Week of December 28, 2025

COPD, bronchiectasis health care experiences differ by sex

Lexington, KY - A greater proportion of women vs. men with COPD or bronchiectasis had their first health care visit within 6 months of symptom onset, according to data published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation. In contrast, receipt of a confirmed diagnosis within 6 months of this visit was reported by a larger proportion of men vs. women, according to researchers.  “Chronic lung disease care is not one size fits all,” Radmila Choate, PhD, MPH, associate professor of epidemiology at the University of Kentucky College of Public Health, told Healio. “Clinicians should recognize that women may present with different symptoms, patterns of diagnostic delay and different disease-related burdens. “Asking more targeted questions about symptom intensity, quality of life and changes in symptoms around menopause may help clinicians identify specific needs earlier,” Choate said. “Addressing functional symptoms, emotional health and menopausal status can support more tailored patient-centered care.” Using responses from a COPD Foundation survey, Choate and colleagues evaluated 632 patients (mean age, 70 years; 74% women), of which 68% (68% women) self-reported COPD with/without bronchiectasis or nontuberculous mycobacteria (NTM) and 32% (87% women) self-reported bronchiectasis with/without NTM, to determine how men and women differ in health care experiences, disease burden and symptoms. “While sex differences are often discussed from a biological perspective, patient-reported experiences are rarely examined, and we saw a clear need to address this gap,” Choate told Healio. “Our multidisciplinary research team included not only researchers, clinicians and COPD Foundation leadership, but also patient partners with lived experience, which helped us design a survey that captured real-world challenges, not only clinical metrics.” Between the sets of women and men with COPD, researchers reported a significant difference in age (mean, 70.3 years vs. 72.2 years) and the proportion of patients who had their first health care visit within 6 months of symptom onset (43% vs. 29%). Although the above proportions of women and men differed, a comparable proportion of women and men received a confirmed diagnosis within 6 months of their first health care visit (55% vs. 60%), according to the study. When asked if they had their diagnosis explained to them by a health care provider in an understandable way, 27% of women responded, “not explained at all,” which was significantly greater than the 18% of men that had this response. The response of “not explained in a way I understood” was given by 9% of women and 16% of men. Notably, diagnosis-related anxiety, depression or fear was reported by a significantly larger proportion of women vs. men (78% vs. 66%). 

For more information: https://tinyurl.com/ymcht4aw

Week of December 21, 2025

New study concludes that High Dose Flu vaccine outperforms regular dose

Denmark, Spain - Two large-scale trials comparing high-dose inactivated influenza vaccine (HD-IIV) versus standard-dose inactivated influenza vaccine (SD-IIV) against hospitalisation outcomes have been conducted in Denmark and Spain. The researchers analysed pooled data to assess the relative vaccine effectiveness (rVE) of HD-IIV versus SD-IIV against severe clinical outcomes in older adults. HD-IIV demonstrated superior protection compared with SD-IIV against hospitalisation for influenza or pneumonia and also reduced the incidence of the secondary endpoints of cardiorespiratory hospitalisation, laboratory-confirmed influenza hospitalisation, and all-cause hospitalisation. They concluded that the HD-11V influenza vaccine could result in substantial public health benefits. 

To review the Flunity-HD study: https://www.thelancet.com/article/S0140-6736(25)01742-8/abstract

Week of December 14, 2025

Emphysema found during lung cancer screening raises risk for mortality

New York, NY - Among asymptomatic adults who underwent lung cancer screening, risks for all-cause, COPD and cardiovascular disease mortality were heightened if emphysema was found during screening, according to results published in Radiology. “Clinically, these findings suggest emphysema is not merely an incidental CT finding, but a distinct disease entity associated with worst outcomes and increased mortality, not only from lung cancer but also from respiratory and cardiovascular diseases,” Claudia I. Henschke, PhD, MD, radiologist and professor of radiology in the department of diagnostic, molecular and interventional radiology  at Icahn School of Medicine at Mount Sinai, said in a press release. In a prospective cohort study, Henschke and colleagues evaluated 9,047 asymptomatic adults (4,614 women; median age, 65 years; median smoking history, 43 pack-years) aged 40 to 85 years with a history of smoking and a low-dose CT screening for lung cancer between June 2000 and December 2008 to uncover if mortality up to 25 years later can be predicted by a single visual emphysema score collected at this screening. This population included 2,637 adults (29.1%) with emphysema, and most (n =  1,908) had mild emphysema as opposed to moderate (n = 512) or severe (n = 217) emphysema based on scores from an experienced chest radiologist. For 79.2% of patients with emphysema, the study noted that a diagnosis of emphysema or COPD was not previously reported. Researchers found emphysema in significantly more men vs. women (30.1% vs. 28.2%) and current smokers vs. former smokers (37.5% vs. 24.8%). Further, as age and cumulative smoking exposure went up, so did evidence of emphysema. The last day of follow-up was Dec. 31, 2024, and over the median follow-up period of 23.3 years, 3,738 (41.3%) adults died, according to the study. More adults died of CVD vs. COPD (n = 1,153 vs. n = 295). “Given that both emphysema and coronary artery calcification stem from smoking, future research on their progression may provide further insights into their interplay and refine CVD and COPD risk stratification,” Henschke and colleagues wrote. Approximately half of the 30 million Americans living with COPD (including emphysema) go undiagnosed by spirometry. The United States Preventative Services Task Force has long recommended against the use of spirometry as a screening tool in asymptomatic people because there has been minimal evidence that COPD interventions done before symptom onset had any effect on outcomes. This study may represent the first step toward freeing our health care system from that dogma.

For more information: https://tinyurl.com/3v4ybnz6

Week of December 7, 2025

What to know about the H3N2 flu strain that has experts concerned 

Houston, TX - The U.S. may be in for yet another rough flu season, particularly as influenza A H3N2 mutated into a new subclade and has been associated with an earlier-than-usual start to flu season in other parts of the world. H3N2 picked up about seven new mutations in its hemagglutinin protein -- which enables it to attach to receptors on human cells -- as it spread through the Southern Hemisphere late this summer, which is far more than the one or two needed to evade prior immunity, said Pedro Piedra, MD, a pediatric infectious diseases physician at Baylor College of Medicine and Texas Children's Hospital in Houston. "Last year, we had one of the most severe influenza seasons that we've had for many years. In part, it was driven by H3N2," Piedra told MedPage Today. "This year, chances are that it will be equally as severe, again driven by H3N2." He said flu season is off to an early start where he practices in Texas, and "in general that means that we're going to have a more intense flu season," though he cautioned that it's "hard to predict what flu is going to do." In Texas, flu is "hitting the children harder right now," Piedra noted. The U.K., Japan, and Canada also saw an early start to their influenza seasons this year, according to Katelyn Jetelina, PhD, MPH, author of the "Your Local Epidemiologist" Substack newsletter. Antonia Ho, MBChB, MSc, PhD, of the University of Glasgow in Scotland, said in a statement on the U.K.'s Science Media Centre that the U.K.'s flu season started 5 weeks earlier than usual. In its latest weekly flu surveillance report with data through Nov. 16, the U.K.'s Health Security Agency said flu activity showed "mixed trends and continues to circulate at low levels after an unusually early start to the flu season." It also noted that flu test positivity and hospitalizations both fell slightly compared with the prior week. The CDC's latest weekly flu surveillance report, for the week ending Nov. 15, showed that about 3% of all clinical lab viral samples were positive for influenza this week, and that this trend was on the rise. The report noted that flu activity "remains low nationally, but is increasing, primarily among children." While the mutations in H3N2 are more extensive than usual, they are not a larger "shift" in the virus. Instead, it is a drift from subclade J to subclade K, Jetelina wrote. It's not unusual for more than one subclade to circulate in any given season, rather than one becoming dominant, Piedra said. That appears to be what's happening now, with subclade K continuing to account for 50% to 55% of strains that have been antigenically characterized, he added. "For the last few weeks, subclade K stayed around 50% to 55%, so it had not replaced the other subclades in circulation," Piedra said. "Will it? Time will tell. But generally for H3N2, it's always difficult for one subclade to dominate." Given the mismatch with the circulating strains and those in the vaccine, experts say there could be more breakthrough infection this year, leading to a higher influenza burden overall. Last year's flu season was the worst in more than a decade, according to a report in CDC's Morbidity & Mortality Weekly Report. At nearly 40,000 flu-associated hospitalizations in the 2024-2025 season, the cumulative hospitalization rate of about 127 per 100,000 population was the highest rate since the 2010-2011 flu season. Nonetheless, even with a mismatch, the vaccine has a high likelihood at still protecting well against more severe outcomes, Piedra said. "I would brace for another severe influenza season," he added. "Our best method to protect against a bad flu season is with vaccines. And for those who have not been vaccinated or have breakthrough infections, antivirals are very important, but they need to be used early to be effective." 

For more information: https://tinyurl.com/4mbmv32b

Week of November 30, 2025

2026 GOLD report addresses disease activity, technology, exacerbations in COPD 

Marburg, Germany - To keep up with COPD research and care developments, the 2026 Global Initiative for Chronic Obstructive Lung Disease report features two new sections/chapters, two completely revised chapters and several updated sections. Claus F. Vogelmeier, MD, head of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) science committee and head of the respiratory department at Philipps University of Marburg, presented key changes of the report during the 2025 GOLD International COPD conference. The 2026 GOLD report newly highlights disease activity and emerging technologies in COPD. Importantly, the GOLD website states that the final version of the report will be available this week. “The document has been restructured,” Vogelmeier said. “There is now a big appendix so that you are not sort of overflowed by information. There is a table of abbreviations in there, and all the references have been checked and updated throughout the document.” According to the 2026 key changes summary, the report features 330 new references and 14 new figures. In terms of new sections/chapters, the 2026 report has two, one on disease activity and one on technology. The section on disease activity recommends lowering this as a key objective in COPD management. “In the context of COPD, reducing disease activity means that you may be able to interfere with symptoms, you may reduce exacerbations and that you see no worsening of objective markers,” Vogelmeier said. While speaking on this section, Vogelmeier pointed out that disease stability is different from disease control. “[Disease stability] means that you have a low disease activity state with no exacerbations, no worsening of symptoms and no accelerated loss of lung function,” he said. “The other term is disease control, and it is also a state of low disease activity, defined by no exacerbation and no worsening of symptoms, but in addition to that, these symptoms have to have a low impact on the patient.” Notably, working toward disease stability applies to all patients with COPD no matter their disease stage, according to a study graph by Dave Singh, MD, and colleagues, and Vogelmeier emphasized it as “a worthwhile treatment goal.” Vogelmeier further said there are reasons related to future research and physician-patient communication for why disease stability is relevant. 

For more information: https://tinyurl.com/3btkrcak

Week of November 23, 2025

Tool determines likelihood for mucus plugs in patients with COPD

Boston, MA - Among adults with COPD, the likelihood for having mucus plugs on CT can be determined using a tool that considers 11 “readily available” factors, according to results published in American Journal of Respiratory and Critical Care Medicine. “Clinicians can now use basic clinical information to estimate whether a patient is likely to have mucus plugs,” Alejandro A. Diaz, MD, MPH, assistant professor of medicine at Harvard Medical School and associate scientist at Brigham and Women’s Hospital, told Healio. “This can guide decisions about when to order a CT scan, whether for patient care or research.” In this study, Diaz and colleagues analyzed 3,397 adults aged 45 to 80 years with Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 to 4 COPD from the COPDGene Study and 1,215 adults aged 40 to 75 years with GOLD 2 to 4 COPD from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study to develop and validate an index that can detect which patients have greater odds for airway mucus plugs on CT. “COPD is the fourth leading cause of death worldwide, yet treatments have focused almost exclusively on bronchodilators and inhaled steroids for decades,” Diaz said. “Mucus plugs are a major but overlooked problem. “Since detecting [mucus plugs] requires CT scans, which expose patients to radiation, we wanted to find simple ways to predict who is most likely to have mucus plugs, especially when scans are missing or outdated,” he continued. Researchers used the COPDGene cohort to develop the model and the ECLIPSE cohort to test the model. In both cohorts, less than 20% of patients had at least three lung segments with mucus plugs (COPDGene, 16.1%; ECLIPSE, 19.3%). As Healio previously reported, the risk for respiratory and cancer mortality among patients with COPD went up with mucus plugging in at least three lung segments. Using insights from previous literature, the study noted that 12 variables were considered for use in the index: age, sex, BMI, smoking status, pack-years smoked, cough, phlegm, dyspnea, history of exacerbations in the year before enrollment, chronic bronchitis, 1 to 4 GOLD grade and FEV1/FVC. Only one variable, pack-years smoked, was not part of the final model. “We found 11 different factors linked to mucus plugs — more than expected,” Diaz told Healio. “While we had hoped for fewer, the good news is that these factors are already commonly checked when recruiting patients for COPD studies.” Researchers observed an area under the receiver operating characteristic curve of 0.75 in distinguishing patients with vs. without mucus plugs on CT in the development cohort. A  similar area under the receiver operating characteristic curve of 0.73 was found in the testing cohort. Notably, GOLD grade, BMI and age emerged as the most influential variables linked to mucus plugs on CT scans, according to the study. Factors with intermediate influence included sex, phlegm, FEV1/FVC and current smoking, leaving dyspnea, cough, prior exacerbation and chronic bronchitis as the factors with the lowest influence. “Participants aged 65 years and older, as well as females, had an elevated risk of [mucus plugs] on CT,” Diaz and colleagues wrote. “Reduced ability to clear secretions from the airways and hormonal changes may partially explain these associations.” Researchers further outlined that each factor in the Simple Index for predicting Mucus Plugs (SIMP) is assigned a specific number of points, and the following factors were worth zero points: aged younger than 65 years, male sex, BMI of at least 35 kg/m2, former smoking status, GOLD grade 1, FEV1/FVC of at least 0.6 to less than 0.7, no chronic bronchitis, no prior exacerbation, no dyspnea, no cough and no phlegm. According to the study, each SIMP point increase raised the likelihood for having mucus plugs on CT (OR = 1.05; 95% CI, 1.05-1.06).“Future work will focus on building stronger prediction  Diaz said. 

For more information: https//tinyurl.com/3vuam9nr

Week of November 16, 2025

Mortality in COPD exacerbation hospitalization lower with prior bariatric surgery

Chicago, IL -  Patients hospitalized for acute COPD exacerbation had reduced odds for in-hospital mortality if they had a prior history of bariatric surgery, according to data presented at the CHEST Annual Meeting. “Our findings are consistent with superior outcomes in patients admitted for acute exacerbation of COPD who had received prior bariatric surgery compared to those who did not,” Nameer Ascandar, MD, MPH, internal medicine resident at HCA Florida Sarasota Doctors Hospital, said during his presentation. Impact of prior bariatric surgery on  “Our study results underscore the benefit of bariatric surgery in minimizing in-hospital mortality and adverse outcomes in patients admitted with acute exacerbation of COPD,” he said. Using 2017 to 2022 National Inpatient Sample data, Ascandar and colleagues assessed 218,485 patients hospitalized for acute exacerbation of COPD (AECOPD) with history of obesity to determine how a prior history of bariatric surgery impacts in-hospital mortality, respiratory failure, need for prolonged mechanical ventilation and discharge disposition. “Patients with obesity, particularly those with comorbid conditions like obstructive sleep apnea, are more likely to require hospitalizations for exacerbation,” Ascandar said. A small proportion of this studied population had prior bariatric surgery (3.8% [n = 8,245]; 76.5% women) while the remaining 210,240 patients (23.5% women) did not have prior bariatric surgery. Ascandar noted that the Elixhauser Comorbidity Index score among those with prior bariatric surgery was 6, and this did not significantly differ from the score of 7 among those without prior bariatric surgery. In multivariable linear and logistic regression analysis adjusted for baseline characteristics and comorbidities, researchers found a reduced likelihood for in-hospital mortality among patients with vs. without prior bariatric surgery (adjusted OR = 0.69; 95% CI, 0.51-0.93). Notably, when divided by race, the odds for in-hospital mortality were decreased among Black patients vs. white patients (aOR = 0.74; 95% CI, 0.64-0.84) and elevated among Asian patients vs. white patients (aOR = 1.75; 95% CI, 1.08-2.83). In addition to mortality, Ascandar highlighted that patients with vs. without prior bariatric surgery had reduced odds for needing prolonged (greater than 96 hours) mechanical ventilation (aOR = 0.53; 95% CI, 0.39-0.73), having acute hypercapnic respiratory failure (aOR = 0.56; 95% CI, 0.43-0.72) and being discharged to a non-home location (aOR = 0.68; 95% CI, 0.59-0.78). Researchers also evaluated hospitalization costs in the two groups and observed a smaller cost among those with prior bariatric surgery by $2,600 (95% CI, –$3,600 to –$1,600). “Our findings warrant further investigation on the direct relationship, as this is an association rather than a causation that we’re reporting here,” Ascandar said during the presentation. “This will help determine whether bariatric surgery could be a priori in patients with obesity and consider a lower BMI threshold in patients who are at high risk for AECOPD to possibly receive bariatric surgery.” 

