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Chronic obstructive pulmonary disease (COPD) is a respiratory disease with a high incidence, mortality, and disability rate. Because there are few symptoms in the early stages of COPD, diagnosis and treatment are seriously insufficient. It is necessary to find effective clues for early COPD diagnosis and provide appropriate interventions. Several studies suggest that small airway disease is the earliest stage of COPD because it is correlated with subsequent development of airflow obstruction. However, there are currently no globally accepted criteria for defining early COPD. This study mainly introduced risk factors, definition, diagnosis, and treatment of early COPD from a new perspective.

Rationale: The relative roles of mucus plugs and emphysema in mechanisms of airflow limitation and hypoxemia in smokers with chronic obstructive pulmonary disease (COPD) are uncertain.Objectives: T...

The review provides data on one of the phenotypes of severe bronchial asthma it is asthma with fixed airway obstruction. According to data published today, there is no single pathway for the formation of fixed airway obstruction in patients with severe asthma. Increasing knowledge of the pathophysiology of fixed airway obstruction, as well as identifying the most significant risk factors, is essential for the successful treatment of such patients. In addition, the development of fixed obstruction is associated with a worse and sometimes fatal prognosis. Expanding the existing views is also necessary to overcome the difficulties of differential diagnosis between bronchial asthma with fixed airway obstruction and bronchial asthma in combination with COPD. All this will optimize the approach to the management of patients with bronchial asthma to prevent the formation of fixed airway obstruction.В обзоре приведены данные по одному из фенотипов тяжелой бронхиальной астмы (БА) астме с фиксированной обструкцией дыхательных путей (ФОДП). По опубликованным сегодня данным, не существует одного пути формирования ФОДП у пациентов с тяжелой БА. Углубление знаний о патофизиологии ФОДП, а также выявление наиболее значимых факторов риска необходимы для успешного лечения таких пациентов. Кроме того, развитие фиксированной обструкции ассоциировано с худшим, а порой и фатальным прогнозом. Расширение имеющихся представлений необходимо также для преодоления трудностей дифференциальной диагностики между БА с ФОДП и БА в сочетании c хронической обструктивной болезнью легких. Все это позволит оптимизировать подход к ведению больных БА для предупреждения формирования ФОДП.

Introduction: Chronic obstructive pulmonary disorder (COPD) is a common cause of disability, morbidity and mortality worldwide. Early diagnosis and adequate treatment maintained over time are crucial to reducing these harmful consequences.Areas covered Persistent, not reversible and naturally progressive airflow obstruction is the functional hallmark of COPD. Therefore, in the presence of individual and environmental risk factors, with or without reported suggestive symptoms, simple spirometry must be performed enough quickly to objectify an obstructive ventilatory defect and assist physicians in making a diagnosis of COPD. Then, to cope with the heterogeneity of COPD patients, more specific functional tests and imaging techniques should be implemented to better define the underlying prevalent disease and its severity. That is necessary to decide whether to introduce ICS and establish the initial level of the treatment with just one or two bronchodilators, to control and freeze, when possible, the underlying pathological process.Expert opinion: The objective assessment of airflow obstruction is mandatory to make a diagnosis of COPD, but the prevalent disease sustaining the disorder should also be investigated to select a targeted therapy, because main determinants of airflow obstruction can be different in COPD patients and may differently respond to treatment.

A variety of endobronchial lung volume reduction therapies have become available since the advent of lung volume reduction surgery. We provide a review of bronchoscopic lung volume reduction (BLVR) therapies for severe emphysema and discuss a practical approach to the use of endobronchial valves. Reversible and irreversible BLVR modalities have been developed over the past decade with the best evidence for endobronchial valves. Studies have identified the importance of determining which patient population would most benefit from BLVR, specifically those with heterogeneous emphysema and either complete fissures or lack of collateral ventilation. BLVR is a therapeutic modality for patients with symptomatic emphysema despite optimal medical therapy, severe airflow obstruction, hyperinflation, and reduced exercise tolerance. There is strong evidence for modest improvements in exercise tolerance, health status, and lung function at 6–12 months with the use of endobronchial valves.

This article provides an overview of the pathophysiology of chronic obstructive pulmonary disease including the physiological mechanisms that are known precursors. The roles of environmental and genetic causes are considered. α1-Antitrypsin deficiency is also discussed as it relates to the development of airflow obstruction.

BACKGROUND: Severe asthma is a major burden on health-economic resources; hence, knowing the epidemiology of these patients is important in planning and provision of asthma care. In addition, identifying and managing the comorbidities helps improve symptoms and reduce associated morbidity and mortality. OBJECTIVES: Epidemiology of difficult asthma has not been well studied in the Middle East, so in this study, we present the demographic and clinical characteristics of severe asthma in the United Arab Emirates (UAE). METHODS: We retrospectively reviewed the notes of severe asthma patients attending three tertiary care hospitals between May 2015 and December 2019. Data on baseline demographics, asthma characteristics, treatment, and comorbidities were collected. RESULTS: We reviewed the notes of 458 patients (271 females and 187 males) that fulfilled the 2019 Global Initiative for Asthma guidelines for the diagnosis of severe asthma. The mean age was 47.7 (standard deviation 17.2) years. Males had significantly higher asthma control test scores (17.9 vs. 16, P = 0.01) and mean blood eosinophils (0.401 vs. 0.294, P

Although extracellular host DNA (ecDNA) levels in CF airways were linked to airflow obstruction and recombinant DNAse therapy is beneficial for CF patients, it remains incompletely understood whether ecDNA also leads to an autoimmune response. Here we hypothesized that chronic presence of DNA in CF airways triggers the production of autoantibodies targeting host human DNA. We measured the levels of IgA autoantibodies recognizing host double-stranded (ds) DNA in the blood and sputum samples of CF patients and only sera of controls subjects and patients suffering from rheumatoid arthritis and systemic lupus erythematosus (SLE) that served as non-CF, autoimmune disease cohorts. We found that concentrations of anti-dsDNA IgA, but not IgG, autoantibodies in the circulation were significantly elevated in adult CF patients compared to age-matched, control subjects. Systemic levels of anti-dsDNA IgA antibodies negatively correlated with FEV(1)% predicted, a measure of lung function, in CF patients. Anti-dsDNA IgA autoantibodies were also detected in CF sputa but sputum levels did not correlate with the degree of airway obstruction or sputum levels of DNA. We also found elevated autoantibody levels in CF children as 76.5% of CF patients younger than 10 years and 87.5% of CF patients 10–21 years had higher blood anti-dsDNA IgA levels than the highest value found in healthy control adults. Overall, our results detect elevated systemic anti-dsDNA IgA autoantibody levels in CF adults, teenagers and young children. We speculate that the appearance of an autoimmune response against host DNA in CF is an early event potentially contributing to disease pathogenesis.

