Author Affiliations

1. Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
2. Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
3. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Address correspondence to:

Ilona Jaspers, PhD
Department of Pediatrics
University of North Carolina at Chapel Hill
Chapel Hill, NC
Phone: (919) 966-8657
Email: ilona_jaspers@med.unc.edu

Abstract

Despite compelling epidemiological evidence linking vitamin D deficiency to adverse outcomes in chronic obstructive pulmonary disease (COPD), asthma, and cystic fibrosis, randomized controlled trials have consistently failed to demonstrate clinically meaningful benefits from oral vitamin D supplementation. This disconnect between observational associations and interventional evidence represents a significant paradox in pulmonary medicine. Recent meta-analyses have found limited protective or therapeutic effects of oral supplementation on exacerbation rates, lung function, hospitalizations, or quality-of-life measures. We propose that this therapeutic failure reflects not a lack of vitamin D's efficacy but rather a fundamental limitation in the route of delivery.

Oral vitamin D supplementation undergoes hepatic metabolism and systemic dilution before reaching respiratory tissues. High expression of cytochrome P450 family 24 subfamily A member 1, the vitamin D-inactivating enzyme, in pulmonary vasculature suggests that orally delivered vitamin D may be degraded before reaching the lung lumen. The respiratory epithelium possesses complete machinery for vitamin D activation, and vitamin D receptors are expressed throughout airway epithelial and immune cells, making direct pulmonary delivery mechanistically feasible. Preclinical studies demonstrate that nebulized or inhaled vitamin D reduces inflammation, protects epithelial barrier function, and improves lung function in murine models of respiratory disease without producing off-target systemic effects or hypercalcemia.

Direct lung delivery of vitamin D represents an unexplored therapeutic strategy that could transform management of chronic respiratory diseases, like COPD, by achieving local therapeutic concentrations while minimizing systemic exposure. Clinical trials investigating safety, dosing optimization, and efficacy are warranted.

Citation

Citation: Schichlein KD, Jaspers I, Drummond MB. Reconsidering vitamin D supplementation in pulmonary disease: the case for targeted respiratory delivery. J COPD F. 2026; 13(3): 249-254. doi: http://doi.org/10.15326/jcopdf.13.3.2025.0713

Keywords

COPD, asthma, vitamin D, inhalation, cystic fibrosis

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Author Affiliations

1. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
2. Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
3. Alpha-1 Clinical Resource Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
4. Department of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States
5. Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama Birmingham, Birmingham, Alabama, United States
6. Birmingham VA Health Care System, Birmingham, Alabama, United States

Address correspondence to:

Drew Robinson, MD
University of Alabama at Birmingham
Phone: (281) 683-6791
Email: ddrobinson@uabmc.edu

Abstract

Rationale: Alpha-1 antitrypsin deficiency (AATD) is a genetically inherited condition that can result in serious lung and liver disease. It is unclear whether testing for common alleles is sufficient or if testing for rare variants is helpful in identifying clinically significant disease.

Methods: A retrospective review was performed on adult patients who had alpha-1 antitrypsin phenotyping from January 2016 through December 2021. We recorded clinical characteristics and then grouped patients based on Pi*types: normal, Pi*Z-heterozygotes (Het), Pi*ZZ, Pi*S-Hets, and defined a Pi*Non-S/Non-Z group to include other identified Pi*types. Chi-square and Kruskal-Wallis tests were used for bivariate analyses, generalized linear models for modeling forced expiratory volume in 1-second (FEV₁), and logistic regression modeling for health care utilization outcomes adjusted for race, age, and sex.

Results: A total of 1777 tests were ordered from January 2016 through December 2021. Testing identified 79.5% Pi*MM, 8.4% Pi*Z-Het, 8.4% Pi*S-Het, 3.3% Pi*Non-S/Non-Z, and 0.5% Pi*ZZ. FEV₁ to forced vital capacity and FEV₁ percentage predicted were lowest in the Pi*Non-S/Non-Z group compared to the other groups. The Pi*Non-S/Non-Z group had higher mean neutrophil lymphocyte ratio compared to the other groups (p=0.021), higher hospitalization for acute respiratory events (27.6%; p=0.019), intensive care unit utilization (15.3%, p=0.011), and death (25.4%, p=0.041) compared to the other groups.

Conclusions: AATD Pi*typing identified several allelic combinations not previously linked with clinical disease. Compared to other Pi*type groups, the Pi*Non-S/Non-Z group had impairments in pulmonary function, elevated inflammatory markers, higher health care utilization, and death. Our results underpin the need to explore relationships between rare allelic combinations and clinical outcomes.

Citation

Citation: Robinson DD, Chiu CY, Hampton JI, Solomon GM, Wells JM. Clinical characteristics and health care resource utilization among individuals undergoing alpha-1 antitrypsin testing in a quaternary health system. J COPD F. 2026; 13(3): 227-236. doi: http://doi.org/10.15326/jcopdf.13.3.2025.0723

Keywords

alpha-1 antitrypsin deficiency, forced expiratory volume in 1 second, health care utilization, forced vital capacity, patient characteristics

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Click to read Clinical Characteristics and Health Care Resource Utilization Among Individuals Undergoing Alpha-1 Antitrypsin Testing in a Quaternary Health System

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Author Affiliations

1. Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
2. Family Physician Airways Group of Canada, and University of Toronto, Toronto, Ontario, Canada
3. Scientific Affairs, AstraZeneca, Mississauga, Canada
4. BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
5. Milliman, New York, New York, United States

Address correspondence to:

Mohit Bhutani, MD, FRCPC, FCCP
Division of Pulmonary Medicine
Department of Medicine
University of Alberta
Edmonton, Alberta, Canada
Phone: (780) 492-3739
Email: mohit.bhutani@ualberta.ca

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of death in Canada. The Efficacy and Safety of Triple Therapy in Obstructive Lung Disease (NCT02465567) and Informing the Pathway of COPD Treatment (NCT02164513) randomized controlled trials (NCT02164513) demonstrated reduced exacerbations and all-cause mortality for patients with COPD on single-inhaler triple therapy (SITT). The 2023 Canadian Thoracic Society (CTS) COPD pharmacotherapy guidelines recommend triple therapy, and preferably SITT use, in patients with moderate to severe symptom burden and high future risk of exacerbations. The clinical impact of broader SITT use in Canada has not yet been studied.

Aim: We aimed to estimate the benefit of appropriate SITT use according to CTS COPD guidelines on mortality, exacerbations, and their corresponding costs in Canada.

Methods: We used a stochastic model using literature-derived characteristics (e.g., incidence, changes in COPD severity, treatment, mortality, and exacerbations) that simulated the Canadian COPD population. Patients were assigned percentage of forced expiratory volume in 1 second predicted levels, and their annual characteristics were modeled for 2025–2034 under 2 scenarios: “status quo” (current practice) and “increased SITT” (following CTS guidelines).

Results: Based on our simulated results for the flagged population, “Increased SITT” use over 10 years compared to current treatment reduced moderate and severe exacerbation rates by 23% and 12%, respectively, for a reduction of 159,000 severe and 2.81 million moderate exacerbations and reduced the all-cause mortality rate by 22%. In the flagged population alone, this reduction in exacerbations would equate to a savings of CA$3.9 billion over 10 years.

Conclusion: Appropriate use of SITT, informed by the 2023 CTS COPD guidelines, could lower mortality, exacerbation frequency, and their corresponding costs in patients with COPD.

Citation

Citation: Bhutani M, Kaplan A, Kayaniyil S, et al. Implementation of 2023 Canadian Thoracic Society guidelines for single-inhaler triple therapy could reduce exacerbation and mortality rates in COPD: PROMETHEUS Canada. J COPD F. 2026; 13(3): 184-194. doi: http://doi.org/10.15326/jcopdf.13.3.2025.0687

Keywords

COPD, single-inhaler triple therapy, population model

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Click to read Implementation of 2023 Canadian Thoracic Society Guidelines for Single-Inhaler Triple Therapy Could Reduce Exacerbation and Mortality Rates in COPD: PROMETHEUS Canada

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Author Affiliations

1. Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States
2. The Permanente Medical Group, Diablo Service Area, Walnut Creek, California, United States
3. Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, United States
4. Division of Pulmonary/Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, United States

Address correspondence to:

Laura C. Myers, MD, MPH
Kaiser Permanente Northern California
Division of Research
Pleasanton, CA 94588
Phone: (925) 433-3491
Email: Laura.c.myers@kp.org

Abstract

Background: A translation gap exists in how patients with chronic obstructive pulmonary disease (COPD) utilize mitigation strategies to limit exposure to wildfire smoke. This study examines patients’ points of view about barriers and facilitators of strategy uptake.

Methods: We performed semistructured, virtual interviews with members of Kaiser Permanente Northern California until thematic saturation. We recruited participants aged ≥65 in the lowest quartile of socioeconomic status because they are disproportionately exposed to air pollution with fewer resources to mitigate exposure. Qualitative analysis was performed using inductive and deductive approaches.

Results: Of 90,696 adults, we interviewed 31 in January 2025. Participants were racially and ethnically diverse (19% Black, 10% Hispanic, 3% Native American, 68% non-Hispanic White), from 10 counties. Three major themes were: (1) patients tended to get wildfire and air quality information from internet and smartphone apps, not clinical encounters, but expressed openness to receiving information from clinicians, (2) there appeared to be modifiable barriers to uptake of mitigation strategies, such as education and supplying equipment (e.g., masks, air cleaners), and (3) patients preferred real-time alerts sent to their phones from trusted sources, such as health care entities, to change their behavior during periods of poor air quality.

Conclusion: By understanding patients’ perspectives about their relationship with wildfire smoke, we gained practical information to begin designing interventions to protect patients’ health during periods of poor air quality.

Citation

Citation: Yao J, Lydon CM, Pak N, et al. Understanding COPD patients’ perspectives on utilizing strategies to limit their exposure to wildfire smoke. J COPD F. 2026; 13(3): 206-215. doi: http://doi.org/10.15326/jcopdf.13.3.2025.0682

Keywords

COPD, wildfire smoke, qualitative interviews

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Click to read Understanding COPD Patients’ Perspectives on Utilizing Strategies to Limit Their Exposure to Wildfire Smoke

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, United States
2. Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States
3. Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, United States

Address correspondence to:

Sonal Mallya, MD, MHS
5501 Hopkins Bayview Circle, 4th Floor
Baltimore, MD 21224
Phone: (617) 823-9347
Email: smallya1@jhmi.edu

Abstract

Background: Individuals with chronic obstructive pulmonary disease (COPD) often face direct and indirect medical costs from unplanned emergency department visits and hospitalizations for acute exacerbations, out-of-pocket expenses for inhaled bronchodilators, and income loss from disability. Yet financial toxicity, which describes the objective burden and subjective distress resulting from medical costs, has not been studied in COPD. Individual experiences of financial toxicity in COPD offer insight into challenges that may be unique to this population.

Methods: We conducted semistructured interviews with 30 purposively sampled individuals with physician-diagnosed COPD. Transcripts were analyzed using inductive coding by 2 independent coders, and codes and were categorized through thematic analysis.

Results: Thirty participants completed semistructured interviews, of whom 56% were women, 43% non-Hispanic White, and 43% non-Hispanic Black. The mean age was 69.5 years, and 24 (70%) had public health insurance only. Several themes emerged including: (1) the sources of material burden in COPD; (2) adjustments to disease management, such as medication nonadherence or foregoing treatments; (3) adjustments to financial planning, including both changes to day-to-day spending and disruptions in major financial plans; (4) emotional impact; and (5) communication with health care providers.

Conclusion: Our findings are the first, to our knowledge, to describe the impact of financial toxicity in individuals with COPD. Financial toxicity in COPD is common and may adversely impact disease self-management, financial self-management, and psychological well-being. Additional research is needed to examine its impact on patient-reported outcomes and to develop interventions to reduce its burden.

Citation

Citation: Mallya SG, Holloway K, Eaton CK, et al. Exploring the impact of financial toxicity in COPD: a qualitative study. J COPD F. 2026; 13(3): 216-226. doi: http://doi.org/10.15326/jcopdf.13.3.2025.0712

Keywords

COPD, qualitative research, financial toxicity

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Author Affiliations

1. The Second Clinical College, Guangzhou Medical University, Guangzhou, China
2. State Key Laboratory of Respiratory Disease, Guangzhou Chest Hospital, Guangzhou, China
3. The Third Clinical College, Guangzhou Medical University, Guangzhou, China
4. The First Clinical College, Guangzhou Medical University, Guangzhou, China
5. State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease and National Center for Respiratory Medicine and Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
6. Guangzhou National Laboratory, Guangzhou, China

^* Theses authors contributed equally to this work.

Address correspondence to:

Fan Wu, MD, PhD
The First Affiliated Hospital of Guangzhou Medical University
Guangzhou, China
Email: wu.fan@vip.163.com.
Yumin Zhou, MD, PhD
The First Affiliated Hospital of Guangzhou Medical University
Guangzhou National Laboratory
Guangzhou, China
Email: zhouyumin410@126.com

Abstract

Background: The forced expiratory volume in 3 seconds (FEV₃) to forced expiratory volume in 6 seconds (FEV₆) ratio is a novel spirometry measure that identifies early airflow abnormalities, but its long-term prognosis value in the general population remains unclear. We aimed to evaluate the long-term all-cause mortality risk among participants with a reduced FEV₃/FEV₆.

Methods: Data were obtained from the National Health and Nutrition Examination Survey cycles 1988–1994 and 2007–2012. Reduced FEV₃/FEV₆ was defined as an FEV₃/FEV₆ less than the lower limit of normal. Multivariable logistic regression was used to assess the relationship of reduced FEV₃/FEV₆ with comorbidities and chronic respiratory symptoms. The relationship between reduced FEV₃/FEV₆ and all-cause mortality was evaluated using Cox regression models. The nonlinear relationship between FEV₃/FEV₆ and all-cause mortality was assessed using restricted cubic splines. Subgroup analyses were conducted to validate the robustness of the relationship.

Results: Overall, 25,159 participants were enrolled in the 308-month median follow-up analysis, of whom 8.8% (2225/25,159) had reduced FEV₃/FEV₆. Participants with reduced FEV₃/FEV₆ exhibited increased risks of congestive heart failure, asthma, chronic bronchitis, emphysema, respiratory symptoms, and all-cause mortality risk (adjusted hazard ratio=1.23, 95% confidence interval: 1.13–1.34, P<0.001). The findings remained consistent across subgroups. A nonlinear U-shaped association was observed between FEV₃/FEV₆ and all-cause mortality, with the turning point at 1.04.

Conclusions: Participants with reduced FEV₃/FEV₆ had worse respiratory health outcomes, suggesting that FEV₃/FEV₆ can be used as a prognostic spirometry indicator.