For more information: https://tinyurl.com/5n8wrej8

Week of November 9, 2025

Quitting smoking, even late in life, linked to slower cognitive decline

London, UK - Quitting smoking in middle age or later is linked to slower age-related cognitive decline over the long term, according to a new study by UCL (University College London) researchers. The study, published in The Lancet Healthy Longevity, looked at data from 9,436 people aged 40 or over (with an average age of 58) in 12 countries, comparing cognitive test results among people who quit smoking with those of a matched control group who kept smoking. The research team found that the cognitive scores of those who had quit smoking declined significantly less than their smoking counterparts in the six years after they quit. For verbal fluency, the rate of decline roughly halved, while for memory it slowed by 20%.Because slower cognitive decline is related to reduced dementia risk, their findings add to a growing body of evidence suggesting quitting smoking might be a preventative  strategy for the disease. However, more research is needed to confirm this. Lead author Dr. Mikaela Bloomberg (UCL Institute of Epidemiology & Health Care) said, "Our study suggests that quitting smoking may help people to maintain better cognitive health over the long term even when we are in our 50s or older when we quit. "We already know that quitting smoking, even later in life, is often followed by improvements in physical health and well-being. It seems that, for our cognitive health too, it is never too late to quit. "This finding is especially important because middle-aged and older smokers are less likely to try to quit than younger groups, yet they disproportionately experience the harms of smoking. Evidence that quitting may support cognitive health could offer new compelling motivation for this group to try and quit smoking. "Also, as policymakers wrestle with the challenges of an aging population, these findings provide another reason to invest in tobacco control." Smoking is thought to harm brain health in part because it affects cardiovascular health—smoking causes damage to blood vessels that supply oxygen to the brain. Smoking is also thought to affect cognitive health by causing chronic inflammation and directly damaging brain cells through oxidative stress (due to the creation of unstable molecules called free radicals). Co-author Professor Andrew Steptoe (UCL Institute of Epidemiology & Health Care) said, "Slower cognitive decline is linked to lower dementia risk. These findings add to evidence suggesting that quitting smoking might be a preventative strategy for the disease. However, further research will be needed that specifically examines dementia to confirm this."Previous studies, the researchers noted, had found a short-term improvement in cognitive function after people stopped smoking. But whether this improvement was sustained over the longer term—particularly when people quit smoking later in life—was not known. To answer this question, the research team looked at data from three ongoing studies where a nationally representative group of participants answered survey questions every two years. The studies covered England, the US, and 10 other European countries. More than 4,700 participants who quit smoking were compared with an equal number of people who carried on smoking. The two groups were matched in terms of their initial cognitive scores and other factors such as age, sex, education level, and country of birth. The research team found that the two groups' scores in memory and verbal fluency tests declined at a similar rate in the six years prior to participants of one group quitting smoking. These trajectories then diverged in the six years following smoking cessation. For the smokers who quit, the rate of decline was about 20% slower for memory and 50% slower for verbal fluency. In practical terms, this meant that with each year of aging, people who quit experienced three to four months less memory decline and six months less fluency decline than those who continued smoking. This was an observational analysis, so unmeasured differences between smokers who quit and continuing smokers could remain; while the trends before quitting were similar, the study cannot prove cause and effect. However, the research team noted their findings were consistent with earlier studies showing that adults aged over 65 who quit smoking during early, or midlife have comparable cognitive scores to never smokers, and that former and never smokers have a similar risk of dementia a decade or longer after quitting. 

For more information: https://tinyurl.com/4knv29fe

Week of November 2, 2025

Active cigarette smoking linked to elevated pneumonia rates in COPD

Chicago, IL -  A significant link was found between active cigarette smoking and an elevated rate of pneumonia in COPD, whereas this was not true for active e-cigarette or cigar smoking, according to data presented at the CHEST Annual Meeting. “We demonstrated that adults with COPD have higher rates of acquiring pneumonia over a 12-month timeframe if they are actively smoking cigarettes,” William He, MD, of Mount Sinai West-Morningside Hospital and Columbia University Mailman School of Public Health, said during his presentation. A significant link was found between active cigarette smoking and an elevated rate of pneumonia in COPD, whereas this was not true for active e-cigarette or cigar smoking, according to study data. Using 2016 to 2018 (Wave 4) and 2018 to 2019 (Wave 5) data from the Population Assessment of Tobacco and Health study, He and Silvia S. Martins, MD, PhD, assessed 777 adults (60.1% women) with self-reported COPD to determine how active cigarette, e-cigarette and cigar smoking — past 30-day smoking in Wave 4 — are linked to pneumonia events in Wave 5. “Recurrent infections are common in individuals who have COPD,” He said. “This includes viral, bacterial, as well as other types of pneumonia, and through all the literature ... active smoking is associated with worse outcomes in COPD. “We defined pneumonia as a discrete numerical variable,” He added. “This allowed us to do Poisson regression analysis.” Notably, the majority of adults were aged 65 years or older (34.9%), 55 to 64 years (35.9%) or 45 to 54 years (20.7%). He also pointed out that only one individual was aged 18 to 24 years. In terms of health comorbidities, He outlined that hypertension was found in the highest number of adults, followed by hyperlipidemia, diabetes, congestive heart failure and stroke. The proportion of active smokers/users varied across the included tobacco products, with the highest proportion found for cigarette smokers (67.7%), followed by e-cigarette users (13.3%) and cigar smokers (9.9%). After adjusting for age category, sex, illicit drug use and health comorbidities, researchers observed a significant link between active cigarette smoking and an elevated rate of pneumonia (adjusted rate ratio [aRR] = 1.27; 95% CI, 1.07-1.5) in multivariable Poisson Regression analysis. In contrast, active e-cigarette use was not significantly linked to pneumonia rates (aRR = 0.86; 95% CI, 0.69-1.06), and the same was true when evaluating active cigar smoking (aRR = 1.06; 95% CI, 0.84-1.33). “This was an observational study, and for this analysis, we did not incorporate study weights, but it is overall a survey design in terms of the PATH study,” He said. “Some of the future work we’re working on, we do incorporate study weights to overall be more representative.” 

For more information: https://tinyurl.com/yu348vk6

Week of October 26, 2025

Dupilumab benefits patients with COPD regardless of cardiovascular, metabolic disease

Amsterdam, the Netherlands - Among adults with COPD and type 2 inflammation, having a history of cardiovascular or metabolic disease did not change benefits seen with dupilumab, according to a poster presented at the European Respiratory Society International Congress. “Dupilumab is already approved for eligible patients with COPD, and these findings emphasize that the presence of cardiovascular and metabolic comorbidities does not impact the important effect of dupilumab to alleviate two key aspects of disease: exacerbation reduction and lung function improvement,” John R. Hurst, MBBS, professor of respiratory medicine at University College London, told Healio. Data were derived from Hurst JR, et al. PA4575: Dupilumab efficacy in patients with chronic obstructive pulmonary disease and cardiovascular or metabolic disease: BOREAS and NOTUS. Presented at: European Respiratory Society International Congress; Sept. 27-Oct. 1, 2025; Amsterdam.In a post hoc analysis of pooled BOREAS and NOTUS phase 3 trial data, Hurst and colleagues evaluated adults with COPD and type 2 inflammation (blood eosinophil count 300 cells/μL at screening) on long-acting beta agonists/long-acting muscarinic antagonists/inhaled corticosteroid who received either 300 mg subcutaneous dupilumab (Dupixent; Regeneron, Sanofi; n = 938) or placebo (n = 936) every 2 weeks for 52 weeks to determine if benefits seen with the drug differ based on having a history of CVD or metabolic disease. This population included 1,253 patients (dupilumab, n = 625; placebo, n = 628) with a history of CVD, defined as “hypertension, heart failure, myocardial infarction, ischemic heart disease, atrial fibrillation or other documented cardiac conditions,” and 621 patients (dupilumab, n = 313; placebo, n = 308) without a history of CVD. Researchers defined metabolic disease as a “history of diabetes, dyslipidemia or obesity” (BMI ≥ 30 kg/m2), and 758 patients (dupilumab, n = 386; placebo, n = 372) met this definition, leaving 1,116 patients (dupilumab, n = 552; placebo, n = 564) without a history of metabolic disease. In both those with and without a history of CVD, the rate of annualized moderate or severe exacerbations significantly dropped to a similar degree with dupilumab vs. placebo (with CVD, –31%; without CVD, –33%), according to the poster. This was also the case in patients with and without a history of metabolic disease, as researchers found that both groups had a significant decrease in the rate of annualized moderate or severe exacerbations with dupilumab vs. placebo (with metabolic disease, –32%; without metabolic disease, –31%). The poster further highlighted that between baseline and week 52, there was a comparable level of improvement in prebronchodilator FEV1 with dupilumab vs. placebo when split into those with a history of CVD (least-squares mean difference, +55 mL) and those without a history of CVD (least-squares mean difference, +104 mL). Researchers also reported no significant difference in this outcome based on history of metabolic disease, as both groups had a similar level of improvement in prebronchodilator FEV1 with dupilumab vs. placebo (least-squares mean difference: with metabolic disease, +62 mL; without metabolic disease, +77 mL). “I would characterize the results as important and reassuring,” Hurst told Healio. “People with COPD and cardiovascular or metabolic comorbidities are at higher risk of poor outcomes, so to see that dupilumab has similar efficacy in these groups too is important in clinical practice.” In terms of safety, a similar proportion of patients receiving dupilumab and patients receiving placebo experienced a treatment-emergent adverse event in the group with a history of CVD (74% vs. 72%) and the group without a history of CVD (69% vs. 68%). This pattern was also observed for treatment-emergent serious adverse events in the group with a history of CVD (15% vs. 18%) and the group without a history of CVD (11% vs. 10%), according to the poster. “It’s important to note that the safety profile of dupilumab was not different in those with and without cardiovascular and metabolic comorbidities,” Hurst said and added. “Future studies will continue to assess various subgroups of interest from the pivotal BOREAS and NOTUS clinical trials. 

For more information: https://tinyurl.com/w8u5ft8d

Week of October 19, 2025

Dupixent approved in Canada for adults with inadequately controlled COPD

Toronto, ON - Health Canada has approved Dupixent® (dupilumab injection) as an add-on maintenance treatment in adult patients with chronic obstructive pulmonary disease (COPD) characterized by raised blood eosinophils inadequately controlled by the combination of an inhaled corticosteroid (ICS), a long-acting beta2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA), or on a combination of a LABA and a LAMA if ICS is not appropriate. COPD is a respiratory disease that damages the lungs, causes progressive lung function decline and is the fifth leading cause of death in Canada.  

This approval was based on findings from two clinical studies conducted in adult patients already receiving maximal standard-of-care inhaled therapy. The BOREAS and NOTUS studies showed a 30% and 34% reduction in moderate or severe exacerbations over one year.

COPD with Type 2 inflammation, characterized by elevated blood eosinophil levels, has limited treatment options — especially for patients who remain uncontrolled despite triple therapy. The approval of Dupixent® covers inadequately controlled patients who are already on a combination of an inhaled corticosteroid (ICS), a long-acting beta2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), or on a combination of a LABA and a LAMA if ICS is not appropriate.

Dr. Ken Chapman
Director, Asthma & Airway Centre, University Health Network,
Professor of Medicine, University of Toronto

"This is an exciting discovery for some of my most at-risk patients living with COPD. Although we've made slow and steady progress to improve the lives of those who struggle with chronic bronchitis or emphysema, we've had little to offer the most vulnerable of them who have exacerbations frequently. We know that these frequent visits to the walk-in clinic, emergency room or hospital ward mark a period of rapid decline. Research with Dupixent® shows that a simple blood test will identify which of these vulnerable patients is most likely to enjoy fewer flareups, better lung function, and improved quality of life when treated with this novel therapy."

Dr. Jean Bourbeau
Director, COPD clinic and Pulmonary Rehabilitation, McGill University Health Centre (MUHC)
Respirologist, Respiratory Division, Department of Medicine, MUHC

"The unmet need in COPD with acute exacerbations is huge considering not only the patient impact and premature death but COPD being the number one cause of hospital admissions in Canada. Identifying treatable traits of type 2 inflammation and considering a targeted specific therapy strategy in COPD is now possible with a novel biologic therapy such as dupilumab. Let's not accept that it is normal for our patients to continue to have recurrent and/or severe exacerbations, let's take action." 

Henry Roberts
Managing Director, Chronic Obstructive Pulmonary Disease Association Canada (COPD Canada)

"Our community members often share how breathlessness forces them into isolation, missing family gatherings and simple pleasures like walking outdoors. The approval of Dupixent® represents a beacon of hope for Canadians living with uncontrolled COPD who have been waiting far too long for meaningful treatment advancements."

James Guy
General Manager Specialty Care and Sanofi Country Lead Canada

"This approval marks a pivotal moment in COPD management for patients in Canada. By advancing breakthrough science in respiratory medicine, we're delivering meaningful solutions for Canadian patients whose condition is not being effectively managed by existing treatments. We are committed to working alongside healthcare providers to ensure this new option reaches patients living with uncontrolled COPD."

About BOREAS and NOTUS Phase 3 Trials

The approval is based on results from the landmark phase 3 BOREAS and NOTUS  studies, which were separately published in The New England Journal of Medicine and evaluated the efficacy and safety of Dupixent® in adults with uncontrolled COPD with evidence of type 2 inflammation (i.e., blood eosinophils ≥300 cells per μL). All patients were on background maximal standard-of-care inhaled therapy (with nearly all on triple therapy). In terms of efficacy, Dupixent® patients in BOREAS (n=468) and NOTUS (n=470) experienced the following, respectively, compared to placebo (BOREAS n=471; NOTUS n=465):

30% and 34% reduction in the annualized rate of moderate or severe COPD exacerbations over 52 weeks, the primary endpoint.

Improvements in lung function (pre-bronchodilator FEV1) from baseline by 160 mL and 139 mL at 12 weeks compared to 77 mL and 57 mL. These improvements were observed as early as week 2 and 4 and were sustained at 52 weeks in both studies.

Improvements in health-related quality of life (statistically significant in BOREAS and nominally significant in NOTUS), as assessed by the St. George's Respiratory Questionnaire.

Safety results in both studies were generally consistent with the known safety profile of Dupixent® in its approved indications. The most common side effects across indications include injection site reactions, conjunctivitis, conjunctivitis allergic, arthralgia, oral herpes, and eosinophilia. Adverse events more commonly observed with Dupixent® (≥5%) compared to placebo in either COPD study were back pain, COVID-19, diarrhea, headache and nasopharyngitis. Additional adverse reactions of injection site bruising, injection site induration, injection site rash and injection site dermatitis were reported in the COPD studies.

Dupixent® for COPD patients have been approved by other regulatory authorities around the world including the European Union, the US, China and Japan. 

For more information: https://tinyurl.com/5x4erx2e

Week of October 12, 2025

CDC report hints at the effectiveness of this year's influenza vaccine

Atlanta, GA - Influenza vaccines have cut flu-associated outpatient visits and hospitalizations by half during the Southern Hemisphere's 2025 flu season, according to an interim analysis of surveillance data from eight countries. Over the Southern Hemisphere's flu season from April through September, the adjusted vaccine effectiveness (VE) rate against outpatient visits associated with influenza-like illness (ILI) was 50.4% (95% CI 33.2-63.2), while the adjusted VE rate against hospitalizations for severe acute respiratory infection (SARI) was 49.7% (95% CI 46.3-52.8), reported Savanah Russ, PhD, of the CDC's National Center for Immunization and Respiratory Diseases, and colleagues. Only 21.3% of people with ILI were vaccinated against the flu, with an even lower percentage for people with SARI (15.9%), they noted in the Morbidity and Mortality Weekly Report. "Health authorities in Northern Hemisphere locations might anticipate similar levels of protection against influenza illness, should the same influenza viruses circulate during the upcoming season," Russ and colleagues wrote. The Southern Hemisphere's 2025 flu vaccine composition is the same as the composition for the upcoming 2025-2026 Northern Hemisphere season. The CDC's Advisory Committee on Immunization Practices recommends routine flu vaccination for everyone ages 6 months and older without contraindications. U.S. hospitalizations for flu reached record overall levels and peak-weekly marks during the 2024-2025 season, topping all rates over the prior 14 seasons. Influenza A was the most common identified virus in both outpatient and hospitalized patients. That strain was present in 82.4% of people with ILI and 94.9% of those with SARI. Influenza A(H1N1)pdm09 was the most prevalent variant, at 39.9% and 58.7% of ILI and SARI cases, respectively. Among patients with ILI, the adjusted VE rate against any influenza A subtype was 45.4%, and 53.3% against influenza A(H1N1)pdm09. Among people with SARI, the adjusted VE rate was 46.1% against any influenza A subtype and 41.6% against influenza A(H1N1)pdm09. Adjusted VE rates against influenza B were 62.3% in those with ILI and 77.6% in those with SARI. The researchers used Southern Hemisphere national vaccination registries, medical records, and self-reports to determine vaccination status. Anyone who had a vaccine at least 14 days before flu symptoms was considered vaccinated. The analysis included 2,122 patients with ILI and 42,752 patients with SARI. Among those with SARI, 85.3% were young children, people with comorbidities, or older adults, considered priority vaccination groups. The VE data were contributed by Argentina, Australia, Brazil, Chile, New Zealand, Paraguay, South Africa, and Uruguay. Study limitations included the potential for preliminary data to differ from estimates at the end of the flu season. The small sample size may reduce the accuracy of the VE estimate, and 61% of potential patients were excluded from the analysis because of missing reverse-transcription PCR flu test results. 

