The global initiative for chronic obstructive lung disease (GOLD) 2023 combined the C and D groups into the E group. This study aimed to explore the necessity of combining the GOLD C and D groups based on prognosis and inhaled treatment response in patients with chronic obstructive pulmonary disease (COPD). This study retrospectively analyzed data from the Real-world Diapnosis and Treatment of COPD cohort study from January 2017 to June 2022. The baseline demographic and clinical data were organized. According to the GOLD 2017, patients were classified into 4 groups (A, B, C, and D). At follow-up, the number of moderate-to-severe exacerbations in 1 year and all-cause mortality in 3 years were recorded. A total of 4970 COPD patients were included in this study, with a mean age of 62.4 ± 8.4 years; 86.9% were male, and 77.6% were smokers. The GOLD C group included 156 (3.1%) patients. Logistic regression with stratified adjustment showed that patients in the GOLD A and B groups had the lowest risk of future exacerbation (A group: odds ratio [OR] = 0.369, 95% confidence interval [CI] = 0.249-0.546; B group: OR = 0.447, 95% CI = 0.339-0.671), frequent exacerbation (A group: OR = 0.291, 95% CI = 0.169-0.503; B group: OR = 0.458, 95% CI = 0.296-0.709), and hospitalization (A group: OR = 0.349, 95% CI = 0.219-0.556; B group: OR = 0.394, 95% CI = 0.267-0.582), whereas patients in the GOLD D group had similar risk values to patients in the GOLD C group. Stratified logistic regression also showed that different inhaled treatments had no impact on the risk of future exacerbation, frequent exacerbation, and hospitalization in the GOLD C group, while in GOLD D group, long-acting β-2-agonist/long-acting muscarinic antagonist (LABA/LAMA) or LABA/LAMA/inhaled corticosteroids could decrease the risk of future any exacerbation and frequent exacerbation but the risk of hospitalization was similar among different inhaled treatment groups. The GOLD C group, as the smallest group, showed a similar prognosis to the GOLD D group. The effect of different inhaled treatments was almost the same in the GOLD C group, while LABA/LAMA and LABA/LAMA/inhaled corticosteroids were superior for patients in the GOLD D group.

