Chron Respir Dis [JOURNAL]
Sun
200 papers
Use of oscillatory positive expiratory pressure (OPEP) devices to augment sputum clearance in COPD: An updated systematic review and meta-analysis.
Alzahrani AA, Alghamdi SM, Majrshi MS … +4 more , Alasmari AM, Birring SS, Grillo LJ, Hopkinson NS
Chron Respir Dis · 2026 · PMID 42333474 · Full text
IntroductionEffective airway clearance is crucial in COPD management, and oscillatory positive expiratory pressure (OPEP) devices are a potential adjunct therapy for this. However, their clinical efficacy remains uncerta...
IntroductionEffective airway clearance is crucial in COPD management, and oscillatory positive expiratory pressure (OPEP) devices are a potential adjunct therapy for this. However, their clinical efficacy remains uncertain due to limited trial data.AimTo update our previous (2020) systematic review investigating the use of OPEP devices to augment sputum clearance in COPD.MethodsRandomised Clinical Trails s evaluating OPEP devices in COPD were identified from PubMed, CINAHL, Medline, Cochrane, and Embase (2020-2024). Outcomes included lung function, exercise capacity, exacerbations, and health-related quality of life (HRQoL), with pooled estimates calculated using random-effects models.ResultsTwelve trials (741 participants) were included. OPEP devices significantly reduced exacerbations (Odds Ratio: 0.39) and improved exercise capacity (+49 m at 6MWD). Small improvements were observed in FVC%, while HRQoL changes were not statistically significant. Accumulating evidence suggests benefits for sputum clearance and reduced antibiotic use. Devices were generally well accepted and safe.ConclusionOPEP devices appear to be safe and may reduce exacerbations, improve functional exercise capacity, and support sputum clearance in COPD.
Exposure to indoor wood smoke, rather than hypoxemia, is a risk factor for cognitive impairment in COPD patients living at high altitude.
González-García M, Proaños NJ, Casas-Herrera A … +3 more , Alí-Munive A, Aguirre-Franco CE, Torres-Duque CA
Chron Respir Dis · 2026 · PMID 42309502 · Full text
BackgroundIn the general population without COPD, indoor air pollution from biomass is a causal factor of cognitive impairment (CI). CI is also common in patients with tobacco smoke COPD and has been associated with hypo...
BackgroundIn the general population without COPD, indoor air pollution from biomass is a causal factor of cognitive impairment (CI). CI is also common in patients with tobacco smoke COPD and has been associated with hypoxemia and cardiovascular comorbidities. CI and its risk factors have not been evaluated in COPD patients living at high altitude, who experience greater hypoxemia and frequent exposure to wood smoke.MethodsPatients with COPD residing at high altitude with FEV1/FVC <0,70 and COPD risk factors (wood smoke, Tobacco smoke or combined exposure). Measurement of the Mini-Mental State Examination to assess CI, educational level, comorbidities, exacerbations, arterial blood gases, diffusion (DLCO), and 6-min walk test (6MWT). Comparisons between groups with and without CI using the X2 test and unpaired t-test. Logistic regression with odds ratio (OR) calculation was used to evaluate the association of CI with the variables of interest.ResultsIn the 199 patients included, 16.1% had CI, the majority with mild involvement (68.8%). Those with CI had more frequent exposure to wood smoke (p<0.001), older age (p=0.017), lower educational level, PaO2 (p=0.032), DLCO (p=0.036), and fewer meters in the 6MWT (p=0.007), with no differences in sex, severity of obstruction or comorbidities. Adjusting for the other variables, exposure to wood smoke was associated with CI [OR and 95% CI: 4.82 (1.62-14.33).ConclusionsIn patients with mild to moderate COPD living at high altitude, regardless of hypoxemia, age, educational level, comorbidities, and lung function, exposure to wood smoke was associated with CI.
Post COVID REspiratory mechanisms and the efficacy of a breathing exercise intervention for DYsregulated breathing (Remedy): A feasibility RCT study.
Tc HD, S C, J K … +5 more , J P, S M, F M, Tm M, Ce B
Chron Respir Dis · 2026 · PMID 42301723 · Full text
BackgroundDysregulated breathing is a major cause of persisting breathlessness for many people following acute COVID-19 illness. There is little evidence to support the use of breathing interventions within this populati...
