Background Expiratory central airway collapse (ECAC) may represent an imaging-defined marker of chronic obstructive pulmonary disease (COPD). However, evidence regarding the clinical significance of ECAC in COPD remains limited. Therefore, we aimed to evaluate the presence of ECAC in patients with COPD and its association with respiratory health outcomes. Methods This study included patients with COPD from a prospective, community-based cohort. The patients underwent spirometry, questionnaires, and paired inspiratory/expiratory chest computed tomography at baseline, and annual exacerbation assessment and spirometry during the 3-year follow-up. ECAC was defined as a reduction in airway cross-sectional area of ≥50% during end-expiration compared with the area during end-inspiration at any of three anatomical levels: the aortic arch, carina, and bronchus intermedius. The outcomes were exacerbation risk and annual rate of lung function decline. Results 915 patients with COPD were included in the baseline analysis, 892 completed 3-year follow-up. The ECAC detection rate among patients with COPD was 8.7% (80/915). Patients with ECAC had higher total exacerbation (RR=1.50, 95%CI: 1.11–2.04, p=0.009) and moderate-to-severe exacerbation (RR=1.50, 95%CI: 1.07–2.09, p=0.017) risks than those without ECAC. With each additional anatomical level of ECAC, total (RR=1.22, 95%CI: 1.06–1.41, p=0.006) and moderate-to-severe (RR=1.18, 95%CI: 1.01–1.39, p=0.043) exacerbation risks increased. No significant difference was found in lung function decline between patients with and without ECAC. Conclusion ECAC was associated with a higher exacerbation risk among patients with COPD, suggesting that ECAC may serve as an imaging-based prognostic marker of COPD to guide future exacerbation risk assessment.
Background Chronic bronchitis (CB) and small airway dysfunction (SAD) are each linked to exacerbations and disease progression in COPD, but their interrelationship remains incompletely understood. Research question Is chronic bronchitis associated with SAD in moderate-to-very severe COPD? Methods In this real-world cohort, 102 consecutively recruited patients with GOLD 2–4 COPD underwent clinical characterization, spirometry, and impulse oscillometry (IOS). CB was defined by the Chronic Airways Assessment Test (CAAT) and SAD severity was assessed using a composite score based on IOS z-scores of R5, AX, and sign-reversed X5. Results Among 102 patients, 46 were CB+ and 56 CB−. FEV 1 % predicted was similar between groups (38.7 versus 37.1; p=0.45), whereas CB+ patients had more exacerbations during the previous year (2 versus 0.5; p=0.04) and higher CAAT scores (30 versus 19.5; p<0.001). Several IOS indices indicated greater impairment in CB+, particularly reactance parameters and composite SAD severity. CB was associated with increased odds of moderate-to-severe SAD in unadjusted analysis (OR 2.64, 95% CI 1.02–7.24) and after adjustment for age, sex, current smoking, BMI, FEV 1 % predicted, and previous exacerbation history (adjusted OR 4.47, 95% CI 1.40–16.67). Within CB+, IOS correlated with the modified CAAT scores (ρ=0.39–0.51; all p<0.01) and poorer 1-minute sit-to-stand performance (ρ=−0.35 to −0.41; p=0.035 to<0.01). CB+ patients with moderate-to-severe SAD were more likely to have previous COPD exacerbations than those with no/mild SAD (RR 1.90, 95% CI 1.09–5.40). Interpretation CAAT-defined CB in moderate-to-very severe COPD is independently associated with more pronounced IOS-defined SAD. In patients with CB, greater SAD relates to higher symptom burden, poorer functional performance, and increased exacerbation risk based on historical data. These findings suggest that SAD detected by IOS is clinically relevant in patients with COPD and CB.
Background: Despite their clinical overlap, wheezing, asthma, and rhinitis are often managed in isolation. Aim: to identify and characterise joint trajectories of these conditions using a unified analytical framework in childhood and adulthood. Methods: We used data from the population-based INfancia y Medio Ambient (INMA) birth cohort (Spain, ages 6–18 years), and the European Community Respiratory Health Survey (ECRHS) adult cohort (11 European countries and Australia, ages 19–67-years). Wheezing, asthma, and rhinitis symptoms, and a wide range of clinical and risk factors, were assessed using harmonised questionnaires and standardised tests. We identified trajectories separately for each cohort using longitudinal k-means clustering. Results: Five joint trajectories were identified in children (INMA, n=959) and seven in adults (ECRHS, n=9275). An asymptomatic trajectory was most prevalent in both cohorts (58% and 48%, respectively). Rhinitis-only trajectories appeared as persistent (17% children, 11% adults) or with onset at various life stages (adolescence to late-adulthood). A persistent multimorbidity trajectory was identified in both groups (6–7%), characterised by high maternal asthma, frequent respiratory symptoms, and low lung function. Age-specific trajectories included resolving wheezing/asthma in children (7%, linked to frequent respiratory infections) and, in adults, resolving mid-adulthood rhinitis (7%, with high maternal eczema/allergy), and wheezing with rhinitis (10%, uniquely associated to high smoking, low education, manual occupations, and impaired lung function). Conclusion: We identified both shared and age-specific trajectories of wheezing, asthma, and rhinitis across the lifespan. These distinct trajectories, ranging from isolated rhinitis to environment-driven multimorbidity, demand age-tailored, integrated clinical management, and investigation into underlying biological mechanisms.
Background COPD is the third leading cause of death worldwide. However, little is known about the characteristics of patients who die from COPD. The aim of this study was to determine the relationship between change or persistence in Global Initiative for Chronic Obstructive Lung Disease group E (GOLD-E) status over time and COPD- and cardiovascular (CV)-related death. Methods Patients with COPD were identified by International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes in the French national health insurance database. Patients who died from COPD or CV diseases between 1 January 2017 and 31 December 2022 were matched with living COPD patients. We performed a case–control analysis to compare the impact of the change in GOLD-E status between two periods: 13–24 months (period 2 (2026)) and 0–12 months (period 1 (2025)) prior to death or the index date. Results A total of 500 673 COPD patients died during the study period. Of these, 67 250 died from COPD and 41 585 from CV events. Of the patients whose deaths were COPD related, the proportion of patients with GOLD-E 2026 status increased between the two periods (58.3% versus 79.2%), but decreased in their matched living controls (58.3% versus 36.9%). Of the patients with GOLD-E 2026 status during period 2, becoming and remaining GOLD-E 2026 within their final 12 months was associated with COPD-related death (odds ratios 5.40 (95% CI 5.03–5.79) and 4.16 (95% CI 3.87–4.48), respectively; p<0.0001). Interpretation These data demonstrate that being GOLD-E for 2 years in a row is associated with a high risk of COPD-related death, of the same magnitude as being GOLD-E for 1 year.
