Clinical and Functional Characteristics of Subjects with Asthma, COPD, and Asthma-COPD Overlap: A Multicentre Study in Vietnam

Introduction. Subjects with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) share common features of patients with asthma and COPD. Our study was planned to describe the clinical and functional features of subjects with ACO compared to asthma and COPD patients.Subjects and Methods. Study subjects who met the inclusion criteria were classified into three different groups: asthma, COPD, and ACO groups. All study subjects underwent clinical examination and biological and functional testing. They were then followed for 6 months to evaluate the response to conventional treatment.Results. From March 2015 to March 2017, 76 asthmatic (mean age: 41 ± 22 years), 74 COPD (59 ± 13 years), and 59 ACO (52 ± 14 years) subjects were included. The percentage of subjects with dyspnea on excretion in the ACO group was higher than that in asthma and COPD groups (P<0.001andP<0.05, resp.). Subjects with COPD and ACO had significant airflow limitation (FEV1) compared to asthma (64 ± 17% and 54 ± 14% versus 80 ± 22%;P<0.01andP<0.01, resp.). The levels of FENO in subjects with asthma and ACO were significantly higher than those in subjects with COPD (46 ± 28 ppb and 34 ± 12 ppb versus 15 ± 8 ppb;P<0.001andP<0.001, resp.). VO2max and 6MWD were improved in study subjects after 6 months of treatment. Increased CANO and AHI > 15/hour had a significant probability of risk for ACO (OR = 33.2,P<0.001, and OR = 3.4,P<0.05, resp.).Conclusion. Subjects with ACO share the common clinical and functional characteristics of asthma and COPD but are more likely to have sleep apnea. The majority of patients with ACO have a favourable response to combined treatment.

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Clinical and functional peculiarities at patients with bronchial asthma, chronic obstructive pulmonary disease and overlap of asthma-chronic obstructive pulmonary disease

Nephrology (Saint-Petersburg) ◽

10.36485/1561-6274-2020-24-4-80-86 ◽

2020 ◽

Vol 24 (4) ◽

pp. 80-86

Author(s):

V. I. Trofimov ◽

D. Z. Baranov

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Bronchial Asthma ◽

Blood Test ◽

Chronic Obstructive ◽

Inflammation Markers ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Functional Features ◽

Lower Airways

BACKGROUND: a comparative analysis of laboratory and instrumental tests at patients with bronchial obstructive diseases seems very actual due to the wide prevalence of these diseases. THE AIM: to evaluate characteristics of spirometry as well as allergic (total IgE, sputum eosinophils) and infectious (blood and sputum leucocytes, ESR, CRP, fibrinogen) inflammation markers at patients with bronchial obstructive diseases. PATIENTS AND METHODS: 104 case histories of patients with bronchial asthma, chronic obstructive pulmonary disease and overlap were analyzed including age, duration of smoking (pack-years), laboratory (clinical blood test, biochemical blood test, general sputum analysis, sputum culture) and instrumental (spirometry, body plethysmography, echocardiography) tests. Data were processed statistically with non-parametric methods. RESULTS: COPD patients were older than other groups’ patients, had the highest pack-years index. ACO patients were marked with maximal TLC and Raw, minimal FEV1, FEF25-75, FEV1/FVC. Patients with COPD had the highest inflammation markers (leucocyte count, CRP, fibrinogen). CONCLUSION: high active inflammation may cause severe lower airways possibility disorders at patients with COPD. Data related to a possible role of K. pneumoniaе in the pathogenesis of eosinophilic inflammation in lower airways are of significant interest. Patients with ACO occupy an intermediate position between asthma and COPD patients based on clinical and functional features.

