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Background Predicted postoperative forced expiratory volume in 1 s (ppoFEV1) and expected transfer factor for CO (TLCO) values < 30–35% are often considered to be a contraindication for anatomical lung resection in patients with lung cancer. Based on our prior positive experience in lung volume reduction surgery (LVRS), we retrospectively analyzed all patients with impaired pulmonary function undergoing anatomical minimally-invasive lung resection, either for LVRS or treatment of non-small cell lung cancer (NSCLC) at our institute. Methods From August 2016 to April 2021, n = 42 consecutive anatomical lung resections were performed in patients with poor lung function (< 35% ppoFEV1). We retrospectively searched our records and investigated the patients’ pre- and postoperative conditions and their outcome. Results We included 16 patients (9 males, age 68.4 ± 8.9 years old) scheduled for lung cancer surgery. The procedures were performed via uniportal video assisted thoracoscopic surgery (VATS; n = 10, 62.5%, including one non-intubated VATS) or via thoracotomy (n = 6, 37.5%) and included lobectomy (9 patients, 55.3%) or (multiple) segmentectomy. Resected parenchyma as described by total number of removed segments was 3.9 ± 1.6 segments. Preoperative FEV1 was 35.1 ± 7.2%, with an expected ppoFEV1 28.1 ± 5.9%. Measured postoperative FEV1 was 39 ± 8.7% (p < 0.001). Postoperative complications included persistent air leak (PAL) in 7 patients (43.8%), atelectasis in 3 (18.8%), pleural effusion in 4 (25%), pneumonia in 1 (6.3%), and empyema in one (6.3%), patients. No patient required continuous O2 therapy or died. Conclusions Even in severely impaired lung function, anatomical resection appears to be feasible with reasonable morbidity and mortality. Highlight box Key findings Surgical indications for anatomical lung resection might be now expanded and include a larger number of patients with limited lung capacity previously considered unresectable. What is known and what is new? In the aging society, the number of lung cancer patients with low lung function patients is increasing. In our retrospective study, the result of anatomical lung resection for patients with low lung function was acceptable. What is the implication, and what should change now? Our result may expand the operative indication related to lung function and increase the radical resection possibility in elderly patients, a large group of lung cancer patients.

Background Preserved Ratio Impaired Spirometry (PRISm) is defined as FEV1/FVC ≥ 70% and FEV1 < 80%pred by pulmonary function test (PFT). It has highly prevalence and is associated with increased respiratory symptoms, systemic inflammation, and mortality. However, there are few radiological studies related to PRISm. The purpose of this study was to investigate the quantitative high-resolution computed tomography (HRCT) characteristics of PRISm and to evaluate the correlation between quantitative HRCT parameters and pulmonary function parameters, with the goal of establishing a nomogram model for predicting PRISm based on quantitative HRCT. Methods A prospective and continuous study was performed in 488 respiratory outpatients from February 2020 to February 2021. All patients underwent both deep inspiratory and expiratory CT examinations, and received pulmonary function test (PFT) within 1 month. According to the exclusion criteria and Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification standard, 94 cases of normal pulmonary function, 51 cases of PRISm and 48 cases of mild to moderate chronic obstructive lung disease (COPD) were included in the study. The lung parenchyma, parametric response mapping (PRM), airway and vessel parameters were measured by automatic segmentation software (Aview). One-way analysis of variance (ANOVA) was used to compare the differences in clinical features, pulmonary function parameters and quantitative CT parameters. Spearman rank correlation analysis was used to evaluate the correlation between CT quantitative index and pulmonary function parameters. The predictors were obtained by binary logistics regression analysis respectively in normal and PRISm as well as PRISm and mild to moderate COPD, and the nomogram model was established. Results There were significant differences in pulmonary function parameters among the three groups (P < 0.001). The differences in pulmonary parenchyma parameters such as emphysema index (EI), pixel indices-1 (PI-1) and PI-15 were mainly between mild to moderate COPD and the other two groups. The differences of airway parameters and pulmonary vascular parameters were mainly between normal and the other two groups, but were not found between PRISm and mild to moderate COPD. Especially there were significant differences in mean lung density (MLD) and the percent of normal in PRM (PRM Normal ) among the three groups. Most of the pulmonary quantitative CT parameters had mild to moderate correlation with pulmonary function parameters. The predictors of the nomogram model using binary logistics regression analysis to distinguish normal from PRISm were smoking, MLD, the percent of functional small airways disease (fSAD) in PRM (PRM fSAD ) and Lumen area. It had a good goodness of fit (χ 2  = 0.31, P < 0.001) with the area under curve (AUC) value of 0.786. The predictor of distinguishing PRISm from mild to moderate COPD were PRM Emph (P < 0.001, AUC = 0.852). Conclusions PRISm was significantly different from subjects with normal pulmonary function in small airway and vessel lesions, which was more inclined to mild to moderate COPD, but there was no increase in pulmonary parenchymal attenuation. The nomogram based on quantitative HRCT parameters has good predictive value and provide more objective evidence for the early screening of PRISm.

