Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation最新文献

{"title":"The Effects of Aerobic Exercise on Prognosis, Quality of Life, and Psychological Outcomes of Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.","authors":"Mingchun Zhang, Misbah Ullah Khan","doi":"10.15326/jcopdf.2025.0657","DOIUrl":"10.15326/jcopdf.2025.0657","url":null,"abstract":"<p><strong>Objectives: </strong>This meta-analysis assessed the effects of aerobic exercise on the function, prognosis, quality of life, and psychological outcomes of patients with chronic obstructive pulmonary disease (COPD).</p><p><strong>Methods: </strong>The Cochrane Library, Scopus, PubMed, and Web of Science were searched from the inception to June 20, 2025 to identify eligible studies. A random-effects model was employed for meta-analysis.</p><p><strong>Results: </strong>Twenty randomized controlled trials with 1003 participants were included. The risk of bias was high in most studies, particularly because blinding was not feasible. For most outcomes, we observed high heterogeneity among studies. The meta-analysis indicated that compared to the control group, patients with COPD undergoing exercise training had a significantly increased 6-minute walk test (weighted mean difference [WMD] 42.44m), forced expiratory volume in 1 second (FEV₁) (WMD 0.08L), FEV₁ to forced vital capacity (FVC) (WMD 5.42%), and peripheral capillary oxygen saturation (WMD 1.56%), which suggests that aerobic exercise can improve the functional capacity and respiratory reserve of patients with COPD.\u0000On the other hand, the results revealed that compared to the control group, aerobic exercise markedly decreased the St George’s Respiratory Questionnaire (SGRQ) symptom score (standard mean difference [SMD] -1.13), the SGRQ total score (SMD -1.44), the modified Medical Research Council score for dyspnea (SMD -0.81), and the Hospital Anxiety and Depression Scale (HADS)-anxiety score (SMD -1.17), but its effect on the HADS-depression score (SMD -0.25) did not meet the threshold of statistical significance.\u0000Subgroup analysis unveiled that aerobic exercise can offer greater benefits in the long term, and those with FEV₁ and FEV₁/FVC of more than 50% can benefit more from aerobic exercise.</p><p><strong>Conclusion: </strong>Aerobic exercise may improve the functional capacity, symptoms, respiratory reserve, quality of life, and psychological outcomes of patients with COPD.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"167-176"},"PeriodicalIF":2.3,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isoflavone Intake is Associated With Decreased Chronic Obstructive Pulmonary Disease Morbidity.","authors":"Daniel C Belz, Ernesto Quiroz, Han Woo, Mariah K Jackson, Nirupama Putcha, Ashraf Fawzy, Wendy Lorizio, Corrine K Hanson, Nadia N Hansel","doi":"10.15326/jcopdf.2025.0695","DOIUrl":"10.15326/jcopdf.2025.0695","url":null,"abstract":"<p><strong>Introduction: </strong>Isoflavones, phenolic compounds in legumes and soy products, are linked to reduced risk of chronic diseases such as coronary heart disease. However, effects on respiratory diseases like chronic obstructive pulmonary disease (COPD) are understudied.</p><p><strong>Methods: </strong>Former smokers with COPD were enrolled in a prospective cohort study. Morbidity was assessed at baseline, 3, and 6 months using the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), modified Medical Research Council (mMRC), St George’s Respiratory Questionnaire (SGRQ), Ease of Cough and Sputum Clearance (ECSC), and exacerbation history. Spirometry and biomarkers of platelet activation, inflammation, and oxidative stress were obtained. Dietary intake was assessed via a food frequency questionnaire, with total isoflavone intake calculated as the sum of genistein, daidzein, glycitein, formononetin, and biochanin A. Associations were analyzed with generalized estimating equation regression analysis and adjusted for baseline covariates.</p><p><strong>Results: </strong>A total of 99 participants (mean age 66.4, 55% female, 41% White, and a baseline forced expiratory volume in 1 second percentage predicted of 49.8%) had a mean isoflavone intake of 1.8mg (standard deviation [SD]=3.1). One SD increase in total isoflavone intake was associated with lower CAT (β=–2.0, <i>p</i>=0.011), CCQ (β=–0.2, <i>p</i>=0.029), and ECSC (β=–0.70, <i>p</i> <0.001) scores, and 7.4% lower urinary 11-dehydro-thromboxane B2 (<i>p</i>=0.047). A trend toward better SGRQ scores was observed but was not significant. Isoflavones were not associated with mMRC or exacerbations.