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Exercise tolerance and dyspnea in patients with chronic obstructive pulmonary disease

Vojnosanitetski pregled ◽

10.2298/vsp1001036c ◽

2010 ◽

Vol 67 (1) ◽

pp. 36-41

Author(s):

Ivan Cekerevac ◽

Zorica Lazic ◽

Ljiljana Novkovic ◽

Marina Petrovic ◽

Vojislav Cupurdija ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Function ◽

Exercise Tolerance ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Diffusion Capacity ◽

Tolerance Level ◽

Lung Hyperinflation ◽

Copd Patients

Background/Aim. Peripheral muscle weakness and nutritional disorders, firstly loss of body weight, are common findings in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to analyse the impact of pulmonary function parameters, nutritional status and state of peripheral skeletal muscles on exercise tolerance and development of dyspnea in COPD patients. Methods. Thirty COPD patients in stable state of disease were analyzed. Standard pulmonary function tests, including spirometry, body pletysmography, and measurements of diffusion capacity were performed. The 6-minute walking distance test (6MWD) was done in order to assess exercise tolerance. Level of dyspnea was measured with Borg scale. In all patients midthigh muscle cross-sectional area (MTCSA) was measured by computerized tomography scan. Nutritional status of patients was estimated according to body mass index (BMI). Results. Statistically significant correlations were found between parameters of pulmonary function and exercise tolerance. Level of airflow limitation and lung hyperinflation had significant impact on development of dyspnea at rest and especially after exercise. Significant positive correlation was found between MTCSA and exercise tolerance. Patients with more severe airflow limitation, lung hyperinflation and reduced diffusion capacity had significantly lower MTCSA. Conclusion. Exercise tolerance in COPD patients depends on severity of bronchoobstruction, lung hyperinflation and MTCSA. Severity of bronchoobstruction and lung hyperinflation have significant impact on dyspnea level.

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Predictors of co-morbidities in chronic obstructive pulmonary disease patients at a tertiary care centre in north India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20194984 ◽

2019 ◽

Vol 7 (11) ◽

pp. 4154

Author(s):

Kaushlendra Pratap Narayan ◽

S. K. Verma ◽

Surya Kant ◽

R. A. S. Kushwaha ◽

Santosh Kumar ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Inflammatory Process ◽

Tertiary Care ◽

Airflow Limitation ◽

Pulmonary Vasculature ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Co Morbidity

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. COPD is characterised by an intense inflammatory process in the airways, parenchyma, and pulmonary vasculature. It is possible in some cases that the inflammatory process may overflow into the systemic circulation, promoting a generalised inflammatory reaction. Patient with COPD often have concomitant chronic illness (co-morbidities). The aim of this study is to know the pattern of co-morbidities in COPD patients.Methods: This study was a cross sectional observational study conducted on 172 COPD patients (IPD and OPD) diagnosed on the basis of GOLD guideline 2017. Co morbidities were diagnosed as per standard defined criteria laid down in the respective guidelines.Results: 55.3% of the patients with COPD had co morbidities. 18/88(20.5%) patients presented with multiple co-morbidities. 49/88, 55.7% COPD patients were affected with cardiac (either only cardiac or had multiple organs affected besides cardiac), the commonest co-morbidity. Amongst cardiac, hypertension and congestive heart failure (CHF) was the commonest (n=19/49, 38.8% each) followed by CAD/CSA/IWMI/IHD/AF. Others were metabolic (n=14/88, 15.9%), GERD (n=13/88, 14.8%), Depression (n=11/88, 12.5%). Less prevalent co-morbidities were Osteoporosis (n=8/88, 9.1%), Lung cancer (n=6/88, 6.8%), Bronchiectasis (n=5/88, 5.6%) and OSA (n=3/88, 3.4%).Conclusions: Urban indwelling, advancing age and duration of illness, presentation with low mood, loss of pleasure/ interest, appetite disturbances and heart burn with relief on taking proton pump inhibitor can be predictors of co-morbidities in COPD patients. Chance of finding co-morbidities may be multifactorial. Thus, it is important to look out for co morbidities in each and every COPD patients.