Citation

Citation: Liao S, Liang J, Ou J, et al. Clinical significance of a reduced forced expiratory volume in 3 seconds to forced expiratory volume in 6 seconds ratio in adults. J COPD F. 2026; 13(3): 195-205. doi: http://doi.org/10.15326/jcopdf.13.3.2025.0649

Keywords

COPD, all-cause mortality, forced expiratory volume in 3 seconds, forced expiratory volume in 6 seconds, small airway dysfunction

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Click to read Clinical Significance of a Reduced Forced Expiratory Volume in 3 Seconds to Forced Expiratory Volume in 6 Seconds Ratio in Adults

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Author Affiliations

1. Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
2. Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States
3. Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
4. Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
5. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, United States
6. Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, United States
7. Department of Genomic Medicine, Cleveland Clinic, Cleveland, Ohio, United States
8. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
9. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
10. Medical Service, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan, United States
11. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
12. Division of Pulmonary, Critical Care and Occupation Medicine, Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
13. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, Unites States
14. Division of Pulmonary, Allergy, and Critical Care Medicine, Chan Medical School, University of Massachusetts, Boston, Massachusetts, United States
15. Department of Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Wake Forest University, Winston-Salem, North Carolina, United States
16. Division of Pulmonary Medicine, Mayo Clinic, Phoenix, Arizona, United States
17. Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
18. Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
19. Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco, San Francisco, California, United States
20. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, California, United States
21. Division of Pulmonary, Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
22. Department of Physiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
23. Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, United States

     

^*Co-senior authors

Address correspondence to:

Jane C. Fazio MD, PhD
Division of Pulmonary and Critical Care Medicine
David Geffen School of Medicine
University of California
Los Angeles, CA
1100 Glendon Ave, Suite 850-861
Los Angeles, CA 90024
Email: jfazio@mednet.ucla.edu

Abstract

Rationale: Nebulizers are an alternative to handheld devices for inhaled therapies in chronic obstructive pulmonary disease (COPD). Understanding nebulizer utilization patterns is essential to developing therapy guidelines.

Objectives: We aimed to describe characteristics of nebulizer users versus nonusers and factors associated with baseline nebulizer use and longitudinal uptake.

Methods: We analyzed the Subpopulations and Intermediate Outcome Measures in COPD Study, a prospective cohort of 2973 participants with or without tobacco use and/or COPD. We used cross-sectional multivariable logistic regression and interval-censored proportional hazard models to analyze factors associated with nebulizer use and uptake among tobacco-exposed participants with preserved spirometry (TEPS) and COPD from enrollment (Visit 1) through 4–7 years of follow-up (Visit 5).

Results: Nebulizer utilization was highest in advanced COPD, 49% of Global initiative for chronic Obstructive Lung Disease (GOLD) Group D participants at baseline. Nebulizer treatments were primarily as-needed short-acting bronchodilators. Baseline nebulizer use was associated with respiratory exacerbations in the prior year (1, odds ratio [OR] 1.81, 95% confidence interval [CI] [1.24, 2.64]; 2, OR 1.86, 95% CI [1.07, 3.22]; 3 or more, OR 1.87, 95% CI [1.07, 3.28]), lower forced expiratory volume in 1 second (FEV₁) (OR 2.81 per liter decrease, 95% CI [2.09, 3.77]), COPD Assessment Test (CAT) score >10 (OR 1.89, 95% CI [1.17, 3.03]), 6-minute walk distance (6MWD) (OR 1.03 per 10 meter lower 6MWD, 95% CI [1.02, 1.05]), and a history of asthma (OR 2.41, 95% CI [1.76, 3.30]). Longitudinal uptake was similarly associated with exacerbations, lower FEV₁, CAT score >10, and asthma. Patterns were consistent between TEPS and COPD.

Conclusion: Nebulizers were predominantly used by participants with frequent exacerbations, high symptom burden, and advanced COPD, and long-acting nebulized medications were underutilized. Randomized controlled trials are needed to compare nebulizers with hand-held devices.

Citation

Citation: Fazio JC, Hong AW, Markovic D, et al. Exacerbations and decreased lung function predict nebulizer use and uptake in COPD and tobacco-exposed persons with preserved spirometry. J COPD F. 2026; 13(2): 111-124. doi: http://doi.org/10.15326/jcopdf.13.2.2025.0714

Keywords

COPD, outcomes, nebulizer, pulmonary physiology, medication delivery systems

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Click to read Exacerbations and Decreased Lung Function Predict Nebulizer Use and Uptake in COPD and Tobacco-Exposed Persons With Preserved Spirometry

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Author Affiliations

1. Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Lumezzane, Italy
2. Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
3. Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Institute of Marina di Ginosa, Marina di Ginosa, Italy
4. Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States

^*These authors equally contribute to the work.

Address correspondence to:

Michele Vitacca, MD
Respiratory Rehabilitation Unit
Istituti Clinici Scientifici Maugeri IRCCS
Via G Mazzini, 129 25065 Lumezzane, Italy
Email: michele.vitacca@icsmaugeri.it

Abstract

Background: Acute exacerbations of COPD (AECOPDs) may cause exercise-induced desaturation (EID), affecting recovery and rehabilitation outcomes. The prevalence and clinical implications of EID during early postexacerbation pulmonary rehabilitation are unclear. This study aimed to determine the prevalence of EID in COPD patients recovering from AECOPDs, with and without long-term oxygen therapy (LTOT) at rest, and to compare clinical, functional, and physiological characteristics.

Methods: This retrospective, multicenter study included 262 COPD patients admitted for inpatient pulmonary rehabilitation after AECOPDs. Participants were stratified by resting oxygen therapy status. EID was defined as a ≥4% fall in peripheral oxygen saturation from baseline with nadir <90% during the 6-minute walking test. Clinical, functional, and physiological parameters were compared across subgroups.

Results: Overall, 132 patients (50.4%) exhibited EID. Prevalence was higher in patients on oxygen at rest (61.5%) than in those breathing room air (33.9%, p <0.0001). Patients on oxygen therapy had greater lung function impairment, reduced exercise capacity, and higher dyspnea-related disability. EID was associated with greater heart rate response in patients on supplemental oxygen but not consistently with perceived dyspnea or fatigue, highlighting the importance of objective oximetry during exercise testing. Regardless of EID, individuals on oxygen walked shorter distances than those on room air.

Conclusions: EID is common in COPD patients recovering from AECOPD, especially those receiving LTOT, and is linked to more severe functional impairment. Systematic EID assessment using objective oximetry during early pulmonary rehabilitation may support individualized oxygen titration and exercise prescriptions. Prospective studies are needed to clarify its prognostic implications.

Citation

Citation: Paneroni M, Spinello L, Salvi B, et al. Prevalence of exercise-induced desaturation among COPD patients enrolled in early inpatient pulmonary rehabilitation. J COPD F. 2026; 13(2): 136-146. doi: http://doi.org/10.15326/jcopdf.13.2.2025.0724

Keywords

COPD, pulmonary rehabilitation, oxygen therapy, exercise-induced desaturation, 6-minute walk test

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Click to read Prevalence of Exercise-Induced Desaturation Among COPD Patients Enrolled in Early Inpatient Pulmonary Rehabilitation

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Author Affiliations

1. Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
2. Global Allergy and Airways Patient Platform, Vienna, Austria
3. Biomedical Research Group Oxford (PPI), Oxford, United Kingdom
4. Inogen Global, Zurich, Switzerland
5. COPD Baton Pass, Salisbury, United Kingdom
6. Global Medical Affairs, General Medicines, GSK, London, United Kingdom
7. Global Clinical Operations Research and Development, GSK, Collegeville, Pennsylvania, United States
8. Value Evidence and Outcomes Research, GSK, Dubai, United Arab Emirates
9. Advanced Pipeline Unit Respiratory, GSK, London, United Kingdom
10. Institute of Infection and Immunity, City St George’s, University of London, London, United Kingdom

Address correspondence to:

Rainer Gloeckl, PhD
Schoen Klinik Berchtesgadener Land
Malterhoeh 1
83471 Schoenau am Koenigssee
Germany
Phone: 49 8652 931630
Email: rgloeckl@schoen-klinik.de

Abstract

Background: The Chronic Obstructive Pulmonary Disease (COPD) Exacerbation Recognition Tool (CERT) was developed to improve patients’ recognition of COPD exacerbations. This validation study concerned the cross-cultural and linguistic validation of 46 CERT translations across 25 countries and 6 continents.

Methods: This study employed a rigorous, certified (International Organization for Standardization-17100) methodology. Dual forward translations for each language were developed by independent translators who were native speakers of the target language and then reconciled by a linguistic validation consultant (LVC). Independent linguists provided a back translation of the reconciled translation, which was reviewed by the LVC and project manager. Linguistic validation was performed for each language through cognitive debriefing interviews with at least 5 participants with COPD who were native speakers of the target language. These participants also reviewed 7 sets of images produced for different global regions to reflect patients from a diversity of cultures, countries, and religions, to determine if the images were representative of themselves and/or other people living with COPD. The images were amended as needed and reshown to the participants for approval.

Results: The translations were found to be conceptually equivalent to the original CERT and harmonized with each other. Participants found the CERT easy to use and understand and confirmed that the images were representative of themselves and/or other people living with COPD.

Conclusion: CERT translations were created using a patient-centric approach and appear to be easily understandable and valid across many languages and cultures.

Citation

Citation: Gloeckl R, Tal-Singer R, Deussen P, et al. COPD exacerbation recognition tool: translation, linguistic, and cross-cultural validation. J COPD F. 2026; 13(2): 147-157. doi: http://doi.org/10.15326/jcopdf.13.2.2025.0745

Keywords

COPD, education, exacerbation, patient-centered

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Click to read COPD Exacerbation Recognition Tool: Translation, Linguistic, and Cross-Cultural Validation

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Author Affiliations

1. School of Medicine, University of Connecticut, Farmington, Connecticut, United States
2. Bronchiectasis and NTM Association, Miami, Florida, United States
3. Divisions of Infectious Diseases and Ophthalmology, Oregon Health and Science University, Portland, Oregon, United States
4. Pulmonary Critical Care, Northwell Health, New Hyde Park, New York, United States
5. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
6. Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
7. Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University School of Medicine, New Orleans, Louisiana, United States
8. Division of Pulmonary, Critical Care and Sleep Medicine, Lenox Hill Hospital at Northwell Health, New York, New York, United States

Address correspondence to:

Alexander Geyer, MD
Division of Pulmonary, Critical Care and Sleep Medicine
Lenox Hill Hospital at Northwell Health
New York, NY
Email: ageyer@northwell.edu

Abstract

Background: Pseudomonas aeruginosa (P aeruginosa), Haemophilus influenzae (H influenzae), and Staphylococcus aureus (S aureus) may chronically infect bronchiectatic airways. Chronic rhinosinusitis (CRS) is common in people with bronchiectasis. Bacterial airway infection and CRS are associated with greater bronchiectasis disease severity. However, the relationship between these pathogens and CRS in people with bronchiectasis is unclear.

Research Question: Is history of CRS associated with sputum positivity for P aeruginosa, S aureus, and/or H influenzae in people with bronchiectasis?

Study Design and Methods: People with bronchiectasis from the U.S. Bronchiectasis and NTM Research Registry with and without physician-reported CRS were compared with respect to demographic and clinical characteristics using cross-sectional study design. Multivariable logistic regression models were used to assess the relationship between CRS and the presence of P aeruginosa, S aureus, and H influenzae in sputum.

Results: Of 1352 people with bronchiectasis and known CRS status, 222 (16%) had a history of CRS. Those with CRS were more likely to have a sputum culture positive for P aeruginosa (35% CRS versus 26% non-CRS group; p=0.007), but not S aureus (13% versus 10%; p=0.21) or H influenzae (6% versus 7%; p=0.55). After adjusting for patient demographics and clinical characteristics, CRS was associated with P aeruginosa (odds ratio: 1.5; 95% confidence interval: 1.07 to 2.08).

Interpretation: We report an association of history of CRS and sputum culture positivity for P aeruginosa (but not S aureus or H influenzae) in people with bronchiectasis.

Citation

Citation: Grabauskas T, Brunton AE, Metersky ML, et al. Association of chronic rhinosinusitis and Pseudomonas aeruginosa in sputum of patients with non-cystic fibrosis bronchiectasis. J COPD F. 2026; 13(2): 158-166. doi: http://doi.org/10.15326/jcopdf.13.2.2025.0732

Keywords

bronchiectasis, chronic rhinosinusitis, Pseudomonas aeruginosa, Haemophilus influenzae, Staphylococcus aureus

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Click to read Association of Chronic Rhinosinusitis and Pseudomonas aeruginosa in Sputum of Patients With Non-Cystic Fibrosis Bronchiectasis

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Author Affiliations

1. Department of Pharmacy, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
2. School of Public Health, Fujian Medical University, Fuzhou, China
3. Department of Pharmacy, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
4. Department of Pharmacy, First Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
5. Department of Pharmacy, People’s Hospital of Henan University of Chinese Medicine, Zhengzhou, China
6. Department of Pharmacy, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
7. Department of Pharmacy, Pingtan County General Laboratory Area Hospital, Fuzhou, China
8. Department of Pharmacy, Huaihe Hospital of Henan University, Kaifeng, China
9. Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
10. Department of Pharmacy, Affiliated Hospital of Guilin Medical University, Guilin, China
11. Department of Pharmacy, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, China
12. Department of Pharmacy, Traditional Chinese and Western Medicine Hospital of Wuhan,Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
13. Department of Pharmacy, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, China

^* contributed to the work equally

Address correspondence to:

Jinhua Zhang, PhD
Department of Pharmacy
Fujian Maternity and Child Health Hospital
College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics
Fujian Medical University
#18 Daoshan Road
Fuzhou, 350001, China
Phone: 86 591 83357896 8301
Email: pollyzhang2006@126.com

Abstract

Background: Chronic obstructive pulmonary disease (COPD) may influence bleeding in atrial fibrillation (AF). We evaluated bleeding and all-cause death risks under warfarin versus direct oral anticoagulants (DOACs).

Methods: Based on a retrospective cohort from 12 centers of patients with AF on oral anticoagulation, we evaluated the associations of COPD and anticoagulant class with clinical outcomes using overlap-weighted logistic regression. Prespecified sensitivity and subgroup analyses were performed.

Results: COPD was associated with higher bleeding risk only among patients treated with warfarin (total bleeding: odds ratio [OR] 2.53, 95% confidence interval [CI] 1.00–6.45; risk difference [RD] 9.05%, 95% CI 0.15%–22.50%; minor bleeding: OR 3.00, 95% CI 1.09–8.24; RD 8.53%, 95% CI 0.56%–21.53%). Among patients with AF and COPD, DOACs were associated with reduced risks of total bleeding (OR 0.08, 95% CI 0.01–0.50; RD –8.4%, 95% CI -22.0% to -5.3%) and minor bleeding (OR 0.01; RD -9.5%, 95% CI -23.1% to -4.5%) compared with warfarin.

Subgroup analyses suggested that DOACs were associated with increased mortality at estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m² (OR 3.07, 95% CI 0.78–12.03; RD 9.9%) but lower mortality at eGFR <60mL/min/1.73m² (OR 0.20, 95% CI 0.05–0.78; RD -24.1%). Factor Xa inhibitors were associated with a higher major bleeding risk compared with dabigatran (OR 4.56, 95% CI 1.70–12.26; RD 10.2%, 95% CI 0.2%–20.1%; with a number needed to harm of 10).

Conclusions: In AF with comorbid COPD, DOACs minimize bleeding versus warfarin and may confer survival benefit in renal impairment. Differential bleeding risk should be considered when choosing among DOACs.