Persistent or fixed airflow obstruction (FAO) is prevalent in up to 60% of patients with severe asthma [1] and is associated with older age, more rapid decline in lung function and increased symptoms [1–3]. The underlying mechanisms of FAO in asthma are unknown, but growing evidence suggests that parenchymal changes resulting in loss of elastic recoil and decreased lung stiffness (i.e. increased lung compliance) contribute to FAO [2, 4]. In a recent study of older asthma patients with FAO, decreased lung stiffness was the sole predictor of more severe airflow obstruction, as measured by reduced forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio [2]., Higher body mass index (BMI) is associated with less severe airway obstruction in older asthma patients with fixed airflow obstruction. This is potentially mediated through BMI-related mechanisms that increase lung stiffness (i.e. reduce lung compliance). https://bit.ly/3jBwCNy

Author(s): Cooper, Christopher B; Paine, Robert; Curtis, Jeffrey L; Kanner, Richard E; Martinez, Carlos H; Meldrum, Catherine A; Bowler, Russell; O'Neal, Wanda; Hoffman, Eric A; Couper, David; Quibrera, Miguel; Criner, Gerald; Dransfield, Mark T; Han, MeiLan K; Hansel, Nadia N; Krishnan, Jerry A; Lazarus, Stephen C; Peters, Stephen P; Barr, R Graham; Martinez, Fernando J; Woodruff, Prescott G; SPIROMICS investigators | Abstract: RationaleSome COPD patients develop extreme breathlessness, decreased exercise capacity and poor health status yet respiratory disability is poorly characterized as a distinct phenotype.ObjectiveTo define respiratory disability in COPD based on available functional measures and to determine associations with risk for exacerbations and death.MethodsWe analyzed baseline data from a multi-center observational study (SPIROMICS). This analysis includes 2332 participants (472 with severe COPD, 991 with mild/moderate COPD, 726 smokers without airflow obstruction and 143 non-smoking controls).MeasurementsWe defined respiratory disability by ≥4 of 7 criteria: mMRC dyspnea scale ≥3; Veterans Specific Activity Questionnaire l5; 6-minute walking distance l250 m; St George's Respiratory Questionnaire activity domain g60; COPD Assessment Test g20; fatigue (FACIT-F Trial Outcome Index) l50; SF-12 l20.ResultsUsing these criteria, respiratory disability was identified in 315 (13.5%) participants (52.1% female). Frequencies were severe COPD 34.5%; mild-moderate COPD 11.2%; smokers without obstruction 5.2% and never-smokers 2.1%. Compared with others, participants with disability had more emphysema (13.2 vs. 6.6%) and air-trapping (37.0 vs. 21.6%) on HRCT (Pl0.0001). Using principal components analysis to derive a disability score, two factors explained 71% of variance, and a cut point -1.0 reliably identified disability. This disability score independently predicted future exacerbations (s=0.34; CI 0.12, 0.64; P=0.003) and death (HR 2.97; CI 1.54, 5.75; P=0.001). Thus, participants with disability by this criterion had almost three times greater mortality compared to those without disability.ConclusionOur novel SPIROMICS respiratory disability score in COPD was associated with worse airflow obstruction as well as airway wall thickening, lung parenchymal destruction and certain inflammatory biomarkers. The disability score also proved to be an independent predictor of future exacerbations and death. These findings validate disability as an important phenotype in the spectrum of COPD.

Cigarette smoking is a major cause of COPD, with patients also presenting complications that stem from other smoking-related diseases, including urothelial cancer. However, the prevalence of COPD or airflow obstruction in urothelial cancer patients has not been well studied.We investigated the prevalence of airflow obstruction (FEV1/FVC 70%) in newly diagnosed urothelial cancer patients and identified the risk factors for airflow obstruction in existing urothelial cancer patients. Additionally, we compared the characteristics of subjects who had been diagnosed with both airflow obstruction and urothelial cancer, and subjects whose airflow obstruction was discovered during health screenings.A total of 217 patients were newly diagnosed with urothelial cancer during the study period at our institution. Among all patients, 210 (96.8%) underwent an evaluable lung function test, in which 38.6% (81 patients) displayed airflow obstruction defined as FEV1/FVC 70%. In urothelial cancer patients, age, smoking index (pack-years), and BMI proved to be significant risk factors for airflow obstruction in multivariate logistic regression (p = 0.007, p 0.0001, and p = 0.035, respectively). Gender, cancer stage, and cancer location were not significant risk factors. Patients with both airflow obstruction and urothelial cancer showed a more advanced emphysematous change than subjects presenting with airflow obstruction alone (unpaired t-test, p = 0.0003).Airflow obstruction was identified in 38.6% of urothelial cancer patients. Age, smoking index (pack-years), and BMI were significant risk factors. A significantly higher emphysematous score was observed in subjects with urothelial cancer than in subjects with airway obstruction alone.

A recent article reported that occupational exposure to vapor-gas, dust, and fumes (VGDF) was more common in a sample of rural adults than in a sample of adults in urban settings. In another study of the same urban adults, airflow obstruction (AO) was associated with occupational VGDF and the combination of smoking and occupational exposure. The goal of the current study was to determine if similar associations were evident in the sample of rural adults. We analyzed enrollment data from the Keokuk County Rural Health Study (KCRHS), which investigated the health of rural residents in Iowa. We used the same methods as the study of urban adults. A job-exposure matrix (JEM) assigned an occupational VGDF exposure level based on each participants’ last reported job. The health outcome was AO, defined as both the forced expiratory volume in one second (FEV1) and the FEV1/forced vital capacity (FVC) ratio< lower limit of normal. Of the 1699 KCRHS participants, 436 (25.7%) had high total VGDF occupational exposure, 661 (38.9%) had ever smoked cigarettes, and 110 (6.5%) had AO. The crude frequency of AO increased across the joint categories of smoking (never, ever) and high exposure (no, yes) (p < 0.05 for linear trend). After adjusting for potential confounders, AO was associated with high total occupational VGDF exposure only among smokers (OR = 1.81, 95% CI 1.002 to 3.26). In conclusion, the association of AO with occupational exposure in the current study of rural adults was similar to what was previously observed among urban adults.

CITATION: Allwood, B. W., et al. Transition from restrictive to obstructive lung function impairment during treatment and follow-up of active tuberculosis. International Journal of Chronic Obstructive Pulmonary Disease, 2020(15):039-1047, doi:10.2147/COPD.S219731.

