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Clinical Advances in Chronic Obstructive Pulmonary Disease and Its Complications
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Clinical Advances in Chronic Obstructive Pulmonary Disease and Its Complications

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (25 May 2023) | Viewed by 19356

Special Issue Editor

Prof. Dr. Emiel F.M. Wouters

E-Mail Website
Guest Editor
1. Department of Respiratory Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
2. Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
Interests: COPD; asthma; lung physiology; pulmonary rehabilitation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent decades, COPD has evolved from a disease characterized by persistent airflow limitation to a clinical syndrome involving a wide scatter of pathologies beyond the lung. Our current understanding of COPD is hampered by a variety of factors: the definition of COPD based on FEV1/VC ratio, cross-sectional design of studies, and invalid diagnosis of underlying pathologies. Furthermore, current insights underscore the importance of individual lung trajectories in the development of psionically defined flow limitation but have explored neither the impact of these different trajectories on multimorbidity profiles nor the role of lung size itself as a marker of organ health in individuals. Ongoing research has identified that in addition to lung trajectories, other aspects, such as body compositional changes, need to be considered as well, including the interplay between different body compartments, such as fat tissue and gut microbiome. This issue of JCM aims to offer new perspectives to better understand the pathophysiological mechanisms of COPD syndrome.

Prof. Dr. Emiel F.M. Wouters
Guest Editor

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Published Papers (5 papers)

