Our study examined the characteristics of patients in the U.S. Bronchiectasis and NTM Research Registry who were prescribed a treatment option known as high frequency chest wall oscillation therapy to improve mucus removal in bronchiectasis (a form of lung tissue damage that causes a widening of the airways and increased phlegm or mucus production). U.S. guidelines for reimbursement of this therapy allow it to be reimbursed if patients have bronchiectasis and experience a daily cough that produces mucus or at least 2 bronchiectasis flare-ups or exacerbations in the prior year.

In this study, most patients did not receive high frequency chest wall oscillation therapy. However, those that did had more severe disease, worse symptoms, and more frequent exacerbations. Despite U.S. guidelines for reimbursement of high frequency chest wall oscillation, many patients in the Registry who meet the guidelines are not currently prescribed the therapy. These findings show that high frequency chest wall oscillation therapy is potentially not used enough to treat bronchiectasis in the United States. Also, more education for health care providers and more research are needed about advanced treatments for bronchiectasis.

Chronic obstructive pulmonary disease (COPD) is a long-term disease that impacts quality of life. Inflammation (the body’s response to harmful toxins or irritants) plays an important role in COPD and may help cause worsening symptoms and flare-ups. We studied carotenoids, the natural materials that give fruits and vegetables their yellow, orange, and red colors, and may reduce inflammation and COPD symptoms. Understanding if carotenoids are linked to better COPD results could prove nutrition is a useful tool along with standard medical care.

This study involved 98 people with COPD who were low-income in the Baltimore, Maryland area. We found that those with higher levels of carotenoids in their blood generally had better COPD-related health scores, had fewer COPD flare-ups or exacerbations, and had fewer signs of inflammation. This suggests a diet rich in carotenoids, found in fruits and vegetables, may be a good tool for improving COPD symptoms and quality of life.

Future research could test how specific nutrition programs can increase carotenoid levels and improve COPD-related health, especially for those unable to easily get healthy foods. This work may help guide future efforts to combine healthy eating habits with standard COPD treatments to improve quality of life and reduce an individual’s suffering from the disease.

The use of 3 types of inhaled medicines for chronic obstructive pulmonary disease (COPD), known as triple therapy, is a commonly used treatment. In the past, triple therapy was recommended only for people who continued to have flare-ups while using 2 COPD medicines. In 2017, the first inhaler containing all 3 types of medicines in a single device was approved in the United States. We wanted to see how triple therapy has been used, in the time since the single-inhaler option with all 3 medicines became available. We also wanted to see if treatment recommendations or advice were being followed.

This study found people with COPD who started triple therapy from 2019 through 2022 and looked at their history of flare-ups and medicine use in the previous year. We found that single-inhaler triple therapy use increased over time. Over 1/3 of people on the triple therapy were not on any other maintenance inhaler before beginning the triple therapy. Most had a history of few flare-ups, and many had none. This was more common for people using single-inhaler triple therapy.

In summary, we found triple therapy is being used for COPD often not in line with treatment recommendations, and this was more common in people using single-inhaler therapy. These findings highlight potential unnecessary triple therapy use and the need to follow treatment recommendations.

Some people with a long-term lung condition have sudden severe flare-ups of coughing, and breathlessness. These exacerbations can greatly disturb an individual’s daily life.

In this study, we followed 284 patients, comparing their lungs when they were stable, during a severe exacerbation, and again when they recovered from the flare-up. We tested samples from their airways to study the natural bacteria in their lungs and other substances related to the how the body balances its immune or defense system. We also checked if patients were using their inhalers correctly, doing breathing exercises, and eating well.

We found that during severe exacerbations, the nature of the of lung bacteria changed: some germs increased while helpful bacteria decreased. Defense-related substances that cause irritation increased, while protective substances decreased. These changes mostly reversed back after recovery from the exacerbation. Patients who followed their care routines more closely had healthier bacterial balances and lower irritation levels. These results suggest that checking lung bacteria and defense substances could help nurses identify which patients are at higher risk for future severe exacerbations. This information can help nurses provide more personalized care.

