INTRODUCTION:Despite optimal pharmacological treatment, patients with COPD often experience symptoms and report physical, mental, and/or social limitations. This underlines the need for additional, non-pharmacological interventions, such as physical therapy, psychological support, nutritional counseling, and occupational therapy. In this, allied healthcare professionals (AHPs) play a vital role as they bring specialized knowledge and skills to assess and, if needed, treat different aspects of the disease. AREAS COVERED:A broad literature search was conducted to narratively summarize current evidence of allied healthcare, underline the importance of interprofessional collaboration, including the role of patients, and highlight future perspectives. EXPERT OPINION:The evidence of the important role of AHPs in the assessment and treatment of COPD is robust. Unfortunately, allied healthcare is markedly underutilized in patients with COPD. Increasing referral rates to AHPs is essential to optimize COPD management. Collaboration, including the role of the patient, is essential to ensure comprehensive and holistic care, improve outcomes, and enhance communication. In the future, AHPs will be challenged to dare to think beyond their own expertise and expand their scope.

Introduction:It has been postulated that individuals with long COVID have reduced exercise capacity, just as people living with HIV (PLWH), although having even lower exercise capacity. The extent to which long COVID in PLWH resembles long COVID in individuals who presented different COVID-19 phenotypes is unknown, so we aimed to determine if the long COVID profile in PLWH resembled the symptoms experienced by individuals with long COVID following mild/moderate or severe acute COVID-19, 2 years after the initial disease. Material and methods:A pulmonary function test and a 6-min walk test (6MWT) were performed on adult individuals with PACS (Post-Acute COVID Syndrome) in 3 groups: COVID-19+PLWH (plwHCOV), mild/moderate COVID-19 (mmCOV); severe COVID-19 (seCOV). Results:Sixty three individuals were included: plwHCOV (n = 12), mmCOV (n = 33) and seCOV (n = 18). Across all groups, males were predominant. BMI was 25 ± 3, 28 ± 4, and 32 ± 7 kg/m2 in plwHCOV, mmCOV, and seCOV, respectively (p = 0.003). The plwHCOV walked 545 m (±93) at the 6MWT, which was comparable to the mmCOV group (555 m ± 63) but significantly higher than the seCOV group (435 m ± 84) (p < 0.0001). The plwHCOV group had worse forced expiratory volume in 1st second (FEV1%, 80 ± 12) (p < 0.0001), forced vital capacity (FVC%, 83 ± 11) (p = 0.002) and FEV1/FVC (0.80 ± 0.1, p = 0.004) when compared to the seCOV group. Interestingly, PLWH had comparable 6MWT, FEV1, FVC, and FEV1/FVC results as mmCOV. Conclusion:Our results indicate that even 2 years post-COVID-19 infection, PLWH exhibits significantly decreased spirometry compared to the seCOV group. Despite this lung function impairment, their functional capacity was similar to individuals with PACS following mild/moderate COVID-19.

Voice signals originating from the respiratory tract are utilized as valuable acoustic biomarkers for the diagnosis and assessment of respiratory diseases. Among the employed acoustic features, Mel Frequency Cepstral Coefficients (MFCC) are widely used for automatic analysis, with MFCC extraction commonly relying on default parameters. However, no comprehensive study has systematically investigated the impact of MFCC extraction parameters on respiratory disease diagnosis. In this study, we address this gap by examining the effects of key parameters, namely the number of coefficients, frame length, and hop length between frames, on respiratory condition examination. Our investigation uses four datasets: the Cambridge COVID-19 Sound database, the Coswara dataset, the Saarbr & uuml;cken Voice Disorders (SVD) database, and a TACTICAS dataset. The Support Vector Machine (SVM) is employed as the classifier, given its widespread adoption and efficacy. Our findings indicate that the accuracy of MFCC decreases as hop length increases, and the optimal number of coefficients is observed to be approximately 30. The performance of MFCC varies with frame length across the datasets: for the COVID19 datasets (Cambridge COVID-19 Sound database and Coswara dataset), performance declines with longer frame lengths, while for the SVD dataset, performance improves with increasing frame length (from 50 ms to 500 ms). Furthermore, we investigate the optimized combination of these parameters and observe substantial enhancements in accuracy. Compared to the worst combination, the SVM model achieves an accuracy of 81.1%, 80.6%, and 71.7%, with improvements of 19.6%, 16.10%, and 14.90% for the Cambridge COVID-19 Sound database, the Coswara dataset, and the SVD dataset respectively. To validate the generalization of these findings, we employ the Long Short-Term Memory (LSTM) model as a validation model. Remarkably, the LSTM model also demonstrates improved accuracy of 14.12%, 10.10%, and 6.68% across the datasets when utilizing the optimal combination of parameters. The optimal parameters are validated using an external voice pathology dataset (TACTICAS dataset). The results demonstrate the generalization capabilities of the optimized parameters across various pathologies, machine-learning models, and languages.

