Fuqiang Wen

Background: Early identification of patients at high-risk for exacerbation in mild-to-moderate chronic obstructive pulmonary disease (COPD), particularly those with chronic bronchitis (CB) phenotype exhibiting worse outcomes, is critical for slowing lung function decline and reducing the subsequent healthcare burden. While the soluble receptor for advanced glycation end products (sRAGE) correlates with emphysema severity in COPD, in mild-to-moderate COPD or patients with CB symptoms, no prospective investigation has evaluated the association between sRAGE and exacerbation risk. Methods: Sub-cohort data from the COMPASS study, a prospective study in China, were analyzed. Associations between sRAGE levels and exacerbations were assessed treating sRAGE as a continuous variable and categorized into tertile. Negative binomial regression and cox regression were used to assess exacerbation rate and onset time. Subsequent analyses of lung function, COPD Assessment Tool (CAT) score and high-resolution computed tomography (HRCT) parameters were evaluated using linear mixed-effects models based on a cutoff determined by Akaike information criteria (AIC). Results: In the COMPASS sub-cohort, 201 patients had mild-to-moderate COPD and 230 individuals reported CB symptoms. Continuous sRAGE level was not associated with exacerbation risks, but with earlier onset time. In addition, participants in the lowest sRAGE tertile exhibited significant shorter time to first exacerbation in both populations. The lowest tertile was also associated with increased exacerbation risks in patients with CB and showed a borderline significant association in patients with mild-to-moderate COPD. No significant differences in lung function decline, HRCT changes, or CAT score progression were observed between the low- and high-sRAGE groups. Conclusion: Lower sRAGE level may be associated with an increased exacerbation risk in mild-to-moderate COPD and in patients with CB symptoms. Blood sRAGE is a candidate biomarker for identifying subgroups at higher exacerbation risk in populations at high risk of disease progression. Clinical Trial Registration: Clinicaltrials.gov identifier NCT04853225; GSK study code 208630.

Pulmonary function testing (PFT) is a critical diagnostic and management tool for respiratory diseases, yet its implementation in China, particularly within primary hospitals, remains suboptimal. To investigate the current application status of PFTs specifically in western China, a cross‐sectional survey based on an online questionnaire was conducted. Physicians from various hospitals completed this questionnaire, designed according to Chinese PFT Guidelines, during 2023–2024, and the analysis focused on the final valid responses. The study ultimately included data from 488 hospitals. A total of 97.13% were public institutions. A total of 38.32% had established independent respiratory departments. The overall PFT availability was 56.76%, 100.00% in tertiary hospitals, and only 25.00% in primary hospitals. A total of 42.24% of the hospitals had a daily workload of less than 5 people. The primary tests included pulmonary ventilation tests (100.00%), pulmonary volume tests (73.65%), and bronchial dilation tests (72.92%). Instrument calibration was performed in 83.03% of the hospitals, and 68.59% of the hospitals considered filter resistance. Over 60.00% of hospitals used estimated values provided by instruments as sources for PFT. A total of 65.70% of hospitals had a limited number of operators. In conclusion, the application of PFT in western China is characterized by a low implementation rate, imbalanced distribution, limited test variety, and insufficient personnel, especially in primary hospitals. It is essential to promote the widespread implementation and standardization of PFTs in western China.

Inflammation and dyslipidemia have been proven to be associated with chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the relationships between hS-CRP/HDL, AIP, NHHR and COPD. The data was obtained from the National Health and Nutrition Examination Survey. Participants were classified into two groups based on self-reported COPD diagnosis. The hS-CRP/HDL, AIP and NHHR were evaluated for their potential correlation with COPD using the univariate and multivariable logistic regression models. Subsequently, restricted cubic spline (RCS) model was used to further explore the associations between hS-CRP/HDL, AIP, NHHR and COPD. Finally, subgroup analysis and interaction tests were applied. 10419 participants were included, and 1168 of them were self-reported COPD. lg(hs-CRP/HDL) and AIP were statistically significantly elevated in the COPD group compared to those in non-COPD group, while NHHR was not significantly different between the two groups. In a multivariate logistic regression model that adjusted for all relevant factors, there was a 64% increase in the prevalence of COPD for every unit rise in hs-CRP/HDL (OR 1.64 [CI 1.31-2.05]). A significant positive association between hs-CRP/HDL and COPD was observed in most subgroups. However, the AIP and NHHR were not associated with COPD after adjusted for all relevant factors. RCS model supported a positive linear association of hs-CRP/HDL with COPD , and no linear or non-linear association of AIP, or NHHR and COPD. The study suggests elevated hs-CRP/HDL may related to COPD, suggesting its potential as diagnostic marker for COPD.