For more information: https://tinyurl.com/m6jutas8

Week of October 5, 2025

Online group singing intervention improves quality of life in patients with COPD, ILD

Melbourne, Australia - Patients with COPD or interstitial lung disease who partook in a weekly online group singing program reported improved quality of life after 12 weeks, according to data presented at the European Respiratory Society International Congress. “Our results build on growing evidence that singing may help relieve symptoms and improve quality of life for people with severe chronic lung disease,” Natasha Smallwood, PhD, professor and director of respiratory medicine at Alfred Health and Monash University, told Healio. Patients with COPD or ILD who partook in a weekly online group singing program reported improved quality of life after 12 weeks, according to study findings. In the randomized controlled phase 3 SINFONIA trial, Smallwood and colleagues evaluated 101 individuals with COPD or ILD (mean age, 69.6 years; 74.3% female; 63.4% with COPD; 36.6% with ILD) with/without their carers to uncover how a 90-minute online, guided group singing session once a week for 12 weeks impacts quality of life vs. usual care. A registered music therapist led the singing sessions that patients participated in via provided iPads and data plans, according to the presentation. In addition to singing songs, a press release from ERS stated that sessions involved “dedicated time for warmups, breathing exercises ... and social check ins.” “Currently the main approach clinicians offer to patients for symptom management is pulmonary rehabilitation,” Smallwood said. “Research demonstrates that very few people who are eligible for pulmonary rehabilitation ever complete a program, as there are many barriers to participation.” The singing group included 50 patients (mean age, 68.5 years; 80% female; 64% with COPD; 36% with ILD), and the usual care/control group included 51 patients (mean age, 70.6 years; 68.6% female; 62.75% with COPD; 37.75% with ILD). Compared with the usual care group, researchers found that the singing group had more patients lost to follow-up (n = 8 vs. n = 2) and more patients who withdrew (n = 5 vs. n = 2). In each group, one patient died. After excluding these patients, the singing group included 36 patients, and the usual care group included 46 patients. Among those assigned to the singing arm, the pre-defined minimum number of sessions to attend was eight, and 54% attended at least eight sessions. The presentation also noted that eight was the median number of sessions attended. Using the 36-item Short Form Survey (SF-36) to measure quality of life, in which a higher score is favorable, researchers found that those assigned singing had a significantly higher average score at 12 weeks vs. those assigned usual care by 7.4 points (95% CI, 0.67-14.14) in a mixed effects linear regression that accounted for diagnosis, week, group allocation and interaction between week and allocation as fixed effects. Within the singing group, those who attended at least eight sessions vs. less than eight sessions had a significantly higher average SF-36 score by 11 points (95% CI, 3.73-18.33) at week 12. The presentation further highlighted that this degree of difference between the groups went above the minimal clinically important difference of 10 points. “Our study was the first to deliver the singing program entirely online right from the start, and we were delighted to discover that the program still delivered demonstrable benefits,” Smallwood told Healio. “This is a really important finding as many people with severe lung disease find it hard to leave the house due to symptoms, so flexible and home-based health care options are crucial.” When broken down according to sex, age, disease severity, primary diagnosis, prior psych diagnosis, breathlessness severity and previous pulmonary rehabilitation, researchers reported that five subgroups had a mean difference in SF-36 plus 95% confidence intervals that showed improvement with singing vs. usual care. These subgroups included women, patients aged older than 70 years, those with severe disease, those with depression/anxiety and those with no previous pulmonary rehabilitation. Additionally, those with severe disease, those with depression/anxiety and those with no previous pulmonary rehabilitation had a mean difference in SF-36 that went over the minimal clinically important difference, according to the presentation. Smallwood told Healio “This is really interesting, as typically these patients are much harder to treat, so having a new effective, safe treatment approach is essential,” she said. “Our findings mean that in future, clinicians will have more choice regarding the evidence-based recommendations they can suggest to help patients maintain quality of life and manage challenging symptoms,” Smallwood added. Looking ahead, Smallwood said there are still opportunities for research on these programs. “Future studies need to focus on the resources required and how to best deliver singing programs to people with chronic lung disease and symptoms, as these programs are not available in most countries,” Smallwood said. 

For more information: https://tinyurl.com/4pwfcpwn

Pooled analysis reveals lower risk for severe exacerbations with dupilumab in COPD

Amsterdam, the Netherlands - Receiving dupilumab for 52 weeks lowered the risk for severe exacerbations vs. placebo in adults with COPD and type 2 inflammation, according to pooled trial data presented at the European Respiratory Society International Congress. “Severe exacerbations are associated with substantial short-term and long-term consequences, including significant loss of lung function and, in many cases, death,” Surya P. Bhatt, MD, professor in the division of pulmonary, allergy and critical care medicine at The University of Alabama at Birmingham, told Healio. “Preventing these events can significantly impact the life course of disease in these patients,” Bhatt said. In a post hoc analysis of pooled BOREAS and NOTUS phase 3 trial data, Bhatt and colleagues evaluated adults with COPD and type 2 inflammation (blood eosinophil count 300 cells/μL at screening) on long-acting beta agonists/long-acting muscarinic antagonist/inhaled corticosteroid who received either 300 mg subcutaneous dupilumab (Dupixent; Regeneron, Sanofi; n = 938) or placebo (n = 936) every 2 weeks to determine how the drug impacts risk for severe exacerbations, ED visit rates and systemic corticosteroid  use. Notably, the FDA approved dupilumab for treating adults with poorly controlled COPD with type 2 inflammation about 1 year ago.As previously reported, 300 mg dupilumab every 2 weeks for 52 weeks showed a decrease in the annualized moderate/severe exacerbation rate, a positive change in prebronchodilator FEV1 and safety in adults with moderate to severe COPD and type 2 inflammation at week 52 in a pooled analysis of BOREAS and NOTUS. Receiving dupilumab  for 52 weeks also led to health-related quality of life improvement in the pooled population, and the benefits seen with dupilumab did not change based on investigator-reported emphysema. 

For more information: https://tinyurl.com/jfbyn6dr

Week of September 28, 2025

COPD survey reveals daily life impacts, patient-provider communication gaps

Lexington, Kentucky - Among patients with COPD, at least 50% reported that the disease impacts their daily life and emotional health, according to survey results published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation. Additionally, less than half of patients reported providing a great level of detail on their symptoms during discussions with their health care providers (HCPs), according to researchers. “It remains important for health care providers to explain the importance of the various COPD therapies and their correct use,” David M. Mannino, MD, FCCP, FERS, chief medical officer and co-founder of the COPD Foundation, told Healio. “Of course, there [also] remains a need for better therapies and better means of administering them that are less difficult than our current therapies.” Using data from Phreesia’s Patient Insights 28-question quantitative survey offered in January 2025, Mannino and colleagues evaluated responses from 1,615 patients (mean age, 65 years; 59% women; 82% white) with COPD who answered all questions to learn more about symptoms, treatment journeys and potential patient-HCP communication gaps. “Periodically, it is important to understand what is happening in the care of COPD patients,” Mannino said. “The treatment of COPD keeps changing, as well as the health care environment, so it is important to understand what is currently happening.” In a set of 1,981 patients, the study highlighted that 39% reported having COPD symptoms for more than 7 years. When asked about the frequency of symptoms over a 30-day period, a quarter of 1,702 patients said they experienced symptoms every day. Symptoms reported as the most impactful included dyspnea (33% of n = 1,773), fatigue (19%), cough (16%) and phlegm (13%). Further, the impact of COPD on daily life was moderate to great for 64% of 1,773 patients, and the impact of COPD on emotional health reached this level for 50% of 1,792 patients, according to the study. A smaller proportion of patients (36% of n = 1,237) said that COPD impacted their ability to work, namely losing their job (15%) or having to take frequent breaks (14%). Mannino said one notable disappointing finding was that 55% of patients reported providing some, little or no detail, as opposed to great detail, on their symptoms when speaking with their HCPs. Along with this finding, understanding of COPD was limited or nonexistent per responses from 35% of 1,718 patients. “Patients would like to understand more about their disease. Clinicians are typically pressed for time but are able to answer all of their questions,” Mannino said. In terms of treatment, 339 patients had not tried or were currently not on any maintenance medications, and the study noted that “COPD was not severe enough” and “HCP did not recommend it” were the top reasons behind this characteristic (each 27%). Switching to the cohort of patients who had tried maintenance medications, researchers found that the primary type tried was rescue inhalers, and willingness to try another therapy was commonly reported (77%). When asked about inhaler ease of use, the study pointed out that more patients reported agreement with a statement expressing that it is “hard to breathe fast/hard enough with some inhaler doses” (28%) over statements expressing difficultly coordinating breathing with pushing the inhaler button (14%) or understanding instructions (13%). Lastly, researchers observed that a greater proportion of patients on maintenance medications in the past 3 months (n = 1,319) did not vs. did miss a dose (65% vs. 35%), and among those who did, “I simply forgot to take it” was the most common reason (61%; n = 449).“I suspect future studies will be similar to this one, with the hope that in the interim, clinicians will do a better job of educating patients and therapies may also change,” Mannino said. 

For more information: https://tinyurl.com/5f9kpzzz

Week of September 21, 2025

Air pollution tied to 91,000 premature deaths yearly

London, UK - Certain diverse groups, including the Black and Asian populations, were especially affected. Air pollution from oil and gas in the U.S. contributes to tens of thousands of deaths, chronic diseases and health complications annually, according to a new study published in Science Advances. “We don’t want to claim to have discovered these inequities in exposure. The communities living close to busy roadways or nearby petrochemical plants due to high rates of permitting know about this unfair exposure,” Elois Marais, PhD, an associate professor of physical geography at University College London in the U.K., told Healio. “What we hope our study will do is support their claims with rigorous scientific methods and datasets. ”According to Marais and colleagues, past analyses that have examined health burdens attributable to air pollutants have had multiple limitations, such as using only a single air pollutant or examining specific regions. “A consistent quantification of the adverse health outcomes and inequities associated with the myriad air pollutants from individual stages of the entire U.S. oil and gas lifecycle is crucial for policymakers to assess the benefits of transitioning to less polluting alternatives and identify the most adversely affected population subgroups to prioritize to address exposure and health inequities,” they wrote.In the current study, the researchers used 2017 data to examine the contributions the four major lifecycle stages of oil and gas — including “upstream” activities like exploration and extraction, “midstream” activities like storage and transmission, “downstream” activities like gas processing and oil refining, and “end-use” activities such as additional storage and transmission — had on air pollution and chronic health outcomes in the U.S. Marais and colleagues reported that 91,000 premature deaths were attributable to fine particulate matter (PM2.5), nitrogen dioxide (NO2) and maximum daily 8-hour running-mean ozone (MDA8 O3).Meanwhile, 10,350 preterm births, 1,610 cancer cases and 216,000 cases of childhood-onset asthma were attributable to PM2.5, hazardous air pollutants (HAP) and NO2, respectively. The end-use stage contributed to most of the PM2.5-attributable premature deaths (94%), NO2-attributable premature deaths (96%), PM2.5-attributable preterm births (94%), NO2-attributable childhood asthma cases (91%) and HAP-attributable cancer incidences (82%). Texas, Pennsylvania, California and New York were among the states that experienced the greatest health burdens attributable to the oil and gas lifecycle stages, with New York (7,200) and Pennsylvania (6,300) possessing the highest premature mortality totals for all stages from combined exposure to PM2.5, NO2 and MDA8 O3. The researchers also highlighted significant racial and ethnic disparities observed across nearly all the lifecycle stages. Among end-use disparities, the Black population experienced the greatest burden for PM2.5- and NO2-attributable mortality and PM2.5-attributable preterm births, while the Asian population had the greatest burden for HAP-attributable cancer cases and NO2-attributable asthma cases. “In essence, the Black population has a 40%“ to 60% greater chance of adverse health outcomes than national incidences,” Marais said. 

For more information: https://tinyurl.com/358kpkeh

Week of September 14, 2025

Influenza-associated hospitalizations hit record highs last season

Atlanta, GA - Influenza-associated hospitalizations reached record overall levels and peak-weekly marks during the 2024-2025 season, surpassing all rates over the prior 14 seasons, according to an analysis of nationwide surveillance data. The 2024-2025 season's cumulative flu-related hospitalization rates were 1.8 times to 2.8 times greater across all age groups than the median cumulative rates in the seasons since 2010-2011 (127.1 vs 62 per 100,000), according to researchers led by Alissa O'Halloran, MSPH, of the CDC in Atlanta. Last season's weekly flu hospitalization rate peaked in early February 2025, exceeding the previous weekly high mark set in 2017-2018 (13.5 vs 10.2 per 100,000), they noted in the Morbidity and Mortality Weekly Report. "Given similar prevalences of severe disease indicators this season compared with past seasons, the 2024-25 season's severity was likely driven by higher incidence rather than atypical clinical severity," the researchers said. "High rates observed during the 2024-25 season could have been driven by recent lower influenza vaccination coverage in the general population, as well as virus characteristics." The CDC recommends annual flu vaccination for everyone 6 months and older without contraindications. The researchers used data from the FluSurv-NET surveillance system, which includes information on flu-associated hospitalizations in patients of all ages in about 300 hospitals in 14 states. The system covers 9% of the U.S. population. They analyzed hospitalization rates from the 2010-2011 season (range 8.7 to 102.9 per 100,000) through last season. The analysis did not include the 2020-2021 flu season, when there weren't enough flu-related hospitalizations to make rate estimates. Flu hospitalization rates in the 2024-2025 season were greatest in adults 75 and older, at 598.8 per 100,000 (second only to the rate of 726.5 in 2017-2018), and lowest in children and teens ages 5 to 17 years (39.3 per 100,000). Percentages of underlying medical conditions last season matched median numbers from prior seasons. Among children ages 0 to 4 years and 5 to 17 years, asthma was the most common underlying condition (14% and 35.9%, respectively). Among adults ages 18 to 49, obesity was the most common such condition (43.9%), while chronic metabolic disease (45.6%) topped the list among those ages 50 to 64. Cardiovascular disease was the most common underlying condition for adults ages 65 to 74 and those 75 and up (57% and 69.3%, respectively). Nearly 11% of people hospitalized with the flu last year had no underlying medical conditions. As for vaccine coverage, 32.4% of those admitted had received a flu vaccine. While in the hospital, 84.8% of patients received antiviral therapy, though only 61.6% of children 5 to 17 years were given antivirals. That treatment-rate gap is "suboptimal," the study authors noted, "since all patients hospitalized with influenza should receive prompt antiviral treatment, provided they do not have contraindications." Study limitations included potential underestimation because of clinician-driven flu testing, missing vaccination status among a large proportion of the hospitalized patients (28.5%), and potential issues with generalizing the results to the full U.S. population.

For more information: https://www.medpagetoday.com/infectiousdisease/uritheflu/117446

Week of September 7, 2025

High-Dose flu shot may cut some hospitalizations in older adults

Madrid, Spain - The high-dose inactivated influenza vaccine may reduce older people's risk of hospitalization for flu or pneumonia more than a standard-dose shot, according to two large open-label, randomized clinical trials. Neither of the twin trials delivered definitive results on its own. The Danish DANFLU-2 failed to show a significant difference between the two vaccine options' hospitalization rates, while its trial-design-sharing sibling, the Spanish GALFLU study, didn't reach the expected number of events to draw statistically definitive conclusions. Pool the pair's data, however, and a significant protective trend emerged in favor of the high-dose immunization. In DANFLU-2, 0.68% of the 166,218 people who received a high-dose flu shot were hospitalized for influenza or pneumonia, as compared with 0.73% of the 166,220 people receiving the standard-dose shot, translating to a non-significant vaccine effectiveness of 5.9% (95.2% CI -2.1 to 13.4), reported Tor Biering-Sørensen, MD, PhD, of Copenhagen University Hospital in Denmark, and colleagues. GALFLU showed a stronger advantage for the high-dose shot in hospitalization rates for flu or pneumonia among adults age 65 to 79 years, with a relative vaccine effectiveness of 23.7% (95% CI 6.6-37.7). Overall, 0.26% of the 67,093 people taking the high-dose vaccine and 0.34% of the 66,789 people receiving the standard-dose vaccine were hospitalized for either outcome. But GALFLU's lack of sufficient cases didn't allow the researchers to assess statistical significance, reported researchers led by Jacobo Pardo-Seco, PhD, of the Instituto de Investigación Sanitaria de Santiago in Santiago de Compostela, Spain. Results of the two trials were published in the New England Journal of Medicine and presented simultaneously at the European Society of Cardiology Congress. Taken together, the twin trials' pooled results among older adults "showed significant reductions in the primary endpoint of influenza or pneumonia hospitalizations, as well as hierarchically tested cardiorespiratory hospitalizations, laboratory-confirmed influenza hospitalizations, and hospitalizations from any cause," the DANFLU-2 investigators wrote. 