This study was to investigate the role of exosomes derived from distal airway stem cells (DASC) in apoptosis of pulmonary vascular endothelial cells (PVEC) in chronic obstructive pulmonary disease (COPD) and to explore the potential mechanisms. Cigarette smoke extract (CSE) plus cigarette smoke (CS)-induced COPD mice were treated with DASC and exosomes. The microRNA (miR) sequencing of exosomes was performed to explore the underlying mechanisms. We determined the expression of miR-181d-5p and PDAP1 in patients with COPD. Compared with control mice, DASC and exosomes derived from DASC could alleviate emphysema changes, decrease the mean linear intercept and alveolar destructive index, reduce apoptosis of PVEC in COPD mice. Furthermore, miR-181d-5p was significantly decreased in exosomes derived from COPD mice DASC when compared with exosomes derived from normal mice DASC. The knockdown of miR-181d-5p in exosomes derived from DASC could weaken its effects in alleviating emphysema and apoptosis of PVEC, increase the expression of PDAP1, and decrease the expression of miR-181d-5p. The overexpression of miR-181d-5p and knockdown of PDAP1 could significantly reduce apoptosis in CSE-induced PVEC. Furthermore, the overexpression of PDAP1 could reverse the anti-apoptotic effect of miR-181d-5p on CSE-induced PVEC. Finally, the expression of miR-181d-5p was decreased in patients with COPD and positively related to pulmonary function, while the expression of PDAP1 was increased and negatively related to pulmonary function. Exosomes derived from DASC could alleviate lung injury in COPD. The mechanism may be to reduce the apoptosis of PVEC by delivering miR-181d-5p by targeting PDAP1.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 introduces the concept of “disease stability” (DS), classifies patients with ≥1 moderate exacerbation in the previous year as Group E, and recommends long-acting beta2-agonist (LABA) + long-acting muscarinic antagonist (LAMA) or inhaled corticosteroid (ICS) + LABA + LAMA for Group E, LABA + LAMA for Group B, and bronchodilator monotherapy for Group A. This study evaluated DS in patients whose inhaled therapy was aligned with the GOLD 2026 initial treatment strategy and explored associated factors. This retrospective analysis of real-world data included patients enrolled between 1 November 2017 to 30 June 2024. Based on adherence to the initial inhaled therapy recommendations outlined in the GOLD 2026 report, patients were categorised as either aligned or non-aligned; the non-aligned group was further divided into under-treated and over-treated subgroups. DS was defined as the absence of exacerbations, no symptom deterioration, and a decline in FEV1 of less than 60 mL during 1 year of follow-up. A total of 1277 patients were enrolled, of whom 475 (37.2%) achieved DS during the 1-year follow-up. Among patients in the aligned group, 238 (41.0%) achieved DS. Compared with the non-aligned group, the aligned group showed a lower incidence of clinically important deterioration (CID) in the CAT score, fewer future exacerbations, and a higher rate of DS. Subgroup analysis showed that the aligned group had higher odds of DS than the under-treated group, whereas no significant difference was observed compared with the over-treated group. Among patients in GOLD Groups B and E, alignment with the GOLD 2026 recommendations was associated with a higher rate of DS and a lower risk of exacerbations and CID. Influenza or pneumococcal vaccination showed a modest positive association with DS, whereas current smoking and a history of exacerbations were negatively associated with DS among patients receiving GOLD 2026-aligned initial therapy. Alignment with GOLD 2026 initial treatment recommendations was associated with improved DS, particularly in GOLD Groups B and E. Current smoking and a history of exacerbations reduced the likelihood of achieving DS, whereas influenza or pneumococcal vaccination showed a modest positive association with DS.

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated lung function decline, reduced physical activity, and increased mortality. Although prior exacerbations predict future events, patients without an exacerbation history may still be at substantial risk. This study aimed to identify clinical risk factors for future exacerbations in this population. A total of 2,475 COPD patients without an exacerbation in the preceding year were enrolled from the RealDTC study (Registration Date: January 14, 2017). Baseline demographic and clinical data were collected, and patients were followed for three years. They were categorized into exacerbation and non-exacerbation groups based on whether an exacerbation occurred during follow-up. During follow-up, 38.3

This study was to explore how exosomal circRNA_43350 secreted by bone marrow MSCs (BMSCs) influences the development of chronic obstructive pulmonary disease (COPD). Pulmonary microvascular endothelial cells (PMVECs) and animal models of COPD were constructed in this study. Lung tissue morphometry was observed by hematoxylin and eosin staining. Apoptosis related indicators were measured by flow cytometry, western blot assay and TUNEL staining. The expression of circRNA_43350 and miR-342-5p was analyzed by real-time quantitative polymerase chain reaction. Dual luciferase reporter gene assay was used to investigate the relationship between circRNA_43350 and miR-342-5p. After intervention with BMSCs exosomes from normal mice, the cell apoptosis of PMVECs induced by CSE and emphysema in COPD mice were alleviated. Mmu_circRNA_43350 was highly expressed in normal BMSCs exosomes, while decreased significantly in BMSCs exosomes of COPD. After overexpression of circRNA_43350 in the CSE-induced PMVECs and COPD mice, the apoptosis-related indicators were decreased and the changes of emphysema were alleviated. Additionally, circRNA_43350 acted as a miRNA-342-5p sponge in PMVECs. Further study, we found that circRNA_43350 attenuated CSE-induced apoptosis in PMVECs by regulating the expression of miRNA-342-5p, and overexpression of miRNA-342-5p partially reversed the apoptosis-inhibiting effect of circRNA_43350. CircRNA_43350 derived from BMSCs exosomes attenuated CSE-induced apoptosis in PMVECs by regulating the expression of miRNA-342-5p.

