Qiao Zhang,1,* Qinqin Wang,2,3,* Lingjun Liu,2,3 Hong Li,2,3 Xiuqing Liao,4 Qianli Ma2,3 1Department of Respiratory and Critical Care Medicine, Chongqing Songshan General Hospital, Chongqing, People’s Republic of China; 2Department of Chronic Respiratory Disease Management and Rehabilitation Center, Chongqing Songshan General Hospital, Chongqing, People’s Republic of China; 3Department of Allergy and Immunology, Chongqing Songshan General Hospital, Chongqing, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qianli Ma, Department of Chronic Respiratory Disease Management and Rehabilitation Center, Chongqing Songshan General Hospital, 69 Xingguang Avenue, Yubei District, Chongqing, People’s Republic of China, Email cqmql@163.comBackground: Chronic obstructive pulmonary disease (COPD) contributes substantially to global morbidity and mortality, while suboptimal inhaled medication adherence worsens clinical outcomes. Existing evidence confirms disease knowledge shapes self-medication behaviors, yet it remains unclear which distinct COPD knowledge domains correlate with adherence improvements following standardized patient education.Objective: To explore associations between changes in each domain of COPD-related knowledge and variations in inhaled medication adherence following routine outpatient standardized health education.Design and Participants: This was a multicenter, prospective, observational pre–post study. Consecutive stable COPD outpatients aged ≥ 40 years were recruited between June 2024 and June 2025 from two tertiary hospitals in Chongqing, China.Methods: All participants received 30-minute standardized education covering all 13 knowledge subdomains of the Bristol COPD Knowledge Questionnaire (BCKQ). BCKQ, Medication Adherence Report Scale (MARS), and COPD Assessment Test (CAT) were administered at baseline and 3-month follow-up. Spearman correlation and ANCOVA with Holm-Bonferroni correction were used; two supplementary sensitivity models were applied to verify result stability.Results: A total of 894 patients were included in the final analysis. Scores of the total BCKQ, MARS, and CAT all showed statistically significant changes after education (all P < 0.001). Among all 13 knowledge subdomains, only increased epidemiological knowledge scores were positively correlated with improved inhaled medication adherence (ρ = 0.43, P < 0.001). After adjusting for baseline adherence, total baseline knowledge and multiple demographic/clinical confounders, elevated epidemiological knowledge was independently associated with higher follow-up MARS scores (B = 0.33, SE = 0.04, P < 0.001). Consistent statistical significance for ΔEpidemiology was observed across two sensitivity analytical models. Baseline low adherence was 64.0%, and medication-related knowledge gains were not associated with adherence change.Conclusion: Improvements in COPD epidemiological knowledge were independently associated with greater inhaled medication adherence after standardized outpatient education. Prioritizing education on disease progression and long-term threats may be an effective strategy to optimize adherence in busy clinical settings.Keywords: chronic obstructive pulmonary disease, inhaled medication adherence, health education, disease knowledge, patient self-management
Chou-Chin Lan,1,2 Hsiang-Yu Huang,3 Chia-Ling Chen,1 Yi-Ling Lin,4 Shu-Chuan Chen,5 Li-Chu Lee,5 Huei-Min Dai,5 Shih Yi Zhe,5 Cheng-Yang Chiang,6 Yu-Fan Chang,7 Mung-Rung Lee,8 Hsiu Lu,8 Chih-Chiao Yang,9 Chiu-Hui Su,10 Ying-Zhen Chiang,11 Mei-Chen Yang,1,2 Rong-Yaun Shyu,12 Yao-Kuang Wu1,21Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 2School of Medicine, Tzu-Chi University, Hualien, Taiwan; 3Division of Respiratory Therapy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 4Department of Planning and Management, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 5Department of Nursing, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 6Department of Nutrition, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 7Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 8Center of Community and Long-Term Care Services, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 9Department of Social Services, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 10Center of Chest Medicine Examination, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 11Center of Quality Management, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 12Division of Gastroenterology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, TaiwanCorrespondence: Yao-Kuang Wu, Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian City, New Taipei City, 23142, Taiwan, Tel +886 2 6628 9779 ext. 2259, Fax +886 2 6628 9009, Email drbfci@yahoo.com.twBackground: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of hospitalisation and mortality. Although multidisciplinary team (MDT) care models are increasingly used in disease management, long-term real-world data, particularly during the coronavirus disease 2019 (COVID-19) pandemic, remain limited.Methods: We conducted a retrospective analysis of patients hospitalised for AECOPD between 2018 and 2024. A LINE-based MDT model was implemented in 2019. Outcomes included pharmacological and nonpharmacological intervention rates, psychological well-being, health-related quality of life (HRQL), hospital length of stay (LOS), readmissions, and 1-year survival.Results: Among 568 patients, the use of several guideline-based treatments differed significantly