International Journal of Chronic Obstructive Pulmonary Disease最新文献

{"title":"Cardiopulmonary Exercise Testing and Pulmonary Function for Assessing Chronic Obstructive Pulmonary Disease.","authors":"Chunyan Yu, Yong Li, Shiwei Qumu, Jingen Xia, Jieping Lei, Xiaopan Li, Tianyi Yang, Zinan Wang, Shuhao Chen, Ke Huang, Ting Yang","doi":"10.2147/COPD.S620471","DOIUrl":"10.2147/COPD.S620471","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the grading concordance between pulmonary function tests (PFTs) and cardiopulmonary exercise testing (CPET) in grading chronic obstructive pulmonary disease (COPD) and to guide the clinical application of CPET in appropriate patient populations.</p><p><strong>Patients and methods: </strong>A retrospective analysis was conducted on 152 patients with COPD who underwent PFT, CPET, the 6-minute walking test (6MWT), and body composition assessment. COPD was graded using forced expiratory volume in 1 second as a percentage of the predicted value (FEV₁%pred) and Peak Oxygen Uptake per Kilogram of Body Weight (PeakVO₂/kg), respectively. Grading discordance between the two systems was assessed, and clinical characteristics of patients with a higher disease severity grade on CPET were analyzed.</p><p><strong>Results: </strong>Agreement between GOLD and peakVO₂/kg-based CPET grading was slight (linear weighted Kappa = 0.182, 95% CI: 0.087-0.277; P < 0.001), with exact grade concordance observed in 47 of 152 patients (30.9%). Overall, 92 patients (60.5%) were assigned a more severe grade by peakVO₂/kg-based CPET grading than by GOLD. Upward reclassification occurred in 49 of 67 patients with GOLD Mild disease (73.1%) and 41 of 62 patients with GOLD Moderate disease (66.1%). Compared with the non-upgraded group, patients in the CPET-upgraded group were older, had higher BMI, body fat percentage, and fat mass, and were more likely to have cardiovascular comorbidity (all P < 0.05). In partial correlation analyses adjusted for age, sex, and height, peakVO₂/kg was negatively correlated with fat mass (r = -0.287, P = 0.002), whereas peakVO₂%pred was not (r = 0.041, P = 0.657), indicating that the observed discordance was partly related to the body-weight normalization inherent to peakVO₂/kg.</p><p><strong>Conclusion: </strong>Discordance between GOLD and peakVO₂/kg-based CPET grading was common, particularly in patients with mild-to-moderate airflow obstruction, and was associated with age, adiposity, and cardiovascular comorbidity. CPET may provide physiological information complementary to spirometry; however, because peakVO₂/kg-based grading is influenced by adiposity, a more severe CPET grade in overweight or obese patients should not necessarily be interpreted as indicating intrinsically greater cardiopulmonary impairment. PeakVO₂%pred, body composition, and other clinical and physiological findings should be considered alongside peakVO₂/kg when interpreting CPET results.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"620471"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907308","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":"Deep Learning Image Reconstruction Algorithm for Quantitative Assessment of Low-Dose Biphasic Chest CT in Chronic Obstructive Pulmonary Disease.","authors":"Liwei Xue, Qiong Lin, Xiongxin Ye, Xiaoyong Zhang, Borong Tang, Xiaojuan Lin, Wanyi Zheng, Yunjing Xue, Yuanfen Liu","doi":"10.2147/COPD.S614978","DOIUrl":"10.2147/COPD.S614978","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of deep learning image reconstruction (DLIR) on quantitatively assessing emphysema, air trapping and small airway dysfunction in chronic obstructive pulmonary disease (COPD) using low-dose inspiratory-expiratory chest CT.</p><p><strong>Methods: </strong>Sixty-nine COPD patients underwent low-dose inspiratory-expiratory chest CT scans and pulmonary function tests (PFT) were prospectively enrolled. The CT images were reconstructed using 50% adaptive statistical iterative reconstruction (ASiR-V), DLIR-high (DLIR-H), medium (DLIR-M), and low (DLIR-L) strengths. The volumes and its percentages (relative to whole lung) characterizing emphysema, air trapping and small airway dysfunction were quantified on the inspiratory-expiratory CT scans.