Managing COPD medicines is complex. Treatment guidelines or advice are updated each year. Both patients and health care providers have started using artificial intelligence chatbots, like ChatGPT, to answer medical questions. However, how correct and dependable these tools are, is not well understood.

In this study, 3 clinical pharmacists asked ChatGPT the same 5 questions about medicines. The pharmacists used 3 separate computers at the same time. This created 15 total responses. Each pharmacist then rated each response for how correct and useful it was and whether any differences between the responses could affect patient care. The pharmacists each did this alone, without talking to the other pharmacists. Then the pharmacists discussed their ratings of the responses with each other several times until they all agreed.

The results showed that ChatGPT's answers differed in quality, even when asked the same question at the same time. In one case, all 3 ChatGPT responses mentioned an outdated COPD guideline, which could lead to patients receiving the wrong medicines. While most responses were at least somewhat helpful, the differences between them could affect treatment decisions.

These findings suggest that chatbots should not yet replace decisions made by health care providers. Health care providers should check any recommendations created by chatbots against the most current treatment guidelines before using them in patient care.

Two lung function tests that are used commonly in alpha-1 antitrypsin deficiency (alpha-1) lung studies are the forced expiratory volume in 1 second (FEV₁) and the diffusion capacityof the lung for carbon monoxide (DLCO). These lung function tests have not lined up well with medical treatment results in the 50 years that these have been used.

In this study, we looked at how these test results often vary from a large National Institute of Health database in which individuals with alpha-1 were given 3 or more lung function tests over more than 4 years. Using the information from 832 individuals, FEV₁, which reflects how much air someone can forcefully exhale, varied by more than 10% between different tests in the same person, in 82% of people. The differences in results for the DLCO were similar with differences of more than 10% between tests in the same person, in 91% of people.

This research calls into question whether FEV₁ and DLCO changes should be used in medical research studies for alpha-1.

Chronic obstructive pulmonary disease (COPD) is a long-term lung condition that can make breathing difficult. Some people with COPD have high levels of eosinophils, a type of blood cell involved in inflammation (the body’s response to harmful toxins or irritants) and allergic responses. However, little is known about how common allergic sensitization (being sensitive to allergy triggers) is among people with this type of COPD.

We studied 174 former smokers with eosinophilic COPD. We used skin tests to check for sensitivity to 14 common allergens (triggers or irritants), including dust mites, pets, molds, and pollens. We also measured immunoglobulin E, a substance in the blood that is often elevated in people with allergies.

We found that nearly half of participants were sensitive to at least one allergen, and about one-third had elevated immunoglobulin E. Overall, more than half had one or both findings. Allergic sensitization was common even among people who did not have asthma. People who owned cats were also more likely to be sensitive to cat allergens.

These findings suggest that allergic sensitization is common among people with eosinophilic COPD, including those without asthma. Future studies are needed to determine whether identifying allergic sensitization and reducing exposure to allergens could improve symptoms, prevent COPD flare-ups, or help guide treatment.

People with chronic obstructive pulmonary disease (COPD) often experience shortness of breath during exercise or activity. A fear of becoming breathless leads many to avoid exercise. This can lead to a worsening of their physical well-being, creating an endless, negative loop. Previous studies have shown that anxiety and depression can make this cycle worse by increasing distress and reducing the motivation to stay active.

Pulmonary rehabilitation is a known treatment that improves a person’s ability to exercise while also improving their quality of life. However, it may not fully address the emotional challenges that come with having COPD. Adding mental health or psychological support may help break the endless loop of not being active which leads to being even less able to be active. Psychological support during pulmonary rehabilitation may also improve the overall results of the rehab program. Our review looked at medical research studies that compared pulmonary rehab programs that included mental health support with pulmonary rehab programs that did not include this support.

The findings show that adding mental health or psychological support significantly reduces anxiety. Depression symptoms also improved, especially among individuals with higher levels of depression before starting the rehab program. These results highlight the value of including psychological care in routine pulmonary rehabilitation to address both physical and emotional needs.