For more Information: https://tinyurl.com/5cf6s9ju

Week of August 31, 2025

GOLD announces theme of 2025 World COPD Day

Philadelphia, PA - GOLD works with healthcare professionals and public health officials around the world to raise awareness of COPD and to improve prevention and treatment of this lung disease. Through the development of evidence-based strategy documents for management of both COPD, and events such as the annual World COPD Day and the yearly GOLD International COPD Conference, GOLD is working to improve the lives of people with COPD in every corner of the globe. Gold announced that the theme of World COPD Day, November 19, 2025, is to emphasize that shortness of breath is a symptom that should prompt patients and healthcare providers to consider a diagnosis of COPD. 

For more information: https://www.goldcopd.com

Week of August 24, 2025

New theory of aging: Pro-Aging Metabolic Reprogramming

Toronto, ON - Aging is a complex process that has long puzzled scientists. A recent study published in Engineering proposes a new theory called Pro-Aging Metabolic Reprogramming (PAMRP), which could change our understanding of aging. The traditional debate on aging has centered around whether it is a programmed process or a result of stochastic events. The PAMRP theory combines these two perspectives. It suggests that aging is driven by degenerative metabolic reprogramming over time. This involves both the buildup of pro-aging substrates (PASs) through metabolic changes and the emergence of pro-aging triggers (PATs). The combination of PASs and PATs leads to metabolic reprogramming, which in turn causes cellular and genetic reprogramming, ultimately resulting in the aging process. Metabolism plays a crucial role in the PAMRP theory. As organisms age, there are significant changes in metabolic pathways, such as shifts in energy production and nutrient utilization. These changes initially serve as an adaptive mechanism but can become maladaptive over time, contributing to aging. The theory also distinguishes between different types of metabolic reprogramming, such as adaptive and adverse, and between regenerative and degenerative processes. The study provides several lines of evidence to support the PAMRP theory. For example, the conservation of basic metabolic pathways across species and the link between metabolism and aging-related factors like entropy and mitochondrial function. Caloric restriction, which is known to extend lifespan, is also seen as evidence as it regulates key controllers of cellular metabolism.The PAMRP theory has potential implications for anti-aging interventions. It suggests that aging could be preventable, delayable, and even reversible. Compounds that mimic the effects of caloric restriction, known as calorie restriction mimetics (CRMs), could be used to target the metabolic processes involved in aging. However, more research is needed to fully understand and validate the theory, including large-scale clinical trials to test the efficacy of anti-aging interventions in humans. The PAMRP theory offers a new way of looking at the aging process and could pave the way for future research and interventions aimed at slowing or reversing aging. While the theory shows promise, further studies are required to confirm its validity and explore its full potential. 

For more information: https://tinyurl.com/2eb338np

Week of August 17, 2025

Just how harmful is vaping? More evidence Is emerging

Rochester, NY - A new study that found high levels of heavy metals in popular nicotine vapes adds to concerns about the products. When vapes started to become popular in the mid-2010s, the tiny cartridges carried big promises. They were presented as a healthier alternative to cigarettes and a path to quit smoking. Now, researchers are coming to understand the hazards of vapes themselves. In a study from last month, for example, a team of scientists analyzed the mist from popular vapes and found such high levels of heavy metals that one researcher thought their machine had malfunctioned. Other studies have suggested that vaping can affect the heart, lungs and brain. Experts said they were worried that vaping may become harder to study after the Trump administration shut down a unit focused on smoking and health. The government has also slashed funds for programs that help people stop vaping. Data on the long-term health effects is limited, because vapes are relatively new and constantly evolving. Many people who use them are in their teens or 20s; it might take a while before further effects become apparent. Consumers also often use both cigarettes and vapes, which makes it difficult to isolate harms from vaping alone. Vaping is still less common than cigarette use among U.S. adults, 4.5 percent of whom said they vaped in 2021. Nearly 8 percent of high school students reported vaping in the last month in a 2024 survey. Even so, “common sense tells you — your mom would tell you — that a superheated chemical inhaling right into your lungs isn’t going to be good,” said Dr. James H. Stein, a professor of cardiovascular medicine at the University of Wisconsin School of Medicine. Increasingly, research is pointing to the reality that while vapes do not contain the same dangerous chemicals as cigarettes, they come with their own harms. A hit from a vape immediately stresses the cardiovascular system. Your heart rate rises and your blood vessels constrict, which can stiffen arteries in the heart over time. When you vape “all day long, over and over and over again — you’re basically walking around with high blood pressure,” Dr. Stein said. These effects could raise the risk of developing an irregular heart rhythm, stroke and even a heart attack. When vapes heat liquids to higher temperatures, they can release larger amounts of harmful chemicals that can seep into the lungs, enter the bloodstream and flow to the heart, said Irfan Rahman, a researcher at the University of Rochester Medicine who studies nicotine products. The liquids in e-cigarettes can release known carcinogens, like formaldehyde and acetaldehyde, when heated. These and other chemicals can damage blood vessels, drive inflammation and contribute to cardiovascular disease risk. When people quit vaping, they can also experience nicotine withdrawal that can increase heart rate and blood pressure, Dr. Stein added. Vaping causes inflammation in the airways and lungs that can become chronic, Dr. Stein said. It can also exacerbate asthma and symptoms of chronic obstructive pulmonary disease and can lead to a persistent cough and shortness of breath. While we don’t know yet whether vapes cause cancer, which can take decades to develop, we know they can expose users to substances associated with increased cancer risk. Brett Poulin, an assistant professor of environmental toxicology at the University of California, Davis, tested three popular disposable vape brands and found that they released high levels of nickel and antimony, heavy metals linked to lung cancer. (Dr. Poulin’s team also found that vapes release large amounts of lead, a neurotoxin.) Chemicals used in flavored vapes, especially disposable ones, can also damage cell membranes, which increases the risk of lung damage and cancer, as well as heart disease, Dr. Stein said. In rare cases, patients have developed lung scarring and breathing issues known as “popcorn lung” after inhaling diacetyl, a compound in some flavored vapes. (Major vape brands currently say they do not use diacetyl.) In 2019, an outbreak of serious lung injuries, including 68 deaths, was linked to vapes that contained vitamin E acetate. As with cigarettes, pouches and other products that contain nicotine, vapes limit blood flow to the gums, which makes them more vulnerable to disease and infection. Nicotine can also damage gum tissue, Dr. Rahman said. Dr. Pamela Ling, the director of the U.C.S.F. Center for Tobacco Control Research and Education, has worked with teens who sleep with vapes tucked under their pillows and reach for them first thing in the morning. Research has shown that e-cigarettes are addictive. Dependence can be especially problematic for adolescents, whose brains are developing. There are still some support programs for quitting, and smoking cessation medications may offer relief. But it can also be an agonizing process, bringing on withdrawal symptoms like depression, anxiety and irritation. Compounding those concerns: Even more addictive vapes that contain higher levels of nicotine are hitting the market. Dr. Ling said it was now easy to find vapes that have 20,000 puffs of nicotine — an amount rivaling 100 packs of cigarettes. “New products come out on the market faster than we can do science,” she said. 

For more information: https://tinyurl.com/7xy6u6s7

Week of August 10, 2025

Rise in respiratory-related ED visits follows wildfire smoke episode in Ontario 

Toronto, ON - Following a period of heavy wildfire smoke in Ontario, daily ED visits for asthma-related causes rose and stayed up for several days after, according to research published in CMAJ. “Our study indicates that there are opportunities to modify public health impacts of future wildfire smoke,” Hong Chen, PhD, research scientist at Health Canada, senior adjunct scientist at the Institute for Clinical Evaluative Sciences and assistant professor at the Dalla Lana School of Public Health, told Healio. In this quasi-experimental study, Chen and colleagues evaluated the number of ED visits/syndromes in Ontario during early June 2023 and late June 2023, when “heavy wildfire smoke blanketed much of Ontario,” to determine how this wildfire smoke impacted residents’ respiratory and cardiovascular health. “The differential wildfire health impact between the major smoke episodes has not been investigated and reported previously,” Chen said. Between April 1 and May 31, 7.4 μg/m3 was the average PM2.5 concentration in Ontario, and this went up to 53.2 μg/m3 during the early June smoke episode and 65.3 μg/m3 during the late June episode, according to the study. Researchers specifically looked at ED  syndromes/visits for asthma-related causes, other respiratory causes, ischemic heart disease and non-cardiorespiratory causes via Ontario’s real-time syndromic surveillance system (Acute Care Enhanced Surveillance; ACES) and the National Ambulatory Care Reporting System (NACRS).  An interrupted time-series analysis was the primary analysis conducted, and researchers highlighted that this “adjusted for all confounders and us[ed] 2022 as a control.” After the early June wildfire smoke episode, the study reported that daily asthma-related ED syndromes from ACES were elevated from lag day 1 to lag day 6. The highest point during this period was on lag day 2 with a rise of 21.7% (95% CI, 12.9%-31.1%). Researchers observed a very similar outcome when evaluating daily asthma-related ED visits from NACRS. One day after the early June wildfire smoke episode, there was a rise in this ED visit type by 23.6% (95% CI, 13.2%-34.9%). This heightened rate of visits for asthma-related causes continued up to lag day 5, with the highest point found on lag day 1. For ED syndromes/visits for other respiratory causes and non-cardiorespiratory causes, researchers found no significant change in these rates following the early June episode using ACES data and NACRS data. There was a significant rise in ischemic heart disease-related ED syndromes on lag day 5, 6 and 7 following the early June episode using ACES data, but this was not found using NACRS data. Switching to the late June wildfire smoke episode, ED syndrome/visit rates for other respiratory causes, non-cardiorespiratory causes and ischemic heart disease did not significantly change after this episode using ACES data and NACRS data. Daily asthma-related ED syndromes/visits also did not significantly go up in either dataset. Researchers reported that a case-crossover analysis yielded comparable results. Reflecting on the above results, Chen told Healio there have been mixed findings regarding the impact of wildfire smoke on cardiovascular health. “Some studies found increased [emergency room] visits and hospitalizations from cardiovascular diseases with wildfire smoke, but other studies reported no association,” Chen said. According to Chen, there are three main reasons why the impact on cardiovascular health could not be identified in the current study: “differences in population characteristics (eg, the differences in underlying health status of populations or compliance to air quality health messages during the wildfire events), differences in wildfire smoke, which is inherently a complex mixture, and differences in the study methodologies.” This study also focused on acute effects, Chen said.

For more information: https://tinyurl.com/5n7s8hfs

Week of August 3, 2025

Synthetic Nicotine Storms Onto the Vaping Scene

Los Angeles, CA - Unregulated synthetic nicotine analogues, namely 6-methyl-nicotine branded as Metatine in Spree Bar flavored vaping products, have gained "appreciable" awareness and youth among youth, the first prevalence survey showed. In the survey of 1,760 people ages 14 to 25 years, 20.1% recognized 6-methyl-nicotine products, and 8.4% said they had ever used one, reported Adam M. Leventhal, PhD, of the Institute for Addiction Science at the University of Southern California (USC) in Los Angeles, and colleagues in Pediatrics.  "These study findings emphasize the need for targeted regulatory activities addressing synthetic nicotine analogues to prevent uptake among young populations” Leventhal and colleagues concluded. Synthetic nicotine analogues are marketed in flavored vaping products that anti-tobacco groups argue appeal to youth.   regulation of flavored vaping products in general has faced a tough battle, the synthetic nicotine analogues are bypassing U.S. tobacco regulatory safeguards altogether. These products fall into what the researchers called a concerning gap both because they are exempt from premarket tobacco product application (PMTA) requirements and because of their pharmacologic impact. While toxicity in humans remains unclear for these products that have recently entered the market, "animal studies indicate that 6-methyl-nicotine produces systemic toxicity, including neurotoxic effects, potentially at levels higher than nicotine," with methylation at points on the nicotine molecule that might enhance its addictive potential and biological effects. "Indeed, the Spree Bar website claims that Metatine (i.e., 6-methyl-nicotine) provides 'pleasure and enjoyment,' 'combines well with flavors,' 'tastes great,' 'poses no additional risk,' and is 'half the price' and 'tax exempt,'" Leventhal's group pointed out. The cross-sectional study used data from the USC Tobacco Center of Regulatory Science-Teen and Young Adult Tobacco Study, for which participants were recruited through the CINT online platform that connects researchers with opt-in panels of U.S. residents interested in participating in surveys for compensation.

For more information: https://tinyurl.com/m9bwufnp

Week of July 27, 2025

Dupilumab benefits patients with COPD, type 2 inflammation regardless of emphysema

San Francisco, CA - Among patients with COPD and type 2 inflammation, investigator-reported emphysema did not change benefits seen with dupilumab, according to research presented at the American Thoracic Society International Conference. “In the BOREAS and NOTUS trials, one of the inclusion criteria was the presence of cough and expectoration for 3 months in the previous year,” Surya P. Bhatt, MD, professor in the division of pulmonary, allergy and critical care medicine at The University of Alabama at Birmingham, told Healio. “The findings of this study indicate that the benefits of dupilumab in patients with COPD and type 2 inflammation are not confined to those with predominant airway disease but are also applicable to those with emphysema,” Bhatt said. In this post hoc analysis of pooled BOREAS and NOTUS phase 3 trial data, Bhatt and colleagues assessed 1,874 adults with moderate to severe COPD and type 2 inflammation (blood eosinophil count ≥ 300 cells/μL) who were current or former smokers to determine if investigator-reported emphysema impacts benefits observed with dupilumab (Dupixent; Sanofi, Regeneron) in exacerbation rate and lung function. As Healio previously reported, 300 mg dupilumab every 2 weeks for 52 weeks showed a decrease in the annualized moderate/severe exacerbation rate, a positive change in prebronchodilator FEV1 and safety in adults with moderate to severe COPD and type 2 inflammation at week 52 in a pooled analysis of BOREAS and NOTUS. Notably, receiving dupilumab for 52 weeks also led to health-related quality of life improvement in the pooled population. Researchers reported emphysema in 590 patients (31.5%), of which 289 received dupilumab and 301 received placebo. In both those with and without investigator-reported emphysema, the rate of annualized moderate/severe exacerbations dropped to a similar degree with dupilumab vs. placebo (with emphysema, relative risk [RR] = 0.66; 95% CI, 0.53-0.82; without emphysema, RR = 0.7; 95% CI, 0.58-0.85), according to the analysis. Between baseline and week 12, researchers additionally found a comparable level of improvement in prebronchodilator FEV1 with dupilumab vs. placebo when split into those with emphysema (least-squares mean difference, 83 mL; 95% CI, 35-131) and those without emphysema (least-squares mean difference, 83 mL; 95% CI, 45-120).Researchers noted that there was no significant difference in either outcome between the group with emphysema and the group without emphysema, signaling that dupilumab was beneficial regardless of whether the patient had investigator-reported emphysema. “These findings are reassuring in that future studies of biologics targeting airway inflammation do not need to exclude individuals with emphysema,” Bhatt said. 

