pulmonary disease

This monoclonal antibody that blacks the inflammatory response to both neutrophils and eosinophils appears to improve health-related quality of life and reduce moderate to severe exacerbations in people with COPD. However, it may not be available yet and is probably going to be very expensive when it is available.

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Rationale
The efficacy and safety of astegolimab, an anti-ST2 monoclonal antibody, was evaluated in participants with chronic obstructive pulmonary disease (COPD) and frequent exacerbations in the pivotal ALIENTO and ARNASA trials.

Objectives
To report the prespecified pooled analysis of ALIENTO and ARNASA.

Methods
ALIENTO and ARNASA were randomized, double-blind, placebo-controlled trials with similar designs and included participants with COPD, a history of frequent exacerbations, and current/former smoking status, irrespective of blood eosinophil count and chronic bronchitis. Participants were randomized 1:1:1 to astegolimab 476 mg every 2 weeks (Q2W), astegolimab every 4 weeks (Q4W), or placebo for 52 weeks, plus optimized maintenance therapy. The primary endpoint was annualized rate of moderate/severe exacerbations. Secondary endpoints included annualized rate of severe exacerbations. A hierarchical statistical plan was followed with hypothesis testing of secondary efficacy endpoints gated on the primary efficacy endpoint success.

Measurements and Main Results
A total of 2682 participants were included in the pooled intent-to-treat population. Astegolimab significantly reduced the annualized rate of moderate/severe exacerbations by 15% in the Q2W arm (adjusted rate ratio, 0.85 [95% CI, 0.76-0.96]; P = .0077) and by 12% in the Q4W arm (rate ratio, 0.88 [95% CI, 0.78-0.99]; P = .0265). A nominally significant reduction in the annualized rate of severe COPD exacerbations (rate ratio, 0.68 [95% CI, 0.52-0.87]; P = .0028) was observed for astegolimab Q2W vs placebo. Astegolimab was well tolerated.

Conclusions
Astegolimab every 2 weeks reduced the annualized rate of moderate/severe exacerbations in a clinically heterogeneous population of participants with COPD and frequent exacerbations.

Clinical trial registration
ClinicalTrials.gov: NCT05037929; NCT05595642

Author/s:

Jadwiga A Wedzicha, Alvar Agustí, Christopher E. Brightling, Peter Calverley, James D. Chalmers, Neil J. Greening, MeiLan K. Han, Divya Mohan, Julie Ng, Papi, Alberto, Nicolas Roche, Rebecca Saenz, Katerina Samara, Ruth Tal-Singer, Claus F. Vogelmeier, Xiaoying Yang, Bartolome R. Celli

A Multidimensional Diagnostic Approach for Chronic Obstructive Pulmonary Disease

Alex Haga — Mon, 19 May 2025 15:22:35 +0000

Date Added:

May 19, 2025

Journal/Publication:

JAMA

Publication Date:

May 18, 2025

URL:

A Multidimensional Diagnostic Approach for Chronic Obstructive Pulmonary Disease

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.2025.7358

Keywords

copd

pulmonary disease

PMID (1):

40382791

MeSH

Multidimensional criteria for the diagnosis of COPD. James W. Mold, MD, MPH

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Importance: Individuals at risk for chronic obstructive pulmonary disease (COPD) but without spirometric airflow obstruction can have respiratory symptoms and structural lung disease on chest computed tomography. Current guidelines recommend COPD diagnostic schemas that do not incorporate imaging abnormalities.

Objective: To determine whether a multidimensional COPD diagnostic schema that includes respiratory symptoms and computed tomographic imaging abnormalities identifies additional individuals with disease.

Design, setting, and participants: This cohort study included 2 longitudinal cohorts: the Genetic Epidemiology of COPD (COPDGene), which enrolled 10 305 participants between November 9, 2007, and April 15, 2011, with longitudinal follow-up through August 31, 2022; and the Canadian Cohort Obstructive Lung Disease (CanCOLD), which enrolled 1561 participants between November 26, 2009, and July 15, 2015, with follow-up through December 31, 2023.

Exposure: Exposure included the new multidimensional COPD diagnostic schema, defined by (1) major diagnostic category: presence of the major criterion (airflow obstruction based on postbronchodilator forced expiratory volume in the first second of expiration [FEV1]/forced vital capacity ratio <0.70) and at least 1 of 5 minor criteria (emphysema or bronchial wall thickening on computed tomography, dyspnea, poor respiratory quality of life, and chronic bronchitis); or (2) minor diagnostic category: presence of least 3 of 5 minor criteria (which must include emphysema and bronchial wall thickening for individuals with respiratory symptoms potentially due to other causes).

Main outcomes and measures: All-cause mortality, respiratory cause-specific mortality, exacerbations, and annualized change in FEV1.

