BackgroundChronic obstructive pulmonary disease (COPD) is a highly prevalent disease worldwide, with smoking identified as the main risk factor. Emerging evidence suggests that tea consumption may confer protective effects on lung health. However, it remains unclear whether tea consumption can mitigate the adverse effects of smoking on COPD risk. This study aimed to investigate the association between tea consumption and COPD risk, and to examine whether this association differs by smoking status.MethodsThe Predictive Value of Inflammatory Biomarkers and Forced Expiratory Volume in 1 s (PIFCOPD) study is a multicenter prospective cohort (2018–2021) involving 7,252 participants (6,855 with normal lung function; 397 with COPD). Data on demographic characteristics, smoking status, and tea consumption were collected. Logistic regression analysis was used to assess the association between tea consumption and COPD risk. Interaction and stratified analyses based on smoking status were performed.ResultsThe proportion of tea consumption was 20.9% in the normal lung function group and 24.4% in the COPD group, with no significant difference. Tea consumption was not associated with COPD risk in the general population. However, interaction and stratified analysis based on smoking status showed that fully fermented tea consumption was associated with a protective effect against COPD in smokers (OR 0.21), especially when consumed ≥ 7 times per week and for ≥ 10 years. In contrast, jasmine tea emerged as a potential risk factor (OR 1.99), especially when consumed for ≥ 10 years.ConclusionIn the general population, the effect of tea consumption on the prevalence risk of COPD is significant only in smokers, and this effect is modulated by the type, frequency and duration of tea consumption.

Rationale:Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory diseases. Early detection and treatment are critical to prevent the deterioration of COPD. In this study, we aim to establishment and evaluation an algorithm that can detect COPD from physiological parameters and audio data which are collected by a wearable device.Methods: Participants were instructed to use HUAWEI smart wearable devices to collect physiological data, including oxygen saturation, heart rate, respiratory rate, and cough sounds. The collected data served as measurement inputs. To evaluate the accuracy of the HUAWEI smart wearable device and its associated algorithms for lung function assessment and COPD screening, a comparative analysis was conducted. This analysis used the results of medical spirometers and the diagnoses of hospital respiratory specialists as the gold standard for assessing lung function and diagnosing COPD.Results:400 subjects (236 males,164 females; 200 with stable COPD and 200 without COPD) were recruited for algorithm development, among COPD patients, age distribution was≤50 years(30), 51-65years(73), and > 65years(97), with GOLD stages 1(58), 2(102), and 3+4(40). A further 400 subjects (240 males, 160 females;200 with COPD and 200 without COPD) were recruited for testing the algorithm.The overall mean age was 57.8 years, mean BMI was 24.7kg/m2, and mean FEV1/FVC ratio was 0.69.Pulmonary Function results showed an MAE of 6.6% for FEV1/FVC and 10.0% for FVC.COPD screening achieved 80.8% accuracy,80.0% sensitivity and 81.5% specificity.Conclusions:The test results based on Huawei's smart wearable device and its accompanying lung function assessment and COPD screening algorithms are highly consistent with the diagnostic results of medical spirometers and professional doctors, and are effective for lung function assessment and COPD screening.

RATIONALE The role of inflammation in developing Chronic obstructive pulmonary disease (COPD) and lung function decline remains unclear. It is still uncertain which biomarkers have predictive value for COPD and rapid lung function decline. METHODS The Predictive Value of Inflammatory Biomarkers and FEV1 for COPD (PIFCOPD) enrolled 10385 middle-aged and elderly population in ten regions of China from 2018 to 2021. 9951 non-COPD participants performed peripheral blood tests, lung function tests and questionnaire surveys at baseline. 3746 participants were followed up in the first year and 2152 were followed up in the third year. New-onset COPD is defined as forced expiratory volume in the first second (FEV1)/ forced expiratory volume in 6 seconds (FEV6) ≥ 0.7 at baseline and FEV1/FEV6 < 0.7 in follow-up. Rapid lung function decline is defined as a decline in FEV1 of more than 60ml per year. Multivariate logistic regression models were used to examine associations of inflammatory biomarkers and new-onset COPD and rapid lung function decline. RESULTS There were 60 new-onset COPD in the first year and 177 in the third year, with an average annual incidence of 3.05%. Rapid lung function decline (OR: 5.00 95% CI [7.73, 11.94]) and eosinophil count >0.15×109/L (OR 1.13, 95%CI [0.81, 1.56]) are risk factors for new-onset COPD, tea drinking (0.61 [0.39, 0.93]) is a protective factor after adjusting for sex, age, education level and smoking status. Eosinophil count > 0.15×109/L (1.49 [1.22, 1.81]) and hs-CRP >3mg/L (1.31 [1.03, 1.72]) are risk factors for rapid lung function decline, after adjusting for sex, age, education level, body mass index (BMI), cumulative smoking exposure, biomass exposure, household cooking, blood glucose, tea drinking and alcohol drinking. CONCLUSION Rapid lung function decline is the risk factor for new-onset COPD. Hs-CRP > 3mg/L and eosinophils > 0.15×109/L are risk factors for rapid lung function decline.