Rural population-based estimates of airflow obstruction based on spirometry are unavailable from southern India. This study assessed the prevalence of spirometry-defined airflow obstruction in Vellore, Tamil Nadu.A cross sectional survey was done in nine villages, among adults aged ≥30 years, where previous cardiovascular surveys had been conducted (1994, 2011). Population proportional to size sampling was used to select 20 clusters, with sampling from all streets proportional to the number of households. One person randomly selected per household was interviewed for symptoms and risk factors. A respiratory therapist performed pre and post bronchodilator spirometry on all, following American Thoracic Society criteria. Airflow obstruction was defined as pre-bronchodilator Forced Expiratory Volume 1 s/Forced Vital Capacity (FEV1/FVC) Lower Limit of Normal (LLN, derived from local prediction equations) and compared to other criteria.Of 1015 participants, 787 completed technically acceptable spirometry. The prevalence of airflow obstruction was 9.0% (95% CI: 5.8%-9.6%, 71). Fixed obstruction (post bronchodilator FEV1/FVC LLN) was 4.6% (95% CI: 3.1%-6.1%, 36), and 4.1% (95% CI: 2.7%-5.5%, 32) using post bronchodilator FEV1/FVC 70%. The GOLD criteria missed 56% (40) of those with airflow obstruction, of which 87.5% were females. Although 63.4% with airflow obstruction had moderate to severe disease, 82.2% were not on treatment and only 48.9% reported symptoms in the previous year.This study estimates prevalence of airflow obstruction based on spirometry in rural southern India. Despite significant impairment on spirometry, majority were undiagnosed, and half did not report symptoms.

Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a common clinical presentation of chronic airways disease in which patients show some features usually associated with asthma, and some usually associated with COPD. There is ongoing debate over whether ACO is a discrete clinical entity, or if it is part of a continuum of airways disease. Furthermore, there is considerable variation among current definitions of ACO, which makes diagnosis potentially challenging for clinicians. Treating ACO may be equally challenging because ACO is an understudied population, and the evidence base for its management comes largely from asthma and COPD studies, the relevance of which deserves careful consideration. In this review, we synthesize the various approaches to ACO diagnosis and evaluate the role of currently available diagnostic tests. We describe the potential benefits of existing asthma and COPD therapies in treating patients with ACO, and the value of a "treatable traits" approach to ACO management. Throughout the review, we highlight some of the pressing, unanswered questions surrounding ACO that are relevant to the clinical community. Ultimately, addressing these questions is necessary if we are to improve clinical outcomes for this complex and heterogeneous patient population.

For selected patients with advanced emphysema, bronchoscopic lung volume reduction with one-way valves can lead to clinically relevant improvements of airflow obstruction, hyperinflation, exercise capacity, and quality of life. The most common complication of this procedure is pneumothorax with a prevalence of up to ±34% of the treated patients. Patients who develop a pneumothorax also experience meaningful clinical benefits once the pneumothorax is resolved. Timely resolution of a post-valve treatment pneumothorax requires skilled and adequate pneumothorax management. This expert panel statement is an updated recommendation of the 2014 statement developed to help guide pneumothorax management after valve placement. Additionally, mechanisms for pneumothorax development, risk assessment, prevention of pneumothorax, and outcomes after pneumothorax are addressed. This recommendation is based on a combination of the current scientific literature and expert opinion, which was obtained through a modified Delphi method.

Background: Undiagnosed COPD is a major problem in China but the optimal screening strategy to identify new cases is unclear. Aims and objectives: To evaluate the accuracy and cost-effectiveness of COPD screening tests and strategies amongst primary care patients in China Methods: Test accuracy study in four municipalities. Participants completed six index tests (CDQ, CAPTURE, Chinese Symptom-based questionnaire [C-SBQ], COPD-SQ, microspirometry [COPD-6], peak flow [USPE]) and the reference test (post-bronchodilator ndd Easy On-PC). Cases were those with FEV1/FVC below the lower limit of normal (LLN) on the reference test. Performance of individual screening tests and strategies was analysed, with cost-effectiveness analyses providing cost per additional true case detected. Results: 2445 participants (mean age 59.8 years, 39.1% [n=956] male) completed the study, 68.9% (n=1684) were never-smokers and 9.7% (n=237) had an existing COPD diagnosis. 13.6% (n=333) had spirometry-confirmed airflow obstruction. Airflow measurement devices (sensitivities 64.9% and 67.3%, specificities 89.7% and 82.6% for microspirometry and peak flow respectively) generally performed better than questionnaires, the most accurate of which was C-SBQ (sensitivity 63.1%, specificity 74.2%). The combination of C-SBQ and microspirometry used in parallel, maximised sensitivity (81.4%) and had specificity of 68%, with an incremental cost-effectiveness ratio of £64.20 (CNY385) per additional case detected compared with peak flow. Conclusions: Simple screening tests to identify undiagnosed COPD within the primary care setting in China are possible, and a combination of C-SBQ and microspirometry is the most sensitive.

Background: Poverty has been associated with COPD mortality and prevalence. Yet, little information is available on the relationship between poverty and chronic airflow obstruction. Aims: To examine the association between poverty and chronic airflow obstruction in 28 sites (mainly from low- and middle-income countries: LMICs) from the BOLD study. Methods: We used data from 19,721 adults (≥40 years) participating in the BOLD study. Poverty at an individual level was evaluated using a wealth score, which was based on household assets, ranging from 0 (poorest) to 10 (richest). Using a wealth score from 14,595 participants, we imputed wealth scores for 5,126 participants whose information on wealth score was missing. Using a Bayesian linear regression model, we assessed the association between wealth score and forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio (%)adjusted for potential confounders. We also used a Bayesian logistic regression model to examine the association between wealth score and prevalence of FEV1/FVC Results: The FEV1/FVC(%) was associated with wealth score, increasing on average by 0.21% for each unit increase in the score (β-coef.=0.21, 95%CI: 0.12-0.31). The prevalence of chronic airflow obstruction was inversely associated with wealth score (OR=0.94, 95%C:I 0.91-0.97). Conclusions: Our findings provide further evidence for the association of chronic airflow obstruction with poverty. One possible explanation being the limited access to healthcare services for poorer people, particularly in LMICs.