For more information: https://tinyurl.com/38nabawp

Week of July 13, 2025

Influenza now killing more Nova Scotians than COVID-19

Halifax, NS - Flu shot uptake in Nova Scotia for the current respirtory season is highest in older adults, with 63 per cent of people 65 and older having had one. That's more than twice that of the general population. For the first time since the start of the COVID-19 pandemic, the number of Nova Scotians dying from influenza exceeds the number of COVID deaths. According to the province's latest respiratory watch report,124 Nova Scotians have died from influenza during the 2024-25 respiratory season, which runs from Aug. 25, 2024, and will go up until Aug. 29, 2025. There have been 108 COVID deaths so far this season. Dr. Lisa Barrett, an infectious diseases doctor, said the fact there are fewer deaths due to COVID than influenza isn't any kind of positive development for the general population. "Some people have said, 'Oh, thank goodness, we're back to normal,'" she said. "And I'm like, 'Well, now we've got two viruses — not just one — that are still in the really important category for hospitalizations, bad lungs and deaths." Barrett said this year's global flu season was one of the worst of the last decade. Dr. Lisa Barrett, an infectious diseases doctor and researcher at Dalhousie University in Halifax, says a lot of people are dying from influenza and COVID-19. "Yes, influenza has taken over from COVID, but they're both higher than we'd like them to be," she said. Dr. Robert Strang, Nova Scotia's chief medical officer of health, said pandemics don't last forever and COVID-19 has become endemic. He said it is not surprising that influenza deaths have topped COVID-19 deaths. "This is what we'd expect as we return to more of a normal respiratory virus season with a mix of viruses," he said. Where COVID-19 dominated so much discussion in past years, other respiratory illnesses — influenza and respiratory syncytial virus (RSV) in particular — didn't get nearly as much attention. "For some people, we don't need to be as strongly afraid of COVID, but we need to be very respectful and take seriously all respiratory viruses," said Strang. He's encouraging people to practise the same measures that were preached during the peak days of the pandemic. That means washing hands, wearing masks where appropriate, staying home during an illness and getting vaccinated. Dr. Robert Strang, Nova Scotia's chief medical officer of health, says people need to take all respiratory viruses seriously. (CBC) But, on the latter point, fewer people are doing that. Data provided by the province shows that while 29 per cent of the overall population got their flu shots for the 2024-25 season, it was only 18 per cent for COVID-19. For the previous year's campaign, the percentages were 32.8 per cent and 22.8 per cent, respectively. "These vaccines are very effective against preventing ... severe illness and death," said Strang. "That's what we should be focusing on. How do we reduce that number of respiratory virus deaths? And it's through vaccines." Strang said the province will be expanding eligibility for the RSV vaccine this fall to include people 75 and above, regardless of where they live. Previously, eligibility for the publicly funded vaccine was restricted to people 60 and above living in long-term care or in hospital awaiting long-term care placement. 

For more information: https://tinyurl.com/2fnzyuap

Week of June 8, 2025

Germany plans global alternative to PubMed

Bonn, Germany - On March 1, the world's largest database for biomedical literature-- PubMed -- went down, immediately causing a global panic that the nation's essential publishing resource was yet another casualty of the new administration's many budget cuts and executive orders. "OMG, Did PubMed Go Dark?' Blackout Stokes Fears" read the headline in Nature. Though the outage was apparently just a glitch and PubMed was back up the next day, the pause in the ability to access published research prompted the fear that PubMed could disappear, and soon. After all, 3 weeks earlier, the Trump administration cut $4 billion in "indirect costs" that have historically supported medical research in hospitals and other organizations. Other cuts threatened the NIH's external and internal research programs. Many scientists anticipated -- correctly as it turned out -- the cancellation of previously approved spending on hundreds of existing federal grants. The administration had already dismantled the U.S. Agency for International Development. Now that fear has spurred some to action, but not in the U.S. ZB Med, or the German Library of Medicine, has launched an effort to create an open-source global literature infrastructure which its developers are calling a PubMed "alternative." They say there's a need to create such a service in case U.S. funding is curtailed or the quantity or quality of its 37 million citations fall victim to politicization, or a DOGE-like chain saw attack of its trained personnel, sources told MedPage Today. OLSPub or Open Life Science Publication Database would create "a drop-in replacement for what the [National Library of Medicine] currently offers in the event that PubMed is no longer available," Konrad Förstner, one of OLSPub's two project managers, said during a May 14 webcast announcing the project. The session, held in German, was released on May 21 on YouTube with English subtitles. The organizers have committed to an 18-month startup. "There are movements in the USA that concern some of us; for example that research funding has been cut for topics like diversity, that many people are saying that contact has been broken off between researchers, that researchers from the USA have withdrawn," said Miriam Albers, PhD, the other project manager. She noted having a dependence "on one government, on one donor, is simply something that can perhaps be dangerous." They acknowledged the project is not yet funded and is still gathering supporters. 

For more information: https://tinyurl.com/2ej5hjms

Week of June 1, 2025

Diagnostic schema identifies individuals with COPD without airflow obstruction

San Francisco, CA - Using imaging and respiratory symptoms, researchers identified up to 15.4% of individuals without airflow obstruction as having COPD, according to research presented at the American Thoracic Society International Conference. This study, which also found that these individuals vs. individuals without COPD had poorer clinical outcomes, was simultaneously published in JAMA. “The new diagnostic schema has the potential to change clinical practice by making it easier to diagnose patients with COPD when spirometry is not available or does not meet current thresholds for airflow obstruction,” Surya P. Bhatt, MD, professor in the division of pulmonary, allergy and critical care medicine at The University of Alabama at Birmingham, told Healio. “The schema brings the diagnosis closer to the definition of COPD, which includes emphysema and airway disease. “It will also help better characterize individuals with airflow obstruction who may not necessarily have structural changes on lung imaging nor significant respiratory symptoms,” Bhatt said. “These individuals should be closely followed in clinical practice.” In this cohort study, Bhatt and colleagues assessed 9,416 adults (mean age, 59.6 years; 53.5% men; 32.6% Black; 52.5% current smokers) in the COPDGene study and 1,341 adults (mean age, 66.6 years; 56.1% men; 0.7% Black; 41.3% current smokers) in the Canadian Cohort Obstructive Lung Disease (CanCOLD) to uncover if use of a multidimensional COPD diagnostic schema increases the number of individuals classified with COPD and if these patients experience/have elevated risks for four different clinical outcomes.“COPD is a complex heterogenous disease, and many other disease diagnoses have included multidimensional assessments to make a diagnosis,” Bhatt told Healio. "There has been a growing impetus in the respiratory community to move beyond using just airflow obstruction on spirometry for the diagnosis of COPD. “We have known for a while now that several individuals have structural changes on CT that are compatible with a diagnosis of COPD but have not yet developed airflow obstruction,” he continued. “On the other hand, the symptoms of COPD are rather nonspecific. Therefore, the new diagnostic schema integrates spirometry, imaging and respiratory symptoms and aims to provide a more precise diagnosis of COPD.” 

For more information: https://tinyurl.com/35kjr4hz

Week of May 25, 2025

Dupilumab helps patients with COPD, type 2 inflammation avoid negative outcomes

San Francisco, CA - The likelihood for avoidance of five clinically important outcomes in patients with COPD and type 2 inflammation was greater with dupilumab vs. placebo, according to findings from a win ratio analysis. These data on dupilumab (Dupixent; Sanofi, Regeneron) were presented at the American Thoracic Society International Conference. “Dupilumab is already approved for eligible patients with uncontrolled COPD, but these data provide further granularity on the potential impact,” Sanjay Ramakrishnan, PhD, MBBS, FRACP, senior lecturer at The University of Western Australia and research group leader at the Institute for Respiratory Health, reported Healio. “When compared to placebo, patients on dupilumab had a decreased likelihood of a composite of events including death, hospitalization, worsening symptoms and lung function decline. “Physicians can now clearly explain to patients the ways in which they stand to benefit with adding dupilumab into their COPD management plan: running the COPD race with dupilumab means you are 31% more likely to avoid a combination of potentially debilitating outcomes,” Ramakrishnan said.In this win ratio analysis, Ramakrishnan and colleagues assessed adults with moderate to severe COPD and type 2 inflammation (blood eosinophil count ≥ 300 cells/μL) receiving triple therapy from the BOREAS and NOTUS phase 3 trials to find out the difference in clinically important endpoints at 52 weeks between patients receiving 300 mg dupilumab every 2 weeks (n = 938) and patients receiving placebo (n = 936). Notably, a win ratio analysis is “a simple way to appreciate the benefit of [a] treatment” using the most clinically important outcomes, Ramakrishnan said. “Assessing multiple endpoints simultaneously in clinical trials can be challenging because not all outcomes have equivalent clinical importance,” Ramakrishnan said. “A win ratio analysis provides a way to evaluate key outcomes in tandem, but also ranks them in order of clinical importance, allowing for a more complete and appropriate comparison of multiple endpoints between dupilumab and placebo.” The most clinically important outcome in this patient population was “avoiding hospital,” according to the analysis. Researchers also identified moderate exacerbations, lung function loss and symptom deterioration as clinically important outcomes. All four factors plus death made up one outcome. “The approach creates a single measurement that provides a more accurate reflection of treatment efficacy that takes into account the impact of different clinical outcomes on a patient’s life,” Ramakrishnan said. All incorporated into one outcome, researchers reported that the likelihood for avoidance of death, hospitalization, exacerbations, worsening symptoms and worsening lung function was 31% greater (win ratio, 1.31; 95% CI, 1.15-1.48) in the dupilumab vs. placebo group. “Patients receiving dupilumab are 31% more likely than placebo to ‘win’ on a combination of important outcomes,” Ramakrishnan said. Dupilumab continued to be favored over placebo when broken down into the individual clinically important outcomes, according to the analysis. Researchers highlighted that dupilumab had more wins — achievement of the more desirable outcome — vs. losses than placebo for death or a hospital admission/ED visit lasting 24 hours or longer (7.6% vs. 5.6%), moderate exacerbation or ED visit lasting less than 24 hours (22.1% vs. 17.9%) and total number of moderate or severe exacerbations during the evaluated 52 weeks (3.8% vs. 2.8%). “What was quite striking was every 16th patient treated with dupilumab stopped having exacerbations completely,” Ramakrishnan said. “This is incredible, considering participants were having an average of two exacerbations in the previous year.” Dupilumab also had more wins vs. losses for percent-predicted post-bronchodilator FEV1 worsening of at least 100 mL at week 52 compared with placebo (12.1% vs. 8.2%), according to the analysis. Lastly, improvement in St. George’s Respiratory Questionnaire or Respiratory Symptom Tool for COPD scores was won more than lost by dupilumab vs. placebo (2% vs. 1.5%). “We are pleased that the results were in line with what we would have expected based on the pivotal phase 3 trials for dupilumab in COPD, underscoring how it improves multiple, clinically important signs and symptoms of disease compared to placebo,” Ramakrishnan said. Looking ahead, Ramakrishnan said this analysis may have an impact on future trials in patients with COPD. “These data could inform novel ways of conducting clinical trials in COPD to researchers and funders, by demonstrating a robust unified approach to simultaneously rank and assess outcomes of clinical importance to patients,” Ramakrishnan concluded.

For more information: https://tinyurl.com/2rk3938e

Week of May 18, 2025

Women face elevated risk for COPD regardless of cigarette smoking status

Concord, NH - The risk for COPD was heightened among women vs. men who ever smoked, and this was also true among women vs. men who never smoked, according to results published in BMJ Open. “Because COPD has been traditionally thought of as a disease of men who smoke, the main takeaway for everyday clinicians is that women, even women who have never smoked, can get COPD,” Alexander W. Steinberg, MD, assistant professor of clinical practice in the division of pulmonary, critical care and sleep medicine at University of Washington Medical Center and past fellow at Dartmouth Hitchcock Medical Center, told Helio. Using data from the 2020 National Health Interview Survey, Steinberg and colleagues evaluated responses from 23,028 adults aged 40 years or older to determine how gender and cigarette smoking impact the risk for COPD. Researchers divided the cohort into men (n = 10,390) and women (n = 12,638) and found that more women reported physician-diagnosed COPD (7.8% vs. 6.5%). When split based on smoking status, women continued to have a greater weighted COPD prevalence vs. men in both the never smoked cohort (3.2% vs. 1.7%) and the ever smoked cohort (15.9% vs. 11.5%). In contrast, more men reported being former cigarette smokers than women (33.2% vs. 24.4%), and the same was true for current cigarette smokers (13.9% vs. 11.8%). Mean pack-year exposure among those who smoked more than 100 cigarettes in their lifetime was also higher in the group of men (24.4 vs. 20.2), according to the study. Additionally, the proportion of never cigarette users was higher among women vs. men (63.7% vs. 52.9%). Researchers further divided the cohort based on the presence of a COPD diagnosis. Similar to above, more men vs. women with COPD reported former cigarette use (53.3% vs. 41%) and a higher mean pack-year exposure (41.8 vs. 34.8), and more women with COPD never used cigarettes (26.4% vs. 14.3%). The proportion of current cigarette users was comparable in both COPD groups (men, 32.4% vs. women, 32.5%). Other notable smoking characteristics that differed by gender in those with COPD included a lower average number of daily cigarettes in the group of women vs. men (17.6 vs. 21.7) and a lower proportion of women who started smoking before age 15 years (19.1% vs. 28%), according to the study. Researchers also observed a higher proportion of men vs. women with COPD who used cigars (55.6% vs. 20.9%), pipes (35.1% vs. 7.8%) and smokeless tobacco (25.5% vs. 4.6%), but more women vs. men used e-cigarettes (26.4% vs. 19.7%). Following adjustment for several variables (“age, race, family poverty ratio, urban/rural county, pack-year cigarette exposure [per 10 pack-years], age started smoking and e-cigarette use”) and smoking status, researchers found a significantly increased risk for COPD diagnosis among women vs. men (adjusted risk ratio [aRR] = 1.47; 95% CI, 1.3-1.65). Regardless of smoking status, the study noted that women faced a significantly heightened risk for COPD diagnosis compared with men (never smoked, aRR = 1.62; 95% CI, 1.22-2.15; ever smoked, aRR = 1.43; 95% CI, 1.25-1.63). When assessing gender and pack-years, researchers reported no significant interaction between the two factors relating to COPD prevalence, and this was also the case for gender and smoking status. “The main unexpected finding was that while women had a higher risk of COPD despite smoking less, this did not appear to be due to a greater disease prevalence per pack-year exposure,” Steinberg said. “That suggests the high relative rate of COPD in women isn’t driven by a higher susceptibility to smoking. This was also supported by the finding that among never smokers, women still had increased rates of COPD. “My hope is future work can continue to try to understand, in addition to smoking, what drives COPD especially among women,” Steinberg said. 

For more information: https://tinyurl.com/4vd6fczz

Week of May 11, 2025

Another biologic reduces COPD exacerbations

Oxford, UK - Mepolizumab (Nucala) helped prevent exacerbations of chronic obstructive pulmonary disease (COPD) when added to background triple inhaled therapy among patients with an eosinophilic phenotype, the phase III MATINEE trial showed. The anti-interleukin-5 monoclonal antibody cut the annualized rate of moderate or severe exacerbations by a relative 29% compared with placebo (0.80 vs 1.01 events per year, P=0.01), reported Ian Pavord, DM, of the University of Oxford in England, and colleagues in the New England Journal of Medicine. Add-on treatment also delayed time to first moderate or severe exacerbation after randomization (Kaplan-Meier median 419 vs 321 days, HR 0.77, 95% CI 0.64-0.93, P=0.009). "Given that the patient population was already receiving triple therapy and in some cases macrolides and phosphodiesterase-4 inhibitors, that the benefit of mepolizumab as compared with placebo was maintained over 2 years, and that mepolizumab appeared to be safe, these results are promising," wrote Mark T. Dransfield, MD, of the University of Alabama at Birmingham, and Daiana Stolz, MD, of the University of Freiburg in Germany, in an accompanying editorial. However, they cautioned that there were no health-related quality of life, respiratory symptoms, or lung function benefits as previously seen with dupilumab (Dupixent) in a similar COPD population with an eosinophilic phenotype, leading to FDA approval. Dupilumab might be "better than mepolizumab at targeting the complex airway inflammation in COPD, owing to the combined antagonism of interleukin-4 and interleukin-13 with dupilumab as compared with the blocking of interleukin-5 alone with mepolizumab," they suggested. However, "it is notable that none of these trials showed a reduction in the risk of severe exacerbations resulting in hospitalization, which suggests that we have much more to learn about selecting patients for these expensive treatments and that additional biomarkers of response are needed," they added. Some 20% to 40% of COPD patients have elevated blood eosinophil counts characterizing eosinophilic inflammation. "It seems that mepolizumab very likely has a place in the treatment of a subset of patients with COPD who are at risk for exacerbations. However, there is work to do to better define the target population, so let's try, try, and try again," Dransfield and Stolz concluded. The phase III MATINEE trial included 804 patients ages 40 and older (mean age 66, 31% women) who were on inhaled triple therapy for COPD, had a blood eosinophil count of at least 300 cells/μL at screening, and had in the year prior to screening at least two moderate exacerbations treated with systemic glucocorticoids or at least one severe enough to require hospitalization for 24 hours or more. Although COPD characterized as chronic bronchitis was present in 68% of patients, this was not required for enrollment as it was in the dupilumab trials. Patients were randomly assigned to receive 100-mg mepolizumab or placebo subcutaneously every 4 weeks for 52 weeks or extended to 104 weeks. Hierarchical statistical testing of secondary endpoints stopped after the first -- health-related quality of life -- didn't show a significant difference between groups. Adverse event rates were similar between groups as well. Pavord and team called it a strength that the trial enrolled a broad population of patients in whom coexisting asthma had been rigorously excluded but acknowledged underrepresentation of Black patients and limitations due to the COVID-19 pandemic. "Thus, patient behaviors, dropout rates, and reduced exposure to viral and bacterial pathogens may have contributed to exacerbation rates that were lower than those expected before the pandemic," they noted. "Spirometry was performed with the use of local equipment with limited or partial central review, which potentially limited the ability to detect differences in lung function between the mepolizumab and placebo groups." 