Background:Bronchodilator responsiveness testing is mainly used for diagnosing asthma. We aimed to investigate whether it is associated with progression to chronic airflow obstruction over time. Methods:The multinational Burden of Obstructive Lung Disease cohort study surveyed adults, aged 40 years and above, at baseline and followed them up after a mean of 9.1 years. Recruitment took place between January 2, 2003 and December 26, 2016. Follow-up measurements were collected between January 29, 2019 and October 24, 2021. On both occasions, study participants provided information on respiratory symptoms, health status and several environmental and lifestyle exposures. They also underwent pre- and post-bronchodilator spirometry. We defined bronchodilator responsiveness at baseline using the American Thoracic Society and European Respiratory Society (ATS/ERS) 2022 definition, and the presence of chronic airflow obstruction at follow-up as a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) less than the lower limit of normal. We used multi-level regression models to estimate the association between baseline bronchodilator responsiveness and incident chronic airflow obstruction. We stratified analyses by gender and performed a sensitivity analysis in never smokers. Findings:We analysed data from 3701 adults with 56% being women. Compared to those without bronchodilator responsiveness at baseline, those with bronchodilator responsiveness had 36% increased risk of developing chronic airflow obstruction (RR: 1.36, 95%CI 1.04, 1.80). This effect was stronger in women (RR: 1.45, 95%CI 1.09, 1.91) than men (RR: 1.07, 95%CI 0.51, 2.24). Never smokers with bronchodilator responsiveness also were at greater risk of incident chronic airflow obstruction (RR: 1.48, 95%CI 1.01, 2.20). Interpretation:Bronchodilator responsiveness appears to be a risk factor for incident chronic airflow obstruction. It is important that future studies in other large population-based cohorts replicate these findings. Funding:National Heart and Lung Institute, UK Medical Research Council, and Wellcome Trust.

Asthma exacerbations remain life-threatening events despite advancements in biologic therapies. This case series reports on four patients with near-fatal eosinophilic asthma exacerbations who had been admitted to intensive care and were treated with benralizumab as a last resort after failing maximal standard therapies. All patients exhibited marked blood or airway eosinophilia and required intensive care ventilatory support. Following the administration of benralizumab, significant clinical improvements were observed. This series highlights the potential role of benralizumab in treating life-threatening asthma exacerbations driven by eosinophilic airway inflammation and underlines the need for phenotyping and timely intervention in managing such patients with near-fatal asthma while also stressing the need for continued adherence to asthma guidelines to prevent these extreme situations.

BackgroundDyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function.MethodsDyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as >= 2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis.ResultsThe prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC

Background and Objective:Exacerbations negatively impact quality of life of people living with chronic obstructive pulmonary disease (COPD) and can accelerate disease progression. Studies suggest that patients find it difficult to recognize exacerbations and, therefore, under-report exacerbations. We aimed to understand how people living with COPD perceive and communicate their experiences of exacerbations. Methods:A cross-sectional survey including one open-ended question was developed using a targeted literature review, with input from patients and clinicians. People diagnosed with COPD were recruited from online consumer research panels in Brazil, China, France, Spain, UK, and USA and completed the survey. Responses were described overall and in specific subgroups; thematic analysis was used for the open-ended question. Results:Of 857 respondents (median age 58 years; 50.5% male), 623 (72.7%) reported daily shortness of breath; 417 (48.7%) that daily symptoms changed "a little". In the open-ended question, exacerbations were described through a narrative lens detailing subjective experiences of symptoms, their management, potential causes, and emotions felt during exacerbations, with no single preferred term. In the 671 (78.3%) respondents who reported ever having an exacerbation, these were identified as symptoms being "worse than usual" (52.8%) or because respondents had "more trouble than usual with daily activities" (50.1%). Conclusion:While people living with COPD report confidence in their ability to identify exacerbations, there is a disconnect between their experience of exacerbations and the language and definitions used in clinical practice. A discussion guide emphasizing the use of plain language could improve communication between healthcare providers and patients.