</p><p><strong>Results: </strong>The total dose-length product was 128.99 ± 39.00 mGy·cm. For all patients, emphysema parameters were lowest for DLIR-H and highest for ASiR-V; small airway dysfunction parameters were highest with DLIR-H and lowest with ASiR-V; air trapping parameters were lowest with ASiR-V; highest with DLIR-M. Emphysema parameters demonstrated moderate negative correlations with FEV₁/FVC (r = -0.570 to -0.649, all p < 0.001). Air trapping and small airway dysfunction parameters showed weak negative correlations with MEF25%, MEF50%, and MEF75% (r = -0.320 to -0.381, all p < 0.001). When differentiating GOLD I-II from III-IV, all parameters showed AUC values ranging from 0.69 to 0.76, without statistically differences among reconstructions (DeLong's test, p > 0.05), while the optimal thresholds varied across reconstructions.</p><p><strong>Conclusion: </strong>In low-dose inspiratory-expiratory chest CT, DLIR may alter the lung function-related CT parameters compared to ASiR-V, but does not affect their correlations with PFTs or their efficacies in GOLD grading.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"614978"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898171","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":"Integrating Machine Learning for Early COPD Prediction in Lung Cancer Patients: A Focus on Systemic Coagulation-Inflammation Index.","authors":"Qianfei Liu, Ling Hou, Huiling Li, Yin Li, Quanfang Chen","doi":"10.2147/COPD.S627761","DOIUrl":"10.2147/COPD.S627761","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) often coexists with lung cancer, worsening clinical outcomes. This study aimed to develop machine learning models for early COPD screening in lung cancer patients using clinical variables and a novel systemic coagulation-inflammation index (SCI).</p><p><strong>Methods: </strong>We retrospectively enrolled 1016 patients, extracting demographic, smoking, vital, and laboratory data. After feature selection with Boruta and least absolute shrinkage and selection operator (LASSO), six models-logistic regression, decision tree (DT), multilayer perceptron (MLP), support vector machine (SVM), gradient boosting decision tree (GBDT), and extreme gradient boosting (XGBoost)-were trained on 70% of the data and tested on 30%. Model performance was assessed with area under the curve (AUC), accuracy, sensitivity, specificity, precision, F1 score, and calibration, while SHapley Additive exPlanations (SHAP) and contour plots helped interpret the best model and explore predictor interactions.</p><p><strong>Results: </strong>Among the 1,016 patients, 182 (17.9%) had concomitant COPD. Boruta and LASSO identified 8 key predictors: age, historical smoking index (HSI), SCI, eosinophils (EOS), bicarbonate (HCO₃ ^-), sex, lymphocytes (LYM), and hemoglobin (HGB). The GBDT model showed the best performance, with an area under the curve (AUC) of 0.74 (95% CI: 0.69-0.80) and moderate sensitivity (0.68) and specificity (0.66). SHAP analysis revealed age, HSI, and SCI as major risk factors, with contour plots indicating a synergistic effect between SCI, age, and HSI on COPD risk.</p><p><strong>Conclusion: </strong>A GBDT-based model built from routine clinical variables and SCI showed moderate discrimination for identifying patients with lung cancer at high risk of concomitant COPD.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"627761"},"PeriodicalIF":4.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898175","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":"Air Pollution-Associated Intracellular Metals, Immune Gene Expression, and Erythrocyte Indices in COPD with Anemia.","authors":"Chi-Thien Dinh, Jer-Hwa Chang, Tzu-Tao Chen, Ching-Huang Lai, Kuan-Yuan Chen, Po-Hao Feng, Kang-Yun Lee, Chien-Hua Tseng, Huan Minh Tran, Tzu-Hsuen Yuan, Shu-Chuan Ho, Sheng-Ming Wu, Hsiao-Chi Chuang","doi":"10.2147/COPD.S626348","DOIUrl":"10.2147/COPD.S626348","url":null,"abstract":"<p><strong>Background: </strong>Anemia is common in chronic obstructive pulmonary disease (COPD) and may be influenced by air pollution-related metal accumulation. However, the biological links among air pollution, intracellular metals, immune gene expression, and erythrocyte alterations remain unclear.