Background:Preserved ratio impaired spirometry (PRISm) is closely related to chronic obstructive pulmonary disease (COPD). However, there is a lack of relevant research on the treatment of patients with PRISm. Therefore, this study aimed to investigate the risk factors of future exacerbations and treatment responses among different inhalation therapies of patients with PRISm. Methods:This is a retrospective cohort study. Patients with PRISm were registered in the real-world study on the status of diagnosis and treatment of COPD (RealDTC) study between January 2017 and August 2024. Data on demographics, pulmonary function, symptom scores, number of exacerbations and hospitalisations in the past year, inhalation therapy regimens including long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA, and LABA + LAMA + ICS, and comorbidities were collected. The number of exacerbations, frequent exacerbations, hospitalisations, and all-cause of mortality were collected during one year of follow-up. Results:A total of 575 patients were included for the final analysis. During one year of follow-up, 144 (25.0%) patients experienced exacerbations. The patients experienced exacerbations had higher age, symptom score, number of exacerbations and hospitalisations in the past year, as well as higher proportion of biofuel exposure and without inhalation therapy. Logistic regression analysis showed that age, number of hospitalisations in the past year, and without inhalation therapy were the independent risk factors for patients experienced exacerbations. Furthermore, after propensity score matching, the patients without inhalation therapy had higher number of exacerbations, frequent exacerbations, and hospitalisations during one year of follow-up. However, there were no significant differences in future exacerbations, frequent exacerbations, hospitalisations, and all-cause of mortality among LAMA, LABA + LAMA, LABA + ICS, and LABA + LAMA + ICS. Conclusions:Patients with PRISm had high risk of future exacerbations. Inhalation therapy could reduce the risk of future exacerbations and clinicians should recommend mono-LAMA to patients with this condition.

Parthenolide (PTN), a sesquiterpene lactone derived from the medicinal plant feverfew (Tanacetum parthenium), and its derivatives such as dimethylamino parthenolide (DMAPT) and dimethylaminomicheliolide fumarate (ACT001) exhibit distinguished anti-inflammatory, anticancer, antioxidant, and epigenetic activities, with accumulating evidence demonstrating their therapeutic potential in respiratory diseases. This review systematically summarizes the antitumor, anti-inflammatory, antioxidative, and antifibrotic effects of PTN and its derivatives in relevant animal models, elucidates the underlying pharmacological mechanisms involving STAT3, NF-κB, MAPK/ERK, and PI3K signaling pathways, and highlights recent advances in clinical applications and drug delivery strategies. A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus up to February 2026. Results demonstrate that PTN and its derivatives exert significant therapeutic effects in lung cancer, pulmonary fibrosis, asthma, pneumonia, and acute lung injury. We summarize the clinical translation progress of ACT001, including its safety and pharmacokinetic profiles, discuss emerging delivery systems such as micelles, and review the patent landscape of PTN derivatives. By integrating mechanistic insights with progress in clinical applications and drug delivery, this review provides a foundation for further mechanistic studies and supports the translational development of PTN-based therapies for respiratory disorders.

Background:There is limited information available on patients with asthma in hospitals in China. We investigated their clinical and phenotypic characteristics and management. Methods:The China Asthma Data Registry Project (CHART) study is a multicentre, hospital-based, prospective, observational study in which patients were recruited from outpatient clinics. This analysis used baseline cross-sectional data from patients with asthma (≥12 years) enrolled at 58 tertiary hospitals in China between 25 March 2018 and 11 July 2019. Results:A total of 20 683 patients with asthma (56.2% female, 15.0% patients with active tobacco use) were enrolled. Overall, 22.8% had uncontrolled asthma, 39.5% had partially controlled asthma. Furthermore, 45.3% experienced ≥1 exacerbation annually, including 31.7% who required hospitalisation, with only 21.4% having previously used inhaled corticosteroids (ICSs) in the past year. Cough (80.0%) was the most common symptom, followed by wheezing (70.7%), with 14.6% having cough-predominant asthma and 11.4% having cough-variant asthma. Multivariate logistic regression revealed that cough severity independently predicted poor control, irrespective of airflow limitation or inflammatory status. The association was stronger in ICS users than in nonusers across all cough severity metrics: a visual analogue scale (VAS) score ≥40 (aOR 3.88-5.47 versus 2.49-2.94), a cough evaluation test (CET) score ≥12 (aOR 11.15-20.91 versus 3.97-5.55), and a Leicester Cough Questionnaire (LCQ) score <15 (aOR 6.15-13.66 versus 2.45-3.18). Conclusions:We found significant suboptimal control, a high prevalence of cough-related phenotypes, frequent exacerbations and hospital admissions in patients with asthma attending hospitals. This underscores the need to prioritise the assessment and treatment of cough in asthma.