For more information: https://tinyurl.com/44bkpext

Week of May 4, 2025

Antiviral reduced transmission of influenza to close contacts

Ann Arbor, MI - A single dose of the antiviral baloxavir marboxil (Xofluza) led to a lower incidence of influenza virus transmission to household contacts compared with placebo, a phase IIIb randomized trial showed. Five days after receiving the intervention, the adjusted incidence of transmission of laboratory-confirmed influenza was 9.5% with baloxavir compared with 13.4% with placebo (adjusted OR 0.68, 95.38% CI 0.50-0.93, P=0.01), resulting in an adjusted relative risk reduction of 29%, reported Arnold Monto, MD, of the University of Michigan School of Public Health in Ann Arbor, and colleagues in the New England Journal of Medicine. The adjusted incidence of transmission of influenza virus by day 5 that resulted in symptoms was 5.8% with baloxavir and 7.6% with placebo, but this difference was not significant (adjusted OR 0.75, 95.38% CI 0.50-1.12, P=0.16). However, the authors noted that the incidence in the placebo group was lower than their a priori assumptions from sample-size calculations, "possibly because of COVID-19 pandemic-related behavioral changes leading to fewer cases for evaluation."  "Most members of the households in this trial were mainly unvaccinated, and how previous vaccination may affect the incidence of transmission after baloxavir treatment remains unclear," Monto and team wrote. "In a pandemic, development of a vaccine would take time, and the availability of an antiviral drug that reduces disease severity and person-to-person transmission could serve as a new element to combat such a pandemic." "Although vaccines will remain the primary control measure for influenza epidemics and pandemics, antiviral drugs play a complementary role, particularly in a pandemic scenario, as well as in persons who are not vaccinated seasonally," they added. Monto and colleagues reported that the difference in transmission incidence favoring baloxavir occurred "across age groups, seasons, influenza types (A[H1N1pdm09], A[H3N2], and B), times from symptom onset to receipt of baloxavir or placebo, and geographic regions. The matching of influenza subtype and the timing of the trial assessments mitigate the low likelihood of transmission from a non-household source of infection during the follow-up period, which would dilute the treatment effect." In an accompanying editorial, Timothy M. Uyeki, MD, MPH, of the CDC's National Center for Immunization and Respiratory Diseases, and co-authors suggested that it's unclear how baloxavir might perform with novel influenza A viruses. "Data are lacking on the efficacy, effectiveness, appropriate dose administration, or duration of baloxavir use for the treatment or post-exposure prophylaxis of novel influenza A viruses of pandemic potential, including highly pathogenic avian influenza A(H5N1) virus, which limits the use of baloxavir in real­-world public health strategies," they wrote. "During the early phase of an influenza pandemic, when pandemic influenza vaccines are not yet available, early treatment with baloxavir, with its ability to decrease viral shedding, might have greater benefit in reducing transmission than when it is used for seasonal influenza, because most exposed persons will lack specific immunity to the pandemic influenza virus and household transmission is expected to be high," they noted. Though 7.2% of index patients showed emergence of drug-resistant viruses during follow-up, none of these viruses were detected in household contacts. "All influenza antiviral drugs exert a selective pressure on viruses, which can result in the emergence of drug-resistant variants," Monto and team explained. Still, the potential for baloxavir resistance is a concern, the editorialists noted. "Transmission of influenza viruses with reduced baloxavir susceptibility has been uncommon, but transmission of drug-resistant viruses remains a public health concern for all antiviral medications," they wrote. "Thus, ongoing global surveillance for drug­-resistant influenza virus is essential to inform antiviral use." This study, conducted during the 2019-2024 flu seasons across multiple countries, involved 1,457 index patients ages 5-64 who were randomly assigned to receive baloxavir or placebo in the first 48 hours after symptom onset, as well as 2,681 household contacts. Baloxavir was given to 726 index patients, while 731 received placebo. The primary analysis population of index patients included 548 in the baloxavir group (mean age 30.8, 54.7% female) and 544 in the placebo group (mean age 31.8, 51.1% female).No new safety concerns were reported in treated index patients. 

For more information: https://tinyurl.com/3mxfudzf

Week of April 27, 2025

GOLD COPD exacerbation history groups ‘mediocre’ in exacerbation risk estimation

Maastricht, Netherlands - The Global Initiative for Chronic Obstructive Lung Disease, or GOLD, COPD exacerbation history groups were “mediocre” in estimating moderate and severe exacerbation risk at 1 and 4 years, according to results published in JAMA Network Open. “This study revealed poor performance of GOLD’s current cutoffs of two or more moderate [exacerbations of COPD (ECOPD)], one or more severe ECOPD or both for estimating future COPD-related outcomes,” Kiki Waeijen-Smit, MSc, postdoctoral researcher at Maastricht University’s department of respiratory medicine, and colleagues wrote. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD exacerbation history groups were “mediocre” in estimating moderate and severe exacerbation risk at 1 and 4 years, according to study results. Using the German COPD and Systemic Consequences-Comorbidities Network study, Waeijen-Smit and colleagues evaluated 2,291 patients (mean age, 65 years; 60.9% men; mean estimated FEV1, 52.5%) with COPD to determine if the current GOLD groupings using COPD exacerbation history (A, B and E) are accurate in estimating three outcomes: moderate exacerbation risk at 1 and 4 years, future severe exacerbation risk at 1 and 4 years and all-cause mortality risk at 4 years. During a 4.5-year follow-up period, 1,996 patients had data for visit 2, 1,724 had data for visit 3, 1,182 had data for visit 4 and 878 had data for visit 5.Based on area under the receiver operating characteristic curve (AUROC), researchers reported “poor performance” of the COPD exacerbation history categories in estimating 1-year moderate exacerbation risk (AUROC, 0.63; sensitivity, 39.8%; specificity, 85.5%). When estimating severe exacerbation risk, a comparable AUROC was found (0.62; sensitivity, 47.3%; specificity, 76.8%). Switching to estimating 4-year COPD exacerbation risk, AUROCs continued to stay around 0.6 for moderate exacerbation risk estimation (0.6; sensitivity, 35.1%; specificity, 85.3%) and severe exacerbation risk estimation (0.61; sensitivity, 42.7%; specificity 78.8%), according to the study. “The cutoff value with the optimal sensitivity and specificity scores to estimate 1-year moderate ECOPD was 1 moderate and 1 severe ECOPD event within 12 months,” Waeijen-Smit and colleagues wrote. Researchers reported that the above cutoff finding held true for 4-year moderate exacerbation risk estimation, 1-year severe exacerbation risk estimation and 4-year severe exacerbation risk estimation. “Novel cutoffs were suggested, categorizing patients as without exacerbations or with high-risk exacerbations based on a history of 1 or more moderate ECOPD, 1 or more severe ECOPD or both within 12 months,” Waeijen-Smit and colleagues wrote. “Future studies are needed to validate the proposed cutoffs and elaborate further on other determinants aside from ECOPD history to estimate ECOPD risk, as well as their optimal, clinically applicable combination with the proposed novel approach,” Waeijen-Smit and colleagues wrote. “Moreover, the association of this lower cutoff with potential overtreatment of patients and subsequent financial implications needs to be evaluated.” 

For more information: https://tinyurl.com/mw6x9rf8

Week of April 20, 2025

Patients with COPD plus depression or anxiety experience greater disease burden

Columbus, OH - Patients with COPD plus a depression/anxiety disorder had poorer scores related to disease burden and health-related quality of life, according to data published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation. “This study confirms that depression and anxiety disorders are common among people with COPD,” Gennie (Jing) Wang, MD, assistant professor of internal medicine and medical director of the pulmonary function testing lab at The Ohio State University Wexner Medical Center, told Healio. “There is a need for greater recognition and treatment of comorbid depression and anxiety among patients with COPD and to include mental health assessments as part of comprehensive COPD care.” In a cross-sectional, secondary analysis of the Anxiety and COPD Evaluation, Wang and colleagues assessed 220 patients with COPD who underwent the Mini-International Neuropsychiatric Interview (MINI) to determine the prevalence of depression and anxiety disorders that meet diagnostic criteria in this population. Researchers then compared several measures of disease burden captured via questionnaires in patients with vs. without depression/anxiety disorders. Based on MINI criteria, the study reported a current major depressive disorder in 18 patients (8%) and a current anxiety disorder in 17 patients (8%). After breaking down those with an anxiety disorder into specific diagnoses, researchers noted that 10 had agoraphobia, six had a panic disorder, six had PTSD, four had generalized anxiety disorder and three had social anxiety disorder. Between those with vs. without a depressive disorder, researchers found significant differences in age (median, 60 years vs. 66 years; P = .016) and household income (< $22,000; 61% vs. 30%; P = .014). Switching to those with vs. without an anxiety disorder, age significantly differed between the two groups (median, 59 years vs. 65 years; P = .018), as did age of COPD onset (median, 48 years vs. 55 years; P = .03). 

For more information: https://tinyurl.com/ev3htc57

Week of April 13, 2025

Subclinical cardiac damage evident among cigarette smokers, even quitters

Baltimore, MD - Markers of subclinical heart damage were observed among individuals who smoke cigarettes, even decades after quitting, according to a study published in the Journal of the American College of Cardiology. New data from the Cross-Cohort Collaboration-Tobacco Work Group showed that cigarette smoking was associated with elevated markers of inflammation, thrombosis and atherosclerosis, all of which decreased after cessation, except for coronary calcium, which remained elevated 30 years later. “Understanding the mechanisms of smoking-related injury and the most sensitive biomarkers of subclinical harm is critical to clinical trial planning and tobacco regulatory policy, and might be important for planning studies and informing regulatory of new and emerging tobacco products as well,” Michael J. Blaha, MD, MPH, professor of medicine and director of clinical research at the Ciccarone Center for the Prevention of Cardiovascular Disease at Johns Hopkins Medicine, said. “The degree to which new and emerging tobacco products affect these same biomarkers will need to be explored.” The data included 22 studies with 182,364 participants with at least one of nine markers of subclinical CVD measured at baseline: high-sensitivity C-reactive protein, interleukin-6, glycoprotein acetylation, fibrinogen, D-dimer, coronary artery calcium, carotid intima-media thickness, carotid plaque and ankle-brachial index. All patients (mean age, 58 years; 69% women) self-reported smoking status, intensity and/or pack-years. Overall, 15.3% of participants reported currently smoking, with an average of 16.7 cigarettes per day and a mean of 30 pack-years. More than one-third (34.6%) of participants reported formerly smoking, with a median of 19 years since quitting and mean of 22.4 pack-years. The researchers reported that, compared with never smokers, all former and current smokers had higher levels of all imaging and physiological markers for subclinical atherosclerosis (P for all < .05) and all blood markers of inflammation and thrombosis (P for all < .05), except for D-dimer among former smokers (OR = 1; 95% CI, 0.96-1.04). Among participants who reported currently smoking, Blaha and colleagues observed a 1% to 9% increase in all imaging, physiological and blood markers, except for D-dimer, per 10 cigarettes smoked. Beyond the smoking intensity of 20 cigarettes per day, levels of blood markers of subclinical CV damage plateaued while markers of atherosclerosis continued to rise, according to the study. “Smoking affects a diverse array of biomarkers of subclinical CV injury across multiple domains — inflammation, thrombosis and atherosclerosis — which is quite alarming,” Blaha said. “Even low levels of smoking cause cardiovascular injury that can persistent long after dose reduction — less cigarettes per day — or cessation.” 

For more information: https://tinyurl.com/pzut3de4

Week of April 6, 2025

Use spirometry to detect COPD during lung cancer screenings 

Philadelphia, PA - Due to the destructive nature of COPD on patients’ lungs and well-being, timely diagnosis is key, and integrating spirometry at the time of lung cancer screening could help identify this disease early in an at-risk population. “COPD remains vastly underdiagnosed,” Nathaniel Marchetti, DO, professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University and medical director of the respiratory intensive care unit at Temple University Hospital, told Healio. “In the U.K., they find that anywhere from 30% to 60% of the people that underwent low-dose CT and spirometry had airflow obstruction, had evidence of COPD, but didn’t know it,” Marchetti added. The value of spirometry at the time of lung cancer screening is largely due to the individuals that are recommended to undergo this screening, Marchetti told Healio. “With the low-dose CT screening population, we have a group that’s at an extremely high risk for having COPD because they have a very significant pack-year history of smoking,” Marchetti said. As previously reported in late 2023, a study using the Danish LC Registry and the National Registry of COPD during a 10-year period found a substantial overlap between patients with COPD and individuals referred to undergo lung cancer diagnostics. Additionally, a study published in 2020 in Annals of the American Thoracic Society reported that 57% of 986 U.K. individuals from the Lung Screen Uptake Trial had COPD as measured using pre-bronchodilator spirometry. Of these, 67% had undiagnosed COPD, which was classified as no prior diagnosis of COPD, chronic bronchitis or emphysema but meeting the Global Initiative for Obstructive Lung Disease (GOLD) criteria using spirometry. Marchetti highlighted that individuals newly diagnosed with COPD at the time of lung cancer screening usually have early rather than late-stage COPD, allowing the opportunity for treatment before the disease progresses. “With any disease, not just COPD, the earlier, the better,” Marchetti told Healio. Notably, COPD is not the only disease/condition that can be caught early during lung cancer screening. According to Marchetti, interstitial lung abnormalities, thyroid nodules, coronary artery calcifications, liver masses and breast masses could be found. “If you’re paying the money to get a CAT scan of the chest that includes the thyroid, the heart, the lungs, the chest wall and upper part of the abdomen, you should look at everything,” Marchetti said. A study published in Radiology also found that assessment of body composition measurements on lung cancer screening low-dose CT scans revealed patients at high risk for mortality due to lung cancer, cardiovascular disease and all causes. 

For more information: https://tinyurl.com/y4pwhmv3

Week of March 30, 2025

Wood dust exposure negatively impacts lung function

Ribat, Sudan - Between a group of carpenters and an age-, sex- and height-matched group of university employees, carpenters had worse average lung function values, according to results published in BMC Pulmonary Medicine. “Wood dust’s effects on carpenters’ respiratory systems are worth further discussion,” Noura Mohamed Elfatih, of the department of physiology at The National Ribat University in Sudan, and colleagues wrote. “Awareness campaigns should be undertaken to educate carpenters about lung health and preventative measures.” In a comparative cross-sectional community-based study, Elfatih and colleagues assessed 65 carpenters (mean age, 51.6 years; mean BMI, 21.9 kg/m2) and 65 university employees (mean age, 49.8 years; mean BMI, 22.6 kg/m2) matched to the carpenters by age, sex and height to uncover how wood dust exposure impacts four lung function measures: FEV1, FVC, FEV1/FVC ratio and peak expiratory flow rate (PEFR). Notably, the university employees did not have “prior occupational exposure to respiratory dangers,” according to the study. Within the carpenter group, 30.76% (n = 20) worked for 1 to 10 years, 27.69% (n = 18) worked for 11 to 20 years, 20% (n = 13) worked for 21 to 30 years and the remaining 21.53% (n = 14) worked for more than 30 years. Researchers found respiratory problems in a little over one-third of the evaluated carpenters (35.4%; n = 23). Most reported sneezing (n = 11) or cough (n = 8) whereas fewer reported shortness of breath (n = 3) or chest pain (n = 1). When assessing FEV1, matched individuals had a mean value of 3.07 L, whereas carpenters had a mean value of 2.5 L, which the study noted as a significant reduction (P < .001). Researchers also found a significantly decreased mean FVC in the carpenter group vs. the matched group (2.92 L vs. 3.39 L; P < .001). This pattern of significantly lower values among carpenters vs. matched individuals continued during the evaluation of mean FEV1/FVC (86% vs. 90.58%; P < .001) and mean PEFR (467.39 L/minute vs. 476.71 L/minute; P < .001), according to the study. When divided based on years working/years of wood dust exposure, researchers observed that each lung function measure went down with a greater number of years, and the carpenter group had smaller values than the matched group in the years of exposure/work ranges. Between the carpenters and matched individuals, the carpenters had significantly reduced mean FEV1 when split into 11 to 20 years of exposure (2.52 L vs. 3.15 L; P < .001), 21 to 30 years (2.25 L vs. 2.96 L; P = .002) and more than 30 years (2 L vs. 2.78 L; P < .001). In the same years of exposures as above, researchers reported significantly decreased mean FVC in carpenters vs. matched individuals: 11 to 20 years (2.88 L vs. 3.47 L; P < .001), 21 to 30 years (2.63 L vs. 3.29 L; P = .003) and more than 30 years (2.41 L vs. 3.11 L; P < .001). Carpenters with 1 to 10 years of wood dust exposure had a significantly poorer mean FEV1/FVC than matched individuals with 1 to 10 years working (89.2% vs. 91%; P = .031). According to the study, this was also the case when analyzing those with 11 to 20 years of exposure/work (87.5% vs. 91%; P = .004), 21 to 30 years of exposure/work (85.55% vs. 90%; P = .01) and more than 30 years of exposure/work (82.9% vs. 89.38%; P < .001). Lastly, researchers found significantly lower mean PEFR in carpenters with 11 to 20 years of exposure/work vs. matched individuals with this number of years (476.9 L/minute vs. 485.7 L/minute; P = .005), as well as in carpenters with more than 30 years of exposure/work vs. matched individuals with this number of years (426.1 L/minute vs. 444.6 L/minute; P < .001). In terms of correlation, the study highlighted that wood dust exposure length was significantly (P < .001) correlated to three lung function measures: FEV1, FVC and PEFR. “To reduce the detrimental effects of wood dust on carpenter respiratory health, we recommended that individuals receive preemployment instructions on the risks and wear personal protection equipment at the workplace,” Elfatih and colleagues wrote. “In addition, regular medical check-ups and good ventilation in the workplace should be considered.” 