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Research

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14 pages, 723 KiB  
Article
Prevalence and Factors Affecting Appropriate Inhaler Use in Elderly Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study
by Le Khac Bao, Nguyen Dang Khoa, Le Thi Kim Chi and Nguyen Tuan Anh
J. Clin. Med. 2023, 12(13), 4420; https://doi.org/10.3390/jcm12134420 - 30 Jun 2023
Cited by 3 | Viewed by 2245
Abstract
Background: Chronic obstructive pulmonary disease (COPD) mainly affects individuals aged 60 and older. The proper use of inhalers is crucial for managing COPD. This study aimed to evaluate the prevalence and factors affecting the appropriate use of inhalers among elderly patients with COPD. [...] Read more.
Background: Chronic obstructive pulmonary disease (COPD) mainly affects individuals aged 60 and older. The proper use of inhalers is crucial for managing COPD. This study aimed to evaluate the prevalence and factors affecting the appropriate use of inhalers among elderly patients with COPD. Methods: We enrolled 91 elderly patients with COPD admitted to the Department of Respiratory, University Medical Center HCMC between October 2020 and May 2021. Patients who were capable of using the inhaler would have their inhaler usage recorded through video footage. Two respiratory experts carefully analyzed 133 video-recorded demonstrations for evaluation purposes. Results: 18.7% of the patients demonstrated the correct inhaler technique. Pressurized metered dose inhaler (pMDI) and Turbuhaler had the lowest documented correct usage rates (11.9% and 10.0%, respectively). Two critical steps, namely “holding breath for about five seconds or as long as comfortable” and “breathing out gently,” were commonly performed incorrectly when using pMDI, Respimat, Breezhaler, or Turbuhaler. Multivariable logistic regression analysis showed that lower mMRC scores (AOR = 5.3, CI 1.1–25.5, p = 0.037) and receiving inhaler instruction within the past three months (AOR = 5.2, CI 1.3–20.1, p = 0.017) were associated with increased odds of using the inhaler correctly. Conclusions: Our study found that less than 20% of elderly patients with COPD use inhalers correctly. Common errors include inadequate breath-holding and gentle exhalation. mMRC scores and recent inhaler instruction were predictors of proper use. These findings can aid clinicians in improving inhaler management for elderly patients with COPD. Full article
(This article belongs to the Special Issue Clinical Advances in Chronic Obstructive Pulmonary Disease and Its Complications)
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13 pages, 2301 KiB  
Article
COPD Exacerbation-Related Pathogens and Previous COPD Treatment
by Yun Su Sim, Jin Hwa Lee, Eung Gu Lee, Joon Young Choi, Chang-Hoon Lee, Tai Joon An, Yeonhee Park, Young Soon Yoon, Joo Hun Park and Kwang Ha Yoo
J. Clin. Med. 2023, 12(1), 111; https://doi.org/10.3390/jcm12010111 - 23 Dec 2022
Cited by 9 | Viewed by 2864
Abstract
We evaluated whether the pathogens identified during acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) are associated with the COPD medications used in the 6 months before AE-COPD. We collected the medical records of patients diagnosed with AE-COPD at 28 hospitals between January [...] Read more.
We evaluated whether the pathogens identified during acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) are associated with the COPD medications used in the 6 months before AE-COPD. We collected the medical records of patients diagnosed with AE-COPD at 28 hospitals between January 2008 and December 2019 and retrospectively analyzed them. Microorganisms identified at the time of AE-COPD were analyzed according to the use of inhaled corticosteroid (ICS) and systemic steroid after adjusting for COPD severity. We evaluated 1177 patients with AE-COPD and available medication history. The mean age of the patients was 73.9 ± 9.2 years, and 83% were males. The most frequently identified bacteria during AE-COPD were Pseudomonas aeruginosa (10%), followed by Mycoplasma pneumoniae (9.4%), and Streptococcus pneumoniae (5.1%), whereas the most commonly identified viruses were rhinovirus (11%) and influenza A (11%). During AE-COPD, bacteria were more frequently identified in the ICS than non-ICS group (p = 0.009), and in the systemic steroid than non-systemic steroid group (p < 0.001). In patients who used systemic steroids before AE-COPD, the risk of detecting Pseudomonas aeruginosa was significantly higher during AE-COPD (OR 1.619, CI 1.007–2.603, p = 0.047), but ICS use did not increase the risk of Pseudomonas detection. The risk of respiratory syncytial virus (RSV) detection was low when ICS was used (OR 0.492, CI 0.244–0.988, p = 0.045). COPD patients who used ICS had a lower rate of RSV infection and similar rate of P. aeruginosa infection during AE-COPD compared to patients who did not use ICS. However, COPD patients who used systemic steroids within 6 months before AE-COPD had an increased risk of P. aeruginosa infection. Therefore, anti-pseudomonal antibiotics should be considered in patients with AE-COPD who have used systemic steroids. Full article
(This article belongs to the Special Issue Clinical Advances in Chronic Obstructive Pulmonary Disease and Its Complications)
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12 pages, 1199 KiB  
Article
Chronic Bronchitis Affects Outcomes in Smokers without Chronic Obstructive Pulmonary Disease (COPD)
by Alvise Casara, Graziella Turato, Marta Marin-Oto, Umberto Semenzato, Davide Biondini, Mariaenrica Tinè, Nicol Bernardinello, Elisabetta Cocconcelli, Pablo Cubero, Elisabetta Balestro, Paolo Spagnolo, Josè M. Marin, Manuel G. Cosio, Marina Saetta and Erica Bazzan
J. Clin. Med. 2022, 11(16), 4886; https://doi.org/10.3390/jcm11164886 - 20 Aug 2022
Cited by 1 | Viewed by 3198
Abstract
Background. Chronic bronchitis (CB) importantly affects outcomes in smokers with COPD, but the effects on smokers without COPD are less well known and less emphasized. The aim of our study was to investigate the possible effects of CB on clinical outcomes in smokers [...] Read more.
Background. Chronic bronchitis (CB) importantly affects outcomes in smokers with COPD, but the effects on smokers without COPD are less well known and less emphasized. The aim of our study was to investigate the possible effects of CB on clinical outcomes in smokers without COPD (noCOPD) and compare them with the effects in smokers with COPD (COPD). Methods. For that purpose, we studied 511 smokers, 302 with and 209 without COPD, followed for 10 years in an academic COPD ambulatory setting. Chronic bronchitis was defined as the presence of cough and sputum production for at least 3 months in each of two consecutive years. All subjects underwent clinical and functional examination with spirometry, diffusion capacity (DLco), 6-min walking test (6MWT), mMRC Dyspnoea Scale, COPD Assessment Test (CAT), and recording of annual frequency of exacerbations. All-cause mortality during follow-up was recorded. Results. 27% of noCOPD and 45% of COPD had CB. noCOPD with CB had lower FEV1 and DLco, worse 6MWT, more dyspnoea, a higher number of exacerbations and lower survival than noCOPD without CB. CB did not affect FEV1 decline in noCOPD but it significantly did in COPD. Conclusions. The presence of chronic bronchitis in smokers without COPD will significantly affect symptoms, quality of life, and survival, underlining the importance of recognizing the condition and managing it accordingly. Full article
(This article belongs to the Special Issue Clinical Advances in Chronic Obstructive Pulmonary Disease and Its Complications)
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Review