BACKGROUND AND OBJECTIVE:Deteriorations in respiratory health, also known as exacerbations, are important events in the progression of chronic respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD) and asthma. Changes in vocal characteristics during episodes of respiratory distress suggest that voice analysis could be a valuable tool for monitoring exacerbations. This study aims to develop a remote monitoring method for automatically detecting exacerbations in COPD and asthma patients using only speech data. METHODS:This study proposes a speech-based approach for remote monitoring of asthma and COPD exacerbations, leveraging optimized Mel-Frequency Cepstral Coefficients (MFCC) alongside multi-domain acoustic features. We demonstrate that the optimized MFCC outperforms state-of-the-art feature extraction techniques, while integrating complementary features from the time, frequency, energy, and spectral domains further enhances predictive accuracy. To ensure model transparency and facilitate clinical adoption, we employ SHapley Additive exPlanations (SHAP) to identify key speech biomarkers contributing to exacerbation detection. RESULTS:Compared with the state-of-the-art methods, our method exhibits excellent classification performance with an accuracy of 0.892 and an AUC of 0.955 on the TACTICAS dataset. Moreover, the most salient features ranked by SHAP values are MFCC-related features and energy features, which explains the reason behind the improvement observed with feature fusion. CONCLUSIONS:Comprehensive experiments and comparisons with existing algorithms highlight the potential of speech-based monitoring for respiratory conditions in real-world settings. The proposed method outperforms state-of-the-art approaches, offering a promising avenue for exacerbation diagnosis and monitoring while potentially reducing the burden on both patients and healthcare providers.

INTRODUCTION:Evidence of an association between breathlessness and quality of life from population-based studies is limited. We aimed to investigate the association of both physical and mental quality of life with breathlessness across several low-, middle- and high-income countries. METHODS:We analysed data from 19 714 adults (31 sites, 25 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We measured both mental and physical quality of life components using the SF-12 questionnaire, and defined breathlessness as grade ≥2 on the modified Medical Research Council scale. We used multivariable linear regression to assess the association of each quality-of-life component with breathlessness. We pooled site-specific estimates using random-effects meta-analysis. RESULTS:Both physical and mental component scores were lower in participants with breathlessness compared to those without. This association was stronger for the physical component (coefficient = -7.59; 95%CI -8.60, -6.58; I2 = 78.5%) than for the mental component (coefficient = -3.50; 95%CI -4.36, -2.63; I2 = 71.4%). The association between physical component and breathlessness was stronger in high-income countries (coefficient = -8.82; 95%CI -10.15, -7.50). Heterogeneity across sites was partly explained by sex and tobacco smoking. CONCLUSION:Quality of life is worse in people with breathlessness, but this association varies widely across the world.

Background:Chronic cough (CC) can impact daily life and persist for years. Its prevalence varies globally, but whether quality of life in CC also varies across regions is unknown. This study investigates the association of CC with mental and physical component scores of the 12-item Short Form Health Survey reflecting health-related quality of life in a multinational study. Methods:We analysed data from 19 642 adults (≥40 years), recruited between 2 January 2003 and 26 December 2016 in 31 sites (25 countries) from the Burden of Obstructive Lung Disease study, who provided information on quality of life and CC. We assessed associations using linear regression, adjusted for confounders, and used random-effects meta-analysis to examine differences by sex and gross national income. Findings:Overall, lower mental (-1.42, 95% CI -2.11 to -0.73; I2=32.7%) and physical (-2.59, 95% CI -3.22 to -1.96; I2=40.1%) health scores were associated with CC. The association between physical health score and CC did not materially differ between sexes or gross national income. In males, physical health seems to be more affected by CC amongst those living in low- and middle-income countries (LMICs). In females, mental health also seems to be more affected by CC amongst those living in LMICs. Interpretation:CC impairs health-related quality of life globally. However, it appears that physical health in males and mental health in females living in LMICs may be particularly affected by CC. These findings support the need to consider CC as a target for specific interventions to attenuate its burden on health and the economy.