BackgroundDysregulated breathing is a major cause of persisting breathlessness for many people following acute COVID-19 illness. There is little evidence to support the use of breathing interventions within this population.MethodsA feasibility study was conducted to investigate the potential role of supervised, remote online yogic breathing as an intervention, compared to usual care. The intervention was a six-week group programme, in which they were encouraged to attend bi-weekly. Primary outcomes of attendance, completion and acceptability were recorded and a survey following the intervention. Secondary measures of breathlessness and physical function were collected.ResultsOf 122 people invited who had reported dysregulated breathing at the time of clinical consult, 40 consented and 34 were randomised (Intervention n=17, usual care n=17), 33 had initial assessment (n=16 and n=17) and with post-intervention outcomes available in n=13 and n=14, respectively. Of the 13 in the intervention arm, 5 people completed >75% of sessions and the post intervention assessment. The median number of sessions attended per participant was 7. No safety issues were recorded. The survey (n=13) of the actual intervention highlighted it was well received but there was limited options for attending. Although some breathlessness measures improved in the people receiving the intervention, there was no significant difference when comparing the intervention to usual care arms.ConclusionsThe feasibility of the study was limited in this select population of people after COVID-19 with dysregulated breathing. The intervention was well received, but attendance at all the sessions was challenged by the limited options for the sessions.
Diurnal and seasonal variation in six-minute walk distance in pulmonary hypertension: Implications for clinical monitoring.
Robertson L, Bunclark K, Toshner M … +7 more , Pepke-Zaba J, Sheares K, Cannon J, Taboada Buasso D, Sylvester KP, Newman J, Knox-Brown B
Chron Respir Dis · 2026 · PMID 42273732 · Full text
IntroductionThe American Thoracic Society (ATS) six-minute walk test (6MWT) guidelines recommend repeat testing at the same time of day to minimise intraday variability. Whether diurnal or seasonal factors affect the 6MW...
IntroductionThe American Thoracic Society (ATS) six-minute walk test (6MWT) guidelines recommend repeat testing at the same time of day to minimise intraday variability. Whether diurnal or seasonal factors affect the 6MWT in pulmonary hypertension (PH) is unclear. We investigated associations between six-minute walk distance (6MWD) and secondary 6MWT parameters with time of day and season using cross sectional and longitudinal analyses.MethodsThis single-centre retrospective study (2019-2025) included PH patients undergoing 6MWT as per ATS guidelines. Cross-sectional analyses compared morning (AM, 07:00-12:00) vs afternoon (PM, 12:01-18:00) and seasonal effects on 6MWD using adjusted linear models. Longitudinal effects were examined with adjusted linear mixed effects models.ResultsThe cross-sectional cohort included 1,665 patients (AM n=734, PM n=931). Estimated marginal mean (EMM) 6MWD was higher in the morning than afternoon (354m vs 339m; p=0.005), with no seasonal variation (Winter 338m, Spring 354m, Summer 345m, Autumn 343m; p=0.20). The longitudinal cohort included 554 patients. EMM 6MWD was similar between AM and PM (396m vs 400m; p=0.16) and across seasons (Winter 395m, Spring 395m, Summer 399m, Autumn 398m; p=0.43). Maximal heart rate (MHR) was higher in the afternoon (115 vs 113 bpm; p=0.002) and lower in Summer/Autumn (113 bpm) vs Winter (116 bpm) and Spring (115 bpm; p=0.017).Conclusion6MWD was stable across time of day and season, supporting greater flexibility in scheduling 6MWTs than suggested by guidelines. Small variations in MHR were associated with circadian and seasonal influences but did not affect 6MWD. Prospective studies are needed to confirm these findings.
Remote behaviour change service for inactive adults with lung disease: A non-randomised controlled study.
Aw J, H R, M S … +10 more , A B, C R, M S, J P, J S, C W, A D, M H, An S, G L
Chron Respir Dis · 2026 · PMID 42224628 · Full text
ObjectivesTo determine whether a remote behaviour change service (Active Steps), delivered by a UK charity, can increase physical activity over a 12-month period in adults with lung disease.MethodsActive Steps (n=166) co...
ObjectivesTo determine whether a remote behaviour change service (Active Steps), delivered by a UK charity, can increase physical activity over a 12-month period in adults with lung disease.MethodsActive Steps (n=166) consisted of 1:1 telephone health coaching for 12 months alongside printed (e.g. activity diary and chart, information and goal setting booklet) and digital behaviour change strategies (e.g. exercise videos, motivational newsletters, pedometer). A concurrent control group was recruited (n=80) for comparison. Self-reported physical activity (Short Active Lives Survey) and self-reported health (EQ-VAS) were collected at baseline, 3, 6, and 12 months. Logistic regression models (adjusted for confounders) were used to analyse the odds of becoming physically active or average changes in physical activity time and EQ-VAS.Results: The number of participants defined as physically active at 12 months was greater with Active Steps (46%) compared to controls (23%) which was statistically significant in an unadjusted (odds ratio (OR) [95% confidence intervals (CI)]:2.8 [1.3-6.1], p=0.011) but not adjusted model (OR: 2.2 [0.9-5.4], p=0.097). : Compared to controls, Active Steps increased the number of participants physically active at 3 and 6 months, increased the weekly minutes of moderate-vigorous physical activity and improved self-reported health (EQ-VAS) across all timepoints.DiscussionOur findings suggest that charity-led remote behaviour change support is effective in the short-to-medium-term in adults with lung disease, but high participant attrition necessitates caution in interpreting sustained effect estimates at 12 months. Further long-term evaluations are needed to address adherence and sustainability of such services.