The study aimed to observe the airway mucus plugs in patients with stable chronic obstructive pulmonary disease (COPD) versus those with acute exacerbation of COPD(AECOPD), and examine the clinical characteristics and prognosis in stable COPD and AECOPD with mucus plugs detected by computed tomography (CT). This prospective study enrolling patients registered in the RealDTC study from July 1, 2017 and June 30, 2023. Mucus plugs were visually-identified on CT. The symptom change, pulmonary function change, readmission, exacerbation and all-cause mortality were observed during follow up. The study enrolled 2764 COPD patients, of whom 848(30.8%) exhibited mucus plugs. The prevalence of mucus plugs in AECOPD was higher than stable COPD (45.5% versus 29.4%). Mucus plugs were associated with older age, biofuel exposure, higher CAT score, lower FEV1%predicted, lower LAA−950HU% and higher WA%. Besides, mucus plugs increased risk of moderate-to-severe exacerbation during 1-year and 2-year follow-up, and death during total visit than those without mucus plugs both in stable COPD and AECOPD. Furthermore, mucus plugs were related to symptom deterioration, and decline in pre-and post-BD FEV1, pre-BD FEV1% and post-BD FEV1/FVC in stable COPD. In AECOPD, the presence of mucus plugs was associated with the increased length of hospital stay and higher total costs during hospitalization, as well as the escalated risk of readmission. The prevalence of airway mucus plugs in AECOPD was higher than stable COPD. Mucus plugs are related to biomass exposure, worse pulmonary function, more severe symptom, less emphysema and greater airway wall thickness. Moreover, mucus plugs may be related the elevated risk of future exacerbations and mortality. They were also associated with less improvement in pulmonary function and symptoms in stable COPD, and prolonged hospital stays, higher costs and elevated risk of readmission in AECOPD.

Many studies explored the features of Chronic obstructive pulmonary disease (COPD) with asthma-like features. We aimed to compare the exacerbation and mortality during one-year follow-up among COPD patients with asthma-like features with different inhalation therapies in the Chinese population (compare Without-inhaled corticosteroids(ICS)and With-ICS inhalation therapy, and then ICS + long-acting β-2-agonist(LABA) and ICS + LABA + long-acting muscarinic antagonists (LAMA). This real-world observational study was conducted in the RealDTC cohort (ChiCTR-POC-17010431, Trial Regisrtation Date: 2017.01.14). COPD patients with asthma-like features in China from July 1, 2017, to June 31 2022 were recruited into the study and followed-up for 12 months. The Without-ICS inhalation therapy cohort included patients with LAMA or LABA + LAMA therapy, the With-ICS inhalation therapy cohort included patients with ICS + LABA or ICS + LABA + LAMA therapy. Of the 2735 eligible participants, the With-ICS inhalation therapy cohort was less likely to experience moderate-to-severe exacerbation and severe exacerbation during follow-up than the Without-ICS inhalation therapy cohort after PSM in multivariate analysis, but not death. The ICS + LABA + LAMA group had a lower risk of moderate-to-severe and frequent exacerbations than the ICS + LABA group after PSM. In addition, patients with CAT ≥ 10, or with previous exacerbation history, or with GOLD II and GOLD III + IV grade, receiving ICS + LABA + LAMA had a decreased risk of exacerbation compared to ICS + LABA. COPD patients with asthma-like features with With-ICS inhalation therapy based on bronchodilators were less likely to experience future exacerbations than those Without-ICS inhalation therapy, but not death. In addition, ICS + LABA + LAMA therapy decreased the risk of exacerbation compared to ICS + LABA therapy during follow-up, especially in patients with CAT ≥ 10, or with previous exacerbation history, or with GOLD II and GOLD III + IV grade.

