Introduction:Pulmonary hypertension (PH) is a frequent and serious complication of advanced chronic obstructive pulmonary disease (COPD) and is associated with a poor prognosis and limited treatment options. Current management focuses on optimizing COPD care, while the role of pulmonary vasodilators remains controversial. Ensifentrine, a dual phosphodiesterase (PDE) 3/4 inhibitor with bronchodilatory and anti-inflammatory properties, may offer a therapeutic benefit in COPD-associated PH. This study aims to retrospectively evaluate the effects of six months of nebulized ensifentrine on pulmonary hemodynamics and functional outcomes in patients with severe COPD and associated pre-capillary PH. Methods:We conducted a single-center, retrospective chart review of patients with GOLD stage III and IV COPD and confirmed pre-capillary PH (mean pulmonary artery pressure [mPAP] ≥20 mmHg, pulmonary vascular resistance [PVR] >2 Wood units, pulmonary capillary wedge pressure ≤15 mmHg). Five patients treated with nebulized ensifentrine (3 mg twice daily) between September 2024 and May 2025 were included. Hemodynamics via right heart catheterization (RHC) and 6-minute walk distance (6MWD) were measured at baseline and at 6 months. Results:The cohort (mean age 76 years, 60% male, mean FEV1 33.4% predicted) demonstrated severe emphysema and PH (baseline mPAP 53.2 mmHg, PVR 9.5 WU, cardiac index 2.5 L/min/m2). After 6 months, mean changes were as follows: • mPAP: decreased by 1.6 mmHg • Cardiac index: increased by 0.1 L/min/m2 • PVR: decreased by 1.0 WU • 6MWD: improved by 31 m • mMRC dyspnea score improved from 3.6 to 3.2 • CAT score from 23 to 21.6 • DLCO increased modestly (29%→31.2% predicted). • No adverse events, exacerbations, or hospitalizations were observed during this period. • The combination of ensifentrine with roflumilast was well tolerated. Discussion:Pulmonary hypertension in COPD is associated with worse outcomes, yet treatment options remain limited and uncertain. In this small retrospective case series of five patients with very severe COPD and confirmed pre-capillary PH, the addition of ensifentrine to optimized therapy was associated with modest but potentially meaningful improvements in symptoms, exercise capacity (6MWD), and select hemodynamic parameters, without worsening oxygenation. Its dual PDE3/PDE4 inhibition and inhaled delivery provide a plausible mechanism for bronchodilation, anti-inflammatory effects, and selective pulmonary vasodilation while minimizing ventilation-perfusion mismatch. However, the findings are highly preliminary given the very small sample size, lack of a control group, retrospective design, and significant selection bias, limiting generalizability and causal inference. Overall, the results are hypothesis-generating and suggest that ensifentrine may have therapeutic potential in COPD-associated PH, but larger, prospective, randomized trials are needed to confirm efficacy, safety, and its role in treatment algorithms. Conclusion:In this retrospective study, ensifentrine was safe and was associated with modest improvements in pulmonary hemodynamics and functional status in patients with severe COPD with pre-capillary PH. These preliminary findings warrant confirmation in larger, prospective, controlled trials.
Introduction Patients with Inflammatory Bowel Disease (IBD) may experience a range of extraintestinal pulmonary manifestations. Anti-TNFα therapy has emerged as a crucial treatment option for IBD patients. Despite the pro-inflammatory role of TNFα in pulmonary diseases, anti-TNFα therapy has no major value in their treatment. Therefore, this study aimed to investigate the prevalence of pulmonary manifestations and the impact of anti-TNFα therapy on lung function parameters in IBD patients. Methods Thirty two patients with IBD were recruited. These patients received pulmonary function tests prior to and at least 6 weeks after initiating anti-TNFα therapy. Pulmonary function was evaluated by standardized body plethysmography, including the measurement of lung diffusion capacity (DLCO SB). Results FEV1 and vital capacity (VC) were within normal range before and during anti-TNFα therapy. Mean residual volume (RV) was moderately increased before initiation of anti-TNFα therapy. RV decreased during the course of therapy, from 2.7 L (interquartile range (IQR) 2.04 - 3.06) or 159% (IQR 129.25 - 184.75) prior to anti-TNFα therapy to 2.5 L (IQR 2.14 - 3.00) or 138% (IQR 127.00 - 165.25) during anti-TNFα therapy ( p =0.031 for absolute values and p =0.014 for relative values. DLCO SB was slightly reduced before anti-TNFα therapy and decreased even further during anti-TNFα therapy, from 76.1% to 72%. Discussion Lung function tests in our IBD cohort were almost normal. FEV1 and VC were within normal range. RV was moderately increased, and DLCO SB was slightly decreased. These might indicate an extraintestinal involvement of IBD. During anti-TNFα therapy, RV slightly improved, whereas DLCO SB decreased even further, albeit only slightly. In our IBD cohort, anti-TNFα therapy did not significantly influence lung function parameters. Conclusion Our study shows that anti-TNFα therapy in Inflammatory Bowel Disease (IBD) only slightly changes lung function parameters, including diffusion capacity, at least in patients with mild IBD.