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45 pages, 5392 KiB  
Review
The AGE-RAGE Axis and the Pathophysiology of Multimorbidity in COPD
by Niki L. Reynaert, Lowie E. G. W. Vanfleteren and Timothy N. Perkins
J. Clin. Med. 2023, 12(10), 3366; https://doi.org/10.3390/jcm12103366 - 9 May 2023
Cited by 11 | Viewed by 4450
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease of the airways and lungs due to an enhanced inflammatory response, commonly caused by cigarette smoking. Patients with COPD are often multimorbid, as they commonly suffer from multiple chronic (inflammatory) conditions. This intensifies the burden [...] Read more.
Chronic obstructive pulmonary disease (COPD) is a disease of the airways and lungs due to an enhanced inflammatory response, commonly caused by cigarette smoking. Patients with COPD are often multimorbid, as they commonly suffer from multiple chronic (inflammatory) conditions. This intensifies the burden of individual diseases, negatively affects quality of life, and complicates disease management. COPD and comorbidities share genetic and lifestyle-related risk factors and pathobiological mechanisms, including chronic inflammation and oxidative stress. The receptor for advanced glycation end products (RAGE) is an important driver of chronic inflammation. Advanced glycation end products (AGEs) are RAGE ligands that accumulate due to aging, inflammation, oxidative stress, and carbohydrate metabolism. AGEs cause further inflammation and oxidative stress through RAGE, but also through RAGE-independent mechanisms. This review describes the complexity of RAGE signaling and the causes of AGE accumulation, followed by a comprehensive overview of alterations reported on AGEs and RAGE in COPD and in important co-morbidities. Furthermore, it describes the mechanisms by which AGEs and RAGE contribute to the pathophysiology of individual disease conditions and how they execute crosstalk between organ systems. A section on therapeutic strategies that target AGEs and RAGE and could alleviate patients from multimorbid conditions using single therapeutics concludes this review. Full article
(This article belongs to the Special Issue Clinical Advances in Chronic Obstructive Pulmonary Disease and Its Complications)
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19 pages, 1444 KiB  
Review
The Pleiotropic Role of Vitamin K in Multimorbidity of Chronic Obstructive Pulmonary Disease
by Ianthe Piscaer, Rob Janssen, Frits M. E. Franssen, Leon J. Schurgers and Emiel F. M. Wouters
J. Clin. Med. 2023, 12(4), 1261; https://doi.org/10.3390/jcm12041261 - 5 Feb 2023
Cited by 9 | Viewed by 5880
Abstract
Although defined by the presence of airflow obstruction and respiratory symptoms, patients with chronic obstructive pulmonary disease (COPD) are characterized by multimorbidity. Numerous co-occurring conditions and systemic manifestations contribute to the clinical presentation and progression of COPD; however, underlying mechanisms for multimorbidity are [...] Read more.
Although defined by the presence of airflow obstruction and respiratory symptoms, patients with chronic obstructive pulmonary disease (COPD) are characterized by multimorbidity. Numerous co-occurring conditions and systemic manifestations contribute to the clinical presentation and progression of COPD; however, underlying mechanisms for multimorbidity are currently not fully elucidated. Vitamin A and vitamin D have been related to COPD pathogenesis. Another fat-soluble vitamin, vitamin K, has been put forward to exert protective roles in COPD. Vitamin K is an unequivocal cofactor for the carboxylation of coagulation factors, but also for extra-hepatic proteins including the soft tissue calcification inhibitor matrix Gla-protein and the bone protein osteocalcin. Additionally, vitamin K has been shown to have anti-oxidant and anti-ferroptosis properties. In this review, we discuss the potential role of vitamin K in the systemic manifestations of COPD. We will elaborate on the effect of vitamin K on prevalent co-occurring chronic conditions in COPD including cardiovascular disorders, chronic kidney disease, osteoporosis, and sarcopenia. Finally, we link these conditions to COPD with vitamin K as a connecting factor and provide recommendations for future clinical studies. Full article
(This article belongs to the Special Issue Clinical Advances in Chronic Obstructive Pulmonary Disease and Its Complications)
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