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Theme Issue:
Challenges and Opportunities in COPD
Chronic obstructive pulmonary disease (COPD) remains a major global health challenge, marked by its complex pathophysiology, heterogeneous patient populations, and significant burden on healthcare systems.
This theme issue highlights contemporary perspectives on both the obstacles and emerging opportunities in COPD care. Advances in early detection, precision medicine, and novel pharmacologic and non-pharmacologic interventions are explored with the goal of improving symptom control and long-term outcomes.
Key challenges include managing acute exacerbations, addressing comorbidities, and reducing health disparities. At the same time, opportunities arise from the integration of digital health tools, remote monitoring, and personalized rehabilitation strategies that support patient-centered care.
The growing role of artificial intelligence in risk prediction, together with environmental and lifestyle interventions, further illustrates the evolving landscape of COPD management. Ethical considerations—such as equitable access to therapies and shared decision-making—remain central to these discussions.
Together, the contributions in this issue underscore the dynamic interplay of scientific innovation, clinical practice, and patient engagement in shaping the future of COPD management.
This theme issue was organized in collaboration with the Respiratory Health Committee
Contents
Review Article
Use of Benzodiazepines in Treatment of Depression and Anxiety in Patients with Chronic Obstructive Pulmonary Disease. Trends, Controversies and Alternatives
Chronic obstructive pulmonary disease (COPD) is primarily affecting the lungs but is also associated with a number of accompanying conditions known as comorbidities. Depression, anxiety and insomnia are very common among older people and especially those with COPD. Treatment of these conditions is often related to prescription of benzodiazepines, a class of drugs which is highly addictive and has adverse effects on the respiratory function.
By Velin K. Stratev and Christian Søborg— Department of pulmonary and infectious diseases, North Zealand Hospital, Denmark
Review Article
Echocardiographic evaluation for phenotyping pulmonary hypertension in COPD. A review of the literature and a proposal for clinical practice
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous lung condition characterised by chronic respiratory symptoms (dyspnoea, cough, sputum production) due to an inflammatory state affecting the airways, lung parenchyma and pulmonary vasculature. When the inflammatory state is particularly severe, the damage to the lung tissue leads to an imbalance between ventilation and perfusion (V/Q) in the alveoli and to hypoxemia, a factor that increases remodeling of the vascular bed, vascular resistance, worsening hypoxemia and pulmonary hypertension, a common complication that in COPD is usually mild.
By Rino Frizzelli - Department of Community Medicine - Cardiology, Viadana Hospital -ASST Carlo Poma - Mantova, Italy; Annalisa Frizzelli - Department of Medicine and Surgery, Respiratory Disease and Lung, Function Unit, University of Parma, Italy
Research Article
Effects of High Frequency Chest Wall Oscillation (HFCWO) on Clinical Symptoms in Chronic Obstructive Lung Disease
Mucociliary clearance plays a critical role in pulmonary host defense. Abnormal mucociliary clearance contributes to the pathogenesis of pulmonary disorders, including COPD. In bronchiectasis, treatments targeting mucus obstruction in the airways include the use of high frequency chest wall oscillation (HFCWO) therapy. This prospective outcome based study was designed to investigate the changes in symptoms and quality of life (QOL) to measure the effect of adjunctive HFCWO therapy to standard of care therapy for patients with COPD.
Bruner Meaghan M., Bazan Clarissa, Liu Bo, Cheng Christina, Edwards Lloyd J., Solomon George M., MD - University of Alabama at Birmingham, Birmingham, AL USA ; Marion Chad - Wake Forest University School of Medicine, Winston-Salem, NC USA; Sievert Chet - Clinical Research Associates LLC, Mahtomedi, MN USA
Review Article
Comorbidities of COPD: Mechanisms and Treatment. Update 2023
Chronic obstructive pulmonary disease (COPD) is chronic disease that affects mostly the lungs but there is growing evidence that it is also a systemic condition associated with a number of accompanying diseases known as comorbidities. Chronic inflammation and oxidative stress are the highlight pathogenic processes that interrelate COPD and comorbidities with additional disease specific risk factors and mechanisms. Through complex interactions COPD increases the risk for certain comorbidities and they in turn have negative impact on health status and contribute to mortality in COPD patients.
