Background: The etiology of pulmonary disease is complex and influenced by various factors, resulting in a significant public health issue, with 16 million Americans living with chronic obstructive pulmonary disease (COPD) and 24 million with asthma, and cases are on the rise. The purpose of this study was to explore demographic, health status, and lifestyle behaviors with pulmonary disease so patterns of risk can be understood and inform interventions. Methods: This cross-sectional study utilized the National Inpatient Sample Data from 2019 (NIS 2019). The predictor variables consisted of: demographics (age (18+), sex, race), health status (obesity, depression, diabetes), lifestyle behaviors (smoking, alcohol use, and aspirin use), and the outcome variable was pulmonary disease. To ensure accuracy, the data was weighted by the variable discharge weight (DISCWT), and chi-square analyses and ANOVA tests were conducted to determine the independence of categorical and numerical predictor variables. Descriptive statistics were conducted for all variables, simple and multiple logistic regression analyses were performed to identify factors that contribute to the likelihood of having pulmonary disease. Results: The sample of the NIS 2019 data included 6,043,654 cases of which, 22.65% of inpatients had pulmonary disease. The collective sample demographic characteristics were: mean age of 58.4 years, and more than half of inpatients were females (57.05% compared to 42.95% males). In terms of health, 17.75% of the sample were obese, 28.8% had diabetes, and 14.25% were depressed. Within the collective sample, 16.8% of inpatients reported smoking, 9.09% drank alcohol, and 14.51% consumed aspirin (long-term (current) use of aspirin). Results of the multivariate statistical analyses reveal that individuals who were obese were 68.3% more likely to have pulmonary disease compared to non-obese patients (aOR = 1.683, CI 1.679-1.686, pConclusion: Results of our study provide important insights between pulmonary disease and associated risk patterns. As pulmonary symptoms have risen in the wake of the COVID-19 pandemic, there is an urgent public health need to explore disruption of risk pathways to avoid overwhelming fragile global healthcare systems.

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COPD is characterized by an abnormal regulatory T cell (Treg) response with a shift towards a Th1 and Th17 cell responses. However, it is unclear if the function of Treg cells is impaired by smoking and in COPD. In addition, the miRNA profile of Treg cells in COPD is unknown and whether miRNA deregulation contributes to COPD immunopathogenesis. We set the objective to study Treg cell function isolated from peripheral blood of patients with COPD versus controls and to compare their miRNA profiles. We also were interested in exploring the function of some of the differentially expressed Treg cell miRNAs. We assessed the Treg cell function by observing their suppressive activity on autologous effector T cells and analyzed their miRNA expression initially by microarray analysis then conducted real time RT-PCR validation for selected miRNAs. In Silico target gene analysis for the validated miRNAs suggested that miR-199-5p is particularly relevant to Treg cell physiology so its function was investigated further using CCD-986Sk and MOLT-4 cells. We found no difference in Treg cell function between COPD and controls but we were able to identify 6 and 96 miRNAs that were differentially expressed in COPD versus control Treg cells. We confirmed that miR-199a-5p was repressed by approximately 4 fold in Treg cells of COPD patients compared to cells in healthy smokers. Importantly, miR-199a-5p had significant overrepresentation of its target genes in the Treg cell transcriptome, with many targets associated with the TGF-b activation pathway. We also confirmed the function of miR-199a5p in an in-vitro loss-of-function cell model running TaqMan® arrays of the Human TGF-b Pathway. These findings suggest that the abnormal repression of miR-199a-5p in patients with COPD compared to unaffected smokers may be involved in modulating the adaptive immune balance in favor of a Th1 and Th17 response. / Microbiology and Immunology

No / Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition worldwide and is associated with significant mortality. This paper gives an overview of the relevant literature regarding care needs in advanced COPD from the perspective of the patient or carer, and aims to explore the appropriateness of a palliative care approach in this group. Publications revealed that patients with COPD have a high symptom burden that impacts on quality of life and social functioning. Information provision in COPD is often lacking and the implications of diagnosis and prognosis are not routinely discussed. The impact on families and carers is considerable, many patients have significant care requirements which can affect family relationships. Although patients with COPD have regular contact with health services, access to specialist services and palliative care is poor. This paper highlights the need for increased provision for palliative care in COPD, alongside dedicated education and training for health professionals, and continued research to identify the most appropriate ways of delivering this care.