across study years, including long-acting muscarinic antagonists (64% in 2018 to 93% in 2024), long-acting beta-agonists (74% to 100%), systemic corticosteroids (79% to 96%), and inhaled corticosteroids (59% to 86%) (all p< 0.001). Pulmonary rehabilitation differed significantly across years (p< 0.001), increasing from 51.9% in 2018 to 98.6% in 2024 despite a temporary decline in 2022. Smoking cessation success also differed across years (p=0.006). The 14-day readmission rate differed significantly across years (p=0.043), ranging from a peak of 17.3% in 2020 to 2.9% in 2024. No significant differences across years were observed in LOS or 1-year survival. Psychological distress and CAT scores also differed across study years.Conclusion: The LINE-based MDT model was associated with higher rates of several care-process measures, particularly pulmonary rehabilitation. However, adjusted comparisons between 2024 and 2018 showed no significant differences in major hospital outcomes. These observational findings suggest a potential role for digitally coordinated MDT care in supporting multidisciplinary AECOPD care, although causal effects cannot be established.Trial Registration: Not applicable.Keywords: multidisciplinary team, acute exacerbation of COPD, pulmonary rehabilitation, health-related quality of life, COVID-19
Zhenlin Wang,1 Jinhui Xu,2 Yufan Xi,3 Zhi Luo,3 Jiabin Cheng,4 Zhao Xu,1 Peng Liang1,51Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Queen Mary School, Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 3West China Clinical Medical School, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 4The First Clinical Medical College of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 5Day Surgery Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of ChinaCorrespondence: Peng Liang, Department of Anesthesiology, West China Hospital, Sichuan University; Day Surgery Center, West China Hospital, Sichuan University. No. 37 Guoxuexiang, Chengdu, Sichuan, 610041, People’s Republic of China, Tel +86 18980602201, Email liangpengwch@scu.edu.cn Zhao Xu, Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, Sichuan, 610041, People’s Republic of China, Tel +86 18980602574, Email davidxuzhao@gmail.comBackground: Postoperative delirium (POD) is a frequent and serious complication following surgery, particularly in high-risk patients such as those with chronic obstructive pulmonary disease (COPD). The relationship between COPD and the development of POD remains unclear, with existing studies providing inconsistent findings. This meta-analysis aims to evaluate the association between COPD and postoperative delirium in surgical patients.Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, MEDLINE, Web of Science, Embase, and the Cochrane Library, and other grey resources. Observational studies and randomized controlled trials assessing the incidence of POD in COPD patients were included. Data were extracted on study design, participant demographics, surgical context, and POD assessment. Both fixed-effect and random-effects models were evaluated, with model selection guided by statistical heterogeneity and study characteristics. Subgroup analyses were performed to explore heterogeneity.Results: A total of 26 studies involving 43,051 patients were included. Both unadjusted and adjusted analyses showed a significant association between COPD and the increased risk of POD. The pooled odds ratio (OR) for the association in adjusted analyses was 2.08 (95% CI: 1.60– 2.71, P < 0.001; I2 = 67.2%). In the adjusted subgroup analysis, the association remained statistically significant in non-cardiac surgery but did not reach statistical significance in cardiac surgery; however, the between-subgroup difference was not statistically significant (P for interaction = 0.139). Geographic variation was identified as a potential effect modifier, with studies conducted in Asia showing a stronger association.Conclusion: The available evidence suggests an association between COPD and higher odds of POD in surgical patients, including in studies reporting multivariable-adjusted estimates. However, the predominantly observational evidence and between-study heterogeneity warrant cautious interpretation and do not establish causality. These findings highlight the potential importance of tailored perioperative management strategies for patients with COPD, although their effectiveness in reducing POD risk requires further investigation. Further well-designed prospective studies are necessary to confirm these findings and explore the underlying mechanisms. However, insufficient data on COPD severity precluded an assessment of whether this association varied across GOLD stages.Keywords: postoperative delirium, chronic obstructive pulmonary disease, postoperative neurocognitive dysfunction, risk factors