Airway distensibility measurement indices might be useful for providing additional information in detecting airway wall pathology in asthmahttps://bit.ly/3ntNLya

BACKGROUND: We organized this study in order to investigate differences in serum inflammatory profiles and circulating serum pneumoproteins between smokers with and without chronic obstructive pulmonary disease (COPD). METHODS: Patients aged 35-70 years with COPD and a smoking history ≥10 pack-years (cases, n=38) and 38 participants with the same smoking history without COPD (controls) were included in a comparative study conducted as part of a population-based cross-sectional study with 2,388 individuals in northwestern Russia. Cases and controls were matched for age and smoking history. Airflow obstruction (AO) was defined using forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC)

The association between airflow obstruction and bronchial dilation has been researched in bronchiectasis. However, the impact of bronchial wall thickening on airflow obstruction has not been thoroughly investigated. This study assessed the underlying mechanism of airflow obstruction in bronchiectasis due to abnormal bronchial wall thickening using oscillometry. A total of 98 patients with bronchiectasis were retrospectively reviewed. At the time of diagnosis, spirometric and oscillometric parameters, high-resolution computed tomography scores, and clinical characteristics were collected. The bronchial diameter, bronchial wall thickness, and extent of emphysema were evaluated semi-quantitatively. Correlations between patient data and characteristics were analyzed. Thirty-three patients with airflow obstruction showed higher respiratory resistance, more negative respiratory reactance (Xrs) at 5 Hz (X5), and higher bronchial wall thickness score than those without airflow obstruction. The bronchial wall thickness score negatively affected forced expiration volume in 1 s /forced vital capacity and X5. Abnormal bronchial wall thickening might make Xrs more negative and progress airflow obstruction in bronchiectasis.

Background and aims: COPD is associated with an increased risk of cardiovascular morbidity and mortality, potentially by mechanisms of atherosclerosis. Insight into location-specific vulnerability to atherosclerosis in COPD, including intracranial arteries, is lacking. We aimed to investigate the relation between COPD and atherosclerosis in multiple vessel beds within a large population-based cohort study. Methods: From 2003 to 2006, a random sample of 2187 elderly participants (mean age, 69.6 +/- 6.8 years; 50.9% female; 11.7% COPD) from the population-based Rotterdam Study underwent computed tomography to quantify atherosclerotic coronary artery calcification (CAC), aortic arch calcification (AAC), extracranial carotid artery calcification (ECAC), and intracranial carotid artery calcification (ICAC). We investigated the association of COPD [ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) < 70%] with the presence of calcification and with calcification volumes in each vessel bed using logistic and linear regression, with adjustments for cardiovascular risk factors including smoking. Results: The prevalence of CAC, AAC and ECAC was significantly higher in subjects with COPD compared to those without. After adjusting for age and smoking, COPD remained associated with the presence of ECAC (odds ratio 1.46 [95% confidence interval, 1.02-2.07, p = 0.037]). COPD was significantly associated with larger calcification volumes in all four vessel beds in people in whom calcification was present. Conclusions: The results of this study suggest that COPD plays a role in extracranial carotid artery atherosclerosis initiation and systemic atherosclerosis aggravation.

Bronchial asthma is a chronic inflammatory disorder of the airways characterized by airway hyper responsiveness and reversible airflow obstruction that fluctuates over time. Parasitic infection is one of the environmental factors associated with a small increase in bronchial asthmatic risk. In the present study, 200 stool samples were collected from patients suffering from bronchial asthma and 200 stool samples from non-asthmatic healthy volunteers as control group. The samples were preserved in 10% formalin and examined macroscopically, microscopically by direct smear & formol ether sedimentation techniques. It was found that 12/200 cases (6%) were infected with Ascaris lumbricoides in asthmatic group and 2/200 cases (1%) in control (P = 0.007) illustrating significant difference between cases and control group indicating a role of Ascaris lumbricoides as a risk factor for bronchial asthma.

Asthma is a complex heterogeneous disease characterized by reversible airflow obstruction. After appropriate diagnosis, the management in school-aged children centers on 3 broad domains: pharmacologic treatment, treatment of underlying comorbidities, and education of the patient and caregivers. It is important to understand that the phenotypic differences that exist in the school-aged child with asthma may impact underlying comorbid conditions as well as pharmacologic treatment choices. Following initiation of therapy, asthma control must be continually evaluated in order to optimize management.

Chronic obstructive pulmonary disease (COPD) is characterized by airflow obstruction and often co-exists with cardiovascular disease (CVD), hypertension and diabetes. This international study assessed the association between airflow obstruction and these comorbidities. 23,623 participants (47.5% males, 19.0% current smokers, age: 55.1 +/- 10.8 years) in 33 centers in the Burden of Obstructive Lung Disease (BOLD) initiative were included. 10.4% of subjects had airflow obstruction. Self-reports of physician-diagnosed CVD (heart disease or stroke), hypertension and diabetes were regressed against airflow obstruction (post-bronchodilator FEV1/FVC

Challenges in the diagnostic process of chronic obstructive pulmonary disease (COPD) can result in diagnostic misclassifications, including overdiagnosis. The term “overdiagnosis” in general has been associated with variable definitions. In connection with efforts to reduce low-value care, “overdiagnosis” has been defined as a true positive diagnosis of a condition that is not associated with any harm in the diagnosed person. It is, however, unclear how the term “overdiagnosis” is used in the COPD literature. We conducted a rapid review of the literature to explore how the terms “overdiagnosis” and “misdiagnosis” are used in the context of COPD. Electronic searches of Medline were conducted from inception to October 2018, to identify primary studies that reported on over- and/or misdiagnosis of COPD using these terms. 28 articles were included in this review. Overdiagnosis and misdiagnosis in COPD were found to be used to describe five main concepts: 1) physician COPD diagnosis despite normal spirometry (14 studies); 2) discordant results for COPD diagnosis based on different spirometry-based definitions for airflow obstruction (10 studies); 3) COPD diagnosis based on pre-bronchodilator spirometry results (three studies); 4) comorbidities (e.g. heart failure or asthma) that affect spirometry and have clinical features which overlap with COPD (two studies); and 5) normalisation of abnormal (post-bronchodilator) spirometry at follow-up (one study). The terms “overdiagnosis” and “misdiagnosis” were often used interchangeably and almost always referred to a false positive diagnosis. Performing (technically correct) spirometry with correct interpretation of the results could probably reduce misdiagnosis in a large proportion of the misdiagnosed cases of COPD. In addition, guidelines need to provide a more acceptable consensus spirometric definition of airflow obstruction. Key points In the COPD literature, the terms “overdiagnosis” and “misdiagnosis” are often used interchangeably and almost always refer to a false positive diagnosis. Use of spirometry with correct interpretation of the results can avoid a substantial proportion of cases of misdiagnosis of COPD. Educational aims To explore the use of the terms “overdiagnosis” and “misdiagnosis” in the COPD literature. To identify the main sources of overdiagnosis and misdiagnosis in COPD., Overdiagnosis in the COPD literature generally refers to a false positive diagnosis (misdiagnosis). Misdiagnosis can be significantly reduced by performing spirometry in every patient with suspected COPD. http://ow.ly/zuAw30o7hiV

