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Maximilian Boesch,1 Florent Baty,1 Stefan Bilz,2 Martin H Brutsche,1 Frank Rassouli1 1Lung Center, Cantonal Hospital St.Gallen, St.Gallen, Switzerland; 2Division of Endocrinology & Diabetes, Cantonal Hospital St.Gallen, St.Gallen, SwitzerlandCorrespondence: Maximilian Boesch, Ph.D., Lung Center, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, St. Gallen, CH-9007, Switzerland, Tel +41-71-494-7143, Email maximilian.boesch@kssg.chIntroduction: Lung function constraints and comorbidities such as coronary heart disease, sarcopenia, and mood disorders make chronic obstructive pulmonary disease (COPD) patients avoid physical activity (PA). However, PA represents an important pillar of COPD management and is explicitly recommended by professional associations to enhance physical functioning and positively modulate disease progression.Methods: In this monocentric, prospective, observational feasibility study, it was our primary objective to investigate the association between PA and the evolution of the COPD assessment test (CAT) and the occurrence of acute exacerbations of COPD (AECOPD), respectively. To this end, we equipped 42 COPD patients with an activity tracking wearable and telemonitored their daily PA levels over one year using a dedicated web-based interface. Patients additionally provided weekly CAT scores using the same telehealth platform and came in for 3 study visits to assess functional parameters and biochemical markers related to nutrition and inflammation.Results: A principal study finding was that PA was inversely associated with CAT score (drop of 0.21 points associated with an increase of 1000 daily steps, p = 0.004), and that the 50% of patients with higher PA levels showed less CAT score progression over time (0.42 points per year) than the 50% of patients with lower PA levels (3.26 points per year) (p < 0.001). In addition, higher PA levels were significantly associated with a lower likelihood of experiencing a moderate-to-severe AECOPD (31% risk reduction associated with an increase of 1000 daily steps, p = 0.0097).Discussion: Our study demonstrates the relevance of PA for key COPD outcome metrics in a real-world setting and underpins the importance of PA for COPD self-management in everyday life. Our study paves the way for future intervention trials to prospectively identify medically relevant PA thresholds and establish training recommendations for different patient subgroups.Keywords: CAT score, COPD, physical activity, telemonitoring, wearable device

Kai-Michael Beeh,1 Karl Scheithe,2 Heike Schmutzler,3 Saskia Krüger3 1Insaf Respiratory Research Institute, Wiesbaden, Germany; 2Department of Biostatistics, GKM Gesellschaft Für Therapieforschung mbH, Munich, Germany; 3Medical Department, BERLIN-CHEMIE AG, Berlin, GermanyCorrespondence: Kai-Michael Beeh, Insaf Respiratory Research Institute, Biebricher Allee 34, Wiesbaden, 65187, Germany, Tel +49 (0) 611 9854410, Email k.beeh@insaf-wi.dePurpose: Real-life effectiveness data on once-daily single-inhaler triple therapy (odSITT) with the inhaled corticosteroid fluticasone furoate (FF), the long-acting muscarinic antagonist umeclidinium (UMEC), and the long-acting β2-agonist vilanterol (VI) in patients with chronic obstructive pulmonary disease (COPD) are important to complement evidence from well-controlled randomized clinical trials. Effectiveness of odSITT was quantified by assessing health status and symptoms in usual care.Patients and Methods: ELLITHE was a single-country (Germany), multicenter, open-label, non-interventional effectiveness study between 2020 and 2022, evaluating the effect of treatment initiation with FF/UMEC/VI 100/62.5/25 μg once-daily via the ELLIPTA inhaler on improvements in clinical outcomes versus baseline in COPD patients. The primary endpoint was the change in the total COPD Assessment Test (CAT) score between baseline and month 12. Key secondary endpoints included change in CAT score over time, occurrence of exacerbations until month 12, changes in forced expiratory volume in one second (FEV1), inhaler adherence, and safety.Results: Nine hundred and six patients were included (age 66.6 years, 55.6% male, mean FEV1 52.6% of predicted, mean CAT 21.5 units, 1.4 exacerbations/year pre-study). About 63.9% of patients were escalated from dual therapies, and 18% were switched from multiple-inhaler triple therapies. Reductions in CAT score at month 12 were statistically significant and above the threshold of clinical importance (− 2.6 units; p < 0.0001). CAT score also improved at interim visits. CAT improvements were more pronounced in patients with high baseline scores and better inhaler adherence. Exacerbations during follow-up were rare (0.2 events/year) compared to pre-study (1.4 events/year). FEV1 was improved by 93 mL (p < 0.0001). No new safety effects were observed.Conclusion: In usual care, treatment with odSITT resulted in significant and clinically relevant improvements of CAT score and FEV1 in COPD patients, regardless of the occurrence of exacerbations. These findings challenge the current guideline recommendations for SITT only in patients experiencing exacerbations.Keywords: CAT score, real-world evidence, lung function, exacerbation, treatment adherence