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Preliminary Study to Evaluate Three Different Treatments on Stable Chronic Obstructive Pulmonary Disease Patients Based on Markov Model

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2019/6478926 ◽

2019 ◽

Vol 2019 ◽

pp. 1-16

Author(s):

Xue-qing Yu ◽

Shu-guang Yang ◽

Han Li ◽

Yang Xie ◽

Jian-sheng Li ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Markov Model ◽

Pulmonary Disease ◽

Western Medicine ◽

Combined Treatment ◽

Cost Utility ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Life Years

This study evaluates the costs and utilities of different treatment strategies for stable chronic obstructive pulmonary disease (COPD) patients based on Markov model and provides guidance for clinical decision and health policy making. Patients with stable COPD from four subcenters had been investigated. A Markov model with three states, namely, GOLD 1-2, GOLD 3-4, and death, was built using TreeAge Pro 2011 software. Cost-utility ratio (CUR) and incremental cost-utility ratio (ICUR) from forty Markov circles were applied to measuring the economics evaluation of three different treatments. A total of 236 stable COPD patients were randomly assigned into three groups, Western medicine group (79 cases), traditional Chinese medicine (TCM) group (79 cases), and combined group (78 cases). The results of Markov cohort simulation showed that the accumulative quality-adjusted life years (QALYs) of the three above groups per 100 000 people in 40 years were 1 702 773, 1 616 797, and 1 709 668 years, respectively, and the accumulative costs were 13 582 138 466, 1 207 904 113, and 14 656 607 371 Yuan, respectively. The CURs of the three groups were 87 235, 74 602, and 87 223 Yuan/QALY, respectively. ICURs of combined group were 8 707 and 41 705 Yuan as against Western medicine group and TCM group, respectively. Therefore, combined treatment has a lower cost, higher health output, and more socioeconomic benefits in the long run. Markov model is recommended to conduct health economics evaluation of different treatments for COPD.

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Increased levels of Nε-(carboxymethyl)lysine in epithelial lining fluid from peripheral airways in patients with chronic obstructive pulmonary disease: a pilot study

Clinical Science ◽

10.1042/cs20100096 ◽

2010 ◽

Vol 119 (3) ◽

pp. 143-149 ◽

Cited By ~ 9

Author(s):

Hiroshi Kanazawa ◽

Toyoki Kodama ◽

Kazuhisa Asai ◽

Saeko Matsumura ◽

Kazuto Hirata

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Epithelial Lining ◽

Obstructive Pulmonary Disease ◽

Epithelial Lining Fluid ◽

Peripheral Airways ◽

Copd Patients ◽

Carboxymethyl Lysine

It has been reported that small airway inflammation is closely associated with the severity of airflow limitation in COPD (chronic obstructive pulmonary disease). We tested a new method of measurement of biochemical constituents in ELF (epithelial lining fluid) obtained separately from the central or peripheral airways using a bronchoscopic microsampling technique. The present study was designed to determine the validity of measuring CML [Nε-(carboxymethyl)lysine] levels in ELF for the assessment of small airway inflammation in COPD. Ten non-smokers, ten current smokers and 16 COPD patients were included in the present study. Concentrations of CML, 8-isoprostane and IL-8 (interleukin-8) were measured in ELF separately from the central or peripheral airways. CML levels in central airways did not differ significantly, but were markedly higher in peripheral than in central airways in the three groups. However, CML levels in peripheral airways of COPD patients were significantly higher than those in non-smokers and current smokers. In COPD patients, the CML level in peripheral airways was significantly correlated with FEV1 (forced expiratory volume in 1 s) (r=−0.82, P=0.002) and FEV1/FVC (forced vital capacity) (r=−0.57, P=0.03). Moreover, CML levels in peripheral airways were significantly correlated with levels of both 8-isoprostane (r=0.76, P=0.003) and IL-8 (r=0.67, P=0.01). In conclusion, these findings suggest that elevated levels of CML in ELF from peripheral airways were observed in COPD patients, and this parameter was correlated with the severity of airflow limitation.

