Chronic Obstructive Pulmonary DiseaseChronic obstructive pulmonary disease or COPD, ranks as the third leading cause of death worldwide, trailing only behind heart disease and strokes. The condition impedes breathing by damaging the airways and/or lungs. It may cause chronic coughing, mucus and wheezing and permanently disable the affected individual. In affluent countries, one can easily avoid it by self-care, especially by avoiding smoking.

On the other hand, in developing countries, air pollution and the living environment are much more significant factors. Interestingly, estimates suggest that 50% of COPD cases in Sub-Saharan Africa occur in individuals who have never smoked and it often remains undiagnosed. It is a silent killer of so much of the population simply because they are impoverished.

Chronic Obstructive Pulmonary Disease in Nigeria

The lifestyle of the people in Nigeria likely causes chronic obstructive pulmonary disease in the country. Whether or not people smoke tobacco, most African kitchens suffer from poor ventilation due to biomass smoke. Biomass fuel includes anything from a living thing, mostly wood or animal waste. Fires, often fueled by more biomass or kerosene, are also constant for heating or light. Although women are less likely to smoke than men, they have the same amount of COPD cases because they spend far more time inside the house.

COPD prevalence in Nigeria is attributable to factors beyond solely toxic air. Malnourishment at birth is a high-risk factor, potentially leading to weaker or misshapen lungs. Unborn and newborn infants, sharing environmental exposures with their mothers, may also encounter lung defects. Moreover, in economically disadvantaged African communities, high rates of HIV and tuberculosis persist. These diseases, if causing lung damage, contribute to the risk factors for COPD.

Prevention

COPD remains incurable, with survival strategies centered around removing oneself from potential dangers, such as tobacco use, engaging in regular exercise and maintaining optimal lung health. Ideally, addressing this concealed epidemic involves preventive measures to stop it before it begins.

However, the World Health Organization has implemented multiple steps to protect Africans from chronic obstructive pulmonary disease. The first is the WHO Framework Convention on Tobacco Control, approved by 180 countries, including Nigeria, which aims to help protect people from tobacco smoke. The second is the Global Alliance against Chronic Respiratory Diseases (GARD), a network aimed solely at eliminating respiratory illnesses like COPD and asthma in low- and medium-income countries.

Various other proposals have been suggested to prevent illnesses caused by indoor air pollution. One approach involves the construction of homes equipped with chimneys or flues, allowing smoke to exit the living spaces efficiently. Creating infrastructure to provide homes with electricity or gas for cooking could eliminate the use of biomass fuel and its associated smoke.

Enhancing housing conditions goes beyond improving living standards; it has the potential to not only create better living environments but also to save lives.

– Varsha Pai
Photo: Pixabay

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The inauguration of the state's inaugural pulmonary rehabilitation center at King George's Medical University marks a significant advancement in healthcare for patients with chronic respiratory conditions. Vice-chancellor Professor Sonia Nityanand unveiled the facility, introducing a new era of specialized care in respiratory medicine. This center is poised to offer comprehensive services including cardio-pulmonary physiotherapy, diet and psychological counselling, and aims to extend its expertise through training programs for doctors across Uttar Pradesh.

Revolutionizing Respiratory Care

Under the leadership of Professor Surya Kant, the head of the Department of Respiratory Medicine, the center is set to cater to a vast demographic, with an estimated 10 crore individuals across the country suffering from conditions such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, or post-TB sequelae. These conditions, characterized by persistent breathlessness, have shown limited response to conventional medication and inhalers, underscoring the necessity for alternative therapeutic avenues like pulmonary rehabilitation. The center's multifaceted approach, integrating medical, physiotherapeutic, nutritional, and psychological interventions, aims to significantly enhance patient outcomes.

A Collaborative Effort for Comprehensive Care

The team at the newly inaugurated center comprises specialists from various disciplines, including respiratory disease experts, physiotherapists, diet counselors, and social workers. This multidisciplinary team is dedicated to not only providing direct patient care but also to equipping healthcare professionals from medical colleges across the state with the requisite knowledge and skills in pulmonary rehabilitation. The initiative represents a collaborative endeavor to elevate the standard of respiratory care and to disseminate best practices in the management of chronic respiratory diseases.

Looking Ahead: The Future of Pulmonary Rehabilitation

As the center begins its journey, the focus is not only on the immediate impact on patient care but also on the long-term implications for the treatment of chronic respiratory diseases in the state and beyond. With the backing of research and a comprehensive treatment model, the center is set to play a pivotal role in reshaping the landscape of respiratory care. The emphasis on training and capacity building among healthcare providers is expected to amplify the reach and effectiveness of pulmonary rehabilitation, making it a cornerstone of chronic respiratory disease management.

The inauguration of this pulmonary rehabilitation center at King George's Medical University heralds a new chapter in healthcare, promising improved quality of life for countless individuals living with chronic respiratory conditions. Through collaborative efforts, innovative approaches, and a commitment to excellence, the center is well-positioned to become a beacon of hope and a model for respiratory care nationwide.



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In the glitz and glamour of Hollywood, where the air is filled with dreams and aspirations, veteran producer Lynda Obst has long been a prominent figure. With a career spanning five decades, Obst has left an indelible mark on the industry, boasting an impressive roster of credits that include iconic films like "Sleepless in Seattle," "Interstellar," and "How to Lose a Guy in 10 Days." Yet, behind the scenes, amidst the smoke and laughter of countless conversations, Obst harboured a secret – a battle silently raging within her own lungs.

The Barbie Controversy: Obst's Unfiltered Response

Amidst the fervour surrounding the 2024 Oscar nominations, a storm brewed over the perceived snub of "Barbie," a film that garnered commercial success but lacked individual nods for its female architects. In a Facebook post that resonated deeply with her followers, Obst unleashed a candid critique, drawing from her vast experience in the industry to dissect the complexities of gender bias in Hollywood. Her words struck a chord, sparking a conversation that transcended the confines of social media.

A New Lynda Obst Emerges

COPD

However, beyond the glitz of Tinseltown, Obst was grappling with a personal revelation – a diagnosis that would alter the course of her life. Six years prior, she received the sobering news of her chronic obstructive pulmonary disease (COPD), a condition synonymous with irreversible lung damage and respiratory struggles. In a candid interview, Obst peels back the layers of vulnerability, revealing the profound impact of her diagnosis on her career, her relationships, and her sense of self.

The Smoking Heyday: A Reckoning with the Past

For Obst, the road to COPD was paved with smoke – a habit cultivated over decades of camaraderie and connection in Hollywood's inner circles. From cigarettes to joints, she indulged with gusto, relishing the company of fellow smokers and movie stars alike. Yet, as the smoke cleared, she confronted the harsh reality of her condition, a poignant reminder of the consequences of her former vice.

Also Read:  Primary Progressive Aphasia; Here’s Everything To Know About Talk Show Host Wendy Williams’ Diagnosis

Navigating Life with COPD: From Smoke to Oxygen

Today, at 73, Obst confronts each day with resilience and resolve, armed with a newfound appreciation for the preciousness of breath. Gone are the packs of cigarettes and bags of weed, replaced instead by a portable oxygen device – a lifeline tethered to her journey of healing. With each breath, she defies the limitations imposed by her diagnosis, embracing a new mantra of self-care and perseverance.

COPD Unveiled: Understanding the Condition

According to Dr Manish Itolikar, Consultant Physician, Fortis Hospital, Mulund, chronic obstructive pulmonary disease (COPD) is a relentless adversary, characterized by obstructed airflow, debilitating symptoms, and a heightened risk of complications. From shortness of breath to chronic cough, its manifestations are as varied as they are insidious. Yet, amidst the shadows of adversity, there exists a glimmer of hope – a testament to the resilience of the human spirit and the power of knowledge in the fight against COPD.

Also Read:  Talk Show Host Wendy Williams Diagnosed With Frontotemporal Dementia; Here Are The Symptoms To Look Out For

Conclusion: A Legacy of Resilience

As Lynda Obst navigates the uncharted waters of COPD, she emerges not as a victim, but as a beacon of resilience and strength. Her journey serves as a reminder that beneath the veneer of fame and success lies the shared humanity that unites us all. In her vulnerability, she finds empowerment, paving the way for a future where honesty and authenticity reign supreme.

In the tapestry of Hollywood's narrative, Lynda Obst's story is a testament to the transformative power of adversity – a reminder that even in the face of life's greatest challenges, the human spirit remains unyielding.

 

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Understanding the Link Between Poor Sleep and Muscle Dysmorphia in Young Adults: Tips for Better Sleep

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“It’s a great program, and I am enjoying it. The staff is just wonderful, so helpful.”

When it comes to bettering her health, retiree Pamela Ghee is embodying the same traits of resilience and determination she had while serving in the U.S. Army Reserves for 31 years as a comptroller, retiring as a Lieutenant Colonel and as a school counselor for over 30 years.

In particular, Pamela shares that it was years of smoking that has put her in her current predicament, resulting in a variety of health issues.

“I was coughing like crazy, and my excuses were that I had a cold, or that it was my allergies, but I knew it was neither. I knew I had to stop smoking. It was getting ridiculous,” said Pamela. “After quitting, I really started to realize the health effects.”

Over the course of the past few years, Pamela noticed she had severe shortness of breath, which led to requiring a cardiac stent. This stent helped, but Pamela still was feeling short of breath. After undergoing multiple medical evaluations to make sure nothing was wrong, Pamela underwent a pulmonary function test. It turns out the stent was fine, but results showed that her Chronic Obstructive Pulmonary Disease (C.O.P.D.) was going to require her to need pulmonary rehabilitation.

A Pathway to Improved Quality of Life

Pamela taking a photo of herself in a green hat while walking outsideVeterans Affairs (VA) recently set her up with The Pulmonary Rehabilitation Program at Cooperman Barnabas Medical Center (CBMC), accredited by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), which offers patients an educational and supportive program monitored by trained medical professionals.

Linda Hardy, BBA, RRT-NPS, RPFT, AE-C, respiratory therapist at The Pulmonary Rehabilitation Program at CBMC explains that the program is designed to aid people with breathing problems maintain and improve the quality of their lives. Through early intervention and individually planned and designed education, therapy, exercise, motivation and lifestyle adjustment programs, patients can once again take control of their daily activities and lives.

“Our program is customized based on the unique needs of the patient,” shares Linda. “Our patients can expect to work one-on-one with a licensed respiratory therapist, who will help them develop their own goals.”

Pamela speaks fondly of her experiences since she started. “Linda Hardy was and is wonderful, everybody I work with is. Linda was my intake person and she was the one that determined my oxygen level was dropping while I was just walking and helped get me all set-up and started with their pulmonary rehabilitation program.”

As for the exercise program, Pamela continues to express her appreciation. “It’s a great program, and I am enjoying it. The staff is just wonderful, so helpful. In addition to Linda, I want to give a special thank you to her teammates, Lilly Earl, BBA, CRT, and Priya Mistry, RRT, as well. They push me to increase my workout, so that I can eventually workout without needing the oxygen.” Pamela says.

For Pamela, her goal is to use the treadmill without the oxygen, “If I can’t do the treadmill for the full 20 minutes at the pace I’m going with the oxygen, but I could do 10 minutes without it, then that would be a goal,” she explains.

Breathing Better, Living Better

Kristin G. Fless, MD
Kristin G. Fless, MD

“Pulmonary rehabilitation is also meant to teach patients various methods of minimizing symptoms of their pulmonary disease and recognizing early symptoms of declining health so they can work with their physicians to get the best treatment,” explains Kristin G. Fless, MD, Medical Director of Pulmonology Services and Chair of the Department of Medicine at CBMC.

“The staff at pulmonary rehab are teaching me really good breathing techniques and tips on how to breathe better and not overexert,” says Pamela. She finds this extremely beneficial because she loves to travel, and is involved in several community groups, church and different events where she is out and about.

“Right now, I have a travel backpack with oxygen and I take it with me regularly no matter where I am going. One of the keys is to walk slow, and if I do pick up pace and need to have the oxygen, then I just put it on and keep going.”

In the future, Pamela hopes to not need her oxygen backpack, and to be fully sufficient on her own from putting in the work at pulmonary rehab. Each session she pushes to get to that next level. If Pamela could share any other recommendation besides considering pulmonary rehabilitation if it might be beneficial, it would be to quit smoking!

“There are people I know with C.O.P.D. that were never smokers, but there are also a lot of people out there with C.O.P.D. as a result of smoking,” Pamela shares. “I know it’s difficult to quit smoking, but it is important to try the best you can, and really work at quitting. The damage shows up later in life, it doesn’t show up in your younger years when you’re having a good time. You get older and the damage is done and it’s irreversible.”

The Benefits of Pulmonary Rehabilitation for Lung Disease

While there is no cure for lung disease, the symptoms can be treated. Lung disorders can make it difficult to breathe, cause chronic coughing and cause persistent stress and anxiety. In the Pulmonary Rehabilitation program at CBMC, patients work to slow down and minimize the debilitating symptoms of lung disease through a combination of exercise, education, breathing retraining and nutritional counseling.

The Pulmonary Rehabilitation Program at Cooperman Barnabas Medical Center strives to help patients:

  • Increase knowledge of your pulmonary disease and self-care management
  • Increase ability to tolerate daily living activities
  • Minimize symptoms associated with your pulmonary disease
  • Recognize early symptoms of declining health
  • Reduce need for hospitalization

For more information, please call our Pulmonary Rehabilitation specialists at Cooperman Barnabas Medical Center, 973-322-8926 or visit The Pulmonary Rehabilitation Program at Cooperman Barnabas Medical Center.

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Severe Asthma Pipeline Assessment, 2024: FDA, EMA, and PMDA

(Las Vegas, Nevada, United States) As per DelveInsight's assessment, globally, Severe Asthma pipeline constitutes key companies continuously working towards developing Severe Asthma treatment therapies, analysis of Clinical Trials, Therapies, Mechanism of Action, Route of Administration, and Developments analyzes DelveInsight.

"Severe Asthma Pipeline Insight, 2024" report by DelveInsight outlines comprehensive insights into the present clinical development scenario and growth prospects across the Severe Asthma Market.

The Severe Asthma Pipeline report embraces in-depth commercial and clinical assessment of the pipeline products from the pre-clinical developmental phase to the marketed phase. The report also covers a detailed description of the drug, including the mechanism of action of the drug, clinical studies, NDA approvals (if any), and product development activities comprising the technology, collaborations, mergers acquisition, funding, designations, and other product-related details.

Some of the key takeaways from the Severe Asthma Pipeline Report: www.delveinsight.com/sample-request/severe-asthma-pipeline-insight?utm_source=openpr&utm_medium=pressrelease&utm_campaign=gpr

• Companies across the globe are diligently working toward developing novel Severe Asthma treatment therapies with a considerable amount of success over the years.

• Severe Asthma companies working in the treatment market are Lanier Biotherapeutics, Bio-Thera Solutions, Kinaset Therapeutics, CSPC ZhongQi Pharmaceutical Technology, Oneness Biotech Co., Ltd., Chia Tai Tianqing Pharmaceutical Group, AB Science, GlaxoSmithKline, and others, are developing therapies for the Severe Asthma treatment

• Emerging Severe Asthma therapies in the different phases of clinical trials are- LNR 125.38, BAT2606, KN-002, CM326, FB 704A, TQC2731, Masitinib, GSK3511294, and others are expected to have a significant impact on the Severe Asthma market in the coming years.

• In February 2022, In order to treat asthma and chronic obstructive pulmonary disease (COPD), Honeywell and AstraZeneca have formed a business agreement to create and sell next-generation respiratory inhalers that use propellants with almost no global warming potential (GWP).

• In March 2021, GlaxoSmithKline initiated a trial titled, "A 52-week, Randomized, Double-blind, Placebo controlled, Parallel-group, Multi-centre Study of the Efficacy and Safety of GSK3511294 Adjunctive Therapy in Adult and Adolescent Participants with Severe Uncontrolled Asthma with an Eosinophilic Phenotype".

Severe Asthma Overview

The chronic lung disease known as asthma causes the airways to become inflamed and hyperactive. Asthma has a wide range of signs and symptoms that can be brought on by breathing in environmental allergens including pollen, dust, animal dander, mould, or other irritants. When someone is diagnosed with severe asthma, they need to take other longer-acting drugs along with medium- or high-dose inhaled corticosteroids.

Get a Free Sample PDF Report to know more about Severe Asthma Pipeline Therapeutic Assessment-

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Emerging Severe Asthma Drugs Under Different Phases of Clinical Development Include:

• LNR 125.38: Lanier Biotherapeutics

• BAT2606: Bio-Thera Solutions

• KN-002: Kinaset Therapeutics

• CM326: CSPC ZhongQi Pharmaceutical Technology

• FB 704A: Oneness Biotech Co., Ltd.