</p><p><strong>Methods: </strong>We examined associations between air pollutants, intracellular metals, gene expression, and erythrocyte indices in sixty-one COPD patients and ten healthy controls. Annual exposures to particulate matter with aerodynamic diameter ≤10 µm (PM₁₀), ≤2.5 µm (PM_2.5), nitrogen dioxide (NO₂), and nitrogen oxides (NOx) were estimated using land use regression. Metals were quantified by inductively coupled plasma mass spectrometry (ICP-MS) and single-cell ICP-MS. Gene expression in peripheral blood mononuclear cells (PBMCs) was profiled by RNA sequencing.</p><p><strong>Results: </strong>In COPD, PM_2.5 was associated with higher red blood cell (RBC) count (β = 0.0314×10⁶ cells/µL; 95% confidence interval (CI): 0.0066 ~ 0.0561) and ln(red cell distribution width) (β = 0.0051; 95% CI: 0.0003 ~ 0.0098). PM_2.5 was also associated with higher ln(chromium (Cr)) in PBMCs (β = 0.0632; 95% CI: 0.0124 ~ 0.1139), ln(zinc (Zn)) in RBCs (β = 0.1338; 95% CI: 0.0388 ~ 0.2288), and ln(cadmium (Cd)) in RBCs (β = 0.1297; 95% CI: 0.0125 ~ 0.2469). RBC Cr, Cd, lead, and vanadium were positively associated with hemoglobin, hematocrit, and mean corpuscular volume. In PBMCs, Cr, Cd, Zn, and single-cell iron were associated with <i>ALPL, CXCR1</i>, and <i>PI3</i> expression. Anemic COPD patients showed upregulation of <i>IFI27</i> and <i>TRAV38-1</i> and downregulation of <i>DEFA1, PI3, CXCR1</i>, and <i>ALPL</i>.</p><p><strong>Conclusion: </strong>Intracellular metals, particularly Cr and Cd, were associated with immune-related gene expression profiles and anemia-related erythrocyte indices in COPD. These findings suggest potential biological associations among air pollution exposure, intracellular metal burden, immune dysregulation, and hematologic alterations in COPD.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"626348"},"PeriodicalIF":4.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898159","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":"Addressing Cardiopulmonary Risk in COPD: A Multidisciplinary Expert Opinion Framework for the United States Healthcare System.","authors":"Stephen Brunton, Patrick A Cambier, Nathaniel Marchetti, Joel Solis","doi":"10.2147/COPD.S596426","DOIUrl":"10.2147/COPD.S596426","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a prevalent and devastating condition responsible for substantial morbidity and mortality in the United States (US). Although the burden of cardiopulmonary (CP) comorbidity in COPD is increasingly known, CP risk remains frequently under-recognized and suboptimally managed in routine clinical practice. Definitions of CP risk in COPD vary across the literature and clinical settings. CP risk may be broadly defined as the risk of serious respiratory and/or cardiovascular events in patients with COPD, including COPD exacerbations, myocardial infarction, stroke, heart failure decompensation, arrhythmia, and death. While current clinical guidelines recognize comorbidity, there remain no clear protocols for screening, risk assessment, or a coordinated multidisciplinary approach to address the CP risk in patients with COPD. To address these gaps, a multidisciplinary expert panel developed consensus-based guidance through an iterative process incorporating an expert-led narrative review supported by targeted desk searches alongside multiple rounds of expert input. This paper identifies critical gaps in the management of CP risk among patients with COPD in the US and outlines actionable steps towards improvement of care. Actionable recommendations include encouraging earlier screening and risk assessment to identify patients at risk of exacerbations and improving patient access to multidisciplinary teams, prompting earlier initiation or optimization of evidence-based treatment. Furthermore, implementation of fully coordinated treatment strategies through primary care settings and increasing the use of preventative strategies in the clinic such as spirometry, vaccination, and smoking cessation are recommended. By shifting to proactive, multidisciplinary care, healthcare practitioners can better address the complex needs of patients with COPD to reduce their CP risk and improve individual and population-level outcomes.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"596426"},"PeriodicalIF":4.