Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)

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

Deadline for manuscript submissions: 26 July 2024 | Viewed by 7514

Special Issue Editor


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Guest Editor
1. Pulmonary Department, Research Institute of Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
2. Respiratory Department, Hospital Clinico San Carlos, 28015 Madrid, Spain
3. Department of Medicine, Universidad Complutense de Madrid, 28015 Madrid, Spain
Interests: chronic obstructive pulmonary disease; respiratory diseases; lung

Special Issue Information

Dear Colleagues,

Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitation and persistent respiratory symptoms. Various functional respiratory tests, radiological tests, as well as clinical questionnaires are available to assess the severity and follow-up of COPD.

There have been advances in the treatment of COPD, with bronchodilator drugs, LAMA and LAMA, as well as inhaled corticosteroids, and different combinations of these in a single device. In the near future, biological drugs will be incorporated with new therapeutic targets. Non-pharmacological measures, such as respiratory rehabilitation, smoking cessation, oxygen therapy and mechanical ventilation, vaccination, and lifestyle changes have been shown to improve the prognosis of the disease.

The aim of this Special Issue is to gather articles focused on improving the diagnosis of COPD, as well as advances in the treatment of this disease, which consider both pharmacological and non-pharmacological interventions.

Dr. Juan Luis Rodriguez Hermosa
Guest Editor

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Keywords

  • COPD
  • diagnosis
  • respiratory rehabilitation
  • inhaled therapy
  • biological therapies

Published Papers (7 papers)

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Editorial

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3 pages, 205 KiB  
Editorial
Exploring Mechanisms in COPD: Time for Biomarker Reappraisal?
by Ilektra Voulgareli, Petros Bakakos and Stelios Loukides
J. Clin. Med. 2023, 12(21), 6729; https://doi.org/10.3390/jcm12216729 - 25 Oct 2023
Viewed by 701
Abstract
Chronic obstructive pulmonary disease (COPD) is a widespread condition often overlooked in diagnosis [...] Full article