Citation

Citation: Zhao N, Wei T, Huang X, et al. Comparison of bleeding risks and all-cause death between warfarin and direct oral anticoagulants in patients with atrial fibrillation and chronic obstructive pulmonary disease: a multicenter retrospective cohort study. J COPD F. 2026; 13(2): 93-103. doi: http://doi.org/10.15326/jcopdf.13.2.2025.0648

Keywords

chronic obstructive pulmonary disease, atrial fibrillation, direct oral anticoagulants, warfarin, bleeding

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Click to read Comparison of Bleeding Risks and All-Cause Death Between Warfarin and Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Chronic Obstructive Pulmonary Disease: A Multicenter Retrospective Cohort Study

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
2. Medical Nutrition Program, College of Allied Health Professions, University of Nebraska, Omaha, Nebraska, United States

*Co-first authors

Address correspondence to:

Daniel C. Belz, MD, MPH
Division of Pulmonary and Critical Care Medicine
Johns Hopkins University
Baltimore, Maryland
Phone: (410) 955-3841
Email: dbelz2@jhmi.edu

Abstract

Introduction: Isoflavones, phenolic compounds in legumes and soy products, are linked to reduced risk of chronic diseases such as coronary heart disease. However, effects on respiratory diseases like chronic obstructive pulmonary disease (COPD) are understudied.

Methods: Former smokers with COPD were enrolled in a prospective cohort study. Morbidity was assessed at baseline, 3, and 6 months using the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), modified Medical Research Council (mMRC), St George’s Respiratory Questionnaire (SGRQ), Ease of Cough and Sputum Clearance (ECSC), and exacerbation history. Spirometry and biomarkers of platelet activation, inflammation, and oxidative stress were obtained. Dietary intake was assessed via a food frequency questionnaire, with total isoflavone intake calculated as the sum of genistein, daidzein, glycitein, formononetin, and biochanin A. Associations were analyzed with generalized estimating equation regression analysis and adjusted for baseline covariates.

Results: A total of 99 participants (mean age 66.4, 55% female, 41% White, and a baseline forced expiratory volume in 1 second percentage predicted of 49.8%) had a mean isoflavone intake of 1.8mg (standard deviation [SD]=3.1). One SD increase in total isoflavone intake was associated with lower CAT (β=–2.0, p=0.011), CCQ (β=–0.2, p=0.029), and ECSC (β=–0.70, p <0.001) scores, and 7.4% lower urinary 11-dehydro-thromboxane B2 (p=0.047). A trend toward better SGRQ scores was observed but was not significant. Isoflavones were not associated with mMRC or exacerbations.

Conclusion: Increased isoflavone intake was associated with improved respiratory morbidity and reduced platelet activation, suggesting a potential dietary pathway influencing COPD morbidity.

Citation

Citation: Belz DC, Quiroz E, Woo H, et al. Isoflavone intake is associated with decreased chronic obstructive pulmonary disease morbidity. J COPD F. 2026; 13(2): 125-135. doi: http://doi.org/10.15326/jcopdf.13.2.2025.0695

Keywords

chronic obstructive pulmonary disease, Diet, isoflavones, food frequency questionnaire, respiratory morbidity

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Click to read Isoflavone Intake is Associated With Decreased Chronic Obstructive Pulmonary Disease Morbidity

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Author Affiliations

1. Hanoi Medical University, Hanoi, Vietnam
2. Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
3. Thang Long University, Hanoi, Vietnam

Address correspondence to:

Phan Thanh Thuy, MD, PhD
Hanoi Medical University
Hanoi, Vietnam
Email: phanthuy@hmu.edu.vn

Abstract

Background: Nocturnal symptoms and sleep disturbances are increasingly recognized as clinically important in chronic obstructive pulmonary disease (COPD) but remain understudied in low- and middle-income countries. The objective of this study was to assess sleep quality and determine its association with respiratory symptoms in Vietnamese outpatient COPD patients.

Methods: We conducted a cross-sectional study on 289 consecutive patients (≥ 40 years old) with a confirmed COPD diagnosis who were being monitored at the COPD management unit of Bach Mai Hospital, Hanoi (February2025 to May 2025). Demographic and clinical data (modified Medical Research Council [mMRC] dyspnea scale, COPD Assessment Test [CAT] score, forced expiratory volume in 1 second [FEV₁] after bronchodilator use, comorbidities, and number of hospitalizations in the previous year) were collected through structured interviews and medical record reviews. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI).

Results: The mean PSQI total score was 9.2 ± 3.7; 85.8% of participants met the threshold for poor sleep. A total of 65.4% of patients had an mMRC grade ≥ 2, 88.9% had a CAT score ≥ 10, and 88.9% of patients had an acute hospitalization in the past year. A high CAT score, a high mMRC grade, long disease duration, and FEV₁ below 50% were risk factors for impaired sleep quality as measured by the PSQI.

Conclusion: Poor sleep quality is highly prevalent among Vietnamese outpatient COPD patients and is closely associated with respiratory symptom burden and disease severity. These findings underscore the importance of routine sleep quality assessment in COPD management and suggest that optimizing symptom control may contribute to improved sleep and overall patient outcomes.

Citation

Citation: Thuy PT, Thu NT, Khan NC. Silent nights, restless lungs: sleep quality and associated factors among COPD patients in Vietnam—a cross-sectional study. J COPD F. 2026; 13(2): 104-110. doi: http://doi.org/10.15326/jcopdf.13.2.2025.0664

Keywords

chronic obstructive pulmonary disease, sleep quality, Pittsburgh Sleep Quality Index, nocturnal symptoms, Vietnam

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Click to read Silent Nights, Restless Lungs: Sleep Quality and Associated Factors Among COPD Patients in Vietnam — A Cross-Sectional Study

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Author Affiliations

1. Department of Respiratory and Critical Care Medicine, Yiwu Central Hospital, Yiwu, China
2. Department of Respiratory and Critical Care Medicine, University of Okara, Okara, Pakistan

Address correspondence to:

Mingchun Zhang, MD
Department of Respiratory and Critical Care Medicine
Yiwu Central Hospital
Yiwu, 322099, China
Email: agneszhang2011@sina.com

Abstract

Objectives: This meta-analysis assessed the effects of aerobic exercise on the function, prognosis, quality of life, and psychological outcomes of patients with chronic obstructive pulmonary disease (COPD).

Methods: The Cochrane Library, Scopus, PubMed, and Web of Science were searched from the inception to June 20, 2025 to identify eligible studies. A random-effects model was employed for meta-analysis.

Results: Twenty randomized controlled trials with 1003 participants were included. The risk of bias was high in most studies, particularly because blinding was not feasible. For most outcomes, we observed high heterogeneity among studies. The meta-analysis indicated that compared to the control group, patients with COPD undergoing exercise training had a significantly increased 6-minute walk test (weighted mean difference [WMD] 42.44m), forced expiratory volume in 1 second (FEV₁) (WMD 0.08L), FEV₁ to forced vital capacity (FVC) (WMD 5.42%), and peripheral capillary oxygen saturation (WMD 1.56%), which suggests that aerobic exercise can improve the functional capacity and respiratory reserve of patients with COPD.

On the other hand, the results revealed that compared to the control group, aerobic exercise markedly decreased the St George’s Respiratory Questionnaire (SGRQ) symptom score (standard mean difference [SMD] -1.13), the SGRQ total score (SMD -1.44), the modified Medical Research Council score for dyspnea (SMD -0.81), and the Hospital Anxiety and Depression Scale (HADS)-anxiety score (SMD -1.17), but its effect on the HADS-depression score (SMD -0.25) did not meet the threshold of statistical significance.

Subgroup analysis unveiled that aerobic exercise can offer greater benefits in the long term, and those with FEV₁ and FEV₁/FVC of more than 50% can benefit more from aerobic exercise.

Conclusion: Aerobic exercise may improve the functional capacity, symptoms, respiratory reserve, quality of life, and psychological outcomes of patients with COPD.

Citation

Citation: Zhang M, Khan MU. The effects of aerobic exercise on prognosis, quality of life, and psychological outcomes of patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. J COPD F. 2026; 13(2): 167-176. doi: http://doi.org/10.15326/jcopdf.13.2.2025.0657

Keywords

COPD, quality of life, meta-analysis, symptom burden, FEV₁, aerobic exercise

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Click to read The Effects of Aerobic Exercise on Prognosis, Quality of Life, and Psychological Outcomes of Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

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Author Affiliations

1. Department of Medicine, University of Chicago, Chicago, Illinois, United States
2. Humana Inc., Louisville, Kentucky, United States

Address correspondence to:

Valerie G. Press, MD, MPH
University of Chicago
5841 S Maryland Ave MC 2007
Chicago, IL, 60637
Email: vpress@bsd.uchicago.edu

Abstract

Background: Individuals with chronic obstructive pulmonary disease (COPD) rely on inhaler-based medications to treat and control symptoms. Most patients do not use correct technique. Teach-to-goal (TTG) inhaler education programs have been found to improve inhaler technique. There is limited understanding as to whether TTG inhaler education is effective when delivered over the phone.

Objective: We aimed to find out the effect of a phone-based TTG inhaler technique education program among Medicare Advantage beneficiaries with COPD.

Study Design and Methods: Beneficiaries with a diagnosis of COPD within the prior 2 years, who had filled at least one maintenance inhaler prescription at least once in the prior year, had a value-based insurance design plan, and received the inhaler education component of the COPD intervention program were evaluated. Inhaler technique was measured by validated checklists, and patients self-reported their technique.

Results: Of 1876 patients analyzed, n=13 used more than one inhaler. At the initial assessment, 39.4% of participants were using their inhalers incorrectly. By the end of the first education session, the percentage of participants who were using their inhaler incorrectly decreased to 6.9%.

Interpretation: A phone-based TTG inhaler education program offered by a large national health plan demonstrated improvements in inhaler technique across different inhaler devices and subpopulations. The multiple-session approach was likely critical for longer-term retention of correct technique, though further study is needed to confirm this. Some subgroup populations are also at greater risk for baseline inhaler misuse and/or post-training inhaler misuse indicating a need for further evaluation of how to tailor inhaler education by individuals’ needs.

Citation

Citation: Press VG, Katsikas A, Swankoski K, Boudreau E, Thomas E. Phone-based teach-to-goal inhaler education program for Medicare advantage beneficiaries with COPD. J COPD F. 2026; 13(2): 84-92. doi: http://doi.org/10.15326/jcopdf.13.2.2025.0667

Keywords

COPD, self-management, inhaler technique, teach-to-goal, value-based care

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Click to read Phone-Based Teach-To-Goal Inhaler Education Program for Medicare Advantage Beneficiaries With COPD

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Author Affiliations

1. College of Public Health, University of Kentucky, Lexington, Kentucky, United States
2. Department of Medicine, National Jewish Health, Denver, Colorado, United States
3. AlphaNet, Inc., Coral Gables, Florida, United States
4. College of Medicine, University of Kentucky, Lexington, Kentucky, United States
5. COPD Foundation, Miami, Florida, United States
6. Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, United States

Address correspondence to:

Radmila Choate, PhD, MPH
College of Public Health
University of Kentucky
Lexington, KY
Phone: (859) 218-2237
Email: Radmila.choate@uky.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Choate R, Holm KE, Sandhaus RA, Mannino DM, Strange C. Severe obesity and alpha-1 antitrypsin deficiency-associated COPD: a dual burden on health and quality of life. J COPD F. 2026; 13(2): 177-183. doi: http://doi.org/10.15326/jcopdf.13.2.2025.0672

Keywords

COPD, alpha-1 antitrypsin deficiency, severe obesity

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Click to read Severe Obesity and Alpha-1 Antitrypsin Deficiency-Associated COPD: A Dual Burden on Health and Quality of Life

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Author Affiliations

1. Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States
2. Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
3. Department of Medicine, University of Colorado Anschutz, Aurora, Colorado, United States
4. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
5. U.S. Food and Drug Administration, Silver Spring, Maryland, United States
6. Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
7. Department of Population Health Sciences, Duke University, Durham, North Carolina, United States
8. COPD Foundation, Miami, Florida, United States
9. Center for Health Research, Kaiser Permanente Northwest, Washington, D.C., United States

Address correspondence to:

Jerry A. Krishnan, MD, PhD
Mile Square Health Center
1220 S. Wood Street
University of Illinois Chicago
Chicago, IL 60608
Phone: (312) 413-0637
Email: jakris@uic.edu

Abstract

Rationale: Chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization and death, particularly among patients with chronic bronchitis and frequent exacerbations. Results of placebo-controlled clinical trials indicate that treatment escalation with either long-term oral roflumilast or azithromycin can reduce COPD exacerbations. However, head-to-head comparative data from clinical trials are lacking, so the relative harms and benefits of these treatments are unclear.

Objective: The RofLumilast or Azithromycin to preveNt COPD Exacerbations (RELIANCE) study is an investigator-initiated, multicenter, randomized, pragmatic clinical trial embedded in clinical practice to evaluate the effectiveness of treatment escalation with long-term azithromycin versus roflumilast in patients with COPD and chronic bronchitis.

Methods/Design: We solicited preferences from patients, clinicians, and other stakeholders during the design and implementation phases of the study, including feedback that informed modifications related to the COVID-19 pandemic. Eligibility criteria did not require assessments outside of clinical practice, with exclusions principally for safety. The composite endpoint of first all-cause hospitalization or death served as the primary outcome. Enrollment was initially through university-affiliated clinical centers but was subsequently expanded to recruit patients in community-based practices who might not otherwise participate in research. We employed human-centered design principles to improve the usability of study activities from the perspective of participants, study staff, and treating clinicians.

Final Design: The final study design offered the option for patients with COPD and chronic bronchitis at high-risk of hospitalization or death to be remotely consented, prescribed a medication according to the randomized treatment allocation, and complete virtual follow-up study visits in a decentralized clinical trial.

Citation

Citation: Krishnan JA, Holbrook JT, Sugar EA, et al. Rationale and design of the roflumilast or azithromycin to prevent COPD exacerbations clinical trial. J COPD F. 2026; 13(1): 17-28. doi: http://doi.org/10.15326/jcopdf.13.1.2025.0669

Keywords

COPD, clinical trials, acute exacerbation of COPD, hospital readmission reduction

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Click to read Rationale and Design of the Roflumilast or Azithromycin to Prevent COPD Exacerbations Clinical Trial

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Author Affiliations

1. Senior Department of Pulmonary and Critical Care Medicine, the Eighth Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
2. Department of Pulmonary and Critical Care Medicine, the Seventh Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
3. Department of Neurology, School of Rehabilitation Medicine, Capital Medical University, China Rehabilitation Research Center, Beijing, China
4. College of Economics and Management, China Agricultural University, Beijing, China
5. Faculty of Orthopedics, National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese People’s Liberation Army General Hospital, Beijing, China
6. Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
7. Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China

^*Co-first authors

Address correspondence to:

Qiang Tong, PhD, MD
Department of Rheumatology and Immunology
Shanghai Sixth People's Hospital Affiliated
Shanghai Jiao Tong University School of Medicine,
Shanghai, China
Email: jasontong1985@outlook.com
Jianzheng Zhang, PhD, MD
Senior Department of Orthopedics
Fourth Medical Center
PLA General Hospital
Beijing, China
Email: drzhangjianzheng@126.com

Abstract

Background: The association between 25-hydroxyvitamin D (25(OH)D) levels and chronic obstructive pulmonary disease (COPD) remains unclear. The study aims to investigate the association between 25(OH)D concentrations and the incidence and survival of COPD in the U.K. Biobank cohort.

Methods: We conducted a cross-sectional analysis using U.K. Biobank data from 328,855 participants with complete 25-Hydroxyvitamin D (25(OH)D). This analysis examined the association between 25(OH)D levels and COPD prevalence via logistic regression. Additionally, we prospectively followed a cohort of 327,871 individuals without baseline COPD. We assessed the risk of incident COPD and survival outcomes in this cohort using multivariable-adjusted Cox proportional hazards models. Kaplan-Meier estimates were used to generate survival curves.