Background: Approximately 3.2 million global deaths occur each year due to chronic obstructive pulmonary disease (COPD), in which exacerbations of COPD remain a prevailing cause. Exacerbations requiring hospitalization are associated with high mortality, and mortality risk is increased with higher exacerbation frequencies. Aims and Objectives: This study aimed to prospectively identify the risk factors of COPD that cause readmission within 90 days after admission to the hospital due to acute exacerbations of COPD. Materials and Methods: An observational study conducted at the School of Pulmonary Excellence, NSCB Medical College, Jabalpur, from the duration of March 2021 to August 2022 with a sample size of 140 estimated through 56% prevalence of readmission rate in available literature. Study participants, including all patients, were readmitted within 90 days after admission due to acute exacerbation of COPD (post-bronchodilator FEV1/FVC 10 was 64% and

Introduction: COPD is a leading global cause of mortality, expected to rise in prevalence over the next four decades. Patients often find the early hours of the day troublesome, impacting their health-related quality of life (HRQoL). This study aims to address the commonly overlooked issue of morning symptoms in COPD patients, focusing on their severity and correlation with the CAT score and BODE index. The research underscores the significance of understanding and managing morning symptoms to improve the overall well-being of individuals with COPD. Materials and methods: A cross-sectional study involving 128 COPD patients meeting inclusion/exclusion criteria was conducted in hospitals affiliated with Bangalore Medical College & Research Institute. Comprehensive investigations were carried out, and morning symptoms were evaluated using the CDLM questionnaire. Patients were clinically classified into GesEPOC phenotypes and GOLD stages based on FEV1 (%). The severity of COPD was assessed through the BODE index and CAT score, with correlations examined against the CDLM questionnaire. Results: In this study of 128 COPD patients, predominantly males with a mean age of 63 years, the first tertile demonstrated lower CDLM scores, indicating a higher morning impact and more respiratory symptoms. These patients also had lower FEV1%, higher CAT and BODEx scores, and increased exacerbations. Higher CDLM scores were associated with the Non- Exacerbator clinical phenotype of GesEPOC Spanish Classification. Multivariate analysis revealed that lower CDLM scores were independently linked to higher CAT and BODEx scores, lower FEV1%, and increased exacerbations. Conclusion: Evaluation of morning symptoms using capacity of daily living during morning (CDLM) questionnaire revealed there was a strong association with markers of COPD severity. The significant association was found with CAT and BODE index score and GesEPOC phenotypes. The strong negative correlation was learned for CDLM with CAT score and BODE Index score independently. However, the CDLM questionnaire exhibits a ceiling effect, limiting its ability to effectively differentiate between low and high impacts of morning symptoms. [ABSTRACT FROM AUTHOR]

Background: Approximately 3.2 million global deaths occur each year due to chronic obstructive pulmonary disease (COPD), in which exacerbations of COPD remain a prevailing cause. Exacerbations requiring hospitalization are associated with high mortality, and mortality risk is increased with higher exacerbation frequencies. Aims and Objectives: This study aimed to prospectively identify the risk factors of COPD that cause readmission within 90 days after admission to the hospital due to acute exacerbations of COPD. Materials and Methods: An observational study conducted at the School of Pulmonary Excellence, NSCB Medical College, Jabalpur, from the duration of March 2021 to August 2022 with a sample size of 140 estimated through 56% prevalence of readmission rate in available literature. Study participants, including all patients, were readmitted within 90 days after admission due to acute exacerbation of COPD (post-bronchodilator FEV1/FVC <0.70). Data analysis was performed using IBM software SPSS 22.0 and statistical association with the confidence interval of 95% and P<0.05. Results: The majority of COPD cases were male (84%) and belonged to the 50–60 years of age group. There was a statistically significant (P=0.001) association between grades of dyspnea and readmission cases. Dyspnea among readmission patients was found to be 100%. The prevalence of CAT score >10 was 64% and <10 is 36% among readmission patients the association was highly significant and more exacerbation leads to more readmission. Conclusion: In the study, various clinical parameters were found statistically significant between the admission and readmission groups. These parameters were CAT score, previous hospitalization history, previous exacerbation history, SpO2, dyspnea grading, and co-morbidities. The lung function test was difficult to do due to many of readmitted patients were not in a condition to do spirometry. [ABSTRACT FROM AUTHOR]

Background: Despite the evidence-based guidelines promoted by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the overuse of prescription drugs to manage COPD, particularly inhaled corticosteroids (ICS), remains a persistent challenge. In this real-world study, we evaluated how patients with COPD were divided into ABCD groups based on the 2017 GOLD guidelines, determined the rate of adherence to the GOLD treatment recommendations, described the rate of ICS usage, and determined the rate of triple therapy (TT) prescription. Methods: The charts of 2291 patients diagnosed with COPD were retrospectively analyzed, of which 1438 matched the eligibility criteria. Results: The average patient age was 69.6 ± 10.9 years; 52% of patients were female. The average COPD assessment test (CAT) score was 18.3 ± 9.1. The ABCD breakdown was as follows: group A 19.5%, group B 64.1%, group C 1.8%, and group D 14.6%. All groups, except group D, showed discordance in COPD treatment relative to the proposed GOLD guidelines. Only 18.9% of group A and 26% of group B were treated in concordance with the guidelines. TT was primarily used in group D (63.3%) and overused in groups A (30.6%) and B (47.8%). ICS was overused in all groups, particularly in groups A (56.2%) and B (67.3%). Conclusion: Studies from the last decade have consistently revealed a lack of conformity between what physicians prescribe and what GOLD guidelines recommend. The excessive usage of ICS, which continues despite all the associated adverse effects and the attributable costs, is concerning. The awareness of GOLD guidelines among primary care physicians (PCPs) and respiratory specialists needs to be improved. [ABSTRACT FROM AUTHOR]

