BMC Pulmonary Medicine最新文献

{"title":"Association between stress hyperglycemia and pneumonia in patients with stroke: a systematic review and meta-analysis.","authors":"Xinyi Tu, Chenghao Shi, Jiajiang Jiang, Xiaodan Lu, Li Fan, Xiaoxiao Shi, Qian Li, Lizhu Wang","doi":"10.1186/s12890-025-03901-9","DOIUrl":"10.1186/s12890-025-03901-9","url":null,"abstract":"<p><strong>Background: </strong>Pneumonia is a frequent complication post-stroke and stress hyperglycemia (SH) is a physiological response to stroke. Although some studies have provided data on the impact of stress hyperglycemia on pneumonia incidence, no study to date has exclusively focused on investigating the direct relationship between stress hyperglycemia and pneumonia.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across PubMed, EBSCOhost, Web of Science, Embase, CNKI, and Wanfang databases from inception to July 10th, 2024, to identify observational studies comparing the incidence of pneumonia between stroke patients with and without stress hyperglycemia. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS), and pooled ORs for each comparison were estimated using a random-effects model proposed by DerSimonian and Kacker. This systematic review is presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.</p><p><strong>Results: </strong>Twelve studies were included eventually and the pooled incidence rate of pneumonia was 14.4%. The overall incidence of pneumonia in patients with stress hyperglycemia was significantly higher than in those without stress hyperglycemia (OR: 2.01; 95% CI: 1.72 to 2.34, P < 0.01).Significant heterogeneity was observed in the meta-analysis (P = 0.01, I²=54%). Meta-regression revealed that the effect size differed significantly across subgroups defined by SH metrics (blood glucose versus stress hyperglycemia ratio and blood glucose to HbA1c ratio, p < 0.01). These findings underscore important limitations, including measurement variability, significant heterogeneity, and potential residual confounding due to factors such as dysphagia severity, comorbidity burden, and variations in clinical management. Importantly, the overall quality of evidence was rated as low based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, primarily due to the observational design of the included studies and inconsistency across results. Therefore, the findings should be interpreted cautiously and regarded as hypothesis-generating.</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis found that SH was significantly associated with post-stroke pneumonia, with patients exhibiting SH having twice the odds of pneumonia compared to those without.</p><p><strong>Prospective registration: </strong>The protocol for this review is registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42024563263.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"421"},"PeriodicalIF":2.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12403530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942952","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 the BRI and all-cause and cardiovascular mortality in COPD patients.","authors":"Riken Chen, Yuli Cai, Qinghua Chen, Zhaojun Chen, Huan Li, Yihuan Su, Wenxi Li, Yitian Yang, Xing Li, Xinyao Liu, Junfen Cheng, Lijuan Zeng, Huimin Chen, Baozhi Zhang","doi":"10.1186/s12890-025-03868-7","DOIUrl":"10.1186/s12890-025-03868-7","url":null,"abstract":"<p><strong>Objective: </strong>Waist circumference (WC) has been linked to exacerbations in chronic obstructive pulmonary disease (COPD), but the relationship between WC, height, and the Body Roundness Index (BRI) with mortality in COPD patients remains unclear. This study investigates the association between BRI and both all-cause and cardiovascular mortality in COPD patients.</p><p><strong>Methods: </strong>Data from 3,672 COPD participants (1,517 men and 2,155 women; mean age: 53.17 ± 16.46 years) were obtained from NHANES (1999-2018). Multivariable Cox proportional hazards models, Kaplan-Meier analysis, Nelson-Aalen cumulative hazard plots, and restricted cubic spline analyses were used to assess the relationship between BRI and mortality. ROC curves were constructed to evaluate BRI's predictive performance. Subgroup and sensitivity analyses ensured robustness of the models.