet cell hyperplasia was detected only in the HC group; increases in CD68⁺ macrophages and TGF-β, as well as elevated hydroxyproline, were detected only in the DD group and supported the fibrotic response (p < 0.05). Neutrophil increase was specific to the AAC group. In all exposure groups, Akt/NF-κB pathway proteins, caspase-9, and MPO levels increased, while Bcl-xl levels decreased (p < 0.05). The findings indicate that the examined dusts trigger inflammation and apoptosis. Conclusion: Exposure to HCD, AACD, and DD causes lung damage by modulating the Akt/NF-κB signaling cascade; it enhances the apoptotic process through Bcl-xl suppression and caspase-9 increase. DD also induces a marked fibrotic response. Full article

Bovine respiratory syncytial virus (BRSV) is a major viral pathogen associated with bovine respiratory disease (BRD), a leading cause of illness and economic loss in cattle worldwide. In June 2022, an acute respiratory outbreak occurred in a dairy herd in Photharam District, Ratchaburi Province, Thailand, affecting 25 of 103 cows (24.3%) and resulting in three deaths (2.9%). This study aimed to confirm BRSV as the etiological agent of the outbreak and to genetically and phylogenetically characterize Thai BRSV strains using partial G gene sequencing. Clinical signs included fever, nasal discharge, coughing, and subcutaneous emphysema. Nested reverse transcription-polymerase chain reaction (nested RT-PCR), a sensitive method for detecting viral RNA and targeting the F and G genes, confirmed BRSV in all samples. At the same time, bovine parainfluenza virus type 3 (BPIV-3), bovine viral diarrhea virus (BVDV), and bovine herpesvirus 1 (BoHV-1) were not detected. Phylogenetic analysis of partial G gene sequences showed that all Thai isolates clustered closely within subgroup III, with 100% nucleotide identity among themselves and 85.9–97.7% similarity to subgroup III strains from other countries. Amino acid alignment indicated conservation of key antigenic motifs, including the cysteine noose, with only minor substitutions compared to some foreign strains. This study provides the first genetic and phylogenetic characterization of BRSV in Thailand, highlighting the genetic stability of subgroup III and providing baseline molecular data to support regional surveillance, diagnostics, and vaccine strategies. Full article

Background/Objectives: Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder classically associated with emphysema and COPD. However, emerging evidence indicates that its clinical spectrum extends to airway-predominant diseases such as bronchiectasis and asthma, where protease–antiprotease imbalance and neutrophilic inflammation may drive tissue injury. This narrative review aims to synthesize current evidence on the relationship between AATD and airway diseases beyond emphysema, focusing on epidemiological patterns, underlying mechanisms, diagnostic strategies, and therapeutic implications. Methods: A narrative synthesis of the literature was performed, integrating data from registries, with observational and translational studies addressing the prevalence, pathobiology, and therapeutic implications of AATD in bronchiectasis, asthma, and severe asthma. Epidemiologic and mechanistic insights were analyzed to identify overlapping pathways and evidence gaps. Results: Evidence supports a non-negligible prevalence of bronchiectasis and asthma among AATD individuals, particularly in severe or heterozygous genotypes. Neutrophil elastase overactivity, impaired mucociliary clearance, and chronic neutrophilic inflammation emerge as shared mechanisms promoting bronchial remodeling and airflow limitation. In asthma, AATD appears linked to T2-low, steroid-resistant phenotypes and persistent obstruction, whereas in severe asthma cohorts, up to 20% may carry non-PiMM SERPINA 1 variants. No randomized trials have evaluated augmentation therapy and standardized screening algorithms are lacking. Conclusions: AATD represents a systemic disorder with clinically relevant airway manifestations beyond COPD and emphysema. Targeted testing should be considered in patients with idiopathic bronchiectasis or severe asthma. Future genotype-stratified, prospective studies are required to clarify causality, define biomarkers of disease activity, and evaluate the potential role of anti-protease-based therapeutic strategies. Full article

