Objective Pulmonary rehabilitation is recommended for people with chronic respiratory disease, yet attendance barriers persist. There is increasing interest in models that may overcome some of these barriers, including minimal equipment exercise training. The capacity of a purely minimal equipment circuit to elicit an acute physiological response sufficient to confer health benefits has not been evaluated. This study assessed whether a minimal equipment circuit session enabled participants to achieve a training intensity of ≥60% V ˙ O 2 peak. Methods People with chronic respiratory disease referred to pulmonary rehabilitation completed a cardiopulmonary exercise test to determine peak oxygen consumption ( V ˙ O 2 peak), followed by a 60-minute minimal equipment exercise circuit training session. The session included 3 circuits each comprising 7 exercise stations including upper- and lower-limb training. Physiological signs and symptoms were monitored throughout. The primary outcome was the percentage of session spent at or above the desired training intensity (≥60% V ˙ O 2 peak). Results Eighteen participants completed the study (mean (SD) age 67 (11) years). Participants spent a mean 72% (21) of the session at ≥60% V ˙ O 2 peak, with a median [IQR] of 40[32-47] minutes above this threshold. Fifteen participants (83%) achieved the target intensity for ≥30 minutes. Participants reported positive immediate ratings of confidence, comfort, and enjoyment (5-point Likert scale median 5, IQR 4-5) at the conclusion of the minimal equipment session. Conclusion A minimal equipment exercise training session can provide an exercise intensity of ≥60% V ˙ O 2 peak for >70% of the exercise session in people with chronic respiratory disease. This approach requires further investigation as to whether it may support pulmonary rehabilitation delivery in diverse settings.
BackgroundMindfulness-Based Stress Reduction (MBSR) has demonstrated benefits in chronic conditions such as cancer, chronic pain, cardiovascular disease, and type 2 diabetes. However, evidence in chronic obstructive pulmonary disease (COPD) remains limited, particularly regarding the feasibility of implementing a full standardized program within pulmonary rehabilitation.MethodsThis prospective pilot study evaluated the feasibility of delivering a standardized 8-weeks MBSR program to people with COPD enrolled in pulmonary rehabilitation. Feasibility outcomes included recruitment, program completion, attendance at group sessions, home practice, and reasons for withdrawal. Adherence was conceptualized as behavioral engagement, assessed through predefined measures (session attendance and weekly self-reported home practice), and interpreted post hoc using thresholds commonly applied in previous MBSR feasibility studies (attendance ≥6/8 sessions; home practice ≥3 days/week). Reasons for discontinuation were collected by phone or email follow-up. Descriptive statistics were used.ResultsEighteen people with COPD (56% women, mean age 68 (±7.4) years; mean FEV1 48 (±16%) predicted) were enrolled. 14 participants (78%) completed the program, and 86% attended at least eight of nine sessions. Participants reported an average of 4.4 (±2.3) days of home practice per week, indicating regular engagement despite inter-individual variability. Reasons for withdrawal included musculoskeletal pain (n = 2) and limited availability (n = 2).ConclusionsThe standardized, in-person 8-weeks MBSR program was feasible in people with COPD undergoing pulmonary rehabilitation, as reflected by their regular attendance at hospital sessions and reported engagement in home practice. This structured context likely supported adherence and program fidelity, but its generalizability to individuals with reduced mobility or clinical instability remains uncertain. Future research should evaluate the feasibility of extending this approach to broader COPD populations and its potential psychological and clinical benefits.
The option of tracheostomy and prolonged invasive mechanical ventilation (IMV) for chronic respiratory failure in myotonic dystrophy type 1 (DM1) poses challenges in decision-making. The Myotonic Dystrophy Foundation consensus recommendations on respiratory management do not directly address the implications of this intervention given the progressive physical and cognitive manifestations of DM1. Here, we consider IMV in DM1 using the ethical principles of beneficence, non-maleficence, autonomy and justice. We call for further research on post-tracheostomy morbidity, mortality, and quality of life (QOL) to help guide decision-making. Our ethical analysis has yielded programmatic changes we hope will improve patient outcomes.