• TQC2731: Chia Tai Tianqing Pharmaceutical Group

• Masitinib: AB Science

• GSK3511294: GlaxoSmithKline

Severe Asthma Pipeline Therapeutics Assessment

• Severe Asthma Assessment by Product Type

• Severe Asthma By Stage and Product Type

• Severe Asthma Assessment by Route of Administration

• Severe Asthma By Stage and Route of Administration

• Severe Asthma Assessment by Molecule Type

• Severe Asthma by Stage and Molecule Type

DelveInsight's Severe Asthma Report covers around products under different phases of clinical development like

• Late-stage products (Phase III)

• Mid-stage products (Phase II)

• Early-stage product (Phase I)

• Pre-clinical and Discovery stage candidates

• Discontinued & Inactive candidates

• Route of Administration

Further Severe Asthma product details are provided in the report. Download the Severe Asthma pipeline report to learn more about the emerging Severe Asthma therapies

www.delveinsight.com/sample-request/severe-asthma-pipeline-insight?utm_source=openpr&utm_medium=pressrelease&utm_campaign=gpr

Some of the key companies in the Severe Asthma Therapeutics Market include:

Key companies developing therapies for Severe Asthma are - Genentech, Inc., GlaxoSmithKline, Kymab, Sanofi, 4D Pharma plc, AstraZeneca, Sinomab, Avalo Therapeutics, Suzhou Connect Biopharmaceuticals, Avillion, Pearl Therapeutics, ARS Pharmaceuticals, Cumberland Pharmaceuticals, and others.

Severe Asthma Pipeline Analysis:

The Severe Asthma pipeline report provides insights into

• The report provides detailed insights about companies that are developing therapies for the treatment of Severe Asthma with aggregate therapies developed by each company for the same.

• It accesses the Different therapeutic candidates segmented into early-stage, mid-stage, and late-stage of development for Severe Asthma Treatment.

• Severe Asthma key companies are involved in targeted therapeutics development with respective active and inactive (dormant or discontinued) projects.

• Severe Asthma Drugs under development based on the stage of development, route of administration, target receptor, monotherapy or combination therapy, a different mechanism of action, and molecular type.

• Detailed analysis of collaborations (company-company collaborations and company-academia collaborations), licensing agreement and financing details for future advancement of the Severe Asthma market.

The report is built using data and information traced from the researcher's proprietary databases, company/university websites, clinical trial registries, conferences, SEC filings, investor presentations, and featured press releases from company/university websites and industry-specific third-party sources, etc.

Download Sample PDF Report to know more about Severe Asthma drugs and therapies

www.delveinsight.com/sample-request/severe-asthma-pipeline-insight?utm_source=openpr&utm_medium=pressrelease&utm_campaign=gpr

Severe Asthma Pipeline Market Drivers

• Increase in the prevalence of Severe Asthma, development of new and innovative treatment options for severe asthma are some of the important factors that are fueling the Severe Asthma Market.

Severe Asthma Pipeline Market Barriers

• However, high cost of asthma medications, poor adherence to treatment, limited efficacy of existing treatments and other factors are creating obstacles in the Severe Asthma Market growth.

Scope of Severe Asthma Pipeline Drug Insight

• Coverage: Global

• Key Severe Asthma Companies: Lanier Biotherapeutics, Bio-Thera Solutions, Kinaset Therapeutics, CSPC ZhongQi Pharmaceutical Technology, Oneness Biotech Co., Ltd., Chia Tai Tianqing Pharmaceutical Group, AB Science, GlaxoSmithKline, and others

• Key Severe Asthma Therapies: LNR 125.38, BAT2606, KN-002, CM326, FB 704A, TQC2731, Masitinib, GSK3511294, and others

• Severe Asthma Therapeutic Assessment: Severe Asthma current marketed and Severe Asthma emerging therapies

• Severe Asthma Market Dynamics: Severe Asthma market drivers and Severe Asthma market barriers

Request for Sample PDF Report for Severe Asthma Pipeline Assessment and clinical trials

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Table of Contents

1. Severe Asthma Report Introduction

2. Severe Asthma Executive Summary

3. Severe Asthma Overview

4. Severe Asthma- Analytical Perspective In-depth Commercial Assessment

5. Severe Asthma Pipeline Therapeutics

6. Severe Asthma Late Stage Products (Phase II/III)

7. Severe Asthma Mid Stage Products (Phase II)

8. Severe Asthma Early Stage Products (Phase I)

9. Severe Asthma Preclinical Stage Products

10. Severe Asthma Therapeutics Assessment

11. Severe Asthma Inactive Products

12. Company-University Collaborations (Licensing/Partnering) Analysis

13. Severe Asthma Key Companies

14. Severe Asthma Key Products

15. Severe Asthma Unmet Needs

16 . Severe Asthma Market Drivers and Barriers

17. Severe Asthma Future Perspectives and Conclusion

18. Severe Asthma Analyst Views

19. Appendix

20. About DelveInsight

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DelveInsight is a leading Business Consultant and Market Research firm focused exclusively on life sciences. It supports Pharma companies by providing comprehensive end-to-end solutions to improve their performance. It also offers Healthcare Consulting Services, which benefits in market analysis to accelerate business growth and overcome challenges with a practical approach.

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Initiating outpatient pulmonary rehabilitation within 3 weeks post hospital discharge for chronic obstructive pulmonary disease (COPD) exacerbations can cut hospital readmissions by nearly half, according to findings from a systematic review and meta-analysis published in Thorax.

Researchers updated previously published Cochrane reviews that have assessed the efficacy of pulmonary rehabilitation programs after hospital discharge for COPD exacerbation on clinical outcomes. Notably, the 2016 Cochrane review included evidence that “reduced confidence in the observed benefits of pulmonary rehabilitation in the context of an acute exacerbation of COPD,” noted researchers for the current review. The current review, which was used to inform an American Thoracic Society guideline on pulmonary rehabilitation, therefore focused on outpatient rehabilitation programs started within 3 weeks of patient discharge for exacerbation of COPD.

The reviewers identified 17 studies from October 2015 to August 2023, which in total included 1724 patients enrolled in pulmonary rehab programs following hospital discharge for exacerbation of COPD symptoms. Study sample sizes varied between 26 and 389 participants. Of the studies, 6 involved a rehabilitation program initiated during inpatient acute care and continued as outpatient rehabilitation post-discharge; in the remaining studies, outpatient rehabilitation began within 4 weeks post-discharge. The control group constituted 4 studies involving ‘delayed’ pulmonary rehabilitation.

Inclusion/exclusion criteria did not specify a minimum number of exercise sessions. Some of the pulmonary rehabilitation programs studied offered additional components like self-management education, dietary guidance, breathing exercises, and psychological support. For studies that included patients with mixed diagnoses, the results were included if more than 90% of participants had COPD.

[T]hese findings support the need to develop strategies to ensure that people with COPD are
offered pulmonary rehabilitation following hospital discharge for an exacerbation.

The meta-analysis found that pulmonary rehabilitation significantly reduced hospital readmissions by nearly half for patients with COPD (OR, 0.48, 95% CI, 0.30-0.77; I2=67%). In addition, pulmonary rehabilitation programs led to other quality of life improvements, including increased exercise capacity, as evidenced by the ability to walk longer distances in both the 6-minute walk test (mean difference [MD], 57 m; 95% CI, 29-86; I2=89%) and an incremental shuttle walk test (MD, 43 m; 95% CI, 6-79; I2=81%).

Pulmonary rehabilitation was also linked to notable improvements related to respiratory health, as measured by the St. George’s Respiratory Questionnaire (MD, −8.7 points; 95% CI, −12.5 to −4.9; I2=59%) and specific aspects of the Chronic Respiratory Disease Questionnaire (CRQ; emotion: MD, 1.0 points; 95% CI, 0.4-1.6; I2=74).

Moreover, rehabilitation programs led to reductions in dyspnea, as noted by improvements in the CRQ and the modified Medical Research Council Dyspnea Scale (CRQ dyspnea scale MD, 1.0 points; 95% CI, 0.3-1.7; I2=87%; modified Medical Research Council Dyspnea Scale MD, −0.3 points; 95% CI, −0.5 to −0.1; I2=60%).

The analysis did not note that pulmonary rehabilitation had any significant effects on self-efficacy, overall COPD assessment, general quality of life, or mortality rates. No adverse events were reported by those participating in rehabilitation programs.

Limitations of this analysis include the risk for bias in all 17 studies used in the meta-analysis; 12 studies were identified as having a high risk of bias and 5 had a moderate risk of bias. The 2 main issues contributing to bias were the inability to blind participants to the exercise training, which introduced performance bias, and inadequate reporting of methods and outcomes in some studies.

The study authors concluded that “Improvements in key clinical outcomes such as hospital re-admission, exercise capacity and health-related quality of life in the absence of adverse events support the use of pulmonary rehabilitation in the postacute exacerbation phase.” As they further noted, “[T]hese findings support the need to develop strategies to ensure that people with COPD are offered pulmonary rehabilitation following hospital discharge for an exacerbation.”

Disclosures: This research was funded by the American Thoracic Society. Please see original reference for more information.

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Respiratory Devices And Equipment (Therapeutic)  Market

Respiratory Devices And Equipment (Therapeutic) Market

The Business Research Company has updated its global market reports, featuring the latest data for 2024 and projections up to 2033

The Business Research Company offers in-depth market insights through Respiratory Devices And Equipment (Therapeutic) Global Market Report 2024, providing businesses with a competitive advantage by thoroughly analyzing the market structure, including estimates for numerous segments and sub-segments.

Market Size And Growth Forecast:

The respiratory devices and equipment (therapeutic) market size has grown rapidly in recent years. It will grow from $19.9 billion in 2023 to $22.01 billion in 2024 at a compound annual growth rate (CAGR) of 10.6%. The growth in the historic period can be attributed to respiratory conditions prevalence, aging population, technological advancements, respiratory disease management.

The respiratory devices and equipment (therapeutic) market size is expected to see rapid growth in the next few years. It will grow to $32.61 billion in 2028 at a compound annual growth rate (CAGR) of 10.3%. The growth in the forecast period can be attributed to chronic diseases and lifestyle factors, telehealth expansion, technological innovations, copd management. Major trends in the forecast period include digital health and remote monitoring, ventilators and life support systems, respiratory rehabilitation, telehealth integration.

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Market Segmentation:

The main products of the respiratory devices and equipment (therapeutic) market are nebulizers, humidifiers, oxygen concentrators, positive airway pressure devices, ventilators, capnographs, and gas analyzers. A nebulizer is a small machine that turns liquid medicine into a mist, sits with the machine, and breathes in by a connected mouthpiece. The various technologies involved in the respiratory devices and equipment are HEPA filter, electrostatic filtration, microsphere separation, hollow fiber filtration, and others. The market covered in this report is segmented by end-users into home care settings and hospitals.

Major Driver - Rising Respiratory Disease Prevalence Drives Respiratory Devices And Equipment (Therapeutic) Market

The rising prevalence of respiratory diseases such as chronic obstructive pulmonary disorder (COPD) and sleep apnea contributed to the growth of the therapeutic respiratory devices and equipment market. According to World Health Organization, one million people die due to chronic obstructive pulmonary diseases caused by smoking among the 4.9 million people who die due to tobacco consumption and 65 million people suffer from moderate to severe COPD. As per its estimates, COPD is predicted to be the third leading cause of death worldwide and potentially fatal respiratory diseases. Tuberculosis, COPD, and lung cancer will account for about one in five deaths worldwide by 2030. According to National Health Interview Survey by the Centers for Disease Control and Prevention (CDC), the number of adults with diagnosed chronic bronchitis in the USA was 9.0 million. In the USA, it is estimated that 22 million Americans suffer from sleep apnea, with 80% of the cases of moderate and severe obstructive sleep apnea undiagnosed. According to a research study published on American Journal of Respiratory and Critical Care Medicine, in 2021, global prevalence of obstructive sleep apnea was found to be around 20% globally. The increased prevalence of COPD and sleep apnea in the geriatric population is driving the growth of the respiratory devices and equipment (therapeutic) market.

Competitive Landscape:

Major companies operating in the respiratory devices and equipment (therapeutic) market include Hamilton Medical AG, Koninklijke Philips N.V., Smiths Medical, GE Healthcare, Philips Healthcare, Chart Industries Inc., Invacare Corporation, Fisher & Paykel Healthcare Limited, ResMed Inc., Drägerwerk AG & Co. KGaA, Medtronic plc, Masimo Corporation, CareFusion Corporation, Getinge AB, Hill-Rom Holdings Inc., Becton, Dickinson and Company, Air Liquide S.A., Vyaire Medical Inc., Compumedics Limited, Covidien plc, Mindray Medical International Limited, Inogen Inc., Nihon Kohden Corporation, Siemens Healthcare GmbH, Teleflex Incorporated, Breas Medical AB, AirSep Corporation, Rotech Healthcare Inc., 3B Medical Inc.

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Top Trend - Innovations In Artificial Intelligence (AI)-Enhanced Respiratory Devices And Monitoring

The companies in the respiratory devices and equipment (therapeutic) market are increasingly using AI to develop respiratory devices to treat Asthma and COPD. Artificial intelligence supports the development of innovative sensors-equipped inhalers which help patients to track their dosage intake. These sensors are durable and consume less power and help caution the patients by noting the differences or fluctuations in respiration. These are used for both add-on and embedded inhalers. These inhalers with sensors can track data automatically and can alert both the doctors and patients about the health condition of the patients. Also, the companies in developing devices such as AI aided imaging systems and AI aided platforms that will act as voice biomarkers. For instance, in March 2022, Respira Labs, a US-based respiratory technology company, launched AI-powered wearable lung monitor 'Sylvee'. The new product uses acoustic resonance to assess the lung function and detect any variations in the lung function.

The Table Of Content For The Market Report Include:

1. Executive Summary

2. Respiratory Devices And Equipment (Therapeutic) Market Characteristics

3. Respiratory Devices And Equipment (Therapeutic) Market Trends And Strategies

4. Respiratory Devices And Equipment (Therapeutic) Market - Macro Economic Scenario

5. Respiratory Devices And Equipment (Therapeutic) Market Size And Growth

…..

27. Respiratory Devices And Equipment (Therapeutic) Market Competitor Landscape And Company Profiles

28. Key Mergers And Acquisitions

29. Future Outlook and Potential Analysis

30. Appendix

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Pierachille Santus,1 Fabiano Di Marco,2 Fulvio Braido,3 Marco Contoli,4 Angelo Guido Corsico,5 Claudio Micheletto,6 Girolamo Pelaia,7 Dejan Radovanovic,1 Paola Rogliani,8 Laura Saderi,9 Nicola Scichilone,10 Silvia Tanzi,11 Manlio Vella,11 Silvia Boarino,11 Giovanni Sotgiu,9 Paolo Solidoro12

1Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy; 2Department of Health Sciences, Università degli Studi di Milano Pneumology, ASST Papa Giovanni XXIII, Bergamo, Italy; 3Department of Internal Medicine (DiMI), Respiratory Unit for Continuity of Care, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy; 4Department of Translational Medicine, Respiratory Section, University of Ferrara, Ferrara, Italy; 5Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy; 6Cardio-Thoracic Department, Respiratory Unit, University Integrated Hospital, Verona, Italy; 7Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy; 8Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome ”Tor Vergata”, Division of Respiratory Medicine, University Hospital ”Tor Vergata”, Rome, Italy; 9Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy; 10Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy; 11AstraZeneca Italia, Milan, Italy; 12Department of Medical Sciences, University of Turin, S.C. Pneumologia, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy

Correspondence: Pierachille Santus, Università degli Studi di Milano, Via G.B. Grassi 74, Milano, 20157, Italy, Tel +39 0239042801, Fax +39 0239042473, Email [email protected]

Objective: To describe the burden of moderate to severe exacerbations and all-cause mortality; the secondary objectives were to analyze treatment patterns and changes over follow-up.
Design: Observational, multicenter, retrospective, cohort study with a three year follow-up period.
Setting: Ten Italian academic secondary- and tertiary-care centers.
Participants: Patients with a confirmed diagnosis of COPD referring to the outpatient clinics of the participating centers were retrospectively recruited.
Primary and Secondary Outcome Measures: Annualized frequency of moderate and severe exacerbations stratified by exacerbation history prior to study enrollment. Patients were classified according to airflow obstruction, GOLD risk categories, and divided in 4 groups: A = no exacerbations; B = 1 moderate exacerbation; C = 1 severe exacerbation; D = ≥ 2 moderate and/or severe exacerbations. Overall all-cause mortality stratified by age, COPD category, and COPD therapy. A logistic regression model assessed the association of clinical characteristics with mortality.
Results: 1111 patients were included (73% males), of which 41.5% had a history of exacerbations. As expected, the proportion of patients experiencing ≥ 1 exacerbation during follow-up increased according to pre-defined study risk categories (B: 79%, C: 84%, D: 97.4%). Overall, by the end of follow-up, 45.5% of patients without a history of exacerbation experienced an exacerbation (31% of which severe), and 13% died. Deceased patients were significantly older, more obstructed and hyperinflated, and more frequently active smokers compared with survivors. Severe exacerbations were more frequent in patients that died (23.5%, vs 10.2%; p-value: 0.002). Chronic heart failure and ischemic heart disease were the only comorbidities associated with a higher odds ratio (OR) for death (OR: 2.2, p-value: 0.001; and OR: 1.9, p-value: 0.007). Treatment patterns were similar in patients that died and survivors.
Conclusion: Patients with a low exacerbation risk are exposed to a significant future risk of moderate/severe exacerbations. Real life data confirm the strong association between mortality and cardiovascular comorbidities in COPD.