</p><p><strong>Results: </strong>The BRI was associated with all-cause (HR: 1.12, 95% CI: 1.05-1.19) and cardiovascular mortality (HR: 1.14, 95% CI: 1.01-1.29). Kaplan-Meier curves and Nelson-Aalen plots demonstrated that higher BRI quartiles correlated with lower survival probabilities and increased cumulative mortality incidence. ROC curve analysis showed that BRI outperformed other models in predicting all-cause [AUC: 0.81 (0.79-0.82)] and cardiovascular mortality [AUC: 0.79 (0.76-0.81)]. A significant interaction was observed between BRI and alcohol consumption for all-cause mortality. Results remained consistent after excluding participants who died within two years (HR: 1.10, 95% CI: 1.03-1.18) and in the alcohol-consuming subgroup (HR: 1.14, 95% CI: 1.05-1.24).</p><p><strong>Conclusion: </strong>The BRI is associated with increased all-cause and cardiovascular mortality in COPD patients, with higher BRI quartiles linked to greater mortality risk. Targeting BRI may offer a potential strategy to reduce mortality in this population.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"420"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12403296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942915","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":"Associations between dietary index for gut microbiota with COPD prevalence and all-cause mortality: insights from the 1999-2018 NHANES data.","authors":"Xiaopeng Liu, Zhixiong Hu, Qi Zhang","doi":"10.1186/s12890-025-03908-2","DOIUrl":"10.1186/s12890-025-03908-2","url":null,"abstract":"<p><strong>Objective: </strong>Gut microbiota dysbiosis plays a vital role the pathogenesis of chronic obstructive pulmonary disease (COPD). This study aimed to: (1) examine the cross-sectional association between dietary index for gut microbiota (DI-GM), a novel biomarker reflecting gut microbiota composition and function, and COPD prevalence; and (2) assess the prognostic significance of DI-GM score for all-cause mortality in COPD patients.</p><p><strong>Methods: </strong>We analyzed data from the 1999-2018 National Health and Nutrition Examination Survey. DI-GM score was calculated from 24-hour dietary recall. Primary outcomes were COPD prevalence and all-cause mortality risk in COPD patients. Multivariable logistic regression assessed the association between DI-GM and COPD prevalence, while Cox proportional hazards models evaluated all-cause mortality risk in COPD patients.</p><p><strong>Results: </strong>The prevalence of COPD was 6.87% among the 22,859 participants included. Compared to participants with DI-GM score of 0-3, the odds ratio (95% confidence interval) for DI-GM score of 4, 5, and ≥ 6 were 0.88 (0.70-1.11), 0.78 (0.64-0.97), and 0.75 (0.62-0.90), respectively. During a median follow-up time of 84 months, a total of 570 (28.15%) participants died among the 1,580 COPD participants. Compared to DI-GM score of 0-3, the hazard ratios (95% confidence intervals) for DI-GM score of 4, 5, and ≥ 6 were 0.78 (0.60-1.01), 0.63 (0.47-0.83), and 0.69 (0.56-0.85), respectively.</p><p><strong>Conclusion: </strong>Higher DI-GM scores are significantly associated with both reduced COPD prevalence and improved survival in COPD patients. Our results suggest dietary modifications targeting gut microbiota may represent a novel strategy for COPD prevention and management.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"417"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942974","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":"Pseudomonas aeruginosa-driven airway dysbiosis and machine learning prediction of acute exacerbations in non-cystic fibrosis bronchiectasis: a microbial-inflammatory signature approach.","authors":"Wen-Wen Wang, Yu-Han Wang, Jian Xu, Yuan-Lin Song, Jin-Fu Xu","doi":"10.1186/s12890-025-03892-7","DOIUrl":"10.1186/s12890-025-03892-7","url":null,"abstract":"<p><strong>Background: </strong>While Pseudomonas aeruginosa (PA) colonization is linked to poor outcomes in bronchiectasis, emerging evidence suggests that microbial community collapse-marked by diversity loss and depletion of commensal taxa-may better reflect disease progression than pathogen load alone. This study investigates whether airway microbiota dysbiosis driven by PA colonization induces ecological fragility and evaluates the predictive utility of integrating microbial diversity indices with systemic inflammation markers to forecast 1-year acute exacerbation risk using interpretable machine learning.