ObjectivesThe relationship between physical or cognitive frailty and chronic obstructive pulmonary disease (COPD) has been established. This study aimed to evaluate the association between social frailty and disease severity as well as prognosis in people with COPD.MethodsEligible people with stable COPD were prospectively enrolled. Baseline data were collected via medical records and face-to-face interviews, and social frailty was assessed using the Makizako Index (grouping criteria). During a 1-year follow-up, changes in participants' disease status and prognostic outcomes were recorded. Multivariate logistic regression was applied to analyze the associations.ResultsOf 725 participants, 281 had social frailty and 444 were non-frail. Baseline social frailty was associated with a greater number of previous acute exacerbations (p<0.001); with a higher risk of frequent acute exacerbations during follow-up (p<0.001); and with higher risks of hospitalization >7 days and ICU stay >3 days at the first acute exacerbation during follow-up (p<0.001, p=0.006). It also predicted greater dyspnea, abnormal blood gas, worse pulmonary function, elevated inflammatory markers, triple therapy escalation, and escalated steroids during this acute exacerbation (all p<0.01).ConclusionSocial frailty may, to a certain extent, serve as a potential predictor for assessing the prognosis of people with COPD.
BackgroundSelf-management ability for patients with chronic obstructive pulmonary disease (COPD) in China urgently needs to be strengthened. The Health Action Process Approach (HAPA) promotes health-oriented behaviour change by tailoring interventions to each stage of the individual's disease. This approach has been applied across a wide range of fields. However, its application among patients with COPD remains relatively limited.ObjectiveTo construct a patient health management journey map based on the HAPA theory.MethodsUsing the HAPA theory as a framework, a patient health management patient journey map was developed through literature review, reference to standardised guidelines, phenomenological research and expert consultation.ResultsFrom the literature review, 12 relevant articles were included to form the preliminary framework. Semi-structured interviews with 5 respiratory medical staff identified the core stages of the patient journey. In a separate subsequent process, the 8 experts selected for consultation had an average work experience of 19.13 ± 3.27 years. Education levels included 2 with a bachelor's degree and 6 with a master's degree or above; professional titles included 3 associate senior doctors, 3 senior doctors and 2 intermediate doctors; and research specialties included 5 in respiratory medicine and 3 in internal medicine nursing. As for the consultation involvement, 3 experts participated once and 5 experts participated twice or more. The familiarity coefficient with consultation content was 0.851, the judgment basis coefficient was 0.916 and the authority coefficient of the experts was 0.889. The coordination of expert opinions was measured by Kendall's W and was 0.429 (χ2 = 42.452, P < 0.001). Finally, a proof-of-concept test with 5 patients refined the patient journey map's usability by simplifying terminology and adjusting adherence strategies.DiscussionThe patient health management journey map constructed in this study, based on the HAPA theory, is scientific, comprehensive and usable, covering key stages such as disease diagnosis, acute exacerbation management, stable period maintenance and rehabilitation support. It provides patients with comprehensive scientific guidance and promotes the establishment of healthy behaviours.
Background Accurate assessment of asthma symptom control is central to effective management. Spirometry is the gold standard for evaluating lung function and monitoring physiological impairment, and the Global Lung Function Initiative (GLI) has developed widely used spirometric reference equations applicable across populations. However, population-specific equations may better reflect regional characteristics. This study examined the impact of using different spirometric reference equations on asthma assessment. Methods In this cross-sectional study, pre-bronchodilator forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), and FEV 1 /FVC were assessed in 384 adults with asthma, and symptom control status was assessed using the Asthma Control Test (ACT). Reference values, z-scores, and lower limits of normal (LLN) were derived using the GLI Global (GLI-2022 race-neutral) equation (GLIgl), GLI-2012 Caucasian equation (GLI2012_cauc), GLI-2012 Other/mixed equation (GLI2012_other), and Al-Qerem local equation (LOCAL). Agreement between equations was evaluated using Cohen’s kappa, and their sensitivity and specificity for identifying ACT-defined uncontrolled symptoms were assessed. Results Spirometric values differed significantly across equations. Associations between spirometric impairment and ACT-defined uncontrolled symptoms were modest, with low-to-moderate discrimination. Higher FEV 1 and FVC z-scores were consistently associated with higher ACT scores across all equations, although explained variance was limited and model-fit differences were minimal. Pairwise agreement between equation sets was substantial to near-perfect for FEV1 < LLN (kappa = 0.692-0.907) and FEV1/FVC < LLN (kappa = 0.757-0.945), while LLN-defined impairment rates differed across equations. Conclusions The choice of spirometric reference equation substantially influences impairment classification and its concordance with ACT-defined symptom control, but overall predictive performance remains modest. Spirometry should be interpreted as a complementary, rather than standalone, tool in asthma assessment, with careful consideration of population-appropriate reference standards.