OBJECTIVES:To investigate the acute effects of short-term exposure to ambient air pollution on the risk of hospital admissions for osteoarthritis (OA) and its major subtypes. METHODS:Hospital admission data on OA and its major subtypes were sourced from two major urban medical insurance systems in China, covering the period from 2013 to 2017. A two-stage, time-stratified case-crossover design was used to investigate the acute effects of short-term exposure to ambient air pollutants on hospital admissions for OA across 278 Chinese cities with available hospital admission data over 50 cases. The conditional logistic regression model was utilized to assess city-specific associations, which were subsequently pooled by employing a random-effects model. RESULTS:A total of 1,404,095 OA-related hospital admissions were included. At the main time windows, per interquartile range increases in PM2.5 (particulate matter with an aerodynamic diameter of ≤ 2.5 μm), PM10 (particulate matter with an aerodynamic diameter of ≤ 10 μm), NO2 (nitrogen dioxide), SO2 (sulfur dioxide), O3 (ozone), and CO (carbon monoxide) were associated with significant increases in OA-related admissions by 0.70 % (95 % CI: 0.12 %, 1.28 %), 1.08 % (95 % CI: 0.47 %, 1.69 %), 4.50 % (95 % CI: 3.36 %, 5.65 %), 2.75 % (95 % CI: 1.79 %, 3.72 %), 1.33 % (95 % CI: 0.57 %, 2.10 %) and 1.77 % (95 % CI: 0.76 %, 2.79 %), respectively. Short-term exposures to ambient air pollutants were also associated with increased hospital admissions for major OA subtypes, especially gonarthrosis. The attributable fractions of OA admissions ranged from 0.87 % for PM2.5 to 6.22 % for NO2. CONCLUSIONS:Short-term exposure to ambient air pollution is significantly associated with an increased risk and burden of OA admissions.

BACKGROUND:Anorexia is a common problem among patients with chronic obstructive pulmonary disease (COPD). This study aimed to analyze the clinical characteristics and prognosis of COPD patients with anorexia. METHODS:This prospective cohort study included patients registered in the RealDTC study between May 2023 and February 2024. Demographic on COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) scores, pulmonary function, number of exacerbations, inhalation therapy, and the section of anorexia/cachexia subscale (A/CS)-12 of Functional Assessment of Anorexia/Cachexia Therapy (FAACT) scores were collected. A FAACT A/CS-12 score of ≤ 30 was used to identify patients with anorexia. All patients were followed up for one year to collect exacerbations, and mortality. RESULTS:A total of 758 patients with COPD were enrolled, 132 (17.4%) of whom had anorexia. Patients with anorexia had higher age, CAT and mMRC scores, number of exacerbations, and worse pulmonary function. Logistic regression analysis showed that CAT scores of 10-19 (OR = 2.867, 95% CI = 1.423-5.773), 20-29 (OR = 6.932, 95% CI = 3.234-14.857) and ≥ 30 (OR = 67.355, 95% CI = 7.221-628.271), and number of hospitalizations ≥ 1 (OR = 2.041, 95% CI = 1.347-3.093) were independent risk factors for anorexia (p < 0.05). In addition, patients with anorexia experienced more future exacerbations, frequent exacerbations, and hospitalizations (p < 0.05). The ROC curves showed that FAACT A/CS-12 scores had a predictive capacity for future exacerbation, frequent exacerbation, and hospitalization. CONCLUSIONS:The COPD patients with anorexia had worse pulmonary function, higher symptoms burden, and risk of exacerbation and hospitalization.

