Increased depressive symptoms were associated with a higher risk of pre-COPD phenotypes, respiratory symptoms, and mortality, and may be a treatable trait that can help mitigate adverse outcomes in participants with pre-COPD.
Abstract
Background
Depression is a common comorbidity of chronic obstructive pulmonary disease (COPD) and is associated with worse prognosis. However, its association with lung health in individuals with pre-COPD remains unknown. We examined associations of increased depressive symptoms with respiratory symptoms, pre-COPD, and mortality.
Methods
We analysed data from the National Health and Nutrition Examination Survey (NHANES 2007-2012). Non-COPD individuals with available spirometry and Patient Health Questionnaire-9 (PHQ-9) data were included. Pre-COPD phenotypes included small airway dysfunction (SAD), preserved ratio impaired spirometry (PRISm) and nonobstructive chronic bronchitis (NOCB). Logistic and Cox regression models assessed associations of increased depressive symptoms with respiratory outcomes and all-cause mortality, respectively.
Results
Among 10 941 participants, increased depressive symptoms were associated with higher risk of PRISm (adjusted OR (aOR) [95% CI] 1.41[1.07,1.85]), NOCB (aOR [95% CI] 1.90[1.49,2.42]), cough (aOR [95% CI] 2.17[1.72,2.73]), phlegm production (aOR [95% CI] 2.86[2.23,3.67]), exertional dyspnoea (aOR [95% CI] 2.53[2.04,3.13]) and wheeze (aOR [95% CI] 1.86[1.51,2.30]). A one-unit increase in PHQ-9 score was also associated with higher risks of respiratory symptoms and pre-COPD. Additionally, increased depressive symptoms were independently associated with higher all-cause mortality risk among participants with pre-COPD, including SAD (aHR [95% CI] 2.85[1.02,7.95]), PRISm (aHR [95% CI] 2.02[1.01,4.01]) and NOCB (aHR [95% CI] 2.45[1.24,4.84]). Similar associations were observed across depression scores and pre-COPD populations.
Conclusions
Increased depressive symptoms were associated with a higher risk of pre-COPD phenotypes, respiratory symptoms, and mortality. Increased depressive symptoms may be a treatable trait that can help mitigate adverse outcomes in participants with pre-COPD.
Pakistan patients with COPD experienced marked symptom burden and HRQoL impairment, supporting multidimensional assessment beyond spirometry alone, and CAT, FEV₁, and probable depression remained independently associated with HRQoL.
Zarish Younas, Ashar Yousaf, Adden Anis Khan et al.· Journal of Health and Rehabi...· 0 citations
BACKGROUND
Osteoporosis is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD). However, most previous studies have been conducted in European populations. This study aims to explore whether patients with COPD are at increased risk of osteoporosis and osteoporosis-related fractures compared to a propensity score-matched (PSM) cohort of non-COPD patients in the TriNetX US Collaborative Network de-identified electronic health record (EHR) database.
STUDY DESIGN AND METHODS
Adult patients aged 40-65 with a COPD diagnosis (ICD-10: J44.0-J44.9), confirmed by spirometry (FEV1/FVC <70%), and a minimum follow-up of 10 years (3,650 days) were included. Both the ICD-10 code and spirometry criterion were required for COPD diagnosis. A 1:1 propensity score matching (PSM) was conducted to match non-COPD controls based on age, sex, BMI, smoking status, comorbidities, and medication use (including systemic corticosteroids, inhaled corticosteroids, and bone-active medications). The primary outcome was osteoporosis (ICD-10: M81.0). Secondary outcomes included osteoporosis with pathological fracture (M80) and pathological fractures (M84.4, M84.7). Cox proportional hazards models were used to estimate the hazard of osteoporosis after adjusting for confounding variables.
RESULTS
Following PSM, 2,682 COPD patients were compared with 2,682 non-COPD controls. COPD patients exhibited a significantly increased risk of osteoporosis [HR: 1.95 (1.37-2.77), p = 0.0002]. Underweight status (BMI <18.5 kg/m2) further elevated osteoporosis risk [HR: 3.95 (2.19-7.13), p<0.0001], while male sex was highly protective [HR: 0.15 (0.14-0.16), p<0.0001]. Age-stratified analysis showed progressively increasing risk across older age groups, peaking at ages 61-65 [HR: 20.01 (18.77-21.33), p < 0.0001].
