International Journal of Chronic Obstructive Pulmonary Disease最新文献

{"title":"Inflammation-Mediated Causal Effects of MRI-Defined Body-Composition Obesity Axes on Chronic Obstructive Pulmonary Disease, Asthma, and Allergic Rhinitis: A Mendelian Randomization Study.","authors":"Bo Zeng, Chaoqun Zhou, Li Li, Yongbo Zhu","doi":"10.2147/COPD.S635367","DOIUrl":"https://doi.org/10.2147/COPD.S635367","url":null,"abstract":"<p><strong>Background: </strong>Obesity is heterogeneous; conventional anthropometric measures combine fat distribution, ectopic fat deposition, and muscle volume, limiting refined causal inference for chronic airway diseases. We used four magnetic resonance imaging (MRI)-defined obesity axes to assess their causal effects on chronic obstructive pulmonary disease (COPD), asthma, and allergic rhinitis (AR), and to evaluate mediation by circulating inflammatory proteins.</p><p><strong>Methods: </strong>Genetic instruments were selected for four MRI-defined obesity axes. Two-sample Mendelian randomization (MR) used inverse-variance weighting as the primary method, with complementary sensitivity analyses and false discovery rate correction. Non-overlapping FinnGen outcome data were used for discovery, with replication in the Global Biobank Meta-analysis Initiative for COPD and asthma and the Million Veteran Program for AR, followed by meta-analysis. Two-step MR assessed inflammatory protein mediation.</p><p><strong>Results: </strong>Genetically predicted general obesity axis was associated with increased risks of COPD (OR = 1.125, 95% CI: 1.012-1.250), asthma (OR = 1.533, 95% CI: 1.426-1.647), and AR (OR = 1.624, 95% CI: 1.328-1.987). The lower-body fat axis was associated with higher risks of COPD (OR = 1.192, 95% CI: 1.088-1.306) and asthma (OR = 1.135, 95% CI: 1.052-1.224). No causal evidence was observed for the other obesity axes. Replication and meta-analysis largely supported these findings, except for general obesity and AR, which showed borderline pooled evidence (<i>P</i> = 0.055). Mediation analysis identified 17 candidate inflammatory pathways, of which 10 were significant. FLT3L mediated 18.17% of the effect of general obesity on COPD, and CXCL5 mediated 3.78% of its effect on asthma. CD40L receptor and LIFR mediated 5.59% and 12.65% of the lower-body fat-asthma effect, respectively, whereas CD40L receptor, CXCL10, IL-12B, OPG, and TNFRSF9 showed suppressive mediation in selected pathways.</p><p><strong>Conclusion: </strong>MRI-defined obesity axes provided genetic evidence supporting potential causal associations with airway diseases through inflammatory mediation pathways.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"635367"},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Traditional Chinese Medicine in Treating Chronic Obstructive Pulmonary Disease with Osteoporosis: A Systematic Review and Meta-Analysis.","authors":"Xulun Li, Haiqiang Wang, Huiqing Zhang, Xuebing Hu, Feng Gao, Bin Wang","doi":"10.2147/COPD.S637856","DOIUrl":"10.2147/COPD.S637856","url":null,"abstract":"<p><p>This comprehensive meta-analysis on the efficacy and safety of traditional Chinese medicine (TCM) as an adjunctive therapy to conventional treatment of chronic obstructive pulmonary disease (COPD) with osteoporosis (OP) aimed to provide evidence and guidance for clinical practice. We systematically searched four international databases and four Chinese databases to identify relevant randomized controlled trials (RCTs) published up to November 2025. Meta-analysis and sensitivity analysis were performed in R using the meta and gemtc packages. The revised Cochrane risk of bias tool (ROB2) was employed to assess the quality of included studies to ensure their rigor and clinical applicability. A total of 11 eligible studies involving 944 patients were identified. The results indicated that compared with conventional Western medical therapy (CWMT) alone, CWMT plus TCM demonstrated a certain degree of improvement in the primary outcomes, namely bone mineral density (BMD) (standardized mean difference [SMD] = 0.71, 95% confidence interval [CI]: 0.34-1.07, I² = 83.8%, P_HEW < 0.001) and forced expiratory volume in 1 second (FEV1) (SMD = 0.54, 95% CI: 0.17-0.90, I² = 76.5%, P_HEW = 0.007). Statistically significant improvements were observed in some secondary outcomes. The original studies did not adequately report adverse events. The available data only suggested short-term tolerability. According