</p><p><strong>Conclusion: </strong>Increased isoflavone intake was associated with improved respiratory morbidity and reduced platelet activation, suggesting a potential dietary pathway influencing COPD morbidity.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"125-135"},"PeriodicalIF":2.3,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silent Nights, Restless Lungs: Sleep Quality and Associated Factors Among COPD Patients in Vietnam - A Cross-Sectional Study.","authors":"Phan Thanh Thuy, Nguyen Thi Thu, Nguyen Cong Khan","doi":"10.15326/jcopdf.2025.0664","DOIUrl":"10.15326/jcopdf.2025.0664","url":null,"abstract":"<p><strong>Background: </strong>Nocturnal symptoms and sleep disturbances are increasingly recognized as clinically important in chronic obstructive pulmonary disease (COPD) but remain understudied in low- and middle-income countries. The objective of this study was to assess sleep quality and determine its association with respiratory symptoms in Vietnamese outpatient COPD patients.</p><p><strong>Methods: </strong>We conducted a cross-sectional study on 289 consecutive patients (≥ 40 years old) with a confirmed COPD diagnosis who were being monitored at the COPD management unit of Bach Mai Hospital, Hanoi (February2025 to May 2025). Demographic and clinical data (modified Medical Research Council [mMRC] dyspnea scale, COPD Assessment Test [CAT] score, forced expiratory volume in 1 second [FEV₁] after bronchodilator use, comorbidities, and number of hospitalizations in the previous year) were collected through structured interviews and medical record reviews. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI).</p><p><strong>Results: </strong>The mean PSQI total score was 9.2 ± 3.7; 85.8% of participants met the threshold for poor sleep. A total of 65.4% of patients had an mMRC grade ≥ 2, 88.9% had a CAT score ≥ 10, and 88.9% of patients had an acute hospitalization in the past year. A high CAT score, a high mMRC grade, long disease duration, and FEV₁ below 50% were risk factors for impaired sleep quality as measured by the PSQI.</p><p><strong>Conclusions: </strong>Poor sleep quality is highly prevalent among Vietnamese outpatient COPD patients and is closely associated with respiratory symptom burden and disease severity. These findings underscore the importance of routine sleep quality assessment in COPD management and suggest that optimizing symptom control may contribute to improved sleep and overall patient outcomes.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"104-110"},"PeriodicalIF":2.3,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Exercise-Induced Desaturation Among COPD Patients Enrolled in Early Inpatient Pulmonary Rehabilitation.","authors":"Mara Paneroni, Laura Spinello, Beatrice Salvi, Carla Simonelli, Aldo Diasparra, Massimo Venturelli, Michele Vitacca","doi":"10.15326/jcopdf.2025.0724","DOIUrl":"10.15326/jcopdf.2025.0724","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbations of COPD (AECOPDs) may cause exercise-induced desaturation (EID), affecting recovery and rehabilitation outcomes. The prevalence and clinical implications of EID during early postexacerbation pulmonary rehabilitation are unclear. This study aimed to determine the prevalence of EID in COPD patients recovering from AECOPDs, with and without long-term oxygen therapy (LTOT) at rest, and to compare clinical, functional, and physiological characteristics.</p><p><strong>Methods: </strong>This retrospective, multicenter study included 262 COPD patients admitted for inpatient pulmonary rehabilitation after AECOPDs. Participants were stratified by resting oxygen therapy status. EID was defined as a ≥4% fall in peripheral oxygen saturation from baseline with nadir <90% during the 6-minute walking test. Clinical, functional, and physiological parameters were compared across subgroups.</p><p><strong>Results: </strong>Overall, 132 patients (50.4%) exhibited EID. Prevalence was higher in patients on oxygen at rest (61.5%) than in those breathing room air (33.9%,<i> p</i> <0.0001). Patients on oxygen therapy had greater lung function impairment, reduced exercise capacity, and higher dyspnea-related disability. EID was associated with greater heart rate response in patients on supplemental oxygen but not consistently with perceived dyspnea or fatigue, highlighting the importance of objective oximetry during exercise testing. Regardless of EID, individuals on oxygen walked shorter distances than those on room air.