Introduction Effective airway clearance is crucial in COPD management, and oscillatory positive expiratory pressure (OPEP) devices are a potential adjunct therapy for this. However, their clinical efficacy remains uncertain due to limited trial data.Aim To update our previous (2020) systematic review investigating the use of OPEP devices to augment sputum clearance in COPD.Methods Randomised Clinical Trails s evaluating OPEP devices in COPD were identified from PubMed, CINAHL, Medline, Cochrane, and Embase (2020-2024). Outcomes included lung function, exercise capacity, exacerbations, and health-related quality of life (HRQoL), with pooled estimates calculated using random-effects models.Results Twelve trials (741 participants) were included. OPEP devices significantly reduced exacerbations (Odds Ratio: 0.39) and improved exercise capacity (+49 m at 6MWD). Small improvements were observed in FVC%, while HRQoL changes were not statistically significant. Accumulating evidence suggests benefits for sputum clearance and reduced antibiotic use. Devices were generally well accepted and safe.Conclusion OPEP devices appear to be safe and may reduce exacerbations, improve functional exercise capacity, and support sputum clearance in COPD.
Background In the general population without COPD, indoor air pollution from biomass is a causal factor of cognitive impairment (CI). CI is also common in patients with tobacco smoke COPD and has been associated with hypoxemia and cardiovascular comorbidities. CI and its risk factors have not been evaluated in COPD patients living at high altitude, who experience greater hypoxemia and frequent exposure to wood smoke. Methods Patients with COPD residing at high altitude with FEV1/FVC <0,70 and COPD risk factors (wood smoke, Tobacco smoke or combined exposure). Measurement of the Mini-Mental State Examination to assess CI, educational level, comorbidities, exacerbations, arterial blood gases, diffusion (DLCO), and 6-min walk test (6MWT). Comparisons between groups with and without CI using the X2 test and unpaired t-test. Logistic regression with odds ratio (OR) calculation was used to evaluate the association of CI with the variables of interest. Results In the 199 patients included, 16.1% had CI, the majority with mild involvement (68.8%). Those with CI had more frequent exposure to wood smoke (p<0.001), older age (p=0.017), lower educational level, PaO2 (p=0.032), DLCO (p=0.036), and fewer meters in the 6MWT (p=0.007), with no differences in sex, severity of obstruction or comorbidities. Adjusting for the other variables, exposure to wood smoke was associated with CI [OR and 95% CI: 4.82 (1.62-14.33). Conclusions In patients with mild to moderate COPD living at high altitude, regardless of hypoxemia, age, educational level, comorbidities, and lung function, exposure to wood smoke was associated with CI.