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The Prevalence of Diabetes Mellitus in Chronic Obstructive Pulmonary Disease Patients

Jurnal Respirologi Indonesia ◽

10.36497/jri.v40i1.97 ◽

2020 ◽

Vol 40 (1) ◽

pp. 48-57

Author(s):

Mariska Pangaribuan ◽

Faisal Yunus ◽

Triya Damayanti ◽

Rochsismandoko Rochsismandoko

Keyword(s):

Diabetes Mellitus ◽

Cross Sectional Study ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Inhaled Corticosteroid ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Number Of Patients

Backgrounds: Type 2 diabetes mellitus (DM) is a common comorbidity of COPD. COPD may be considered as a risk factor for new onset type 2 DM via multiple pathophysiological alterations such as systemic inflammation, smoking, oxidative stress, obesity and inhaled corticosteroid use. Exact prevalence of DM in COPD patients in Indonesia still unclear. Co-morbid conditions like DM have great impact on the outcome of COPD in the form of severity, morbidity and mortality. Methods: A cross sectional study was done in Asthma-COPD clinic Persahabatan Hospital from February to March 2017 to screen COPD patients for DM. Sixty-four subjects were recruited. Interview, physical examination and laboratory testing were performed in all subjects. Results: A total of 64 patients with COPD (Males=60, Female=4) with mean age 65±8.7 were screened for DM. Patients with known history of DM were 12 subjects (18.8%) and were enrolled as known DM cases. Remaining 52 subjects (81.3%) whose DM status was unclear were screened by random or fasting blood sugar and HbA1c. Two subjects (3.1%) were considered as newly diagnosed DM cases. Prevalence of DM in present study was 21.9%. Number of patients with pre-diabetes was 16 subjects (25%). There was no significant relationship between gender, age, smoking, nutritional status, airflow limitation and inhaled corticosteroid use in occurrence of DM among COPD patients. Conclusions: Prevalence of DM in COPD patients in the present study is 21.9%. It is important to screen all COPD patients for DM routinely. (J Respir Indo. 2020; 40(1): 48-57)

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Cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: echocardiography changes and their relation to the level of airflow limitation

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.848 ◽

2019 ◽

Vol 7 (21) ◽

pp. 3568-3573

Author(s):

Daniela Buklioska Ilievska ◽

Jordan Minov ◽

Nade Kochovska Kamchevska ◽

Biljana Prgova Veljanova ◽

Natasha Petkovikj ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Hypertension ◽

Pulmonary Disease ◽

Doppler Echocardiography ◽

Mean Value ◽

Airflow Limitation ◽

Left Ventricular Ejection ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients

Objective. To compare frequency of echocardiographic changes in patients with chronic obstructive pulmonary disease (COPD) and non-COPD controls and to assess their relation to the level of airflow limitation. Methods. Study population included 120 subjects divided in two groups. Group 1 included 60 patients with COPD (52 male and 8 female, aged 40 to 80 years) initially diagnosed according to the actual recommendations. Group 2 included 60 subjects in whom COPD was excluded serving as a control. The study protocol consisted of completion of a questionnaire , pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray) and two dimensional (2D) Doppler echocardiography. Results. We found significantly higher mean right ventricle end-diastolic dimension (RVEDd) in COPD patients as compared to its dimension in controls (28.0 ± 4.8 vs. 24.4 ± 4.3; P = 0.0000). Pulmonary hypertension (PH) was more frequent in COPD patients than in controls (28.0 ± 4.8 vs. 24.4 ± 4.3; P = 0.0000) showing linear relationship with severity of airflow limitation. The mean value of left ventricular ejection fraction (LVEF%) was significantly lower in COPD patients than its mean value in controls (57.4 ± 6.9% vs. 64.8 ± 2.7; P = 0.0000) with no correlation with severity of airflow limitation. Conclusion. Frequency of echocardiographic changes in COPD patients was significantly higher as compared to their frequency in controls in the most cases being significantly associated with severity of airflow limitation. Echocardiography enables early, noninvasive, and accurate diagnosis of cardiac changes in COPD patients giving time for early intervention. Key words: airflow limitation, chronic obstructive pulmonary disease, Doppler echocardiography, pulmonary hypertension, ventricular dysfunction.