Indoor air pollution (IAP) is a risk factor leading to cataracts. The disease burden of cataracts due to IAP is currently greater in low- and middle-income countries, an in-depth analysis is necessary to track the current time trend of cataracts caused by IAP in low- and middle-income countries. Our data from the global burden of disease 2021 study. In our study, disability-adjusted life years (DALYs) and DALYs rate were used to assess the disease burden of cataracts due to IAP across 17 low- and middle-income countries. The contribution of IAP exposure to the associated burden of cataracts was quantified by using population attribution fractions. Additionally, the estimated annual percentage change was calculated to quantify the long-term trend in the burden of cataracts due to IAP from 1990 to 2021. An age-period-cohort model was used to estimate the effects of age, period, and cohort on time trend of disease burden. In 2021, age-standardized DALY rates (ASDR) values varied widely across the 17 countries. Pakistan had the highest ASDR 122.5 (-35.3 to 247.4). ASDR declined in all 17 countries. For all countries, the age effect increases rapidly after about age 55. South Africa, Brazil, and Mexico have made great progress in the period and cohort effects. The situation of burden for IAP-related cataracts varies across countries, and it is necessary to set targeted public health strategies and interventions.

Background Impaired sleep quality is prevalent in COPD patients, but the CT imaging characteristics of these patients remain unknown. This study explores CT features—including diaphragm thickness (DT), diameter pulmonary artery to aorta ratio (dPA/A), and airway indices—in relation to their sleep quality. Methods This cross-sectional study included 190 COPD patients enrolled Dec 2021–Sep 2024. Baseline data included demographics, CAT scores, pulmonary function, exacerbation history, and CT parameters. Impaired sleep quality was defined as PSQI score ≥5, with patients grouped accordingly. Results A total of 190 COPD patients were enrolled, with a mean age of 64.8 years and predominantly male (93.1%). Over half of the patients (56%) exhibited impaired sleep quality, which was associated with higher CAT scores and lower forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC). Patients in impaired sleep quality group had smaller airway lumen area (LA), mean inner and outer diameters (mID, mOD), and mean wall thickness(mWT), but higher wall area percentage (WA%) and dPA/A. DT, WA%, and dPA/A are independent risk factors for impaired sleep quality. ROC analysis further demonstrated that dPA/A had the greatest discriminative ability (AUC = 0.688), followed by CAT score (0.667), DT (0.632), and WA% (0.602). Conclusion Impaired sleep quality may be associated with DT, airway narrowing, airway wall thickening, reduced lumen diameter and enlarged dPA/A.

Background:The influenza vaccination rate of chronic obstructive pulmonary disease (COPD) patients in China was very low. In this study, we aimed to evaluate the effect of clinician-led intensive health education on influenza vaccination in outpatients with COPD and the effect of influenza vaccination on the risk of acute exacerbations in the real world. Methods:Participants were from the Real World Research of Diagnosis and Treatment of COPD study, a real-world prospective cohort study. COPD patients were included from December 2016 to April 2023 and followed up for one year. In January 2022, clinicians began strengthening health education for outpatients with COPD. We identified patients visiting the clinic from January 2022 to April 2023 as the intensive health education group and those visiting from December 2016 to December 2021 as the control group. We analysed factors associated with influenza vaccination and the effect of influenza vaccine on acute exacerbations by multivariate analysis. Results:7834 patients were included. Compared with the control group, the intensive health education group had a higher rate of influenza vaccination (1.6% vs. 12.2%, P < 0.01). Smoking cessation, high school education or above, influenza vaccination in the past year and intensive health education were independently associated with influenza vaccination. Influenza vaccination reduced the incidence of future acute exacerbations (adjusted odds ratio (aOR) = 0.48; 95% confidence interval (CI) = 0.33-0.68, P < 0.01), frequent acute exacerbations (aOR = 0.47; 95% CI = 0.27-0.82, P = 0.01), and severe acute exacerbation (aOR = 0.38; 95% CI = 0.23-0.63, P < 0.01) in COPD patients. Conclusions:Influenza vaccination reduced the risk of future acute exacerbations in patients with COPD. Clinician-led intensive health education can improve the influenza vaccination of outpatients with COPD, and clinicians and policymakers should pay attention to and apply this method.