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898226","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":"Sex Differences in Documented Multimorbidity and Selected Healthcare-Use Indicators Among Deceased Patients Meeting an Operational Definition of Advanced COPD: A Retrospective Population-Based Cohort Study.","authors":"Anat Romem, Ayal Romem","doi":"10.2147/COPD.S636890","DOIUrl":"10.2147/COPD.S636890","url":null,"abstract":"<p><strong>Background: </strong>Advanced chronic obstructive pulmonary disease (COPD) is associated with multimorbidity and substantial healthcare use. However, sex differences in documented multimorbidity and healthcare use near the end of life remain insufficiently understood.</p><p><strong>Methods: </strong>This retrospective population-based cohort study used routinely collected administrative and clinical data from Clalit Health Services, Israel. The study included deceased patients with advanced COPD during 2016-2020 and 2022-2023. The year 2021 was excluded a priori as the period designated in the study protocol to minimize distortion in healthcare utilization, and mortality patterns; 2020 remained part of the prespecified observation window. The cohort comprised 2261 patients aged ≥55 years who met an operational definition requiring documented COPD, FEV1/FVC <0.70, FEV1 <50% predicted, and at least two opioid prescriptions or dispensations during the final year of life. The opioid criterion was not considered a stand-alone diagnostic criterion or evidence of refractory dyspnea. Women and men were compared regarding demographic characteristics, multimorbidity, selected healthcare-use indicators, coded palliative care encounters, and time from first documented COPD diagnosis to death.</p><p><strong>Results: </strong>The cohort included 547 women and 1714 men. Women were older and more frequently had dementia and rheumatic/connective tissue disease. Men more frequently had myocardial infarction, renal disease, peripheral vascular disease, and diabetes. Men had more documented procedures, although the effect size was small. The mean Charlson Comorbidity Index differed by 0.44 points, of uncertain clinical importance. Coded palliative care encounters were rare and available only for small subsamples. Median time from first documented COPD diagnosis to death was 33 months among women and 29 months among men, without a statistically significant difference (log-rank p=0.328).</p><p><strong>Conclusion: </strong>Sex differences were observed primarily in documented multimorbidity. Healthcare-use and palliative-care findings were partial and descriptive and should not be interpreted as complete end-of-life trajectories or causal effects of sex.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"636890"},"PeriodicalIF":4.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898217","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":"Identifying Biomarkers for Chronic Obstructive Pulmonary Disease in the Salivary Metabolome.","authors":"Denisa Asandei, Keiron O'Shea, Rachel Paes de Araujo, Adrian Mironas, Ricardo Da Costa, Timothy Asibey-Berko, Subhamay Ghosh, Chuan Lu, Scott O'Rourke, Luis A J Mur, Keir E Lewis","doi":"10.2147/COPD.S603467","DOIUrl":"10.2147/COPD.S603467","url":null,"abstract":"<p><strong>Purpose: </strong>We compared salivary metabolomic signatures from patients with stable COPD across a range of severity of airflow obstruction with healthy controls.</p><p><strong>Patients and methods: </strong>In this exploratory study, 47 people with COPD and 48 age-matched, healthy controls, provided saliva that was assessed by flow infusion electrospray mass spectrometry (FIE-MS). Spectra were interrogated using an open-source library DIMEpy package.</p><p><strong>Results: </strong>Four potential biomarkers identified the presence of COPD with a sensitivity of 73% and specificity of 72%. Six metabolites predicted the level of airflow obstruction, FEV1% in the COPD cohort (<i>P</i> < 0.001, R² > 0.3, AUC > 0.7), whilst a range of multivariate approaches targeted six metabolites linked to COPD stage of severity (<i>P</i> < 0.001, AUC > 0.7). Identification of the metabolites suggested changes in pterin biosynthesis, lipid processing, nucleotide metabolism and melatonin in COPD patients.