Background and Objectives: Chronic obstructive pulmonary disease (COPD) is heterogeneous, and phenotype-based classification may better capture differences in clinical burden and healthcare needs beyond standard GOLD categories. We aimed to describe the distribution of GesEPOC COPD phenotypes in Turkey and compare their demographic, clinical, functional, radiological, treatment, and healthcare utilization profiles. Materials and Methods: DIPTUR was a multicenter, observational, cross-sectional study conducted prospectively in 26 centers across 17 Turkish cities (October 2019–June 2021). Stable COPD patients (≥40 years; post-bronchodilator FEV1/FVC < 0.7) without exacerbation or major treatment modification within the previous four weeks were enrolled consecutively. Phenotypes were assigned per GesEPOC: exacerbator with emphysema (EE), exacerbator with chronic bronchitis (ECB), asthma–COPD overlap (ACO), and non-exacerbator (NE). Frequent exacerbators were defined as patients who experienced two or more exacerbations during the 12 months preceding enrollment, based on medical records and patient reports. Results: Among 894 patients, phenotype distribution was NE 44.1%, ECB 26.2%, EE 20.5%, and ACO 9.3%. Male predominance was observed across groups (80–89%; p = 0.006). Active smoking was most frequent in ECB (37.6%; p < 0.001), and BMI was lowest in EE (p < 0.001). Comorbidity patterns differed, with hypertension (p < 0.001), diabetes mellitus (p = 0.029), and heart failure (p < 0.001) most prevalent in ECB. Pulmonary function (FEV1 and FVC) was lowest in EE (both p < 0.001), and severe airflow limitation (GOLD III–IV) was most common in EE and ECB (p < 0.001). Dyspnea (mMRC ≥ 2) was more frequent in EE/ECB than in ACO/NE (p < 0.001). Emphysematous changes on thoracic CT predominated in EE (91.7%; p < 0.001). Long-term oxygen therapy was most common in EE (32.4%; p < 0.001). Emergency admissions, hospitalizations, and total length of stay were markedly higher in EE and ECB than in ACO and NE (all p < 0.001). Conclusions: COPD phenotypes in Turkey show substantial heterogeneity in clinical, functional, radiological, and utilization domains. Exacerbator phenotypes—particularly EE and ECB—represent higher-burden groups, supporting phenotype-oriented management and closer monitoring beyond GOLD classification. Full article

Background/Objective: Little is known about the efficacy of biologics and in particular Dupilumab in patients with severe asthma associated with COPD (SA-COPD) features. The objective of this study was to determine whether Dupilumab has similar clinical/functional efficacy in individuals with SA-COPD and in those with pure severe asthma (SA). Methods: We retrospectively selected 11 consecutive patients with SA with COPD features (smoking history of at least 15 pack/years; emphysema on chest CT scan; FEV₁ < 80%; RV and TLC > 130%; DLCO < 70; salbutamol reversibility test < 12%) treated with Dupilumab for at least 1 year. These subjects were compared with 33 consecutive patients with SA alone who were also treated with the same biologic for at least 12 months. Results: FEV₁ and FEF_25–75 changes after treatment were 10 ± 18.3% and 18.6 ± 26.5% in the SA group, whereas they were 4.8 ± 7.6% and 7.2 ± 6.8% in individuals with SA-COPD (p = 0.909 and p = 0.102 respectively). Similarly, ACT (5.3 ± 3.1 vs. 5.6 ± 3.7; p = 0.783) and exacerbation changes (−2.97 ± 1.3 vs. −4 ± 4.3; p = 0.960) after Dupilumab were similar in the two groups. No differences were also found in FeNO and BEC changes (−18 ± 22 vs. −21.3 ± 21.1 ppb and −63.6 ± 415 vs. −142 ± 299 cells/µL respectively; p = 0.984 and p = 0.481). The percentages of subjects that reduced and stopped OC therapy and those that stepped down the level of ICS dose after treatment were also similar in the two populations. After adjustment for multiple confounding factors, changes in all evaluated outcomes also remained comparable between patients with SA-COPD and those with SA. Conclusions: In our experience, Dupilumab is effective both in patients with SA alone and in those with asthma–COPD overlap. We must always consider T2 inflammation in the management of such patients in order to provide the most appropriate treatment. Full article