INTERPRETATION
COPD is independently associated with an increased risk of osteoporosis. These findings highlight the importance of systematic osteoporosis screening and monitoring as part of comprehensive COPD management, particularly in high-risk subgroups (older adults, females, and those with low BMI).
A. Lohana, U. Akbar, S. Chander et al.· Respiratory Medicine· 0 citations
OBJECTIVE
Patients with chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) frequently exhibit heightened systemic inflammation, oxidative stress, and cardiopulmonary dysfunction, contributing to an increased risk of recurrent exacerbations. The lactate dehydrogenase-to-albumin ratio (LAR) is a readily available biomarker reflecting inflammatory and metabolic stress; however, its association with the frequent-exacerbator phenotype in patients with COPD and CHD remains unclear. This study aimed to evaluate the relationship between admission LAR levels and frequent exacerbations in this high-risk population.
METHODS
This retrospective study analyzed 489 hospitalized patients with acute exacerbations of COPD (AECOPD) and comorbid CHD. Patients with two or more exacerbations were classified as frequent exacerbators. Demographic characteristics, comorbidities, and lab parameters were collected. Multivariable logistic regression and restricted cubic spline analyses were performed to evaluate the association between LAR and the frequent-exacerbator phenotype.
RESULTS
A total of 489 patients with AECOPD and CHD were included, with a mean age of 76 years, and 66.9% were male. Higher admission LAR levels were significantly associated with the frequent-exacerbator phenotype in the unadjusted analysis (Odds Ratio [OR] 1.23; 95% confidence interval [CI] 1.12 ~ 1.35; p < 0.001). The association remained significant after adjustment for potential confounders (adjusted OR 1.34; 95% CI 1.19 ~ 1.51; p < 0.001). Restricted cubic spline analysis demonstrated a significant nonlinear association (p = 0.004), with an inflection point at a LAR value of approximately 5.1 (OR 4.04, p = 0.001), whereas a more modest increase was observed above this threshold (OR 1.45, p = 0.009).
CONCLUSION
Higher admission LAR levels were independently associated with the frequent-exacerbator phenotype among patients with AECOPD and CHD. This readily available biomarker may improve risk stratification and personalized management in this high-morbidity population.
Hongxu Zhang, Mengyu Lian, Jie Song et al.· BMC Pulmonary Medicine· 0 citations
Abstract Introduction The mechanisms through which body mass index (BMI) influences the prognosis of chronic obstructive pulmonary disease (COPD) remain poorly understood. This study investigates whether BMI influences all-cause mortality in patients with COPD through mediating effects of exacerbations and cardiovascular events. Methods Data were obtained from a multicentre prospective COPD cohort (NCT02800499). BMI was assessed both continuously and categorically as <23 (low), 23–27 (normal) and >27 kg/m² (high). The primary outcome was all-cause mortality and secondary outcomes were moderate-to-severe exacerbations and cardiovascular events. Mediation analyses were applied to quantify the contribution of these events to the association between BMI and all-cause mortality. Results Among 3314 patients with COPD, those with low BMI had a higher risk of mortality (adjusted OR, 1.46; 95% CI 1.04 to 2.07), whereas no significant difference was observed among those with high BMI. Mediation analyses indicated that exacerbations partially mediated the relationship between BMI and all-cause mortality, explaining 11.9% of the increased mortality among patients with low BMI and 21.9% of the reduced mortality among those with high BMI. Meanwhile, cardiovascular events showed mediating effects in the opposite direction, contributing to 5.2% lower mortality among patients with low BMI and 11.5% higher mortality among those with high BMI. Conclusions BMI was non-linearly associated with all-cause mortality in COPD. Exacerbations mediated the excess mortality risk among patients with low BMI, whereas the decreasing risk of cardiovascular events in this group contributed to a countervailing effect that tempered the overall association between low BMI and mortality.