Keywords: pulmonary disease chronic obstructive, heart failure, ischaemic heart disease, respiratory medicine, public health

Introduction

Chronic obstructive pulmonary disease (COPD) is a treatable but debilitating medical condition associated with persistent symptoms and chronic airflow obstruction.1 Despite the availability of multiple therapeutic options, COPD is the third leading cause of death worldwide and has a substantial socioeconomic impact.2,3 COPD is diagnosed when patients present with respiratory symptoms and/or history of exposure to risk factors, having bronchial obstruction confirmed by spirometry.2 However, even mild obstruction hides a significant loss of small airways4 making a timely diagnosis and a prompt treatment initiation of great importance to reduce morbidity and mortality.5 Greater understanding of individual variability of COPD progression through multidimensional evaluation may help recommend tailored interventions.6–9 Patients with COPD are susceptible to exacerbations, in fact, 30%-50% of patients experience at least one exacerbation per year.9 Exacerbations are associated with disease severity and history of previous exacerbations itself is considered the most reliable predictor of future exacerbations.10 Nevertheless, patients with mild airflow obstruction and symptoms that may not yet affect activities of daily living can still experience frequent or severe exacerbations.11 Also, mild and moderate exacerbations can increase the risk of future exacerbations, accelerating lung function decline, promoting cardiovascular complications, and increasing mortality.12–14

A Canadian study showed that severe exacerbations leading to hospitalization may increase the risk of a second severe event by 3-fold and may increase mortality up to 50% after 3.6 years of follow-up after a first hospitalization.15 Moreover, after a severe exacerbation, patients are at greater risk of cardiovascular events,16,17 putting pharmacological and non-pharmacological preventive strategies the highest priority in the management of the disease.18 Pharmacological options include long-acting β2 agonists (LABA) and/or long-acting antimuscarinic agents (LAMA), in combination or without inhaled corticosteroids (ICS), that decrease airway inflammation and reduce the rate of exacerbations.19,20

The estimated prevalence of COPD in Italy ranges from 2.6%, assessed via patient-directed survey,21 to 3.01% in primary care,22 thus affecting up to 3.5 million adults and representing the sixth most prevalent chronic disease. It also has large impact on the national healthcare system: the mean annual cost per patient was €3291 in 2015, with the major cost component being hospitalizations following exacerbations.23 Considering the overall socio-economic and healthcare burden of the disease, a detailed clinical profile of COPD patients in Italy appears desirable, but unfortunately to date, real life data are lacking. The present real life study is aimed at describing the clinical and functional characteristics, treatment patterns, impact of exacerbations and comorbidities and their association with mortality in a large cohort of Italian patients with COPD.

Materials and Methods

Study Design

The DescribinG bUrden of COPD and occurrence of mortaLity in a cohort of Italian Patients (GULP) study, part of AstraZeneca’s European AvoidEX program, was an observational, multicenter, retrospective cohort study based on a multicenter database, recently approved as the Italian COPD Registry (Ethics Committee protocol n. 20–27 Sept 2023), conducted in ten Italian academic secondary- and tertiary-care centers: Division of Respiratory Diseases of L. Sacco University Hospital (Università degli Studi di Milano, Milano), Pneumology unit, ASST Papa Giovanni XXIII (Università degli Studi di Milano, Bergamo), Respiratory Unit for Continuity of Care, IRCCS Ospedale Policlinico San Martino (University of Genova, Genova), Respiratory Section, Department of Translational Medicine (University of Ferrara, Ferrara), Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation (University of Pavia Medical School, Pavia), Respiratory Unit, Cardio-Thoracic Department (University Integrated Hospital, Verona), Pulmonary Unit, Dipartimento di Scienze della Salute (Università Magna Graecia, Catanzaro), Unit of Respiratory Medicine, Department of Experimental Medicine (University of Rome “Tor Vergata”, Rome), Biomedical Department of Internal and Specialist Medicine (University of Palermo, Palermo), Pulmonary Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza (University of Turin, Torino). The study was carried out according to the amended Declaration of Helsinki, ICH GCPs, GPP, and the legislation on non-interventional studies and/or observational studies (AIFA guidelines, 20/Mar/2008) and approved by the ethics committee of each participating site. All participants gave written informed consent.

Data protection and privacy legislation compliance were ensured. The dataset covered a period of 365 days prior to the index date and a minimum of 365 days post index date up to three years of follow up. The index date was the date of the study entry, i.e. the date when the patient entered the database with a record of a COPD diagnosis.

Study Objectives

The primary objective was to describe the burden of moderate to severe COPD exacerbations. Rates of moderate and severe exacerbations, as well as all-cause mortality were collected and analyzed.

The secondary objective was to describe treatment patterns at baseline and eventual treatment changes.

The pharmacological inhaled treatments considered were: LAMA or LABA monotherapies or fixed combinations thereof, ICS and a LABA and/or a LAMA or their fixed combinations.

Mortality was assessed at 3 years. Patients were stratified in two groups according to survival status and the following variables were assessed: demographic and clinical characteristics, baseline exacerbations, relationship between mortality and clinical characteristics.

Study Subjects

Electronic records of patients aged ≥40 years with an established diagnosis of COPD between January 1, 2015, and December 31, 2017, and referring to the outpatient clinics of the participating centers were retrospectively reviewed. COPD diagnosis was considered if having age ≥ 40 years old, a smoking history > 20 pack years and a post-bronchodilator forced expiratory volume in one second to slow vital capacity ratio (FEV1/VC) < the lower limit of normal (LLN) criteria.11 Severity of disease was graded using three different classifications proposed by GOLD over time: airflow obstruction (GOLD stages 1 to 4);24 airflow obstruction, exacerbations and respiratory symptoms25 or exacerbations and respiratory symptoms (GOLD A, B, C, or D).26 Patients were excluded if had a current asthma diagnosis or clinically significant alternative respiratory diseases such as interstitial lung disease or bronchiectasis.

Clinical phenotypes of the enrolled patients were obtained following the multifactorial model proposed by Pistolesi et al.27 The presence of chronic cough, sputum, and sputum purulence, adventitious sounds and hyper-resonance at physical examination, chest X-ray parameters, such as increased vascular markings, bronchial wall thickening, increased lung volume and reduced lung density, together with the FEV1/FVC ratio were registered. These parameters were included in the web-based estimation model28 that allowed the assessment of the predominant clinical phenotype: airways obstructive (chronic bronchitis), parenchymal destructive (emphysema), or intermediate. At enrollment, patients were assigned to one of 6 groups based on the ongoing therapy:

  1. LAMA or LABA monotherapy
  2. Combinations of LABA + LAMA
  3. ICS without LABA or LAMA
  4. Combinations of ICS + LABA or ICS + LAMA
  5. Combinations ICS + LABA + LAMA
  6. None of the above

Patients treated with more than one pharmacological class were considered as exposed to combination therapy if they had taken the medications for at least 14 days prior to the index date.

Outcomes and Variables

According to the history of exacerbations in the year before the index date,29 patients were grouped into one of four categories:

  • Category A: no exacerbations
  • Category B: 1 moderate exacerbation (symptomatic deterioration requiring antibiotic therapy or Medium to high-dose systemic corticosteroids)
  • Category C: 1 severe exacerbation (exacerbation requiring hospitalization or emergency visits)
  • Category D: ≥2 moderate and/or severe exacerbations

Moderate exacerbations were defined as claims for courses of oral corticosteroids and/or respiratory antibiotics. Severe exacerbations were defined as need for hospitalization. If more than one of the episodes occurred within a 2-week window, a single exacerbation was considered. If a moderate and a severe exacerbations occurred concurrently within a 2-week window, the episode was considered as a severe exacerbation.

Patient and Public Involvement

Due to the study design, patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.

Statistical Analysis

Categorical variables were summarized with absolute and relative frequencies. Continuous variables were summarized with central tendency (i.e. medians) and variability (i.e. interquartile ranges, IQR) indicators. Statistical differences were evaluated using chi-square or Mann–Whitney tests, as appropriate. COPD exacerbations are described overall and in selected strata. All-cause mortality is described overall and stratified by age (<65, 65–75, >75), COPD category, and COPD therapy. A logistic regression model was used to evaluate association of covariates at enrollment with mortality. Missing data were not imputed. All statistical analyses were performed using the statistical software STATA version 16 (StatsCorp, Texas, USA).

Results

Characteristics of the Study Population

The study included 1111 COPD patients (Table 1). Patients were predominately male (72.9%) with a median (IQR) age of 76 (70–82) years and body mass index of 26.5 (23.4–29.4) Kg/m2. Most participants were current smokers (70.1%) with a median (IQR) smoking history of 40 (30–60) pack-years. 56.8% of patients had emphysema and 14.9% had chronic bronchitis, whereas 28.4% had a mixed phenotype. Most patients had moderate to severe airflow obstruction (GOLD 2 and GOLD 3: 44.8% and 28.1%, respectively). By GOLD 2016 and GOLD 2017 criteria, the highest proportion of patients was classified as GOLD D (46.4% and 41.4%, respectively) (Table 2). Among the COPD therapies, the most widely prescribed were LABA+LAMA (21% in 2015; 25.9% in 2016, and 28.7% in 2017) and combination therapy with ICS +LABA+LAMA (42.4% in 2015; 44.5% in 2016, and 46.6% in 2017). 13.3% of patients died within three years of follow-up.

Table 1 Patients’ Characteristics at Enrollment

Table 2 Exacerbations and Treatment Patterns During the Follow-Up

Exacerbation Patterns in COPD Patients

Prior to the index date, 41.5% (461/1111) of patients had a history of exacerbations. During follow up the majority of patients experienced moderate exacerbations (37.3%, 41.4%, and 40% for each year of follow up, respectively) (Table 2), while the proportion of patients experiencing severe exacerbations was lower though stable over the follow up period (17.8%, 18.9%, 15.3%).

Among patients without prior history of exacerbations (category A), 45.5% experienced an exacerbation during the follow up, 30.6% of which were severe. The proportion of patients with an exacerbation during the follow up period increased in categories B, C and D (60.7%, 83.7%, 97.4%, respectively). Accordingly, the proportion of moderate exacerbations during follow up increased with increasing exacerbation risk from category A to D (28.4%, 60.7%, 58.2%, 90.6%, respectively). Patients that were frequent exacerbators in the year before entering the study (group D) experienced the highest median number of moderate exacerbations during follow up (4 (2–5); p<0.001 compared with other groups). 18.5% of patients with a history of one moderate exacerbation in the previous year (category B) had a severe exacerbation during the follow up. The highest proportion of severe exacerbations was observed in patients with a single severe (category C, 51%) and frequent exacerbators (category D, 34.6%) (Table 3).

Table 3 Exacerbations Over 3 Years in a, B, C and D Categories

COPD Treatments and Therapeutic Switch

A significant percentage of patients switched inhaled therapy by the end of the follow up period (Table 4). Patients on a bronchodilator monotherapy most frequently switched to a LABA/LAMA combination (38.7% of patients previously on a LABA and 22% of patients on a LAMA) (Table 4). The proportion of patients already on LABA/LAMA and on LABA/ICS that switched to a triple combination therapy (ICS/LABA/LAMA) was 14.8% and 28.2% respectively, while 81.8% of patients treated with LABA/LAMA continued the same therapy, a proportion that increased to 89% in patients treated with ICS/LABA/LAMA. ICS were withdrawn in 21.8% of cases in patients treated with ICS/LABA, while this percentage was reduced to 11.1% in patients on ICS/LABA/LAMA, the majority of which (8.7%) were switched to a LABA/LAMA combination (Table 4).

Table 4 Pharmacological Therapy for COPD, 2015 Vs 2017

Characteristics of Deceased Patients

Compared to patients alive at the end of the follow up, patients who died were significantly older, more frequently active smokers, and were significantly more obstructed and hyperinflated (Supplementary Table 1). The proportion of patients that experienced at least one exacerbation during follow up did not differ between groups, but the proportion of patients experiencing moderate exacerbations tended to be less (13.7% vs 16.8%) while severe exacerbations were significantly more frequent in patients that did not survive (23.5%, vs 10.2%; p-value: 0.002) (Supplementary Table 1). Frequent exacerbators were similar between groups (20.6% vs 23.2%). The distribution of treatment patterns at the end of follow up was not different in patients that died and those that survived, although the proportion of patients on ICS/LABA/LAMA tended to be higher in the former group (59.7% vs 47.9%). Cardiovascular comorbidities were the most frequently observed, being significantly more prevalent in deceased patients than in patients alive at the end of follow up (27.2% vs 14.2% for chronic heart failure, p-value: <0.0001; 28.1% vs 17.3% for ischemic heart disease, p-value: 0.006) (Supplementary Table 1). Chronic heart failure and ischemic heart disease were the only comorbidities/clinical characteristics associated with a significantly higher odds ratio (OR) for death (OR: 2.2, p-value: 0.001; and OR: 1.9, p-value: 0.007, respectively) (Figure 1). Mortality was significantly higher in patients with a history of one severe exacerbation (category C): 24.7% VS category A (10.7%), category B (10.4%) and category D (11.2%) (Supplementary Figure 1).

Figure 1 Association between baseline descriptors and mortality outcome during follow-up: multivariable logistic regression model. The forest plot illustrates the odds of mortality with 95% confidence intervals (CI). CI and p-values are reported on the left of y axis. Values higher than 1 favor risk of death.

Abbreviations: BMI, body mass index; IC, inspiratory capacity; IQR, inter quartile range; FEV1, forced expiratory volume in first second.

Discussion

The present study evaluated clinical characteristics, treatment patterns, rates of moderate and severe exacerbations, and survival of a cohort of Italian COPD patients.

The burden of exacerbations was almost constant during the study period: 45.5% of patients that had no exacerbations in the year before entering the study experienced at least one exacerbation over a 3-year follow-up period. Moreover, 79.3% of patients that already had a history of a moderate exacerbation had at least one subsequent event. This suggests that even patients perceived as low-risk should be adequately managed over time, since the absence of previous events in the majority of cases does not prevent the occurrence of future exacerbations, highlighting the importance of preventing exacerbation of any severity in order to reduce the risk of future events, and monitoring progression and preventing worsening of disease represent crucial goals, considering that moderate exacerbations correlate with a high risk of severe exacerbations and increased mortality.15 Indeed, in the present study, mortality was associated with severe exacerbations, which confirms the importance of exacerbation events in prognosis.

COPD mostly affects older adults, and the development of multimorbidity may complicate COPD management.30 People living with COPD have almost twice the risk of heart failure and myocardial infarction when compared with those without COPD belonging to the same age, sex, race, and education level.30 Even COPD patients with no history of cardiovascular disease have a higher risk of cardiovascular complications, such as myocardial infarction and stroke, following a moderate exacerbation.14 We showed that cardiovascular comorbidities are a major risk factor for death in Italian patients with COPD. In fact, among all comorbidities, only chronic heart failure and ischemic heart disease were associated with a significantly higher risk of death, independent of the severity of airflow obstruction or hyperinflation. Apparently, frequent exacerbators (group D) were exposed to a lower risk of hospitalizations compared with group C during follow up. Considered the higher mortality in group C and the proportion of patients with cardiovascular comorbidities among patients that died, it could be speculated that patients with frequent exacerbations, irrespective of the severity of exacerbations, could be exposed to a stricter pulmonary outpatient monitoring and therefore with a higher chance of being managed outside the hospital setting in case of an exacerbation. On the other hand, patients in group C might have had a higher risk of being hospitalized for an acute event, with an increased overall mortality risk secondary to the higher prevalence of cardiovascular risk factors.