</p><p><strong>Methods: </strong>Bronchoalveolar lavage fluid (BALF) samples from 23 patients (8 PA-colonized, 15 non-colonized) underwent 16 S rRNA gene sequencing. Microbial diversity and taxonomic composition were analyzed. An eXtreme Gradient Boosting (XGBoost) model with SHapley Additive exPlanations (SHAP) analysis was constructed to assess exacerbation risk, focusing on microbial and inflammatory markers.</p><p><strong>Results: </strong>PA-colonized patients (P1) exhibited significantly worse clinical severity than non-colonized patients (P2), with higher Bronchiectasis Severity Index scores (8.38 vs. 4.33, P < 0.01), poorer quality-of-life (SGRQ: 35.75 vs. 22.79; CAT: 24.00 vs. 16.26, P < 0.01), and elevated dyspnea (mMRC: 1.62 vs. 0.95, P < 0.05). P1 also had more acute exacerbations annually (retrospective: 3.00 vs. 1.20; prospective: 3.75 vs. 0.80, P < 0.05-0.001). Notably, P1 exhibited significantly reduced alpha diversity compared to P2 (Shannon index: 1.96 vs. 3.47; Simpson index: 0.46 vs. 0.77, P < 0.05). Weighted UniFrac PCoA revealed distinct clustering between groups (R²=0.162, P < 0.05). The XGBoost model, integrating microbial taxa relative abundances, alpha diversity indices, and inflammatory markers demonstrated robust performance in predicting 1-year acute exacerbation risk (AUC = 0.85). SHAP analysis identified the microbial diversity, rather than Pseudomona abundance was the most influential predictor of exacerbation risk.</p><p><strong>Conclusions: </strong>PA colonization disrupts airway microbial diversity and outcompetes commensal species in bronchiectasis, yet our XGBoost model reveals that ecological resilience-not pathogen load-best predicts exacerbation risk when integrated with inflammatory markers. This paradigm shift from pathogen-centric to ecosystem-driven risk assessment provides an actionable framework for personalized management and antibiotic stewardship in chronic airway diseases.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"419"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942964","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":"A giant anterior mediastinal thymolipoma mimicking dextrocardia with cardiomegaly: a case report and review of literature.","authors":"Niroshan Lokunarangoda, Dhammike Rasnayake, Miyuru Dulanjana, Duminda Samarasinghe, Ushani Wariyapperuma","doi":"10.1186/s12890-025-03888-3","DOIUrl":"10.1186/s12890-025-03888-3","url":null,"abstract":"<p><strong>Background: </strong>Thymolipoma is a rare benign anterior mediastinal tumour composed of thymic and adipose tissue, accounting for only 2-9% of thymic neoplasms (Mohamud et al., J Surg Case Rep 2020,2020; Shrivastava and Ntiamoah, Radiol Case Rep 15:1538-1540, 2020). Patients are often asymptomatic, and these masses are often detected incidentally. We present a case of a young male with an anterior mediastinal thymolipoma that initially mimicked dextrocardia and cardiomegaly based on findings from clinical examination and chest radiography.</p><p><strong>Case presentation: </strong>A 22-year-old university student was incidentally noted to have abnormal findings on cardiorespiratory examination. A chest X-ray suggested dextrocardia with cardiomegaly, but further imaging revealed a large anterior mediastinal mass. Contrast-enhanced computed tomography (CT) of the chest showed a well-encapsulated, predominantly fat-density mass (approximately 24 × 15 × 12 cm) in the anterior mediastinum extending into the right hemithorax without invasion of adjacent structures. The lesion caused rightward mediastinal widening but no actual cardiac enlargement, dextroposition or lung collapse. Surgical resection via right mini-thoracotomy was performed. The Gross examination revealed a large, lobulated, encapsulated tumour with a yellow, fatty cut surface and interspersed solid areas. Histopathology confirmed the presence of mature adipose tissue with thymic lobules (cortex, medulla, and Hassall's corpuscles), consistent with thymolipoma, showing no evidence of malignancy. The patient's postoperative recovery was uneventful, and the heart resumed its normal anatomical position.