This study aims to discover drug targeted genes and explore the potential epigenetics mechanisms in bronchiectasis. Cis-expression quantitative trait locus (eQTL) was obtained as exposure, and bronchiectasis from the FinnGen cohort was used as outcome. Mendelian Randomization (MR) was performed to identify therapeutic targets associated with bronchiectasis. Colocalization and summary-data-based MR (SMR) analyses were carried out to further confirm the causal roles of candidate genes in bronchiectasis. The value of these drug targets was validated via drug prediction and molecular docking. Finally, we used mediation analysis to identify the DNA methylation QTLs to bronchiectasis mediated by candidate genes. Ten drug targets were significantly associated with bronchiectasis. Strong evidence for the colocalization of ACVR2A and VRK2 with bronchiectasis was found (PP.H4 > 0.75). SMR analysis revealed that higher expressions of DDR1 and VRK2 were linked to a higher risk of bronchiectasis, and higher expressions of SCD5, TNFRSF4 and XCL2 were linked to a lower risk of bronchiectasis. Finally, mediation analysis revealed potential causality effect of the DNA methylation site cg21568453 to bronchiectasis risk via VRK2. The increased expression of VRK2 regulated by DNA methylation at cg21568453 may promote the occurrence of bronchiectasis.

Aim: Chronic Obstructive Pulmonary Disease (COPD) is a common chronic airway disease that can lead to decreased lung function in patients. It places a heavy economic burden on patients and society. Traditional Chinese medicine (TCM) and Western medicine have played important roles in managing COPD. We aimed to develop an evidence‐based guideline for treating COPD with Chinese and Western Medicine.Methods: We formed a guideline panel of multidisciplinary experts. The clinical questions were identified based on two rounds of issue solicitation and expert demonstration. We searched the literature for direct evidence on the management of COPD and assessed its certainty‐generated evidence using the grading of recommendations, assessment, development, and evaluation (GRADE) approach. The recommendations and their strengths were formulated using the Delphi method.Results: Our guideline covers aspects of the diagnosis and treatment of COPD such as principles and commonly used medications for both traditional Chinese medicine and Western medicine, complications, and the high‐risk populations. 9 clinical questions and 35 recommendations were identified, which covered the combinations of YuPingFeng granule, Buzhong Yiqi decoction, Gushen Dingchuan Pill, Bufei Huoxue Capsules, Runfei cream, Bailing Capsule, Tanyin Pills, etc., and nonpharmacological therapy of TCM such as combined acupoint application, electroacupuncture, and Chinese exercise techniques (Tai Chi, Baduanjin), etc. Recommendations were either high or low or in the form of ungraded consensus‐based statements.Conclusions: This is a comprehensive and systematic evidence‐based guideline and we hope it can systematically and effectively guide clinicians in managing COPD and improve overall medical care.

IntroductionExcessive mucus secretion is pivotal in chronic obstructive pulmonary disease (COPD) pathophysiology, particularly in chronic bronchitis phenotypes. Cystic fibrosis transmembrane conductance regulator (CFTR) has been implicated in COPD-related hypersecretion with acquired dysfunction, and emerged as a therapeutic target. However, the clinical efficacy of CFTR-potentiators in COPD remains controversial.MethodsWe searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal (CSTJ), and Wanfang Database to retrieve eligible studies published before 28 May 2024.ResultsA total of 1172 COPD patients were included, meta-analysis showed that CFTR-potentiators significantly increased forced expiratory volume in 1 s (FEV1) and decreased sweat chloride and fibrinogen levels, with moderate-to-high quality evidence. However, no significant effects were observed on the percentage of detected FEV1 to predicted FEV1 (FEV1% predicted), forced vital capacity (FVC), COPD assessment test (CAT) score, St. George's Respiratory Questionnaire (SGRQ) score, or acute exacerbation times, with low-to-moderate quality evidence.ConclusionOur meta-analysis demonstrated CFTR-potentiators' potential efficacy in increasing FEV1, decreasing sweat chloride and fibrinogen levels, despite limited impacts on FEV1% predicted, FVC, CAT score, SGRQ score, and acute exacerbations, underscoring the necessity for future research to evaluate its effects on mucus hypersecretion, acute exacerbations, hospitalizations, and mortality in COPD management. Review registration PROSPERO Identifier: CRD42024538708