Results: The prevalence of COPD was significantly higher in individuals with 25(OH)D deficiency compared to those with a normal level, as evidenced by an adjusted odds ratio (95% confidence interval [CI]) of 1.266(1.206–1.330) for COPD. During the median follow-up period of 15 years (interquartile range: 14–16 years), the overall COPD incidence was 262.3 per 10,000 person years, with higher rates among those with 25(OH)D deficiency (345.2 per 10,000 person years) compared to normal levels (232.6 per 10,000 person years) (p<0.001). In fully adjusted models, 25(OH)D deficiency was significantly associated with increased COPD incidence (hazard ratio [HR] 1.874, 95% CI 1.659 to 2.117) and mortality (HR 1.598, 95% CI 1.406–1.816). Subgroup analyses revealed stronger associations with COPD incidence among men, current smokers, and individuals not taking vitamin D supplements, as well as an increased COPD mortality risk among patients with depression (p for interaction <0.05).

Conclusions: Our study suggests that 25(OH)D deficiency is associated with COPD incidence and survival, providing a basis for preventive strategies and interventions.

Citation

Citation: Zhu Y, Zhao S, Zhu C, Zhang J, Tong Q. 25-Hydroxyvitamin D deficiency elevates the risk of COPD incidence and mortality: a large population-based prospective cohort study. J COPD F. 2026; 13(1): 59-72. doi: http://doi.org/10.15326/jcopdf.13.1.2025.0638

Keywords

chronic obstructive pulmonary disease, mortality, comorbidities, 25(OH)D, incidence

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Click to read 25-Hydroxyvitamin D Deficiency Elevates the Risk of COPD Incidence and Mortality: A Large Population-Based Prospective Cohort Study

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Author Affiliations

1. Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada

Address correspondence to:

François Maltais
Centre de Pneumologie
Institut Universitaire de Cardiologie et de Pneumologie de Québec
2725 chemin Ste-Foy, QC
Québec, Canada
G1V 4G5
Phone: (418) 656-4747
Email: francois.maltais@med.ulaval.ca

Abstract

Background: Lung resection is the preferred treatment option for lung cancer. Patients with chronic obstructive pulmonary disease (COPD) may be denied surgery due to lung function impairment or other comorbidities.

Objective: We aimed to describe the predictors of lung resection and long-term survival in patients with COPD with early-stage nonsmall cell lung cancer (NSCLC).

Study Design and Methods: This is a retrospective cohort study of patients with COPD who were treated for resectable NSCLC between 2009 and 2019 in a tertiary care hospital. The decision to operate or not followed a thorough clinical evaluation. Survival status was obtained from a provincial registry. A multivariable logistic regression analysis was used to determine predictors of surgery. A propensity score technique was used to control for confounding by indication. Hazard ratios for survival were estimated from a Cox regression model, adjusted for measured baseline confounders and propensity score as covariates.

Results: A total of 1307 patients with COPD were included, including 918 who underwent surgery. Of those, 147 (38%) did not have surgery and were treated with stereotactic body radiotherapy, 86 (22%) were treated with conventional radiotherapy, and 156 (40%) did not receive any active treatment. Predictors of surgery included age, forced expiratory volume in 1 second, adenocarcinoma versus squamous cell carcinoma, and stage 2A versus stage 1A. Propensity score-adjusted survival was significantly reduced with nonsurgical versus surgical approaches.

Interpretation: Lung resection was associated with better survival in patients with COPD and resectable lung cancer compared to nonsurgical approaches.

Citation

Citation: Tardif A, LeBlanc C, Roy P, et al. Lung cancer in patients with COPD: predictors of surgery and long-term survival following lung resection. J COPD F. 2026; 13(1): 29-38. doi: http://doi.org/10.15326/jcopdf.13.1.2025.0643

Keywords

COPD, lung cancer, surgery, stereotactic body radiotherapy

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Click to read Lung Cancer in Patients With COPD: Predictors of Surgery and Long-Term Survival Following Lung Resection

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Author Affiliations

1. Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States
2. Department of Pharmacy Systems Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, United States
3. Osler Medical Training Program, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
4. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois, United States
5. Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States
6. Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, United States

Address correspondence to:

Stephanie L. LaBedz, MD
840 South Wood Street
Room 920-N CSB
Chicago, IL 60612
Email: slabedz@uic.edu

Abstract

Introduction: High rates of medication nonadherence contribute to poor outcomes in chronic obstructive pulmonary disease (COPD), but the mechanisms driving nonadherence remain poorly understood.

Methods: We conducted qualitative semistructured interviews to evaluate barriers and facilitators of inhaler adherence. The Capability, Opportunity, and Motivation model of Behavior informed the semistructured interview guide and analysis.

Results: Short-term lapses in inhaler use commonly resulted from inhaler unaffordability, not possessing the inhaler, forgetfulness, and geographical or logistical issues accessing health care services. Participants overcame these barriers by requesting more affordable inhalers, keeping inhalers in strategic locations, routinizing inhaler use, utilizing reminders or cues, having extra inhalers, and leaning on social support. Nearly half of participants reported using their inhalers differently than prescribed because of insufficient knowledge, skills, or complex motivational barriers. Participants who reported using an incorrect dosage schedule or poor inhaler technique were unaware of their inhaler misuse. Although participants collectively saw some benefit to using inhalers, many were intentionally nonadherent due to conflicting motivational factors. Common motivational barriers to adherence included beliefs that inhalers were not always necessary, nonadherence carried little risk, their self-identity conflicted with having COPD, and emotional distress related to numerous medications. There were strong interactions between reinforcement and other motivational factors that created feedback loops which strengthened or weakened adherence.

Conclusions: Barriers to medication adherence were common and varied by individual. Knowledge and skills barriers are well-suited for interventions that utilize instruction or enablement, whereas motivational barriers could be addressed through reinforcement or interventions tailored at the individual level.

Citation

Citation: LaBedz SL, Okpara EM, Potharazu AV, Joo MJ, Press VG, Sharp LK. Determinants of medication nonadherence among diverse adults with chronic obstructive pulmonary disease. J COPD F. 2026; 13(1): 73-83. doi: http://doi.org/10.15326/jcopdf.13.1.2025.0673

Keywords

COPD, inhalation therapy, medication adherence, maintenance therapy, race

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Click to read Determinants of Medication Nonadherence Among Diverse Adults With Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Division of Pulmonary and Critical Care, Dell Medical School, University of Texas at Austin, Austin, Texas, United States
2. Department of Government, University of Texas at Austin, Austin, Texas, United States
3. Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Texas, United States
4. Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, United States

^†deceased

Address correspondence to:

Trisha M. Parekh, DO, MSPH
Division of Pulmonary and Critical Care
Dell Medical School
University of Texas
1601 Trinity Street Building A
Austin, TX 78712
Email: trisha.parekh@austin.utexas.edu
Phone: (713) 504-7709

Abstract

Rationale: The variation of chronic obstructive pulmonary disease (COPD) population-level exacerbation rates at fine spatial scales is unclear but is important for understanding the potential role of neighborhood-level factors in risk for COPD exacerbations. We aim to describe the spatial distribution of emergency department (ED) visits, hospitalizations, and readmissions for acute exacerbations of COPD (AECOPDs) across census tracts in Travis County, Texas, and understand the neighborhood characteristics that may contribute to census tract-level morbidity.

Methods: We used the Texas Health Care Information Collection data set and the U.S. Census Bureau’s 2019 American Community Survey to calculate census tract-specific population-based incidence rates (PBIRs) and readmission rates from January 2016 through December 2020. Conditional autoregressive models were used to map estimated PBIRs of acute care use outcomes across census tracts. We then examined associations of neighborhood characteristics with census tract-level rates of acute care use.

Results: Census tract-level incidence rates of COPD-related ED visits and hospital admissions exhibited spatial patterning across Travis County. In contrast, there was less spatial patterning of census tract-level readmission rates across census tracts. Several census tract demographic, socioeconomic, and built environment characteristics were associated with census tract-level COPD-related ED visit and hospitalization rates, but not with COPD readmission rates.

Conclusion: There is a spatial pattern of ED visit and hospitalization PBIRs for AECOPDs within Travis County and several associations with neighborhood characteristics. Readmission rates did not exhibit clear spatial patterning across census tracts and did not have similar associations with neighborhood characteristics.

Citation

Citation: Parekh TM, Dunphy P, Hall EM, et al. Census tract variability in COPD emergency department, hospitalization, and readmission rates in Travis County, Texas. J COPD F. 2026; 13(1): 39-48. doi: http://doi.org/10.15326/jcopdf.13.1.2025.0663

Keywords

COPD exacerbation, census tract variability, ecological study, neighborhood

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Click to read Census Tract Variability in COPD Emergency Department, Hospitalization, and Readmission Rates in Travis County, Texas

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Author Affiliations

1. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, United States
2. Department of Anthropology, University of California San Diego, La Jolla, California, United States

Address correspondence to:

Rajat Suri
9500 Campus Point Drive, MC 7381
La Jolla, CA 92037-7381
Email: rsuri@health.ucsd.edu

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease with a high prevalence and cost burden on the health care system. Overall, adherence to prescribed therapies is low and associated with worse outcomes.

Objective: Cost-related nonadherence (CRN) is a type of nonadherence that could be addressed through policy. We evaluated the long-term association of CRN on COPD outcomes in a well-profiled cohort.

Methods: We identified 2521 participants with baseline COPD who answered the social and economic questionnaire in the COPD Genetic Epidemiology study cohort. Of these, 408 participants endorsed experiencing CRN. Multivariable regression models were utilized to assess the association of experiencing CRN and COPD outcomes including functional status, health status, and progression of disease.

Results: Experiencing CRN is associated with worse functional status by the 6-minute walk distance, symptom burden by the COPD Assessment Test score, and health status by the St George’s Respiratory Questionnaire. Longitudinal analysis revealed an association of CRN with faster lung function decline and an increased risk of COPD exacerbations.

Conclusion: Policy changes to address out-of-pocket medication costs may improve COPD outcomes and potentially lead to long-term cost savings.

Citation

Citation: Suri R, Non A, Bailey J, Conrad D. The long-term effects of cost-related nonadherence on COPD outcomes and progression in the COPDGene study cohort. J COPD F. 2026; 13(1): 1-7. doi: http://doi.org/10.15326/jcopdf.13.1.2025.0689

Keywords

COPD, maintenance therapy, adherence, health outcomes

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Author Affiliations

1. Department of Medicine, University of Washington, Seattle, Washington, United States
2. Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, United States
3. Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, United States
4. Department of Psychiatry, University of Washington, Seattle, Washington, United States
5. Department of Medicine, Dartmouth College, Hanover, New Hampshire, United States
6. VA Palo Alto Health Care System, Palo Alto, California, United States
7. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States

Address correspondence to:

Nicholas Wang, MD
Department of Medicine
University of Washington
Seattle, Washington
Phone: (206) 668-1500
Email: nfw506@uw.edu

Abstract

Objective: Untreated chronic obstructive pulmonary disease (COPD) exacerbations are associated with short-term changes in lung function and decreased health-related quality of life (HRQoL). This study aims to examine the association between untreated exacerbations and long-term HRQoL, as well as differences in characteristics between treated and untreated exacerbations.

Methods: A secondary analysis was performed using data from a prospective observational cohort study of participants with COPD. Participants’ HRQoL was measured using the Chronic Respiratory Questionnaire (CRQ) at baseline and at 12 months. Exacerbations were ascertained with phone calls every 2 weeks, with detailed information regarding exacerbations obtained by research staff. Exacerbations were considered treated if participants took prednisone or antibiotics. Mixed models were used to analyze differences in treated and untreated exacerbation characteristics. Linear and logistic regression models were used to examine the association between the number of treated and untreated exacerbations and a change in CRQ at 12 months.

Results: Among 410 participants, 355 experienced 1097 exacerbations during the 12-month study period, of which 460 (42%) were treated. Treated exacerbations were more severe and lasted longer (25.5 versus 19.9 days, p<0.001) compared to untreated exacerbations. Each additional untreated exacerbation experienced was associated with a significant worsening of long-term HRQoL scores compared to those without exacerbations: CRQ dyspnea (adjusted b= -0.10; 95% confidence interval -0.18 to -0.03), CRQ fatigue (b= -0.07; -0.14 to -0.01), and CRQ emotional function (b= -0.08; -0.14 to -0.02).

Conclusion: Untreated COPD exacerbations occurred frequently and were associated with worse long-term HRQoL, despite being shorter and less severe than treated exacerbations.

Citation

Citation: Wang N, Locke ER, Simpson T, et al. The impact of treated and untreated COPD exacerbations on long-term health-related quality of life. J COPD F. 2026; 13(1): 49-58. doi: http://doi.org/10.15326/jcopdf.13.1.2025.0665

Keywords

quality of life, acute exacerbation of COPD, health-related quality of life

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Author Affiliations

1. Department of Rehabilitation, Osaka Anti-Tuberculosis Association, Osaka Fukujuji Hospital, Neyagawa, Osaka, Japan
2. Graduate School of Health Sciences, Kyoto Tachibana University, Yamashina, Kyoto, Japan
3. Faculty of Rehabilitation, Department of Physical Therapy, Kobe International University, Kobe, Hyōgo, Japan

Address correspondence to:

Junpei Oba, RPT, MHS
Department of Rehabilitation
Osaka Anti-tuberculosis Association, Osaka Fukujuji Hospital
3-10 Uchiagetakatsukacho
Neyagawa, Osaka, 572-0854, Japan
Phone: +81-72-821-4781
Email: obajun1007@gmail.com

Abstract

Objective: The objective of this study was to examine the relationships and usefulness of physical activity, physical performance, and physical function in patients with chronic obstructive pulmonary disease (COPD), focusing on 2 newly proposed skeletal muscle indices: the upper limb skeletal muscle mass index (USMI) and lower limb skeletal muscle mass index (LSMI).

Methods: A total of 80 stable patients with COPD who participated in outpatient pulmonary rehabilitation at Osaka Fukujuji Hospital were enrolled. The primary measurements were the USMI, LSMI, and skeletal muscle index (SMI). The explanatory measurements included physical activity, incremental shuttle walking distance (ISWD), quadriceps strength, handgrip strength, the Nagasaki University Respiratory Activities of Daily Living Questionnaire, and pulmonary function. Pearson’s correlation coefficient and stepwise multiple regression analysis were used for the statistical analyses.

Results: USMI showed no significant correlations with physical activity parameters or ISWD. In contrast, LSMI was significantly correlated with weekly exercise volume (r=0.42, p<0.01), daily exercise volume (r=0.42, p<0.01), time spent in activities ≥3 metabolic equivalents of task (r=0.40, p<0.01), and ISWD (r=0.46, p<0.01). Multiple regression analysis identified ISWD as an independent factor for USMI, LSMI, and SMI.

Conclusions: This study demonstrated that LSMI, similar to SMI, was associated with physical activity and exercise capacity in patients with COPD. These findings highlight the importance of evaluating, maintaining, and strengthening lower limb skeletal muscle mass and suggest that LSMI may serve as a useful clinical evaluation index.

Citation

Citation: Oba J, Kotani S, Kubo S, Horie J. Upper and lower limb skeletal muscle mass index as a novel evaluation index in patients with chronic obstructive pulmonary disease. J COPD F. 2026; 13(1): 8-16. doi: http://doi.org/10.15326/jcopdf.13.1.2025.0698

Keywords

chronic obstructive pulmonary disease, upper limb skeletal muscle mass index, lower limb skeletal muscle mass index

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Address correspondence to:

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Abstract

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Citation

Citation: Notice of retraction: duplicate publication of Hanh et al. Metabolic dysfunction-associated fatty liver disease in chronic obstructive pulmonary disease patients: insights from Vietnam, Chronic Obstr Pulm Dis. 2025;12(4):294-303. J COPD F. 2025; 12(6): 537-537. doi: http://doi.org/10.15326/jcopdf.12.6.2025.0591R

Keywords

There are no keywords for this article.