</p><p><strong>Conclusion: </strong>This case highlights that an anterior mediastinal mass, such as a thymolipoma, can masquerade as dextrocardia and cardiomegaly by distorting the mediastinal silhouette. It is essential to distinguish a mediastinal tumour from true congenital dextrocardia or pulmonary conditions, as each requires markedly different management approaches. Thorough imaging and histological evaluation ensured the correct diagnosis and curative surgical treatment. This report emphasises the importance of considering mediastinal pathology in patients with apparent dextrocardia, as detected during examination or imaging.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"418"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942897","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":"Age, comorbidity, race and gender differences in referral to a pulmonologist among patients with sarcoidosis at a large academic medical center.","authors":"John Odackal, Gennaro Di Tosto, Ann Scheck McAlearney, Laura J Rush, Elliott Crouser, Michelle Sharp","doi":"10.1186/s12890-025-03889-2","DOIUrl":"10.1186/s12890-025-03889-2","url":null,"abstract":"<p><strong>Background: </strong>Prior work has reported differences in the prevalence of sarcoidosis as well as patient outcomes based on race, gender, and socioeconomic status. We investigated whether sociodemographic factors were associated with referral to pulmonary medicine at a large academic center for patients with an incident international classification of diseases (ICD) diagnosis of sarcoidosis.</p><p><strong>Methods: </strong>We conducted a single-center retrospective study examining the associations between sociodemographic factors and time to pulmonary medicine referral in patients with an incident ICD diagnosis of sarcoidosis between October 31, 2011, and October 30, 2021. In our center, referral to pulmonary medicine for sarcoidosis is equivalent to referral to the sarcoidosis clinic. Additional outcomes were associations between pulmonology referral and receiving a pulmonary function test (PFT), electrocardiogram (EKG), or computed tomography scan of the chest (CT-chest).</p><p><strong>Results: </strong>We identified 1,017 patients with an incident ICD diagnosis of sarcoidosis. Only 276 (27%) were referred to pulmonary medicine within 1 year of diagnosis. In a Cox proportional hazards model incorporating race, gender, area deprivation index (ADI), age, and tobacco use, Black males (HR = 0.57; 95% = CI 0.38, 0.86) and White females (HR = 0.62; 95% CI = 0.45, 0.85) were less likely to be referred to pulmonary medicine compared to White males. ADI was not associated with time to referral while increasing age (HR = 0.97, 95% = CI 0.96, 0.98) was associated with a decreased likelihood of referral. In a sensitivity analysis incorporating the Charlson Comorbidity Index (CCI), increasing CCI was associated with decreased likelihood of referral (HR = 0.88, 95% = CI 0.80, 0.96). Patients referred to pulmonary medicine were more likely to have received a PFT, EKG, and CT-chest within 1 year of diagnosis.</p><p><strong>Conclusion: </strong>In our cohort of patients with an incident ICD diagnosis of sarcoidosis, Black males, White females, older adults, and adults with more comorbidities were less likely to be referred to pulmonary medicine. Referrals were associated with receiving recommended screening tests for cardiopulmonary disease. Given that pulmonary medicine manages the sarcoidosis clinic at our institution, our findings highlight the importance of considering the impact of sociodemographic factors on referral to a sarcoidosis specialist.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"416"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942949","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":"A nomogram for individualized prediction of acute respiratory distress syndrome in patients with severe traumatic brain injury: a retrospective cohort study.","authors":"Zixuan Wang, Yan Xiao, Min Zhu, Siyao Xu, Yuan Zhong, Xiaohong Liu, Jinqiang Zhuang","doi":"10.1186/s12890-025-03879-4","DOIUrl":"https://doi.org/10.1186/s12890-025-03879-4","url":null,"abstract":"","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"415"},"PeriodicalIF":2.