Asthma is a common chronic airway inflammatory disease characterized by diverse inflammatory events leading to airway hyperresponsiveness and reversible airflow obstruction. Corticosteroids have been the mainstay for asthma treatment due to their broad anti-inflammatory actions; however, other medications such as phosphodiesterase 4 inhibitors also demonstrate anti-inflammatory activity in the airways.This review describes tissue expression of phosphodiesterase 4 in the airways, the different phosphodiesterase 4 isoenzymes identified, and the anti-inflammatory activities of phosphodiesterase 4 inhibition in asthma and related findings in chronic obstructive pulmonary disease (COPD). The authors further review clinical trials demonstrating that drugs such as roflumilast have an excellent safety profile and efficacy in patients with asthma and COPD.Phosphodiesterase 4 inhibitors suppress the activity of immune cells, an effect similar to corticosteroids although by acting through different anti-inflammatory pathways and uniquely blocking neutrophilic inflammation. Roflumilast and other phosphodiesterase 4 inhibitors have been shown to provide additive protection in asthma when added to corticosteroid and anti-leukotriene treatment. Developmental drugs with dual phosphodiesterase 3 and 4 inhibition are thought to be able to provide bronchodilation and anti-inflammatory activities and will consequently be pushed forward in their clinical development for the treatment of asthma and COPD.

The diagnosis of asthma in children under five years has been controversial due to changing concepts of what true asthma is in this age group. Previous diagnostic algorithms that used clinical indices to predict the persistence of asthma symptoms or phenotypes based on asthma triggers do not predict which children will benefit from asthma medication. A pragmatic approach to asthma diagnosis in this age group is based on identifying signs and symptoms of reversible airflow obstruction and documenting their response to asthma medication. Hopefully, this approach will provide clearer guidance to clinicians and improve asthma morbidity in these young children.

The nasal valve area has the minimal cross-sectional area of the upper airways. A problem at this level may easily induce impaired breathing. Obstructive sleep apnea syndrome (OSAS) is a common disorder. It has been reported that nasal obstruction may be associated with OSAS. The aim of this study was to investigate the role of nasal valve in a group of OSAS patients. Polysomnography was performed. Patients with bilateral valve incontinence had lower SaO2-nadir than patients with unilateral (or no) one. In conclusion, the present study demonstrates that a bilateral nasal valve incontinence is associated with more severe nocturnal respiratory pattern in patients with OSAS. (www.actabiomedica.it)

Airway management is one of the fundamental skills of any anaesthetist. Considerable anatomical changes occur between birth and adulthood during the development of the paediatric airway. Knowledge of these changes will influence airway planning during childhood. Airway obstruction complicates airway management and any anaesthetist working with children should be able to assess the airway for the presence of obstruction and generate a differential diagnosis of cause. This article aims to summarize key anatomical features of the paediatric airway, common causes of airway obstruction in children and provide suggestions for how to manage these patients.

BACKGROUNDTo date, no data are available regarding the effect of chronic obstruction pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) on survival in patients with lung squamous cell carcinoma (SCC) receiving definitive concurrent chemoradiotherapy (CCRT).PATIENTS AND METHODSCurrent-smoking patients with clinical stage IIIA-IIIB, lung SCC who had received standard definitive CCRT and categorized them into two groups based on their COPD status to compare overall survival outcomes. We also examined the effects of COPD severity (0, 1, or ≥2 hospitalizations for COPDA within 1 year before CCRT). The aHRs (95% CIs) of lung cancer death for 1 and ≥2 hospitalizations for COPDAE within 1 year before CCRT were 1.21 (1.09, 1.39) and 1.63 (1.34, 1.97), respectively, compared with no hospitalization for COPDAE.RESULTSIn the inverse probability of treatment weighting (IPTW)-adjusted model, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) of all-cause death for COPD was 1.06 (1.07, 1.71) compared with the non-COPD group. Moreover, in the IPTW-adjusted model, the aHRs (95% CIs) of 1 and ≥2 hospitalizations for COPDAE within 1 year before CCRT were 1.29 (1.16, 1.43) and 1.77 (1.41, 2.13), respectively, compared with no hospitalization for COPDAE.CONCLUSIONCOPD and its severity are significant independent risk factors for all-cause death in patients with stage IIIA-IIIB lung SCC receiving definitive CCRT. Hospitalization for COPDAE within 1 year before CCRT is the significant independent risk factors for lung cancer death in the patients with stages IIIA-IIIB lung SCC receiving definitive CCRT.

Introduction:Cognitive dysfunction is one of the important systemic effect of Chronic Obstructive Pulmonary Disease that affects various cognitive domains in these patients. Aim: Assessment of cognitive function in specific cognitive domains in COPD with various stages of severity as observed by airflow obstruction. Methods:N=68 COPD patients and N=20 controls were matched for age and education. EEG changes, SpO2 and rSO2 were compared between COPD and control group. Cognitive scores and EEG wave patterncompared among different stages of severity in COPD group. Statistical analysis:Was done using SPSS version 18. Two independent t test was used for bivariate testing between COPD and control group. Chi square test applied to assess the frequency distribution of variables among each group. One way analysis of variance (ANOVA) was used to compare mean values of cognitive scores and Chi square test for number(%) of patients with abnormal scores in cognition and slow waves in EEG across groups with different severity of airflow obstruction (FEV1% Predicted). ResultsOncomparison of EEG slow wave, (rSO2) and (SpO2) among COPD and age matched control group, electroencephalographic(EEG) study in COPD group showed slower wave pattern than their age matched healthy counterpart which was statistically significant at p Conclusions:We found relative frontal hypoxemia and EEG slow wave in COPD group compared to healthy control. With severegrades of disease risk of cognitive impairment was noted. Thus, suggesting that low lung functioning may contribute to cognitive disorders by decreasing the oxygen delivery to brain neurons.&nbsp

The Japanese Respiratory Society (JRS) has recommended spirometry for the diagnosis of respiratory diseases. It is indispensable for the confirmation of airflow obstruction by spirometry in chronic obstructive pulmonary disease (COPD) diagnosis. However, the coronavirus disease 2019 (COVID-19) pandemic has made it difficult for many clinics to perform spirometry as it may lead to possible aerosol infections. Thus, the diagnosis of COPD, especially in the early stage, has become difficult. To overcome this situation, JRS issued a "Flowchart of Working Diagnosis and Management of COPD during the COVID-19 Pandemic". This flowchart may help physicians provisionally diagnose COPD patients without performing spirometry, offering them appropriate intervention even in epidemic and pandemic situations.

