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Abstract: One of the important comorbidities that has a longstanding research history in COPD is diabetes. Although there are multiple studies on COPD and diabetes, the exact links between these two conditions are still controversial. The exact prevalence of diabetes in COPD varies between 2 and 37 %. The true nature of this relationship is complex and may be partially related to the tradi-tional risk factors for diabetes such as smoking, cardiovascular disease and use of steroids. Howev-er, COPD is a disease that has multiple phenotypes and is no longer regarded as a homogeneous condition. It seems that some COPD patients who overlap with asthma or the obese phenotype are at a particular risk for T2DM. The aim of this review is to analyze the prevalence, risk factors and possible interactions between COPD and diabetes mellitus.

Repeated desaturation of oxyhemoglobin, micro-arousals, which are typical in obstructive sleep apnea syndrome (OSAS), have negative effects on the health of patients, leading to a wide range of complications such as cardiovascular (arterial hypertension, pulmonary hypertension, chronic heart failure, arrhythmias, myocardial infarction) cerebrovascular (strokes), metabolic (insulin resistance, obesity, diabetes mellitus, metabolic syndrome), gastrointestinal (non-alcoholic liver disease), urinary (chronic renal failure), neuropsychiatric complications and a wide range of malignancies. This in turn has a multilateral effect on familial, occupational and social life, as well as increasing the risk of road traffic accidents or accidents at workplace. Awareness, timely screening and prevention of complications play an important role in the diagnosis and treatment of comorbid conditions. This review focuses on comorbidities in OSAS and the effect of CPAP therapy on their prognosis.

Obstructive pulmonary diseases are a group of respiratory conditions characterized by airflow limitation. They are prevalent in the population and lead to significant morbidity and mortality. The two most commonly encountered conditions are asthma and Chronic Obstructive Pulmonary Disease (COPD). Although, for many years, the two conditions were regarded as separate, it was realized that some patients may have an overlap between these illnesses. This observation led to the identification of asthma-COPD overlap (ACO) syndrome. ACO is an umbrella term that is used “to collectively describe patients who have persistent airflow limitation together with clinical features that are consistent with both asthma and COPD”. Its importance in the field of respiratory medicine is increasing every year as there are more data that underline the importance of its timely diagnosis and management. The current review is a timely update of the advances in our understanding of ACO.

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation, bronchial reversible obstruction and hyperresponsiveness to direct or indirect stimuli. It is a severe disease causing approximately half a million deaths every year and thus possessing a significant public health burden. Stroke is the second leading cause of death and a major cause of disability worldwide. Asthma and asthma medications may be a risk factors for developing stroke. Nevertheless, since asthma is associated with a variety of comorbidities, such as cardiovascular, metabolic and respiratory, the increased incidence of stroke in asthma patients may be due to a confounding effect. The purpose of this review is to analyze the complex relationship between asthma and stroke.

Clinical trials evaluating the management of acute exacerbations of COPD assess heterogeneous outcomes, often omitting those that are clinically relevant or more important to patients. We have developed a core outcome set, a consensus-based minimum set of important outcomes that we recommend are evaluated in all future clinical trials on exacerbations management, to improve their quality and comparability. COPD exacerbations outcomes were identified through methodological systematic reviews and qualitative interviews with 86 patients from 11 countries globally. The most critical outcomes were prioritised for inclusion in the core outcome set through a two-round Delphi survey completed by 1063 participants (256 patients, 488 health professionals and 319 clinical academics) from 88 countries in five continents. Two global, multi-stakeholder, virtual consensus meetings were conducted to 1) finalise the core outcome set and 2) prioritise a single measurement instrument to be used for evaluating each of the prioritised outcomes. Consensus was informed by rigorous methodological systematic reviews. The views of patients with COPD were accounted for at all stages of the project. Survival, treatment success, breathlessness, quality of life, activities of daily living, the need for a higher level of care, arterial blood gases, disease progression, future exacerbations and hospital admissions, treatment safety and adherence were all included in the core outcome set. Focused methodological research was recommended to further validate and optimise some of the selected measurement instruments. The panel did not consider the prioritised set of outcomes and associated measurement instruments to be burdensome for patients and health professionals to use.

The DisEntangling Chronic Obstructive pulmonary Disease Exacerbations clinical trials NETwork: #DECODE_NET. Vision statement of an emerging, global network aiming to conduct collaborative clinical research on COPD exacerbation management @ERSpublicationshttps://bit.ly/36kISgp

Background: COPD is characterized by persistent airflow limitation, the severity of which is assessed using FEV1, % predicted. Multiple cohort studies have demonstrated that COPD patients with similar levels of airflow limitation showed high heterogeneity in clinical manifestations and outcomes. The aim of the study was to identify phenotypes using cluster analysis in COPD patients and to compare differences in clinical, physiological and HRQL data between the clusters. Methods: The study was conducted in 433 patients with COPD. We evaluated the following variables in COPD patients: age, gender, body mass index (BMI), modified Medical Research Council (MMRC) scale, 6-min walking distance (6MWD), BODE, rate of exacerbations, spirometry, CCQ and SGRQ. Results: The cohort consisted of 433 COPD patients of which 352 (81%) men and 81 (19%) women with mean age 62,7 ± 9,8 years. Cluster analysis identified 3 clusters: (1) majority were men with severe obstruction, severe symptoms, severe impairment of HRQL, low exercise tolerance, frequent exacerbations; (2) majority were women with moderate airflow limitation, moderate symptoms, moderate deterioration of HRQL, moderate limitation of exercise tolerance, frequent exacerbations; (3) men with mild airflow limitation, mild symptoms, mild deterioration in quality of life, low exercise tolerance, rare exacerbations. Conclusions: COPD patients may be clustered into 3 clusters with different clinical, physiological and HRQL patterns, which may help in future in delivering individualized treatment. These clusters will need to be validated prospectively.

Chronic obstructive pulmonary disease (COPD), a very common disease, is the third leading cause of death worldwide. Due to the significant heterogeneity of clinical phenotypes of COPD there is no single method suitable for predicting patients' health status and outcomes, and therefore multidimensional indices, assessing different components of the disease, were developed and are recommended for clinical practice by international guidelines. Several indices have been widely accepted: BODE and its modifications, ADO, DOSE, CODEX, COTE. They differ in their composition and aim, while they are more accurate and better validated in specific settings and populations. We review the characteristics, strengths and limitations of these indices, and we discuss their role in routine management of patients with COPD, as well as in specific clinical scenarios, such as resuscitation and ceiling of care, or decisions to offer more invasive treatments. This analysis may help clinicians to use those indexes in a more practical and appropriate way.