Objective:The purpose of this study is to explore the value of cough sounds and forced exhalation sounds monitored by smartwatches with audio collection capabilities for screening obstructive sleep apnea (OSA) in patients with chronic obstructive pulmonary disease (COPD). Methods:Stable COPD patients were recruited from an outpatient clinic. All participants completed questionnaires and underwent pulmonary function testing and overnight polysomnography (PSG). A novel smartwatch capable of collecting audio signals was worn to continuously monitor peripheral oxygen saturation (SpO₂), heart rate (HR), heart rate variability (HRV), and respiratory rate (RR). Additionally, voluntary cough and forced exhalation sounds were recorded twice daily. Audio data were denoised, segmented, and analyzed using time- and frequency-domain features. Correlations between audio features and OSA diagnosis/severity were assessed and a predicting model were developed based on these data. Results:Among the 29 participants with stable COPD, 26 underwent PSG, and 17 were diagnosed with comorbid OSA. Multiple cough and forced exhalation subfeatures correlated significantly with OSA diagnosis and apnea and hypopnea index (AHI). Cough sounds showed the highest correlation with OSA diagnosis (r = -0.6629, p < 0.001). A logistic regression model using a cough sound subfeature (the median of MFCC_35) achieved 92% accuracy with a Cohen's kappa value of 0.8276 in predicting OSA in COPD patients. Conclusion:This study demonstrates a strong association between cough sounds and OSA risk in COPD patients. Cough sounds recorded by smartwatches may serve as a valuable tool for screening OSA in COPD patients, contributing to the management of patients with overlap syndrome.

BACKGROUND:Airway fistula represents a complex clinical condition where the optimal bronchoscopic management remains controversial. This study aims to evaluate clinical characteristics, bronchoscopic treatment efficacy, and prognostic factors. METHODS:This retrospective study analysed 45 patients with fistulas who underwent a total of 56 bronchoscopic intervention sessions over the past seven years. The fistulas were categorized and analysed based on their size, clinical features and treatment efficacy, with prognostic factors for healing being evaluated. In parallel, a bioinformatic analysis was initiated with 2075 genes sourced from GeneCards. Following filtration, the top 20 hub genes were identified and subsequently subjected to pathway enrichment analysis to elucidate the underlying mechanisms. RESULTS:Compared to the non-remission group, the remission group exhibited significantly smaller fistula diameters, higher lymphocyte counts, and lower high-sensitivity C-reactive protein (hsCRP) levels. Prognostic analysis revealed that fistula size and hsCRP level were independent predictors. Small fistulas (≤5 mm) cases solely underwent blocking agent intervention had a significantly higher remission rate. While the others (>5 mm) were mostly managed with stents, endobronchial valves, and cardiac occluders. Bioinformatic analysis of public data identified significant enrichment in the PI3K-AKT signaling pathway and cytokine-cytokine receptor interaction pathway, pinpointing six core genes, including CXCL8, IL1B, IL6, TNF, TGFB1, and IL13. CONCLUSIONS:Prioritize bronchoscopic treatment with inflammation control for small fistulas; recommend combined therapies for large fistulas.The PI3K-AKT and cytokine pathways may be involved in healing and represent potential targets for future drug development.

Case Presentation A 55-year-old woman presented to the emergency department with fever, cough, and progressive dyspnea for 3 days. Chest CT scan showed diffuse pulmonary lesions, and arterial blood gas analysis showed a Pao2 of 56 mm Hg on room air. Consequently, she was transferred to the respiratory ICU because of rapidly progressing respiratory failure. Her medical history indicated a 20-year history of psoriasis. She initiated treatment with ixekizumab (an interleukin-17 inhibitor) 3 months ago. A chest radiograph before ixekizumab treatment showed no abnormalities. After administration of ixekizumab therapy, her skin lesions demonstrated significant improvement. She denied any history of tobacco use or chronic lung disease.