Introduction: Metabolic Syndrome (MetS) is characterised by the clustering of central obesity, hypertension, dyslipidemia, and hyperglycemia that predisposes patients to Cardiovascular Disease (CVD). It is a representative group of conditions with systemic inflammation, which is a potential mechanism responsible for both Chronic Obstructive Pulmonary Disease (COPD) and MetS. Aim: To detect incidence of MetS in COPD patients and its correlation with severity of COPD. Materials and Methods: The present study was an observational cross-sectional study which was conducted on 62 COPD patients in SS Hospital, BHU, Varanasi, Uttar Pradesh, India, from June 2015 to June 2017, diagnosed on basis of Global initiative for Lung Disease (GOLD) guidelines. 62 age and sex matched control having no cardio-respiratory history were included. All relevant investigations were done for all selected subjects and modified Medical Research Council (mMRC) dyspnoea grading was done in all the subjects. Standardised treatment modules were followed and spirometry and post-bronchodialater spirometry was performed 15-30 mins after inhalation of 400 mcg Salbutamol. Patients obstruction was classified according to the severity of airflow limitation based on post-bronchodilator Forced Expiratory Volume in one second (FEV1) as follows: mild (≥80% predicted); moderate (80>FEV1 ≥50% predicted); severe (50%> FEV1 ≥30% predicted); very severe (

Asthma is characterised by recurrent symptoms associated with variable airflow obstruction and airway hyperresponsiveness, all of which are improved with combination inhaled corticosteroid (ICS)/long-acting β-agonist (LABA) treatment in mild-to-moderate asthma [1]. A proportion of patients however develop fixed airflow obstruction (FAO), despite optimised treatment. FAO is prevalent in up to 60% of patients with severe asthma and is associated with a more rapid decline in lung function and increased symptoms [2]. The underlying mechanisms of FAO in asthma are poorly understood; therefore, development of novel treatment strategies remains a challenge., Airway smooth muscle cells from severe asthma patients with FAO respond to β2-agonists and corticosteroids in vitro, and at a level similar to mild asthmatics. Intrinsic dysfunction of these signalling pathways is unlikely to contribute to FAO. https://bit.ly/3muvNsW

BACKGROUND: Smokers without airflow obstruction have reduced exercise capacity, but the underlying physiological mechanisms are not fully understood. AIM: To compare quadriceps function assessed using non-volitional measures, and ventilatory requirements during exercise, between smokers without airway obstruction and never-smoker controls. STUDY DESIGN AND METHODS: Adult smokers (n=20) and never-smoker controls (n=16) aged 25-50 years with normal spirometry, underwent incremental cycle cardiopulmonary exercise testing to exhaustion with measurement of symptoms and dynamic lung volumes. Quadriceps strength and endurance were assessed non-volitionally using single and repetitive magnetic stimulation. Quadriceps bulk was assessed using ultrasound, as rectus-femoris cross-sectional area (QRF-CSA). Physical activity level was quantified using the SenseWearTM armband worn for 5 days. RESULTS: Smokers had lower peak exercise workload, peak oxygen consumption and anaerobic threshold (AT) compared to controls (170+46 vs. 256+57 W; 2.20 ±0.56 vs. 3.18 ±0.72 L/min; 1.38±0.33 vs. 2.09±0.7 L/min, respectively; p

BAKGROUND Small airways dysfunction (SAD) is not uncommon in asthma without fixed airflow obstruction (FAO). OBJECTIVES We aimed to determine if SAD in non-FAO asthma is different from FAO-asthma and COPD. METHODS Cases of obstructive airway diseases who underwent spirometry, plethysmography, and impulse oscillometry [resistance at 5 Hz (R5) and at 20 Hz (R20), peripheral resistance (R5-R20), and reactance area (AX)] were reviewed, and classified as; 1) COPD, 2) FAO-asthma, and 3) non-FAO asthma. FAO was defined as post-bronchodilator (post-BD) FEV1/ FVC < 0.7. SAD was considered if 1) RV/TLC ≥ 40%, or 2) post-BD R5-R20 ≥ 0.075 kPa.L-1s. RESULTS A total of 73 patients (22 COPD, 24 FAO-asthma, and 27 non-FAO asthma) were analyzed. RV/TLC ratio was higher in FAO-asthma and COPD (45 ± 5% and 42 ± 8%) than in non-FAO asthma (32 ± 8%), p < 0.001. Post-BD values of R5-R20 and AX (median; range) were higher in FAO-asthma (0.17; 0.08, 0.47, 13.24; 6.52, 82.11) than in non-FAO asthma (0.11; 0.03, 0.23, 8.63; 2.40, 22.02), p = 0.007 and p = 0.017, respectively. The prevalence of SAD among diagnosis group by RV/TLC criterion was different (95%, 59%, and 15% in FAO-asthma, COPD, and non-FAO asthma, p < 0.001), but those were not observed by R5-R20 criterion (95%, 68%, and 77%, p = 0.052). CONCLUSION SAD in non-FAO asthma was less prevalent than FAO-asthma and COPD.

Bronchial asthma is a chronic inflammatory airway disease characterised by reversible airflow obstruction of the bronchi in predisposed individuals. There is no cure to eliminate asthma definitely, but we have very effective therapies to control the disease. Controlled asthma means having no attacks, a respiratory function as close to normal as possible with greater resistance to stress, and quiet nights. It is estimated that over half of patients (30–80% when taking into account all diseases) do not follow the doctor’s prescriptions. The causes of non-adherence to therapy are even more varied and complex. Sometimes patients are not aware of the importance of following medication prescriptions for their health and long-term well-being and to avoid visits to the emergency room (also today asthma can be fatal). It is reasonable to admit that people suffering from this complex disease have reason to self-reduce the medication when they feel it is not helping them, and when the fear of side effects is greater than the benefits. As with many other diseases, we are working towards a precision therapy or, metaphorically speaking, a tailor-made therapy. This disease certainly requires lifelong therapy, but it is good to keep in mind that therapy can be adjusted.

Chronic obstructive pulmonary disease or COPD is characterized by airflow obstruction, causing respiratory symptoms. There are treatments available for COPD; however, COPD has significant extrapulmonary effects, including well-recognized ones as cardiovascular disease and often underdiagnosed ones as osteoporosis. It is imperative to be aware of these comorbidities to optimize COPD patient care.