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Click to read Notice of Retraction: Duplicate Publication of Hanh et al. Metabolic Dysfunction-Associated Fatty Liver Disease in Chronic Obstructive Pulmonary Disease Patients: Insights From Vietnam, Chronic Obstr Pulm Dis. 2025;12(4):294-303.

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Author Affiliations

1. Department of Physiology and Membrane Biology, University of California, Davis, Davis, California, United States
2. CESFAR – National Center for Respiratory Pharmacoeconomics and Pharmacoepidemiology, Verona, Italy
3. Department of Pulmonology, Spaarne Gasthuis, Haarlem, The Netherlands
4. Institute for Occupational and Maritime Medicine, University Medical Center Hamburg–Eppendorf, Hamburg, Germany

Address correspondence to:

Gerald S. Zavorsky, PhD, RRT
Department of Physiology and Membrane Biology
University of California, Davis
Davis, CA
Email: gszavorsky@health.ucdavis.edu

Abstract

Background: Pulmonary diffusing capacity for nitric oxide (DLNO) remains underutilized despite potential advantages over pulmonary diffusing capacity for carbon monoxide (DLCO). We evaluated whether DLNO better detects emphysema than DLCO, spirometry, or lung volumes in smokers.

Methods: We performed an individual participant data meta-analysis of adult smokers (14–43 pack years) with and without computed tomography-defined emphysema using a standardized 10 ± 2-second breath-hold time double diffusion protocol. Variables were converted to z-scores. Prespecified models contrasted DLCO- versus DLNO-based approaches. Model selection used the Bayesian information criterion (BIC) and leave-one-out information criterion; discrimination used area under the receiver operating characteristic (AUROC) curve and Matthews correlation coefficient (MCC) with repeated cross-validation.

Results: After harmonization and quality control, 408 participants (85 emphysema, 323 controls) were analyzed. The lowest BIC (164.6) occurred for the 3-predictor model with total lung capacity (TLC), forced expiratory volume in 1 second (FEV₁), and DLNO z-scores, with an 88% probability of being superior to the next-lowest BIC model (168.5). Discrimination (AUROC 0.97, 95% confidence interval [CI] 0.95–0.98) and classification (MCC 0.80, 95% CI 0.69–0.89) were high. Hierarchical partitioning showed unique contributions from FEV₁ z-scores (R²=0.35) > DLNO z-scores (R²=0.21) > TLC z-scores (R²=0.11), totaling McFadden’s R²=0.663. Adding DLCO z-scores increased the total R² trivially (by 0.003) and contributed largely shared information with DLNO (variance inflation factors ≤ 4.5). Category-free reclassification and Youden-threshold analyses showed small but favorable gains; the case–control risk gap improved by up to ~5% when adding DLNO to a DLCO-based model.

Interpretation: When predicting the likelihood of emphysema in smokers, a parsimonious z-score model comprising TLC, FEV₁, and DLNO z-scores provides excellent performance and stable rank superiority.

Citation

Citation: Zavorsky GS, Dal Negro RW, van der Lee I, Preisser AM. Emphysema detection in smokers: diffusing capacity for nitric oxide beats diffusing capacity of carbon monoxide-based models. J COPD F. 2025; 12(6): 500-511. doi: http://doi.org/10.15326/jcopdf.12.6.2025.0645

Keywords

emphysema, pulmonary diffusing capacity, z-scores, logistic modeling, predictive accuracy

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Click to read Emphysema Detection in Smokers: Diffusing Capacity for Nitric Oxide Beats Diffusing Capacity for Carbon Monoxide-Based Models

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Author Affiliations

1. The School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
2. Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States
3. Program in Global Disease Epidemiology and Control, Department of International Health, Johns Hopkins University, Baltimore, Maryland, United States
4. CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
5. Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
6. Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States

Address correspondence to:

William Checkley, MD, PhD
Division of Pulmonary and Critical Care
School of Medicine
Johns Hopkins University
1830 E Monument St, Suite 555
Baltimore, MD, 21287
Email: wcheckl1@jhmi.edu

Abstract

Introduction: In South America, the rise in chronic respiratory diseases and weight-related issues due to the ongoing epidemiological transition has prompted research into their interrelationship.

Methods: We sought to assess the association between body mass index (BMI) and bronchodilator responsiveness (BDR) among adults in Peru, Chile, Uruguay, and Argentina, using population-based data from 2 cohort studies. We defined BDR as a ≥12% and ≥200mL increase in either forced expiratory volume in 1 second (FEV₁) or forced vital capacity (FVC) after administration of a short-acting bronchodilator. The analysis also distinguished between FEV₁- and FVC-specific BDR. We used logistic regression adjusted for confounders to evaluate associations with BMI.

Results: Among 7160 participants (55.2% men, mean age 57.3 years), 23.7% had a BMI <25kg/m² and 35.5% had a BMI ≥30 kg/m². Overall, 9.5% met the criteria for BDR; with 7.8% showing FEV₁-specific and 4.9% FVC-specific responses. Compared to a BMI of 20–24.9kg/m², a BMI ≥30kg/m² was associated with higher odds of FVC-specific BDR (adjusted odds ratio = 1.47, 95% confidence interval 1.08–2.03), whereas a BMI <20kg/m² was associated with FEV₁-specific BDR among participants with asthma (6.61, 1.23–35.6) and chronic bronchitis (4.71, 1.28–15.9), and with higher odds of any BDR in those with chronic bronchitis (3.90, 1.19–11.9).

Conclusion: There was a differential relationship between BMI and types of BDR: higher BMI was associated with FVC-specific responsiveness, whereas lower BMI was linked to FEV₁-specific BDR in individuals with asthma and chronic bronchitis and to overall BDR in those with chronic bronchitis.

Citation

Citation: Soriano-Moreno AN, Lescano AG, Gilman RH, et al. Body mass index and bronchodilator responsiveness in adults: analysis of 2 population-based studies in 4 South American countries. J COPD F. 2025; 12(6): 477-489. doi: http://doi.org/10.15326/jcopdf.12.6.2025.608

Keywords

risk factors, epidemiology, body mass index, bronchodilators

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Click to read Body Mass Index and Bronchodilator Responsiveness in Adults: Analysis of 2 Population-Based Studies in 4 South American Countries

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Author Affiliations

1. State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
2. Guangzhou National Laboratory, Guangzhou, China

^* Authors contributed equally

Address correspondence to:

Pixin Ran, MD, PhD and Yumin Zhou, MD, PhD
State Key Laboratory of Respiratory Disease
National Clinical Research Center for Respiratory Disease
National Center for Respiratory Medicine
Guangzhou Institute of Respiratory Health
The First Affiliated Hospital of Guangzhou Medical University
Guangzhou National Laboratory
Guangzhou, China
Email: pxran@gzhmu.edu.cn
Email: zhouyumin410@126.com

Abstract

Background: Patients with airflow limitation according to the fixed ratio but not the lower limit of normal (FR+LLN-) have a poorer respiratory prognosis and higher mortality than the normal fixed ratio. However, whether tiotropium treatment improves respiratory health outcomes in patients with FR+LLN- remains unclear.

Methods: This was a secondary analysis of the 24-month Tiotropium in Early Chronic Obstructive Pulmonary Disease Patients in China (Tie-COPD) study, a multicenter, randomized, double-blind clinical trial comparing tiotropium with placebo for mild-to-moderate COPD. FR+LLN- was defined as a postbronchodilator forced expiratory volume in 1 second (FEV₁) to forced vital capacity ratio of <0.70 but ≥ the lower limit of normal. The primary endpoint was the between-group difference in the change from baseline to 24 months in prebronchodilator FEV₁. Key secondary endpoints included the between-group difference in the annual decline in prebronchodilator FEV₁ and exacerbations.

Results: In the Tie-COPD study, 92 patients (12%) had FR+LLN-. Tiotropium resulted in a significantly higher prebronchodilator FEV₁ at 24 months (adjusted difference 191mL; 95% confidence interval [CI] 99, 283), with a least-squares mean change from baseline of 47mL (95% CI -13, 108) versus -140mL (95% CI -215, -64) with placebo. The annual decline in the prebronchodilator FEV₁ was 24mL/year with tiotropium and 89mL/year with placebo (adjusted difference 60mL/year; 95% CI 2, 118) from 30 days through 24 months. Tiotropium reduced total exacerbations compared with placebo (relative risk=0.50; 95% CI 0.27, 0.94).

Conclusions: This study demonstrated tiotropium treatment improved lung function, ameliorated lung function decline, and reduced exacerbations compared with placebo in patients with FR+LLN-, providing evidence-based medicine support for the treatment in this population.

Citation

Citation: Zhou K, Wu F, Deng Z, et al. Tiotropium in patients with airflow limitation according to the fixed ratio but not the lower limit of normal: a secondary analysis of the Tie-COPD study. J COPD F. 2025; 12(6): 466-476. doi: http://doi.org/10.15326/jcopdf.12.6.2025.0629

Keywords

COPD, tiotropium, lower limit of normal, fixed ratio, Tie-COPD

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Click to read Tiotropium in Patients With Airflow Limitation According to the Fixed Ratio But Not the Lower Limit of Normal: A Secondary Analysis of the Tie-COPD Study

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Author Affiliations

1. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
2. Center for Climate, Health, and the Global Environment, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
3. Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
4. Department of Pediatrics and Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
5. Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts, United States

Address correspondence to:

Mary B. Rice, MD, MPH
330 Brookline Ave, Dana RW-0659
Boston, MA 02459
Phone: (617) 667-5864
Email: mrice1@bidmc.harvard.edu

Abstract

Eosinophilic chronic obstructive pulmonary disease (COPD) is a distinct subtype with clinical and biological differences from noneosinophilic COPD and asthma. Fractional exhaled nitric oxide (FeNO) is an established marker of type 2 airway inflammation in asthma, but its utility in eosinophilic COPD is less well understood. We analyzed baseline data from 176 participants in the Air Purification for Eosinophilic COPD Study, a randomized controlled trial of former smokers with eosinophilic COPD. At enrollment, FeNO and blood eosinophil counts were measured, and participants reported asthma history and severe COPD exacerbations requiring hospitalization in the prior year. Each 50cells/μL higher eosinophil count was associated with a 3.2% increase in FeNO (95% confidence interval [CI]: 0.3–6.1%). Asthma history was associated with a 29.1% higher FeNO (95% CI: 5.2–58.5%). Elevated FeNO, defined as ≥25 or ≥50 parts per billion, was linked to greater odds of an asthma diagnosis and a recent severe exacerbation, although CIs included the null. These findings suggest that FeNO may serve as a practical, noninvasive biomarker of type 2 inflammation in eosinophilic COPD and could help identify patients at higher risk of severe exacerbation.

Citation

Citation: Morejon-Jaramillo PE, Ni W, Nassikas N, et al. Fractional exhaled nitric oxide in eosinophilic COPD. J COPD F. 2025; 12(6): 522-526. doi: http://doi.org/10.15326/jcopdf.12.6.2025.0701

Keywords

COPD, inflammation, exacerbation, noninvasive biomarkers

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Click to read Fractional Exhaled Nitric Oxide in Eosinophilic COPD

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Author Affiliations

1. School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
2. Department of Respiratory and Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
3. Department of Respiratory and Critical Care Medicine, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China

Address correspondence to:

Chengshi He, MS
Department of Respiratory and Critical Care Medicine
Hospital of Chengdu University of Traditional Chinese Medicine
Chengdu, China
Email: 18408293045@163.com

Abstract

Background: Some studies suggest that statins could reduce the risk of chronic obstructive pulmonary disease (COPD), but it is unclear if this effect is related to their lipid-lowering properties. The causal link between serum lipid levels and COPD risk remains uncertain. This study aims to clarify this potential causal relationship and evaluate the impact of lipid-lowering drug target genes on COPD.

Methods: Mendelian randomization (MR) was used to investigate causal associations between lipid levels, lipid-lowering drug target genes, and COPD risk. Data were obtained from publicly available genome-wide association study databases. The inverse variance weighted method was the primary statistical approach for evaluating causal effects, complemented by various sensitivity analyses.

Results: MR analysis demonstrated a causal relationship between low-density lipoprotein cholesterol (LDL-C) and a reduced risk of COPD (odds ratio [OR]=0.90, 95% confidence interval [CI]=0.85–0.95, P=1.50×10⁻⁴). Causal relationships were also identified for 2 lipid-lowering drug target genes, HMGCR (OR=0.63, 95%CI=0.54–0.75, P=4.92×10⁻⁸) and PCSK9 (OR=0.87, 95%CI=0.80–0.95, P=0.001), with a reduced COPD risk. Although MR analysis indicated a potential causal relationship between LPL (OR=0.86, 95%CI=0.79–0.94, P=6.37×10⁻⁴) and reduced COPD risk, colocalization analysis did not support this finding. No associations were observed between other lipid traits, lipid-lowering drug target genes, and COPD.

Conclusion: This study genetically identified causal relationships between serum LDL-C levels, the 2 coding genes HMGCR and PCSK9, and a reduced risk of COPD. These findings suggest that the protective effect of statins on COPD may occur independently of their lipid-lowering function. Further clinical validation is needed to confirm this hypothesis.

Citation

Citation: Jia G, Guo T, Liu L, He C. Lipids, lipid-lowering drug target genes and COPD risk: a Mendelian randomization study. J COPD F. 2025; 12(6): 512-521. doi: http://doi.org/10.15326/jcopdf.12.6.2025.0632

Keywords

COPD, Mendelian randomization, lipids, lipid-lowering drug target genes, causality

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Click to read Lipids, Lipid-Lowering Drug Target Genes, and COPD Risk: A Mendelian Randomization Study

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Author Affiliations

1. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
2. University of Alabama at Birmingham Hospital, Birmingham, Alabama, United States
3. Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, United States
4. Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States

* co-first authors

Address correspondence to:

Camilla Margaroli, PhD
Division of Molecular and Cellular Pathology
Department of Pathology
University of Alabama at Birmingham
901 19th St S, Birmingham, AL 35205
Phone: (205) 975-1077
Email: cmargaroli@uabmc.edu

Abstract

Background: The incidence of infections caused by nontuberculous mycobacteria (NTM) are steadily increasing worldwide, and the most common site of infection is the lung. Clinical characteristics of individuals with NTM pulmonary disease (NTM-PD) demonstrate pronounced geographical heterogeneity. In the United States, NTM-PD has an affinity for postmenopausal White females, many of whom are never-smokers, whereas in Asia, NTM-PD is more common in males with post-tuberculosis lung disease. While these geographical differences are known on the global scale, it remains unclear whether radiographic sex-associated differences in NTM-PD are present within the U.S. cohort.

Objective/Method: In this single center, cross-sectional retrospective study of our patient registry, we sought to assess this knowledge gap by comparing radiographic and clinical features of individuals with NTM-PD by sex.

Results: We observed a significant preponderance of cavitary disease in men, while women commonly presented with bilateral apical fibrosis, increased nodules and tree-in-bud patterns in the lower lobes, and an increased risk of refractory disease and concomitant co-infection.