Current treatments for COPD foresee escalation of therapy from monotherapy to dual/triple therapy based on symptoms and number and severity of exacerbations, and is usually recommended in symptomatic patients with a history of frequent and/or severe exacerbations.2 ICS/LABA/LAMA fixed-dose combinations improve respiratory function, symptoms, health status, and reduce exacerbations compared to dual therapies.31,32 Triple therapy also demonstrated a significant impact on mortality and frequency of moderate or severe exacerbations compared with LABA/LAMA.2,33,34 Our observations showed that patients treated with triple therapy remained on triple therapy throughout the study, whereas patient prescribed ICS/LABA were often stepped up to triple therapy. In spite of the recommendation for ICS treatment only in patients that experience exacerbations,2 in our real life study we observed that the prevalence of ICS prescription in clinical practice reaches 50% of the patients enrolled, suggesting the possibility of overtreatment or inadequate disease control despite maximized bronchodilation in a proportion of patients.

Our work demonstrated a high prevalence of cardiovascular comorbidities in patients with COPD, confirming previous observations.35,36 Furthermore, our analysis showed that after three years of follow up a notable percentage of patients died (13.3%) and only chronic heart failure and ischemic heart disease were associated with higher odds of mortality. Patients that died during the follow up had poorer lung function (lower FEV1 and inspiratory capacity) and had more frequently a history of a severe exacerbation before entering the study, thus justifying the higher proportion treated with triple therapy, but also suggesting that triple therapy is initiated late in the clinical history pf COPD patients. These observations confirm the need for increased alertness on pharmacological optimization and careful patients’ assessment in terms of exacerbations and mortality, and on the connection between chronic cardiac and lung diseases, in order to improve both patients’ quality and quantity of life.

The present study has several limitations. First, patients were enrolled from secondary and tertiary care hospitals, thus the study might suffer from a selection bias, making results not fully generalizable in terms of severity of disease and mortality. Second, in the last years prescription patterns have changed over time due to the market introduction of triple fixed dose combination therapies, therefore switching patterns might have evolved differently than described. Third, the cause of death was not registered therefore any consideration about the possible causative role of cardiovascular comorbidities or exacerbations in the risk of death could not be drawn. Finally, adverse drug effects and major cardiovascular events were not studied and the cause of therapeutic switch was not assessed. Indeed, the study has strengths, mainly represented by the real life setting, the multicenter study and by the length of the follow up period.

Conclusion

In conclusion, this study provided for the first time a detailed clinical overview of the exacerbation burden in patients with COPD in Italy, highlighting from real life data that even patients with a low exacerbation risk are exposed to a significant future risk of moderate to severe exacerbations. The study also confirmed the existence of a strong association between mortality and cardiovascular comorbidities in COPD, in particular with heart failure and ischemic heart disease. Despite the overall exacerbation and mortality burden, a lower than expected number of patients were treated with triple therapy with ICS//LABA/LAMA. The study should represent a starting point and gives the rationale for continuing the implementation of large shared national databases as a source of patients’ characterization and as monitoring tools for preventive pharmacological and non-pharmacological strategies.

Data Sharing Statement

The anonymized dataset will be available upon reasonable request by the Corresponding Author.

Acknowledgments

Medical writing and editorial assistance were provided by Maria Vittoria Verga Falzacappa, PhD (EDRA S.p.A., Milan, Italy) and funded by AstraZeneca.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

This work was supported by Astra Zeneca.

Disclosure

PSa has received lectures fees at national and international meetings and consultancy fees from Boehringer Ingelgheim, Chiesi Farmaceutici, Astra Zeneca, Berlin-Chemie, Edmondpharma, Guidotti, Neopharmed, Novartis, Valeas, GlaxoSmithKline, Alfasigma, Zambon and Sanofi; research grants from Air Liquide, Almirall, Boehringer Ingelgheim, Chiesi Farmaceutici, Pfizer, Edmondpharma. FB declares participation in a company sponsored speaker’s bureau: Astra Zeneca, GSK, Novartis, Boehringer Ingelgheim, Chiesi, MSD, Menarini, Malesci, Guidotti, Sanofi and support for research: Chiesi, Vitalair. M.C. declares grants for research, personal fees and non-financial support from Chiesi and GlaxoSmithKline, personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, Alk-Abello, and Novartis, and research grants from the University of Ferrara, Italy. FDM has received lectures fees at national and international meetings and consultancy fees from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Dompe, Guidotti/Malesci, GlaxoSmithKline, Menarini, Novartis, and Zambon; CM received fees as a speaker from Astrazeneca, GSK, Sanofi, Chiesi, Menarini, Guidotti, Novartis, Zambon, Boehringer. GP has received lecture fees and consultancy fees from Alfasigma, AstraZeneca, Chiesi, GlaxoSmithKline, Guidotti-Malesci, Menarini, Mundipharma, Novartis, Sanofi, Zambon. DR has received fees for lectures from Astra Zeneca, Berlin Chemie, Boehringer Ingelheim, Glaxo Smith Kline, Menarini; fees for consultancy from Damor Farmaceutic and honoraria for consulting and participation to advisory boards from Astra Zeneca, Boehringer Ingelheim. PR participated as a lecturer and advisor in scientific meetings and courses under the sponsorship of Almirall, AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini Group, MSD, Mundipharma, Novartis and Recipharm. Her department was funded by Almirall, Boehringer Ingelheim, Chiesi Farmaceutici, Novartis, and Zambon. NS has received lectures fees at national and international meetings and consultancy fees from Astra Zeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline; research grants from Boehringer Ingelheim, Chiesi Farmaceutici, Sanofi. SB, ST, MV are AstraZeneca employees. PSo has participated as a lecturer, speaker, and advisor in scientific meetings and courses under the sponsorship from Boehringer Ingelheim, Chiesi Farmaceutici, Astra Zeneca, Guidotti-Malesci, Novartis, Valeas, GlaxoSmithKline, Menarini, ABC Farmaceutici, Almirall, Dompè and Biotest. The authors report no other conflicts of interest in this work.

References

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Rituximab does not seem to increase the risk for severe outcomes compared with other cold agglutinin disease (CAD) treatments in people who have the disease and COVID-19, according to a review study.

“Nonetheless, caution is advised when using rituximab in CAD patients with COVID-19 and underlying [autoimmune] conditions due to the heightened risk of severe outcomes in this subgroup, as reported in the literature,” researchers wrote.

The review, “Cold Agglutinin Disease and COVID-19: A Scoping Review of Treatments and Outcomes,” was published in the Journal of Clinical Medicine Research.

CAD is caused by a specific type of self-reactive antibodies, called cold agglutinins, that bind to red blood cells at cold temperatures, causing them to clump and be marked for destruction. This often results in tissues not receiving enough oxygen, which can lead to symptoms such as fatigue and pain.

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Secondary CAD due to underlying cancer, autoimmune disease, infection

CAD is said to be primary when its cause is unknown, or secondary when it occurs due to an underlying condition, such as a blood cancer, another autoimmune disease, or an infection — including with SARS-CoV-2, the virus that causes COVID-19.

The current first-line treatment for CAD involves rituximab (sold as Rituxan, among others), an antibody-based therapy designed to target B-cells, the immune cells that produce antibodies, including cold-agglutinins.

However, “reports suggest that patients with both acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and cold agglutinin disease (CAD) may experience poorer survival when treated with rituximab,” the researchers wrote.

These observations were made among patients with underlying autoimmune conditions, which are usually treated with medications that suppress the immune system.

It is unclear whether the underlying autoimmune disease, marked by a more inflammatory state, or the use of other immunosuppressants — and not specifically rituximab — contributed to the reported worse outcomes.

To better understand rituximab’s effects in people with CAD and COVID-19, but no underlying autoimmune disease, a team of researchers in the U.S. systematically reviewed studies published up to December 2023 that reported disease outcomes in such cases.

The analysis included a total of 19 studies, 17 of them case reports and two were case series. Most were conducted in the U.S. (42%) and India (15%), and others across Europe and Asia.

We did not find an increased risk of severe outcomes among patients with CAD infected with COVID-19 who were treated with rituximab compared to those treated with other therapies.

Review included 23 patients with CAD and COVID-19

A total of 23 patients, mostly women (61%), with a mean age of 61 years, were included in the review. Most patients were diagnosed with CAD upon SARS-CoV-2 infection, with two patients previously diagnosed.

The most common initial symptoms were anemia, which means low levels of hemoglobin, or the protein in red blood cells that carries oxygen through the body, and severe pneumonia, a type of lung infection.

Patients often had other simultaneous health conditions, including high blood pressure, type 2 diabetes, kidney failure, cirrhosis (when the liver is severely scarred), chronic obstructive pulmonary disease, or leukemia (a type of blood cancer).

Treatments for CAD included rituximab, red blood cell transfusions, plasma exchange (a procedure that helps remove cold agglutinins), and immunosuppressive steroids, usually in combination. Rituximab was used in four patients (17.4%).

No significant difference was reported in the prevalence of co-existing health diseases between patients treated with rituximab and those given other therapies.

Overall, 17 patients (74%) recovered, while five (21%) died. No outcomes were reported for one patient. Nine patients (39%) were admitted to an intensive care unit (ICU).

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More deaths reported for patients on treatments other than rituximab

Among patients treated with rituximab, one (25%) was admitted to the ICU, and none died. In contrast, among the 19 patients who received other treatments, eight (42%) were admitted to the ICU, and five (26%) died.

“We did not find an increased risk of severe outcomes among patients with CAD infected with COVID-19 who were treated with rituximab compared to those treated with other therapies,” the researchers wrote, adding, however, that the findings were based on case reports and case series alone.

In previous reports, the simultaneous use of other immunosuppressants in people with underlying autoimmune conditions may have erroneously attributed the increased risk of severe outcomes to rituximab therapy, the team noted.

“There is a need for further studies examining the effect of rituximab use among COVID-19 patients with CAD and [autoimmune] conditions while adjusting for underlying immune suppression of these autoimmune conditions,” the researchers concluded.

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Participant characteristics

A total of 271 participants (mean ± SD, 61 years ± 12) were assessed, and 113 participants were women (41.7%). The baseline and clinical characteristics are summarized in Table 1. Of the 271 participants, the median body mass index was 21.8 kg/m2 (IQR, 17.1–29.1), and 80 (29.5%) were smokers. 148 participants (54.6%) had different types of comorbidities and common comorbidities included hypertension (82 participants, 30.3%), type II diabetes mellitus (80 participants, 29.5%), ischemic heart disease (61 participants, 22.5%), chronic obstructive pulmonary disease (18 participants, 6.6%) and previous venous thromboembolism (10 participants, 3.7%). The median hospital stay was 12 days (IQR, 4–20 days), with 68 participants (25.1%) requiring the highest level of ventilatory support in the form of invasive ventilation or noninvasive positive pressure ventilation. Participants are treated with medications mainly including paxlovid (183 participants, 67.5%), azvudine (60 participants, 22.1%) and glucocorticoid (69 participants, 25.5%).

Table 1 Comparison of baseline and clinical characteristics between participants with normal and abnormal CT in the lung at 6-month follow-up.

Compared of baseline and clinical characteristics, age (mean, 58 years ± 11 vs 65 years ± 12, P < 0.001), smoker (42 participants [24.3%] vs 38 participants [38.8%], P = 0.04), heart rate (mean, 83 times per minute ± 14 vs 92 times per minute ± 16, P = 0.02), respiratory rate (mean, 20 times per minute ± 7 vs 24 times per minute ± 9, P = 0.03), oxygen saturation on room air (SaO2, 96%, IQR, 88–99% vs 92%, IQR, 80–98%, P = 0.001), chronic obstructive pulmonary disease (COPD, 10 participants [5.8%] vs 8 participants [8.1%], P = 0.02), length of hospital stay (11 days, IQR, 4–14 days vs 16 days, IQR, 10–27 days, P < 0.001), invasive ventilation (2 participants [1.6%] vs 15 participants [15.3%], P < 0.001) and using paxlovid (147 participants [85.0%] vs 36 participants [36.7%], P < 0.001) demonstrated a statistically significant difference between participants with normal and abnormal chest CT at 6-month follow-up.

Comparison of CT findings

All participants underwent a 6-month follow-up chest CT at a median of 177 days (IQR, 155–203 days) after hospital admission and pulmonary residual abnormalities were found in 98 participants (36.2%). Compared to the initial CT (Table 2), participants with GGO decreased from 270 (99.6%) to 66 (24.4%) and consolidation decreased from 111 (41.0%) to 20 (7.4%) (Fig. 2). Meanwhile, participants with reticulation increased from 19 (7.0%) to 57 (21.0%). The ARDS pattern in three participants (1.1%) and crazy paving pattern in two participants (0.7%) at initial CT had disappeared at 6-month follow-up CT. Participants with organizing pneumonia pattern increased from four (1.5%) to seven (2.6%). Among CT evidence of fibrotic-like changes, participants with linear atelectasis increased from four (1.5%) to seven (2.6%) (Fig. 3), participants with bronchiectasis and parenchymal bands increased from six (2.2%) to 31 (11.4%) (Fig. 4) and 14 (5.2%) (Fig. 5) respectively. There was no change in the three participants (1.1%) with honeycombing. In summary, 39 participants (14.4%) demonstrated new suspicious fibrotic-like changes at 6-month follow-up CT.

Table 2 Comparison of CT Findings in the lung between initial and 6-month follow-up CT.
Figure 2
figure 2

Serial chest CT scans in a 45-year-old man with severe coronavirus disease 2019 pneumonia. (A, B) Initial CT scans obtained on day 5 after the onset of symptoms showed extensive ground-glass opacities (GGO) with some areas of consolidation bilaterally. (C, D) CT scans obtained on day 9 showed extensive consolidation with few GGOs bilaterally. (E, F) CT scans obtained on day 179 showed almost absorption of the abnormalities with mild GGOs and interstitial thickening remaining.

Figure 3
figure 3

Serial chest CT scans in a 61-year-old man with coronavirus disease 2019 pneumonia. (A, B) Initial CT scans obtained on day 4 after the onset of symptoms showed multiple ground-glass opacities and consolidation bilaterally. (C) CT scans obtained on day 22 showed moderate consolidation and reticulation in the lower lung lobes bilaterally. (D) CT scans obtained on day 191 showed obviously absorption of the abnormalities with subtle reticulation and linear atelectasis (arrow) in the lower lung lobes.

Figure 4
figure 4

Serial chest CT scans in a 60-year-old man with coronavirus disease 2019 pneumonia. (A, B) Initial CT scans obtained on day 8 after the onset of symptoms showed multiple ground-glass opacities and interstitial thickening bilaterally. (C, D) CT scans obtained on day 180 showed traction bronchiectasis (white arrow) and interlobar pleural traction (black arrow) in the upper lobe of right lung.

Figure 5
figure 5

Serial chest CT scans in a 54-year-old man with coronavirus disease 2019 pneumonia. (A) Initial CT scans obtained on day 9 after the onset of symptoms showed multiple ground-glass opacities and interstitial thickening bilaterally. (B)CT scans obtained on day 169 showed traction bronchiectasis (white arrow) and parenchymal bands (black arrow) in the lower lung lobes.

Comparison of chest CT scores

In the Chest CT scores (Table 3), a significantly decrease was found for any abnormality (P < 0.001), GGO (P < 0.001), and consolidation (P < 0.001), whereas a significantly increase for fibrotic-like abnormalities (P < 0.001) compared with the initial CT scans. Meanwhile, reticulation showed insignificantly change between two CT scans (P = 0.33).

Table 3 Comparison of Chest CT Scores between initial and 6-month Follow-up CT.

Factors associated with pulmonary residual abnormalities

In the univariate analysis, paxlovid (odd ratio [OR]: 0.08; 95% CI 0.03, 0.21; P < 0.001), invasive ventilation (OR 9.3; 95% CI 2.8, 29; P < 0.001), age > 60 years (OR 6.5; 95% CI 2.7, 17; P < 0.001), SaO2 less than 93% at admission (OR 4.5; 95% CI 1.4, 14; P < 0.001), hospitalization more than 15 days (OR 3.8; 95% CI 1.3, 11; P = 0.002), and respiratory rate more than 23 times per minute at admission (OR 3.3; 95% CI 1.3, 8.7; P = 0.004) were associated with pulmonary residual abnormalities at 6-month follow-up CT. In the multivariate analysis, the predictive factors were invasive ventilation (OR 13.6; 95% CI 1.9, 45; P < 0.001), age > 60 years (OR 9.1; 95% CI 2.3, 39; P = 0.01), paxlovid (OR 0.11; 95% CI 0.04, 0.48; P = 0.01), hospitalization more than 15 days (OR 6.1; 95% CI 1.2, 26; P = 0.002), heart rate greater than 100 times per minute (OR 5.9; 95% CI 1.1, 27; P = 0.03), and SaO2 less than 93% at admission (OR 5.6; 95% CI 1.4, 13; P = 0.02) (Table 4).

Table 4 Univariable and multivariable analysis of pulmonary residual abnormalities at 6-month follow-up CT.