Christian Gessner,1 Frederik Trinkmann,2,3 Sanaz Bahari Javan,4 Raimund Hövelmann,4 Valentina Bogoevska,4 George Georges,5 Elena Nudo,6 Carl-Peter Criée7 1Pneumologische Praxis Leipzig, Universitätsklinikum Leipzig, Institut für Klinische Immunologie, Leipzig, Germany; 2Pneumology and Critical Care Medicine, Thoraxklinik at University Hospital Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany; 3Department of Biomedical Informatics (DBMI) at the Center for Preventive Medicine and Digital Health Baden-Württemberg (CPD-BW), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany; 4Department of Medical Affairs, Chiesi GmbH, Hamburg, Germany; 5Corporate R&D, Chiesi USA Inc., Cary, NC, USA; 6Global Medical Affairs, Chiesi Farmaceutici S.p.A., Parma, Italy; 7Department of Sleep and Respiratory Medicine, Evangelical Hospital Goettingen-Weende, Bovenden, GermanyCorrespondence: Christian Gessner, Pneumologische Praxis Leipzig, Universitätsklinikum Leipzig, Institut für Klinische Immunologie, Tauchaer Straße 12, Leipzig, 04357, Germany, Tel +49 341 60 20 960, Email ch.gessner@pneumologe-leipzig.dePurpose: Real-word evidence on the effectiveness of switching from dual therapies or triple therapies (multiple inhalers) to extrafine single-inhaler triple therapy (efSITT), which consists of the inhaled corticosteroid (ICS) beclomethasone, the long-acting β2-agonist (LABA) formoterol and the long-acting muscarinic antagonist (LAMA) glycopyrronium, in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) is limited. The impact of switching to efSITT on health-related quality of life (HRQoL), COPD specific symptoms, lung function and treatment adherence were assessed in routine clinical care.Patients and Methods: Patients were recruited at 148 sites in Germany between 2017 and 2020 in this multicenter, non-interventional observational study. Demographics, clinical data and treatment history were collected at baseline. HRQoL (measured by COPD Assessment Test [CAT]), lung function and adherence (measured by Test of Adherence to Inhalers [TAI]) were assessed at baseline and after six months. Descriptive analyses were conducted by prior treatment and GOLD groups as well as for the overall population.Results: 55.1% of the 2623 included patients were male. Mean age was 65.8 years. 57.5% of the patients were previously treated with ICS+LABA+LAMA (multiple inhalers), 23.9% with ICS/LABA (single or two inhalers) and 18.6% with LAMA/LABA (single or two inhalers). After six months, largest mean improvements in the total CAT score were observed in the ICS/LABA (− 3.9) and LAMA/LABA (− 3.9) prior treatment groups as well as in patients in GOLD group B (− 2.9). In the overall population, the CAT items for cough, phlegm, and dyspnea decreased on average by − 0.4 points each. After six months, FEV1 increased by 2.0 percentage points in relation to predicted values. The percentages of measured sRtot and RV of predicted values decreased by 24.5 and 4.4 percentage points, respectively. The percentage of patients with good adherence increased from 67.8% to 76.5%.Conclusion: Treatment switch to efSITT resulted in an improvement of HRQoL, COPD specific symptoms, lung function parameters and adherence under real-world conditions.Keywords: COPD, extrafine single inhaler triple therapy, treatment adherence, CAT score

ObjectiveTo understand the quality of life in patients with pulmonary tuberculosis within three years after treatment， determine its related factors， and make suggestions for improving the short-term quality of life in patients with pulmonary tuberculosis after treatment.MethodsA telephone survey was used to investigate registered tuberculosis patients in Shanghai in 2018 using the short form 12 （SF-12） and the chronic obstructive pulmonary disease （COPD） assessment test questionnaire （CAT）.ResultsA total of 975 patients with pulmonary tuberculosis who had completed the treatment were included in the study. The total physiological score was determined to be 49.18±10.25， and the total psychological score was 50.27±8.03 （t=5.62，P

Objective To explore the correlation between the scores of the three respiratory questionnaires and its correlation with the severity of pulmonary ventilation function, and evaluate the role of three existing respiratory questionnaires when assessing the severity of chronic obstructive pulmonary disease and lung ventilation function impairment. Methods A total of 109 patients with stable chronic obstructive pulmonary disease were enrolled in Zhongshan Hospital, Fudan University from Apr 7, 2019 to Apr 11, 2020. The demographic situation, clinical symptoms, complications, education level, respiratory questionnaire scores (CAT, mMRC and SGRQ score), lung function parameters, therapeutic drugs were recorded, and the correlation between each index and the 3 respiratory questionnaire scores was analyzed. Results Among 109 patients, 62 patients (56.88%) had mild to moderate COPD (FEV1% pred ≥ 50%)and 47 patients (43.12%) had severe to very severe COPD (FEV1% pred<50%). The correlation analysis showed that there was a good correlation among SGRQ, mMRC and CAT scores (P<0.05). Stratified analysis showed that SGRQ (total score and symptom part score), mMRC and CAT scores could better reflect the level of pulmonary function (FEV1% PRED) (r：0.4-0.5) in patients with severe to very severe COPD, while there was no significant correlation in patients with mild to moderate chronic obstructive pulmonary disease. Conclusion The 3 kinds of respiratory questionnaires have good correlation and can be used to evaluate COPD. SGRQ score is of great value in scientific research of respiratory diseases. CAT score is more focused on clinical use, which is convenient and fast. The SGRQ score and CAT score were well correlated with the severe to very severe pulmonary ventilation function impairment. [ABSTRACT FROM AUTHOR]

