American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Feb 2025
Respiratory Exacerbations and Lung Function Decline in People with Smoking History and Normal Spirometry.
The impact of respiratory exacerbation on chronic obstructive pulmonary disease (COPD) is well established. The effects of respiratory exacerbations in people with cigarette smoking but normal spirometry are unknown. ⋯ Respiratory exacerbations in people with cigarette smoking but normal spirometry were associated lung function decline. Experiencing a severe respiratory exacerbation was associated with increased mortality.
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Am. J. Respir. Crit. Care Med. · Feb 2025
Current Smoker: A Clinical COPD Phenotype Affecting Disease Progression and Response to Therapy.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition of the lungs, characterized by chronic respiratory symptoms, primarily dyspnea, cough, and sputum production, due to airway and/or alveoli abnormalities that cause persistent, and often progressive, airflow obstruction. Although the underlying mechanisms responsible for COPD remain poorly understood, over the last several decades, clinical phenotypes and endotypes have been suggested. These include frequent exacerbator and eosinophilic groups that guide tailored therapies for patients with that clinical expression. ⋯ Rates range between 3% and 37% globally, with factors including sex, age, race, education level, and geography influencing the rate of addiction. Importantly, several studies have shown that smoking detrimentally affects treatment efficacy of COPD medications; this is particularly true of inhaled corticosteroids and macrolides. In this review, we discuss the effects of smoking on the pathophysiology of COPD and the clinical impact of smoke exposure in patients with COPD.