Background Dysregulated breathing is a major cause of persisting breathlessness for many people following acute COVID-19 illness. There is little evidence to support the use of breathing interventions within this population. Methods A feasibility study was conducted to investigate the potential role of supervised, remote online yogic breathing as an intervention, compared to usual care. The intervention was a six-week group programme, in which they were encouraged to attend bi-weekly. Primary outcomes of attendance, completion and acceptability were recorded and a survey following the intervention. Secondary measures of breathlessness and physical function were collected. Results Of 122 people invited who had reported dysregulated breathing at the time of clinical consult, 40 consented and 34 were randomised (Intervention n=17, usual care n=17), 33 had initial assessment (n=16 and n=17) and with post-intervention outcomes available in n=13 and n=14, respectively. Of the 13 in the intervention arm, 5 people completed >75% of sessions and the post intervention assessment. The median number of sessions attended per participant was 7. No safety issues were recorded. The survey (n=13) of the actual intervention highlighted it was well received but there was limited options for attending. Although some breathlessness measures improved in the people receiving the intervention, there was no significant difference when comparing the intervention to usual care arms. Conclusions The feasibility of the study was limited in this select population of people after COVID-19 with dysregulated breathing. The intervention was well received, but attendance at all the sessions was challenged by the limited options for the sessions.
IntroductionThe American Thoracic Society (ATS) six-minute walk test (6MWT) guidelines recommend repeat testing at the same time of day to minimise intraday variability. Whether diurnal or seasonal factors affect the 6MWT in pulmonary hypertension (PH) is unclear. We investigated associations between six-minute walk distance (6MWD) and secondary 6MWT parameters with time of day and season using cross sectional and longitudinal analyses.MethodsThis single-centre retrospective study (2019-2025) included PH patients undergoing 6MWT as per ATS guidelines. Cross-sectional analyses compared morning (AM, 07:00-12:00) vs afternoon (PM, 12:01-18:00) and seasonal effects on 6MWD using adjusted linear models. Longitudinal effects were examined with adjusted linear mixed effects models.ResultsThe cross-sectional cohort included 1,665 patients (AM n=734, PM n=931). Estimated marginal mean (EMM) 6MWD was higher in the morning than afternoon (354m vs 339m; p=0.005), with no seasonal variation (Winter 338m, Spring 354m, Summer 345m, Autumn 343m; p=0.20). The longitudinal cohort included 554 patients. EMM 6MWD was similar between AM and PM (396m vs 400m; p=0.16) and across seasons (Winter 395m, Spring 395m, Summer 399m, Autumn 398m; p=0.43). Maximal heart rate (MHR) was higher in the afternoon (115 vs 113 bpm; p=0.002) and lower in Summer/Autumn (113 bpm) vs Winter (116 bpm) and Spring (115 bpm; p=0.017).Conclusion6MWD was stable across time of day and season, supporting greater flexibility in scheduling 6MWTs than suggested by guidelines. Small variations in MHR were associated with circadian and seasonal influences but did not affect 6MWD. Prospective studies are needed to confirm these findings.
ObjectivesTo determine whether a remote behaviour change service (Active Steps), delivered by a UK charity, can increase physical activity over a 12-month period in adults with lung disease.MethodsActive Steps (n=166) consisted of 1:1 telephone health coaching for 12 months alongside printed (e.g. activity diary and chart, information and goal setting booklet) and digital behaviour change strategies (e.g. exercise videos, motivational newsletters, pedometer). A concurrent control group was recruited (n=80) for comparison. Self-reported physical activity (Short Active Lives Survey) and self-reported health (EQ-VAS) were collected at baseline, 3, 6, and 12 months. Logistic regression models (adjusted for confounders) were used to analyse the odds of becoming physically active or average changes in physical activity time and EQ-VAS.ResultsPrimary outcome: The number of participants defined as physically active at 12 months was greater with Active Steps (46%) compared to controls (23%) which was statistically significant in an unadjusted (odds ratio (OR) [95% confidence intervals (CI)]:2.8 [1.3-6.1], p=0.011) but not adjusted model (OR: 2.2 [0.9-5.4], p=0.097). Secondary outcomes: Compared to controls, Active Steps increased the number of participants physically active at 3 and 6 months, increased the weekly minutes of moderate-vigorous physical activity and improved self-reported health (EQ-VAS) across all timepoints.DiscussionOur findings suggest that charity-led remote behaviour change support is effective in the short-to-medium-term in adults with lung disease, but high participant attrition necessitates caution in interpreting sustained effect estimates at 12 months. Further long-term evaluations are needed to address adherence and sustainability of such services.