A qualitative study on medication literacy among patients with chronic obstructive pulmonary disease.
Jiahui Z, Jiaqi L, Yue Z … +4 more , Ruining Z, Hao G, Xinqian S, Linping S
Chron Respir Dis · 2026 · PMID 42223991 · Full text
ObjectiveGuided by the medication literacy conceptual model, this study represents an interpretive exploration of medication literacy among patients with Chronic Obstructive Pulmonary Disease (COPD) to provide evidence f...
ObjectiveGuided by the medication literacy conceptual model, this study represents an interpretive exploration of medication literacy among patients with Chronic Obstructive Pulmonary Disease (COPD) to provide evidence for strategies aimed at improving medication adherence.MethodsUsing purposive sampling, 18 patients were recruited from the respiratory department and outpatient clinics of a tertiary general hospital in Shanxi Province between March and July 2025. Data were collected via semi-structured interviews and analyzed using directed content analysis method.ResultsThe analysis yielded four primary themes: functional, communicative, and critical medication literacy, as well as medication numeracy. These findings indicate that medication literacy in COPD patients is influenced by multidimensional factors, highlighting the complex challenges and subjective barriers in both cognitive and behavioral domains.ConclusionThese findings suggest that future interventions could prioritize patient-centered, personalized nursing interventions tailored to these specific literacy deficits-particularly in numeracy and critical processing-to effectively enhance treatment adherence and quality of life for COPD patients.
A retrospective study to understand the journey and health status of patients with unexplained or refractory chronic cough in the Netherlands.
van den Berg JWK, Edens M, Oedit Doebé AR … +2 more , van der Velden H, Heezen MR
Chron Respir Dis · 2026 · PMID 42175528 · Full text
IntroductionThis study aims to characterize the patient journey for refractory chronic cough (RCC) or unexplained chronic cough (UCC) before visiting the Isala Chronic Cough Clinic (ICCC) in the Netherlands.MethodData fr...
IntroductionThis study aims to characterize the patient journey for refractory chronic cough (RCC) or unexplained chronic cough (UCC) before visiting the Isala Chronic Cough Clinic (ICCC) in the Netherlands.MethodData from 152 patients with RCC or UCC was collected between January 2017 and September 2021from General Practitioner (GP) and hospital charts, the EQ-5D-5L questionnaire, and a patient survey about the care pathway and cough impact on everyday life, based on a single-centre, observational, retrospective study design.ResultsMean age at first ICCC visit was 60.3 ± 11.6 years; 66.4% of patients was female. More patients had RCC (80.9%) than UCC (19.1%). Mean cough duration before ICCC visit was 8.5 ± 6.5 years. 41.4% of patients reported cough >10 years. Common patient-reported problems were social embarrassment (58.0%), exhaustion (54.2%), and sleep disturbance (45.0%). Urinary incontinence was prevalent among women (48.9%). Prior to ICCC, 59.2% had consulted 2-4 specialists for their cough and 16.2% had seen more than 4.ConclusionThis study highlights the long time to diagnosis of RCC or UCC, and the negative effect on patients' physical and psychological health, and everyday activities. Increased awareness may shorten time for diagnosis, and novel therapies may help reduce this disease burden.
Explainable machine learning model for predicting acute exacerbations of COPD combining sarcopenia index and traditional risk factors: A retrospective single-center exploratory study.
Zhang AB, Zhou LW, An YF … +3 more , Qin QQ, Wei JT, Chen H
Chron Respir Dis · 2026 · PMID 42161359 · Full text
ObjectivesChronic obstructive pulmonary disease (COPD) is a common respiratory disorder. Acute exacerbation of COPD (AECOPD) severely affects patients' quality of life and prognosis. This study aimed to identify novel ri...
ObjectivesChronic obstructive pulmonary disease (COPD) is a common respiratory disorder. Acute exacerbation of COPD (AECOPD) severely affects patients' quality of life and prognosis. This study aimed to identify novel risk factors and develop an effective predictive model for AECOPD using machine learning (ML) models.MethodsIn this retrospective single-center study, clinical data and biomarkers from 565 participants were analyzed using ML algorithms. Feature selection employed least absolute shrinkage and selection operator regression. Eight ML models were trained and evaluated using receiver operating characteristic (ROC) and clinical decision curve analysis. The Shapley Additive explanations (SHAP) framework assessed feature contributions. An online personalized risk calculator was developed based on the optimal model and individual SHAP values.ResultsThe XGBoost model demonstrated excellent discriminative performance, with areas under the ROC curve of 0.818 and 0.838 for the training and test sets, respectively. Key predictors identified by SHAP analysis included age, current smoking status, frequency of exacerbations in the previous year, albumin levels, sarcopenia index, and COPD Assessment Test score. These variables were integrated into an online calculator for research to illustrate individualized AECOPD risk estimation. However, external validation is still required before its clinical application.ConclusionsWe developed a preliminary ML model for predicting AECOPD, which provides a valuable tool for clinical risk assessment. The results also highlighted the correlation between sarcopenia and AECOPD risk.