to network meta-analysis results, among the three treatment approaches, the TLKRBS (tonifying the lung and kidney and resolving blood stasis) approach had the highest probability of being ranked first for increasing BMD (surface under the cumulative ranking curve [SUCRA] = 98.82%) and FEV1 (SUCRA = 99.99%), indicating a substantial effect on improvement. The combination of CWMT and TCM may yield more favorable outcomes compared to CWMT alone for treating COPD with OP. The meta-analysis results indicate that the therapeutic efficacy of TCM combined with CWMT may be improved to a certain extent compared with CWMT alone. However, the certainty of the evidence is limited due to small sample sizes, high heterogeneity, and risks of bias. Future high-quality RCTs with rigorous designs, larger sample sizes, and standardized outcome measures are warranted to strengthen the evidence base for the application of TCM in patients with COPD and comorbid OP and to further confirm its efficacy.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"637856"},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmet Needs and New Opportunities in Chronic Obstructive Pulmonary Disease in Italy: A Narrative Review with Insights from the GULP Study.","authors":"Dejan Radovanovic, Fulvio Braido, Marco Contoli, Angelo Guido Corsico, Fabiano Di Marco, Claudio Micheletto, Girolamo Pelaia, Paola Rogliani, Nicola Scichilone, Paolo Solidoro, Pierachille Santus","doi":"10.2147/COPD.S628160","DOIUrl":"https://doi.org/10.2147/COPD.S628160","url":null,"abstract":"<p><p>The \"DescribinG bUrden of COPD and occurrence of mortaLity in a cohort of Italian Patients\" (GULP) study was conducted to investigate the potential of biological treatments for patients with severe chronic obstructive pulmonary disease (COPD). The purpose of this article was to perform a narrative review highlighting the role of type 2 inflammation in the mechanism of disease for COPD, summarizing the efficacy data of the Phase III RCTs that investigated biologics in COPD, and exploring the potential role for biological treatment in this setting with a particular focus on Italian patients with COPD. To this end, we conducted an exploratory analysis of GULP study data to identify patients at high risk of exacerbations, with high symoptom burden and classify them based upon the eosinophilic counts, to provide further insights into the potential use of biologics in this cohort. Out of the 1111 patients of the GULP cohort, we retrieved in total 286 (25.7%) GULP participants with ≥2 moderate or ≥1 severe exacerbation per year. Of them, despite maintenance therapy with dual bronchodilators or triple therapy, a high symptom burden (dyspnea, cough and chronic sputum production) was present in between 51.1 and 74.8%, while patients that presented with eosinophilic COPD accounted for the 7.2% of the patients at risk. This indicates that biological agents, specifically those that target the type 2 inflammatory response in COPD, should be considered in symptomatic patients with COPD and unstable disease, but that careful and pro-active phenotyping through clinical and biomarker evaluation is mandatory. Dupilumab is currently approved in Italy for eosinophilc exacerbating COPD patients, and through its favorable efficacy and safety profile, could represent a valid opportunity for these patients.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"628160"},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADAMTS5 May Serve as a Useful Biomarker for Chronic Obstructive Pulmonary Disease.","authors":"Qingli Yang, Yu Nie, Jinchun Wang, Xiaofei Liu, Yiqiong Wen, Jing Hou, Shu Hua, Lingyu Li, Shibo Sun","doi":"10.2147/COPD.S622230","DOIUrl":"https://doi.org/10.2147/COPD.S622230","url":null,"abstract":"<p><strong>Background: </strong>A disintegrin-like and metalloprotease with thrombospondin type I repeats 5 (ADAMTS5) is related to inflammation and regulates the extracellular matrix. This study aimed to investigate the plasma ADAMTS5 levels and the correlations between ADAMTS5 and pulmonary function parameters in patients with chronic obstructive pulmonary disease (COPD) and to test the efficiency of ADAMTS5 for COPD diagnosis.