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942971","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":"Evaluating the impact of altitudinal variations on COVID-19 mortality rates: a comprehensive analysis.","authors":"Emre Karsli, Damla Anbarli Metin, Arda Kocatas, Feride Fulya Ercan, Ramazan Sabirli, Aylin Koseler, Matteo Pellegrini","doi":"10.1186/s12890-025-03900-w","DOIUrl":"https://doi.org/10.1186/s12890-025-03900-w","url":null,"abstract":"<p><strong>Background: </strong>High altitude, known for its effects on respiratory diseases, was analyzed for its potential protective role. Data from the New York Times COVID-19 repository, U.S. Census Bureau, and topographic maps were utilized, covering January 2020 to August 2022, including pre- and post-vaccination periods. This study investigates the influence of high altitude on COVID-19 mortality, fatality rates, and vaccination outcomes in the United States. COVID-19, caused by SARS-CoV-2, has shown significant disparities in severity and outcomes across populations.</p><p><strong>Methods: </strong>This study utilized publicly available data from the New York Times COVID-19 repository and the US Census Bureau's American Community Survey to analyze case fatality rates across mainland US counties from January 21, 2020, to August 13, 2022. Average altitude data were obtained from topographic maps, and counties outside the mainland USA were excluded. Vaccination-related data were assessed using the cutoff date of December 14, 2020. The rural-urban status of counties was determined using the Index of Relative Rurality (IRR) from Waldorf and Kim's study, which included 3105 of 3109 counties.</p><p><strong>Results: </strong>Counties above 1500 m exhibited significantly lower case numbers, deaths, cases per million, and fatality rates compared to counties below this altitude. Pre-vaccination fatality rates were notably reduced in high-altitude regions (p = 0.0001), while post-vaccination data continued to demonstrate lower fatality rates (p < 0.0001). A positive correlation between rurality and post-vaccination fatality rates was observed (rho = 0.176, p = 0.0001). Altitude, alongside vaccination status, was identified as a critical factor influencing fatality rates (p = 0.001 for both). Additionally, a significant positive correlation between rurality (Index of Relative Rurality) and post-vaccination fatality rates was observed (rho = 0.176, p = 0.0001).</p><p><strong>Conclusions: </strong>Our findings highlight that high-altitude adaptations, such as increased lung capacity and epigenetic changes, may mitigate COVID-19 severity. However, the role of environmental and genetic factors remains insufficiently explored. Importantly, the study underscores healthcare inequities in rural high-altitude areas, where limited vaccination access exacerbates mortality risks. While altitude shows promise as a protective factor, addressing healthcare access disparities and further investigating high-altitude physiological and genetic adaptations are imperative for optimizing COVID-19 outcomes in diverse populations.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"413"},"PeriodicalIF":2.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942926","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":"Progression from GOLD A/B to GOLD E: a claims analysis of patients with COPD newly initiating inhaled therapy.","authors":"Trishul Siddharthan, Sanjay Sethi, Emily Wan, Claudia Lamprey, Kavita Aggarwal, Amy Dixon, Yi Pan, Vickram Tejwani","doi":"10.1186/s12890-025-03898-1","DOIUrl":"https://doi.org/10.1186/s12890-025-03898-1","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with substantial morbidity and mortality. Acute COPD exacerbations are a primary driver of significant burden and contribute to disease progression.</p><p><strong>Methods: </strong>This retrospective, observational cohort study used the Optum Clinformatics^® Data Mart database to identify patients with COPD who were classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) A/B0 or A/B1 based on exacerbation history (i.e., they had either 0 [GOLD A/B0] or 1 [GOLD A/B1] moderate exacerbation and 0 severe exacerbations in a 12-month baseline period). Patients were required to be aged ≥ 40 years and to have newly initiated inhaled maintenance therapy for COPD from January 2016 to June 2023. The rates of and time to progression to GOLD E (defined in the claims data as experiencing 2 moderate exacerbations within a 12-month period or 1 severe exacerbation) were estimated using the Kaplain-Meier method. Predictors of progression to GOLD E were analyzed using multivariable Cox proportional hazard models.