Summary Asthma differs from many other chronic conditions in that most key management decisions are made in non-specialist settings, such as general practitioner surgeries and accident and emergency departments. Diagnosis in primary care relies on recognition of a characteristic pattern of symptoms and the occurrence of asthma attacks, sometimes supplemented by basic lung function tests. Ongoing management is guided by the assessment of symptoms and simple lung function measures of airflow obstruction, with little attempt made to personalise management. This approach is flawed because the inadequate specificity of symptoms, as well as the low sensitivity of variable airflow obstruction, means that a diagnosis of asthma is often difficult to exclude with confidence. Moreover, even if diagnosed correctly, dissociation between inflammation, airflow obstruction, and symptoms means that a generalised stepwise approach to managing asthma on the basis of symptoms is unlikely to be successful in a substantial proportion of patients. As a result, effective treatments are used inefficiently, and outcomes are often worse than they could be. Rather than use of either a population-based or personalised approach for the diagnosis and management of asthma, we recommend a new combined approach, in which treatment decisions are driven by objective assessment of key treatable mechanistic traits.

Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) defines a subgroup of patients with asthma who have persistent airflow obstruction or patients with COPD who may exhibit variable airflow limitation and/or evidence of type 2 inflammation. Additional investigations are needed to determine whether ACO represents a distinct disorder with unique underlying pathophysiology, whether ACO patients should be managed differently from those with asthma or COPD, and whether the diagnosis affects long-term outcomes. This article presents the data about the clinical features of ACO, the current information regarding the underlying pathophysiology of the syndrome, and current understanding of therapeutic options.

Introduction: Many patients couldn’t reach sufficient expiration time during spirometry testing, which reduces the FVC value relatively, and the FEV1 / FVC ratio appears to be incorrectly high. We aimed to determine the prediction point for the FEV1 / FVC ratio in patients with insufficient expiratory maneuver based on bronchoprovocation tests (BPT). Methods: In our retrospective cross-sectional study, pd20 values, FET values, plateau presence in the volume-time curve, FIVC - FVC value, FEV1 / FVC ratio were recorded in patients with BPT suspended between 2018-2019. Spirometric measurements of patients with FET ≥6s and Results: A total of 99 patients (mean age was 34,78), 34 males and 65 females, were included in the study. 40 patients had bronchial hyperreactivity (BHR: PD20 ≤16 mg / ml). The mean FET was 4.9 ± 1.7 s and 42.6% of the patients were ≥6 s. In patients with FET Conclusion: The prediction point for FEV1 / FVC can be calculated for determining airflow obstruction in patients with insufficient expiratory maneuver.

Introduction: PROMS (Patient Reported Outcomes Measures) are self-report questionnaires, completed by patients, which seek to measure their perception of their health status and health-related quality of life. The most popular tools used by pulmonologists to evaluate the stage of COPD are CAT (COPD Assessment Test) and mMRC scale. FEV1 is used to assess the severity of airflow obstruction. Aim-Objectives: To investigate the possible correlation of CAT score, mMRC and FEV1 to the number of acute exacerbations of COPD (AECOPD) per year. Methods: This is a retrospective study which included patients diagnosed with stable COPD disease based on symptoms and post-bronchodilator airflow limitation as it was depicted by spirometry. History of AECOPD in the last three years was collected. Results: One hundred thirteen COPD patients were included in the study. Patients’ demographic data and clinical characteristics are shown in Table 1. CAT score and mMRC scale were positively correlated to the number of AECOPD (r=0,428, p=0,000 and r=0,450, p=0,000 respectively). Additionally, FEV1%pred was negatively correlated to the number of AECOPD (r=-0,274, p=0,004). CAT score was positively correlated to mMRC scale (r=0,59, p=0,000). Interestingly, CAT score and mMRC scale were negatively correlated to FEV1 % pred (r= -0,454, p=0,000 and r=-0,467, p=0,000 respectively). Conclusion: Based on our data, CAT score, mMRC and FEV1% pred could be used as predictors of AECOPD.

COPD is characterized by progressive airflow obstruction and eventually lung hyperinflation. Whole body plethysmography (Pleth) and Helium Dilution (He) are the most common techniques used for the evaluation of lung volume, although there is no agreement on the method of choice. In our study we aim to compare Pleth and He derived lung volume in COPD patients, how much difference there is between the two methods in terms of TLC, RV, RV/TLC and the influence of airflow obstruction. We also assess the relationship between hyperinflation and airway resistance. Methods: 50 COPD patients were enrolled. TLC, RV and RV/TLC were obtained both with He and Pleth. Results: We reported a statistically significant difference between these two techniques in terms of Mean percentage value of TLC (p= 0.02) and RV (p=0.04),while RV/TLC measured with the two methods was similar. We described a much significant difference among patients with severe airflow obstruction (FEV1 50%. Moreover, we reported that the values of effective specific airways resistance (SReff) and RV/TLC have a strong positive correlation (r:0.78; p

Fractional exhaled nitric oxide (FeNO) is a single-breath test used in asthma diagnosis and management. Whilst a number of studies in mild to moderate asthma have demonstrated excellent repeatability of FeNO by assessing intra-device reproducibility from consecutive blows [1–3], the between-session and diurnal variability have been inconsistent [4–9]. Asthma is a highly variable disease. The excessive diurnal variability in airflow obstruction is a marker for disease severity, poor control and mortality. Diurnal variability of FeNO is also a predictor for poor asthma control [8]. We have demonstrated that FeNO has a significant time-of-the-day difference with a median of 12 parts per billion (ppb) between peak and trough readings within a 24-hour cycle in stable mild/moderate asthma [10]; whether this same-day variation is clinically significant in the diagnosis and management of asthma remains unclear. FeNO has been readily used in the monitoring of severe asthma, but its same-day reproducibility as a single-breath test is unknown in this group. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. Wang has nothing to disclose. Conflict of interest: Dr. Alahmadi has nothing to disclose. Conflict of interest: Dr. Niven has nothing to disclose. Conflict of interest: Stephen J Fowler has no conflict of interest

Background COPD is a leading cause of mortality. Research Question We hypothesized that applying machine learning to clinical and quantitative CT imaging features would improve mortality prediction in COPD. Study Design and Methods We selected 30 clinical, spirometric, and imaging features as inputs for a random survival forest. We used top features in a Cox regression to create a machine learning mortality prediction (MLMP) in COPD model and also assessed the performance of other statistical and machine learning models. We trained the models in subjects with moderate to severe COPD from a subset of subjects in Genetic Epidemiology of COPD (COPDGene) and tested prediction performance in the remainder of individuals with moderate to severe COPD in COPDGene and Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE). We compared our model with the BMI, airflow obstruction, dyspnea, exercise capacity (BODE) index; BODE modifications; and the age, dyspnea, and airflow obstruction index. Results We included 2,632 participants from COPDGene and 1,268 participants from ECLIPSE. The top predictors of mortality were 6-min walk distance, FEV1 % predicted, and age. The top imaging predictor was pulmonary artery-to-aorta ratio. The MLMP-COPD model resulted in a C index ≥ 0.7 in both COPDGene and ECLIPSE (6.4- and 7.2-year median follow-ups, respectively), significantly better than all tested mortality indexes (P Interpretation An MLMP-COPD model outperformed four existing models for predicting all-cause mortality across two COPD cohorts. Performance of machine learning was similar to that of traditional statistical methods. The model is available online at: https://cdnm.shinyapps.io/cgmortalityapp/.