Results: Among 9416 adults in COPDGene (mean [SD] age at enrollment, 59.6 [9.0] years; 5035 [53.5%] were men; 3071 [32.6%] were Black; 6345 (67.4%) were White; 4943 [52.5%] currently smoked), 811 of 5250 individuals (15.4%) without airflow obstruction were newly classified as having COPD by minor diagnostic category, and 282 of 4166 individuals (6.8%) with airflow obstruction were classified as not having COPD. Reclassified individuals with a new COPD diagnosis had greater all-cause mortality (adjusted hazard ratio, 1.98; 95% CI, 1.67-2.35; P < .001) and respiratory-specific mortality (adjusted hazard ratio, 3.58; 95% CI, 1.56-8.20; P = .003), more exacerbations (adjusted incidence rate ratio, 2.09; 95% CI, 1.79-2.44; P < .001), and more rapid FEV1 decline (adjusted β = -7.7 mL/y; 95% CI, -13.2 to -2.3; P = .006) compared with individuals classified as not having COPD. Among individuals with airflow obstruction on spirometry, those no longer classified as having COPD based on this new diagnostic schema had outcomes similar to those without airflow obstruction. Among 1341 adults in CanCOLD, individuals newly classified as having COPD experienced more exacerbations (adjusted incidence rate ratio, 2.09; 95% CI, 1.25-3.51; P < .001).

Conclusions and relevance: A new COPD diagnostic schema integrating respiratory symptoms, respiratory quality of life, spirometry, and structural lung abnormalities on computed tomographic imaging newly classified some individuals as having COPD. These individuals had an increased risk of all-cause and respiratory-related death, frequent exacerbations, and rapid lung function decline compared with individuals classified as not having COPD. Some individuals with airflow obstruction without respiratory symptoms or evidence of structural lung disease were no longer classified as having COPD.

Author/s:

COPDGene 2025 Diagnosis Working Group and CanCOLD Investigators, Surya P Bhatt, Ehsan Abadi, Antonio Anzueto, Sandeep Bodduluri

Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance

John Bayhi — Fri, 13 Sep 2019 12:52:13 +0000

Date Added:

September 13, 2019

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

U.S. Department of Health & Human Services / Centers for Disease Control and Prevention

Publication Date:

September 13, 2019

Issue:

Volume:

Pages:

787-790

URL:

Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance

Type:

Public Health Announcements

Format:

Article

DOI (1):

10.15585/mmwr.mm6836e2

Keywords

PMID (1):

31513561

MeSH

electronic nicotine delivery systems

volatile organic compounds

Neoplasms

Lung Diseases

centers for disease control and prevention (U.S.)

The latest information from the CDC on lung disease associated with vaping. James W. Mold, MD, MPH

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On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available.

Author/s:

Schier, JG, Meiman, JG, Layden, J, Mikosz, CA, VanFrank, B, King, BA, Salvatore, PP, Weissman, DN, Thomas, J, Melstrom, PC, Baldwin, GT, Parker, EM, Courtney-Long, EA, Krishnasamy, VP, Pickens, CM, Evans, ME, Tsay, SV, Powell, KM, Kiernan, EA, Marynak, KL, Adjemian, J, Holton, K, Armour, BS, England, LJ, Briss, PA, Houry, D, Hacker, KA, Reagan-Steiner, S, Zaki, S, Meaney-Delman, D, CDC 2019 Lung Injury Response Group

Pulmonary Health Effects of Agriculture

Jeffrey Wilson — Tue, 12 Mar 2019 22:39:48 +0000

Date Added:

March 12, 2019

Journal/Publication:

Current Opinion in Pulmonary Medicine

Publisher:

Wolters Kluwer

Publication Date:

March 1, 2016

Issue:

Volume:

Pages:

144-149

URL:

Pulmonary Health Effects of Agriculture

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1097/MCP.0000000000000247

Keywords

PMID (1):

26761627

MeSH

pulmonary disease, chronic obstructive

agriculture

occupational exposure

Agricultural workers are at increased risk for a number of different acute and chronic lung disorders. This is a nice review of each of them.

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PURPOSE OF REVIEW:

Occupational exposures in the agricultural industry are associated with numerous lung diseases, including chronic obstructive pulmonary disease, asthma, hypersensitivity pneumonitis, lung cancer, and interstitial lung diseases. Efforts are ongoing to ascertain contributing factors to these negative respiratory outcomes and improve monitoring of environmental factors leading to disease. In this review, recently published studies investigating the deleterious effects of occupational exposures in the agricultural industry are discussed.

RECENT FINDINGS:

Occupational exposures to numerous agricultural environment aerosols, including pesticides, fungi, and bacteria are associated with impaired respiratory function and disease. Increases in certain farming practices, including mushroom and greenhouse farming, present new occupational exposure concerns. Improved detection methods may provide opportunities to better monitor safe exposure levels to known lung irritants.

SUMMARY:

In the agricultural industry, occupational exposures to organic and inorganic aerosols lead to increased risk for lung disease among workers. Increased awareness of respiratory risks and improved monitoring of agricultural environments are necessary to limit pulmonary health risks to exposed populations.

Author/s:

Nordgren, Tara M., Bailey, Kristina L.