For more information: https://tinyurl.com/ycxutv8c

Week of March 23, 2025

Restricting flavored e-cigarettes cuts vaping rates but raises smoking rates for young adults

Columbia, Missouri - In recent years, vaping has become popular as an alternative to traditional cigarettes. Flavored electronic cigarettes—known as e-cigarettes—have become so popular among young adults that some states have implemented restrictions such as flavor bans and taxes on e-cigarettes in an effort to reduce teen vaping. A new study from researchers at the University of Missouri and the Yale School of Public Health found that state restrictions on flavored e-cigarettes led to a decrease in vaping among young adults in the United States. However, those restrictions also led to an increase in traditional cigarette smoking among young adults compared to states without such restrictions. The findings show that well-intentioned public health policies can have unintended effects—a topic of interest for Mizzou's Michael Pesko, a professor of economics in the College of Arts and Science. "We should always be cognizant that any policy will have unintended effects, especially in the public health space. In this case, our study finds flavored e-cigarette restrictions have the unintended effect of sizably increasing cigarette use," Pesko said. "This is not good from a public health perspective because cigarettes are far more dangerous products. It's the equivalence of steering a ship away from a storm straight into a whirlpool." A reasonable and achievable policy goal is to reduce tobacco-related disease and death, Pesko said. "One important component to achieving that is to enact policies that shift away from the most harmful tobacco products to less harmful alternatives," he said. "E-cigarette flavor restrictions have the opposite effect of pushing many people towards more harmful tobacco." In the study, Pesko also found that in Maryland, a state with a policy that exempted menthol-flavored e-cigarettes from a ban on other flavors, both vaping and smoking rates decreased, showing that a more nuanced approach to regulation might be the best way to tackle public health issues. The popularity of e-cigarettes began to rise around 2010. Pesko worked at the Centers for Disease Control and Prevention at the time, and the trend sparked his interest in his current research. The paper, "Flavored e-cigarette sales restrictions and young adult tobacco use," is published in JAMA Health Forum. 

For more information: https://tinyurl.com/3x3vvzba

Week of March 16, 2025

Genetic Risk Predictor Might Boost Detection of Undiagnosed 

Ann Arbor, Michigan - Considering a risk score generated from multiple genetic variants linked to chronic obstructive pulmonary disease (COPD) caught undiagnosed cases of the disease better than conventional risk factors and respiratory symptoms alone, a study showed. Adding the COPD polygenic risk score (PRS) to the Lung Function Questionnaire clinical risk score significantly improved the area under the curve by 0.03 to 0.06, suggesting a 3 to 6 percentage point increase in accuracy in identifying spirometry-defined, moderate to severe COPD, as researchers led by Matthew Moll, MD, MPH, of Brigham and Women's Hospital and Harvard Medical School in Boston, reported in JAMA. If a threshold of 10% risk of COPD was used to make spirometry referrals, the addition of the polygenic risk score correctly reclassified 13.8% of COPD cases in one of the cohorts analyzed for validation but didn't improve reclassification in the other. "The findings suggest that an individual's genetic risk for COPD, as indicated by a PRS, has a potential added value to conventional case-finding approaches for identifying undiagnosed COPD and guiding referrals for confirmatory spirometry, particularly in community-based settings," the group concluded. While the U.S. Preventive Services Task Force recommends against spirometry to check everyone for COPD, some 5% of adults have undiagnosed COPD, based on Framingham Heart Study findings, and some 70% of COPD in the U.S. is undiagnosed. "Underdiagnosis of COPD is a significant global problem," commented Wassim W. Labaki, MD, of the University of Michigan in Ann Arbor, whose group previously reviewed risk assessment tools for COPD. "Timely diagnosis is essential to initiate appropriate medical therapy early in the disease course and to prioritize addressing modifiable contributing factors such as cigarette smoking, occupational hazards, and environmental exposures." Genetic testing, while not yet routine for any screening or case-finding in clinical practice, is appealing to help select individuals for spirometry testing, as it "only needs to be performed once, can aid in identifying risk for several diseases, and shows potential for complementing questionnaires for COPD case-finding," Labaki noted. And, Moll's group noted, whole-genome genotyping can cost $35 or less per person. "A potentially practical approach would be to apply the PRS in the case finding of COPD among individuals who already have their genome genotyped for other reasons." Since the COPD PRS was developed based on the U.K. Biobank and SpiroMeta (also largely European) genome-wide association study data, Moll and colleagues analyzed its performance on two cohorts of U.S. patients. 

For more information: https://tinyurl.com/4fuhnt85

Week of March 9, 2025

Will the egg shortage affect flu shots? 

Nashville, TN - While millions of vaccine doses are made using chicken eggs each year, experts say the current egg shortage won't hamper next year's flu vaccine production cycle. Previous bird flu outbreaks and decades-old public health infrastructure have led industry to protect the hens used for vaccine production, experts told MedPage Today. Moreover, flu vaccines that don't require eggs are available, and mRNA-based flu shots are in development. William Schaffner, MD, professor of infectious diseases at Vanderbilt University Medical Center in Nashville, said that during a bird flu scare about 20 years ago, "it became clear that the entire egg production had to be ... protected from wild bird contamination." "The manufacturers who use eggs to produce influenza vaccine control very, very carefully the supply of eggs and the hens that produce them," Schaffner told MedPage Today. Indeed, a Sanofi spokesperson told MedPage Today that the eggs used to manufacture vaccines are pharmaceutical grade and produced in a controlled environment. "Sanofi's network of egg suppliers utilizes biosecurity measures to protect the flocks from A/H5N1 outbreaks," the spokesperson wrote. "Our biosecurity protocols are designed to prevent pathogens from entering sites where eggs and egg-based vaccines are made," they said, adding that Sanofi maintains contingency flocks year-round. Egg-based vaccines have been dominant since the 1940s, though newer technologies and methods are available, including the new recombinant flu vaccines. 

For more information: https://tinyurl.com/yc5kr9e3

Week of March 2, 2025

Smoking before age 15 years raises COPD risk in later years

Vermont, NH - The adjusted risk for COPD was elevated among adults who identified as regular cigarette smokers before age 15 years, according to results published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation. Notably, adjustment was for multiple smoking factors, including smoking status, cigarette pack-years, smoking duration, secondhand smoke exposure and sociodemographic covariates, according to researchers. “Even though childhood cigarette smoking rates are declining, it is crucial to continue to support ongoing guidelines and efforts aimed at reducing childhood smoking,” Laura M. Paulin, MD, MHS, pulmonologist with Dartmouth Health, told Healio. “Our research reinforces that the developing lungs of children are particularly vulnerable to cigarette smoking, and delaying and avoiding cigarette initiation completely has the potential to markedly decrease COPD risk decades later.” In this study, Paulin and colleagues assessed 10,126 adults (53.4% women; 80.2% white) aged 40 years or older from the Population Assessment of Tobacco and Health Study in 2018 to 2019 to determine how COPD risk is linked to age of regular smoking initiation (< 15 years old vs. ≥ 15 years old). Researchers used multivariable analysis that accounted for smoking status, cigarette pack-years/smoking duration, second-hand smoke exposure and sociodemographic covariates to find this relationship. As Healio previously reported, this research group found that in adulthood, the risk for COPD rose with regular cigarette smoking starting before age 15 years in a study published in American Journal of Respiratory and Critical Care Medicine. Notably, this study accounted for the above factors except second-hand smoke exposure. Nearly half of the total cohort never smoked (47.2%), and researchers observed more former smokers than current smokers (35.3% vs. 17.5%). A self-reported COPD diagnosis was noted for 13.4% of adults, and this diagnosis was reported more frequently in the cohort who started smoking regularly before age 15 years vs. the cohort who started smoking regularly at age 15 years or older and the cohort who never smoked (29% vs. 21.1% vs. 7.5%). Researchers observed that 45.9% of the group who started smoking regularly before age 15 years were current smokers, which was significantly larger than the 33.3% observed in the group who started smoking regularly at age 15 years or older. Compared with the cohort of regular smokers at age 15 years or older, the study noted more mean pack-years in the cohort of regular smokers before age 15 years (48.8 vs. 30.8). In terms of smoking duration, the mean length of time was 34.2 years for those reporting early-onset/childhood smoking, whereas this length of time was shorter for those reporting later-onset smoking (27.3 years). Lastly, second-hand smoke exposure based on the past 7 days was higher among the regular smokers before vs. at 15 years or older (10.1 hours vs. 5.7 hours), according to the study. After accounting for these measures of cigarette use, researchers found that childhood cigarette smoking raised the risk for COPD (adjusted RR = 1.27; 95% CI, 1.06-1.51). “It is remarkable that the association between early age of starting cigarette smoking with COPD prevalence remained significant, even when accounting for multiple measures of cigarette use throughout the lifetime, well beyond the time of cigarette onset,” Paulin told Healio. 

For more information: https://tinyurl.com/ye2y9tn8

Week of February 23, 2025

Chronic lower respiratory diseases rank sixth on 2022 top causes of death

Atlanta, GA - In 2022, chronic lower respiratory disease was the sixth highest cause of death in the U.S., according to results published in National Vital Statistics Reports. Using 2022 death certificate data from the 50 U.S. states and District of Columbia, Sally C. Curtin, MA, statistician at the CDC, and colleagues evaluated causes of death to determine the most reported causes. Diseases of the heart topped the 2022 list, and chronic lower respiratory diseases occupied the sixth spot. Notably, the report included bronchitis, emphysema, asthma and “other chronic lower respiratory diseases” in this classification. Compared with 2021 U.S. death certificate data, the report highlighted a 3.5% rise in the number of deaths due to chronic lower respiratory diseases in 2022. When researchers broke down deaths from chronic lower respiratory diseases by sex, females had a greater burden of deaths vs. males (5% vs. 4%), but for both sexes, this cause of death held the sixth spot. The report also split up the deceased into six age groups: 1 to 9 years; 10 to 24 years; 25 to 44 years; 45 to 64 years; 65 years and older; and 85 years and older. In five age groups, chronic lower respiratory disease was one of the 10 leading causes of death. It ranked tenth in the 1-to-9-year group, ninth in the 10-to-24-year group, seventh in the 45-to-64-year group, fifth in the 65 and older group and sixth in the 85 year and older group. Of the five non-Hispanic racial groups, researchers observed the highest rank of chronic lower respiratory disease deaths among white individuals (fifth leading cause; 5.2% of total deaths). Notably, this cause was found in the top 10 leading causes of death in the remaining four racial groups: American Indian and Alaska Native (seventh; 3.2% of total deaths), Black (eighth; 2.7% of total deaths), Native Hawaiian and other Pacific Islander (eighth; 2.4% of total deaths) and Asian (10th; 2% of total deaths). Among Hispanic individuals, death due to a chronic lower respiratory disease was ninth on the list of leading causes (2% of total deaths), according to the report. Additionally, researchers assessed causes of infant death in this year and reported respiratory distress of newborn as the eighth leading cause. “Cause-of-death ranking is a standard method of presenting mortality statistics and is a useful tool for illustrating the relative burden of cause-specific mortality, but it must be used cautiously with a clear understanding of the limitations underlying the method,” Curtin and colleagues wrote.

For more information: https://tinyurl.com/mtuc8zk5

Week of February 16, 2025

Flu at highest level in 15 years, CDC data show

Atlanta, GA - CDC data show that seasonal influenza activity is significantly elevated across the United States, and that influenza activity is at its highest level in more than 15 years. According to the CDC, there have been at least 24 million illnesses, 310,000 hospitalizations and 13,000 deaths — including 57 pediatric deaths — related to influenza this season.One way the CDC tracks the severity of influenza seasons is by estimating the percentage of outpatient and ED visits that are attributed to influenza-like illness (ILI), which the CDC updates weekly. ILI rates climbed as high as around 7.4% during the 2022-2023 season and 7.7% during the 2017-2018 season, but the 2024-2025 influenza season has peaked even higher at 7.75% in the most recent week with available data — the highest rate since the 2009 swine flu pandemic. Additionally, the rate of clinical lab tests that were positive for influenza reached a high of 31.6% as of Feb. 1, up from 29.4% the week before and 18.6% at the start of the year. “To my recollection, this is the most severe flu season we've had in the last 15 years,” Aaron E. Glatt, MD, MACP, FIDSA, FSHEA, chairman of the department of medicine and chief of the division of infectious diseases at Mount Sinai South Nassau and professor of medicine at the Icahn School of Medicine at Mount Sinai, told Healio. Most cases reported and subtyped in the most recent influenza surveillance report were influenza A viruses H1N1 (53.7%) and H3N2 (46.3%). The CDC noted that no cases were H5 bird flu, and that there has yet to be a case of H5 human-to-human transmission. Glatt said he does not believe there is one specific factor causing the surge in influenza cases this season. Instead, he explained that there could be many contributing factors, including the end of masking, social distancing and other COVID-19 pandemic-era precautions that “tremendously suppressed” respiratory illness transmission, as well as people becoming more comfortable being in large groups in small spaces again. Another possible reason is a lack of immunity from not having influenza during the previous few seasons because of these and other precautions, Glatt said. “Obviously, that doesn't apply to everybody and that doesn't apply as an absolute blanket statement, but that must be contributing to it,” he said. “There are probably other factors as well, but it's not unusual,” he added. “We've had bad flu seasons in the past, prior to COVID.” Glatt’s message to providers and patients is that the vaccine is safe and can have a huge impact on illness severity. Perspective from William Schaffner, MD “They have to realize that the flu vaccine is not a perfect vaccine, but it's a safe vaccine. It may not prevent you from getting the flu, but it certainly will have a role in preventing you from getting much more serious flu, and I think that's very, very important for people to realize,” he said. “Flu is a fatal disease — not for everybody, but it can be. Therefore, it's very important that people get vaccinated and take the appropriate precautions.” We are in the midst of a very large influenza outbreak right now here in the U.S. It covers essentially the entire country, and it looks to be among the most serious influenza outbreaks over the last 20 years. It's certainly true that my hospital’s ICUs and EDs are full of patients who are seriously ill with influenza. This is conventional seasonal influenza, not bird flu. The two leading viruses are both influenza A viruses — H1N1 and H3N2. It's affecting, as you can imagine, the entire spectrum of the population — even healthy people can be put in the ED within 48 hours by influenza — but it hits most severely the people in high-risk groups, including people aged 65 years and older; people who have an underlying chronic medical condition of any kind, including heart disease, lung disease, diabetes — you name it — and people who are immunocompromised. Many people among them, of course, are unvaccinated. It's very late, but if you haven't been vaccinated, do so today. Don't wait. And make a resolution this fall in preparation for the next influenza season. Everyone aged 6 months and older should take advantage of influenza vaccine. 