</p><p><strong>Methods: </strong>Seventy-nine patients with COPD and 36 healthy subjects were recruited. The plasma ADAMTS5 levels of all subjects were detected by ELISA. The correlations between ADAMTS5 and pulmonary function parameters were analyzed. The multiple linear regression analysis with stepwise selection was used to explore the relationship between ADAMTS5 and pulmonary function parameters. Receiver-operating characteristic (ROC) curve was used to investigate the role of ADAMTS5 in the diagnosis of COPD.</p><p><strong>Results: </strong>All patients with COPD were divided into acute exacerbation of COPD (AECOPD) group (n=45) and stable COPD (S-COPD) group (n=34). Additionally, healthy subjects were included in control group (n=36). Plasma ADAMTS5 levels in AECOPD or S-COPD groups were significantly higher than those in control group (83.49±17.10ng/mL vs 61.59±15.33ng/mL, p<0.001; 69.87±11.84ng/mL vs 61.59±15.33ng/mL, p=0.014, respectively). In addition, plasma ADAMTS5 levels in AECOPD group were significantly higher than in S-COPD group (p<0.001). Meanwhile, the ADAMTS5 was negatively correlated with FVC%, FEV1%, FEV1/FVC%, PEF%, or FEF25-75%. Importantly, the ADAMTS5 was associated with FVC% and FEV1/FVC%. In addition, the area under the ROC curve (AUC) of ADAMTS5 for the diagnosis of COPD was 0.789 and the optimal threshold was 63.22ng/mL, exhibiting the sensitivity and specificity of 83.54% and 75.00%, respectively. Moreover, the ADAMTSS5 was an independent risk factor for COPD.</p><p><strong>Conclusion: </strong>The level of plasma ADAMTS5 is increased and independently associated with FVC% and FEV1/FVC% in COPD. The ADAMTS5 exhibits moderate diagnostic accuracy in COPD. The ADAMTS5 has the potential to serve as a promising biomarker for COPD diagnosis.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"622230"},"PeriodicalIF":4.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Chronic Obstructive Pulmonary Disease and the Risks of Falls and Osteoporosis: A Cohort Study in the UK Biobank.","authors":"Pengruofeng Liu, Lusha Nie, Yinxi Tan, Hexiang Peng, Yi Zheng, Huangda Guo, Zuyao Yang, Tao Wu, Jie Huang, Mengying Wang","doi":"10.2147/COPD.S647358","DOIUrl":"https://doi.org/10.2147/COPD.S647358","url":null,"abstract":"<p><strong>Objective: </strong>To explore the associations of chronic obstructive pulmonary disease (COPD) with falls and osteoporosis, and the potential modifications of the associations.</p><p><strong>Methods: </strong>We included 47,4669 participants without prior falls or osteoporosis from the UK Biobank. COPD at baseline was defined using a combination of self-reported information and hospitalization records with ICD-9 code of 496 or ICD-10 code of J40-J44, while the fall and osteoporosis were ascertained by ICD-10 until the day (April 6th, 2021). Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of COPD with falls and osteoporosis. Additionally, subgroup and interaction analyses were performed to explore potential effect modifiers.</p><p><strong>Results: </strong>Among the included participants, 45.8% were males and the mean age was 56.4 years. A total of 22,363 (4.7%) participants had COPD. During a median follow-up of 12.1 years, 28,527 participants experienced falls and 8811 were diagnosed with osteoporosis. After adjustment for demographic characteristics, lifestyle factors, and comorbidities, COPD was associated with higher risks of falls (HR 1.51, 95% CI 1.45 to 1.58) and osteoporosis (HR 2.37, 95% CI 2.22 to 2.53). A significant interaction with sex was observed for osteoporosis (HR 2.94, 95% CI 2.54 to 3.40 in males and HR 2.25, 95% CI 2.09 to 2.42 in females, <i>P</i> for interaction<0.001). Smoking status significantly modified the association with falls, with HRs of 1.37 (95% CI 1.28 to 1.47) in never smokers, 1.54 (95% CI 1.44 to 1.64) in previous smokers, and 1.77 (95% CI 1.61 to 1.95) in current smokers (<i>P</i> for interaction<0.001).</p><p><strong>Conclusion: </strong>COPD was associated with the increased risks of falls and osteoporosis. These associations may be modified by sex and smoking status.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"647358"},"PeriodicalIF":4.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Factors Associated with One-Year Smoking Cessation Among Smokers with COPD: A Subgroup Analysis of a Multicentre Randomised Trial.","authors":"Feride Marım, Dilek Karadoğan, Tahsin Gökhan Telatar, İlknur Kaya, Siahmet Atlı, Neslihan Köse Kabil, Merve Yumrukuz Şenel, Aycan Yüksel, Burcu Yalçın, Ökkeş Gültekin, Merve Erçelik, Metin Akgün","doi":"10.2147/COPD.S616474","DOIUrl":"https://doi.org/10.2147/COPD.S616474","url":null,"abstract":"<p><strong>Background: </strong>Smoking cessation is the most effective intervention for modifying the clinical course of chronic obstructive pulmonary disease (COPD), yet many patients continue to smoke after diagnosis. We evaluated the characteristics associated with cessation at one year among smokers with COPD in a multicentre randomised cessation trial.