Purpose This study utilizes electrical impedance tomography (EIT) to explore spatial–temporal heterogeneity in regional lung function among patients with chronic obstructive lung disease (COPD), preserved ratio impaired spirometry (PRISm), and those with normal lung function. Methods Subjects who had pulmonary function test at Sir Run Run Shaw Hospital from 28 December 2023 to 30 March 2024 were screened. Regional lung functions were accessed with EIT regarding spatial distribution, abnormal area size, and expiratory time. The correlations between smoking index, SGRQ score, and EIT-related parameters were also evaluated. Results A total of 194 patients were screened and 161 patients were included (56 COPD, 21 PRISm, and 84 normal). Spatial distribution of regional FEV1EIT ( P  < 0.001), FVCEIT ( P  = 0.025), FEV1/FVCEIT ( P  < 0.001), MMEFEIT ( P  = 0.012), T-75EIT ( P  < 0.001), and FIVCEIT ( P  = 0.020) showed significant differences among the three groups. The percentage of abnormal FEV1/FVCEIT areas detected via EIT was 83.40% (25–75% percentiles 52.29%-98.39%) in the COPD group, 25.46% (17.31%-41.31%) in the PRISm group, and 10.37% (3.34%-19.04%) in the normal group. The time constant map revealed that the patients with COPD exhibited the longest exhalation times. Elevated smoking index and SGRQ scores were associated with increased heterogeneity and larger areas of abnormal FEV1/FVCEIT. Conclusion Through EIT-based pulmonary function assessment, it is possible to sensitively identify the spatio-temporal heterogeneity in COPD and PRISm patients. Regional lung function impairments, particularly in PRISm patients with an FEV1/FVC ratio ≥ 0.7, were detected using EIT, highlighting its potential for early COPD diagnosis.

Purpose Preserved ratio impaired spirometry (PRISm) and chronic obstructive pulmonary disease (COPD) belong to lung function injury. PRISm is a precursor to COPD. We compared and evaluated the different basic information, imaging findings and survival curves of 108 lung cancer patients with different pulmonary function based on high resolution computed tomography (HRCT). Methods This retrospective study was performed on 108 lung cancer patients who did pulmonary function test (PFT) and thoracic HRCT. The basic information was evaluated: gender, age, body mass index (BMI), smoke, smoking index (SI). The following pulmonary function findings were evaluated: forced expiratory volume in 1s (FEV 1 ), forced vital capacity (FVC), FEV 1 /FVC ratio. The following computed tomography (CT) findings were evaluated: appearance (bronchiectasis, pneumonectasis, atelectasis, ground-glass opacities [GGO], interstitial inflammation, thickened bronchial wall), diameter (aortic diameter, pulmonary artery diameter, MPAD/AD ratio, inferior vena cava diameter [IVCD]), tumor (volume, classification, distribution, staging [I, II, III, IV]). Mortality rates were calculated and survival curves were estimated using the Kaplan-Meier method. Results Compared with normal pulmonary function group, PRISm group and COPD group were predominantly male, older, smoked more, poorer lung function and had shorter survival time after diagnosis. There were more abnormal images in PRISm group and COPD group than in normal lung function group (N-C group). In PRISm group and COPD group, lung cancer was found late, and the tumor volume was larger, mainly central squamous carcinoma. But the opposite was true for the N-C group. The PRISm group and COPD group had significant poor survival probability compared with the normal lung function group. Conclusions Considerable differences regarding basic information, pulmonary function, imaging findings and survival curves are found between normal lung function group and lung function injury group. Lung function injury (PRISm and COPD) should be taken into account in future lung cancer screening studies.

The epidemiological patterns of incident chronic obstructive pulmonary disease (COPD) and lung adenocarcinoma are changing, with an increasing fraction of disease occurring in patients who are never-smokers or were not exposed to traditional risk factors. However, causative mechanism(s) are obscure. Overactivity of Src family kinases (SFKs) and myeloid cell–dependent inflammatory lung epithelial and endothelial damage are independent candidate mechanisms, but their pathogenic convergence has not been demonstrated. Here we present a novel preclinical model in which an activating mutation in Lyn, a nonreceptor SFK that is expressed in immune cells, epithelium, and endothelium—all strongly implicated in the pathogenesis of COPD—causes spontaneous inflammation, early-onset progressive emphysema, and lung adenocarcinoma. Surprisingly, even though activated macrophages, elastolytic enzymes, and proinflammatory cytokines were prominent, bone marrow chimeras formally demonstrated that myeloid cells were not disease initiators. Rather, lung disease arose from aberrant epithelial cell proliferation and differentiation, microvascular lesions within an activated endothelial microcirculation, and amplified EGFR (epidermal growth factor receptor) expression. In human bioinformatics analyses, LYN expression was increased in patients with COPD and was correlated with increased EGFR expression, a known lung oncogenic pathway, and LYN was linked to COPD. Our study shows that a singular molecular defect causes a spontaneous COPD-like immunopathology and lung adenocarcinoma. Furthermore, we identify Lyn and, by implication, its associated signaling pathways as new therapeutic targets for COPD and cancer. Moreover, our work may inform the development of molecular risk screening and intervention methods for disease susceptibility, progression, and prevention of these increasingly prevalent conditions.