Arto Yuwono Soeroto,1 Dadan Setiawan,2 Nabila Nauli Asriputri,3 Guntur Darmawan,4 Geraldo Laurus,3 Prayudi Santoso1 1Division of Respiratory and Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia; 2Department of Internal Medicine, Occupational Health General Hospital, Bandung, West Java, Indonesia; 3Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia; 4Department of Internal Medicine, Faculty of Medicine, Krida Wacana Christian University, Jakarta, IndonesiaCorrespondence: Arto Yuwono Soeroto Tel +62 811 246 930Email aysoeroto@yahoo.co.idPurpose: This study aimed to assess the association between vitamin D levels and forced expiratory volume in one second (FEV1), number of exacerbations, and symptoms based on COPD assessment test (CAT) scores in stable COPD patients in Indonesia.Patients and Methods: An observational cross-sectional study was conducted. Subjects were stable COPD patients who were treated at a pulmonary clinic in a tertiary referral hospital in West Java from March to June 2018.Results: Thirty subjects were recruited this study with an average age 62± 8 years. The mean vitamin D level was 20.17± 8.91 ng/mL. Half of the patients had low vitamin D level (< 20ng/mL) (50%). The mean FEV1 (%) predicted value was 37.2± 14. The median exacerbation per year was 1 (0– 5) and symptoms based on CAT score was 14 (3– 34). No correlation was found between vitamin D levels and FEV1 (%) predicted value (r=0.126, p=0.253). Vitamin D level was inversely correlated with number of exacerbations (r=− 0.639, p< 0.001) and CAT (r= − 0.802, p< 0.001).Conclusion: Low level of vitamin D was associated with more frequent exacerbation and higher CAT scores but was not associated with FEV1 (%) predicted.Keywords: COPD, vitamin D, FEV1, CAT score

Background: Cadmium is a ubiquitous toxic heavy metal and environmental toxicant. Inflammation exerts central roles in the process of chronic obstructive pulmonary disease (COPD). However, few epidemiological studies on the correlation between cadmium exposure and COPD are available. The aim of this study was to evaluate the correlations among serum cadmium, inflammatory cytokines and pulmonary function in COPD patients. Methods: All 940 COPD patients were finally recruited in this study. Demographic characteristics and clinical information were extracted. Fasting serum was collected. Serum cadmium was detected through graphite furnace atomic absorption spectrophotometry. Serum inflammatory cytokines were measured using enzyme‐linked immunosorbent assay. Results: All patients were classified into three groups according to the tertile division of serum cadmium concentration: low (<0.77 μg/L, L), medium (0.77–1.01 μg/L, M), and high (1.01 μg/L, H). Logistic regression analysis found that serum cadmium was inversely correlated with pulmonary function before and after adjusted confounding variables. When stratified by gender, serum cadmium was still negatively correlated with pulmonary function in COPD patients. Moreover, higher serum cadmium elevated CAT (COPD Assessment Test) score before and after adjusted confounding variables. Though a non‐linear association between serum cadmium and inflammatory cytokines, serum cadmium was positively associated with inflammatory cytokines (TNF‐α and MCP‐1). TNF‐α and MCP‐1 exerted a partial mediator in the association between cadmium exposure and pulmonary function decline in COPD patients. Conclusions: Serum cadmium concentration is inversely correlated with pulmonary function among COPD patients. Inflammatory cytokines may be important mediators for cadmium‐induced pulmonary function decline in COPD patients. [ABSTRACT FROM AUTHOR]

