Reem Ibrahim Elkorashy

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition that frequently coexists with cardiovascular diseases (CVDs). They share risk factors, overlapping clinical manifestations, and bidirectional pathophysiological interactions contributing to increased morbidity and mortality. Cardiovascular disease and cardiovascular risk are often underrecognized in patients with COPD, while COPD may likewise remain undiagnosed in patients with established CVD. This Egyptian expert consensus aimed to develop practical recommendations for identifying and managing COPD in patients with established or suspected CVD. It also emphasized bidirectional screening, recognition of cardiopulmonary interactions, pharmacological treatment, exacerbation prevention, and integrated multidisciplinary care. Methods: A modified Delphi approach was used to develop 45 consensus statements on COPD–CVD overlap. An 18-member expert group, comprising 14 pulmonologists and 4 cardiologists, included a four-member steering committee responsible for the literature review and initial statement development. The statements were discussed and refined during a face-to-face meeting in January 2025, followed by one anonymous electronic voting round among the 14-member voting panel using a five-point Likert scale. Consensus was defined as at least 70% agreement. Results: The consensus included 45 statements. The voting results demonstrated very strong agreement (≥ 90%) in 42 (93.3%) of the statements, strong agreement (≥ 75% to < 90%) in two statements (4.44%), and moderate agreement (70% to < 75%) in one statement (2.22%). Conclusions: Current consensus indicates that COPD and CVD are closely interconnected conditions that require coordinated cardiopulmonary assessment instead of isolated disease management. The consensus highlighted bidirectional case-finding, cardiovascular risk assessment in COPD, recognition of cardiovascular disease in patients with respiratory symptoms, exacerbation prevention, and multidisciplinary care. Management should remain individualized according to respiratory phenotype, cardiovascular status, exacerbation risk, and other clinically relevant comorbidities.

Introduction: Urinary incontinence (UI), characterised by the involuntary discharge of urine, is an escalating health issue, especially common among patients with chronic obstructive pulmonary disease (COPD), with prevalence rates ranging from 34.9% to 49.6%. This study sought to evaluate the efficacy of pelvic floor muscle training (PFMT) versus Pilates exercises in enhancing UI, cough symptoms and quality of life (QoL) in individuals with COPD. Material and methods: Sixty patients aged 50 years and above with COPD-related UI were randomly allocated to two intervention groups: Group A ( n = 30) underwent PFMT, whereas Group B ( n = 30) engaged in Pilates. Both therapies were conducted triweekly for 12 weeks. The outcome measurements comprised the 1-hour and 24-hour pad tests, incontinence severity index (ISI), cough symptom score (CSS) and the incontinence quality of life questionnaire (I-QOL). Results: Both groups exhibited substantial enhancements following the intervention ( p < 0.001). Group B exhibited more significant decreases in urine leakage – 80.16% in the 1-hour pad test and 66.51% in the 24-hour test – relative to Group A. Group B demonstrated greater reductions in ISI (63.23%) and CSS (74.06%), as well as significant enhancements in cough-related symptoms (296.57%) and I-QOL scores (65.65%). Conclusions: Twelve weeks of either PFMT or Pilates significantly enhanced UI and QoL in patients with COPD. Nonetheless, Pilates demonstrated more advantages, suggesting its superior therapeutic efficacy in addressing UI and associated symptoms in this demographic.

Background Pulmonary arterial hypertension (PAH) is a progressive, cureless disease, characterized by increased pulmonary vascular resistance and remodeling, with subsequent ventricular dilatation and failure. New therapeutic targets are being investigated for their potential roles in improving PAH patients’ symptoms and reversing pulmonary vascular pathology. Method We aimed to address the available knowledge from the published randomized controlled trials (RCTs) regarding the role of Rho-kinase (ROCK) inhibitors, bone morphogenetic protein 2 (BMP2) inhibitors, estrogen inhibitors, and AMP-activated protein kinase (AMPK) activators on the PAH evaluation parameters. This systematic review (SR) was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CDR42022340658) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Overall, 5092 records were screened from different database and registries; 8 RCTs that met our inclusion criteria were included. The marked difference in the study designs and the variability of the selected outcome measurement tools among the studies made performing a meta-analysis impossible. However, the main findings of this SR relate to the powerful potential of the AMPK activator and the imminent antidiabetic drug metformin, and the BMP2 inhibitor sotatercept as promising PAH-modifying therapies. There is a need for long-term studies to evaluate the effect of the ROCK inhibitor fasudil and the estrogen aromatase inhibitor anastrozole in PAH patients. The role of tacrolimus in PAH is questionable. The discrepancy in the hemodynamic and clinical parameters necessitates defining cut values to predict improvement. The differences in the PAH etiologies render the judgment of the therapeutic potential of the tested drugs challenging. Conclusion Metformin and sotatercept appear as promising therapeutic drugs for PAH. Clinical Trials Registration This work was registered in PROSPERO (CDR42022340658).

Background: The pandemic had a significant impact on those with underlying chronic health conditions being at risk of developing a more severe disease with rapid progression, significant complications, and with increased risk of mortality.This was also expected in the pulmonary vascular community owing to the vulnerable nature of this population, who are characterized by an increase in the pulmonary vascular resistance leading to right heart failure.This study is aiming to identify the incidence of COVID-19 infection among pulmonary hypertension patients receiving specific therapy as well as the predictors of the COVID-19 disease severity and outcome in those patients.Results: Data analysis of 197 PAH and CTEPH patients, showed that the incidence of SARS-CoV-2 infection is 10.66% (n= 21). Seven patients (33.3%) required hospitalization. Mortality rate is 14.3% (3/21).Severity of COVID19 disease in those patients has statistically significant moderate to strong correlation with higher values of d-dimer (r= 0.821,P= 0.000), ferritin (r= 0.718,p= 0.000), CRP (r= 0.613,p= 0.04), acute renal failure (r= 0.557,p= 0.009), and hypoxemia (r= 0.825,p= 0.000).Mortality from COVID-19 show moderate to strong statistically significant correlations with acute renal failure (r= 0.795,p= 0.000), hypoxemia (r= 0.645,p= 0.002), higher values of ferritin (r= 0.689,p= 0.001) and d-dimer (r= 0.603,P= 0.004).Conclusions: COVID-19 in PAH and CTEPH patients is challenging, higher COVID-19 infection rate is present in those patients and is associated with increased disease severity and higher mortality.