</p><p><strong>Conclusion: </strong>This proof-of-concept study shows metabolic fingerprinting of saliva samples is feasible and can differentiate patients with COPD from people (including smokers) without COPD and correlates with COPD severity as defined by level of airflow obstruction. Metabolic fingerprinting also offers insights into the metabolic pathways involved in COPD aetiology.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"603467"},"PeriodicalIF":4.1,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888681","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":"Admission Systemic Immune-Inflammation Index and 90-Day AECOPD-Related Unplanned Readmission: A Single-Center Retrospective Cohort Study.","authors":"Qiong Chen, Sufang Xu, Jin Wang, Mei Feng, Shaowen Wang, Man Qin","doi":"10.2147/COPD.S632787","DOIUrl":"10.2147/COPD.S632787","url":null,"abstract":"<p><strong>Background: </strong>The systemic immune-inflammation index (SII) is derived from routine blood counts, but its incremental value for disease-specific early readmission after acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains uncertain. We evaluated the association between admission SII and 90-day AECOPD-related unplanned readmission and its value beyond available clinical variables.</p><p><strong>Methods: </strong>This single-center retrospective development cohort included 207 unique patients hospitalized for AECOPD from January 2024 to January 2025; only the first eligible hospitalization per patient was analyzed. Readmissions were ascertained from electronic records and structured telephone follow-up completed on June 30, 2025. SII was calculated from the first blood count obtained within 24 hours of arrival. Logistic regression, receiver operating characteristic analysis, 1000-resample bootstrap internal validation, calibration assessment and decision curve analysis were performed. Bootstrap validation assessed optimism in discrimination, calibration and net benefit.</p><p><strong>Results: </strong>Seventy-eight patients (37.7%) experienced AECOPD-related unplanned readmission within 90 days. Each 500-unit increase in SII was associated with higher adjusted odds of readmission (odds ratio 1.329, 95% confidence interval 1.153-1.530; p < 0.001). Apparent AUC was 0.809 (95% confidence interval 0.742-0.869) for the integrated model versus 0.752 (0.678-0.821) for the limited clinical model. The absolute increase was 0.057 (bootstrap 95% confidence interval 0.014-0.101), and adding SII improved model fit (likelihood-ratio p < 0.001). Optimism-corrected AUC, calibration intercept and slope were 0.785, -0.003 and 0.874. Otherwise identical NLR and PLR models had corrected AUCs of 0.775 and 0.765; pairwise differences were inconclusive.</p><p><strong>Conclusion: </strong>Higher admission SII was associated with 90-day AECOPD-related unplanned readmission and improved discrimination beyond a limited clinical model. These exploratory single-center findings require external validation, recalibration and prospective impact assessment before clinical implementation.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"632787"},"PeriodicalIF":4.1,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876224","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":"Exploratory CT-Based Assessment of Emphysema Burden in Smokers with Bipolar Disorder Receiving Lithium Treatment.","authors":"Şaban Melih Şimşek, Meltem Hazel Şimşek, Ruhsel Cörüt, Fatma Gül Helvacı Çelik, Gökhan Tonkaz, Abdulkadir Kaya, Selçuk Takır","doi":"10.2147/COPD.S626791","DOIUrl":"10.2147/COPD.S626791","url":null,"abstract":"<p><strong>Purpose: </strong>Experimental studies suggest that lithium may modulate emphysema-related tissue injury through activation of the WNT/β-catenin signaling pathway. However, clinical data examining the relationship between lithium exposure and emphysema burden remain limited. This study aimed to investigate the association between long-term lithium use and CT-derived emphysema burden in smokers with bipolar disorder.</p><p><strong>Patients and methods: </strong>This retrospective observational study included 67 smokers with bipolar disorder who had received lithium treatment for at least 5 years and 71 matched controls with similar demographic and smoking characteristics. Quantitative emphysema measurements were obtained from thoracic computed tomography using low attenuation area percentage (LAA%). Multivariable linear regression analyses were performed adjusting for age, sex, BMI, and smoking exposure.