Hyun Woo Lee, Sang Hyuk Kim, Tae-Hyung Kim et al.· BMJ Open Respiratory Researc...· 0 citations
BACKGROUND
Depression is a common and clinically significant comorbidity in chronic obstructive pulmonary disease (COPD), adversely influencing prognosis and survival. Although smoking cessation improves mental health in the general population, its effect on depression risk after a new COPD diagnosis remains uncertain.
METHODS
Using the National Health Insurance Service-National Health Screening Cohort, we conducted a nationwide population based cohort study of 5,671 adults newly diagnosed with COPD between 2003 and 2014. Smoking status before and after diagnosis was classified as continual smokers, short term quitters (<2 years), long term quitters (≥2 years), and never smokers. Incident depression was defined using ICD 10 codes F32-F33 with antidepressant prescriptions. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) for depression.
RESULTS
Over 48,621 person years of follow up, 603 incident depression cases occurred. Long term quitters showed a significantly lower risk of depression compared with continual smokers (aHR 0.66; 95% CI 0.45-0.97). The association was strongest among patients with severe COPD (aHR 0.40; 95% CI 0.20-0.82) and was consistently observed in subgroups defined by male sex, age under 65 years, lower comorbidity burden, higher household income, and body mass index below 25 kg/m2.
CONCLUSIONS
In this nationwide cohort of newly diagnosed COPD patients, sustained smoking cessation was associated with a substantially reduced risk of subsequent depression, particularly in those with severe disease. These findings support emphasizing long term smoking cessation as a core element of comprehensive COPD management to improve both mental health and overall outcomes in routine clinical practice worldwide settings.
Jang Ho Doo, Jiwon Yu, Sun Jae Park et al.· Respiratory Medicine· 0 citations
Background: Chronic obstructive pulmonary disease (COPD) is thought to have increased association with metabolic syndrome (MS) which represents a cluster of factors that increase the risk of cardiovascular diseases and diabetes mellitus. However, the extent of association of COPD with MS and its individual components are still an unsettled issue, and it is likely to vary from population to population. This study was undertaken to assess association of COPD with metabolic syndrome.
Methods: This cross-sectional study conducted at the Department of Respiratory Medicine in National Institute of Diseases of the Chest and Hospital from January 2019–December 2019. A total of 91 patients with chronic obstructive pulmonary disease (COPD) were enrolled in this study.
Results: Out of 91 patients with COPD, more than one third (34.1%) patients were belonged to age 51-60 & 61-70 years respectively with mean age 60.4±10.9 years ranging from 42 to 90 years. Majority (85.7%) patients were male. Male to female ratio was 6:1. Twenty seven (29.7%) were service holder and most of the patients 76(83.5%) were smoker. Mean BMI was 20.6±4.0 kg/m2, mean waist circumference was 86.9±6.8 cm, mean SBP 120.1±17.5 mmHg and mean DBP 76.3±11.1 mmHg. Mean FEV1/FVC post bronchodilator was 51.2±9.5 percent. Mean triglycerides was 149.9±38.4 mg/dl, mean HDL-C was 39.4±9.8 mg/dl, mean fasting glucose was 104.1±28.0 mg/dl. Metabolic syndrome was found in 19(20.9%) patients. Age, sex, occupational status, smoking, BMI, waist circumference, hypertension, triglycerides, HDL-C, fasting glucose and metabolic syndrome were not statistically significant (p>0.05) when compared grade of COPD.
Conclusion: In conclusion, the present study demonstrated that metabolic syndrome present in 20.9% of COPD patients. Age, sex, occupational status, smoking, BMI, waist circumference, hypertension, triglycerides, HDL-C, fasting glucose and metabolic syndrome were not statistically significant when compared grade of COPD. Thus, considering COPD as a systemic disease and screening for components of metabolic syndrome could form a part of routine work-up of these patients.
Chest Heart J. 2022; 46(1) : 10-17
Mohammad Ezazul Karim, K. C. Ganguly, Bipul Kanti Biswas et al.· Chest & Heart Journal· 0 citations