Background&Method: The aim of this study is to evaluate the correlation between CAT score, mMRC score, Inflammatory markers and severity of COPD exacerbation was carried in Department of Respiratory Medicine, Lilavati Hospital and Research Centre, Mumbai. Study population and sample size was 75 patients (inpatients and outpatients) visiting Lilavati Hospital and Research Centre diagnosed with acute exacerbation in already proven cases of COPD on the basis of anthonisen criteria were enrolled in the study. Patients attending Pulmonary medicine OPD / in-patients of Lilavati Hospital and Research centre diagnosed as AECOPD (Clinician based diagnosis), satisfying the inclusion and exclusion criteria were included in study after written informed consent. Number of COPD exacerbations in the last 1 year, on bases of history given by patient was noted. And according to that they were divided in frequent and non frequent exacerbators. With frequent exacerbators having two or more than two exacerbations in the previous year. Also Patient's FEV1 on the basis of the last available spirometry report was noted and patient was characterized as per the GOLD criteria of COPD severity. Result: In our study 57 patients had two or more exacerbations in the previous year(frequent exacerbators) and 18 patients had less than 2 exacerbation in the previous year. It was found that CAT score was significantly higher in frequent exacerbators as compared to others. In frequent exacerbators CAT score mean was 30.35, and in non frequent exacerbators Mean CAT score was 25.89. Non-parametric correlation between pre-treatment values of various variables. CAT score and mMrc grades shows significant correlation. (p values <0.01). CRP and PCT levels also shows significant correlation.(p values <0.05). Conclusion:The CAT score is associated with the changes of systemic inflammation following exacerbations, and it is as responsive to the treatments as other measures such as mMrc dyspnea scale and inflammatory biomarkers. The CAT scores can reflect the health status of COPD patients, and are potentially useful to assess the treatments response following COPD exacerbations. The CAT is particular useful for health settings where access to other advance diagnostics are limited. CAT score was significantly higher at exacerbation in patients with history of frequent exacerbations. The CAT is particular useful for health settings where access to other advance diagnostics are limited. CAT score was significantly higher at exacerbation in patients with history of frequent exacerbations. CAT score not only includes dyspnea but also other components like cough, phlegm, chest tightness, limitation of daily activities, sleep quality and energy which makes it a better score for assessment of quality of life. [ABSTRACT FROM AUTHOR]

Introduction/Objective. The chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on outcomes of COPD patients. Pulmonary rehabilitation (PR) interrupts the vicious circle caused by exacerbations. It has not been widely implemented as standard of COPD treatment yet. The aim of study was to examine the effectiveness of PR in prevention of exacerbations. Method. The prospective observation study included stable COPD patients between January 2015 and December 2018. The effects of PR on exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account age, comorbidity, vaccination status (against seasonal flu), body mass index (BMI). Results. Study included 1,674 patients (956 males, age 65.93 Ѓ} 8.45, current or ex-smokers 94.9%; 21 ≥ BMI 1,406 patients, 84%, FEV1 < 80% 1,448 patients, 86.5%). The PR rate was 48.1%. There was significant difference in PR status with respect to age (p = 0.020), comorbidities (p = 0.015), FEV1 (p < 0.001), respiratory symptoms using COPD assessment test (CAT) score (p < 0.001), vaccination against seasonal flu (p < 0.001). Exacerbations occurred more frequently in non-PR patients (415 (51.6%) vs. 641 (73.7%), p < 0.001). In multivariate analysis, PR (RR 0.421; 95% CI (0.307–0.577); p < 0.001) and BMI ≥ 21kg/m2 (RR 0.605; 95% CI (0.380–0.965); p = 0.035) were independent protective factors and CAT score >10 (RR 2.375; 95% CI (1.720–3.280); p < 0.001) and FEV1 < 80% (RR 2.021; 95% CI (1.303–3.134); p = 0.002) were independent risk factors from exacerbations. Conclusion. Patients who successfully completed PR treatment had significantly less frequent exacerbations compared to patients that not pass through PR program.

Joon Young Choi,1 Hyoung Kyu Yoon,2 Kyeong-Cheol Shin,3 So-Young Park,4 Chang Youl Lee,5 Seung Won Ra,6 Ki Suck Jung,7 Kwang Ha Yoo,4 Chang-Hoon Lee,8 Chin Kook Rhee9 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Republic of Korea; 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; 3Division of Pulmonology and Allergy, Regional Center for Respiratory Disease, Yeungnam University Medical Center, Daegu, Republic of Korea; 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea; 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon, Republic of Korea; 6Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; 7Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Republic of Korea; 8Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; 9Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of KoreaCorrespondence: Chin Kook RheeDivision of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, Republic of KoreaTel +82 2 2258 6067Fax +82 2 599 3589Email chinkook77@gmail.comPurpose: Previous studies have used various definitions to classify chronic obstructive pulmonary disease (COPD) patients into chronic bronchitis (CB) and non-CB patients. This study was performed to identify differences among three definitions of CB based on the classical method, St. George’s Respiratory Questionnaire (SGRQ), and the CAT (COPD Assessment Test) score.Patients and methods: We extracted data from the multicenter Korea COPD Subgroup Study (KOCOSS) cohort, for which patients recruited from among 47 medical centers in South Korea beginning in April 2012. Patients were classified according to three different definitions of CB: 1) classical definition; 2) SGRQ (using questions regarding cough and sputum); and 3) CAT score (comprising cough [CAT1] and sputum [CAT2] subscale scores).Results: A total of 2694 patients were enrolled in this study. The proportions of CB were 10.8%, 35.8%, and 24.0% according to the classical, SGRQ, and CAT definitions, respectively. The three definitions yielded consistently significant differences between CB and non-CB patients in modified Medical Research Council dyspnea scale CAT score, SGRQ score, number of moderate-to-severe exacerbations per year and forced expiratory volume in 1 second. By three definitions, CB consistently predicted future risk of exacerbation. The kappa coefficient of agreement between the classical definition and SGRQ definition was 0.29, that of the classical definition and CAT definition was 0.32, and that of the SGRQ definition and CAT definition was 0.44.Conclusion: Patients with CB according to the new definitions based on SGRQ or CAT score showed similar clinical characteristics to those defined according to the classical definition. The new CB definitions may be used as alternatives to the classical definition.Keywords: chronic bronchitis, CAT score, SGRQ score, chronic obstructive pulmonary disease, KOCOSS database