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Study on correlation between six minute walk test and BODE index in chronic obstructive pulmonary disease patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204876 ◽

2020 ◽

Vol 8 (11) ◽

pp. 3911

Author(s):

Babulal Bansiwal ◽

Anees K. V. ◽

Maneesha Jelia ◽

Satyam Agarwal

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Clinical Symptoms ◽

Pearson Correlation ◽

Outpatient Department ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Bode Index ◽

Copd Patients

Background: Chronic obstructive pulmonary disease is preventable and treatable disease with progressive persistent airflow limitation and enhanced chronic inflammatory response in the airways. Indian council of medical research conducted a study and found that total burden of COPD in India has more than doubled to about 14.84 million in 2011 from about 6.45 million in 1971Methods: It was an open label cross sectional study. It was conducted on patients attending the outpatient department of respiratory medicine, new medical college and hospital, Kota, over a period of one year. 100 COPD patients attending the respiratory outpatient department of GMC, Kota and fulfilling the inclusion criteria’s were included in the study. A diagnosis and severity of COPD was established by clinical symptoms and spirometric data as per GOLD guideline (ratio of FEV1 and forced vital capacity <0.7).Results: We found a significant negative correlation (Pearson correlation coefficient r = -0.664, p< 0.001) between 6 MWD and BODE index in study population.Conclusions: Thus, we concluded that the functional exercise capacity of COPD patients measured by 6MWT deteriorates linearly with severity of the disease assessed by the GOLD staging criteria. Hence we can use 6 MWT for assessing the severity of COPD in place of spirometry where the facility of spirometry is not feasible.

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EFEKTIVITAS TEKNIK PURSED LIPSBREATHING PADA PASIEN PENYAKIT PARU OBSTRUKSI KRONIK (PPOK): STUDY SYSTEMATIC REVIEW

Jurnal Kesehatan ◽

10.24252/kesehatan.v12i2.10180 ◽

2019 ◽

Vol 12 (2) ◽

pp. 137

Author(s):

Barakatul Qamila ◽

Maria Ulfah Azhar ◽

Risnah Risnah ◽

Muhammad Irwan

Keyword(s):