</p><p><strong>Conclusions: </strong>EID is common in COPD patients recovering from AECOPD, especially those receiving LTOT, and is linked to more severe functional impairment. Systematic EID assessment using objective oximetry during early pulmonary rehabilitation may support individualized oxygen titration and exercise prescriptions. Prospective studies are needed to clarify its prognostic implications.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":"13 2","pages":"136-146"},"PeriodicalIF":2.3,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Chronic Rhinosinusitis and <i>Pseudomonas Aeruginosa</i> in Sputum of Patients With Non-Cystic Fibrosis Bronchiectasis.","authors":"Titas Grabauskas, Amanda E Brunton, Mark L Metersky, Kevin Winthrop, Nicole C Lapinel, George M Solomon, Kunal Jakharia, Michelle Korah-Sedgwick, Alexander Geyer","doi":"10.15326/jcopdf.2025.0732","DOIUrl":"10.15326/jcopdf.2025.0732","url":null,"abstract":"<p><strong>Background: </strong><i>Pseudomonas aeruginosa</i> (<i>P aeruginosa</i>), <i>Haemophilus influenzae</i> (<i>H influenzae</i>), and <i>Staphylococcus aureus (S aureus)</i> may chronically infect bronchiectatic airways. Chronic rhinosinusitis (CRS) is common in people with bronchiectasis. Bacterial airway infection and CRS are associated with greater bronchiectasis disease severity. However, the relationship between these pathogens and CRS in people with bronchiectasis is unclear.</p><p><strong>Research question: </strong>Is history of CRS associated with sputum positivity for <i>P aeruginosa, S aureus</i>, and/or <i>H influenzae</i> in people with bronchiectasis?</p><p><strong>Study design and methods: </strong>People with bronchiectasis from the U.S. Bronchiectasis and NTM Research Registry with and without physician-reported CRS were compared with respect to demographic and clinical characteristics using cross-sectional study design. Multivariable logistic regression models were used to assess the relationship between CRS and the presence of <i>P aeruginosa, S aureus,</i> and <i>H influenzae</i> in sputum.</p><p><strong>Results: </strong>Of 1352 people with bronchiectasis and known CRS status, 222 (16%) had a history of CRS. Those with CRS were more likely to have a sputum culture positive for <i>P aeruginosa</i> (35% CRS versus 26% non-CRS group; <i>p</i>=0.007), but not <i>S aureus</i> (13% versus 10%; <i>p</i>=0.21) or <i>H influenzae</i> (6% versus 7%; <i>p</i>=0.55). After adjusting for patient demographics and clinical characteristics, CRS was associated with <i>P aeruginosa</i> (odds ratio: 1.5; 95% confidence interval: 1.07 to 2.08).</p><p><strong>Interpretation: </strong>We report an association of history of CRS and sputum culture positivity for <i>P aeruginosa</i> (but not <i>S aureus</i> or <i>H influenzae</i>) in people with bronchiectasis.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"158-166"},"PeriodicalIF":2.3,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phone-Based Teach-To-Goal Inhaler Education Program for Medicare Advantage Beneficiaries With COPD.","authors":"Valerie G Press, Aina Katsikas, Kaylyn Swankoski, Emily Boudreau, Emily Thomas","doi":"10.15326/jcopdf.2025.0667","DOIUrl":"10.15326/jcopdf.2025.0667","url":null,"abstract":"<p><strong>Background: </strong>Individuals with chronic obstructive pulmonary disease (COPD) rely on inhaler-based medications to treat and control symptoms. Most patients do not use correct technique. Teach-to-goal (TTG) inhaler education programs have been found to improve inhaler technique. There is limited understanding as to whether TTG inhaler education is effective when delivered over the phone.</p><p><strong>Ojjective: </strong>We aimed to find out the effect of a phone-based TTG inhaler technique education program among Medicare Advantage beneficiaries with COPD.</p><p><strong>Study design and methods: </strong>Beneficiaries with a diagnosis of COPD within the prior 2 years, who had filled at least one maintenance inhaler prescription at least once in the prior year, had a value-based insurance design plan, and received the inhaler education component of the COPD intervention program were evaluated. Inhaler technique was measured by validated checklists, and patients self-reported their technique.</p><p><strong>Results: </strong>Of 1876 patients analyzed, n=13 used more than one inhaler. At the initial assessment, 39.4% of participants were using their inhalers incorrectly. By the end of the first education session, the percentage of participants who were using their inhaler incorrectly decreased to 6.9%.