</p><p><strong>Results: </strong>Right, left, and total lung LAA% values were lower in the lithium-treated group than in controls (7.53% vs 10.11%, p=0.009; 7.73% vs 10.02%, p=0.019; and 7.64% vs 10.07%, p=0.011, respectively). In multivariable analysis, lithium treatment remained independently associated with lower total LAA% after adjustment for age, sex, body mass index, and smoking exposure (B = -2.636, standardized β = -0.236, 95% CI -4.537 to -0.736; p = 0.007). Weak inverse correlations between serum lithium concentrations and emphysema measurements were observed in unadjusted analyses but were no longer significant after multivariable adjustment.</p><p><strong>Conclusion: </strong>Long-term lithium exposure was associated with lower CT-derived emphysema burden in smokers with bipolar disorder. Given the observational design and potential influence of inspiratory effort during CT acquisition, these findings should be considered hypothesis-generating rather than evidence of a protective effect. Prospective longitudinal and mechanistic studies are warranted to clarify the relationship between lithium exposure and smoking-related parenchymal lung injury.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"626791"},"PeriodicalIF":4.1,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876157","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":"Network Structure of Dyspnea-Related Fear in Older Adults with Acute Exacerbation of COPD: A Biopsychosocial Network Model.","authors":"Yuqing Yang, Yu Zhang, Qi Wu, Xinyu Yang, Shilang Wang, Shunlin Liu","doi":"10.2147/COPD.S613643","DOIUrl":"10.2147/COPD.S613643","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to construct a biopsychosocial network model of dyspnea-related fear in older adults with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), identify central and bridge nodes within the psychological system, and explore structural associations linking fear symptoms to emotional distress and functional impairment.</p><p><strong>Methods: </strong>A total of 317 hospitalized older adults with AECOPD were enrolled. Eight variables were assessed, including fear of dyspnea (Fear-D), fear of activity (Fear-A), anxiety (Anx), depression (Dep), psychological resilience (Psy-R), self-efficacy (Self-E), social support (Social-S), and activities of daily living (ADL). Gaussian Graphical Models (GGM) were estimated using EBICglasso. Centrality indices, bridge strength, node predictability (R²), and non-parametric bootstrap procedures were applied to evaluate network stability and accuracy.</p><p><strong>Results: </strong>Anxiety demonstrated the highest expected influence (z = 1.34), functioning as the most central node. Fear-D and Fear-A formed a cohesive dyad (edge weight = 0.51), while Anx and Dep exhibited the strongest edge (0.76). Protective factors (Self-E and Psy-R) showed negative associations with fear and anxiety nodes and significant bridge strength across communities. ADL was structurally embedded between psychological and emotional domains. Network stability analysis confirmed high robustness (CS coefficient > 0.70). The topology reflects a \"indicating a structured pattern of fear-emotion co-occurrence and resource-related associations\" configuration. Social support (Social-S) demonstrated near-zero centrality, suggesting minimal structural integration within the network under acute hospitalization conditions.</p><p><strong>Conclusion: </strong>Dyspnea-related fear in older AECOPD patients operates within a structured pattern of emotional and resource co-occurrence rather than a simple linear fear-disability pathway. Anxiety serves as the most central node, whereas self-efficacy functions as a cross-domain bridge node. Targeting high-centrality emotional nodes and strengthening resource bridges may optimize precision psychological intervention in AECOPD.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"613643"},"PeriodicalIF":4.1,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876185","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}