Background Intelligent wearable devices have potential for chronic obstructive pulmonary disease (COPD) monitoring, but the effectiveness of combining cough and blowing sounds for disease assessment is unclear. Objective The objective was to assess COPD severity via physiological parameters and audio data collected by a smartwatch. Methods COPD patients underwent lung function tests, electrocardiograms, blood gas analysis, and 6-min walk tests. The patients’ peripheral arterial oxygen saturation (SpO 2 ), heart rate variability (HRV), heart rate (HR), and respiratory rate (RR) were continuously monitored via a smartwatch for 7–14 days, and voluntary cough and forceful blowing sounds were recorded twice daily. The HR, SpO 2 , and RR were categorized into all-day, sleep, and wake periods and summarized using the mean, standard deviation, median, 25th percentile, 75th percentile and percent variation. The correlations among lung function, physiological parameters, and audio data were analyzed to develop a model for predicting COPD severity. Results Twenty-nine stable patients, with a mean age of 67.0 ± 5.8 years, were enrolled, and 89.7% were male. HR, HRV, RR, cough sounds, and blowing sounds were significantly correlated with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade, with cough sounds showing the highest correlation (r = 0.7617, p < .001). Cough sounds also had the strongest correlation with the mean 6-minute walking distance (r = 0.6847, p < .001), whereas blowing sounds had the strongest correlation with the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity index (r = −0.6749, p < .001). A logistic regression model using the RR and blowing sounds as key predictors achieved accuracies of 0.77–0.89 in determining the GOLD grade, with a Cohen's kappa coefficient of 0.6757. Conclusions Audio data were more strongly correlated with lung function in COPD patients than were physiological parameters. A smartwatch with audio collection capabilities effectively assessed COPD severity. Trial Registration ClinicalTrials.gov NCT05551169

Background No studies have investigated whether high-sensitivity C reactive protein (hsCRP) can be used to predict the forced expiratory volume in 1 s (FEV1)/estimated value of FEV1 (FEV1%pred). This study aimed to assess the association between hsCRP and FEV1%pred in middle-aged and elderly individuals without underlying lung disease.Methods The data for this study were obtained from a prospective cohort study that included 1047 middle-aged and elderly citizens from Beijing aged 40–75 years without any evidence of underlying lung diseases with FEV1 >70% after receiving inhalational bronchodilators. The baseline analysis of the participants was performed from 30 May 2018 to 31 October 2018. Restricted cubic spline regression and multivariate linear regression models were used to assess the non-linear association and linear association between hsCRP and FEV1/FEV in 6 s (FEV6) and FEV1%pred, respectively.Results The hsCRP values of 851 participants were recorded; the values were normal in 713 (83.8%) participants. The remaining 196 participants (18.7%) had missing data. A non-linear association was observed between normal hsCRP values and FEV1/FEV6. hsCRP was linearly and negatively correlated with FEV1%pred, and each 1 SD increase in hsCRP was significantly associated with a 2.4% lower in FEV1%pred. Significantly higher FEV1/FEV6 differences were observed in the female subgroup than those in the male subgroup (p=0.011 for interaction).Conclusions hsCRP had a non-linear association with FEV1/FEV6 and a linear negative association with FEV1%pred in individuals with normal hsCRP values. hsCRP can be used to predict FEV1%pred, which can be used to predict the development of chronic obstructive pulmonary disease. hsCRP has a stronger association with lung function in women than that in men.Trial registration number NCT03532893.

Background Consumer wearable devices such as wristbands and smartwatches have potential application value in communicable disease surveillance. Objective We investigated the ability of wearable devices to monitor COVID-19 patients of varying severity. Methods COVID-19 patients with mobile phones supporting wearable device applications were selected from Dalian Sixth People Hospital. Physiological parameters from the wearable devices and electronic questionnaires were collected from the device wearing until 14 days post-discharge. Clinical information during hospitalization was also recorded. Based on imaging data, the patients were categorized into the milder group without pneumonia and the more severe group with pneumonia. We plotted the curves of the physiological parameters of the two groups to compare the differences and changes. Results Ninety-eight patients were included in the analysis. The mean age was 39.6 ± 10.5 years, including 45 males (45.9%). There were 24 asymptomatic patients, 10 mild patients, 60 moderate patients, and 4 severe patients. Compared with the milder group, the more severe group had higher heart rate-related parameters, while the heart rate variability (HRV) was the opposite. In the more severe group, the heart rate-related parameters showed a downward trend from 0 to 7 days after the fever resolution. Among them, the resting heart rate and sleep heart rate decreased on the 25th day after the onset and were close to the milder group 1 week after discharge. Conclusions Consumer wearable devices have the potential to monitor respiratory infections. Heart rate-related parameters obtained from these devices can be sensitive indicators of COVID-19 severity and correlate with disease evolution. Trial registration ClinicalTrials.gov NCT04459637.