Research

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15 pages, 867 KiB  
Article
Detection of Alpha-1 Antitrypsin Levels in Chronic Obstructive Pulmonary Disease in Respiratory Clinics in Spain: Results of the EPOCONSUL 2021 Audit
by Myriam Calle Rubio, Marc Miravitlles, José Luis López-Campos, Juan J. Soler-Cataluña, Bernardino Alcazar Navarrete, Manuel E. Fuentes-Ferrer and Juan Luis Rodriguez Hermosa
J. Clin. Med. 2024, 13(4), 955; https://doi.org/10.3390/jcm13040955 - 7 Feb 2024
Viewed by 822
Abstract
Background: Alpha-1 antitrypsin deficiency (AATD) is an underdiagnosed condition despite being one of the most common inherited disorders in adults that is associated with an increased risk of developing chronic obstructive pulmonary disease (COPD). The aim was to evaluate the frequency of performing [...] Read more.
Background: Alpha-1 antitrypsin deficiency (AATD) is an underdiagnosed condition despite being one of the most common inherited disorders in adults that is associated with an increased risk of developing chronic obstructive pulmonary disease (COPD). The aim was to evaluate the frequency of performing AAT levels and associated factors in COPD patients in an audit conducted in 2021–2022, as well as to compare with a previous audit conducted in 2014–2015. Methods: EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to COPD patients in respiratory clinics in Spain based on available data from medical registries. Results: 4225 patients with a diagnosis of COPD from 45 centers were audited in 2021. A total of 1670 (39.5%) patients underwent AAT determination. Being treated at a specialized COPD outpatient clinic (OR 1.88, p = 0.007), age ≤ 55 years old (OR 1.84, p = 0.007) and a FEV1 < 50% (OR 1.86, p < 0.001) were associated with a higher likelihood of being tested for AAT, while Charlson index ≥ 3 (OR 0.63, p < 0.001) and genotyping of AATD availability (OR 0.42, p < 0.001) showed a statistically significant negative association. The analysis of cases included in respiratory units that participated in both audits showed an increase in the proportion of cases with AAT serum level testing available (adjusted OR 2.81, p < 0.001). The percentage of individuals with serum AAT levels < 60 mg/dL (a severe AATD) was 4%. Conclusions: Our analysis identifies significant improvements in adherence to the recommendation to test AAT levels in COPD patients, performed in 4 out of 10 patients, being more likely at younger ages and with higher COPD severity, and with a detection of severe AATD of 4% among those tested, suggesting that clinicians still perform AAT testing in COPD patients selectively. Therefore, efforts are still needed to optimize AATD screening and establish new early detection strategies to reduce morbidity and mortality in these patients. Full article
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12 pages, 1361 KiB  
Article
Endotyping Eosinophilic Inflammation in COPD with ELAVL1, ZfP36 and HNRNPD mRNA Genes
by Ilektra Voulgareli, Maria Semitekolou, Ioannis Morianos, Myrto Blizou, Maria Sfika, Georgios Hillas, Petros Bakakos and Stelios Loukides
J. Clin. Med. 2024, 13(3), 854; https://doi.org/10.3390/jcm13030854 - 1 Feb 2024
Viewed by 698
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a common disease characterized by progressive airflow obstruction, influenced by genetic and environmental factors. Eosinophils have been implicated in COPD pathogenesis, prompting the categorization into eosinophilic and non-eosinophilic endotypes. This study explores the association between [...] Read more.
Background: Chronic obstructive pulmonary disease (COPD) is a common disease characterized by progressive airflow obstruction, influenced by genetic and environmental factors. Eosinophils have been implicated in COPD pathogenesis, prompting the categorization into eosinophilic and non-eosinophilic endotypes. This study explores the association between eosinophilic inflammation and mRNA expression of ELAVL1, ZfP36, and HNRNPD genes, which encode HuR, TTP and AUF-1 proteins, respectively. Additionally, it investigates the expression of IL-9 and IL-33 in COPD patients with distinct eosinophilic profiles. Understanding these molecular associations could offer insights into COPD heterogeneity and provide potential therapeutic targets. Methods: We investigated 50 COPD patients, of whom 21 had eosinophilic inflammation and 29 had non-eosinophilic inflammation. Epidemiological data, comorbidities, and pulmonary function tests were recorded. Peripheral blood mononuclear cells were isolated for mRNA analysis of ELAVL1, ZfP36, and HNRNPD genes and serum cytokines (IL-9, IL-33) were measured using ELISA kits. Results: The study comprised 50 participants, with 66% being male and a mean age of 68 years (SD: 8.9 years). Analysis of ELAVL1 gene expression revealed a 0.45-fold increase in non-eosinophilic and a 3.93-fold increase in eosinophilic inflammation (p = 0.11). For the ZfP36 gene, expression was 6.19-fold higher in non-eosinophilic and 119.4-fold higher in eosinophilic groups (p = 0.07). Similarly, HNRNPD gene expression was 0.23-fold higher in non-eosinophilic and 0.72-fold higher in eosinophilic inflammation (p = 0.06). Furthermore, serum levels of IL-9 showed no statistically significant difference between the eosinophilic and non-eosinophilic group (58.03 pg/mL vs. 52.55 pg/mL, p = 0.98). Additionally, there was no significant difference in IL-33 serum levels between COPD patients with eosinophilic inflammation and those with non-eosinophilic inflammation (39.61 pg/mL vs. 37.94 pg/mL, p = 0.72). Conclusions: The data suggest a notable trend, lacking statistical significance, towards higher mRNA expression for the ZfP36 and HNRNPD genes for COPD patients with eosinophilic inflammation compared to those with non-eosinophilic inflammation. Full article
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11 pages, 1028 KiB  
Article
The Clinical Profile of Patients with COPD Is Conditioned by Age
by Diego Morena, José Luis Izquierdo, Juan Rodríguez, Jesús Cuesta, María Benavent, Alejandro Perralejo and José Miguel Rodríguez
J. Clin. Med. 2023, 12(24), 7595; https://doi.org/10.3390/jcm12247595 - 9 Dec 2023
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Abstract
In recent years, many studies have analyzed the importance of integrating time, or aging, into the equation that relates genetics and the environment to the development and origin of COPD. Under conditions of daily clinical practice, our study attempts to identify the differences [...] Read more.
In recent years, many studies have analyzed the importance of integrating time, or aging, into the equation that relates genetics and the environment to the development and origin of COPD. Under conditions of daily clinical practice, our study attempts to identify the differences in the clinical profile of patients with COPD according to age and the impact on the global burden of the disease. This study is non-interventional and observational, using artificial intelligence and data captured from electronic medical records. The study population included patients who were diagnosed with COPD between 2011 and 2021. A total of 73,901 patients had a diagnosis of COPD. The mean age was 73 years (95% CI: 72.9–73.1), and 56,763 were men (76.8%). We observed a specific prevalence of obesity, heart failure, depression, and hiatal hernia in women (p < 0.001), and ischemic heart disease and obstructive sleep apnea (OSA) in men (p < 0.001). In the analysis by age ranges, a progressive increase in cardiovascular risk factors was observed with age. In conclusion, in a real-life setting, COPD is a disease that primarily affects older subjects and frequently presents with comorbidities that are decisive in the evolutionary course of the disease. Full article
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11 pages, 1849 KiB  
Article
Subtypes of Patients with Mild to Moderate Airflow Limitation as Predictors of Chronic Obstructive Pulmonary Disease Exacerbation
by Nam Eun Kim, Eun-Hwa Kang, Ji Ye Jung, Chang Youl Lee, Won Yeon Lee, Seong Yong Lim, Dong Il Park, Kwang Ha Yoo, Ki-Suck Jung and Jin Hwa Lee
J. Clin. Med. 2023, 12(20), 6643; https://doi.org/10.3390/jcm12206643 - 20 Oct 2023
Viewed by 841
Abstract
COPD is a heterogeneous disease, and its acute exacerbation is a major prognostic factor. We used cluster analysis to predict COPD exacerbation due to subtypes of mild–moderate airflow limitation. In all, 924 patients from the Korea COPD Subgroup Study cohort, with a forced [...] Read more.
COPD is a heterogeneous disease, and its acute exacerbation is a major prognostic factor. We used cluster analysis to predict COPD exacerbation due to subtypes of mild–moderate airflow limitation. In all, 924 patients from the Korea COPD Subgroup Study cohort, with a forced expiratory volume (FEV1) ≥ 50% and documented age, body mass index (BMI), smoking status, smoking pack-years, COPD assessment test (CAT) score, predicted post-bronchodilator FEV1, were enrolled. Four groups, putative chronic bronchitis (n = 224), emphysema (n = 235), young smokers (n = 248), and near normal (n = 217), were identified. The chronic bronchitis group had the highest BMI, and the one with emphysema had the oldest age, lowest BMI, and highest smoking pack-years. The young smokers group had the youngest age and the highest proportion of current smokers. The near-normal group had the highest proportion of never-smokers and near-normal lung function. When compared with the near-normal group, the emphysema group had a higher risk of acute exacerbation (OR: 1.93, 95% CI: 1.29–2.88). However, multiple logistic regression showed that chronic bronchitis (OR: 2.887, 95% CI: 1.065–8.192), predicted functional residual capacity (OR: 1.023, 95% CI: 1.007–1.040), fibrinogen (OR: 1.004, 95% CI: 1.001–1.008), and gastroesophageal reflux disease were independent predictors of exacerbation (OR: 2.646, 95% CI: 1.142–6.181). The exacerbation-susceptible subtypes require more aggressive prevention strategies. Full article
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Review