</p><p><strong>Results: </strong>Of the 156,462 included patients, the largest proportion of patients (46.6%) were initiated on long-acting beta-agonists/inhaled corticosteroids. The majority of patients progressed to GOLD E over 5 years. The risk of progressing to GOLD E was approximately 3 times higher in the GOLD A/B1 versus GOLD A/B0 group (hazard ratio [HR] 2.92; 95% CI 2.84-3.00; P < 0.001). The strongest predictor of progressing to GOLD E was history of having a moderate exacerbation. Other independent predictors included older age, having Medicare versus commercial insurance, and the presence of Elixhauser comorbidities.</p><p><strong>Conclusions: </strong>Despite use of inhaled maintenance treatments for COPD, most patients still progressed to a frequent or severe exacerbator phenotype. New therapies are needed to modify the disease trajectory in COPD.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"412"},"PeriodicalIF":2.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942962","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":"Impact of COVID-19 and lockdown on outcomes of COPD patients in Turkey: lessons for the future.","authors":"Demet Polat Yulug, Elif Sen, Aylin Ozgen Alpaydin, Sibel Nayci, Eylem Sercan Ozgur, Oya Baydar Toprak, Ahmet Melih Sahin, Elif Selcuk, Salih Yigit, Funda Elmas Uysal, Alev Gurgun, Nurdan Kokturk, Ayshan Mammadova, Yelda Varol, Ayşe Baha, Mehmet Polatli, Aybüke Yaz, Irem Serifoglu Rahatli, Ali Kocabas","doi":"10.1186/s12890-025-03883-8","DOIUrl":"https://doi.org/10.1186/s12890-025-03883-8","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic and related public health restrictions have substantially altered healthcare access and delivery, particularly for patients with chronic conditions such as chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the impact of the COVID-19 pandemic and lockdown measures on COPD-related symptoms and hospital admissions, and to compare these outcomes with the pre-pandemic period.</p><p><strong>Methods: </strong>This multicenter cross-sectional study was conducted between July 2021 and February 2022 across ten tertiary pulmonary outpatient clinics in Turkey. A total of 347 COPD patients were included. Data on demographics, spirometry, symptom progression, medication access, COVID-19 history, and hospital admissions were collected via structured questionnaire and medical records. Pandemic-related outcomes were compared with data from the pre-pandemic year (March 2019-March 2020). Additional multivariable regression analyses were performed to identify predictors of hospital admission and COVID-19-related hospitalization.</p><p><strong>Results: </strong>The mean number of hospital admissions significantly decreased during the pandemic compared to the pre-pandemic period (p < 0.001), while patient-reported respiratory symptoms increased over time. Hospital admissions were lowest during the first pandemic period, when restrictions were most intense. Regression analyses showed that lower FEV₁, advanced GOLD stage, and inhaled corticosteroid (ICS) use were independently associated with increased hospital admissions. COVID-19 was diagnosed in 21.1% of patients. Lower FEV₁, GOLD stage, and smoking were significantly associated with COVID-19-related hospitalization.</p><p><strong>Conclusion: </strong>Although COPD-related hospital admissions decreased during the pandemic, respiratory symptoms progressively worsened. These findings reflect the complex interplay between public health measures, healthcare accessibility, and chronic disease management. Disease severity and airflow limitation were key determinants of adverse outcomes. Maintaining access to routine care and adopting personalized approaches in COPD management are essential during public health emergencies.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"414"},"PeriodicalIF":2.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942889","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}