To investigate the impact of long-term passive smoking on the pathogenesis of chronic obstructive pulmonary disease (COPD) in women. We conducted a community-based cross-sectional study involving 2,360 women aged ≥40 years in Jinan, China (October 1, 2022-April 30, 2023). Participants underwent comprehensive assessments including pulmonary function tests (spirometry), hematological analyses, and structured questionnaires evaluating COPD symptoms and passive smoking exposure. Based on exposure history, subjects were stratified into long-term passive smoking (LPS, n = 610) and non-passive smoking (NPS, n = 1,750) cohorts. Comparative analysis revealed significant pulmonary function impairment in the LPS group versus NPS controls: lower FEV1 (2.97±0.61 vs 3.25±0.37 L, p < 0.05), reduced FEV1% predicted (78.20±10.18 vs 81.47±14.69, p < 0.05), decreased FEV1/FVC ratio (83.32±11.20 vs 87.23±10.32%, p < 0.05). Small airway dysfunction was more pronounced in LPS participants, evidenced by: diminished MEF75% (77.58±11.95 vs 86.08±14.02 L/s, p < 0.05), reduced MEF50% (62.76±19.79 vs 89.36±16.78 L/s, p < 0.05), lower MMEF (80.87±12.80 vs 87.46±11.26 L/s, p < 0.05). The LPS group demonstrated: higher prevalence of preserved ratio impaired spirometry (PRISm, 5.74% vs 2.91%); increased annual exacerbation frequency (p < 0.05), elevated systemic inflammatory markers (p < 0.05), greater symptom severity (p < 0.05). Our findings demonstrate that chronic passive smoke exposure constitutes an independent risk factor for COPD development in women, associated with higher disease prevalence, accelerated pulmonary function decline, increased exacerbation frequency and enhanced systemic inflammation.

Purpose: To analyze the relationship between body mass index (BMI) and lung function, which may help optimize the screening and management process for chronic obstructive pulmonary disease (COPD) in the early stages. Patients and Methods: In this cross-sectional study using data from the Enjoying Breathing Program in China, participants were divided into two groups according to COPD Screening Questionnaire (COPD-SQ) scores (at risk and not at risk of COPD) and three groups based on lung function (normal lung function, preserved ratio impaired spirometry [PRISm], and obstructive lung function). Results: A total of 32,033 subjects were enrolled in the current analysis. First, in people at risk of COPD, overweight and obese participants had better forced expiratory volume in one second (FEV1; overweight: 0.33 liters (l), 95% confidence interval [CI]: 0.27 to 0.38; obesity: 0.31 L, 95% CI: 0.22 to 0.39) values than the normal BMI group. Second, among people with PRISm, underweight participants had a lower FEV1 (-0.56 L, 95% CI: -0.86 to -0.26) and forced vital capacity (FVC; -0.33 L, 95% CI: - 0.55 to -0.11) than participants with a normal weight, and obese participants had a higher FEV1 (0.22 L, 95% CI: 0.02 to 0.42) and FVC (0.16 L, 95% CI: 0.02 to 0.30) than participants with a normal weight. Taking normal BMI as the reference group, lower FEV1 (- 0.80 L, 95% CI: -0.97 to -0.63) and FVC (-0.53 L, 95% CI: -0.64 to -0.42) were found in underweight participants with obstructive spirometry, and better FEV1 (obesity: 0.26 L, 95% CI: 0.12 to 0.40) was found in obese participants with obstructive spirometry. Conclusion: Being underweight and severely obese are associated with reduced lung function. Slight obesity was shown to be a protective factor for lung function in people at risk of COPD and those with PRISm. Keywords: body mass index, lung function, preserved ratio impaired spirometry, chronic obstructive pulmonary disease