OBJECTIVES:Morning dry mouth, commonly seen in Obstructive Sleep Apnea (OSA) patients, is absent in current OSA screening tools. This study evaluated the link between morning dry mouth and OSA's clinical symptoms and complications, aiming to determine its viability as a screening indicator. METHODS:This research analyses baseline data from a prospective cohort study (the PIFCOPD study). Demographic information, medical history, and the presence of morning dry mouth symptoms were collected. The STOP-Bang questionnaire was performed for OSA screening. Logistic regression analyses were employed to establish the correlations between morning dry mouth and the clinical symptoms and comorbidities of OSA. RESULT:1291 participants (62.1±7.5 years; 501 males, 790 females) were included, of which 416 reported morning dry mouth (32.2%). 42.6% in the high-risk OSA group and 22.1% in the low-risk group reported morning dry mouth. Individuals with morning dry mouth also showed higher STOP-Bang scores (3.3±1.6 vs. 2.3±1.4, P<0.01). Significant associations were found between morning dry mouth and loud snoring, observed sleep apnea, daytime fatigue, and hyperlipidemia (P<0.01), but not with alcohol consumption, tea consumption, diabetes, or hypertension. CONCLUSION:Morning dry mouth is associated with increased OSA risk and its clinical signs, suggesting its potential as an OSA screening symptom. CLINICAL TRIAL REGISTRATION:This study has been registered at www.ClinicalTrials.gov (registration identifier: NCT03532893) on 21 May 2018.

Abstract Background The associations between short- and long-term exposure to ambient fine particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5) and allergic symptoms in middle-aged and elderly populations remain unclear, particularly in China, where most cities have severe air pollution. Methods Participants (n = 10,142; age = 40–75 years) were recruited from ten regions in China from 2018 to 2021 for the Predictive Value of Inflammatory Biomarkers and Forced Expiratory Volume in 1 s (FEV1) for Chronic Obstructive Pulmonary Disease (PIFCOPD) study. Short-term (lag0 and lag0–7 day) and long-term (1-, 3- and 5-year) PM2.5 concentrations at residences were extracted from the air pollutant database known as Tracking Air Pollution (TAP) in China. Multivariate logistic regression models were used to estimate associations for short- and long-term PM2.5 exposure concentrations and long-term exposure models were additionally adjusted for short-term deviations. Results A 10 µg/m3 increase in PM2.5 on the day the allergic symptoms questionnaire was administered (lag0 day) was associated with higher odds of allergic nasal (1.09, 95% CI 1.05, 1.12) and eye symptoms (1.08, 95% CI 1.05, 1.11), worsening dyspnea caused by allergens (1.06, 95% CI 1.02, 1.10), and ≥ 2 allergic symptoms (1.07, 95% CI 1.03, 1.11), which was similar in the lag0–7 day concentrations. A 10 µg/m3 increase in the 1-year average PM2.5 concentration was associated with an increase of 23% for allergic nasal symptoms, 22% for eye symptoms, 20% for worsening dyspnea caused by allergens, and 21% for ≥ 2 allergic symptoms, similar to the 3- and 5-year average PM2.5 concentrations. These associations between long-term PM2.5 concentration and allergic symptoms were generally unchanged after adjustment for short-term deviations. Conclusions Short- and long-term exposure to ambient PM2.5 was associated with an increased risk of allergic nasal and eye symptoms, worsening dyspnea caused by allergens, and ≥ 2 allergic symptoms. Trial registration Clinical trial ID: NCT03532893 (29 Mar 2018).