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34 pages, 706 KiB  
Review
Putative Bidirectionality of Chronic Obstructive Pulmonary Disease and Periodontal Disease: A Review of the Literature
by Hiroyuki Tamiya, Akihisa Mitani, Masanobu Abe and Takahide Nagase
J. Clin. Med. 2023, 12(18), 5935; https://doi.org/10.3390/jcm12185935 - 13 Sep 2023
Cited by 3 | Viewed by 1306
Abstract
The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide and is currently the third leading cause of death globally. The long-term inhalation of toxic substances, mainly cigarette smoke, deteriorates pulmonary function over time, resulting in the development of COPD in adulthood. [...] Read more.
The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide and is currently the third leading cause of death globally. The long-term inhalation of toxic substances, mainly cigarette smoke, deteriorates pulmonary function over time, resulting in the development of COPD in adulthood. Periodontal disease is an inflammatory condition that affects most adults and is caused by the bacteria within dental plaque. These bacteria dissolve the gums around the teeth and the bone that supports them, ultimately leading to tooth loss. Periodontal disease and COPD share common risk factors, such as aging and smoking. Other similarities include local chronic inflammation and links with the onset and progression of systemic diseases such as ischemic heart disease and diabetes mellitus. Understanding whether interventions for periodontal disease improve the disease trajectory of COPD (and vice versa) is important, given our rapidly aging society. This review focuses on the putative relationship between COPD and periodontal disease while exploring current evidence and future research directions. Full article
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15 pages, 1742 KiB  
Review
Exploring Current Concepts and Challenges in the Identification and Management of Early-Stage COPD
by Esperanza Doña, Rocío Reinoso-Arija, Laura Carrasco-Hernandez, Adolfo Doménech, Antonio Dorado and José Luis Lopez-Campos
J. Clin. Med. 2023, 12(16), 5293; https://doi.org/10.3390/jcm12165293 - 14 Aug 2023
Cited by 2 | Viewed by 1662
Abstract
The need to improve health outcomes, as well as disease prognosis, has led clinicians and researchers to propose new ways of identifying COPD in its earliest forms. This initiative is based on the hypothesis that an earlier intervention would have a greater prognostic [...] Read more.
The need to improve health outcomes, as well as disease prognosis, has led clinicians and researchers to propose new ways of identifying COPD in its earliest forms. This initiative is based on the hypothesis that an earlier intervention would have a greater prognostic impact. However, the operational definition of a patient in the initial stages of the disease is complex, and there is still no unanimously accepted definition. GOLD has recently proposed different concepts to identify COPD in its early stages, such as COPD in young people or COPD with mild functional impairment. In addition, GOLD proposes two other concepts, called pre-COPD (symptomatic non-obstructive patients) and PRISm (preserved ratio with impaired spirometry), which aim to identify the patient at risk of developing this chronic airflow obstruction. However, despite the attractiveness of these concepts, none have been taken up universally by the medical community. A universally accepted identification of how to define COPD in its early stages is necessary as a preliminary step in order to design clinical trials to find out the best way to treat these patients. This review deals with these concepts of COPD at the onset of the disease, highlighting their importance and the problems involved in identifying them as therapeutic targets in real clinical practice. Full article
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