Background and Objectives: The 2023 GOLD report introduced seven etiological categories, known as etiotypes, to better reflect the heterogeneity of chronic obstructive pulmonary disease (COPD). However, the clinical, functional, radiological, and psychosocial characteristics associated with these etiologies remain insufficiently defined. This study aimed to explore the differences among GOLD 2023 etiotypes in a stable COPD cohort. Materials and Methods: This prospective, observational, cross-sectional study included 315 stable outpatients with COPD from a tertiary clinic between June and July 2025. Etiological classification was based on predefined criteria, including genetic predisposition, impaired lung development, exposure-related mechanisms, infection-related mechanisms, and asthma-like characteristics. Patients were evaluated using clinical instruments (mMRC and CAT), psychological assessments (LCQ, BDI, BAI, and CAFS), pulmonary function tests, and thoracic CT scans. Results: COPD due to environmental exposure (COPD-E) was the most common type (98.7%), followed by infection-related (COPD-I, 13.3%), asthma-related (COPD-A, 9.8%), and combined forms (COPD-D and COPD-G, each 2.5%). Participants with COPD-A were younger (median 54 vs. 66 years; p < 0.001), reported less tobacco exposure (36 vs. 50 pack-years; p < 0.001), and showed less CT-detected emphysema (31.6% vs. 78.3%; p < 0.001). COPD-G exhibited more severe airflow obstruction (FEV₁ 25.5% predicted; p < 0.001), higher symptom burden (CAT score 21 vs. 6; p < 0.001), and lower oxygen saturation (p = 0.001). Eosinophil counts and psychosocial measures did not significantly differ by etiology. Conclusions: The GOLD 2023 COPD etiotypes demonstrated distinct clinical and functional profiles, reflecting diverse underlying mechanisms of the disease. Recognizing these etiological differences can help clinicians tailor diagnostic evaluations, guide individualized treatment strategies, and ultimately improve patient outcomes. Understanding disease etiology remains a cornerstone for accurate diagnosis, personalized management and optimized therapeutic decisions in COPD. Full article

Age-related chronic, low-grade inflammation, known as inflammaging, contributes to tissue damage and disease. In the lungs, inflammaging leads to abnormal tissue remodeling, reduced function, and decreased immunity. A key factor in inflammaging is declining acetylcholine signaling, which normally suppresses inflammation and promotes tissue repair. We tested whether increasing acetylcholine responsiveness could reverse age-related lung damage. Aged mice were treated with donepezil to increase acetylcholine availability. After six months, blood oxygen saturation and voluntary activity were significantly improved. Histologically, treated mice showed a reversal of alveolar enlargement (a hallmark of emphysema) and complete restoration of elastic fibers. Donepezil treatment also dramatically increased bronchus-associated lymphoid tissue (iBALT) formation. iBALT is the repository of tissue-resident memory lymphocytes, including memory cholinergic lymphocytes that produce acetylcholine to suppress inflammation during secondary infections. The age-related loss of iBALT contributes to the increased risks associated with respiratory infection in the elderly. This indicates that age-related lung function and respiratory immune deficits can be modulated by improving acetylcholine signaling. Repurposing an approved medication provides a direct pathway to clinical application for improving respiratory health and infection resistance during aging. Full article

Background: Anatomical lung resection is performed in cancer patients with severe emphysema who may also benefit from lung volume reduction (LVR). However, anatomical lung volume reduction surgery (LVRS) for emphysema alone is uncommon. This study compares the outcomes of anatomical and traditional LVRS. Methods: Patients undergoing surgery for emphysema were retrospectively analysed. They were grouped as anatomical LVRS (A-LVRS) and traditional LVRS (T-LVRS) patients. Various outcomes were compared between groups. Results: Thirty-three (33) patients were divided into A-LVRS (14) and T-LVRS (19) groups. The mean age was 62.1 ± 8.8 and 17 (51.5%) were females. Demographic and preoperative variables were similar between these groups. Overall complications, length of stay (LOS), critical care complex (CCC) re-admission, CCC-LOS and hospital re-admissions were similar. Drain stay duration was shorter in the A-LVRS vs. the T-LVRS group (6.4 vs. 12.6 days, respectively, p = 0.042) and air leak-related complications were also fewer in the A-LVRS group (21.4% vs. 57.9%, respectively, p = 0.036). Reduction in the COPD assessment test was greater in the A-LVRS vs. T-LVRS group (17 vs. 7.8, p = 0.045). Forced expiratory volume 1 s (FEV₁) was improved by 8.25% in the A-LVRS vs. 2.9% in the T-LVRS group (p = 0.049). The lung transfer factor for carbon monoxide (TLCO) increased by 7.9% in the A-LVRS group versus a decrease of −1.01% in the T-LVRS group (p = 0.031). More lung volume was removed in the A-LVRS vs. the T-LVRS group (1625.4 vs. 352.4 cm³, p = 0.035). In-hospital/30-day/90-day deaths and long-term survival were similar. Conclusions: Anatomical LVRS is safe and may provide better outcomes in selected parameters compared with traditional LVRS. Full article