ObjectiveGuided by the medication literacy conceptual model, this study represents an interpretive exploration of medication literacy among patients with Chronic Obstructive Pulmonary Disease (COPD) to provide evidence for strategies aimed at improving medication adherence.MethodsUsing purposive sampling, 18 patients were recruited from the respiratory department and outpatient clinics of a tertiary general hospital in Shanxi Province between March and July 2025. Data were collected via semi-structured interviews and analyzed using directed content analysis method.ResultsThe analysis yielded four primary themes: functional, communicative, and critical medication literacy, as well as medication numeracy. These findings indicate that medication literacy in COPD patients is influenced by multidimensional factors, highlighting the complex challenges and subjective barriers in both cognitive and behavioral domains.ConclusionThese findings suggest that future interventions could prioritize patient-centered, personalized nursing interventions tailored to these specific literacy deficits-particularly in numeracy and critical processing-to effectively enhance treatment adherence and quality of life for COPD patients.
IntroductionThis study aims to characterize the patient journey for refractory chronic cough (RCC) or unexplained chronic cough (UCC) before visiting the Isala Chronic Cough Clinic (ICCC) in the Netherlands.MethodData from 152 patients with RCC or UCC was collected between January 2017 and September 2021from General Practitioner (GP) and hospital charts, the EQ-5D-5L questionnaire, and a patient survey about the care pathway and cough impact on everyday life, based on a single-centre, observational, retrospective study design.ResultsMean age at first ICCC visit was 60.3 ± 11.6 years; 66.4% of patients was female. More patients had RCC (80.9%) than UCC (19.1%). Mean cough duration before ICCC visit was 8.5 ± 6.5 years. 41.4% of patients reported cough >10 years. Common patient-reported problems were social embarrassment (58.0%), exhaustion (54.2%), and sleep disturbance (45.0%). Urinary incontinence was prevalent among women (48.9%). Prior to ICCC, 59.2% had consulted 2-4 specialists for their cough and 16.2% had seen more than 4.ConclusionThis study highlights the long time to diagnosis of RCC or UCC, and the negative effect on patients' physical and psychological health, and everyday activities. Increased awareness may shorten time for diagnosis, and novel therapies may help reduce this disease burden.
Objectives: Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder. Acute exacerbation of COPD (AECOPD) severely affects patients' quality of life and prognosis. This study aimed to identify novel risk factors and develop an effective predictive model for AECOPD using machine learning (ML) models. Methods: In this retrospective single-center study, clinical data and biomarkers from 565 participants were analyzed using ML algorithms. Feature selection employed least absolute shrinkage and selection operator regression. Eight ML models were trained and evaluated using receiver operating characteristic (ROC) and clinical decision curve analysis. The Shapley Additive explanations (SHAP) framework assessed feature contributions. An online personalized risk calculator was developed based on the optimal model and individual SHAP values. Results: The XGBoost model demonstrated excellent discriminative performance, with areas under the ROC curve of 0.818 and 0.838 for the training and test sets, respectively. Key predictors identified by SHAP analysis included age, current smoking status, frequency of exacerbations in the previous year, albumin levels, sarcopenia index, and COPD Assessment Test score. These variables were integrated into an online calculator for research to illustrate individualized AECOPD risk estimation. However, external validation is still required before its clinical application. Conclusions: We developed a preliminary ML model for predicting AECOPD, which provides a valuable tool for clinical risk assessment. The results also highlighted the correlation between sarcopenia and AECOPD risk.