Background: Chronic obstructive pulmonary disease (COPD) increases susceptibility to sleep disturbances. This study aimed to evaluate the association between COPD severity criteria with sleep quality. Methods: One hundred fifty‐eight patients in Rasul Akram Hospital of Iran University of Medical Sciences, Tehran, Iran, from April 2019 to March 2021 diagnosed with COPD were examined using the Pittsburgh Sleep Quality Index (PSQI), COPD Assessment Test (CAT), modified Medical Research Council (mMRC) dyspnoea scale, spirometry and pulse oximetry. Results: Of 158 subjects, 125 patients were male (79%), and 33 were female (21%). The mean subject's age and FEV1/FVC ratio were 62.6 ± 11.5 and 65.6 ± 14.9%, respectively. The mean CAT scoring and Spo2 saturation reported 16.2 ± 7 and 91.5 ± 10.8%, respectively. The mean PSQI score was 8.2 ± 3.8. The association between PSQI score with FEV1 and FEV1/FVC ratio was not statistically significant (p = 0.64 and 0.58, respectively), whereas the association between PSQI scores with CAT score (p ˂ 0.0001, r2 = 0.51) and dyspnoea severity (p ˂ 0.0001, r2 = 0.29) were statistically significant. The patients with higher CAT score demonstrated poor sleep quality, particularly in longer sleep latency (p = 0.001, r2 = 0.056), bad subjective sleep quality (p ˂ 0.0001, r2 = 0.286), lower sleep efficiency (p = 0.002, r2 = 0.077), higher sleep disturbance (p ˂ 0.0001, r2 = 0.225), daytime dysfunction (p ˂ 0.0001, r2 = 0.259) and sleep medication intake times a week (p = 0.01, r2 = 0.069). Dyspnoea severity was attributed to bad subjective sleep quality (p ˂ 0.0001, r2 = 0.069), higher sleep disturbances (p = 0.005, r2 = 0.08), and daytime dysfunction (p ˂ 0.0001, r2 = 0.108). Conclusion: The PSQI has a significant association with the CAT and mMRC for COPD patients and is linked to the disease's severity. [ABSTRACT FROM AUTHOR]

Background:Chronic obstructive pulmonary disease (COPD) is a common treatable and preventable diseasecharacterized by progressive airflow limitation with an enhanced chronic inflammatory response in the airways.Acute exacerbation of COPD is associated with substantial morbidity and mortality.This study aimed to predict the outcome and future risk of COPD exacerbations and to improve the health quality of COPD patients.Patients and methods: A Cohort prospective study was designed to investigate thirty four hospitalized COPD patients with COPD exacerbation whether in the ward or in the ICU and follow up them for 12 months.Results:Outcome of the exacerbation at admission among the studied patients; 32.4% of had sputum eosinophilia and most of them (76.5%) received LABA as treatment before admission. There was no statistically significant association between eosinophils level at admission and the outcome among the studied group where one patient (9.1%) died among patients with eosinophilia≥2% and also one patient (4.3%) died among patients with eosinophils<2%.Only (31.25%) of the survived patients had sputum eosinophilia(>1.25%), half of them (50.0%) had future single exacerbation, about one third (34.4%) had two exacerbations and (15.6%) had no further exacerbations. all of them (100.0%)received LABA, LAMA and ICS as a triple therapy. There was statistically significant higher TLC, neutrophil count and longer hospital stay among patients with eosinophils<2% than patients with eosinophils ≥2%. But regarding degree of exacerbation, management and outcome, there was no statistically significant difference between patients with low and high eosinophilia. Conclusion:High neutrophil level in peripheral blood duringfollow up period of COPD patients, besides low eosinophil level in both blood and sputum are considered predictor factors for future COPD exacerbations. [ABSTRACT FROM AUTHOR]

Objective To evaluate the incidence and risk factors for anxiety and/or depression in patients with chronic obstructive pulmonary disease(COPD)，and to explore the correlation between the anxiety depression symptoms and CAT score of patients with COPD；to provide scientific evidence for the negative emotion intervention of COPD patients in the future. Methods　A total of 313 patients with COPD were enrolled in this study from the Second People's Hospital of Jinning District and the First Hospital of Kunming from July 2019 - October 2019. We used the Hospital Anxiety and Depression Scale ( HADS) and COPD Assessment Test ( CAT) to conduct the questionnaire survey and collect data of the patients，and then use SPSS 24.0 for analysis. Results　Among the 312 patients，COPD patients with anxiety accounted for 49.2% ( 154 cases), COPD with depression accounted for 37.2% (116 cases), COPD with both anxiety and depression accounted for 22.8%(71 cases). COPD patients with anxiety were associated with paying method of medical expenditure, hospitalization frequency, complications and CAT score(P < 0.05), and patients with depression were associated with hospitalization frequency and CAT score (P < 0.05). CAT score and anxiety depression symptoms are interrelated. Conclusion　The prevalence of COPD complicated with anxiety and depression is high. And frequent hospitalization and CAT scores are the high risk factors. The degree of anxiety and depression was positively correlated with the severity of the patient's condition. [ABSTRACT FROM AUTHOR]