By Velin Stratev, and Odd-Magne Fjeldstad - Department of pulmonary rehabilitation and lifestyle medicine, Cathinka Guldbergs Hospital, Norway
Research Article
The assessment of Chronic Obstructive Pulmonary Disease (COPD) and its relation to the Mediterranean diet in Moroccan adults - BOLD study
The results of this study confirmed previous results showing significant associations of COPD risk with some components of MDS. Extensive studies are needed to explore MDS components better and suggest more effective interventions to maintain healthy eating habits and reduce COPD risk.
Abdelilah Benslimane, Khaoula El Kinany, Inge Huybrechts, Zineb Hatime, Meimouna Mint Sidi Deoula, Mohamed Chakib Benjelloun, Mohamed El Biaz, Chakib Nejjari, and Karima El Rhazi ; Department of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco International Agency for Research on Cancer (IARC) World Health Organization; Lyon, France Department of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco Respiratory Department, Hassan II University Hospital Center, Fez, Morocco. Mohammed VI University of Health Sciences, Casablanca, Morocco.
Special Article
COPD and Unexplained Hypoxaemia: a combination to be explored
Chronic obstructive pulmonary disease (COPD) is a slowly progressive disease characterized by inflammation that involves the airways, lung parenchyma, and pulmonary vasculature commonly associated with lung function decline and alveolar impairment of gas exchange. All these alterations can lead to hypoxaemia. In COPD hypoxaemia presenting refractory to very high concentration of inspired O2 with a drop of SpO2 (peripheral saturation) > 5% during the upright position and an improvement on recumbency (platypnea/ortodeoxya syndrome) can be suspect for righ-to-left shunt, e.g. intrapulmonary shunt or most frequently a patent foramen ovale.
Rino Frizzelli - Department of Community Medicine - Cardiology , Viadana Hospital - ASST Carlo Poma - Mantova, Italy
Research Article
Targeting the ATP-Axis in Lungs as a New Therapeutic Modality for COPD
Adenosine 5’-triphosphate (ATP) is found in every cell of the body, where it plays a critical role in cellular metabolism and energetics. ATP is released from cells under physiologic and pathophysiologic conditions; extracellular ATP acts as an autocrine and paracrine agent. Its effects on targeted cells are mediated by subtypes of purinergic receptors (P2R). In the lungs, relatively large amounts of ATP are released under inflammatory conditions.
Amir Pelleg, Ph.D., Peter J. Barnes, FRS, and Edward S Schulman, M.D.,- Danmir Therapeutics, LLC National Heart & Lung Institute, Imperial College London, United Kingdom 2Division of Pulmonary, Critical Care and Allergy, Drexel University School of Medicine, Philadelphia, Pennsylvania
Review Article
Mitigating the impact of breathlessness in Chronic Obstructive Pulmonary Disease: Can a structured specialty palliative care intervention fill in the gap in our treatment algorithms?
Breathlessness is a distressing symptom, uniformly faced at some point in the disease process in all patients with Chronic Obstructive Pulmonary Disease (COPD). Despite maximal medical therapy and pulmonary rehabilitation, patients with COPD continue to experience refractory dyspnea, pain, poor appetite, limitations of physical activity, emotional distress, depression, and an overall poor health-related quality of life. Our current GOLD ABE pharmacologic treatment algorithm provides maximal disease-specific therapy directed at optimization of physiologic airflow obstruction and exacerbation frequency, however, leaving a gap in how best to approach the complex and multifactorial symptom of refractory breathlessness that occurs despite these pharmacologic interventions and pulmonary rehabilitation.