Chronic respiratory diseases such as Chronic Obstructive Pulmonary Disease, Asthma, Interstitial Lung Disease, Cystic Fibrosis, and Pulmonary Hypertension affect over 500 million people globally and pose significant challenges for diagnosis, management, and long-term care. Traditional approaches often rely on episodic clinical assessments and patient-reported symptoms, which fail to capture the dynamic nature of respiratory health. The integration of wearable technology offers a transformative solution, enabling continuous, real-time monitoring of physiological and behavioural parameters. This review explores the evolving role of wearable devices, including activity trackers, smartwatches, spirometers, and biosensors, in modernising chronic respiratory disease management. Evidence across disease domains demonstrates that wearables can enhance physical activity, predict exacerbations, support remote rehabilitation, and facilitate personalised care. In Chronic obstructive pulmonary disease, step counters and biometric sensors have shown improvements in activity levels and early exacerbation detection. Asthma care benefits from AI-driven platforms that integrate environmental and physiological data to optimise treatment. For Interstitial lung disease and Cystic fibrosis, home spirometry and sweat biomarker monitoring empower patients and improve disease tracking. In Pulmonary hypertension, wearables provide insights into activity and sleep patterns, complementing traditional assessments. Despite promising outcomes, barriers remain. Technical limitations, data reliability, digital literacy, privacy concerns, and integration into clinical workflows hinder widespread adoption. Economic and equity considerations further challenge scalability, particularly in low-resource settings. Looking forward, the convergence of multimodal sensing, AI analytics, and digital therapeutics will enable proactive, personalised, and equitable respiratory care. Addressing validation, interoperability, and ethical governance will be critical to realising the full potential of wearable technology in CRD management.
BackgroundIndividuals with early-stage non-small cell lung cancer (NSCLC) often show reduced exercise capacity and physical activity (PA) after surgery, with or without (neo-)adjuvant therapy. However, understanding of peoples' lived-lives following lung cancer diagnosis and surgery remains unknown.ObjectiveThis study aimed to deeper understand how lung cancer diagnosis and surgery shape individuals' daily lives within one to three months post-surgery.MethodsAdults (18+) with stage I-IIIA NSCLC were recruited one to three months after surgery or (neo-)adjuvant therapy including radio-/chemo-/immunotherapy. A rapid ethnographic approach was used. Participants were observed at home during three two-hour visits, with a semi-structured interview during the last visit. Field notes and transcripts were thematically analyzed in Atlas.ti using a hybrid approach. Initial themes were deductively guided by the 14-domain TDF and inductively refined. Final themes were mapped onto the COM-B model.Results16 individuals (69% female; 69±7 years; 3820±2207 steps/day; 6±8 min/day moderate-to-vigorous PA; 44% received (neo-)adjuvant therapy) participated in home observations (86h total, range 4-6h) and a semi-structured interview during the last visit (383min total, range 16-44min). Four key themes were identified; 1) Physical consequences affecting daily life; 2) Emotional and social coping; 3) Motivation and barriers influencing PA and rehabilitation; 4) Gaps in education and guidance.ConclusionLung cancer surgery (with or without (neo-)adjuvant therapy) causes physical, emotional, and social challenges that impair daily life. PA and engagement to rehabilitation is often limited by symptoms and contextual barriers. Tailored rehabilitation addressing individuals' living conditions, physical, and emotional needs are considered crucial for recovery.
ObjectivesFrailty is a multifactorial state of reduced physiological reserve and increased vulnerability, common in lung transplantation (LTx) candidates and associated with morbidity and mortality. There is no consensus on appropriate frailty instruments or optimal prehabilitation. Aims were to: (1) identify frailty measures in UK adult LTx candidates, (2) describe prescribed prehabilitation interventions, and (3) explore barriers to prehabilitation.MethodsAn anonymous online QualtricsXM survey was circulated via UK LTx coordinators and social media. Eligible respondents were professionals contributing to adult pre-operative assessment and listing decisions. Results were analysed using SPSS.ResultsThirty-one respondents met criteria, representing all five UK LTx centres. Frailty was always assessed by 58.1% and sometimes by 25.8%, though comprehensive measurement tools were rarely used. Functional tools included the Short Physical Performance Battery and sit-to-stand tests. Assessments occurred pre-listing and during waitlisting. Frailty was discussed at all listing meetings and influenced transplant suitability. Outpatient prehabilitation included face to face, telephone, and local referrals, targeting exercise, nutrition, and psychosocial needs. Reported barriers were travel, funding, and limited space.ConclusionUK lung transplant services conceptually recognise frailty as multidimensional and clinically important, but operationally rely on pragmatic, largely physical proxy measures. Prehabilitation provision is variable and often externally delivered constrained by system-level resource and access barriers.