</p><p><strong>Interpretation: </strong>A phone-based TTG inhaler education program offered by a large national health plan demonstrated improvements in inhaler technique across different inhaler devices and subpopulations. The multiple-session approach was likely critical for longer-term retention of correct technique, though further study is needed to confirm this. Some subgroup populations are also at greater risk for baseline inhaler misuse and/or post-training inhaler misuse indicating a need for further evaluation of how to tailor inhaler education by individuals’ needs.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"84-92"},"PeriodicalIF":2.3,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exacerbations and Decreased Lung Function Predict Nebulizer Use and Uptake in COPD and Tobacco Exposed Persons With Preserved Spirometry","authors":"Jane C. Fazio, Andrew W. Hong, Daniela Markovic, R. Graham Barr, Eugene R. Bleecker, Russell P. Bowler, David J. Couper, Jeffrey L. Curtis, M. Bradley Drummond, Spyridon Fortis, MeiLan K. Han, Victor Kim, Fernando J. Martinez, Jill Ohar, Victor E. Ortega, Robert Barnes Iii, J. Michael Wells, Sheiphali A. Gandhi, Prescott G. Woodruff, Nirupama Putcha, Christopher B. Cooper, Donald P. Tashkin, Russell G. Buhr, Igor Barjaktarevic","doi":"10.15326/jcopdf.2025.0714","DOIUrl":"10.15326/jcopdf.2025.0714","url":null,"abstract":"<p><strong>Rationale: </strong>Nebulizers are an alternative to handheld devices for inhaled therapies in chronic obstructive pulmonary disease (COPD). Understanding nebulizer utilization patterns is essential to developing therapy guidelines.</p><p><strong>Objectives: </strong>We aimed to describe characteristics of nebulizer users versus nonusers and factors associated with baseline nebulizer use and longitudinal uptake.</p><p><strong>Methods: </strong>We analyzed the Subpopulations and Intermediate Outcome Measures in COPD Study, a prospective cohort of 2973 participants with or without tobacco use and/or COPD. We used cross-sectional multivariable logistic regression and interval-censored proportional hazard models to analyze factors associated with nebulizer use and uptake among tobacco-exposed participants with preserved spirometry (TEPS) and COPD from enrollment (Visit 1) through 4–7 years of follow-up (Visit 5).</p><p><strong>Results: </strong>Nebulizer utilization was highest in advanced COPD, 49% of Global initiative for chronic Obstructive Lung Disease (GOLD) Group D participants at baseline. Nebulizer treatments were primarily as-needed short-acting bronchodilators. Baseline nebulizer use was associated with respiratory exacerbations in the prior year (1, odds ratio [OR] 1.81, 95% confidence interval [CI] [1.24, 2.64]; 2, OR 1.86, 95% CI [1.07, 3.22]; 3 or more, OR 1.87, 95% CI [1.07, 3.28]), lower forced expiratory volume in 1 second (FEV1) (OR 2.81 per liter decrease, 95% CI [2.09, 3.77]), COPD Assessment Test (CAT) score >10 (OR 1.89, 95% CI [1.17, 3.03]), 6-minute walk distance (6MWD) (OR 1.03 per 10 meter lower 6MWD, 95% CI [1.02, 1.05]), and a history of asthma (OR 2.41, 95% CI [1.76, 3.30]). Longitudinal uptake was similarly associated with exacerbations, lower FEV1, CAT score >10, and asthma. Patterns were consistent between TEPS and COPD.</p><p><strong>Conclusion: </strong>Nebulizers were predominantly used by participants with frequent exacerbations, high symptom burden, and advanced COPD, and long-acting nebulized medications were underutilized. Randomized controlled trials are needed to compare nebulizers with hand-held devices.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"111-124"},"PeriodicalIF":2.3,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Obesity and Alpha-1 Antitrypsin Deficiency-Associated COPD: A Dual Burden on Health and Quality of Life.","authors":"Radmila Choate, Kristen E Holm, Robert A Sandhaus, David M Mannino, Charlie Strange","doi":"10.15326/jcopdf.2025.0672","DOIUrl":"10.15326/jcopdf.2025.0672","url":null,"abstract":"","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"177-183"},"PeriodicalIF":2.3,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale and Design of the Roflumilast or Azithromycin to Prevent COPD Exacerbations Clinical Trial.","authors":"Jerry A Krishnan, Janet T Holbrook, Elizabeth A Sugar, Richard Albert, Steve Rennard, Nina Bracken, Jiaxian He, Marie Bradley, Kevin Coughlin, Candace C Fuller, Bradley Hammill, Elisha Malanga, Vincent M Malanga, David Mannino, Richard A Mularski, Hugh Musick, Jean Rommes, Julie DeLisa, Sengwee Toh, Robert A Wise","doi":"10.15326/jcopdf.2025.0669","DOIUrl":"10.15326/jcopdf.2025.0669","url":null,"abstract":"<p><strong>Rationale: </strong>Rationale: Chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization and death, particularly among patients with chronic bronchitis and frequent exacerbations. Results of placebo-controlled clinical trials indicate that treatment escalation with either long-term oral roflumilast or azithromycin can reduce COPD exacerbations. However, head-to-head comparative data from clinical trials are lacking, so the relative harms and benefits of these treatments are unclear.