Modernisation of chronic respiratory disease management: The integration of wearable technology.
Armstrong M
Chron Respir Dis · 2026 · PMID 42158961 · Full text
Chronic respiratory diseases such as Chronic Obstructive Pulmonary Disease, Asthma, Interstitial Lung Disease, Cystic Fibrosis, and Pulmonary Hypertension affect over 500 million people globally and pose significant chal...
Chronic respiratory diseases such as Chronic Obstructive Pulmonary Disease, Asthma, Interstitial Lung Disease, Cystic Fibrosis, and Pulmonary Hypertension affect over 500 million people globally and pose significant challenges for diagnosis, management, and long-term care. Traditional approaches often rely on episodic clinical assessments and patient-reported symptoms, which fail to capture the dynamic nature of respiratory health. The integration of wearable technology offers a transformative solution, enabling continuous, real-time monitoring of physiological and behavioural parameters. This review explores the evolving role of wearable devices, including activity trackers, smartwatches, spirometers, and biosensors, in modernising chronic respiratory disease management. Evidence across disease domains demonstrates that wearables can enhance physical activity, predict exacerbations, support remote rehabilitation, and facilitate personalised care. In Chronic obstructive pulmonary disease, step counters and biometric sensors have shown improvements in activity levels and early exacerbation detection. Asthma care benefits from AI-driven platforms that integrate environmental and physiological data to optimise treatment. For Interstitial lung disease and Cystic fibrosis, home spirometry and sweat biomarker monitoring empower patients and improve disease tracking. In Pulmonary hypertension, wearables provide insights into activity and sleep patterns, complementing traditional assessments. Despite promising outcomes, barriers remain. Technical limitations, data reliability, digital literacy, privacy concerns, and integration into clinical workflows hinder widespread adoption. Economic and equity considerations further challenge scalability, particularly in low-resource settings. Looking forward, the convergence of multimodal sensing, AI analytics, and digital therapeutics will enable proactive, personalised, and equitable respiratory care. Addressing validation, interoperability, and ethical governance will be critical to realising the full potential of wearable technology in CRD management.
The lived experiences of individuals with early stage non-small cell lung cancer following lung surgery: A rapid ethnographic approach.
Haesevoets S, Muijsenberg AJL, Cops D … +7 more , Harrison SL, Criel M, Ruttens D, Daenen M, Spruit MA, Demeyer H, Burtin C
Chron Respir Dis · 2026 · PMID 42139296 · Full text
BackgroundIndividuals with early-stage non-small cell lung cancer (NSCLC) often show reduced exercise capacity and physical activity (PA) after surgery, with or without (neo-)adjuvant therapy. However, understanding of p...
BackgroundIndividuals with early-stage non-small cell lung cancer (NSCLC) often show reduced exercise capacity and physical activity (PA) after surgery, with or without (neo-)adjuvant therapy. However, understanding of peoples' lived-lives following lung cancer diagnosis and surgery remains unknown.ObjectiveThis study aimed to deeper understand how lung cancer diagnosis and surgery shape individuals' daily lives within one to three months post-surgery.MethodsAdults (18+) with stage I-IIIA NSCLC were recruited one to three months after surgery or (neo-)adjuvant therapy including radio-/chemo-/immunotherapy. A rapid ethnographic approach was used. Participants were observed at home during three two-hour visits, with a semi-structured interview during the last visit. Field notes and transcripts were thematically analyzed in Atlas.ti using a hybrid approach. Initial themes were deductively guided by the 14-domain TDF and inductively refined. Final themes were mapped onto the COM-B model.Results16 individuals (69% female; 69±7 years; 3820±2207 steps/day; 6±8 min/day moderate-to-vigorous PA; 44% received (neo-)adjuvant therapy) participated in home observations (86h total, range 4-6h) and a semi-structured interview during the last visit (383min total, range 16-44min). Four key themes were identified; 1) Physical consequences affecting daily life; 2) Emotional and social coping; 3) Motivation and barriers influencing PA and rehabilitation; 4) Gaps in education and guidance.ConclusionLung cancer surgery (with or without (neo-)adjuvant therapy) causes physical, emotional, and social challenges that impair daily life. PA and engagement to rehabilitation is often limited by symptoms and contextual barriers. Tailored rehabilitation addressing individuals' living conditions, physical, and emotional needs are considered crucial for recovery.
Frailty and prehabilitation in lung transplant candidates: A cross-sectional UK survey of assessment, provision and barriers.