Systematic Review ◽

Respiratory Muscles ◽

Chronic Obstructive ◽

Inclusion Criteria ◽

Breathing Patterns ◽

Obstructive Pulmonary Disease ◽

Main Complaint ◽

Copd Patients ◽

Research Questions ◽

Quantitative Descriptive

Chronic obstructive pulmonary disease (COPD) is one of the chronic diseases characterized by limited air flow contained in the respiratory tract. Breathing shortness becomes the main complaint feeling by COPD patients. Pursed lips breathing (PLB) technique can increase pulmonary compliance to retrain the respiratory muscles to function properly and prevent respiratory distress. This study aims to determine the effectiveness of pursed lips breathing technique in COPD patients. The research used a quantitative descriptive design with a systematic review approach. There were 315 articles published from 2015-2019. From 315 articles, 7 articles that met the inclusion criteria and research questions. Based on the result of the Systematic Review that has been conducted on pursed lips breathing technique in COPD patients, it was concluded that the PLB technique is effective to reduce breathing frequency and improve oxygen saturation. PLB technique given 3 times per day in every morning, afternoon, and evening with a time of 6-30 minutes for 3 consecutive days. The PLB technique is effective in reduce frequency respiratory and increase oxygenation in COPD patients with ineffective breathing patterns. Furthermore, it is suggested that PLB techniques can be applied as one of the nurses' independent interventions in nursing care for COPD patients to reduce patients complaints of breathing shortness.ABSTRAKPenyakit paru obstruksi kronik (PPOK) merupakan salah satu penyakit kronik yang ditandai dengan terbatasnya aliran udara yang terdapat di dalam saluran pernapasan. Sesak napas menjadi keluhan utama yang dirasakan oleh pasien PPOK. Teknik pernapasan pursed lips breathing (PLB) merupakan teknik pernapasan yang membantu meningkatkan compliance paru untuk melatih kembali otot pernapasan berfungsi dengan baik serta mecegah distress pernapasan. Penelitian ini bertujuan untuk mengetahui efektivitas teknik pursed lips breathing pada pasien PPOK. Penelitian menggunakan desain deskriptif kuantitatif dengan pendekatan systematic review. Terdapat 315 artikel yang dipublikasi dari tahun 2015-2019. Dari 315 artikel 7 artikel yang sesuai dengan kriteria inklusidan pertanyaan penelitian, dimana kriteria inklusi tersebut ialah artikel tahun 2015-2019 full text yang sesuai dengan topik penelitia yaitu teknik PLB pada pasien PPOK, terdapat ISSN dan atau DOI, artikel yang berfokus pada intervensi terapi Pursed Lips Breathing, artikel yang berfokus pada pemenuhan oksigenisasi dan frekuensi pernapasan sebagai alat ukur. Berdasarkan hasil Systematic Review yang telah dilakukan tentang teknik pursed lips breathing pada pasien PPOK disimpulkan bahwa teknik PLB efektif menurunkan frekuensi pernapasan dan meningkatkan pemenuhan oksigenisasi dalam tubuh. Dengan demikian pemberian latihan yaitu 3x sehari setiap pagi, siang, dan sore dengan waktu 6-30 menit selama 3 hari berturut-turut. Teknik PLB efektif dalam menurunkan frekuensi pernapasan dan meningkatkan pemenuhan oksigenisasi pada pasien PPOK dengan pola napas tidak efektif. Selanjutnya, disarankan teknik PLB dapat dijadikan sebagai salah satu intervensi mandiri perawat dalam melakukan asuhan keperawatan pada pasien PPOK untuk mengurangi keluhan sesak.

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Extended Bacteria Culture-Based Clustering Identifies a Phenotype Associating Increased Cough and Enterobacterales in Stable Chronic Obstructive Pulmonary Disease

Frontiers in Microbiology ◽

10.3389/fmicb.2021.781797 ◽

2021 ◽

Vol 12 ◽

Author(s):

Anaëlle Muggeo ◽

Jeanne-Marie Perotin ◽

Audrey Brisebarre ◽

Sandra Dury ◽

Valérian Dormoy ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Clinical Symptoms ◽

Bacterial Load ◽

Stable State ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Mass Spectrometry Identification

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by airflow limitation. This chronic respiratory disease represents the third leading cause of death worldwide. Alteration of the airway microbiota has been reported to be associated with exacerbation frequency in COPD, but its role on the symptoms in patients at stable state is still incompletely described. This study aimed to determine whether bacteria isolated in sputum can be associated with the clinical features of COPD patients within stable state. Our study highlights, for the first time, that altered microbiota with Enterobacterales is associated with pejorative clinical symptoms in stable COPD patients. The airway microbiota of 38 patients was analyzed using an extended culture approach and mass spectrometry identification. Cluster analysis by principal coordinate analysis of the bacterial communities showed that the patients could be classified into three distinct clusters in our cohort. The clusters showed no differences in proportions of the phylum, but one of them was associated with a high prevalence of Enterobacterales (71.4% in cluster 1 vs. 0% in cluster 3), loss of microbiota diversity, and higher bacterial load (107 vs. 105 CFU/ml, respectively) and characterized by predominant cough and impact on mental health. These novel findings, supported by further studies, could lead to modifying the processing of COPD sputum in the everyday practice of clinical microbiology laboratories.

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