Factors associated with pulmonary fibrotic-like changes

In the univariate analysis, paxlovid (OR 0.11; 95% CI 0.04, 0.32; P < 0.001), invasive ventilation (OR 8.8; 95% CI 2.1, 26; P < 0.001), smoker (OR 7.4; 95% CI 3.0, 16; P < 0.001), SaO2 less than 93% at admission (OR 4.5; 95% CI 1.2, 16; P = 0.002) and age > 60 years (OR 4.2; 95% CI 1.3, 11; P = 0.002) were associated with pulmonary fibrotic-like changes at 6-month follow-up CT. In the multivariate analysis, the predictive factors were invasive ventilation (OR 10.3; 95% CI 2.9, 33; P = 0.002), smoker (OR 9.9; 95% CI 2.4, 31; P = 0.01), paxlovid (OR 0.1; 95% CI 0.03, 0.48; P = 0.01), SaO2 less than 93% at admission (OR 7.8; 95% CI 1.5, 19; P = 0.02), age > 60 years (OR 6.1; 95% CI 2.3, 22; P = 0.03) and heart rate greater than 100 times per minute (OR 4.9; 95% CI 1.7, 11; P = 0.04) (Table 5).

Table 5 Univariable and multivariable analysis of pulmonary fibrotic-like changes at 6-month follow-up CT.

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Respiratory Inhaler Devices Market Characteristics

Respiratory Inhaler Devices Market Characteristics

The Business Research Company has updated its global market reports, featuring the latest data for 2024 and projections up to 2033

The Business Research Company offers in-depth market insights through Respiratory Inhaler Devices Global Market Report 2024, providing businesses with a competitive advantage by thoroughly analyzing the market structure, including estimates for numerous segments and sub-segments.

Market Size And Growth Forecast:

The respiratory inhaler devices market size has grown strongly in recent years. It will grow from $38.54 billion in 2023 to $41.35 billion in 2024 at a compound annual growth rate (CAGR) of 7.3%. The growth in the historic period can be attributed to smoking epidemic, allergic disorders, pharmaceutical innovation, aging population.

The respiratory inhaler devices market size is expected to see strong growth in the next few years. It will grow to $54.72 billion in 2028 at a compound annual growth rate (CAGR) of 7.3%. The growth in the forecast period can be attributed to air quality concerns, digital health integration, regulatory emphasis on inhaler safety, personalized treatment. Major trends in the forecast period include inhaler device miniaturization, sustainability and eco-friendly inhalers, home-based care, technological advancements.

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Market Segmentation:

The main products of respiratory inhaler devices are dry powder inhalers, metered dose inhalers and nebulizers. Dry powder inhalers (DPIs) are medical devices that deliver powdered medications directly to the lungs for respiratory conditions. The technologies involved include manually operated inhaler devices and digitally operated inhaler devices for the treatment of asthma, chronic obstructive pulmonary disease, pulmonary arterial hypertension and others. The end user are hospitals and clinics, respiratory care centers and others.

Major Driver - Rising Prevalence Of Respiratory Diseases Drives Growth Of Respiratory Inhaler Devices Market

The growing prevalence of respiratory diseases is expected to propel the growth of the respiratory inhaler devices market going forward. Respiratory diseases are disorders that affect the lungs and the respiratory system, leading to breathing difficulties and impaired lung function. Respiratory inhaler devices are used to deliver medications directly to the lungs, providing fast and targeted relief for respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), respiratory syncytial virus infection and other respiratory conditions. For instance, in March 2023, according to the Centers for Disease Control and Prevention, a US-based national public health organization, in the United States, 8,300 tuberculosis (TB) cases were reported in 2022, a rise from 7,874 cases in 2021. Therefore, the growing prevalence of respiratory diseases propels the growth of the respiratory inhaler devices market.

Competitive Landscape:

Major players in the respiratory inhaler devices market are Merck & Co. Inc., Novartis AG, AstraZeneca PLC, Gerresheimer AG, GlaxoSmithKline PLC, 3M, Boehringer Ingelheim International GmbH, Koninklijke Philips N.V., Viatris Inc., Teva Pharmaceutical Industries Ltd., Catalent Inc., Perrigo Company PLC, AptarGroup Inc., Recipharm AB, Chiesi Farmaceutici S.p.A., Cipla Limited, Hikma Pharmaceuticals PLC, Zydus Lifesciences Limited, Lupin Limited, Glenmark Pharmaceuticals Ltd., Orion Corporation, Sumitomo Pharma America Inc., Beximco Pharmaceuticals Ltd., Hovione Limited, Vectura Group Limited, H&T Presspart Manufacturing Ltd., Pari Medical Holding GmbH, OMRON Healthcare Europe B.V., Medisol Lifescience Pvt. Ltd., Consort Medical plc.

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Top Trend - Adoption Of Advanced Metered Dosage Inhaler (MDI) Technology By Market Leaders To Enhance Respiratory Inhaler Devices

Major companies operating in the respiratory inhaler devices market are adopting new technologies, such as metered dosage inhalers, to sustain their position in the market. A metered dosage inhaler (MDI) is a portable aerosol device that delivers a precise dose of medication to the lungs in the form of a mist or inhaled spray. For instance, in February 2022, AptarGroup Inc., a US-based consumer dispensing packaging and drug delivery device manufacturer, launched HeroTracker Sense. This advanced digital respiratory health solution converts a conventional metered dosage inhaler (pMDI) into a smart, connected medical apparatus. HeroTracker Sense is made to track patients' use of MDIs and facilitate better adherence to their recommended therapy to improve the lives of patients worldwide who suffer from chronic respiratory diseases like asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis and other respiratory conditions brought on by COVID-19. HeroTracker Sense provides valuable analytics and insights into patient training, onboarding and performance to healthcare providers (HCPs) through the Aptar Pharma Cohero Health BreatheSmart Connect portal.

The Table Of Content For The Market Report Include:

1. Executive Summary

2. Respiratory Inhaler Devices Market Characteristics

3. Respiratory Inhaler Devices Market Trends And Strategies

4. Respiratory Inhaler Devices Market - Macro Economic Scenario

5. Respiratory Inhaler Devices Market Size And Growth

…..

27. Respiratory Inhaler Devices Market Competitor Landscape And Company Profiles

28. Key Mergers And Acquisitions

29. Future Outlook and Potential Analysis

30. Appendix

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Key chronic obstructive pulmonary disease (COPD) treatment market players include GlaxoSmithKline plc, AstraZeneca plc, Boehringer Ingelheim International GmbH, Novartis International AG, Teva Pharmaceutical Industries Ltd., Mylan N.V. Merck 7 Co., Inc., Sunovion Pharmaceuticals Inc., Chiesi Farmaceutici S.p.A. and Circassia Pharmaceuticals plc,

New York, Feb. 29, 2024 (GLOBE NEWSWIRE) -- The global chronic obstructive pulmonary disease (COPD) treatment market size is estimated to attain at ~9% CAGR from 2024 to 2036. The market is expected to garner a revenue of USD 22 billion by the end of 2036, up from a revenue of ~USD 10 billion in the year 2023.The advancements in inhalation therapies are evaluated to drive the market size. The recent advancements in the respiratory therapy sector include the invention of inhaled corticosteroids and biologics and the development of new delivery systems such as breath-activated[MK1]  inhalers. Apart from this, AstraZeneca is working on HFO 1234ze pMDI[MK2]  (pressurized metered dose inhalers) which is in phase I clinical trial.

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Additionally, technological improvements in the development of user-friendly inhalation devices are likely to have a positive impact on the market size. The integration of a feedback mechanism in these devices ensures to administration of their medication at the right dose. The dry powder inhalers that provide feedback with the dose counter include Novolizer, Genuair, and NEXThaler[MK3]  through visual and voice signals to confirm the inhalation dose.

Government Support in Creating Awareness and Taking Actions is Driving the Growth of the Chronic Obstructive Pulmonary Disease (COPD) Market

The government's support in starting initiatives and awareness programs to promote health education regarding respiratory diseases is fueling the market size. The program is aimed to promote early diagnosis and enhance patient outcomes. Cancer Research UK developed the Improving Early Diagnosis of Cancer ‘Waterfall’ infographic to promote early diagnosis in England with an ambition to achieve a diagnosis[MK4]  of over 70% of cancer patients at stage I or II by the end of 2028.

Chronic Obstructive Pulmonary Disease (COPD) Treatment Market: Regional Overview

Investment in the COPD Research and Development by the Government is Strengthening the Market Growth in Asia Pacific Region

The chronic obstructive pulmonary disease (COPD) treatment market in the Asia Pacific region is anticipated to hold the largest revenue share of 39% by the end of 2036. The government investment in the research and development activities of COPD in the region to advance the treatment methods is fostering the market size. Also, the rising healthcare expenditure and prevalence of COPD are intensifying the market growth. The incidence of COPD in India was around 5% among[MK5]  adults as of 2023.

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Increasing Incidence of COPD Cases and Use of Tobacco is Propelling the Market Expansion in North America Region

The North American region market of chronic obstructive pulmonary disease (COPD) is estimated to garner the second largest market share in the coming years owing to the prevalence of COPD cases in the region. Further, the increasing number of tobacco consumers and the presence of air pollutants in the environment are drastically raising the COPD incidents in the region thereby boosting the market growth. As of 2021 reports, more than 45 million adults in the U.S. use[MK6]  tobacco or any other product.

Chronic Obstructive Pulmonary Disease (COPD) Treatment , Segmentation by Type

  • Bronchodilators

  • Antibiotics

The antibiotics segment of the chronic obstructive pulmonary disease (COPD) treatment market is projected to gain a significant revenue share of 60% during the forecast period. The market segment growth is attributed to the recognition of antibiotics application in the case of chronic obstructive pulmonary disease (COPD) by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD suggests that antibiotics for the exacerbations related to bacterial infections. Antibiotic usage in patients with stable COPD is observed to reduce exacerbation odds[MK7]  by over 40% as of 2023 reports.

Chronic Obstructive Pulmonary Disease (COPD) Treatment, Segmentation by End-User

  • Hospitals

  • Homecare

  • Research Institutes

The chronic obstructive pulmonary disease (COPD) treatment market from the hospitals segment is predicted to secure a noteworthy market share in the year 2036. The market segment growth is credited to the conducive environment of the hospitals that provide comprehensive COPD care such as rehabilitation programs and multidisciplinary care teams. The high incidence of COPD and the difficulty in management along with the requirement for special care in serious cases is propelling the market demand.  The percentage of COPD and asthma admissions in the hospital according to the ICD codes rose from 8o% i.e., 210,500 in[MK8]  1999 to 384,000 in 2020, and from 60% hospital admission rate with 400 in 1999 to 642 in 2020 for every 100,000 people across the world.

A few of the well-known industry leaders in the chronic obstructive pulmonary disease (COPD) treatment market that are profiled by Research Nester are GlaxoSmithKline plc, AstraZeneca plc, Boehringer Ingelheim International GmbH, Novartis International AG, Teva Pharmaceutical Industries Ltd., Mylan N.V. Merck 7 Co., Inc., Sunovion Pharmaceuticals Inc., Chiesi Farmaceutici S.p.A. Circassia Pharmaceuticals plc and others.

Recent Development in the Market

  • AstraZeneca declared the owing of Caelum Biosciences, a US biotech company developing new medicines for chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). The acquisition adds to the strength of AstraZeneca in the respiratory franchise and expands its pipeline with promising late-stage assets.

  • AstraZeneca and Merck revealed a partnership for a Phase 3 clinical trial evaluation done on Lynparza (olaparib), targeted therapy for metastatic pancreatic cancer patients with the combination of gemcitabine and nab-paclitaxel. The collaboration aids in extending the treatment options for this cancer with limited therapeutic options.

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By Eve Glazier, M.D., and Elizabeth Ko, M.D.

Andrews McMeel Syndication

Dear Doctors: I work in a big shop where we make custom furniture. My wife thinks it puts me at risk of COPD and insists I should use a mask. Is she right? I thought COPD was something that happens to smokers. Plus, wearing a mask isn’t very comfortable.

Dear Reader: COPD is short for chronic obstructive pulmonary disease. It’s an umbrella term for a group of diseases in which damage to the tissues of the lungs, along with inflammation, obstruct the airways and make breathing difficult.

Symptoms include shortness of breath, a persistent cough, difficulty taking a deep breath, wheezing, excess mucus and a feeling of tightness in the lungs and chest. Because the airways of someone with COPD are obstructed, they can’t get enough oxygen. This causes an oxygen deficit in tissues throughout the body, which results in weakness, fatigue and a loss of stamina.

The two most common conditions associated with COPD are chronic bronchitis and emphysema. In chronic bronchitis, the lining of the bronchial tubes, which carry air to and from the tiny air sacs of the lungs, become inflamed. This causes excess mucus production and a chronic cough. It also puts the person at increased risk of having repeated respiratory infections. In emphysema, those tiny air sacs, known as alveoli, become permanently damaged. This leads to the oxygen deficit and resulting fatigue and breathing difficulties that we discussed earlier.

Smoking is a primary cause of COPD; The condition develops in response to repeated and long-term exposure to irritating gases and fine particulates, both of which smoking delivers in abundance. however, COPD can be an industrial hazard as well. People who work in occupations as varied as construction, mining, agriculture, welding, brick laying, stonemasonry, textiles, painting, and hair and nail care can all be at risk. When workers in these professions are also smokers, their chance of developing COPD goes up.

Occupational health data show that your own work in a carpentry shop, which exposes you to an environment that is not kind to the lungs, does put you at risk of developing COPD. The act of cutting, carving and sanding wood creates fine, airborne particulates that can damage the lungs and impair their ability to function. So can the fumes and gases emitted by the paints, stains, shellacs and solvents typically used in making furniture.

Even in a well-ventilated shop, particulates and gases will remain in the air. Long-term exposure to these can irritate, inflame and even damage delicate lung tissues, which can eventually lead to COPD.

COPD is a progressive disease. That means it gets worse with the passage of time. Although there is no known cure, it can be managed with medications and changes to behavior. Fortunately, you can significantly lower your own risk of developing this condition with one easy step: Always wear a high-quality, well-fitted mask while at work. It may be a bit uncomfortable, but to protect your lungs, it’s a small price to pay.

Send your questions to [email protected].

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Transparency Market Research

Transparency Market Research

The increasing prevalence of asthma and COPD, and increasing demand for effective nebulizer inhalation tools drive market demand.

Wilmington, Delaware, United States, Feb. 29, 2024 (GLOBE NEWSWIRE) -- Transparency Market Research Inc. - The global soft mist inhalers market is projected to grow at a CAGR of 6.8% from 2022 to 2031. As per the report published by TMR, a valuation of US$ 4.4 billion is anticipated for the market in 2031. As of 2023, the demand for soft mist inhalers is expected to close at US$ 2.5 billion.

With an increasing incidence of respiratory conditions such as asthma, COPD (Chronic Obstructive Pulmonary Disease), and bronchitis globally, there's a growing demand for effective inhalation therapy, thus boosting the market for soft mist inhalers.

Many patients prefer inhalation therapy over traditional oral medications due to its convenience, faster onset of action, and targeted delivery to the lungs. Soft mist inhalers offer a user-friendly alternative, further fueling market growth.

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The global aging population is prone to respiratory ailments, which is driving the demand for respiratory care devices, including soft mist inhalers. As the elderly population grows, so does the market for respiratory devices, creating opportunities for market expansion.

Rising awareness about respiratory diseases and the importance of effective management, coupled with increased healthcare expenditure, particularly in emerging markets, is boosting the adoption of soft mist inhalers. Governments and healthcare organizations are also focusing on promoting inhalation therapy, further propelling market growth.

Soft mist inhalers are increasingly being used for a wide range of indications beyond asthma and COPD, including cystic fibrosis, pulmonary hypertension, and respiratory infections. This expansion of indications broadens the market base and drives demand for soft mist inhalers.

Key Takeaways from the Market Study

  • As of 2022, the soft mist inhalers market was valued at US$ 2.4 billion.

  • In terms of type, the reusable inhalers segment held a prominent share of the global soft mist inhalers market in 2021.

Soft Mist Inhalers Market: Key Trends and Opportunistic Frontiers

  • The rising incidence of respiratory conditions such as asthma, COPD, and bronchitis is driving demand for soft mist inhalers as effective treatment options.

  • Growing emphasis on patient-centered care in respiratory medicine, leading to increased adoption of soft mist inhalers due to their ease of use, improved compliance, and better patient outcomes.

  • Soft mist inhalers are being explored for a wider range of respiratory conditions beyond asthma and COPD, such as cystic fibrosis and respiratory infections, expanding the market potential.

  • Ongoing innovations in soft mist inhaler technology, including improvements in dose accuracy, breath-actuation synchronization, and portability, are enhancing patient convenience and driving market growth.

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Soft Mist Inhalers Market: Regional Analysis

  • North America dominates the soft mist inhalers market due to the high prevalence of respiratory diseases, well-established healthcare infrastructure, and favorable reimbursement policies. Additionally, the presence of key market players and ongoing technological advancements further bolster market growth in this region.