INTRODUCTION:Real-world evidence of asthma management in primary care is limited but of paramount importance for improving care quality. This study described the trends of initial pharmacological treatments prescribed by Dutch general practitioners (GPs) from 2010 to 2021. METHODS:This was a repeated cross-sectional study of adults with asthma using the PHARMO data network. Initial treatments were defined based on the first prescription within 90 days of diagnosis. Trends were analysed using joinpoint regression and compared across age groups and between sexes. RESULTS:95,523 adults with asthma were included (39.9% male; median [Q1, Q3] age 45 [31, 59] years). SABA without ICS increased until 2018 from 17.0% to 29.5% and then decreased to 26.1% by 2021. In contrast, ICS-LABA decreased from 25.1% to 22.1% until 2018, increasing subsequently to 30.6% in 2021. ICS without LABA remained unchanged until 2013. Between 2013 and 2019, it increased from 13.8% to 15.8%, followed by a decline to 11.2%. Triple therapy was consistently around 1%. Patients without prescriptions for asthma decreased over the study period (34.2%-25%). SABA without ICS was more prescribed to young adults than middle-aged adults and the elderly, whereas the opposite was found for ICS-LABA and ICS-LABA-LAMA in both sexes (all adjusted-p<0.05). CONCLUSION:The observed changes in initial treatment of asthma in Dutch primary care seem to reflect the updating of recommendations, however, many patients were on SABA without ICS or did not receive a prescription from their GP, emphasising the need for strategies to improve asthma care. Age-related differences warrant further investigation.

Low body mass index (BMI) is a common feature of severe chronic obstructive pulmonary disease (COPD) but in the general population, cigarette smoking is also associated with low body weight. Many people with COPD remain smokers after diagnosis, and it is unclear whether low BMI is because of the disease itself or its most common risk factor. We aim to assess the independent and combined effects of smoking and COPD on BMI trajectories. 27,651 patients without COPD and 25,990 with COPD from The Health Improvement Network (2005-2019) were grouped into: never-smokers, former smokers, sustained quitters, intermittent smokers, and continuous smokers (ten total COPD-smoking status groups). BMI trajectories over 10-year time horizon were modeled by these status groups using multivariable mixed-effect models adjusted for age (in continuous years), sex, Townsend score (a measure of material deprivation), alcohol consumption (yes/no), exacerbation history (yes/no, only for COPD patients) and any history of asthma, cancer, chronic kidney disease, diabetes, or cardiovascular disease (yes/no). Individuals with COPD who smoked at baseline (intermittent, sustained quitter, or continuous smokers) had a lower initial BMI (27.1 kg/m² [26.9-27.3]; 26.6 [26.4-26.9]; 26.2 [26.0-26.4], respectively) than non-COPD controls in the same smoking categories (28.0 [26.6-28.2]; 27.6 [27.2-27.9]; 26.7 [26.4-26.9]). Current smokers had lower initial BMIs than never and former smokers, regardless of COPD status. In individuals with COPD, compared to former smokers, continuous smokers lost weight faster (-0.071 kg/m²/year [-0.097 to -0.045]; p < 0.001), while quitters gained weight (0.266 [0.233 to 0.298]; p < 0.001). Non-COPD controls showed similar but less pronounced patterns when continuous smokers and quitters (-0.059 [-0.090 to -0.028] and 0.213 [0.173 to 0.254], respectively; both p < 0.001) were compared to former smokers. Those with a baseline BMI of < 30 also showed a decrease in longitudinal BMI, especially among COPD patients. COPD patients had lower baseline BMI than controls, but BMI trajectories were similar between groups, with continuous smokers losing weight faster and quitters gaining weight. These findings suggest that smoking behaviour significantly influences weight loss in COPD, emphasizing its importance in clinical evaluations and nutritional support consultations.