Chronic obstructive pulmonary disease (COPD) and asthma remain among the most prevalent respiratory disorders worldwide, characterized by chronic inflammation, oxidative stress, and impaired quality of life. Although there has been significant advancement in the pharmacologic therapies, complementary strategies that can potentially target the underlying mechanisms and complement the conventional treatment are growing in interest among numerous patients and providers. This narrative review used systematic search methods in PubMed, Google Scholar, and ScienceDirect to select herbal medicines and nutraceuticals that were studied for COPD and asthma, with a specific selection using objective pulmonary functionality parameters (FEV1, FVC, FEV1/FVC). Analysis of evidence identified multiple interventions with a clinically significant effect, such as Astragalus membranaceus, Rhodiola rosea, nanocurcumin, Bufei granule, and Wuqinxi breathing exercises, most of which have anti-inflammatory, antioxidant, and immunomodulatory effects. The other agents, including Withania somnifera, Maxingshigan decoction, and L-carnitine, exhibited significant but inconsistent efficacy, whereas compounds like N-acetylcysteine, resveratrol, and cannabis had little effect. Mechanistic research indicates NF-kB, MAPK, Nrf2, and cytokine signaling pathways as typical therapeutic targets. Despite the limitations of methodological heterogeneity, the results indicate the judicious use of the choice of herbal and nutraceutical interventions in comprehensive respiratory care. Such supportive interventions can be patient-centered, enhance medication compliance, and offer an added effect in combination with evidence-based pharmacologic therapies. The quality of therapeutic application of the drug needs to be established through further high-quality therapeutic trials in order to determine the safety, dosing, and long-term outcomes.
Introduction:Peak Expiratory Flow (PEF) is a practical marker of airway patency and cough effectiveness, yet perioperative evidence from Latin American surgical populations is limited. This study aimed to quantify postoperative PEF variability after abdominal surgery and identify associated factors. Methods:We conducted a prospective observational study at a Peruvian hospital in 2024. Adults undergoing elective abdominal surgery performed PEF testing with a Mini-Wright meter preoperatively and on postoperative day 7 using a standard three-maneuver protocol. The highest valid value was retained. The primary outcome was PEF variability, defined as the difference between preoperative and postoperative PEF (L/min). Group comparisons used non-parametric tests, and multivariable linear regression identified independent predictors. Results:Eighty-two patients were included; 58.5% were women, and the median age was 48 years. Mean preoperative and postoperative PEF values were 367.9 ± 71.9 and 346.0 ± 74.8 L/min, respectively. Median PEF variability was 20 L/min (IQR 10-30). Variability did not differ by sex or BMI. Age was the only independent predictor of greater decline. Discussion:Abdominal surgery was associated with an early postoperative reduction in expiratory flow, particularly in older adults. Conclusion:Routine perioperative PEF assessment may help identify patients who require closer respiratory monitoring and early supportive therapy in resource-constrained surgical settings.
Introduction The neutrophil-lymphocyte ratio (NLR) is an emerging inflammatory biomarker in community-acquired pneumonia (CAP) with potential prognostic implications. Biomarker-concordant corticosteroid dosing strategies based on other inflammatory markers have been found to be associated with improved clinical outcomes. The NLR is a readily available and affordable biomarker and could help guide corticosteroid use in CAP. Our goal is to evaluate the association between NLR-concordant corticosteroid prescription and patient outcomes. Methods Single-center prospective cohort study of adults with CAP who were admitted to the Mayo Clinic in Rochester, Minnesota, between December 10, 2023, and March 11, 2025. Patients with available NLR within 24 hours of admission were evaluated. Those who received steroids after 24 hours of admission, stayed in the hospital shorter than 24 hours, and were not yet discharged were excluded. Steroid use was classified as 'biomarker-concordant' if given when NLR > 12 or withheld when NLR <= 12, and 'biomarker-discordant' otherwise. All-cause mortality was the primary outcome. Results Of 545 admissions with CAP, 465 were included. Steroid use was biomarker-discordant in 222 (47.7%) patients and biomarker-concordant in 243 (52.3%) patients. Systemic corticosteroid use within 24 hours was more common in the discordant group (127 (57.2%) versus 77 (31.7%)). After adjusting for the pneumonia severity index, there were no significant differences in clinical outcomes between groups including in-hospital mortality (odds ratio [95% C.I.] = 1.120 [0.463, 2.706]), 30 – day mortality (hazard ratio [95% C.I.] = 1.423 [0.747, 2.710]), oxygen-free days (estimate [95% C.I.] = 0.61 [–0.655, 1.879), or hospital-free days (estimate [95% C.I.] 0.222 [–0.943, 1.386]) between biomarker-discordant versus concordant corticosteroid use. Discussion Despite growing interest in biomarker-guided corticosteroid strategies, NLR-based concordance was not associated with clinical outcomes in this cohort, suggesting that its role may be limited to risk stratification rather than treatment guidance. Conclusions In this observational cohort of hospitalized CAP patients, a biomarker-concordant corticosteroid treatment strategy based on the NLR was not associated with improved clinical outcomes.