  • The Asia Pacific region is witnessing rapid growth in the soft mist inhalers market, propelled by factors such as the growing prevalence of respiratory disorders, rising healthcare awareness, and improving access to healthcare services. Increasing disposable income levels and expanding healthcare infrastructure also play a crucial role in driving market growth in countries like China, India, and Japan.

Competitive Landscape

The soft mist inhalers market is characterized by its fragmented nature, hosting numerous players vying for market dominance. These companies are strategically prioritizing investments in research and development as well as forging collaborations to bolster their market presence and enhance their competitive edge.

Key Players Profiled

Key Developments in the Market

  • Merxin Ltd. introduced MRX004 represents a soft mist inhaler device designed to offer an interchangeable AB rated opportunity for tiotropium/olodaterol, formulated similarly to the Respimat.
    MRX004 is versatile, serving as a soft mist inhaler suitable for various applications, including delivering new molecules to the lungs, repurposing existing ones, managing product life cycles, and reformulating compounds from nebulizers or pMDI/DPI devices.

  • In January 2024 - Recipharm, a prominent contract development and manufacturing organization (CDMO), is excited to unveil an exclusive license and collaboration agreement with Medspray and Resyca. Together, they will focus on the development of soft mist nasal delivery devices intended for both single and combination drug products.

Soft Mist Inhalers Market – Key Segments

Type

Application

Age Group

End User

  • Hospitals

  • Clinics

  • Others (Home Care, etc.)

Region

  • North America

  • Latin America

  • Europe

  • Asia Pacific

  • Middle East & Africa

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Olympus Canada Inc. (OCI) has broadened its healthcare offerings by introducing the Spiration Valve System (SVS) to treat severe emphysema, marking a pivotal advancement in respiratory care. This innovative technology, previously utilized for addressing prolonged air leaks, now offers hope to Canadians suffering from severe emphysema, a form of chronic obstructive pulmonary disease (COPD) characterized by damaged lung air sacs. The device aims to improve lung function and quality of life by redirecting airflow within the lungs.

Expanding Treatment Horizons

The availability of the Spiration Valve System in Canada signifies a major step forward in the treatment of severe emphysema. By placing the umbrella-shaped device in the most diseased parts of the lung through a minimally invasive procedure, the treatment focuses on enhancing lung efficiency and patient comfort. Supported by the EMPROVE trial, which demonstrated sustained clinical benefits over 24 months, the SVS stands as the only endobronchial valve treatment available in Canada for this condition.

Rising COPD Hospital Admissions

Amidst an escalating number of COPD hospital admissions in Canada, which have surged over 68% from 2002 to 2017, the introduction of the SVS comes at a critical time. Contributing factors to this increase include air pollution, wildfire smoke, and stable smoking rates. These statistics highlight the urgent need for effective treatments like the Spiration Valve System. With COPD affecting a significant portion of the younger adult population (ages 40-64), the potential for SVS to mitigate hospital admissions and improve patient outcomes is substantial.

Potential Risks and Benefits

While the SVS presents a promising treatment option for severe emphysema, potential risks such as pneumothorax, worsening COPD symptoms, pneumonia, and dyspnea have been identified. Patients considering this treatment should consult with healthcare professionals to weigh the benefits against possible complications. Olympus Canada's commitment to enhancing respiratory care through innovative solutions like the Spiration Valve System offers new hope to those battling severe emphysema, aiming to improve their quality of life significantly.

The deployment of the Spiration Valve System in Canada not only showcases Olympus Canada's dedication to advancing medical technology but also represents a beacon of hope for severe emphysema sufferers. As the healthcare landscape continues to evolve, the introduction of such groundbreaking treatments underscores the importance of innovation in addressing complex health challenges, ultimately paving the way for better patient outcomes and a healthier future.



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Introduction

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that can be prevented and treated. It primarily involves various airway and/or alveolar abnormalities caused by excessive exposure to the toxic particles or gases, and can result in persistent and progressively worsening chronic respiratory symptoms and airflow limitations.1 It is estimated that COPD would become the fourth leading cause of premature death by 2040.2 Meanwhile, COPD is ranked as sixth leading cause of all-age mortality and years of life loss (YLLs) by 2019, and its rank was proportional to the age.3

The enormous financial burden of COPD is closely related to both itself and its multiple comorbidities.4 In 2011, the ‘comorbidities’ were included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and used for the comprehensive evaluation of COPD. In the 2023 GOLD guidelines, the concept of “heterogeneous lung condition” was proposed,1 emphasizing the diversity and individual differences in clinical manifestations of COPD patients. The reason for this is that various factors, such as hypoxia, oxidative stress (OS), systemic inflammation and other mechanisms, can lead to damage in multiple organs and tissues throughout the body. These include the cardiovascular, endocrine, hematological, locomotor, neuropsychiatric, and digestive system.5 The risk of comorbidities in COPD patients is also elevated by factors such as smoking history and advanced age.6 In addition, several extrapulmonary comorbidities of COPD have been found to considerably increase the risk of acute exacerbation, complicate the treatment, and impose a heavy medical burden on COPD patients.4,7

Therefore, a comprehensive understanding and early diagnosis of comorbidities are extremely important to optimize the treatment and prognosis of COPD. This review summarizes recent advances in the study of such above extrapulmonary comorbidities in COPD.

Method

We conducted a comprehensive search on Medline/PubMed and China national knowledge infrastructure (CNKI) up to December 2023 to identify studies relevant to this review. The combination of the following keywords was used as the potential search terms: “Comorbidities in COPD”, “Relationship”, “Prevalence”, “Risk factors”, “Treatment”, “Management”, “Survival and Quality of Life” and so on. In addition, the reference lists of the retrieved articles were further examined in order to determine their significance to the subject matter of this review.

COPD and Cardiovascular Diseases (CVD)

A meta-analysis of observational studies found that the probability of cardiovascular events was significantly increased in patients with COPD compared to patients without COPD [OR=2.46; 96% CI; 2.02–3.00; P<0.0001], and the risk of ischemic heart disease (IHD), cardiac dysrhythmia, heart failure, and arterial circulation diseases in COPD patients was two to five times higher than those in the non-COPD population.8

COPD and CVD have a significant overlap in risk factors, pathophysiological mechanisms, clinical characteristics, and symptoms, which in turn worsen the prognosis for individuals affected by both conditions.9,10 Although smoking is a common and significant risk factor for the two diseases mentioned above, an increasing number of studies have indicated that smoking is not the only link between COPD and CVD. Obesity, hypoxia, aging, lifestyle, and genetics may also be common risk factors.11 In addition, under the stimulation of different factors (eg, inflammation, hypoxia, and OS), in some COPD patients, cardiovascular damage may occur in the early stages.12 Here, hypoxia can induce stress responses in hemodynamics, leading to an increase in cardiac output index, leading to increased peripheral vascular contraction and OS.12 Furthermore, increased oxidative stress can further stimulate persistent systemic inflammation, which in turn can effectively alter the vascular structure.13 The systemic inflammatory response, in turn can significantly enhance cytokine activity, contributing to platelet aggregation and blood coagulation.14,15 Additionally, OS not only causes extensive damage to the airway epithelium, but can also adversely affect both the function and quantity of endothelial cells. The dysfunction of endothelial cells can disrupt the vascular homeostasis, while excessive endothelial cell apoptosis can effectively reduce their antioxidant, anti-inflammatory, and antithrombotic abilities.16 This series of reactions can significantly increase the possibility of cardiovascular events.

Clinically, patients with COPD and CVD may sometimes experience exertional dyspnea, and both can increase the patient’s fatigue, which can further limit their physical activity and continuously reduce their activity tolerance. Patients with both diseases develop severe symptoms. The most important drugs for COPD currently include bronchodilators (eg, β receptor agonists, anti-cholinergic drugs, and theophyllines), corticosteroids, and other symptomatic therapeutic drugs.4 It is important to emphasize that recent studies have indicated that the use of dual long-acting bronchodilators can significantly increase the risk of cardiovascular events.17 However, in the treatment of cardiovascular complications, treatment with β receptor agonist appears to violate the principles of COPD therapy. Interestingly, studies have reported that selective cardiac β receptor agonists exhibit more significant benefits than potential risks in mild to moderate reversible respiratory diseases or coronary artery disease with COPD.18,19 However, its use in COPD patients combined with heart failure remains controversial.20 Meanwhile, statins have shown numerous benefits such as antioxidant, anti-inflammatory, antithrombotic, and immunomodulatory properties.21 These effects prove effective in managing inflammation, reducing the severity of COPD, and lowering CVD-related mortality,22,23 in addition to reducing the risk of pulmonary hypertension.24 However, some studies have demonstrated that the beneficial effects of statins may depend on the patient’s age and corticosteroid use.25 Additionally, antiplatelet agents can significantly reduce the risk of ischemic events in patients with COPD.26 These agents can also contribute to delaying the progression of emphysema,27 improving dyspnea and quality of life in patients.28 Furthermore, angiotensin-converting enzyme inhibitor (ACEI) / angiotensin receptor block (ARB) have also been proposed to display a beneficial effect on the risk of cardiovascular events. These drugs may also potentially delay the progression of emphysema while improving the lung function,29,30 with dual cardiorespiratory protective properties. In addition, the imbalance between protease and antiproteinase is also a major pathogenic mechanism of COPD and CVD. Matrix metalloproteinases (MMPs) play an important role and antiproteinase inhibitors are expected to be employed as novel therapeutic targets.15 Although some MMP inhibitors were found to be safe in cancer trials, their success rate is relatively limited.31 Therefore, large-scale prospective studies are still needed to further evaluate the safety and effectiveness of MMP inhibitors in COPD patients affected with CVD. It is noteworthy that numerous studies have demonstrated that both COPD and CVD share common mechanisms such as oxidative stress and systemic inflammation. This suggests that antioxidant therapy could provide a novel and effective therapeutic direction for the treatment of COPD and its associated cardiovascular diseases. However, further extensive prospective studies are required to validate this potential therapeutic direction.

COPD and Endocrine Diseases

According to statistics, up to 40% of COPD cases are associated with one or more diseases related to metabolic syndrome (MetS), with diabetes being the most common.32,33 COPD is also regarded as a common comorbidity of diabetes, and they mutually increase the risk of disease and unfavorable prognostic factors.34,35 It is worth indicating that the severity of diabetes has been strongly related to the deterioration of lung function, which could be related to the limited activity and the reduced quality of life of COPD patients.36,37 In contrast, hyper glycaemia can also cause a decline in lung function and physical performance.38 For instance, in a 30-year follow-up study involving more than 27,000 non-smokers, low FEV1 was found to precede diabetes and has a significant predictive effect on diabetes incidence.39 Multiple shared risk factors and pathological changes play a vital role in their cooccurrence and interaction, including smoking, obesity, age, hypoxia, oxidative stress, inflammation, and so on.34

A sustained systemic inflammatory response and OS are considered as major factors in the progression of these two diseases.33 The inflammation of airways can cause harm to pancreatic beta cells and obstruct the signaling pathway of insulin, resulting in insulin resistance.40,41 At the same time, the hyperglycemic state can lead to inflammation and oxidative stress, resulting in damage to the pulmonary blood vessels.42 Additionally, the damage to the endothelial cells in the pulmonary blood vessels can lead to connective tissue proliferation and subsequently reduce pulmonary compliance.43 In addition, the advanced glycation end products (AGEs) associated with hyper glycaemia can trigger inflammation and attenuate alveolar retraction, thus exacerbating the patient’s ventilatory deficits.44 At the same time, diabetic autonomic neuropathy can also dysregulate airway diastolic function.45 Additionally, hypoxia has the potential to impact glucose metabolism and insulin sensitivity,29 leading to an increased risk of excessive oxidation and oxidative stress. Furthermore, it can disrupt the defense provided by antioxidants as well as antiproteases, and evolve into a potential risk factor for diabetes mellitus.33 Interestingly, although corticosteroids can also increase the risk of diabetes.46 For instance, corticosteroids, which are commonly used in COPD patients, some studies have reported that the risk of diabetes was only significantly increased upon treatment with high-doses of corticosteroids.47,48 However, other studies have suggested that the combined use of inhaled corticosteroids (ICS) and statins could increase the risk of developing new-onset diabetes.49 Therefore, more long-term observational studies and randomized controlled trials should be conducted in the future to assess the potential safety of drug combinations.

For the treatment of COPD cases combined with diabetes, blood sugar control is essential, as it has been linked to immune dysfunction.50 Recently, the hypoglycemic drug metformin has received significant attention because of its properties of anti-inflammatory and antioxidant. It effectively improves lung outcomes by reducing the production of pro-inflammatory factors through the activation of AMP-activated protein kinase (AMPK).51 Furthermore, it promotes the breakdown of inflammatory mediators by stimulating autophagy,52 with a primary focus on inhibiting the nuclear factor of kappa B (NF-κB) pathway, which is considered to play a crucial role in promoting inflammation.53,54 In addition, metformin can also attenuate oxidative stress-induced cytotoxicity and inhibit the inflammatory response in macrophages through an AMPK-dependent pathway.55 However, the use of metformin still remains controversial. Several large-scale cohort studies have demonstrated that metformin can significantly reduce the risk of exacerbation and all-cause mortality in COPD patients.56,57 However, another retrospective cohort study suggested that metformin failed to improve the blood glucose elevation caused by COPD in non-diabetic patients.58 Hence, additional clinical trials of metformin with stronger evidence are needed to validate its effectiveness in delaying progression. Among other oral hypoglycemic agents, thiazolidinedione drugs and dipeptidyl peptidase-4 (DPP-4) inhibitors can substantially attenuate the inflammatory reactions while lowering blood sugar, thereby protecting the lung tissues.59,60 Sulfonylureas can reduce risk of acute exacerbation of COPD, bacterial pneumonia and cardiovascular events.61 However, recently, there has been growing attention on glucagon-like peptide 1 (GLP-1) receptor agonist and sodium-glucose cotransporter 2 (SGLT-2) inhibitor. Research suggests that GLP-1 receptor agonists can enhance airway function and reduce the risk of exacerbation of COPD.62,63 Additionally, SGLT-2 inhibitors have shown a reduced risk of exacerbating obstructive airway disease when compared to DPP-4 inhibitors.64 In addition to medication, reducing sedentary time, increasing exercise, and implementing individual nutritional interventions can also effectively improve the quality of life and prognosis of COPD patients with diabetes.

COPD and Hematological Diseases

A number of previous studies have shown that high incidence of hypoxia in COPD patients could lead to a compensatory increase in erythropoietin (EPO), leading to secondary hyperhemoglobinemia. However, recent studies in China and abroad suggest that anemia was also one of the comorbidities of COPD and its incidence rate was even higher than that of hyperhemoglobinemia.65,66 It was found that compared to hyperhemoglobinemia, anemia has a greater impact on the disease severity and quality of life in COPD patients.67,68 As shown in a 9-year multicenter clinical study in Korea, anemia (WHO criteria) can serve as an independent risk factor for mortality in COPD.69 In addition, it has been observed that COPD patients affected with anemia had a higher comorbidity burden, especially CVD and MetS,70 which further increased their disease burden and risk of death.

Currently, COPD combined with anemia is considered to belong to the anemia of chronic disease (ACD), commonly known as “inflammatory anemia”, which is essentially an immune- driven inflammatory response.71,72 Prolonged chronic inflammation in COPD patients can significantly weaken the proliferative stimulation response of EPO and shorten the lifespan of red blood cells.73 In addition, some inflammatory factors can directly inhibit hypoxia-induced activation of EPO, which leads to an increase in OS. These factors also interfere with EPO receptor-mediated signaling pathways, thus inhibiting the production of EPO.74 During chronic inflammation, phagocytes have been found to inhibit inflammation by depleting iron and affect iron metabolism as well as transport. This is primarily caused by high levels of hepcidin, leading to iron deficiency in the body, which evolves into iron deficiency anemia (IDA).75,76 Thus, iron deficiency can affect lung function and disease progression in COPD,77,78 forming a vicious circle. Furthermore, since COPD is a chronic wasting disease with malnutrition, there may be a deficiency of hematopoietic raw materials,79 resulting in a decrease in red blood cells.