Conclusion: Results from this study demonstrate several sex-associated differences in the radiographic phenotype of NTM-PD and may be the result of differences in pre-existing risk factors that contribute to the development of NTM-PD. Future studies will be required to better assess the broad applicability of these findings to centers from other geographic regions where the underlying etiology of disease may vary.

Citation

Citation: Garcia B, Mullins M, Lim L, Henostroza G, Margaroli C. Sex-associated radiographic and clinical differences in nontuberculous mycobacteria pulmonary disease. J COPD F. 2025; 12(6): 455-465. doi: http://doi.org/10.15326/jcopdf.12.6.2025.0622

Keywords

lung disease, gender bias, nontuberculous mycobacterial lung infections

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Click to read Sex-Associated Radiographic and Clinical Differences in Nontuberculous Mycobacteria Pulmonary Disease

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Author Affiliations

1. Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
2. Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
3. Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
4. Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
5. German Center for Lung Research, associated partner site Berlin, Berlin, Germany
6. German Center for Child and Adolescent Health, partner site Berlin, Berlin, Germany
7. Capnetz Foundation, Hannover, Germany

*Authors contributed equally

Address correspondence to:

Jacopo Saccomanno, MD
Department of Infectious Diseases, Respiratory Medicine and Critical Care
Charité – Universitätsmedizin Berlin
Hindenburgdamm 30
12204 Berlin, Germany
Email: Jacopo.saccomanno@charite.de

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is classified by its clinical phenotypes—chronic bronchitis and emphysema. A computed tomography (CT)-based mucus plug score (MPS) was recently identified as a biomarker to a subgroup of COPD patients with increased airway mucus plugs. While not necessarily linked to more pronounced symptoms or structural lung changes, mucus plugs are associated with increased mortality. Interestingly, a higher MPS seems to be associated with a lower body mass index (BMI), likewise associated with increased mortality. This study aims to characterize patients with advanced emphysema presenting for lung volume reduction therapy with a special focus on mucus plug occurrence.

Material and Methods: This retrospective, monocentric study assessed MPS in advanced COPD (Global initiative for chronic Obstructive Lung Disease [GOLD] stages 3 or 4) and emphysema patients evaluated for lung volume reduction therapy at Charité-Universitätsmedizin Berlin. CT scans were analyzed for mucus plugging, and clinical data were obtained from the emphysema registry.

Results: A total of 127 CT scans were assessed for MPS. About 50% had no mucus plugs (score = 0), 25% had an intermediate burden (score 1–2), and 25% had a high burden (score ≥3). A higher MPS correlated with a lower BMI, more pronounced emphysema, and worse lung function, including forced expiratory volume in 1 second, vital capacity, and diffusing capacity of carbon monoxide. Residual volume, partial pressure of carbon dioxide, the 6-minute walk test, and quality-of-life parameters were unaffected. Multivariate regression analysis found a strong association between mucus plugs and BMI, showing that a decrease in BMI was associated with a higher mucus burden (p<0.001; coefficient of -1.584).

Interpretation: This study supports an association between high MPS and BMI in a vulnerable subgroup of advanced COPD patients. Further research is needed to understand the pathophysiology and consequences of mucus plugs, aiming for individualized risk assessments and treatment strategies.

Citation

Citation: Saccomanno J, Elgeti T, Spiegel S, et al. Association of mucus plugging and body mass index in patients with advanced COPD GOLD stages 3 or 4 with emphysema. J COPD F. 2025; 12(6): 490-499. doi: http://doi.org/10.15326/jcopdf.12.6.2025.0617

Keywords

COPD, emphysema, body mass index, mucus plugging

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Click to read Association of Mucus Plugging and Body Mass Index in Patients With Advanced COPD GOLD Stages 3 or 4 With Emphysema

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Author Affiliations

1. Department of Respiratory Medicine, Freeman Hospital, The Newcastle Upon Tyne Hospitals Teaching Foundation Trust, Newcastle, United Kingdom
2. School of Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
3. Faculty of Medical Sciences, School of Biomedical, Nutritional, and Sport Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
4. School of Pharmacy, Newcastle University, Newcastle Upon Tyne, United Kingdom
5. Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom

^* Co-first authors

Address correspondence to:

Henil Upadhyay, MBBS
The Newcastle Upon Tyne Hospitals NHS Foundation Trust
Newcastle, United Kingdom
Email: h.upadhyay@nhs.net

Abstract

Chronic obstructive pulmonary disease (COPD) is a global health challenge. Increasing numbers of patients with COPD are prescribed multiple medications (both for COPD and non-COPD disorders). This increases the risk of polypharmacy in these patients which can be linked with patient harm. However, the definition of polypharmacy is varied across literature (ranging from use of ≥3 to ≥20 medications).

This review aims to report the prevalence of polypharmacy, report the varying definitions of polypharmacy, and report medication related harms amongst patients with COPD.

We identified 28 studies reporting polypharmacy rates in COPD populations. A total of 13 studies (46.3%) defined polypharmacy as the use of ≥5 medications; however, the remaining studies had different definitions of polypharmacy. The available studies include multiple different countries and settings (primary care, secondary care, and community-based surveys). Polypharmacy and hyper polypharmacy (use of ≥10 medications) rates varied from 3.9% to 81.4% and 6.6% to 74.6% respectively.

Polypharmacy in patients with COPD is common but poorly understood due to difficulty in comparing previous literature with differences in methodologies, patient populations, and definitions of polypharmacy. The multimorbid COPD population is likely at higher risk to the effects of polypharmacy through poor adherence, adverse drug reactions, and drug-drug interactions. Clinicians should be mindful of the patient’s age, comorbidities, and drug-drug interactions while prescribing medications in the COPD clinic.

Citation

Citation: Upadhyay H, Akter F, Koumides A, Husband A, DeSoyza A. Polypharmacy in patients with COPD: a scoping review. J COPD F. 2025; 12(5): 440-449. doi: http://doi.org/10.15326/jcopdf.12.5.2025.0630

Keywords

COPD, medication, multimorbidity, chronic airways obstruction

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Click to read Polypharmacy in Patients With COPD: A Scoping Review

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Author Affiliations

1. Lahey Hospital and Medical Center, UMass Chan Medical School-Lahey, Burlington, Massachusetts, United States
2. Tufts University School of Medicine, Boston, Massachusetts, United States
3. Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States

Address correspondence to:

Victor Pinto-Plata, MD
Department of Pulmonary and Critical Care Medicine
Lahey Hospital and Medical Center
41 Mall Road
Burlington, MA 01805
Phone: (781)744-8482
Email: Victor.M.Pinto-Plata@lahey.org

Abstract

Background: Chronic obstructive pulmonary disease (COPD) remains underdiagnosed and undertreated. Because screening asymptomatic individuals for COPD is not recommended, several case-finding tools have been explored. The COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) questionnaire and peak expiratory flow (PEF) rate (CAPTURE tool) have been tested in the primary care setting, with disappointing results. We hypothesized that these tools could yield better results in a computed tomography lung screening (CTLS) program, where individuals have a history of cigarette smoking and higher prevalence of COPD.

Methods: We recruited 67 patients referred to a CTLS program at a single institution. Participants completed the CAPTURE and COPD Assessment Test (CAT) questionnaires. Spirometric testing was completed with a portable device and low-dose chest computed tomography (CT) was performed according to a standard protocol.

Results: The group’s mean age was 66 ±7 years, 43% were male, with a 37 pack-year smoking history. Eighteen (27%) had COPD (forced expiratory volume in 1 second of 60 ±22% predicted) and a higher CAT score (12 [interquartile range (IQR) 6–15]) compared to the nonobstructed group (CAT=7 [IQR 3–10]), p<0.02. Combining the CAPTURE questionnaire with PEF generated the best COPD diagnostic criteria (sensitivity=0.82, specificity=0.73, area under the receiver operating curve [AUROC]=0.784), followed by combining the CAPTURE questionnaire and emphysema presence (sensitivity=0.73, specificity=0.71, AUROC=0.779). The CAPTURE questionnaire alone had a sensitivity=0.766, specificity=0.616, and AUROC=0.669.

Conclusions: The CAPTURE tool is an effective method to find COPD cases in lung cancer screenings. A CT diagnosis of emphysema can substitute peak flow in this population.

Citation

Citation: Spetrini R, Pikman P, Kang V, et al. Prospective COPD case finding in a lung cancer screening program: a pilot study. J COPD F. 2025; 12(5): 411-418. doi: http://doi.org/10.15326/jcopdf.12.5.2025.0636

Keywords

COPD, COPD Assessment Test, lung cancer screenings, underdiagnosis, case identification

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Click to read Prospective COPD Case Finding in a Lung Cancer Screening Program: A Pilot Study

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Author Affiliations

1. Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin, China
2. Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
3. Division of Clinical Research, The First Hospital of Jilin University, Changchun, Jilin, China

Address correspondence to:

Suyan Tian, PhD
Division of Clinical Research
The First Hospital of Jilin University
Changchun, Jilin, China
Email: wmxt@jlu.edu.cn

Abstract

Background: Cathepsins, a family of lysosomal proteolytic enzymes, have been implicated in the pathogenesis of various complex diseases, including chronic obstructive pulmonary disease (COPD). However, the causal relationship between cathepsins and COPD remains unclear.

Methods: This study employed Mendelian randomization (MR) to investigate the potential causal effects of cathepsin levels on COPD risk. This MR analysis utilized genetic data from individuals of European ancestry in the INTERVAL study and FinnGen consortium. Specifically, summary-level genetic data for 9 cathepsins (B, E, F, G, H, O, L2, S, and Z) were obtained from the INTERVAL study, while COPD summary statistics were sourced from the FinnGen consortium. We conducted comprehensive MR analyses, including univariable MR, reverse MR, multivariable MR (MVMR), and MR least absolute shrinkage and selection operator, to assess causal relationships between cathepsin levels and COPD risk.

Results: Univariable MR analysis revealed no significant causal relationships (forward or reverse) between the 9 cathepsins and COPD risk. However, MVMR analysis identified cathepsins O and S as having direct causal effects on COPD. For cathepsins O and S, odds ratio was estimated as 1.130 (p=0.022, 95% confidence interval [CI] = 1.018–1.255) and 1.068 (p=0.025, 95% CI = 1.008–1.132), respectively. Furthermore, these 2 cathepsins were independent risk factors for COPD after adjusting for smoking.

Conclusion: To our knowledge, this is the first MR study to systematically evaluate the causal role of cathepsins in COPD. Further research, particularly clinical trials, is warranted to validate these associations and explore the therapeutic potential of targeting cathepsins in COPD management.

Citation

Citation: Duan C, Zhang A, Tian S. Genetic evidence for causal relationships between circulating cathepsin levels and chronic obstructive pulmonary disease: a Mendelian randomization study. J COPD F. 2025; 12(5): 380-389. doi: http://doi.org/10.15326/jcopdf.12.5.2025.0626

Keywords

chronic obstructive pulmonary disease, Mendelian randomization, causal inference, cathepsin

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Click to read Genetic Evidence for Causal Relationships Between Circulating Cathepsin Levels and Chronic Obstructive Pulmonary Disease: A Mendelian Randomization Study

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, United States
2. Early Respiratory and Immunology Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Boston, Massachusetts, United States
3. Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
4. Lovelace Scientific Resources, Albuquerque, New Mexico, United States
5. Lovelace Biomedical Research Institute, Albuquerque, New Mexico, United States
6. Dynamic Omics, Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, United States
7. Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, AstraZeneca, Gothenburg, Sweden
8. Faculty of Medicine, University of Southampton, Southampton, United Kingdom
9. Late Respiratory and Immunology Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
10. Late Respiratory and Immunology Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Durham, North Carolina, United States

Address correspondence to:

Yohannes Tesfaigzi, PhD
Mass General Hospital
Division of Pulmonary and Critical Care Medicine
Harvard Medical School
Boston, MA, United States
Phone: (617) 525-3480
Email: ytesfaigzi@bwh.harvard.edu

Abstract

Background: Pulmonary function tests may predict future outcomes; however, they are not often performed in middle-aged individuals at risk for future airway obstruction. We examined whether smokers with low lung function (LLF) have an increased risk of developing health problems and mortality over time.

Methods: Current and ever smokers (n=830) from the Lovelace Cohort aged 40–60 years without baseline airway obstruction and with at least 2 spirometry measurements over 18 months were included. Participants were divided into high lung function (HLF) and LLF function tertiles based on forced expiratory volume in 1 second percentage predicted (FEV₁%pred). Lung function, health status, and comorbidities were compared at baseline and over 17 years; mortality at 17 years was also assessed. From these participants, 61 HLF (baseline FEV₁%pred >99%) and 26 LLF (baseline FEV1%pred <88%) were examined at 17 years follow-up using logistic regression.

Results: Baseline demographic and clinical characteristics were generally similar between the LLF and HLF tertiles, except for age, sex, body mass index, and lung function. In the overall cohort (LLF, n=277; HLF, n=277), survival of the HLF versus LLF cohort showed a hazard ratio of 0.49 (p=0.02). At the 17-year follow-up, LLF was associated with increased prevalence of wheeze, cardiovascular diseases, chronic lung diseases, diabetes, and worse health status.

Conclusions: Smokers with LLF without airflow obstruction exhibited reduced survival and an increased risk for development of chronic morbidities. Thus, spirometry may be used to identify at-risk individuals, allowing for early preventative interventions that can improve long-term health outcomes. Take home message: Among ever smokers without airflow obstruction, LLF is associated with increased mortality and poor health status. Spirometry may identify at-risk patients, enabling early emphasis on interventions with the potential to improve long-term health outcomes.

Citation

Citation: Tesfaigzi Y, Brown MN, Liu C, et al. Low lung function in middle-aged smokers impacts health status, morbidities, and mortality: an observational analysis of the Lovelace smokers cohort. J COPD F. 2025; 12(5): 357-367. doi: http://doi.org/10.15326/jcopdf.12.5.2025.0605

Keywords

comorbidity, mortality, lung function, health status, middle-aged smokers

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Click to read Low Lung Function in Middle-Aged Smokers Impacts Health Status, Morbidities, and Mortality: An Observational Analysis of the Lovelace Smokers Cohort

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Author Affiliations

1. Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States

Address correspondence to:

Stephen T. Russell, MD
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine
Department of Medicine
Emory University School of Medicine
615 Michael Street
Suite 205
Atlanta, GA 30322
Email: struss2@emory.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Russell ST, Lama VN, Kempker JA. Bronchodilator response in COPD: definitions, reference equations, and race. J COPD F. 2025; 12(5): 450-454. doi: http://doi.org/10.15326/jcopdf.12.5.2025.0611

Keywords

COPD, spirometry, bronchodilator response, reference equations

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Click to read Bronchodilator Response in COPD: Definitions, Reference Equations, and Race

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Author Affiliations

1. Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
2. Amgen Discovery Research, Thousand Oaks, California, United States
3. Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States
4. Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States
5. Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
6. Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States

Address correspondence to:

Igor Barjaktarevic, MD, PhD
Division of Pulmonary and Critical Care
Department of Medicine
David Geffen School of Medicine
University of California Los Angeles
10833 Le Conte Avenue, 37-131 CHS
Los Angeles, CA 90095
Email: ibarjaktarevic@mednet.ucla.edu

Abstract

Background: Chronic obstructive pulmonary disease (COPD) phenotyping is an approach for developing tailored therapies. The eosinophilic phenotype is associated with exacerbation risk and response to specific treatments. This study evaluates the relationship between sputum and blood eosinophilia, hypothesizing that sputum eosinophil percentage (SpE%) better reflects disease severity and exacerbation risk than blood eosinophil counts (BEC).