Background A disintegrin and metalloproteinase domain-15 (ADAM15) is expressed by activated leukocytes, and fibroblasts in vitro. Whether ADAM15 expression is increased in the lungs of COPD patients is not known. Methods ADAM15 gene expression and/or protein levels were measured in whole lung and bronchoalveolar lavage (BAL) macrophage samples obtained from COPD patients, smokers, and non-smokers. Soluble ADAM15 protein levels were measured in BAL fluid (BALF) and plasma samples from COPD patients and controls. Cells expressing ADAM15 in the lungs were identified using immunostaining. Staining for ADAM15 in different cells in the lungs was related to forced expiratory volume in 1 s (FEV1), ratio of FEV1 to forced vital capacity (FEV1/FVC), and pack-years of smoking history. Results ADAM15 gene expression and/or protein levels were increased in alveolar macrophages and whole lung samples from COPD patients versus smokers and non-smokers. Soluble ADAM15 protein levels were similar in BALF and plasma samples from COPD patients and controls. ADAM15 immunostaining was increased in macrophages, CD8+ T cells, epithelial cells, and airway α-smooth muscle (α-SMA)-positive cells in the lungs of COPD patients. ADAM15 immunostaining in macrophages, CD8+ T cells and bronchial (but not alveolar) epithelial cells was related inversely to FEV1 and FEV1/FVC, but not to pack-years of smoking history. ADAM15 staining levels in airway α-SMA-positive cells was directly related to FEV1/FVC. Over-expressing ADAM15 in THP-1 cells reduced their release of matrix metalloproteinases and CCL2. Conclusions These results link increased ADAM15 expression especially in lung leukocytes and bronchial epithelial cells to the pathogenesis of COPD.

BACKGROUND: The clinical significance of visually evident emphysema on CT images in individuals without spirometric evidence of chronic obstructive pulmonary disease (COPD) by current diagnostic criteria is, to the knowledge of the authors, unknown. PURPOSE: To evaluate whether participants with visually evident emphysema at CT were more likely to have progressive disease and increased mortality at 5 years compared with those without visual emphysema. MATERIALS AND METHODS: This secondary analysis of the prospective Genetic Epidemiology of COPD study evaluated current or former smokers enrolled between 2008 and 2011 who did not meet current criteria for COPD (defined as Global Initiative for Obstructive Lung Disease stage 0). Statistical analysis was performed by using linear mixed models to estimate mean physiologic, imaging, and clinical outcomes for those with and without visual emphysema. Hazard ratios for mortality were calculated by using Cox regression models with emphysema as the main predictor. RESULTS: Of the 4095 participants, 48.3% (1979 participants; 1096 men and 883 women; mean age, 57 years ± 8 [standard deviation]) had trace or greater visual emphysema at CT and 51.7% (2116 participants; 1068 men and 1048 women; mean age, 56 years ± 8) had no emphysema at CT. At 5 years, participants with visual emphysema at CT demonstrated progressive airflow obstruction with lower values of ratio of forced expiratory volume in 1 second (FEV(1))-to–functional vital capacity (FVC) ratio (−1.7 vs −0.7) and greater progression in quantitative emphysema measured by 15th percentile lung density (−3.3 vs −0.3 HU), adjusted lung density (−3.1 vs −0.2 g/L), and percentage of lung voxels with CT attenuation less than −950 HU (0.17 vs −0.20) than participants without emphysema (P < .001 for each). The rate of quantitative emphysema progression increased with greater grades of emphysema severity within the emphysema group. CONCLUSION: The presence of visual emphysema at CT in current and former Global Initiative for Obstructive Lung Disease stage 0 smokers predicted structural and physiologic disease progression. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Grenier in this issue.

Background A variety of maintenance inhaler therapies are available to treat asthma and COPD. Patient-centric treatment choices require understanding patient preferences for the alternative therapies. Methods A self-completed web-based discrete choice experiment was conducted to elicit patient preferences for inhaler device and medication attributes. Selection of attributes was informed by patient focus groups and literature review. Results The discrete choice experiment was completed by 810 patients with asthma and 1147 patients with COPD. Patients with asthma most valued decreasing the onset of action from 30 to 5 min, followed by reducing yearly exacerbations from 3 to 1. Patients with COPD most and equally valued decreasing the onset of action from 30 to 5 min and reducing yearly exacerbations from 3 to 1. Both patients with asthma and patients with COPD were willing to accept an additional exacerbation in exchange for a 15 min decrease in onset of action and a longer onset of action in exchange for a lower risk of adverse effects from inhaled corticosteroids. Patients with asthma and COPD valued once-daily over twice-daily dosing, pressurised inhalers over dry powder inhalers and non-capsule priming over single-use capsules, although these attributes were not valued as highly as faster onset of action or reduced exacerbations. Conclusions The most important maintenance inhaler attributes for patients with asthma and COPD were fast onset of symptom relief and a lower rate of exacerbations. Concerns about safety of inhaled corticosteroids and device convenience also affected patient preferences but were less important.

Background Asthmatic smokers have reduced quality of life and need frequent specialist visits/hospitalization. Smoking habit represents for asthmatics a higher risk for comorbidities and lung function impairment. The impact of cigarette smoking on asthmatics should be addressed to evaluate the related risk factors. Methods This real-life observational study evaluated demographic, clinical/functional, and biological parameters of 521 asthmatic patients stratified as never (0 PY), light (1–10 PY), and heavy smokers (>10PY). Results The heavy smokers with asthma were more frequently older, male, overweight, and non-allergic than other asthmatics. Although similar ICS dose and severity among groups, heavy smokers had more significant airflow limitation (FEV1/FVC = 0.65 ± 0.10, p Conclusions Heavy smokers had more severe obstructive impairments than light and never smokers with similar ICS dose, showing a steroid insensitivity, but displayed less allergy with low FeNO and blood eosinophil count, thus being a definite phenotype.