Hemoglobin can transport oxygen to the various tissues and organs. However, the decrease in hemoglobin in anemia patients leads to a reduction in oxygen supply capacity. Although the blood oxygen partial pressure is sometimes within the normal range, the patient may still be in a state of hypoxia. Therefore, patients with anemia are more likely to develop symptoms such as dyspnea, affecting the motor ability and quality of life.67 Therefore, it is important to actively improve the hemoglobin level. For clinical improvement of anemia, we generally choose direct blood transfusions, EPO injections, and supplementation with hematopoietic raw materials. However, it has been suggested that patients with COPD combined with anemia are resistant to EPO due to the inhibitory effect of inflammatory factors on erythroid progenitor cells.80 Furthermore, although iron supplementation has been found to be effective in reducing the levels of OS in COPD patients, recent studies have further shown that iron therapy could affect the composition of the microbiota as well as the distribution of fecal metabolites, to a certain extent, which has a potentially detrimental effect on the patients.81,82 It is worth noting that intravenous iron supplementation can be effective in increasing hemoglobin levels while reducing gastrointestinal adverse effects compared to oral iron supplementation. This is particularly significant as inflammation can impair iron absorption in the gut.83 In addition, the supplementation of essential nutrients like vitamins and amino acids plays a pivotal role in facilitating the production of hemoglobin and erythropoiesis, underscoring their potential importance. Vitamin C is recognized as a powerful antioxidant, while vitamin D has the potential to exhibit anti-inflammatory effects.84,85 Although it is currently unclear whether the effectiveness of treating the inflammation response is more effective in the primary disease. There are novel treatment strategies available related to the iron regulatory pathway and hypoxia-inducible factor stabilizers for inflammatory anemia, but their efficacy needs to be further evaluated in clinical trials.76

COPD and Locomotor System Diseases

Skeletal muscle dysfunction and osteoporosis are locomotor system comorbidities found in COPD, and the risk of incidence is 1.9 times higher than in normal individuals.86 The incidence of reduced muscle mass in COPD patients is about 15.5%-34%,87 and it is approximately 38.5% in patients affected with osteoporosis.88 Osteoporosis is a systemic metabolic bone disease characterized by a decrease in bone mass and structural deterioration of bone tissue, leading to an increase in bone fragility and the risk of fractures.89 In contrast, osteoporosis is mostly asymptomatic in COPD patients and is typically only detected when a fracture takes place. Therefore, special attention should be paid to the early identification of high-risk patients with COPD combined with osteoporosis.

It has been found that most pathogenic factors can simultaneously affect muscle strength and bone strength in COPD patients. In addition to the patient’s low body mass index, malnutrition and decreased exercise tolerance, systemic inflammatory responses, OS, hypoxia, intake of hormone drugs and vitamin D deficiency are all considered as potential risk factors, increasing bone loss and even leading to fragility fractures.90,91 Furthermore, fractures associated with osteoporosis could further increase the poor prognosis of COPD due to lack of exercise and prolonged bed rest, such as deterioration of the lung function, poor quality of life, as well as increased hospitalization and mortality rates.92 This can potentially create a vicious cycle of these two diseases and places a heavy burden on patients. Under the normal circumstances, bone resorption by osteoclasts and bone formation by osteoblasts alternate in bone tissues to maintain the balance of bone mass.93 However, both the hypoxic state and systemic inflammation in COPD patients could effectively stimulate the proliferation and differentiation of osteoclasts, thus affecting the bone metabolism.94,95 In addition, in patients who smoke, nicotine not only stimulates osteoclast activity, but also triggers apoptosis in osteoblasts, thereby further contributing to osteoporosis.96,97 It is important not to overlook that COPD patients may suffer from deficiency of Vitamin D due to limited activity, reduced sunlight exposure, malnutrition, and the promotion of Vitamin D metabolism by corticosteroids. This deficiency can potentially lead to bone loss as a result of the inability to maintain calcium homeostasis.98

In terms of pharmacological treatment, corticosteroid is an effective treatment for COPD, however, the potential development of secondary osteoporosis due to prolonged usage should not be ignored.99 Although oral administration has been reported to cause apoptosis of bone cells and loss of bone strength,100 there is still controversy regarding the impact of inhaled corticosteroids (ICS) on bone strength.91,101 Currently, the GOLD does not explicitly state that using ICS could lead to significant negative impacts associated with osteoporosis. However, numerous studies have indicated that the use of ICS raises the risk of osteoporosis regardless of the duration of exposure.102 In general, except in patients with COPD in the acute exacerbation stage, systemic application of corticosteroids should be avoided to reduce the risk of bone related adverse effects. In the treatment of osteoporosis, bisphosphonates have been shown to be effective in the treatment of hormone-related bone loss, and are usually combined with calcium and vitamin D.103 In addition, some novel drugs, including denosumab and teriparatide, have been found to have more potent effects in improving the bone density, preventing fractures, and have higher safety.104–106 Hence, these are expected to become a first-line medication for the treatment of osteoporosis-related corticosteroids.107 It has also been suggested that romosozumab, a sclerostin inhibitor that both induces bone formation and inhibits bone resorption, could possibly reduce the risk of fracture to a greater extent in comparison to alendronate.108 Additionally, the use of some antioxidants is considered as a new potential therapeutic direction to prevent and reduce the negative effects of OS on bone remodeling and osteoblastic cells.109 However, additional research is necessary in order to thoroughly investigate the potential risks associated with them.

COPD and Mental Disorders

The combined nervous system diseases associated with COPD mainly include emotional disorders, cognitive impairments, pulmonary encephalopathy and consciousness disorders. Emotional disorders (eg, anxiety and depression) are the most common and easily misdiagnosed. Interestingly, a systematic retrospective study found that the incidence of COPD patients developing emotional disorders was approximately three times higher in comparison to the control group.110 However, the incidence of COPD combined with anxiety and depression has been shown to be between 19.5% −50% in China, and the incidence varies between different studies due to various factors, such as sample size, diagnostic tools, and disease severity.111,112

Patients with COPD often find themselves in a vicious cycle of “dyspnea- decreased activity- increased mental symptoms - dyspnea exacerbation”.113 However, a variety of factors such as behavior, societal influence, and the illness itself contribute to the development of anxiety and depression. In addition, COPD patients suffer from recurrent illness and reduced social engagement that perpetuates anxiety/depression, which in turn can increase the risk of acute exacerbation of COPD. In addition, to the emotional disorders caused by reduced social participation primarily induced by the degradation of body function, this phenomenon could also be related to the influences of hypoxemia and hypercapnia on areas of the brain areas involved in regulation of both ventilation and defensive behaviors.114,115 For chronic smokers, long-term inhalation of nicotine stimulates the body’s inflammatory response and can cause damage to the glial cells. Consequently, this leads to brain damage and the development of mood disorders,116 and potential impact of cigarette smoke on the regulation of neurohormonal secretion rhythms can also contribute to mood disorders in patients.117 Moreover, the chronic inflammatory response in COPD can also have a direct impact on the central nervous system, including an increase in negative emotions.118 In addition, imbalance of inflammatory factors can also increase risk of mood disorders in COPD patients119. Recently, the potential relationship between imbalance in immune system response and emotional disorders has also been suggested.120 However, the relationship between COPD combined with emotional disorders and immunological mechanisms is complex, and further research is still needed for more in-depth exploration.

COPD catalyzes the development of emotional disorders, and emotional disorders can influence both the occurrence and development of COPD. Therefore, early intervention should be carried out in patients with COPD, focusing on the impact of psychological changes on the development and prognosis of the physical diseases. Currently, the main treatment includes pharmacological therapy and non-pharmacological therapy, while non-pharmacological therapy also includes various treatment methods, such as comprehensive pulmonary rehabilitation therapy, psychological therapy and collaborative nursing mode.121 Although pulmonary rehabilitation is known to improve mood and provide several other benefits to COPD patients, studies have found that it has inconsistent rates of continuation and completion, with only half of participants continuing in a rehabilitation center and merely 30% completing the full duration of their treatment.122 Therefore, it is imperative to conduct further studies on pulmonary rehabilitation programs aimed at providing adequate support and ensuring participants’ successful completion. Additionally, it is crucial to discover viable alternative interventions for patients who are unable to participate in routine pulmonary rehabilitation. It is worth noticing that there could be potential interactions between drugs for COPD and those for anxiety/depression. Tricyclic antidepressants (TCA) may potentiate other adverse effects of beta-2 adrenergic agonists and anticholinergic bronchodilators, but tricyclic antidepressants are not considered absolutely contraindicated for use in patients with COPD because of the above mentioned interactions.123,124 Therefore, both the efficacy and safety of anxiolytic/depressant medications for the treatment of COPD-associated mood disorders still needs to be confirmed by more clinical trials. Additionally, considering the potential influence of inflammatory cytokines on depression, the emergence of cytokine modulators as a potential treatment for depression in individuals with chronic inflammation chronic inflammation125 should be explored. However, it is crucial to conduct more extensive randomized controlled trials with robust evidence to thoroughly assess this field. Overall, to minimize the adverse effects of emotional disorders and improve quality of life, comprehensive interventions including medication, psychology and rehabilitation are required.

COPD and Digestive System Diseases

Common digestive system comorbidities associated with COPD include gastroesophageal reflux, chronic gastritis, peptic ulcer, irritable bowel syndrome and inflammatory bowel disease. Among these, gastroesophageal reflux disease (GERD) is a common but frequently overlooked condition, which can markedly increase the frequency of acute exacerbation of COPD. This primarily results because of airway irritation and damage from reflux of acidic gastric contents, bronchoconstriction due to the cough reflex triggered by vagal stimulation, bacterial reflux and even bacterial colonization due to aspiration.126–128 Similarly, changes in chest pressure due to COPD may increase the risk of GERD. Additionally, recurrent coughing in COPD patients can also exacerbate reflux, and the use of receptor agonists commonly prescribed for COPD have a diastolic effect on the esophageal sphincter while dilating the bronchial tubes, potentially increasing the likelihood of the development of gastroesophageal reflux.129–131 Thus, GERD and COPD can interact with each other. However, there remains a lack of comprehensive knowledge regarding the exact causal relationship between them.

At present, there is a lack of sufficient information on the impact of anti-reflux therapy on COPD, and there is ongoing controversy regarding the appropriateness of using acid-inhibitory drugs, specifically proton pump inhibitors (PPIs). Several studies have indicated that PPI treatment could potentially exacerbate COPD,132 yet others have suggested that the risk of pneumonia was not increased by PPI treatment.133 In addition, some studies have demonstrated that acid-suppressing therapy could improve the scores of lung symptom,134 but paradoxically, the lung function of the majority of patients does not show significant improvement.135,136 In addition, use of azithromycin has been found to be noteworthy as it can promote cholinergic activity to accelerate gastric emptying.137 For the moment, the efficacy and safety of PPIs in patients with chronic obstructive pulmonary disease (COPD), as well as the relationship between increased gastric acidity and progression of COPD, still need to be studied on a larger scale.

Conclusions

COPD is usually accompanied by one or more comorbidities that interact with each other. Chronic inflammation, oxidative stress, hypoxia, and smoking serve as mutual links connecting COPD and comorbidities. Although the mechanisms remain elusive and the current guidelines recommend a management according to the principle of single-disease guideline-directed medical treatment,1 it’s appropriate to treat them as a whole (Figure 1).138 For almost every patient with COPD, the clinical reality is that the disease is a component of multimorbidity. Therefore, we need to find integrated multimorbidity management, considering both pharmacological and nonpharmacological strategies. It’s important for every clinician to realize that an effective patient-centered management approach is a more efficient treatment option. So, multi-disciplinary, multi-level, and effective research is necessary to thoroughly investigate and develop targeted treatment strategies that are more appropriate for COPD and its comorbidities. This strategy can provide strong theoretical support for the management and prevention of these conditions. Moreover, the clinicians should also improve their cognitive and diagnostic abilities in management of COPD-related comorbidities. They should develop personalized and effective diagnosis and treatment approaches for individual patients to optimize their clinical outcomes.

Figure 1 COPD and multimorbidity. This conceptual framework represents the most important change in disease concept since the Review139 by Decramer and Janssens on COPD and comorbidities was published in the first volume of The Lancet Respiratory Medicine, and demands a shift in the management paradigm from an approach that focuses on COPD as a single disease of the respiratory system with comorbidities, to one in which COPD is viewed as a component of multimorbidity. (A) Previously COPD was seen as a single disease. (B) COPD and different comorbidities have generally gained attention because of the progress in understanding, but they were still viewed separately. (C) Patients with COPD and comorbidities should be considered as suffering from a multimorbid state, which should be treated as a whole. COPD=chronic obstructive pulmonary disease. FVC=forced vital capacity.

Note: Reprinted from The Lancet Respiratory Medicine, 11/11, Leonardo M Fabbri, Bartolome R Celli, Alvar Agustí, Gerard J Criner, Mark T Dransfield, Miguel Divo, Jamuna K Krishnan, Lies Lahousse, Maria Montes de Oca, Sundeep S Salvi, Daiana Stolz, Lowie E G W Vanfleteren, Claus F Vogelmeier, COPD and multimorbidity: recognising and addressing a syndemic occurrence, 1020-1034, Copyright 2023, with permission from Elsevier.138

Acknowledgments

We thank all the reviewers who participated in the review, as well as MJE editor (www.mjeditor.com) for the linguistic editing and proof reading of the manuscript.

Disclosure

The authors declare that they have no conflicts of interest in this work.

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85. Fletcher J, Cooper SC, Ghosh S, et al. The role of vitamin D in inflammatory bowel disease: mechanism to management. Nutrients. 2019;11(5):1019. doi:10.3390/nu11051019

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87. Sepúlveda-Loyola W, Osadnik C, Phu S, et al. Diagnosis, prevalence, and clinical impact of sarcopenia in COPD: a systematic review and meta-analysis. J Cach Sarcop Muscle. 2020;11(5):1164–1176. doi:10.1002/jcsm.12600

88. Chen YW, Ramsook AH, Coxson HO, et al. Prevalence and risk factors for osteoporosis in individuals with COPD: a systematic review and meta-analysis. Chest. 2019;156(6):1092–1110. doi:10.1016/j.chest.2019.06.036

89. Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017;4(1):46–56. doi:10.5152/eurjrheum.2016.048

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94. Gorissen B, de Bruin A, Miranda-Bedate A, et al. Hypoxia negatively affects senescence in osteoclasts and delays osteoclastogenesis. J Cell Physiol. 2018;234(1):414–426. doi:10.1002/jcp.26511

95. Liang B, Feng Y. The association of low bone mineral density with systemic inflammation in clinically stable COPD. Endocrine. 2012;42(1):190–195. doi:10.1007/s12020-011-9583-x

96. Lu Y, Di YP, Chang M, et al. Cigarette smoke-associated inflammation impairs bone remodeling through NFκB activation. J Transl Med. 2021;19(1):163. doi:10.1186/s12967-021-02836-z

97. Marinucci L, Balloni S, Fettucciari K, et al. Nicotine induces apoptosis in human osteoblasts via a novel mechanism driven by H2O2 and entailing Glyoxalase 1-dependent MG-H1 accumulation leading to TG2-mediated NF-kB desensitization: implication for smokers-related osteoporosis. Free Radic Biol Med. 2018;117:6–17. doi:10.1016/j.freeradbiomed.2018.01.017

98. Kokturk N, Baha A, Oh YM, et al. Vitamin D deficiency: what does it mean for chronic obstructive pulmonary disease (COPD)? A compherensive review for pulmonologists. Clin Respir J. 2018;12(2):382–397. doi:10.1111/crj.12588

99. Compston J. Glucocorticoid-induced osteoporosis: an update. Endocrine. 2018;61(1):7–16. doi:10.1007/s12020-018-1588-2

100. Chotiyarnwong P, McCloskey EV. Pathogenesis of corticosteroids-induced osteoporosis and options for treatment. Nat Rev Endocrinol. 2020;16(8):437–447. doi:10.1038/s41574-020-0341-0

101. Gonçalves PA, Dos Santos Neves R, Neto LV, et al. Inhaled glucocorticoids are associated with vertebral fractures in COPD patients. J Bone Mineral Metab. 2018;36(4):454–461. doi:10.1007/s00774-017-0854-3

102. Chiu KL, Lee CC, Chen CY. Evaluating the association of osteoporosis with inhaled corticosteroid use in chronic obstructive pulmonary disease in Taiwan. Sci Rep. 2021;11(1):724. doi:10.1038/s41598-020-80815-y

103. Allen CS, Yeung JH, Vandermeer B, et al. Bisphosphonates for steroid-induced osteoporosis. Cochrane Database Syst Rev. 2016;10(10):CD001347. doi:10.1002/14651858.CD001347.pub2

104. Lewiecki EM. New and emerging concepts in the use of denosumab for the treatment of osteoporosis. Therapeutic Advan Musculosk Dis. 2018;10(11):209–223. doi:10.1177/1759720X18805759

105. Saag KG, Wagman RB, Geusens P, et al. Denosumab versus risedronate in corticosteroids-induced osteoporosis: a multicentre, randomised, double-blind, active-controlled, double-dummy, non-inferiority study. Lancet Diabetes Endocrinol. 2018;6(6):445–454. doi:10.1016/S2213-8587(18)30075-5

106. Ding L, Hu J, Wang D, et al. Efficacy and safety of first- and second-line drugs to prevent glucocorticoid-induced fractures. J Clin Endocrinol Metab. 2020;105(1):dgz023. doi:10.1210/clinem/dgz023

107. Yuan C, Liang Y, Zhu K, et al. Clinical efficacy of denosumab, teriparatide, and oral bisphosphonates in the prevention of corticosteroids-induced osteoporosis: a systematic review and meta-analysis. J Orthopaedic Surg Res. 2023;18(1):447. doi:10.1186/s13018-023-03920-4

108. Anagnostis P, Gkekas NK, Potoupnis M, et al. New therapeutic targets for osteoporosis. Maturitas. 2019;120:1–6. doi:10.1016/j.maturitas.2018.11.010

109. Marcucci G, Domazetovic V, Nediani C, et al. Oxidative stress and natural antioxidants in osteoporosis: novel preventive and therapeutic approaches. Antioxidants. 2023;12(2):373. doi:10.3390/antiox12020373

110. Zareifopoulos N, Bellou A, Spiropoulou A, et al. Prevalence, contribution to disease burden and management of comorbid depression and anxiety in chronic obstructive pulmonary disease: a narrative review. COPD. 2019;16(5–6):406–417. doi:10.1080/15412555.2019.1679102

111. Huang J, Bian Y, Zhao Y, et al. The impact of depression and anxiety on chronic obstructive pulmonary disease acute exacerbations: a prospective cohort study. J Affective Disorders. 2021;281:147–152. doi:10.1016/j.jad.2020.12.030

112. Liu YJ, Tian XL, Guo XH, et al. Prevalence of anxiety and depression in chronic obstructive pulmonary disease. Chin J Respir Crit Care Med. 2020;19(5):425–429.