McGarrigle L, Norman G, Hurst H … +1 more , Todd C
Chron Respir Dis · 2026 · PMID 42076840 · Full text
ObjectivesFrailty is a multifactorial state of reduced physiological reserve and increased vulnerability, common in lung transplantation (LTx) candidates and associated with morbidity and mortality. There is no consensus...
ObjectivesFrailty is a multifactorial state of reduced physiological reserve and increased vulnerability, common in lung transplantation (LTx) candidates and associated with morbidity and mortality. There is no consensus on appropriate frailty instruments or optimal prehabilitation. Aims were to: (1) identify frailty measures in UK adult LTx candidates, (2) describe prescribed prehabilitation interventions, and (3) explore barriers to prehabilitation.MethodsAn anonymous online Qualtrics survey was circulated via UK LTx coordinators and social media. Eligible respondents were professionals contributing to adult pre-operative assessment and listing decisions. Results were analysed using SPSS.ResultsThirty-one respondents met criteria, representing all five UK LTx centres. Frailty was always assessed by 58.1% and sometimes by 25.8%, though comprehensive measurement tools were rarely used. Functional tools included the Short Physical Performance Battery and sit-to-stand tests. Assessments occurred pre-listing and during waitlisting. Frailty was discussed at all listing meetings and influenced transplant suitability. Outpatient prehabilitation included face to face, telephone, and local referrals, targeting exercise, nutrition, and psychosocial needs. Reported barriers were travel, funding, and limited space.ConclusionUK lung transplant services conceptually recognise frailty as multidimensional and clinically important, but operationally rely on pragmatic, largely physical proxy measures. Prehabilitation provision is variable and often externally delivered constrained by system-level resource and access barriers.
Trends in chronic ischemic heart disease mortality in patients with interstitial lung disease in the United States from 1999 to 2023.
Wu F, Xue Y, Luan Y … +3 more , Zhang F, Ma X, Zhang W
Chron Respir Dis · 2026 · PMID 42033661 · Full text
BackgroundInterstitial lung disease (ILD) patients often have comorbid chronic ischemic heart disease (CIHD), which may worsen prognosis. Large-scale studies on long-term CIHD mortality trends in ILD patients are lacking...
BackgroundInterstitial lung disease (ILD) patients often have comorbid chronic ischemic heart disease (CIHD), which may worsen prognosis. Large-scale studies on long-term CIHD mortality trends in ILD patients are lacking. This study analyzes CIHD-related mortality trends in US adults with ILD from 1999 to 2023.MethodsCIHD-related mortality data were extracted from the CDC WONDER database for ILD patients aged ≥25 years. International Classification of Diseases, 10th Revision (ICD-10) codes J84.1, J84.8, J84.9 identified ILD, and code I25 identified CIHD. Age-adjusted mortality rates (AAMR), annual percentage change (APC), and average annual percentage change (AAPC) per 100,000 were calculated using Joinpoint regression.ResultsBetween 1999 and 2023, there were 92,779 CIHD-related deaths among U.S. decedents with interstitial lung disease (ILD, listed as an underlying or contributing cause of death in death certificates); this accounted for a substantial proportion of cardiovascular-related deaths in this decedent population. The overall AAMR showed a slight upward trend (AAPC=0.51%), but with significant nonlinearity: a decrease from 2003-2018 (APC=-1.29%), increased sharply from 2018 to 2021 (APC = 9.75%), with the increase concentrated during the COVID-19 pandemic years. The age-adjusted mortality rate rose modestly from 1.54 per 100,000 in 2018 to 1.60 in 2019 (+3.9%), then surged to 1.73 in 2020 (+8.1%) and peaked at 1.98 in 2021 (+14.5% from 2020). After 2021, mortality declined to 1.88 in 2023. Mortality was higher in men, non-Hispanic Whites, adults >85 years, and in southern and nonmetropolitan areas. Each subgroup showed a significant increase in mortality during 2020-2021, coinciding with the pandemic, while pre-pandemic trends were more gradual.ConclusionsCIHD-related mortality in ILD patients showed a fluctuating upward trend over 25 years, with a significant jump during the COVID-19 pandemic. This underscores the systemic impact of public health emergencies on cardiovascular health in vulnerable populations. Cardiovascular risk assessment and management should be integrated into routine ILD care, with tailored strategies for high-risk groups and regions.
Understanding exacerbation risk in BLVR: A logistic regression approach to complication prediction.
Wienker J, Darwiche K, Karpf-Wissel R … +10 more , Büscher E, Haubold J, Kersting D, Hautzel H, van de Sand L, Kassem A, Mersmann K, Taube C, Opitz M, Struß M
Chron Respir Dis · 2026 · PMID 42018974 · Full text
BackgroundChronic obstructive pulmonary disease (COPD) with emphysema is associated with persistent airflow limitation and frequent exacerbations. Bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBV...