BackgroundInterstitial lung disease (ILD) patients often have comorbid chronic ischemic heart disease (CIHD), which may worsen prognosis. Large-scale studies on long-term CIHD mortality trends in ILD patients are lacking. This study analyzes CIHD-related mortality trends in US adults with ILD from 1999 to 2023.MethodsCIHD-related mortality data were extracted from the CDC WONDER database for ILD patients aged ≥25 years. International Classification of Diseases, 10th Revision (ICD-10) codes J84.1, J84.8, J84.9 identified ILD, and code I25 identified CIHD. Age-adjusted mortality rates (AAMR), annual percentage change (APC), and average annual percentage change (AAPC) per 100,000 were calculated using Joinpoint regression.ResultsBetween 1999 and 2023, there were 92,779 CIHD-related deaths among U.S. decedents with interstitial lung disease (ILD, listed as an underlying or contributing cause of death in death certificates); this accounted for a substantial proportion of cardiovascular-related deaths in this decedent population. The overall AAMR showed a slight upward trend (AAPC=0.51%), but with significant nonlinearity: a decrease from 2003-2018 (APC=-1.29%), increased sharply from 2018 to 2021 (APC = 9.75%), with the increase concentrated during the COVID-19 pandemic years. The age-adjusted mortality rate rose modestly from 1.54 per 100,000 in 2018 to 1.60 in 2019 (+3.9%), then surged to 1.73 in 2020 (+8.1%) and peaked at 1.98 in 2021 (+14.5% from 2020). After 2021, mortality declined to 1.88 in 2023. Mortality was higher in men, non-Hispanic Whites, adults >85 years, and in southern and nonmetropolitan areas. Each subgroup showed a significant increase in mortality during 2020-2021, coinciding with the pandemic, while pre-pandemic trends were more gradual.ConclusionsCIHD-related mortality in ILD patients showed a fluctuating upward trend over 25 years, with a significant jump during the COVID-19 pandemic. This underscores the systemic impact of public health emergencies on cardiovascular health in vulnerable populations. Cardiovascular risk assessment and management should be integrated into routine ILD care, with tailored strategies for high-risk groups and regions.
Background Chronic obstructive pulmonary disease (COPD) with emphysema is associated with persistent airflow limitation and frequent exacerbations. Bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) improves lung function and quality of life but carries a risk of postprocedural complications, including acute exacerbations and pneumonia. Predictors of these adverse events remain incompletely defined. Purpose To identify clinical and inflammatory factors associated with postprocedural exacerbations in patients undergoing BLVR with EBVs, aiming to support individualized risk stratification. Patients and Methods We retrospectively analyzed 320 patients with advanced emphysema treated with EBVs between 2015 and 2022. Patients underwent comprehensive preprocedural evaluation, including pulmonary function testing, imaging, perfusion scintigraphy, 6-minute walk test and COPD Assessment Test. Postprocedural exacerbations within 8 weeks were documented clinically and radiographically. Binary logistic regression, including multivariable modeling, was used to identify independent predictors. Results Thirty-five patients (10.9%) developed post-BLVR exacerbations, six of whom had pneumonia. Exacerbation risk was independently associated with diabetes mellitus type II (OR 11.0, p < 0.001), elevated C-reactive protein >1 mg/dL (OR 9.35, p < 0.001), WBC >11 cells/nL (OR 5.46, p = 0.002), prior exacerbation frequency (OR 2.94, p < 0.001) and low BMI (OR 0.78, p < 0.001). Residual volume showed a trend toward significance (p = 0.058). The final model demonstrated excellent discriminative ability (AUC = 0.923). While lung function improvement was attenuated in the exacerbation group, quality of life gains were comparable. Conclusion Elevated inflammatory markers, diabetes, frequent prior exacerbations and low BMI were independently associated with early postprocedural exacerbations following BLVR with EBVs. Comprehensive preprocedural assessment and targeted management of these risk factors may enhance patient safety and improve outcomes.