For more information: https://tinyurl.com/4uwyzjt8

Week of February 9, 2025

Over 2 million Americans projected to get cancer diagnosis this year

Atlanta, GA - The American Cancer Society projected approximately 2 million new cancer diagnoses and 618,000 new cancer deaths in the U.S. in 2025, with a cancer burden increasingly borne by younger populations, particularly women. While cancer continues to be a leading cause of death overall in the U.S., and the leading cause among persons under the age of 85, "there is really some good news here," said William Dahut, MD, chief scientific officer of the American Cancer Society, during a press briefing. "There is a decrease in cancer mortality." Specifically, due to smoking reductions, earlier detection of some cancers, and improvements in treatment, there was a 34% drop in the cancer death rate from 1991 through 2022. This translated to about 3 million fewer cancer deaths in men and about 1.44 million fewer deaths in women than if mortality had remained at its peak, according to the society's annual cancer statistics report, led by Rebecca Siegel, MPH, of the American Cancer Society in Atlanta, and published in CA: A Cancer Journal for Clinicians . However, Siegel and colleagues noted that progress is lagging in cancer prevention, as incidence rates continue to increase for several cancers, including melanoma, prostate cancer, breast cancer, colorectal cancer, and pancreatic cancer. They also said disparities in cancer incidence and mortality continue to be concerning, with native Americans bearing the highest cancer mortality, including rates double to triple those in white people for kidney, liver, stomach, and cervical cancer, while Black people have a twofold higher mortality than white people for prostate, stomach, and uterine corpus cancers. "And there are some things that we really need to be more conscious of," Dahut added. "Particularly, that is the change in the risks that are gender based, and the continued shift [in cancer risk] to younger populations." Although overall cancer incidence has generally declined in men, it has risen in women, with the result that the male-to-female rate ratio has narrowed from a peak of 1.6 in 1992 to 1.1 in 2021. Moreover, rates in women ages 50 to 64 years surpass those in men (832.5 vs 830.6 per 100,000), and younger women (younger than 50 years) have an 82% higher incidence rate than males in the same age group (141.1 vs 77.4 per 100,000), up from 51% in 2002. 

For more information: https://tinyurl.com/5n7ah4kc

Week of February 2, 2025

Getting lung cancer screening staff involved improved tobacco cessation

Houston, TX - Integrating smoking cessation into a lung cancer screening program had the biggest benefit for patients who wanted to quit, a randomized trial showed. Self-reported tobacco abstinence was greater at both 3 and 6 months with higher levels of integration of smoking cessation assistance in the lung cancer screening program, reported Paul Cinciripini, PhD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues in JAMA Internal Medicine. Patients who received 12-week nicotine replacement therapy or prescription pharmacotherapy and counseling by tobacco treatment specialists within the lung cancer screening program had the highest rate of abstinence (37.1% at 3 months and 32.4% at 6 months). This was significantly better than the 25.2% and 20.5% rates among those given nicotine replacement therapy and counseling through the quit line without any lung cancer screening program clinician involvement (OR 1.75 at 3 months and 1.86 at 6 months, both P=0.01). A hybrid intervention with quit line referral plus 12 weeks of nicotine replacement therapy or pharmacotherapy prescription by the lung cancer screening clinician also led to higher self-reported quit rates than the least integrated intervention at 3 months, but this didn't differ significantly from either other group at 6 months (27.1% and 27.6% at the two time points). "For those who smoke, lung cancer screening presents a critical opportunity for us to support them in quitting," Cinciripini said in a statement. In an accompanying editorial, Judith Prochaska, PhD, MPH, of Stanford University in Palo Alto, California, wrote that the trial "lends strong support for intensive, integrated tobacco cessation treatment within [lung cancer screening] programs and for considering integration more broadly." Smoking cessation counseling is already recommended for people who meet criteria for annual lung cancer screening, as approximately 60% of U.S. patients eligible for this screening currently use tobacco, she noted. While it's been known that formal smoking cessation programs increase the likelihood of quitting, "and evidence is strongest for interventions that provide multiple contacts with patients," the most effective way of delivering this assistance hasn't been clear, Prochaska added. 

For more information: https://tinyurl.com/3wy9d4bz

Week of January 26, 2025

Risk for cardiovascular events stays high one year after COPD exacerbation

London, UK - After a COPD exacerbation, patients face a raised risk for cardiovascular events. The time linked to the greatest risk for nonfatal cardiovascular events differed based on exacerbation severity. Among patients with COPD who experienced an exacerbation, the risk for cardiovascular events was highest in the following 2 weeks and stayed elevated more than 1 year after, according to study results. These findings were published in American Journal of Respiratory and Critical Care Medicine. “Given the novel finding of sustained [hazard ratios] beyond a year after exacerbation irrespective of exacerbation severity, long-term cardiovascular health should be prioritized in addition to reducing exacerbation events and optimizing COPD management,” Emily L. Graul, MS, a research assistant in epidemiology at Imperial College London at the time of this study, and colleagues wrote. “If we can proactively screen for cardiac state (eg, using echocardiography) in patients with COPD, perhaps we can treat and/or prevent future events.” Using the Clinical Practice Research Datalink Aurum primary care database, Graul and colleagues assessed 213,466 patients with COPD in England between 2014 and 2020, to find out how the risk for incident, nonfatal hospitalized cardiovascular events changes based on time since COPD exacerbation and exacerbation severity. Conditions that fell under cardiovascular events included acute coronary syndrome, arrhythmia, heart failure, ischemic stroke and pulmonary hypertension. A total of 146,448 patients experienced an exacerbation, and a greater number of patients experienced moderate vs. severe exacerbations first (119,124 vs. 27,324). In terms of cardiovascular events during the median 2.4-year follow-up period, researchers observed 40,773 events. The most common cardiovascular event was arrhythmia (49.3%), followed by heart failure (31.1%), acute coronary syndrome (10.1%), ischemic stroke (5.88%) and pulmonary hypertension (3.66%). Compared with the cohort without exacerbations, the crude incidence rate of cardiovascular events per 100 person-years was greater in the cohort with exacerbations (8.79 vs. 3.66). Further, within the cohort of those who experienced an exacerbation, researchers noted a higher incidence rate in the severe vs. moderate exacerbation group (15.7 vs. 7.79 per 100 person-years). Considering all COPD exacerbations, the risk for nonfatal cardiovascular events was heightened as soon as 1 to 14 days after the exacerbation (adjusted HR = 3.19; 95% CI, 2.71-3.76), and this period had the greatest risks for three individual cardiovascular events: heart failure (aHR = 2.87; 95% CI, 2.36-3.5), arrhythmias (aHR = 2.86; 95% CI, 2.36-3.47) and pulmonary hypertension (aHR= 2.85; 95% CI, 1.57-5.17). As time passed, the risk fell but was still increased after the 1-year mark (aHR = 1.84; 95% CI, 1.78-1.91). The time linked to the greatest risk for nonfatal cardiovascular events differed based on exacerbation severity. For severe exacerbations, patients faced the greatest risk 1 to 14 days after the exacerbation (aHR = 14.5; 95% CI, 12.2-17.3). More specifically, researchers found elevated risks for arrhythmia (aHR = 12.7; 95% CI, 10.3-15.7) and heart failure (aHR = 8.31; 95% CI, 6.79-10.2) within the 1-to-14-day period after a severe exacerbation. In contrast, patients who experienced a moderate exacerbation faced the most increased risk for cardiovascular events 14 to 30 days after the exacerbation (aHR = 1.94; 95% CI, 1.63-2.31). Similar to the analysis that considered all exacerbations, the risk for cardiovascular events after both moderate and severe exacerbations went down after the 1-year mark but was still heightened (moderate, aHR = 1.74; 95% CI, 1.67-1.8; severe, aHR = 2.71; 95% CI, 2.59-2.86). “Although there is a clear window of opportunity for prompt clinical intervention and treatment optimization after an exacerbation, continued recognition and optimization is important for reducing this long-term cardiopulmonary risk,” Graul and colleagues wrote. “The prevention of COPD exacerbations may ultimately help reduce cardiovascular risk.” 

For more information: https://tinyurl.com/z8k959ff

Week of January 19, 2025

FDA releases draft guidance on pulse oximeter study recommendations 

Silver Spring, Mayland - The FDA announced its draft guidance on recommendations for studies assessing pulse oximeters to ensure the devices perform similarly in individuals with different skin pigments, according to a press release. Panelists at an FDA Medical Devices Advisory Committee meeting in 2022 previously pointed out that pulse oximeters show clear “disparate performance” for darker skin pigmentation. The FDA announced its draft guidance on recommendations for studies assessing pulse oximeters to ensure the devices perform similarly in individuals with different skin pigments.  Additionally, a recent systematic review published in British Journal of Anaesthesia demonstrated this fault of pulse oximeters by finding that among individuals with darker skin tones, pulse oximeters often overestimated their oxygen saturation levels. In this review, pulse oximeter inaccuracy due to darker skin tones was found in 30 out of 44 assessed studies. Prior to issuing this draft guidance, the FDA’s Medical Devices Advisory Committee met in February 2024 to discuss proposed changes to premarket studies assessing pulse oximeter performance, which were generally well received by the panelists. The recently published draft guidance recommends the use of controlled desaturation laboratory studies for device analysis but also states that real-world data collection could be used in certain cases. Additionally, studies focused on determining pulse oximeter accuracy and performance should involve many participants, according to the release. When assessing skin tone, the guidance recommends subjective and objective methods. According to the release, the Monk Skin Tone Scale is an example of a subjective method, whereas calculation of individual typology angle is an example of an objective method. The last main recommendation in the guidance is to provide a labeling statement after achieving performance accuracy in a new premarket submission. This statement should “clearly identify that the pulse oximeter has demonstrated that it performs comparably across groups of individuals with diverse skin pigmentation,” according to the release. Notably, the FDA stated in the release that the drafted recommendations outlined above and in the guidance, document are for pulse oximeters used for medical purposes rather than those used for general wellness or sporting/aviation. “This draft guidance is aligned with the FDA’s broader commitment to helping facilitate the development of high-quality, safe and effective medical devices,” Michelle Tarver, MD, PhD, director of the FDA’s Center for Devices and Radiological Health, said in the release. “Our draft recommendations are based on the best available science to help address concerns of disparate performance of pulse oximeters based on an individual’s skin pigmentation.” The FDA noted that the guidance document is not yet finalized. Comments are currently being accepted regarding the document. 

For more information: https://tinyurl.com/5bknjbc6

Week of January 12, 2025

Women's disadvantage on lung transplant waitlists may be a more global problem

Nantes, France - Women are less likely than men to get a needed lung transplant and spend an average of 6 weeks longer waiting for one, but they do better with the transplant, a French study found. In French registry data, women waited 115 days for a lung transplant on average versus 73 days for men (P<0.001). Women were also less likely to receive a lung transplant (91.7% vs 95.6%, P=0.001). However, among those who received a lung transplant, fewer women died overall during follow-up (34.4% vs 42.7%, P<0.001), with survival rates at 1, 3, and 5 years of 83%, 73%, and 70% versus 79%, 69%, and 61%, respectively, researchers led by Adrien Tissot, MD, of Nantes University Hospital in France, reported in ERJ Open "Clinicians, patients, and policymakers must acknowledge this gender difference as it's essential for appropriate action to be taken. Early listing for women or revising allocation policy of donor lung to recipient could be considered," Tissot said in a statement. And it's not just France, she said: "We believe our findings, such as the potential role of size matching and its consequence on access to lung transplantation, and length of time on the waiting list, may also apply in other countries where lung transplantation is performed." The findings corroborate and extend those from the U.S. transplant system. United Network for Organ Sharing (UNOS) lung transplantation waiting list data from 2005-2010 showed women were more likely than men to die or become too sick for transplantation within 3 years of listing (16.1% vs 11.3%, OR 1.58, P<0.001). Both UNOS and European lung transplant registries have a predominance of women waiting for lungs (60% and 58%, respectively), according to a 2019 review. "Understanding the gender disparities in transplantation is a crucial first step to making patient care better for women and reducing the time they spend on the waiting list," commented Michael Perch, MD, of Rigshospitalet in Copenhagen and chair of the European Respiratory Society's Group on Lung Transplantation, who was not involved in the research. "There could be several reasons why women are waiting an average of 6 weeks longer than men, including differences in education and health literacy, socioeconomic differences, immunological factors, and donor-recipient size matching." The researchers emphasized their finding that women with oversized lung transplantation, as defined by predicted total lung capacity ratio and weight mismatch, did not have worse survival. "Clinicians and policymakers alike must question why there is a focus on gender and size matching in transplantation when evidence shows that, in lungs, these factors do not determine a woman's chance of survival, and it ultimately risks an increase of women dying while waiting for a transplant," Perch said in a statement. "It is unacceptable for women to be waiting longer than men for these lifesaving donations, so effective corrective measures must be introduced." Size matching in France has relied solely upon height and sex, Tissot's group noted. "This study may support a more widespread use of [donor-to-recipient predicted total lung capacity ratio] for size matching, which may be more accurate and may decrease the volume reduction number, as volume reduction was associated with reduced overall survival. As a result, it may possibly allow a higher proportion of female recipients to receive male donor transplants in a safe way and thus, addressing some of the gender inequalities on the waiting list. "Because most of the data on gender differences in lung transplantation have come from the U.S., Tissot's group performed a retrospective study of patients at the 12 transplantation centers in France using data from the Cohort in Lung Transplantation (COLT) database, which had started as a registry of French transplant centers and expanded across Europe. The study included 1,710 participants (802 women and 908 men) waitlisted for lung transplant between 2009 and 2018 and followed for an average of 5.7 years after transplantation. The main underlying reason for waitlisting was chronic obstructive pulmonary disease or emphysema in most patients, followed by cystic fibrosis and interstitial lung disease. Women entered the waitlist at a younger age on average than did men (47 vs 54 years, P<0.001) and had fewer comorbidities but more pretransplant anti-human leukocyte antigen antibodies (46% vs 26%, P<0.001). Not unexpectedly, men's height and weight were higher (67 vs 53 kg and 173 vs 160 cm, both P<0.001). Women were less likely to be on long-term oxygen therapy (81% vs 86%, P=0.03) and had a greater 6-minute walk test distance (45% vs 43% of predicted, P=0.03). The main limitations of the study were the retrospective nature of the analysis, the smaller cohort compared to UNOS-based studies, a high rate of missing data for measures including volume reduction and 6-minute walking test performance, and the lack of data on reason for waitlist removal. 

For more information: https://tinyurl.com/3x8jnk72

Week of January 5, 2025

Lung cancer screening in patients with COPD is complex

Philadelphia, PA -  Performing spirometry in patients with COPD before lung cancer screening could help identify those who would benefit most from screening, according to a presentation at the 2024 GOLD COPD International Conference as reported by Helio. “Lung cancer is the most common cause of cancer death throughout the world, with an estimated 1.8 million individuals dying from lung cancer in 2022, and by 2040, an estimated 2.5 million people succumbing to this disease,” M. Patricia Rivera, MD, the C. Jane David and C. Robert Davis Distinguished Professor in pulmonary medicine, chief of the division of pulmonary diseases and critical care medicine and associate director of diversity and inclusion at the Wilmot Cancer Institute at University of Rochester Medical Center, said during her presentation. As previously reported, research presented at ESMO Congress revealed a substantial overlap between patients with COPD and patients referred to undergo lung cancer diagnostics. When thinking about causes of lung cancer, Rivera, also co-director of the North Carolina Lung Screening Registry, said the most common one is tobacco smoking, but individuals also may develop lung cancer due to radon exposure, asbestos exposure, silica exposure, family history, history of prior cancer or an underlying lung disease. Among patients with COPD, studies have found that the risk for lung cancer is elevated in the presence of smoking, Rivera said. “Individuals who smoke and have COPD are reported to have a sixfold increase incidence of lung cancer compared to individuals who smoke and do not have evidence of obstructive lung disease,” Rivera said. Rivera also highlighted para septal emphysema as a risk factor for lung cancer but noted some “conflicting data” on the factor. “There are studies that have shown that while airflow obstruction is associated with an increased risk of lung cancer, para septal emphysema actually reduces the risk,” Rivera said. Patients with obstruction and worsening obstruction have been shown to face a heightened risk for lung cancer, but Rivera followed this up by noting there are also data suggesting a potential benefit of the COPD inflammatory environment. “COPD is associated with a poor prognosis in lung cancer, but interestingly, COPD with inflammatory component or inflammatory environment may result in better [response] to immunotherapy in patients with lung cancer treated with these drugs,” Rivera said. At the present, there is uncertainty surrounding the link between COPD and lung cancer, and Rivera said this may be due to great reliance on self-reported data, emphysema reported by radiologists and spirometry when studying the diseases. “We know that these results can have reporting biases, observer error, as well as operator error, so it’s been really difficult to get to the bottom of the link between these two diseases,” Rivera said. Notably, epithelial mesenchymal transformation, chronic inflammation, oxidative stress and DNA damage are pathogenic mechanisms involved in both COPD and lung cancer, according to Rivera. “In patients with COPD, there is chronic, ongoing inflammation typically in lower airways, and this chronic inflammatory response leads to increased cytokine release, which then recruit and turn on neutrophils, macrophages as well as B and T lymphocytes,” Rivera said. “This chronic, ongoing inflammatory process is a pro-tumor inflammatory microenvironment that leads to DNA damage, genetic mutations and then the downstream effects resulting in tumor formation.” 

For more information: https://tinyurl.com/34hhejbz