Background:Depression and anxiety exacerbate the pernicious cycle of dyspnea, inactivity, and deconditioning in people with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) is a well-proven management for improving exercise capacity and health-related quality of life in people with COPD. Recently, evidence suggested that adjunctive psychological interventions may enhance the efficacy of PR by targeting the bidirectional dyspnea-anxiety cycle and modifying maladaptive behaviors. Objective:To evaluate the added benefit of psychological interventions in comparison to conventional PR alone. Methods:Four electronic databases (PubMed, EMBASE, Web of Science, and CINAHL) were searched from their inception to March 31, 2025. Studies retrieved were screened according to the selection criteria. Statistical analyses were performed using Cochrane RevMan Manager 5.4. Appraisal of study quality and the certainty of evidence were evaluated. Results:Five studies were included in this meta-analysis. Primary analysis results showed significant improvements in anxiety (Standardized Mean Difference, SMD = -0.55; 95% CI: -0.85 to -0.25, p = 0.0004). There was no improvement in depression (SMD = -0.38, 95% CI = -0.97 to 0.22, p = 0.22) or physical outcomes (6-minute walking distance: (Mean difference, MD = 16.45, 95% CI = -17.38 to 50.27, p = 0.34). Subgroup analysis results demonstrated significantly greater improvement in depression among people with clinical symptoms at baseline (p = 0.004). Conclusion:The addition of adjunctive psychological interventions may enhance the efficacy of PR for people with COPD when compared to those receiving PR alone. The findings suggest that better improvements were observed among patients with clinical psychological symptoms at baseline.
Background:Alpha-1 antitrypsin deficiency (AATD) has considerable interindividual variability in lung disease progression. Pulmonary impairment is often measured by forced expiratory volume in one second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO). This study aimed to quantify within-person variability in pulmonary function test (PFT) measures and identify baseline factors associated with variability. Methods:Adult participants with AATD enrolled in the National Heart, Lung, and Blood Institute (NHLBI) Registry (1989-1992) were eligible for inclusion in this analysis if they had three serial PFTs and severe genetic deficiency. PFT variability was evaluated using linear mixed-effects models (LMM) with maximum likelihood estimation. Intra-subject variability was assessed through residual analyses. Baseline predictors, including age, sex, augmentation therapy, liver disease, and FEV1% predicted, were examined as fixed effects. Results:The analytic FEV1 cohort (n = 832) had a mean age of 46.3 ± 10.1 years, 44.4% were female, and 99% were white. Over a mean of 4.4 ± 1.4 years of follow-up, participants completed an average of 5.7 ± 2.0 spirometry tests. FEV1 varied by more than 10% of baseline in 82% of participants and by more than 20% in 55%. DLCO varied by more than 10% in 91% and by more than 20% in 43% of participants. Conclusion:Substantial individual variability in FEV1 and DLCO was observed in this large AATD cohort. These findings suggest that FEV1 and DLCO are unreliable as clinical trial or stopping rule endpoints in AATD.
Background:Chronic obstructive pulmonary disease (COPD) management is complex and rapidly evolving. ChatGPT is a large language model (LLM) shown to generate treatment plans for chronic conditions, yet its accuracy, usefulness, and consistency for COPD remain poorly characterized. This study evaluated the accuracy, usefulness, and impact variability of simultaneous ChatGPT-4.0 responses to COPD medication management questions. Methods:Five COPD treatment questions were simultaneously entered into three separate computers using ChatGPT-4.0 during a single session, generating 15 total responses. Three residency-trained, board-certified clinical pharmacists rated each response across three domains - accuracy, usefulness, and impact variability - using a 3-point ordinal scale (0 to 2) via a three-round modified Delphi process. Consensus was defined a priori as unanimous agreement among all three panelists. Results:Of 45 response-domain ratings, consensus was achieved in 40 (88.9%). Accuracy ranged from poor (0) to good (2), usefulness from somewhat (1) to very useful (2), and impact variability from low (0) to high (2). For one question on stable COPD pharmacotherapy, all three simultaneous responses cited a retired clinical practice guideline, resulting in poor accuracy ratings. For two questions - treating exacerbations and managing a complex case - one response per question was rated higher in usefulness than the others. Conclusion:Simultaneous ChatGPT-4.0 responses to identical COPD prompts differed materially in accuracy and potential clinical impact. LLM outputs should augment rather than replace clinician judgment and must be deployed with current guideline grounding and appropriate local oversight.
Rationale:Inhaled triple therapy (TT) combining a long acting beta agonist, long acting muscarinic antagonist, and inhaled corticosteroid is recommended for COPD patients with frequent exacerbations. Despite guideline criteria, TT is often initiated in patients unlikely to benefit. Objectives:To characterize trends in the use of TT among COPD patients and concordance with guideline recommendations. Methods:This observational study used de identified commercial and Medicare Advantage Part D claims from the Optum Research Database (2018-2022). Patients ≥40 years old with COPD who initiated TT between 2019 and 2022 were included. Baseline characteristics, prior respiratory medication use, and exacerbation history during the 12 month period before TT initiation (index date) were summarized overall and stratified by calendar year and TT type (single inhaler TT [SITT] vs multiple inhaler TT [MITT]). A subgroup analysis evaluated maintenance naive initiators, defined as no maintenance inhaler use in the prior 12 months. Results:A total of 60,169 patients initiating TT were included. The proportion using SITT increased steadily from 53.0% in 2019 to 79.3% in 2022. Most patients (61.9%) had a low exacerbation history consistent with GOLD group A/B, increasing from 53.0% to 66.0% over the study period. Approximately 40% had zero exacerbations in the previous 12 months. One third of initiators were maintenance naive. SITT use was associated with significantly higher odds of guideline discordant initiation relative to MITT (adjusted OR 5.04; 95% CI: 4.76-5.33). Conclusion:TT initiation discordant with GOLD recommendations has increased in the United States, coinciding with an increase in the use of SITT over the corresponding period.
Objective:To investigate changes in airway microbiota and immune markers across Chronic Obstructive Pulmonary Disease (COPD) stages and their associations with clinical phenotypes and nursing factors, providing a basis for precision nursing. Methods:284 stable COPD patients (GOLD 2-3) were enrolled. Sputum and clinical data were collected at baseline (T0), exacerbation (T1), and recovery (T2). Microbiota structure was analyzed via 16S rRNA sequencing, and levels of immune markers such as interleukin-8 (IL-8) and IL-1β were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Statistical analysis was performed by integrating clinical scale scores and nursing adherence data. Results:At T1, airway microbial α diversity was remarkably lower than at T0 and T2 (p < 0.01). The relative abundances of Haemophilus and Prevotella increased, while those of Veillonella and Lactococcus decreased (p < 0.01). Levels of IL 8, IL 1β, and TNF α were elevated, and Secretory Leukocyte Protease Inhibitor (SLPI) levels were reduced at T1 (p < 0.01). Notable correlations were found between microbiota and immune markers (e.g., Haemophilus abundance with IL 8 levels, r = 0.52, p < 0.01), and these were positively associated with clinical scores such as COPD Assessment Test (CAT) and St. George's Respiratory Questionnaire (SGRQ) (p < 0.05). Patients with >80% inhaler adherence and regular breathing exercises/nutrition had higher microbial diversity and attenuated inflammation (p<0.05). Conclusion:The airway microbiota-immune axis in COPD patients demonstrates a disease stage-dependent imbalance, characterized by microbial dysbiosis and enhanced pro-inflammatory responses during acute exacerbation. Good nursing adherence can modulate this axis's homeostasis, offering novel targets for precision nursing.