Peng-Fei Liu,1 Peng Yan,1 Da-Hui Zhao,1 Wen-Fang Shi,1 Song Meng,1 Yang Liu,2 Bin Liu,2 Guo-Feng Li,2 Li-Xin Xie1 1Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, 2Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Logistic University of Chinese People’s Armed Police Force, Tianjin, People’s Republic of China Objective: The objective of the study was to analyze the effect of environmental factors on the differential expression of microRNAs in the peripheral blood of migratory and local patients in northern People’s Republic of China and on clinical symptoms of local patients in northern People’s Republic of China with COPD. Methods: A total of 118 patients in the northern region and 8 migratory patients were enrolled in this prospective study. We collected general information. Blood samples were collected from 9 patients in the Beijing group, from 8 patients in the migratory group and from 9 healthy control subjects. After extracting the total RNA from these 3 groups, serum miRNA was identified by Solexa sequencing. We collected COPD assessment test (CAT) and Modified British Medical Research Council (mMRC) scores at different levels of air pollution and also collected the number of exacerbations over the year prior to the baseline and in the year preceding the follow-up. Results: In total 9 miRNAs were differentially expressed. When air quality index (AQI) >100, the CAT and mMRC scores at baseline were significantly higher than those when the AQI ≤100 (P100, the follow-up CAT and mMRC scores were significantly higher than those when AQI ≤100 (P100, the baseline CAT score of this fewer symptoms group was 10.00 (6.25–12.00). The median CAT score was close to 10. When AQI ≤100, the follow-up CAT score of the fewer symptoms group was 8.00 (4.25–12.00). However, when AQI >100, the follow-up CAT score of the fewer symptoms group was 9.50 (6.00–16.75). The median CAT score was close to 10. Conclusion: Environmental factors may cause differential expression of miRNAs in the peripheral blood of migratory and local patients in northern People’s Republic of China. Air pollution may aggravate clinical symptoms of patients with COPD. Keywords: COPD, miRNA, environment, CAT score, mMRC

Introduction: It is widely recognised that health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients. Most previous studies were conducted among the younger adult population and there is limited information on the elderly population. This study aimed to determine the COPD assessment test (CAT) score in the elderly with COPD. Methods: This was a cross-sectional study involving 140 elderly patients who had been diagnosed with COPD at two selected government institutions. Data on socio-demographic and health status were collected by interviewing patients and reviewing their medical records. The HRQOL was measured using CAT. The independence sample t-test and one-way ANOVA were conducted to compare the CAT scores with socio-demographic and health status. Results: The socio-demographic and health characteristics of the patients were as follows: majority (54%) were aged 60-70 years, male (97%), Malay (59%), married (75%), ex-smokers (72%), had attained primary education (48%), had co-morbidities (54%), no history of hospitalisation or visits to the emergency department due to COPD (57%), and were in moderate stage of airflow obstruction (53%). The mean of CAT score was 21.87±6.85 and the majority of the patients were classified as having worst symptoms of COPD (93%) as they had high CAT score which was ≥ 10. Conclusion: Majority of the patients in this study had high scores of CAT, which indicated poor HRQOL. Ex-smokers had higher scores compared to non-smokers. More attention need to be given to these subgroups in order to increase their quality of life. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. Although predominantly denoted as a pulmonary disease, COPD also presents with various extra-pulmonary effects which influence different aspects of patients’ physical, emotional and mental well-being. Traditionally, evaluation of COPD severity is based on determination of pulmonary function and particularly on forced expiratory volume in 1 second (FEV1). However, numerous evidences show that FEV1 is not a parameter of sufficient strength when compared to the value of clinical symptoms, e.g. shortness of breath, cough, and COPD patients’ quality of life (QoL). Besides, many clinical manifestations of COPD (anxiety, depression and decreased physical ability) are best expressed by patients themselves, and can be better determined by appropriate questionnaires. Some of currently recommended questionnaires used worldwide are CAT (COPD assessment test) and modified Medical Research Council (mMRC) dyspnea score, in combination with FEV1. Global initiative for COPD – GOLD with its current directives from 2013 includes CAT and mMRC parallel with a number of clinical exacerbations and FEV1 as the most valid parameters and based on that, introduces COPD classification into four groups – A,B,C and D, according to the severity of disease. Therefore, we consider that a full insight into the patient’s QoL and treatment efficacy are impossible without introduction of these self-evaluation questionnaires to the classical instrumental respiratory function evaluation in COPD patients.

Whitening, or sphering, is a common preprocessing step in statistical analysis to transform random variables to orthogonality. However, due to rotational freedom there are infinitely many possible whitening procedures. Consequently, there is a diverse range of sphering methods in use, for example, based on principal component analysis (PCA), Cholesky matrix decomposition, and zero-phase component analysis (ZCA), among others. Here, we provide an overview of the underlying theory and discuss five natural whitening procedures. Subsequently, we demonstrate that investigating the cross-covariance and the cross-correlation matrix between sphered and original variables allows to break the rotational invariance and to identify optimal whitening transformations. As a result we recommend two particular approaches: ZCA-cor whitening to produce sphered variables that are maximally similar to the original variables, and PCA-cor whitening to obtain sphered variables that maximally compress the original variables. [ABSTRACT FROM AUTHOR]