Methods: This was a single-center, prospective observational cohort with 107 participants aged 40–80 with clinically diagnosed COPD. Participants completed spirometry, a 6-minute walk test, and questionnaires, and blood and sputum samples were provided at baseline and 3 months. BEC and SpE% were measured via routine complete blood counts and flow cytometric analyses (fluorescence-activated cell sorting [FACS]). Eosinophilic phenotype thresholds were defined as BEC≥300 cells/μL and SpE%≥2%, and associations with clinical characteristics and outcomes were investigated.

Results: Adequate sputum specimens were obtained less frequently than blood (60.7% versus 98%). SpE% showed poor repeatability (interclass coefficient 0.36) and poor correlation with FACS (Spearman’s 𝜌=0.008, p=0.58). Conversely, BEC showed higher repeatability (𝜌=0.67, p<0.01) and better correlation with FACS (𝜌=0.74, p<0.01). More participants were classified as eosinophilic COPD by sputum (33.3%) than by blood (19.6%). BEC values were poorly correlated with SpE% (𝜌=0.13, P=0.39), and sputum and blood-based diagnostic criteria showed poor agreement (64.5%, Cohen’s 𝜅 0.10). High SpE%, but not high BEC, was associated with lower forced expiratory volume in 1 second percentage predicted.

Conclusions: In stable COPD patients, BEC and SpE% did not correlate well, and blood- and sputum-based diagnostic criteria identified different individuals. Defining eosinophilic COPD requires a better understanding of the bio-compartment sampled, testing methods, and cut-off values used.

Citation

Citation: LeMaster WB, Ingersoll SA, Phee H, et al. Diagnosing type 2 inflammation in COPD: comparison of blood and sputum eosinophil assessment in the University of California, Los Angeles COPD phenotyping study. J COPD F. 2025; 12(5): 368-379. doi: http://doi.org/10.15326/jcopdf.12.5.2024.0599

Keywords

COPD, biomarkers, phenotypes, eosinophils, sputum, blood

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Click to read Diagnosing Type 2 Inflammation in COPD: Comparison of Blood and Sputum Eosinophil Assessment in the University of California, Los Angeles COPD Phenotyping Study

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Author Affiliations

1. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
2. COPD Foundation, Miami, Florida, United States
3. Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
4. Department of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
5. Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania, United States
6. Division of Pulmonary, Allergy and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, United States
7. Section for Pulmonary and Critical Care Medicine, Birmingham VA Medical Center, Birmingham, Alabama, United States

Address correspondence to:

M. Bradley Drummond, MD, MHS
Division of Pulmonary Diseases and Critical Care Medicine
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Phone: (919) 966-7054
Email: brad_drummond@med.unc.edu

Abstract

Chronic obstructive pulmonary disease (COPD) among individuals living in rural areas is associated with worse health outcomes. New strategies are needed to study interventions and deliver proven therapies to people with COPD in rural areas. This statement from the COPD Foundation Medical and Scientific Advisory Committee highlights specific challenges in capturing the key characteristics of rural residents and identifies approaches to improve research for COPD in rural areas. Specifically, geographic isolation, access to specialist care, lack of broadband access, and complex tobacco and exposure histories are drivers of COPD health disparities in rural populations that are not captured by conventional definitions of rurality. To improve the design of research studies among people with COPD living in rural settings, certain actions are identified. These include the inclusion of specific covariates such as distance and travel time to health care services and multidimensional assessment tools for societal and individual health determinants in data collection; deploying qualitative and mixed-methods research designs to assess cultural differences driving health care access and health behaviors; decentralized carousel recruitment models in study design; and operationalizing research partnerships to improve support for primary care providers engaged in research. These approaches will permit robust assessment of the complex matrices driving disparate health outcomes among people with COPD in rural areas.

Citation

Citation: Thornton ME, Mannino DM, Ohar JA, et al. Improving research for COPD in rural areas: a statement from the COPD Foundation Medical and Scientific Advisory Committee. J COPD F. 2025; 12(5): 419-425. doi: http://doi.org/10.15326/jcopdf.12.5.2025.0618

Keywords

pulmonary disease, research priorities, chronic obstructive, rural health

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Click to read Improving Research for COPD in Rural Areas: A Statement from the COPD Foundation Medical and Scientific Advisory Committee

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Author Affiliations

1. PPD Evidera Patient-Centered Research, Thermo Fisher Scientific, London, United Kingdom
2. Patient-Centered Research, COPD Foundation, Miami, Florida, United States
3. Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

Address correspondence to:

Ashley Duenas, MSc
PPD Evidera Patient-Centered Research
Thermo Fisher Scientific
The Ark, 201 Talgarth Rd, Hammersmith W6 8BJ
United Kingdom
Phone: +44-20-8576-5052
Email: ashley.duenas@thermofisher.com

Abstract

Objectives: A critical step in designing clinical trials to evaluate treatment efficacy in chronic obstructive pulmonary disease (COPD) is selecting fit-for-purpose outcome measures that reflect health concepts meaningful to people living with COPD. The purpose of this review was to summarize and synthesize qualitative literature addressing how patients with COPD describe aspects of their disease, to inform health concept selection and outcome measure selection.

Methods: A literature review and metasynthesis of qualitative research published from 2013 to 2023 was performed. Studies meeting criteria underwent critical appraisal and data extraction. Studies were summarized and synthesized with constant comparative analysis to review author interpretations and direct patient quotes.

Results: Nineteen studies addressing the patient experience of COPD met screening criteria for full review and data synthesis. In total, 507 patients (range: 8–64 individuals per study) across 11 countries participated in these studies via interviews (63.2%), focus groups (15.8%), or online forums (5.3%). Prominent COPD symptoms included breathlessness, cough, mucus, wheezing, chest discomfort, difficulty sleeping, tiredness, and weakness. Patients described significant impacts on physical activity, emphasizing difficulties with activities of daily living. The symptoms experienced and the persistent limitation on physical activity had severe consequences on social and role functioning and psychological and emotional health.

Conclusions: This qualitative metasynthesis summarizes evidence about symptoms experienced by patients with COPD and the impact of these symptoms on daily life. The synthesis provides an empirical foundation for the development of a standardized set of patient-inspired health concepts to be considered when selecting outcome measures for COPD clinical trials.

Citation

Citation: Duenas A, Kornalska K, Hamilton A. A metasynthesis of qualitative literature to inform the selection of meaningful and measurable health concepts for clinical trials in COPD. J COPD F. 2025; 12(5): 426-439. doi: http://doi.org/10.15326/jcopdf.12.5.2025.0633

Keywords

COPD, qualitative research, patient experience, health concepts, health outcomes

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Click to read A Metasynthesis of Qualitative Literature to Inform the Selection of Meaningful and Measurable Health Concepts for Clinical Trials in COPD-related

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Author Affiliations

1. Pulmonology Department, Unidade Local de Saúde de Santo António, Porto, Portugal
2. Institute of Biomedical Sciences Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
3. Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Porto, Portugal

Address correspondence to:

Beatriz Ferraz, MD
Largo do Prof. Abel Salazar
4099-001 Porto
Portugal
Phone: +351 91 717 44 95
Email: beatrizferraz26@gmail.com

Abstract

Purpose: Chronic obstructive pulmonary disease (COPD) remains a challenging condition to manage due to its variability in clinical presentation and progression. While disease control is a well-defined concept in asthma, its relevance in COPD is less clear. This study aimed to evaluate the clinical utility of a COPD control framework, developed in Spain, in Portuguese outpatients by analyzing exacerbation rates among controlled and uncontrolled patients.

Methods: This prospective, observational study enrolled 133 COPD outpatients, evaluated at baseline (V0), 6 months (V1), and one year (V2). Patients were classified as controlled or uncontrolled based on criteria assessing clinical stability and disease impact, incorporating dyspnea severity, rescue medication use, physical activity, sputum color, and recent exacerbation history. Patients classified as controlled and uncontrolled were compared regarding the occurrence of an exacerbation (hospitalization, emergency visit, or ambulatory exacerbation) during follow-up.

Results: At baseline, 33.1% of patients were classified as controlled. This proportion increased to 46.2% at V1 but decreased to 31.6% at V2. Notably, only 12% remained consistently controlled throughout follow-up. There was a consistent trend of higher exacerbation rates among those previously uncontrolled. Only the difference in emergency visits at 12 months reached statistical significance (27.1% versus 7.8% in controlled patients, p=0.023).

Conclusion: This study provides the first independent validation of COPD control criteria in a Portuguese cohort. Although the control framework proved feasible for clinical application, its predictive value for exacerbations was low in this severe-disease cohort. Future research should expand on these findings in diverse populations to optimize COPD management strategies.

Citation

Citation: Ferraz BD, Cardoso MF, Rodrigues C, et al. Exploring clinical control of COPD: insights from a Portuguese outpatient population. J COPD F. 2025; 12(5): 390-398. doi: http://doi.org/10.15326/jcopdf.12.5.2025.0628

Keywords

chronic airways obstruction, dyspnea, acute exacerbations, COPD management, Exacerbation of COPD Tool

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Click to read Exploring Clinical Control of COPD: Insights From a Portuguese Outpatient Population

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Author Affiliations

1. Department of Epidemiology and Environmental Health, College of Public Health, University of Kentucky, Lexington, Kentucky, United States
2. Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
3. COPD Foundation, Miami, Florida, United States
4. Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States

Address correspondence to:

Radmila Choate, PhD, MPH
111 Washington Avenue, Ste 215B
University of Kentucky College of Public Health
Department of Epidemiology and Environmental Health
Lexington, KY 40536
Phone: (859) 218-2237
Email: radmila.choate@uky.edu

Abstract

Rationale: Chronic lung diseases, including chronic obstructive pulmonary disease (COPD) and bronchiectasis (BE), may differ by sex in symptom onset, diagnostic delays, and disease burden. This study examined health care experiences and symptom burden among individuals with self-reported COPD, BE, or nontuberculous mycobacteria (NTM).

Methods: This cross-sectional study analyzed data from an online survey of U.S. and international participants with self-reported COPD, BE, or NTM, recruited via COPD Foundation social media. The questionnaire, developed with input from COPD Foundation leadership, physician-researchers, and patient stakeholders, assessed health care experiences, disease burden, and symptoms. A subset of women answered menopause-related questions. Descriptive statistics were compared by sex and disease group: COPD (with/without BE or NTM) and BE (with/without NTM). T-tests assessed continuous variables; Chi-square or Fisher’s exact tests analyzed categorical variables.

Results: Among 632 respondents (mean age 70±9 years, 74% women), 68% reported COPD and 32% BE. Women with COPD were younger (p=0.048) and sought care sooner after symptom onset (p<0.010) than men. More women with COPD did not have their diagnosis explained by a health care provider (p=0.038) and reported diagnosis-related anxiety, depression, or fear (p=0.007). Among participants with BE, men were more likely to receive a confirmed diagnosis sooner (p=0.038) and during hospitalization (p=0.024). Disease management burden, pulmonologist visit frequency, Chronic Airways Assessment Test scores, numbers of comorbidities, and financial burden were similar across groups. Over 75% of women were postmenopausal, and one-third reported worsened pulmonary symptoms postmenopause.

Conclusions: Differences in diagnostic delays and symptom burden highlight the need for further research into health care disparities to improve pulmonary care and outcomes.

Citation

Citation: Choate R, Aksamit TR, Torrence J, et al. Navigating COPD and bronchiectasis: a COPD Foundation survey of differences in patient-perceived health care experiences by sex. J COPD F. 2025; 12(5): 399-410. doi: http://doi.org/10.15326/jcopdf.12.5.2025.0620

Keywords

COPD, bronchiectasis, sex, self-perceived experiences

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Click to read Navigating COPD and Bronchiectasis: A COPD Foundation Survey of Differences in Patient-Perceived Health Care Experiences by Sex

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Author Affiliations

1. South Texas Veterans Healthcare System, University of Texas Health, San Antonio, Texas, United States
2. College of Nursing, University of Alabama, Huntsville, Alabama, United States
3. COPD Foundation, Miami, Florida, United States

Address correspondence to:

Antonio Anzueto, MD, PhD
South Texas Veterans Healthcare System
University of Texas Health
San Antonio, Texas
Phone: (210) 275-4204
Email: anzueto@uthscsa.edu

Abstract

This review addresses the multifaceted challenges and opportunities in managing chronic obstructive pulmonary disease (COPD), from both the patient and health care professional (HCP) perspectives. Coauthored by a patient organization advocate, a pulmonologist, and a nurse practitioner, this article synthesizes insights gained through collaborative discussions and a comprehensive literature review. It highlights the critical importance of early diagnosis of COPD, emphasizing that delayed diagnosis can lead to significant underdiagnosis and mismanagement of the disease. Lung function declines more rapidly in the early stages of COPD. Therefore, delayed or underdiagnosed COPD results in a lost opportunity to improve or maintain lung function, prevent exacerbations, and enhance the quality of life. The typical patient journey is also outlined in this article, underscoring the necessity of encouraging patients to actively engage in their care. Patients and HCPs collectively call for improvements in COPD management, emphasizing the importance of maintenance therapy; a deeper understanding of COPD exacerbations, focusing on their prevention; and fostering a partnership between patients and their HCPs in care management. The role of HCPs is crucial in promoting the self-management and awareness of COPD among patients. By integrating patient perspectives into clinical practice, health care systems can better address the complex needs of patients with COPD and ultimately enhance their health outcomes.

Citation

Citation: Anzueto A, Hoy H, Gainer C. Challenges and opportunities for the management of COPD: a narrative review of patient and health care professional perspectives. J COPD F. 2025; 12(4): 339-356. doi: http://doi.org/10.15326/jcopdf.12.4.2024.0597

Keywords

chronic obstructive pulmonary disease, diagnosis, disease burden, health care professional perspectives, patient perspectives

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Click to read Challenges and Opportunities for the Management of COPD: A Narrative Review of Patient and Health Care Professional Perspectives

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Author Affiliations

1. Department of Medicine, University of Oklahoma, Health Sciences Center, Oklahoma City, Oklahoma, United States
2. Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, United States
3. The Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States
4. Department of Medicine, Mayo Clinic, Scottsdale, Arizona, United States

^*Contributed equally to this manuscript.

Address correspondence to:

Joe Zein, MD, PhD
Mayo Clinic
13400 E Shea Blvd
Scottsdale, AZ 85259, United States
Email: zein.joe@mayo.edu

Abstract

Background and Objectives: Chronic obstructive pulmonary disease (COPD) and asthma account for a significant health care burden within the United States. The asthma-COPD overlap (ACO) phenotype has been associated with increased exacerbation frequency and health care utilization compared to either disease alone. However, hospital-based outcomes of these diagnoses have not been described in the literature.

Methods: Hospitalization data were extracted from the Healthcare Cost and Utilization Project Nationwide Readmissions Database (HCUP-NRD 2012–2015). Using International Classification of Diseases, Ninth Revision, Clinical Modification codes, we classified patients as having asthma, COPD, or ACO. We used analytic sample weights to compute national estimates, and weighted regression analyses to evaluate hospitalization outcomes.

Results: Of 2,522,013 patients reviewed, 1,732,946 (68.7%) had COPD, 668,867 (26.5%) had asthma, and 120,200 (4.8%) had ACO. Patients with ACO were younger than those with COPD (63 versus 69 years old, p< 0.05), with a higher rate of respiratory failure and an increased hospital length of stay. Index admission mortality was higher in patients with COPD (adjusted odds ratios [OR] [95%]: 2.10 [1.84; 2.40]) and asthma (adjusted OR [95%]: 1.59 [1.38; 1.83]) as compared to those with ACO. However, the all-cause readmission rate was higher in the COPD group (15.7%) but not in the asthma group (10.7%) as compared to the ACO group (11.5%).