BackgroundChronic obstructive pulmonary disease (COPD) with emphysema is associated with persistent airflow limitation and frequent exacerbations. Bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) improves lung function and quality of life but carries a risk of postprocedural complications, including acute exacerbations and pneumonia. Predictors of these adverse events remain incompletely defined.PurposeTo identify clinical and inflammatory factors associated with postprocedural exacerbations in patients undergoing BLVR with EBVs, aiming to support individualized risk stratification.Patients and MethodsWe retrospectively analyzed 320 patients with advanced emphysema treated with EBVs between 2015 and 2022. Patients underwent comprehensive preprocedural evaluation, including pulmonary function testing, imaging, perfusion scintigraphy, 6-minute walk test and COPD Assessment Test. Postprocedural exacerbations within 8 weeks were documented clinically and radiographically. Binary logistic regression, including multivariable modeling, was used to identify independent predictors.ResultsThirty-five patients (10.9%) developed post-BLVR exacerbations, six of whom had pneumonia. Exacerbation risk was independently associated with diabetes mellitus type II (OR 11.0, < 0.001), elevated C-reactive protein >1 mg/dL (OR 9.35, < 0.001), WBC >11 cells/nL (OR 5.46, = 0.002), prior exacerbation frequency (OR 2.94, < 0.001) and low BMI (OR 0.78, < 0.001). Residual volume showed a trend toward significance ( = 0.058). The final model demonstrated excellent discriminative ability (AUC = 0.923). While lung function improvement was attenuated in the exacerbation group, quality of life gains were comparable.ConclusionElevated inflammatory markers, diabetes, frequent prior exacerbations and low BMI were independently associated with early postprocedural exacerbations following BLVR with EBVs. Comprehensive preprocedural assessment and targeted management of these risk factors may enhance patient safety and improve outcomes.
Comparative assessment of ChatGPT and Gemini answers to common chronic obstructive pulmonary disease questions: An expert panel evaluation by pulmonologists.
Güçsav MO, Serçe Unat D, Akçay O … +3 more , Unat ÖS, Ayrancı A, Erbaycu AE
Chron Respir Dis · 2026 · PMID 41983513 · Full text
BackgroundAI-based chatbots are increasingly used as sources of health information. However, their reliability in delivering accurate and scientifically sound responses to patient questions remains uncertain, especially...
BackgroundAI-based chatbots are increasingly used as sources of health information. However, their reliability in delivering accurate and scientifically sound responses to patient questions remains uncertain, especially in chronic diseases such as chronic obstructive pulmonary disease (COPD). This study aims to compare the reliability of ChatGPT-4o and Gemini 2.5 Flash in providing patient-centered medical information on COPD.MethodsA total of 34 common public questions about COPD were submitted to ChatGPT-4o and Gemini 2.5 Flash. Responses were evaluated blindly by four pulmonologists across three domains: accuracy, clarity, and scientific adequacy. The mean scores and word counts were analyzed and compared via nonparametric tests.ResultsGemini 2.5 Flash outperforms ChatGPT-4o in terms of scientific adequacy (mean score: 4.69 ± 0.31 vs. 4.34 ± 0.45, <0.001). No significant difference was found in accuracy or clarity. The Gemini 2.5 Flash also generated significantly longer responses, particularly in the treatment and prognosis domains (<0.001). Both models provided generally acceptable answers, but ChatGPT-4o's responses were shorter and occasionally less complete.ConclusionsWhile both models delivered largely accurate and understandable content, Gemini 2.5 Flash tended to produce more detailed responses and received higher scientific adequacy ratings; however, this difference should be interpreted in light of the substantial imbalance in response length. These tools may support patient education however, the findings reflect a comparison between AI systems only and should be interpreted within this scope.
Non-pharmacological rehabilitation strategies for pulmonary and physical recovery in ICU survivors after COVID-19: A systematic review.
Medina YF, Rodríguez Grande EI, Galindo JL … +3 more , Vargas Pinilla OC, Soler F, Espitia GV
Chron Respir Dis · 2026 · PMID 41933448 · Full text
BackgroundSurvivors of severe COVID-19 requiring intensive care frequently experience persistent pulmonary and functional impairment consistent with post-critical illness sequelae. The effectiveness of non-pharmacologica...
BackgroundSurvivors of severe COVID-19 requiring intensive care frequently experience persistent pulmonary and functional impairment consistent with post-critical illness sequelae. The effectiveness of non-pharmacological rehabilitation in this severity-specific subgroup remains uncertain.MethodsA systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Epistemonikos, LILACS, and Google Scholar were searched for randomized and observational studies evaluating non-pharmacological rehabilitation in adult ICU survivors of COVID-19. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Given substantial clinical and methodological heterogeneity, quantitative meta-analysis was not performed; a structured narrative synthesis was undertaken.ResultsFourteen studies met inclusion criteria. Five incorporated comparator groups, while nine employed uncontrolled pre-post designs. Interventions ranged from early ICU mobilization to inpatient and outpatient pulmonary rehabilitation. Controlled studies reported variable between-group benefits in dyspnea and functional outcomes, whereas observational studies consistently described within-group improvement over time. However, most studies were at moderate to serious risk of bias, and heterogeneity in intervention timing, dosage, and outcome assessment limited comparability.ConclusionsNon-pharmacological rehabilitation in ICU survivors of COVID-19 is associated with improvement over time; however, the certainty of causal effectiveness remains low. ICU survivors constitute a distinct recovery population within the broader post-COVID spectrum. Adequately powered, multicenter randomized trials with standardized protocols and harmonized outcomes are required to establish long-term effectiveness.