Abstract Objective This study investigated the association between obstructive sleep apnea (OSA) and preserved ratio impaired spirometry (PRISm) in a community population. Methods Baseline data from a prospective cohort study, the Predictive Value of Combining Inflammatory Biomarkers and Rapid Decline of FEV1 for COPD (PIFCOPD), were used for cross-sectional analysis. Participants aged 40–75 years were recruited from the community and their demographic information and medical history were collected. The STOP-Bang questionnaire (SBQ) was used to assess the risk of OSA. Pulmonary function tests were performed using a portable spirometer (COPD-6) and forced expiratory volume in 1 s (FEV1) and 6 s (FEV6) were measured. Routine blood, biochemical, high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 tests were also performed. The pH of the exhaled breath condensate was determined. Results A total of 1183 participants were enrolled, of which 221 with PRISm and 962 with normal lung function. The neck circumference, waist-to-hip ratio, hs-CRP concentration, proportion of males, cigarette exposure, number of current smoker, high risk of OSA, and prevalence of nasal and ocular allergy symptoms were significantly higher in the PRISm group than in the non-PRISm group (p < .05). Logistic regression showed that the risk of OSA (odds ratio, 1.883; 95% confidence interval, 1.245–2.848), waist-to-hip ratio, current smoking, and prevalence of nasal allergy symptoms were independently associated with PRISm after correcting for age and sex. Conclusion These findings showed that OSA prevalence is independently associated with PRISm prevalence. Further studies should confirm the relationship between systemic inflammation in OSA, localized inflammation of the airways, and impaired lung function.

Pigeon paramyxovirus 1 (PPMV-1) is an antigenic host variant of avian paramyxovirus 1. Sporadic outbreaks of PPMV-1 infection have occurred in pigeons in China; however, few cases of human PPMV-1 infection have been reported. The purpose of this article is to report a case of severe human PPMV-1 infection in an individual with probable post-COVID-19 syndrome (long COVID) who presented with rapidly progressing pulmonary infection. The patient was a 66-year-old man who was admitted to the intensive care unit 11 days after onset of pneumonia and recovered 64 days after onset. PPMV-1 was isolated from the patient's sputum and in cloacal smear samples from domesticated pigeons belonging to the patient's neighbour. Residual severe acute respiratory syndrome coronavirus 2 was detected in respiratory and anal swab samples from the patient. Sequencing analyses revealed that the PPMV-1 genome belonged to genotype VI.2.1.1.2.2 and had the 112RRQKRF117 motif in the cleavage site of the fusion protein, which is indicative of high virulence. This case of cross-species transmission of PPMV-1 from a pigeon to a human highlights the risk of severe PPMV-1 infection in immunocompromised patients, especially those with long COVID. Enhanced surveillance for increased risk of severe viral infection is warranted in this population.

OBJECTIVE:To study epidemiological characteristics and hospitalization costs of female inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing.METHODS:A retrospective study was conducted to analyze electronic hospitalization summary reports of female inpatients with AECOPD in Beijing from 2013 to 2020. Clinical characteristics (age distribution and comorbidities), epidemiological characteristics (temporal and spatial distribution characteristics), hospi-talization times and costs of patients were described.RESULTS:A total of 57 911 subjects in 166 hospitals were included in this study, with a mean age of (78.84±8.59) years and the highest number of patients aged 80-89 years (49.06%), followed by patients aged 70-79 years (31.08%), and the lowest number of patients under 50 years (0.41%). The proportions of patients with coronary heart disease, hypertension and heart failure were 30.60%, 30.52% and 26.54% respectively. The median number of daily hospitalizations during the study period was 18 (IQR: 16). The number of daily hospitalizations for AECOPD showed an overall growth trend over the eight years from 2013 to 2020, starting to increase significantly in 2015 and continuing to increase until 2019, then followed by a decline in 2020. The proportion of inpatient admissions was higher in winter and spring (54.09%) than that in summer and autumn (45.91%). The top three districts in terms of the proportion of total inpatient admissions were Xicheng district (14.18%), Chaoyang district (14.12%) and Fengtai district (13.47%). The density of inpatients was relatively high in the western regions, central urban areas and northeastern regions of the city, while the density of inpatients was relatively low in the near suburbs. The median number of hospital days for female patients with AECOPD was 12 days, and the median hospital costs was CNY 20 648.37. Patients from urban areas had longer hospitalization times and higher hospitalization costs than those from suburban areas (P < 0.001). Western medicine expenses accounted for the largest proportion of total hospital expenses (33.32%). During the study period, hospitalization costs exhibited an overall pattern of initial growth, followed by subsequent decline, eventually stabilizing. The differences in hospitalization costs among the patients with different comorbidities were significant.CONCLUSION:Female hospitalized patients with AECOPD in Beijing were older than 70 years, often complicated by cardiovascular disease. AECOPD occurred mainly in winter and spring, with regional differences. The hospitalization costs were closely associated with the patients' age, comorbidities, and the geographicical region.