</p><p><strong>Methods: </strong>This prespecified subgroup analysis included patients with COPD randomised to immediate referral to a smoking cessation clinic or to usual care. Smoking status one year later was determined through a structured telephone interview, and patients who had quit were contacted and their cessation was verified by exhaled carbon monoxide measurement; 48 of the 220 patients (21.8%) were lost to follow-up, leaving 172 patients for analysis. A prespecified six-variable logistic regression model was fitted; Firth penalised regression and an analysis classifying patients lost to follow-up as continuing smokers were prespecified sensitivity analyses.</p><p><strong>Results: </strong>Of 172 patients, 32 (18.6%) had quit at one year: 24 of 93 (25.8%) allocated to immediate referral versus 8 of 79 (10.1%) allocated to usual care (p = 0.010). Quitters were older and had a lower baseline FEV1 in unadjusted comparisons. In the multivariable model, usual care was associated with lower odds of cessation (OR, 0.25; 95% CI, 0.09-0.64), whereas absence of comorbidity (OR, 2.64; 95% CI, 1.06-6.60) and more than 1 exacerbation-related hospitalisation (OR, 9.32; 95% CI, 1.97-44.06) were associated with higher odds; the latter estimate rests on 10 patients and is imprecise. Baseline FEV1 and Fagerström score were not independently associated with cessation.</p><p><strong>Conclusion: </strong>Immediate referral to a cessation clinic was the factor most strongly associated with one-year abstinence, together with absence of comorbidity and, tentatively, repeated hospitalisation; greater disease severity was associated with quitting only in unadjusted comparisons. These exploratory findings support structured cessation pathways in routine COPD care.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"616474"},"PeriodicalIF":4.1,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Incidence of Cardiovascular Diseases Attributable to Chronic Obstructive Pulmonary Disease: A Modelling Study Based on GBD 2021.","authors":"Lu Xu, Xuelian Chen, Xueyun Mao, Jiaqi Chu, Ting Fang, Guozhang Xu, Siyan Zhan, Pengjun Zhang, Zhike Liu","doi":"10.2147/COPD.S636025","DOIUrl":"10.2147/COPD.S636025","url":null,"abstract":"<p><strong>Background: </strong>Population-based evidence quantifying the incidence burden of cardiovascular diseases (CVDs) attributable to chronic obstructive pulmonary disease (COPD) remains limited. This study aimed to estimate the global incidence burden of CVDs attributable to COPD.</p><p><strong>Methods: </strong>Data for individuals aged ≥45 years were obtained from the Global Burden of Disease (GBD) 2021 study. Population attributable fractions (PAFs) were calculated using Levin's formula, based on COPD prevalence from GBD 2021 and pooled relative risks derived and re-pooled from published systematic reviews and meta-analyses. The attributable incidence counts and age-standardized incidence rates (ASIRs) were derived for total CVD and four specific types: ischemic heart disease (IHD), lower extremity peripheral arterial disease (LE-PAD), atrial fibrillation and flutter (AF), and stroke. Trends from 1990 to 2021 were assessed using estimated annual percentage change (EAPC). Future burden was projected to 2050 using the Bayesian age-period-cohort models.</p><p><strong>Results: </strong>In 2021, the global ASIR of total CVD attributable to COPD was 248.93 per 100,000 (95% uncertainty interval (UI): 227.03 to 271.05). Among specific CVDs, IHD had the highest ASIR (93.44 per 100,000), followed by LE-PAD (49.16), AF (24.55), and stroke (23.30). The burden was highest in Eastern Europe, Central Asia, and North Africa and the Middle East, and in low-middle SDI regions. From 1990 to 2021, incident counts of all CVD types more than doubled (EAPC: 2.16% to 2.80%), whereas ASIRs declined modestly (EAPC: -0.89% to -0.10%). By 2050, ASIRs for LE-PAD and AF are projected to increase markedly (EAPC: 3.03% and 3.04%, respectively), with particularly pronounced increases among females.