Fitrian Rayasari,1,2 Kusman Ibrahim,3 Titis Kurniawan,3 Ninik Yunitri41Doctoral Program in Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia; 2Department of Medical and Surgical Nursing, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Jakarta, Indonesia; 3Department of Medical-Surgical, Emergency, and Critical Care Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia; 4Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Jakarta, IndonesiaCorrespondence: Kusman Ibrahim, Department of Medical-Surgical, Emergency, and Critical Care Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia, Email k.ibrahim@unpad.ac.idBackground: Fatigue is prevalent and disabling in chronic obstructive pulmonary disease (COPD), but the factors examined and their reported associations vary across studies.Objective: To map factors examined in relation to fatigue in COPD, characterize their reported association patterns, and descriptively group factors with verifiable direct associations according to potential amenability to change or potential relevance to clinical management.Methods: This PRISMA-ScR-guided review searched Embase, Scopus, and MEDLINE from inception to 30 April 2026. Eligible primary quantitative studies involved adults with COPD and examined at least one distinct factor in relation to a fatigue outcome or explicit fatigue-specific domain. Layer 1 mapped factor-specific fatigue analyses and classified reported findings as significant, non-significant, mixed/attenuated, or not ascertainable. Layer 2 descriptively organized factors with at least one verifiable statistically significant direct association into author-defined categories of potential amenability to change or potential relevance to clinical management. Frequencies were calculated at the publication level.Results: Thirty-eight publications were included; evidence was predominantly observational and cross-sectional. In Layer 1, dyspnea (24 publications), lung function impairment (17), depressive symptoms (15), and anxiety symptoms (10) were frequently mapped. Factors grouped by potential amenability to change included depressive symptoms (11 publications), anxiety symptoms (6), sleep disturbance (6), smoking status (4), exercise capacity (4), and BMI/body composition (2). Factors grouped by potential relevance to clinical management included dyspnea (20), pain (4), comorbidity status/burden (2), current exacerbation (2), and cough (2).Conclusion: Fatigue-related factors in COPD span multiple domains. Dyspnea was prominent among factors potentially relevant to clinical management, whereas depressive and anxiety symptoms, sleep disturbance, smoking status, and exercise capacity were prominent among potentially change-oriented factors. These descriptive findings inform future research but do not establish causality or clinical priority.Keywords: chronic obstructive pulmonary disease, evidence mapping, fatigue, scoping review
Minglong Xu, Bo Yao, Xue Xiao, Zhangli PengDepartment of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhangli Peng, Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China, Email pengzhangli1987@163.com Xue Xiao, Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China, Email xuexiao@zmu.edu.cnPurpose: To evaluate associations of genetically predicted plasma lipid metabolites and immune-cell phenotypes with chronic obstructive pulmonary disease (COPD) and assess candidate immune-mediated lipid-COPD pathways.Methods: We conducted two-sample Mendelian randomization (MR) analyses using genome-wide association study summary statistics for COPD in 458,440 individuals of European ancestry (26,274 cases and 432,166 controls), 179 plasma lipid metabolites in 7,174 Finnish participants, and 731 immune-cell phenotypes in 3,757 Sardinian participants. Genetic instruments selected at P< 1× 10− 5 were linkage-disequilibrium clumped, harmonized and screened for instrument strength. Inverse-variance weighting (IVW) was the primary estimator, with robust adjusted profile score (MR-RAPS) used for sensitivity analysis. Benjamini–Hochberg (BH) correction was applied separately across the complete lipid and immune-cell test families. Reverse MR of 13 selected lipids, cross-ancestry analyses using an East-Asian COPD outcome, and two-step MR of 18 previously selected candidate pathways were exploratory. Indirect effects were estimated, and complementary multivariable MR with conditional F-statistics were evaluated separately; BH correction covered the reverse and indirect-effect families.Results: Twenty-one lipid metabolites and 48 immune-cell phenotypes showed nominal IVW associations with COPD (P< 0.05), however, none met the complete-family threshold of q< 0.05. Six immune-cell phenotypes reached an exploratory (q< 0.10) threshold. MR-RAPS estimates were generally directionally consistent with the European IVW estimates but did not identify any complete-family (q< 0.05) associations. The cross-ancestry outcome analysis did not consistently support the focused European signals. None of the 18 indirect effects survived BH correction. For the pathway from phosphatidylcholine (16:0_20:4) to COPD through CD62L− myeloid dendritic cell absolute count, the indirect effect was 0.0037 (95% CI − 0.0008 to 0.0083; P=0.110; BH q=0.138). Two reverse-MR associations were nominally significant, but neither survived correction across 13 tests (both BH q=0.140). Although multivariable MR identified several direct-effect patterns within the selected candidate set, these findings did not establish mediation.Conclusion: The primary European analyses provided limited evidence for multiplicity-adjusted associations of the evaluated plasma lipid metabolites or immune-cell phenotypes with COPD, and none of the candidate indirect effects was statistically supported. Reverse-MR signals should therefore be considered hypothesis-generating and require validation in independent cohorts and experimental studies. The present findings do not support clinical risk prediction or diagnostic application.Keywords: chronic obstructive pulmonary disease, Mendelian randomization, lipidomics, immune-cell phenotypes, mediation, multivariable Mendelian randomization