Preserved Ratio Impaired Spirometry (PRISm) is a specific subtype of pre-chronic obstructive pulmonary disease (pre-COPD). People with PRISm are at risk of progression to chronic obstructive pulmonary disease (COPD). We developed a model to predict progression in subjects with PRISm. We screened 188 patients whose lung function transitioned from PRISm to COPD and 173 patients with PRISm who remained stable over two years. After excluding 78 patients due to incomplete clinical or laboratory data, a total of 283 patients were included in the final analysis. These patients were randomly divided into a training cohort (227 patients) and a validation cohort (56 patients) at a 8:2 ratio. LASSO regression and multivariate logistic regression were used to identify factors influencing progression. Among the 283 patients, 134 progressed to COPD. The model developed using six variables showed good performance, with areas under the receiver operating characteristic (ROC) curves of 0.87 in the training cohort and 0.79 in the validation cohort. The model demonstrated excellent calibration and was clinically meaningful, as shown by decision curve analysis (DCA) and clinical impact curve (CIC). We developed China’s first prediction model for the progression of lung function from PRISm to COPD in a real-world population. This model is conducive to early identification of high-risk groups of pulmonary function deterioration, so as to provide timely intervention and delay the occurrence and progression of the disease.

Due to modern lifestyles, physical activity (PA) has decreased at a population level, resulting in health concerns worldwide. Increased level of PA can reduce mortality and morbidity in pulmonary diseases, such as asthma and chronic obstructive pulmonary disease (COPD). Many previous studies on the association between pulmonary function and PA assessed PA by questionnaires. We aimed to study the cross-sectional association between pulmonary function and objectively measured PA and sedentary behavior (SB) in population-based data. A total of 4729 subjects participated in the Health 2011 survey, which represents the Finnish adult population. Of these, 1511 completed spirometry and the required 4-day accelerometer wear time. Spirometry values of forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) were determined. We compared the differences in daily PA measured with triaxial accelerometer between those with obstructive or restrictive spirometry results (defined as FEV1/FVC < −1.65 z-score, lower limit of normal [LLN] and FVC < −1.65 z-score, respectively) and those with FEV1 < −1.65 z-score to those with normal spirometry in adjusted logistic regression analysis. Airway obstruction, pulmonary restriction, and FEV1 < LLN were associated with less time spent in moderate (adjusted odds ratio [OR] 0.63, 95% confidence interval [CI] 0.40-0.99; OR 0.65, 95% CI 0.43–1.00; OR 0.58, 95% CI 0.39–0.87, respectively) and moderate-to-vigorous level of PA (OR 0.65, 95% CI 0.43–0.98; OR 0.63, 95% CI 0.42–0.94; OR 0.56, 95% CI 0.38–0.82, respectively). Those with restrictive spirometry had greater time spent sedentary and a lower daily step count when compared to those with normal spirometry. Respective ORs with 95% CIs were 1.09 (1.01–1.19) and 0.85 (0.75–0.96). Our results show the association between impaired pulmonary function and measured lower level of daily PA. Restriction associated with greater time spent sedentary and a lower daily step count when compared with those with normal spirometry, airway obstruction, and FEV1 < LLN.

Background COPD and impairment in diffusing capacity for carbon monoxide (DLCO) are common comorbidities in people with HIV (PWH). HIV may increase susceptibility to inhaled toxins including air pollution. In PWH and people without HIV (PWoH), we investigated whether air pollution exposure was associated with within-group differences in lung function or respiratory symptoms, and whether these associations differed by HIV serostatus or the presence of underlying lung disease. Methods We analyzed cross-sectional data from the Multicenter AIDS Cohort Study (MACS) and the Women’s Interagency HIV Study (WIHS), including participants with pulmonary function tests and accompanying standardized respiratory questionnaires in 2017–2020. The participants were linked to fine particulate matter (PM 2.5 ) and ozone exposure data. Associations between exposures and respiratory outcomes were quantified with regression models. Two subgroup analyses were conducted, restricting to individuals with COPD (FEV 1 /FVC ratio < 0.7) or impaired DLCO (< 80% predicted). Results 338 MACS participants and 1073 WIHS participants were included. Overall, there were no significant associations between pollution exposures and either lung function or respiratory symptoms. In PWH with COPD, 1 µg/m 3 greater exposure to PM 2.5 was associated with worse St. George’s Respiratory Questionnaire (SGRQ) score (4.04 points; 95% CI 0.36–7.72) and worse modified Medical Research Council (mMRC) dyspnea score (0.28 points; 95% CI 0.02–0.53). In PWH with impaired DLCO, 1 µg/m 3 greater PM 2.5 exposure was associated with worse SGRQ (2.14 points, 95% CI 0.2–4.08) and mMRC (0.16 points, 95% CI 0.02–0.29). There were no significant associations between PM 2.5 and respiratory symptoms in PWoH with COPD or impaired DLCO. Ozone exposure was not associated with respiratory symptoms in PWH or PWoH. Conclusions PM 2.5 exposure may act synergistically with HIV infection to worsen respiratory symptoms in people with chronic lung disease. Further study is needed to determine if air pollution leads to decline in lung function in PWH.