</p><p><strong>Conclusion: </strong>Modelled estimates suggest that COPD accounts for approximately 11% of incident CVD cases among adults aged ≥ 45 years globally. These findings support consideration of COPD in future cardiovascular prevention strategies and risk assessment frameworks.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"636025"},"PeriodicalIF":4.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Analysis of ICU Patients with Chronic Obstructive Pulmonary Disease Based on Blood Phosphate Dynamics: A Retrospective Cohort Study from the MIMIC-IV Database.","authors":"Pei Zhou, Chengcheng Liu, Xiaoqin Ju, Du Fan","doi":"10.2147/COPD.S641599","DOIUrl":"10.2147/COPD.S641599","url":null,"abstract":"<p><strong>Purpose: </strong>While the relationship between serum phosphorus concentrations and the prognosis of chronic obstructive pulmonary disease (COPD) has been previously investigated, the prognostic significance of dynamic serum phosphorus fluctuations in patients with COPD admitted to intensive care units (ICUs) remains poorly understood. This study aimed to evaluate the association between longitudinal serum phosphorus trajectories during the early ICU stay and 28-day all-cause mortality, and to explore their potential utility as a prognostic indicator.</p><p><strong>Methods: </strong>This retrospective cohort analysis utilized data from COPD patients registered in the Medical Information Mart for Intensive Care IV database (MIMIC-IV, v3.0). Group-based trajectory modeling (GBTM) was applied to delineate distinct serum phosphorus trajectories over the first seven days following ICU admission. The relationship between these trajectory groups and all-cause mortality was examined using Kaplan-Meier survival curves and multivariable Cox proportional hazards regression. Subgroup analyses were performed to verify the robustness of this association across different patient subgroups.</p><p><strong>Results: </strong>A total of 3627 ICU-admitted patients with COPD were enrolled. GBTM distinguished two distinct longitudinal patterns: a high-phosphate trajectory (mean phosphate range: approximately 5.0-6.5 mg/dL; n = 320, 8.8%) and a low/normal-phosphate trajectory (mean phosphate range: approximately 3.2-3.8 mg/dL; n = 3307, 91.2%). Patients in the high-phosphate group exhibited markedly lower 28-day cumulative survival. Multivariable Cox regression confirmed that this trajectory was independently associated with elevated 28-day mortality risk. Furthermore, the trajectory-based model demonstrated superior predictive performance compared with single-time-point phosphate measurements.</p><p><strong>Conclusion: </strong>Longitudinal trends in serum phosphate levels serve as a significant and independent risk factor for short-term mortality in critically ill patients with COPD.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"641599"},"PeriodicalIF":4.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Caregiver Dyads in Severe and Advanced COPD: Relationships, Caregiving Burden, and Intervention Support: A Narrative Review.","authors":"Yi Zu, Huajun Sun, Da Luo, Yue Du","doi":"10.2147/COPD.S624594","DOIUrl":"10.2147/COPD.S624594","url":null,"abstract":"<p><strong>Background: </strong>Informal caregivers are central to the home management of severe and advanced chronic obstructive pulmonary disease (COPD), particularly when patients have high symptom burden, recurrent exacerbations, respiratory disability, long-term oxygen therapy (LTOT), or home non-invasive ventilation (NIV). This narrative review synthesizes evidence on patient-caregiver relationships, caregiving burden, and intervention support in these high-need COPD phenotypes.</p><p><strong>Methods: </strong>We conducted an iterative narrative review using PubMed as the primary database, citation chaining from included literature, and targeted searches of guideline and organizational sources through March 2026. The synthesis drew on 96 publications spanning quantitative and qualitative studies, systematic and narrative reviews, randomized trials and trial protocols, clinical practice guidelines, and policy reports. Evidence was charted by design, population/phenotype, measures or intervention, main findings and key limitations.