</p><p><strong>Objective: </strong>The RofLumilast or Azithromycin to preveNt COPD Exacerbations (RELIANCE) study is an investigator-initiated, multicenter, randomized, pragmatic clinical trial embedded in clinical practice to evaluate the effectiveness of treatment escalation with long-term azithromycin versus roflumilast in patients with COPD and chronic bronchitis.</p><p><strong>Methods/design: </strong>We solicited preferences from patients, clinicians, and other stakeholders during the design and implementation phases of the study, including feedback that informed modifications related to the COVID-19 pandemic. Eligibility criteria did not require assessments outside of clinical practice, with exclusions principally for safety. The composite endpoint of first all-cause hospitalization or death served as the primary outcome. Enrollment was initially through university-affiliated clinical centers but was subsequently expanded to recruit patients in community-based practices who might not otherwise participate in research. We employed human-centered design principles to improve the usability of study activities from the perspective of participants, study staff, and treating clinicians.</p><p><strong>Final design: </strong>The final study design offered the option for patients with COPD and chronic bronchitis at high-risk of hospitalization or death to be remotely consented, prescribed a medication according to the randomized treatment allocation, and complete virtual follow-up study visits in a decentralized clinical trial.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"17-28"},"PeriodicalIF":2.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upper and Lower Limb Skeletal Muscle Mass Index as a Novel Evaluation Index in Patients with Chronic Obstructive Pulmonary Disease.","authors":"Junpei Oba, Shota Kotani, Satoshi Kubo, Jun Horie","doi":"10.15326/jcopdf.2025.0698","DOIUrl":"10.15326/jcopdf.2025.0698","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to examine the relationships and usefulness of physical activity, physical performance, and physical function in patients with chronic obstructive pulmonary disease (COPD), focusing on 2 newly proposed skeletal muscle indices: the upper limb skeletal muscle mass index (USMI) and lower limb skeletal muscle mass index (LSMI).</p><p><strong>Methods: </strong>A total of 80 stable patients with COPD who participated in outpatient pulmonary rehabilitation at Osaka Fukujuji Hospital were enrolled. The primary measurements were the USMI, LSMI, and skeletal muscle index (SMI). The explanatory measurements included physical activity, incremental shuttle walking distance (ISWD), quadriceps strength, handgrip strength, the Nagasaki University Respiratory Activities of Daily Living Questionnaire, and pulmonary function. Pearson’s correlation coefficient and stepwise multiple regression analysis were used for the statistical analyses.</p><p><strong>Results: </strong>USMI showed no significant correlations with physical activity parameters or ISWD. In contrast, LSMI was significantly correlated with weekly exercise volume (r=0.42, p<0.01), daily exercise volume (r=0.42, p<0.01), time spent in activities ≥3 metabolic equivalents of task (r=0.40, p<0.01), and ISWD (r=0.46, p<0.01). Multiple regression analysis identified ISWD as an independent factor for USMI, LSMI, and SMI.</p><p><strong>Conclusions: </strong>This study demonstrated that LSMI, similar to SMI, was associated with physical activity and exercise capacity in patients with COPD. These findings highlight the importance of evaluating, maintaining, and strengthening lower limb skeletal muscle mass and suggest that LSMI may serve as a useful clinical evaluation index.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"8-16"},"PeriodicalIF":2.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}