Background:The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 revised the combined chronic obstructive pulmonary disease (COPD) assessment, merging groups C and D into group E, and revised the initial inhalation therapy recommendation. We aimed to evaluate the treatment responses among different inhalation therapies in GOLD group E patients stratified by the COPD assessment test (CAT) scores and forced expiratory volume in one-second percentage of predicted (FEV1%pred). Methods:In this retrospective cohort study, we included patients with COPD registered in the Real World Research of Diagnosis and Treatment of COPD (RealDTC) study between January 2017 and June 2023. According to the GOLD 2023 report, we enrolled patients assigned to GOLD group E based on exacerbations in the past year (≥2 exacerbations or ≥1 hospitalisation) in this study. We classified them into the FEV1%pred <50% and FEV1%pred ≥50% groups, or CAT<10 and CAT≥10 groups. Subsequently, we divided all groups into four subgroups: long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA, and LABA + LAMA + ICS. All patients finished one year of follow-up, during which we collected data on exacerbations, frequent exacerbations, hospitalisations, and all-cause mortality. We defined frequent exacerbations as ≥2 exacerbations per year. Results:We enrolled a total of 3173 patients in this study. During one year of follow-up, there were no significant differences in exacerbations, frequent exacerbations, hospitalisations, and all-cause mortality among LAMA, LABA + LAMA, LABA + ICS, and LABA + LAMA + ICS in the FEV1%pred ≥50% and CAT<10 groups. However, the patients treated with LABA + LAMA or LABA + LAMA + ICS had a lower incidence of exacerbations and frequent exacerbations compared with the patients treated with LAMA or LABA + ICS in the FEV1%pred <50% and CAT≥10 groups (P < 0.05). Conclusions:Patients with COPD in GOLD group E should be further stratified to determine the appropriate initial inhalation therapy. This approach may provide more precise treatment for GOLD group E patients.

BACKGROUND:Hyperlipidemia is a common metabolic disorder and a risk factor for cardiovascular disease. The traditional medicine herb, Hippophae rhamnoides L., known as sea buckthorn, has anti-obesity and lipid-lowering effects, while Silybum marianum (L.) Gaertn, known as milk thistle, has hepatoprotective properties and exhibits antioxidant effects. PURPOSE:To evaluate the effect of sea buckthorn and milk thistle solid beverage (H-S solid beverage) in alleviating hyperlipidemia in rats and explore the underlying mechanisms by analyzing plasma and liver metabolomics, lipidomics, and liver transcriptomics. METHODS:A hyperlipidemic rat model was established after 2 weeks of high-fat diet (HFD) feeding in Sprague Dawley rats. The administered doses of H-S solid beverage were 0.30 g/kg/d, 0.15 g/kg/d and 0.075 g/kg/d. Serum biochemical parameter detection, histopathological section analysis, untargeted plasma and liver metabolomics, lipidomics, and liver transcriptomics were performed to determine the therapeutic effects of H-S solid beverage and predict the related pathways in rats with hyperlipidemia. Changes in genes and proteins related to lipid metabolism were detected using real-time quantitative polymerase chain reaction and western blotting. RESULTS:Eighty-nine components were identified in H-S solid beverage using ultra-performance liquid chromatography coupled with quadrupole time of flight mass spectrometry, with flavonoids being the major constituents. The H-S solid beverage significantly reduced body weight, liver index, body fat percentage, lipid accumulation, and liver injury in HFD-fed rats. Fatty acids (FA), bile acid, phosphatidyl ethanolamine, phosphatidylcholine, triglyceride, cholesterol ester, diglyceride and phosphatidylinositol levels were significantly altered in the liver and plasma. Moreover, the transcriptomic analysis suggested that H-S solid beverage significantly altered the hepatic gene expression of cholesterol synthesis (Pdk4, Hmgcs1, and Dhcr24), lipogenesis (Scd, Angptl4, and Angptl8), and FA β-oxidation (Cpt1α, Pparδ, Acsl, Pgc-1α, and Pla2g2d). CONCLUSION:The solid beverage of sea buckthorn and milk thistle was firstly demonstrated to ameliorate HFD-induced hyperlipidemia. The lipid-lowering and hepatoprotective effects of H-S solid beverage significantly regulated cholesterol synthesis and de novo lipogenesis, as well as FA β-oxidation. In summary, this study highlights the potential of H-S solid beverages for the treatment of hyperlipidemia.