</p><p><strong>Results: </strong>Four dimensions emerged from the evidence: (1) multidimensional caregiver burden; (2) changing patient-caregiver relationship dynamics; (3) evolving caregiver roles across the severe-COPD trajectory, including LTOT, home NIV, exacerbations, hospitalization, and palliative care; and (4) intervention and support-system responses. Caregivers report anxiety, depression, fatigue, social restriction, financial strain, and uncertainty, while patient-caregiver disagreement about symptoms and support can intensify distress. Evidence is strongest for guidelines and systematic reviews confirming high need and for selected rehabilitation and breathlessness interventions; it is weaker for caregiver-specific, long-term, technology-supported, and low-resource interventions. The Zarit Burden Interview is widely used but has limited content validity in COPD caregiving; COPD-specific or caregiver-validated measures such as Informal Caregiver Burden Assessment Questionnaire (QASCI) and the Carer Support Needs Assessment Tool warrant greater use.</p><p><strong>Conclusion: </strong>For people with severe or advanced COPD who depend on regular home support, care should more consistently recognize the patient-caregiver dyad as an important unit of assessment and intervention. Routine caregiver needs assessment, education for advanced home therapies, family-inclusive rehabilitation, psychological support, and needs-based palliative care are promising components of care.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"624594"},"PeriodicalIF":4.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and Anxiety Among Patients with COPD: A Nationwide Study from Lithuania.","authors":"Tadas Valiulis, Rasa Gauronskaitė, Rolandas Zablockis, Edvardas Danila","doi":"10.2147/COPD.S606943","DOIUrl":"10.2147/COPD.S606943","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is frequently accompanied by depression and anxiety, which may exacerbate disease outcomes, reduce treatment adherence, and impair quality of life. Despite their clinical significance, these comorbidities remain frequently underdiagnosed and undertreated. This study examined the diagnosed prevalence of depression and anxiety, as well as the patterns of psychotropic medication use among patients with COPD in Lithuania.</p><p><strong>Materials and methods: </strong>A retrospective observational study was conducted using anonymized outpatient administrative data from the Lithuanian State Data Agency, comprising adult patients with COPD (ICD-10 J44.x) between 2020 and 2024. Mental health comorbidities were identified according to ICD-10 codes for anxiety disorders (F41.x), depressive episodes (F32.x), and recurrent depressive disorders (F33.x). Associations between categorical variables and sex differences were analyzed using contingency tables. Crude odds ratios (ORs) and adjusted odds ratios (aORs) from multivariable logistic regression analyses were calculated.</p><p><strong>Results: </strong>Among 64,246 unique patients with COPD, 18.1% had a diagnosed psychiatric disorder, with a higher diagnosed prevalence among women than men (26.8% vs 12.1%; aOR = 2.40, 95% CI 2.32-2.48, p < 0.001). Anxiety disorders were identified in 15.0% of patients, and depressive disorders in 4.6%; women had significantly higher odds of depressive disorders compared with men (aOR = 3.53, 95% CI 3.36-3.72, p < 0.001). Psychotropic medications were prescribed to 61.9% of affected individuals, with women being more likely to receive any psychotropic medication than men (aOR = 0.687 for men vs women, 95% CI 0.644-0.732, p < 0.001). Anxiolytics represented 89.9% of all psychotropic prescriptions, with benzodiazepines accounting for 85.0% of this category. Family physicians were significantly more likely to prescribe anxiolytics than psychiatrists (OR = 10.66, p < 0.001). Antidepressant and neuroleptic prescribing showed statistically significant increasing trends over the study period (p = 0.007 and p = 0.005, respectively), whereas benzodiazepine prescribing rates also increased significantly (p = 0.004).</p><p><strong>Conclusion: </strong>Anxiety and depression are common psychiatric comorbidities among patients with COPD in Lithuania and exhibit notable gender differences. Psychotropic medications were predominantly prescribed in primary care, with benzodiazepines accounting for the majority of anxiolytic treatments. These findings provide updated nationwide data on psychiatric comorbidity and psychotropic prescribing patterns among patients with COPD in Lithuania.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"606943"},"PeriodicalIF":4.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}