Digital exclusion faced by people living with chronic respiratory disease: Challenges, implications and solutions.
Trewartha G, Janssens L, Harrison S
Chron Respir Dis · 2026 · PMID 41928617 · Full text
The introduction of digital health technologies (DHTs) to support the diagnosis, assessment, and management of chronic respiratory diseases (CRD) has great potential to democratise access to healthcare, but will suffer i...
The introduction of digital health technologies (DHTs) to support the diagnosis, assessment, and management of chronic respiratory diseases (CRD) has great potential to democratise access to healthcare, but will suffer if these new technologies cannot be fully utilised by the patients most at need, particularly those from underserved communities. This narrative review addresses the challenges and potential solutions for reducing digital exclusion for people living with CRD. Although sparse, the available evidence suggests that digital exclusion leads to poorer health outcomes in people living with CRD. The barriers that lead to digital exclusion intersect at many different levels and include socioeconomic, demographic, geographical, digital literacy, design/accessibility and psychosocial factors. Solutions to mitigate digital exclusion in people with CRD need to operate at multiple scales with cross-sectoral collaboration, and range from ensuring access to digital tools via large national mobile/broadband infrastructure developments to ensuring DHTs for patient use are designed inclusively and frontline healthcare staff are trained to help patients engage with the tools. Currently, there is a real risk that deploying digital health interventions for CRD care may widen the digital divide and deepen health inequities. To deliver on the digital health promise, all relevant stakeholders need to be focussed on ensuring that the presence of digital exclusion is well monitored and underserved communities such as CRDs are not systematically excluded from implementation and evaluation efforts.
Prescribing trends and environmental impact of prescribed inhaled medicines in Australia.
Lam SWL, Navaratnam VV, Wurzel DF … +2 more , Montgomery B, Blakey JD
Chron Respir Dis · 2026 · PMID 41853857 · Full text
Pressurised metered dose inhalers (pMDIs) release greenhouse gases with substantially higher carbon dioxide equivalent (COe) emission than other inhalers. Data from the Pharmaceutical Benefits Scheme (PBS) from 2013-2023...
Pressurised metered dose inhalers (pMDIs) release greenhouse gases with substantially higher carbon dioxide equivalent (COe) emission than other inhalers. Data from the Pharmaceutical Benefits Scheme (PBS) from 2013-2023, showed 28.3% increase in inhalers prescribed. pMDIs account for 47.5% of inhalers prescribed, contributing to 95.6 of inhaler-related carbon emissions. Targeted strategies to optimise disease control and promote use of non-pMDI inhalers where clinically appropriate can significantly reduce emissions while maintaining high-quality care.
Diagnostic performance of FEV/FEV in detecting airway obstruction and chronic obstructive pulmonary disease: A systematic review and meta-analysis.
Du D, He S, Qin J … +7 more , Wang H, Gao L, Chen M, Li X, Chen Z, Luo F, Shen Y
Chron Respir Dis · 2026 · PMID 41817373 · Full text
BackgroundAlthough the postbronchodilator FEV/FVC is the gold standard for diagnosing COPD, it is not easily obtainable due to various reasons. This study aims to investigate whether FEV/FEV may serve as an easily access...
BackgroundAlthough the postbronchodilator FEV/FVC is the gold standard for diagnosing COPD, it is not easily obtainable due to various reasons. This study aims to investigate whether FEV/FEV may serve as an easily accessible surrogate for FEV/FVC in detecting airway obstruction and COPD.MethodsEligible articles were screened from PubMed, Web of Science and Scopus. The Quality Assessment of Diagnostic Accuracy Studies-2 was applied for quality assessment. The pooled sensitivity, specificity, and area under the curve (AUC) of the summary receiver operating curve were calculated to evaluate the diagnostic performance of FEV/FEV in detecting airway obstruction and COPD and to determine the optimal cutoff value. Sensitivity analyses, subgroup analyses and meta-regression were performed to explore the source of heterogeneity.ResultsWith 28 eligible articles and 65,744 subjects, the FEV/FEV ratio showed good diagnostic performance in detecting both airway obstruction (sensitivity: 0.87, specificity: 0.94, AUC 0.95) and COPD (sensitivity: 0.83, specificity: 0.88, AUC 0.91). Further analyses of the optimal cutoff value suggested that an FEV/FEV<0.72 was the best criterion for detecting airway obstruction (sensitivity: 0.84, specificity: 0.97, AUC 0.96), whereas an FEV/FEV<0.74 was the best criterion for detecting COPD (sensitivity: 0.87, specificity: 0.89, AUC 0.93). The results of subgroup analyses and meta-regression suggested that study design and geographical location may affect the heterogeneity of both sensitivity and specificity in detecting airway obstruction and COPD.ConclusionThe FEV/FEV may serve as an easily accessible alternative in detecting airway obstruction and COPD. However, application of FEV/FEV may also be constrained by availability and affordability of devices. Further studies are required to determine the best-suited population for FEV/FEV application.
