BackgroundMuscle wasting and chronic inflammation are predominant features of patients with COPD. Systemic inflammation is associated with an accelerated decline in lung function. In this study, the prevalence of sarcopenia and the relationships between sarcopenia and systemic inflammations in patients with stable COPD were investigated.Materials and methodsIn a cross-sectional design, muscle strength and muscle mass were measured by handgrip strength (HGS) and bioelectrical impedance analysis in 80 patients with stable COPD. Patients (≥40 years old) diagnosed with COPD were recruited from outpatient clinics, and then COPD stages were classified. Sarcopenia was defined as the presence of both low muscle strength (by HGS) and low muscle mass (skeletal muscle mass index [SMMI]). Levels of circulating inflammatory biomarkers (IL-6 and high-sensitivity TNFα [hsTNFα]) were measured.ResultsSarcopenia was prevalent in 20 (25%) patients. Patients with sarcopenia were older, had lower body mass index, and a higher percentage of cardiovascular diseases. In addition, they had significantly higher modified Medical Research Council scores and lower 6-minute walk distance than those without sarcopenia. HGS was significantly correlated with age, modified Medical Research Council score, and COPD Assessment Test scores. Both HGS and SMMI had associations with IL-6 and hsTNFα (HGS, r=−0.35, P=0.002; SMMI, r=−0.246, P=0.044) level. In multivariate analysis, old age, lower body mass index, presence of cardiovascular comorbidities, and higher hsTNFα levels were significant determinants for sarcopenia in patients with stable COPD.ConclusionSarcopenia is very common in patients with stable COPD, and is associated with more severe dyspnea-scale scores and lower exercise tolerance. Systemic inflammation could be an important contributor to sarcopenia in the stable COPD population.

BackgroundCoronavirus disease (COVID-19) has rapidly spread worldwide. However, the effects of asthma, asthma medication, and asthma severity on the clinical outcomes of COVID-19 have not yet been established.MethodsThe study included 7590 de-identified patients, who were confirmed to have COVID-19 using the severe acute respiratory syndrome-coronavirus-2 RNA–polymerase chain reaction tests conducted up to 15th May 2020; and we used the linked-medical claims data provided by the Health Insurance Review and Assessment Service. Asthma and asthma severity (step suggested by GINA) was defined using the diagnostic code and history of asthma medication usage.ResultsAmong 7590 COVID-19 patients, 218 (2.9%) had underlying asthma. The total medical cost associated with COVID-19 patients with underlying asthma was significantly higher than that of other patients. Mortality rate for COVID-19 patients with underlying asthma (7.8%) was significantly higher than that of other patients (2.8%; p<0.001). However, asthma was not an independent risk factor for the clinical outcomes of COVID-19 after adjustment. Asthma medication use and asthma severity also did not affect the clinical outcomes of COVID-19. However, use of oral short-acting β2-agonists (SABA) was an independent factor to increase the total medical cost burden. Patients with step 5 asthma showed significant prolonged admission duration than those with step 1 asthma in both univariate and multivariate analysis.ConclusionsAsthma led to poor outcomes of COVID-19; however, underlying asthma, use of asthma medication, and asthma severity were not independent factors for poor clinical outcomes of COVID-19, generally.

Purpose The forced mid-expiratory flow (FEF 25-75% ) value is a potentially sensitive marker of obstructive peripheral airflow. We aimed to assess whether FEF 25-75% can be an early predictor of chronic obstructive pulmonary disease (COPD). Patients and Methods Between July 1, 2007 and June 31, 2009, we identified 3624 patients who underwent a pulmonary function test (PFT) in Gangnam Severance Hospital. We selected 307 patients aged over 40 years without COPD who had normal PFT results at baseline and who had follow-up PFT records more than 1 year later. A FEF 25-75% z-score less than −0.8435 was considered low. We defined COPD as a forced expiratory volume in one second/forced vital capacity value of less than 0.7 before July 31, 2019. Results Among 307 patients, 91 (29.6%) had low FEF 25-75% at baseline. After 10 years, the incidence rate of COPD in the low FEF 25-75% group was significantly higher than that in the normal FEF 25-75% group (41.8% vs 7.4%; P-value <0.001). The Cox proportional hazard model showed that age (hazard ratio [HR] 1.09; P -value<0.001), smoking status (occasional smoker HR, 4.59; P -value<0.001 and long-term smoker HR, 2.18; P -value=0.023), and low FEF 25-75% (HR, 3.31; P -value<0.001) were predictive factors for the development of COPD. Conclusion The FEF 25-75% value in patients with normal lung function is a useful predictor for the development of COPD. We should carefully monitor patients who present with low FEF 25-75% values, even if they have normal lung function.

Short term • Increased flow resistance • Increased airway reactivity Long term • Emphysema • Higher airway resistance • Airway onstruction • Airway inflammation Short term • Increased heart rate • Increased blood pressure • Increased aortic stiffness Long term • Increased atherosclerosis • Increased aortic stiffness Abstract E-cigarette aerosols are exceedingly different from conventional tobacco smoke, containing dozens of chemicals not found in cigarette smoke. It is highly likely that chronic use of e-cigarettes will induce pathological changes in both the heart and lungs. Here we review human and animal studies published to date and summarize the cardiopulmonary physiological changes