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, and emphysema is present in the majority of affected patients and can be identified on computed tomography (CT). This study investigated whether radiomic features derived from automatically and adaptively segmented low-attenuation lung regions can capture distinct imaging characteristics of COPD beyond conventional emphysema measures. Radiomic features were extracted from 6078 chest CT scans of 2243 participants from the COPDGene cohort. Emphysematous regions were segmented using the MimSeg method based on Gaussian mixture modelling with patient-adjusted thresholding, and radiomic features were computed for individual lesion clusters and aggregated per patient using summary statistics, yielding 780 features per subject. Uniform Manifold Approximation and Projection (UMAP) was used to generate a low-dimensional embedding, and feature contributions were evaluated using SHAP analysis and statistical testing. The resulting embedding demonstrated structured patterns broadly aligned with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, with greater overlap among GOLD 0–2 and more consolidated groupings for GOLD 3 and 4, reflecting differences in disease severity. The most influential features were predominantly derived from Grey Level Run Length Matrix measures, capturing textural heterogeneity and spatial organisation of emphysematous changes that are not directly described by standard density-based metrics. These findings suggest that radiomic analysis of adaptively segmented CT data may provide complementary and structurally distinct information relative to conventional emphysema measures, supporting a more nuanced characterisation of emphysema patterns in COPD. Full article

The dichotomous outcomes of chronic lung inflammation, represented by either pulmonary emphysema or interstitial fibrosis, involve poorly understood overlapping mechanisms. Recent insights from network theory suggest that percolation phenomena, coupled with the dynamics of extracellular matrix crosslinking, play an important role in determining these divergent pathological trajectories. This review examines how critical percolation thresholds at which local damage or repair transitions to system-wide structural failure or rigidification determine the changes in lung tissue during chronic inflammation. We examine the mechanisms of collagen and elastin crosslinking, the feedback loops that amplify initial perturbations, and the threshold behaviors that push inflamed lung tissue toward either emphysematous destruction or fibrotic consolidation. Understanding these percolation-dependent transitions provides new insights into why similar inflammatory insults can produce opposite structural outcomes and suggests novel therapeutic strategies targeting the crosslinking mechanisms that underlie these critical transitions. Full article

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. Pulmonary function tests (PFTs) and quantitative indices (QIs) of computed tomography (CT) are typically used to diagnose COPD. The purpose of this work was to determine the correlation of the vector divergence operator with PFTs and QIs in COPD patients and compare the divergence of normal lung function to that in COPD. Vector divergence is computed for 73 patients with four-dimensional CT scans retrospectively identified as normal (n = 37) and COPD (n = 36), which includes emphysema (n = 13). The divergence is the flux per unit volume at a point in a vector field and reflects the local lung tissue expansion when the data are taken during inspiration. The divergence measures are strongly correlated with both PFTs and QIs of COPD patients and therefore are a useful biomarker in analyzing regional lung function. In physical terms, the divergence shows that there is a significant difference in lung tissue expansion between normal subjects and patients with airflow obstruction as in emphysema and COPD. The divergence analysis also enables new images using color overlays to provide a functional measure (local expansion capability) to the anatomical CT image. Full article

Accurate and interpretable detection of pulmonary emphysema on low-dose computed tomography (LDCT) remains a critical challenge for large-scale screening and population health studies. This work proposes a quality-controlled and interpretable deep learning pipeline for emphysema assessment using ResNet-152 embeddings. The pipeline integrates automated lung segmentation, quality-control filtering, and extraction of 2048-dimensional embeddings from mid-lung patches, followed by analysis using logistic regression, LASSO, and recursive feature elimination (RFE). The embeddings are further fused with quantitative CT (QCT) markers, including %LAA, Perc15, and total lung volume (TLV), to enhance robustness and interpretability. Bootstrapped validation demonstrates strong diagnostic performance (ROC-AUC = 0.996, PR-AUC = 0.962, balanced accuracy = 0.931) with low computational cost. The proposed approach shows that ResNet embeddings pretrained on CT data can be effectively reused without retraining for emphysema characterization, providing a reproducible and explainable framework suitable as a research and screening-support framework for population-level LDCT analysis. Full article