Global, regional and national trends in burden of chronic obstructive pulmonary disease from 2000 to 2021 and the prediction for 2030.
Xu J, Xu H, Zhang D … +6 more , Deng X, Bian Y, Xu Y, Ao G, Liu J, Xu F
Chron Respir Dis · 2026 · PMID 41800541 · Full text
AimsTo estimate the global burden of chronic obstructive pulmonary disease (COPD) by age, gender and socioeconomic status from 2000 to 2021, and make a prediction until 2030.MethodsData were obtained from the Global Burd...
AimsTo estimate the global burden of chronic obstructive pulmonary disease (COPD) by age, gender and socioeconomic status from 2000 to 2021, and make a prediction until 2030.MethodsData were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. The burden of COPD, referred to absolute numbers of COPD case and age-standardized rates (ASRs) per 100,000 individuals per year. The temporal trends from 2000 to 2021 were examined using Joinpoint models. Bayesian age-period-cohort models were introduced to project the burden until 2030. Finally, a decomposition analysis was conducted to reveal the contributions of aging, population growth and epidemiological changes to trends in COPD burden.ResultsThe crude numbers of incident cases, prevalent cases, deaths, and disability-adjusted life years (DALYs) for COPD remained increasing from 2000 to 2021, and until 2030, worldwide. ASRs of incidence, prevalence, deaths, and DALYs were in decreasing trends, and would continue to decline until 2030. Additionally, in 2021, the ASR of COPD burden was higher in males than females, while the age-specific rate increased with age. The disease burden varied across different regions, with a high burden in low development-level regions. The increasing burden of COPD was primarily driven by rapid aging and population growth.ConclusionsThe global ASRs of COPD burden would remain declining, but the crude burden would continue to increase until 2030. This study has public health implications for population-based interventions against COPD with consideration of residents' age, gender and residing area as well as economic status.
The characteristics of people with COPD who enrol in home-based pulmonary rehabilitation versus centre-based pulmonary rehabilitation: A nationwide cross-sectional study.
Adamson A, Kwok H, Singh SJ … +3 more , Wilkinson TMA, Drover H, Quint JK
Chron Respir Dis · 2026 · PMID 41787943 · Full text
ObjectivesHome-based pulmonary rehabilitation (PR) is increasingly offered as an alternative to centre-based PR. This study explores differences in the characteristics of people with COPD enrolling in home-based versus c...
ObjectivesHome-based pulmonary rehabilitation (PR) is increasingly offered as an alternative to centre-based PR. This study explores differences in the characteristics of people with COPD enrolling in home-based versus centre-based PR in England and Wales and assesses whether availability of home-based PR is associated with increased enrolment.MethodsThis study used data from the UK 2023-24 National Respiratory Audit Programme PR audit. Eligible people had a primary condition of COPD, complete mental health and geographic data, and attended an initial assessment at a centre that completed the clinical and organisational audit. For the primary analysis only, people were further restricted to those enrolled on a purely home-based or centre-based programme at a centre that offered both options. Enrolment was defined as having attended an initial assessment and having at least one scheduled PR session with a defined start date. Differences in characteristics were assessed using Chi-square and Kruskal-Wallis tests. The association between availability of home-based PR and enrolment was assessed using a mixed-effects logistic regression model.Results13719/29981 (45.8%) people were eligible for inclusion in the primary analysis and 25039/29981 (83.5%) were eligible for the secondary analysis. Those who enrolled in a home-based programme were more likely to: be female (58.6% vs 48.2%; p<0.001); be more deprived (55.7% versus 46.6% in IMD quintiles 1 or 2, p<0.001); have a greater mental health burden (28.2% versus 22.2% with at least 1 cognitive impairment recorded, p<0.001); and classified their symptom burden as more severe at assessment (CAT score 23 versus 22, p <0.001). Home-based PR was unavailable for 9099/25039 (36.3%) people. Availability of home-based PR was not associated with reduced non-enrolment in PR when compared with centres that did not offer home-based PR (adj-OR for non-enrolment: 0.79; 95%CI:0.51-1.23)).ConclusionHealthcare providers and those developing home-based PR digital applications should consider tailoring their approach to those who are most likely to opt in, who tend to be younger, female, and have a higher burden of respiratory symptoms and mental health comorbidities.
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