Involuntary adaptations of breathing patterns to counter breathlessness may lead to dysfunctional breathing in obstructive lung diseases. However, no studies examining dysfunctional breathing in Chronic Obstructive Pulmonary Disease (COPD) have been reported. Patients with verified COPD (n = 34), asthma (n = 37) and a healthy control group (n = 41) were recruited. All participants completed the Nijmegen questionnaire for dysfunctional breathing as well as measures of disease activity. Comparisons between groups employed analysis of variance with post-hoc Bonferroni analyses and Pearson correlation for associations. Patients with COPD had significantly higher Nijmegen questionnaire scores than asthmatics (COPD: 23.4 ± 10.6 versus 17.3 ± 10.6, p = 0.016) and healthy individuals (14.3 ± 9.6, p = 0.002). Significantly more patients with COPD had severe dysfunctional breathing with Nijmegen scores >23 (47%; 16/34) compared to asthma (27%; 10/37) and healthy controls (17%; 7/41) respectively (p = 0.019). Dysfunctional breathing was detected in ∼50% of patients with COPD, more so than in asthma or health. Strategies to reduce abnormal breathing behaviours may have important benefits for treatment of breathlessness in COPD. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. Although predominantly denoted as a pulmonary disease, COPD also presents with various extra-pulmonary effects which influence different aspects of patients' physical, emotional and mental well-being. Traditionally, evaluation of COPD severity is based on determination of pulmonary function and particularly on forced expiratory volume in 1 second (FEV1). However, numerous evidences show that FEV1 is not a parameter of sufficient strength when compared to the value of clinical symptoms, e.g. shortness of breath, cough, and COPD patients' quality of life (QoL). Besides, many clinical manifestations of COPD (anxiety, depression and decreased physical ability) are best expressed by patients themselves, and can be better determined by appropriate questionnaires. Some of currently recommended questionnaires used worldwide are CAT (COPD assessment test) and modified Medical Research Council (mMRC) dyspnea score, in combination with FEV1. Global initiative for COPD -- GOLD with its current directives from 2013 includes CAT and mMRC parallel with a number of clinical exacerbations and FEV1 as the most valid parameters and based on that, introduces COPD classification into four groups -- A,B,C and D, according to the severity of disease. Therefore, we consider that a full insight into the patient's QoL and treatment efficacy are impossible without introduction of these self-evaluation questionnaires to the classical instrumental respiratory function evaluation in COPD patients. [ABSTRACT FROM AUTHOR]

This research examined the prevalence of morning symptoms and their relationship with health status, exacerbations and daily activity in patients with chronic obstructive pulmonary disease (COPD). Data on 1489 patients were analysed from a European and USA sample. Results were tested for significance ( p < 0.05) using Mann-Whitney and regression modelling accounting for age, gender, body mass index, comorbidities, symptom severity, smoking status and medication adherence. Morning symptoms were experienced by 39.8% of patients. Controlling for potential confounders, morning symptoms were significantly associated with higher COPD assessment test scores ( p < 0.001) and exacerbation frequency ( p < 0.001), more frequent worsening of symptoms without consulting a Health Care Professional ( p = 0.008), and increased impact on normal daily activities ( p = 0.007); and in the working population, a significantly greater impact on getting up and ready for the day ( p < 0.001) and significantly more days off work per year ( p < 0.001). Our research concluded that in patients with COPD, morning symptoms are associated with poorer health status, impaired daily activities and increased risk of exacerbation in affected patients compared with those patients without morning symptoms. Improved control of patients' morning symptoms may lead to substantial reduction in COPD impact and frequency of exacerbations, and enable patients to increase daily activities, particularly early morning activities. This could, in turn, enable working patients with COPD to be more productive in the workplace. [ABSTRACT FROM AUTHOR]

• AreaFE% was found to be more sensitive parameter than conventional spirometric parameters in the diagnosis of hyperinflation. • Hyperinflation is the main underlying mechanism of a COPD exacerbation. • Low AreaFE% value is an independent risk factor in addition to a high CAT score in predicting future severe exacerbation. • AreaFE% has an excellent discriminative ability in predicting future severe exacerbation. Exacerbations in patients with COPD may still be unpredictable, although the general risk factors have been well defined. We aimed to determine the role of a novel parameter, area under flow-volume loop, in predicting severe exacerbations. In this single-centre retrospective cohort study, 81 COPD patients over 40 years of age with high grade of dyspnea (having a CAT score of ≥10) and a history of ≥1 moderate exacerbation in the previous year were included. Area under flow-volume curve (AreaFE%) was obtained from pulmonary function test graph and calculated from Matlab programme. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors of the severe exacerbation. Patients with severe exacerbation (n = 70, 86.4 %) were older. They had lower FEV1%, FVC%, 6MWD, AreaFE% and higher CAT score than patients without exacerbation. After performing multivariate analysis, high CAT score and low AreaFE% value were found to be independent risk factors for severe exacerbation (OR: 1.12, 95 % CI: 1.065–1.724; p = 0.01 and OR: 1.18, 95 % CI: 0.732−0.974; p = 0.02). We found that a low AreaFE% value was an independent risk factor in addition to a high CAT score and these both have an excellent discriminative ability in predicting the risk of severe exacerbation [ABSTRACT FROM AUTHOR]