Conclusions: While ACO was associated with higher rates of baseline comorbidities, increased length of stay, and higher health care cost during index admission, this did not translate into higher in-hospital mortality, complication rates, or risk for asthma-related readmission mortality when compared to asthma or COPD alone, highlighting the complexity of the ACO disease burden.

Citation

Citation: Modak M, Rowlands WM, Sleiman J, Attaway AH, Bleecker ER, Zein J. Hospitalization outcomes of patients with asthma, COPD, and asthma-COPD overlap syndrome. J COPD F. 2025; 12(4): 260-273. doi: http://doi.org/10.15326/jcopdf.12.4.2024.0566

Keywords

asthma, asthma-COPD overlap, chronic airways obstruction

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Click to read Hospitalization Outcomes of Patients with Asthma, COPD, and Asthma-COPD Overlap Syndrome

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Author Affiliations

1. Internal Medicine Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
2. Pulmonary Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
3. College of Health Sciences, Vin University, Hanoi, Vietnam
4. Outpatient Department, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
5. School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, United Kingdom
6. Internal Medicine, Tan Tao University, Long An Province, Vietnam
7. Respiratory Department, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam

Address correspondence to:

Doan Le Minh Hanh, MD, MSc
Internal Medicine Department
Pham Ngoc Thach University of Medicine
02 Duong Quang Trung street, Ward 12, District 10
Ho Chi Minh City, Vietnam
Email: hanhdlm@pnt.edu.vn

Abstract

Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) affects approximately 38.7% of individuals globally and potentially leads to cirrhosis and hepatocellular carcinoma. This study aims to investigate the prevalence, characteristics, and impact of MAFLD on the frequency of exacerbations in chronic obstructive pulmonary disease (COPD) patients in Vietnam.

Methods: This cross-sectional descriptive study involved stable COPD patients, and using FibroScan to detect fatty liver while applying the 2020 Asian Pacific Association for the Study of the Liver criteria for a MAFLD diagnosis.

Results: Of the 168 COPD patients, 48.8% were diagnosed with MAFLD. Patients with MAFLD had significantly worse lung function, with a lower forced expiratory volume in 1 second (57.2% versus 67.0%, p=0.002) and forced vital capacity (80.8% versus 88.1%, p=0.009), compared to those without MAFLD. The frequency of exacerbations was higher in the MAFLD group, with 46.3% experiencing ≥2 exacerbations in the previous year, compared to 30.2% in the non-MAFLD group (p=0.032). Elevated controlled attenuation parameter (CAP) scores (>289dB/m) were strongly associated with frequent exacerbations in the previous year (odds ratio [OR] 5.64, p=0.001). MAFLD was also identified as an independent factor increasing the risk of exacerbation (OR 3.64, p=0.014).

Conclusion: Nearly half of the COPD patients were diagnosed with MAFLD. MAFLD is associated with worse lung function and an increased frequency of exacerbations in the past year. Elevated CAP scores were found to be a significant risk factor for frequent exacerbations in the past year. MAFLD is an independent risk factor for exacerbations in COPD patients.

Citation

Citation: Hanh DLM, Vu LT, Hanh TLD, et al. Metabolic dysfunction-associated fatty liver disease in chronic obstructive pulmonary disease patients: insights from Vietnam. J COPD F. 2025; 12(4): 294-303. doi: http://doi.org/10.15326/jcopdf.12.4.2024.0591

Keywords

chronic obstructive pulmonary disease, metabolic-associated fatty liver disease, FibroScan, fatty liver

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Author Affiliations

1. Early Intervention in Psychosis Service, South Gloucestershire, Avon and Wiltshire National Health Service Trust, Bristol, United Kingdom
2. University of Exeter Medical School, University of Exeter, Exeter, United Kingdom

Address correspondence to:

David M.G. Halpin, MBBS, DPhil, FRCP
University of Exeter Medical School
University of Exeter
Exeter, EX1 2LU, UK
Email: d.m.g.halpin@ex.ac.uk

Abstract

The prevalence of chronic obstructive pulmonary disease (COPD) is higher in people with schizophrenia than in the general population, even after adjusting for smoking, but schizophrenia has not generally been considered in discussions of COPD multimorbidity. People with schizophrenia die prematurely, and COPD is an important but neglected cause of this mortality. People with schizophrenia have a higher prevalence of ever smoking tobacco than the general population. The link between COPD and schizophrenia may be partially explained by higher rates of smoking, but may also be syndemic, with shared genetic, socioeconomic, and environmental risk factors, and common pathophysiological mechanisms.

People with a mental illness tend to receive medical care intermittently. There is often a lack of continuity of care, and primary and preventive services are infrequently used. Physical symptoms may be viewed as "psychosomatic," leading to underdiagnosis. People with schizophrenia are less likely to receive adequate general medical care, including investigation and treatment, in line with guidelines. Antipsychotic drugs are associated with adverse effects that may be problematic in people with COPD.

The management and outcomes for people with schizophrenia and COPD could be improved by reducing stigma, developing integrated services, undertaking physical health checks that include asking about respiratory symptoms and arranging spirometry when indicated, care coordination that includes addressing physical health issues, vaccination, support with smoking cessation, exercise, and pulmonary rehabilitation.

Citation

Citation: Ratcliffe S, Halpin DMG. COPD and schizophrenia. J COPD F. 2025; 12(4): 328-338. doi: http://doi.org/10.15326/jcopdf.12.4.2025.0631

Keywords

COPD, schizophrenia, mutimorbidity

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Author Affiliations

1. Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
2. Yale-New Haven Health System, Yale-New Haven Hospital, New Haven, Connecticut, United States
3. Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
4. VA Connecticut Healthcare System, West Haven, Connecticut, United States

Address correspondence to:

Nancy Kim, MD, PhD
Associate Clinical Professor of Medicine
Section of Internal Medicine, General Internal Medicine
Yale University School of Medicine
333 Cedar Street
New Haven, CT, 06510
Email: nancy.kim@yale.edu

Abstract

Background: Variable hospital care for chronic obstructive pulmonary disease (COPD) and underutilization of pulmonary rehabilitation (PR) may contribute to poor outcomes. Clinical pathways can optimize care by providing real-time decision support based on evidence and expert consensus. An inpatient COPD pathway was implemented in May 2021.

Objective: The objective was to evaluate the impact of the COPD pathway on length of stay (LOS), discharge disposition, resource use, PR referrals, and readmissions.

Study Design and Methods: A 2-part COPD pathway embedded into the electronic health record was built by multidisciplinary providers across a large academic medical center. Providers could place orders and document notes directly from the pathway. We identified all COPD hospitalizations one year after pathway implementation using International Classification of Diseases, Tenth Revision, Clinical Modification codes according to methods used by the Centers for Medicare & Medicaid Services.

Results: A total of 766 patients contributed to 971 hospitalizations. The pathway was opened in 142 (14.6%) hospitalizations. No significant differences in demographics, insurance, or smoking status were noted between pathway versus nonpathway patients. Bivariate analyses demonstrated lower LOS (5.4 days versus 7.1 days, p=0.001) and total costs ($5756 versus $8781, p< 0.001) with pathway use, but no significant difference between 30-day readmissions (16% versus 22%, p=0.12). In multivariable analysis, pathway use was associated with greater PR referrals (odds ratio [OR] 5.76, 95% confidence interval [CI] 2.47–13.45, p<0.001) and discharges to home (OR 1.96, 95% CI 1.13–3.39, p=0.016).

Conclusion: Despite low utilization, pathway use was associated with more PR referrals and discharges to home with a trend toward lower LOS, resource use, and decreased readmissions.

Citation

Citation: Kim N, Teng W, Akande O, Rhodes D, Rochester CL. Impact of an inpatient COPD care pathway on hospital care process and outcome metrics. J COPD F. 2025; 12(4): 304-316. doi: http://doi.org/10.15326/jcopdf.12.4.2024.0585

Keywords

COPD, hospitalization, discharge, care pathway, electronic health record

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Author Affiliations

1. Columbia University, New York, New York, United States
2. University of Utah, Salt Lake City, Utah, United States
3. University of California, Los Angeles, Los Angeles, California, United States
4. University of Alabama at Birmingham, Birmingham, Alabama, United States
5. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
6. Alpha-1 Foundation, Coral Gables, Florida, United States
7. University of Chicago, Chicago, Illinois, United States
8. Royal College of Surgeons in Ireland, Dublin, Ireland
9. National Jewish Health, Denver, Colorado, United States
10. Boston University, Boston, Massachusetts, United States
11. Medical University of South Carolina, Charleston, South Carolina, United States

*Members of the Alpha-1 Biomarker Consortium Study Group are listed in the Acknowledgements section.

Address correspondence to:

Jeanine M. D’Armiento, MD, PhD
Columbia University
New York, New York
Phone: (212) 305-3745
Email: jmd12@cumc.columbia.edu

Abstract

Rationale: Alpha-1 antitrypsin deficiency (AATD) is the most common genetic cause of chronic obstructive pulmonary disease (COPD), but considerable phenotypic variability exists among affected individuals who share disease-causing variants. Therefore, a multicenter longitudinal cohort study of 270 adult participants with PiZZ AATD will be established with a goal of examining how computed tomography (CT) imaging and serum and airway biomarkers can be used to explain differences in phenotypic manifestations and outcomes.

Methods: Study visits at enrollment, 18 months, and 36 months will obtain spirometry, patient-reported outcomes, and biosampling from blood, nasal mucosa, and sputum. Chest CT image acquisition will be utilized for whole lung and lobar estimations of emphysema based on lung density and to test novel measurements of airway remodeling and lung tissue mechanics. Dried blood spot cards will be collected if the participant experiences an acute exacerbation of COPD during the study. Genetic analysis will be performed with complete SERPINA1 sequencing, and peripheral blood mononuclear cells will be isolated to generate a repository of inducible pluripotent stem cells.

Results: The cohort will be deeply characterized, including imaging, physiology, and symptomatology, cross-sectionally and longitudinally over a 3-year follow-up period. A validation cohort from Ireland will independently enroll patients with identical procedures.

Conclusion: This is the first cohort of AATD to incorporate such detailed metrics of disease, including quantitative emphysema measures, with the overarching goal of improving the understanding of disease heterogeneity in AATD and identifying factors associated with disease severity and progression.

Citation

Citation: Goldklang MP, Pirozzi C, Barjaktarevic I, et al. Rationale and design of the alpha-1 biomarkers consortium study. J COPD F. 2025; 12(4): 274-284. doi: http://doi.org/10.15326/jcopdf.12.4.2025.0603

Keywords

computed tomography, emphysema, biomarkers, spirometry, alpha-1 antitrypsin deficiency

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Author Affiliations

1. COPD Foundation, Miami, Florida, United States
2. Phreesia Life Sciences, Wilmington, Delaware, United States
3. Verona Pharma, Raleigh, North Carolina, United States
4. Davis School of Medicine, University of California, Sacramento, California, United States

Address correspondence to:

David M. Mannino, MD
COPD Foundation
Miami, FL
Phone: (859) 797-2579
Email: dmannino@copdfoundation.org

Abstract

Background: Chronic obstructive pulmonary disease (COPD) affects millions of people and is associated with significant morbidity and mortality. Patients experience a high symptom burden with impacts on quality of life, which have not been well quantified.

Methods: Phreesia’s PatientInsightsquantitative survey was offered in January 2025 to patients with COPD during their check-in process for health care provider (HCP) visits. The survey comprised 28 questions. Survey question categories included COPD symptom experience and impact, and the treatment journey of patients with COPD. The survey also sought to identify potential communication gaps between patients and HCPs that might hinder effective COPD management.

Results: Of 1615 patients surveyed, most (59%) were female, and the majority identified as White (82%). A total of 39% of patients had experienced COPD for over 7 years at the time the survey was conducted, and 25% reported experiencing symptoms all 30 days in a typical month. A large proportion (64%) said that COPD had a moderate-to-great impact on their daily lives. Only 45% of patients had detailed discussions about their COPD with their HCPs. Among patients who had not tried/were currently not on any maintenance medications (n=339), the leading reasons included that their COPD was not severe enough, and that their HCP had not recommended it. Among patients who had tried maintenance medications, the majority (77%) indicated that they would be willing to try another therapy.

Conclusions: Improvements in patient−HCP communication are needed to achieve more effective, timely COPD management.

Citation

Citation: Mannino DM, Trac S, Seth J, Dixon A, Aggarwal K, Kuhn B. Patient burden and insights in COPD: a survey analysis. J COPD F. 2025; 12(4): 317-327. doi: http://doi.org/10.15326/jcopdf.12.4.2025.0616

Keywords

chronic obstructive pulmonary disease, quality of life, symptom burden, patient survey, treatment journey

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Author Affiliations

1. Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
2. The First Hospital of Shanxi Medical University, Taiyuan City, Shanxi Province, China

Address correspondence to:

Jinmeng Zhou, PhD
The First Hospital of Shanxi Medical University
85 Jiefang South Road
Yingze District, Taiyuan City
Shanxi Province, China
Email: syyy_zjm@163.com

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is characterized by progressive airway inflammation and compromised immune defense, often worsened by reduced secretory immunoglobulin A (sIgA) levels. This decline in sIgA is linked to diminished polymeric immunoglobulin receptor (pIgR) activity, which impairs mucosal immunity. MicroRNA-144 (miR-144), a microRNA implicated in inflammation, may contribute to pIgR suppression, though this pathway in COPD remains poorly understood.

Method: Human bronchial epithelial cells were exposed to cigarette smoke extract (CSE) to mimic COPD conditions, and were subsequently divided into control and CSE-treated groups. miR-144 was either inhibited or overexpressed in these cells via transient transfection. Expression levels of miR-144, transforming growth factor beta-induced factor homeobox 1 (TGIF-1), transforming growth factor beta (TGF-β), and pIgR were analyzed using quantitative real-time polymerase chain reaction and Western blot. Additionally, a TGF-β inhibitor was applied to assess TGF-β’s role in miR-144-mediated regulation of pIgR.

Results: CSE treatment significantly upregulated miR-144 and TGIF-1 while reducing TGF-β and pIgR expression. miR-144 inhibition restored TGF-β and pIgR levels, while miR-144 overexpression reduced them further, indicating miR-144’s direct influence on this regulatory pathway. TGF-β inhibition enhanced the reduction of pIgR under miR-144 overexpression, underscoring TGF-β’s key role in pIgR regulation.

Conclusion: miR-144 mediates immune suppression in COPD by downregulating pIgR through the TGF-β pathway, suggesting that miR-144 could serve as a therapeutic target to restore airway immune function and mitigate disease progression in COPD.

Citation

Citation: Liu H, Zhao Y, Cao J, Liang L, Zhou J. The role of microRNA-144 in regulating airway immune dysfunction in COPD through the transforming growth factor-beta/polymeric immunoglobulin receptor pathway: an in vitro study. J COPD F. 2025; 12(4): 285-293. doi: http://doi.org/10.15326/jcopdf.12.4.2024.0592

Keywords

COPD, miR-144, TGF-β, pIgR, in vitro study

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Click to read The Role of MicroRNA-144 in Regulating Airway Immune Dysfunction in COPD Through the Transforming Growth Factor-Beta/Polymeric Immunoglobulin Receptor Pathway: An In Vitro Study

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