Severe asthma exhibits heterogeneity in airflow obstruction, driven by airway remodeling and air trapping, which can be noninvasively assessed via quantitative computed tomography (qCT). This study aimed to identify asthma phenotypes by clustering qCT measurements of airway dimensions, lung volumes, and densitometry, and to elucidate the underlying molecular pathways through sputum proteomics. We applied consensus clustering to qCT data from 239 asthma patients (severe and mild/moderate) and 68 healthy controls from the Chinese C-BIOPRED cohort. Four distinct qCT clusters emerged: cluster 1, characterized by luminal dilation, severe air trapping, and reduced lung density; cluster 2, with thickened airway walls and luminal narrowing without air trapping; cluster 3, showing mild luminal dilation, preserved lung volumes, and optimal spirometry; and cluster 4, featuring airway wall thickening, luminal narrowing, severe air trapping, and profound airflow obstruction. Sputum eosinophilia was elevated in clusters 1 and 4. Proteomics revealed upregulated pathways in apoptosis execution and cornified envelope formation in cluster 1, while clusters 2 and 4 exhibited enhanced complement activation, fibrin formation, plasma lipoprotein assembly, and insulin-like growth factor (IGF) transport regulation. These findings delineate qCT-derived phenotypes and their associated underlying mechanisms of airway remodeling and airflow obstruction in severe asthma.

Background:The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 report revised the combined chronic obstructive pulmonary disease (COPD) assessment. Patients were classified into groups A, B, and E, and the initial inhalation therapy recommendations were revised. This study aimed to investigate the application status of initial inhalation therapy recommendations in patients with COPD and determine whether adherence to the GOLD 2023 report could achieve a better prognosis. Methods:This was a prospective cohort study. Demographic data, COPD assessment test (CAT) and modified Medical Research Council (mMRC) scores, pulmonary function, GOLD grades, GOLD groups, number of exacerbations, comorbidities, and inhalation therapy were collected. The patients were classified into adherent and non-adherent groups based on the provision of initial inhalation therapy recommendations that aligned with the GOLD A, B, and E groupings. All patients finished one year of follow-up to collect data on the number of exacerbations and mortality. Results:A total of 1654 patients were enrolled, of whom 816 (49.3%) were in the adherent group. The patients in the adherent group had higher age, CAT and mMRC scores, and number of exacerbations and hospitalisations, higher proportion of combined with lung cancer and chronic heart disease, and worse pulmonary function. Patients in the adherent group had lower future exacerbations, frequent exacerbations, and hospitalisations. The patients in groups B and E who adhered to the GOLD 2023 report had lower future exacerbations, frequent exacerbations, and hospitalisations, while no significant difference was observed in group A (P < 0.05). Conclusions:In the real world, many patients with COPD do not receive the initial inhalation therapy recommended by the GOLD 2023 report. However, adherence to the GOLD 2023 report may decrease the risk of future exacerbation. It implied that improved the dissemination and uptake of GOLD 2023 recommendations is needed in the clinical practice.