113. Montserrat-Capdevila J, Godoy P, Marsal JR, et al. Overview of the impact of depression and anxiety in chronic obstructive pulmonary disease. Lung. 2017;195(1):77–85. doi:10.1007/s00408-016-9966-0

114. Riske L, Thomas RK, Baker GB, et al. Lactate in the brain: an update on its relevance to brain energy, neurons, glia and panic disorder. Therap Advan Psychopharmacol. 2017;7(2):85–89. doi:10.1177/2045125316675579

115. Freire RC, Perna G, Nardi AE. Panic disorder respiratory subtype: psychopathology, laboratory challenge tests, and response to treatment. Harvard Rev Psych. 2010;18(4):220–229. doi:10.3109/10673229.2010.493744

116. De Luca SN, Chan SMH, Dobric A, et al. Cigarette smoke-induced pulmonary impairment is associated with social recognition memory impairments and alterations in microglial profiles within the suprachiasmatic nucleus of the hypothalamus. Brain Behav Immun. 2023;109:292–307. doi:10.1016/j.bbi.2023.02.005

117. Sundar IK, Yao H, Huang Y, et al. Serotonin and corticosterone rhythms in mice exposed to cigarette smoke and in patients with COPD: implication for COPD-associated neuropathogenesis. PLoS One. 2014;9(2):e87999. doi:10.1371/journal.pone.0087999

118. Pelgrim CE, Peterson JD, Gosker HR, et al. Psychological co-morbidities in COPD: targeting systemic inflammation, a benefit for both? Eur J Pharmacol. 2019;842:99–110. doi:10.1016/j.ejphar.2018.10.001

119. Zhang T, Wang G, Li Q, et al. Relationship between serum Th1/Th2 imbalance and depression in elderly patients with COPD and its clinical implications. Technol Health Care. 2023;31(6):2047–2058. doi:10.3233/THC-230665

120. Foley ÉM, Parkinson JT, Mitchell RE, et al. Peripheral blood cellular immunophenotype in depression: a systematic review and meta-analysis. Mol Psychiatry. 2023;28(3):1004–1019. doi:10.1038/s41380-022-01919-7

121. Recio Iglesias J, Díez-Manglano J, López García F, et al. Management of the COPD patient with comorbidities: an experts recommendation document. Int J Chronic Obstr. 2020;15:1015–1037. doi:10.2147/COPD.S242009

122. Taylor SJC, Sohanpal R, Steed L, et al. Tailored psychological intervention for anxiety or depression in COPD (TANDEM): a randomised controlled trial. Eur Respir J. 2023;62(5):2300432. doi:10.1183/13993003.00432-2023

123. Yohannes AM, Alexopoulos GS. Pharmacological treatment of depression in older patients with chronic obstructive pulmonary disease: impact on the course of the disease and health outcomes. Drugs Aging. 2014;31(7):483–492. doi:10.1007/s40266-014-0186-0

124. Pollok J, van Agteren JE, Carson-Chahhoud KV. Pharmacological interventions for the treatment of depression in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2018;12(12):CD012346. doi:10.1002/14651858.CD012346.pub2

125. Kappelmann N, Lewis G, Dantzer R, et al. Antidepressant activity of anti-cytokine treatment: a systematic review and meta-analysis of clinical trials of chronic inflammatory conditions. Mol Psychiatry. 2018;23(2):335–343. doi:10.1038/mp.2016.167

126. Huang C, Liu Y, Shi G. A systematic review with meta-analysis of gastroesophageal reflux disease and exacerbations of chronic obstructive pulmonary disease. BMC Pulm Med. 2020;20(1):2. doi:10.1186/s12890-019-1027-z

127. Harding SM, Allen JE, Blumin JH, et al. Respiratory manifestations of gastroesophageal reflux disease. Ann N Y Acad Sci. 2013;1300:43–52. doi:10.1111/nyas.12231

128. Lee AS, Lee JS, He Z, et al. Reflux-aspiration in chronic lung disease. Ann Am Thorac Soc. 2020;17(2):155–164. doi:10.1513/AnnalsATS.201906-427CME

129. Broers C, Tack J, Pauwels A. Review article: gastro-oesophageal reflux disease in asthma and chronic obstructive pulmonary disease. Aliment Pharmacol Ther. 2018;47(2):176–191. doi:10.1111/apt.14416

130. Lee AL, Goldstein RS. Gastroesophageal reflux disease in COPD: links and risks. Int J Chronic Obstr. 2015;10:1935–1949. doi:10.2147/COPD.S77562

131. Zou M, Zhang W, Xu Y, et al. Relationship between COPD and GERD: a bibliometrics analysis. Int J Chronic Obstr. 2022;17:3045–3059. doi:10.2147/COPD.S391878

132. Lee SW, Lien HC, Chang CS, et al. The impact of acid-suppressing drugs to the patients with chronic obstructive pulmonary disease: a nationwide, population-based, cohort study. J Res Med Sci. 2015;20(3):263–267. doi:10.4103/1735-1995.156174

133. Kang J, Lee R, Lee SW. Effects of gastroesophageal reflux disease treatment with proton pump inhibitors on the risk of acute exacerbation and pneumonia in patients with COPD. Respir Res. 2023;24(1):75. doi:10.1186/s12931-023-02345-1

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Having chronic obstructive pulmonary disease (COPD) makes us patients more susceptible to lung infections. These infections can creep up on us quickly and progress to a severe condition in just a few days. This was the case for me two summers ago.

During my hospital stay, I was given six treatments of chemotherapy. The nurse told me I was being given it because I had skin cancer removed. The doctor then clarified that the treatment aimed to reduce the inflammation. The doctor’s explanation was quite a relief as I knew they were investigating a spot on my lung.

After treatment, when I wanted to brush my hair, I wasn’t initially alarmed by the handful of hair that was left in my brush. At the time, I hadn’t brushed my hair for several days. But once I returned home, the hair kept falling out. I didn’t lose all of it, and most of it grew back. I didn’t think much more about it.

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In the grand scheme of things, hair isn’t that important to me. I actually enjoyed the extraordinarily little amount of hair that was left under my arms and on my legs. I dealt well with all of the hair depletion — except my eyebrows. Eyebrows frame a person’s eyes and add a lot of individuality to the face.

I still struggle to fill in the blank spots with an eyebrow pencil. Some days, I think I’ve made them look like my natural eyebrows, while on other days, not so much.

I write about this because our appearance has a lot of influence on our self-esteem. In an article published by the The Peak Counseling Group, I learned that people who struggle with self-esteem are prone to negativity. Further reading supports the idea that self-esteem is related to mental health.

I don’t want to look into the mirror to brush my teeth, wash my face, or comb my hair. A few days ago, I realized this was holding me back from starting the day. Identifying the problem is the first step in the scientific method of problem-solving.

The problem is that I try not to let having so few hairs in my eyebrows bother me, but it does bother me — a lot. Admitting this to a friend and writing about it has helped me feel better about this issue. I will try to become more proficient in filling in the blank spots.

This problem might be a reason to treat myself to a day at the beauty salon to learn from the experts. We need to take care of ourselves to do and be our best.


Note: COPD News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of COPD News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to chronic obstructive pulmonary disease.

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RICHMOND HILL, ON, Feb. 28, 2024 /PRNewswire/ -- Olympus Canada Inc. (OCI) announced today the expansion of its respiratory portfolio with the availability of the Spiration™ Valve System for the treatment of severe emphysema.

The Spiration Valve System (SVS), previously only indicated for the treatment of prolonged air leaks, is now indicated for the treatment of severe emphysema, a form of chronic obstructive pulmonary disease (COPD).

"Olympus Canada is excited to strengthen its leadership role in the respiratory space with the expanded use of the Spiration Valve System for the treatment of severe emphysema," said Mike Lauzon, OCI Medical Business Unit Vice President. "Studies looking at the durability of SVS treatment point to the positive, long-term impact it can have on emphysema patients. We are pleased to offer a treatment option that could bring meaningful improvement to people's lives."

Emphysema is characterized by a loss of elasticity and enlargement of the air sacs of the lung. The diseased lobes of the lungs become hyperinflated causing patients to have significant challenges with breathing.

The Spiration Valve is an umbrella-shaped device that is placed in the most diseased parts of the lung during a short bronchoscopic procedure. Treatment with endobronchial valves such as the Spiration Valve, the only endobronchial valve treatment option available in Canada, can improve lung function by redirecting air away from hyperinflated portions of the lung to healthier portions. Results from the EMPROVE trial showed sustained clinical benefits at 24 months in severe emphysema patients treated with the Spiration Valve System. These benefits include statistically significant improvements in lung function, shortness of breath and quality of life.1

Annual hospital admissions for COPD in Canada have risen sharply since 2002, according to study findings published in the Canadian Medical Association Journal. Researchers identified 1.13 million COPD hospitalizations between 2002 and 2017. Annual hospital admissions over that period increased more than 68% from 52,937 to 89,384. The study also noted that about 21% of the admissions were for younger adults between the ages of 40-64. Researchers suggested that environmental factors such as air pollution and wildfire smoke may be among the factors contributing to the increase in admissions.2

While smoking rates appear to have plateaued in Canada, researchers expect the burden of COPD treatment and hospitalizations to increase due to population growth and aging; smoking is a main contributor to emphysema. COPD hospitalizations could be avoided with proper preventive or early therapeutic interventions, according to the study.2

Potential adverse events which may be associated with the use of the Spiration Valve System may include, but are not limited to, pneumothorax, worsening of COPD symptoms, pneumonia, and dyspnea. A full list of prescriptive information and additional information on indications, contraindications, warnings, precautions and potential complications is available here.

For more information, visit the Spiration Valve System product page or the OCI pulmonology product page for information about the entire Olympus portfolio.

About Olympus Canada
Olympus is passionate about creating customer-driven solutions. For more than 100 years, Olympus has focused on making people's lives healthier, safer and more fulfilling by helping to detect, prevent, and treat disease. Olympus Canada Inc. (OCI) – a subsidiary of Olympus Corporation of the Americas – manages the company's operations and workforce throughout Canada in roles such as sales, marketing, service, and support functions. Based in Richmond Hill, ON, OCI is committed to developing our employees and supporting our local communities. For more information, visit olympuscanada.com.

1 Criner GJ, Mallea JM, Abu-Hijleh M, et al. Sustained Clinical Benefits of Spiration Valve System in Severe Emphysema Patients: 24-Month Follow-Up of EMPROVE [published online ahead of print, 2023 Nov 10] Ann Am Thorac Soc. 2023;10.1513/AnnalsATS.202306-520OC
2 Amegadzie, J. E., et al. "Trends in hospital admissions for chronic obstructive pulmonary disease over 16 years in Canada." Pub. Sept. 11, 2023, Canadian Medical Association Journal. doi.org/10.1503/cmaj.221051

SOURCE Olympus Canada

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The MightySat Medical, an over-the-counter medical fingertip pulse oximeter, has received clearance from the US Food and Drug Administration (FDA) for use without a prescription, according to a press release from manufacturer Masimo.

The device is the first and currently the only medical fingertip pulse oximeter available directly to consumers without a prescription, and it includes the same technology used by many hospitals, according to the company.

Pulse oximeter use is important for patients with diagnosed breathing problems or lung diseases such as asthma, chronic obstructive pulmonary disease, lung cancer, flu, pneumonia, or COVID-19 to collect accurate data on arterial blood oxygen saturation that they can share with their healthcare providers, according to the company. However, challenges of pulse oximeter use include measuring accuracy when patients are moving, measuring patients with poor circulation, and measuring patients with darker skin types. The MightySat Medical is designed to provide reliable measures of oxygen saturation and pulse rate across all patient groups, the manufacturers wrote in the press release.

Other over-the-counter pulse oximeters that are not cleared by the FDA may create confusion among patients about the accuracy of their measurements, according to the company.

"Healthcare providers can also now be confident when referring their patients to get MightySat Medical knowing that it has actually been cleared by the FDA as an OTC medical pulse oximeter," said Joe Kiani, Masimo founder and CEO, in the press release.

MightySat Medical is indicated for individuals aged 18 years and older who are well or poorly perfused under no motion conditions and is not intended as a diagnostic or screening tool for lung disease, according to the release. Treatment decisions based on data from the device should be made only in consultation with a healthcare provider, the company said.

The FDA's website offers guidance related to at-home pulse oximeter use, with recommendations and limitations, as well as information on initiatives to ensure accurate and equitable pulse oximetry for all patients.

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Mechanical Ventilators

Mechanical Ventilators

The global ???????????????????????????????????????? ???????????????????????????????????????????? ???????????????????????? is estimated to witness increased sales during forecast period. This increased sales rate is attributed to growing older population and rising cases of respiratory diseases. Mechanical ventilator is an artificial breathing device majorly used for treating patients with severe medical conditions. Growing number of acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD) in the worldwide population is driving the growth of the global mechanical ventilators market.

The global mechanical ventilators market was worth US$ 1.9 Bn and is projected to reach a value of US$ 5.5 Bn by the end of 2027, is anticipated to grow at a CAGR of 12.8% during the forecast period.

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Teleflex Incorporated,VYAIRE,Dragerwerk AG & Co. KGaA,GE Healthcare,Medtronic plc,Koninklijke Philips N.V.,Smiths Medical,ResMed Inc.,Bunnell Inc.,,Getinge AB.

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Critical Care Ventilators

Neonatal Ventilators

Transport and Portable Ventilators

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Invasive

Non-invasive

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Home Care

Hospitals and Clinics

Ambulatory Surgical Centers

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In April, 2020, U.S. government under the Defense Production Act- issues US $1.1Bn in ventilator contracts to Koninklijke Philips N.V. and G.E. Healthcare.

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According to the World Health Organization (WHO), chronic respiratory disease comprise all such medical conditions that affect the airways and other lung structures. Some common chronic respiratory diseases are asthma, chronic obstructive lung disease, including chronic obstructive pulmonary disease, bronchitis and emphysema, lung cancer and neoplasms of respiratory and intrathoracic pulmonary heart disease and diseases of pulmonary circulation.

According to WHO, around 65 million people suffer from chronic obstructive pulmonary disease (COPD) and 3 million die from it each year, making it the third-leading cause of death worldwide.

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Market size and growth projections

Segment-wise analysis

Regional dynamics and trends

Regulatory landscape

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Technological advancements and innovations

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North America(USA, Canada and Mexico)

Europe(UK, Germany, France and the Rest of Europe)

Asia Pacific(China, Japan, India, and the Rest of the Asia Pacific region)

South America(Brazil, Argentina and the Rest of South America)

Middle East and Africa(GCC and Rest of the Middle East and Africa)

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Transparency Market Research, a global market research company registered at Wilmington, Delaware, United States, provides custom research and consulting services. Our exclusive blend of quantitative forecasting and trends analysis provides forward-looking insights for thousands of decision makers. Our experienced team of Analysts, Researchers, and Consultants use proprietary data sources and various tools & techniques to gather and analyses information.

Our data repository is continuously updated and revised by a team of research experts, so that it always reflects the latest trends and information. With a broad research and analysis capability, Transparency Market Research employs rigorous primary and secondary research techniques in developing distinctive data sets and research material for business reports.

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Nikhil Sawlani

Transparency Market Research Inc.

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