Objective
Mortality from coronavirus disease 2019 (COVID‐19) is increased in patients with chronic obstructive pulmonary disease (COPD). Furthermore, higher BMI is related to severe disease. Severe ...acute respiratory syndrome coronavirus 2 utilizes angiotensin converting enzyme 2 (ACE2) to gain cellular entry.
Methods
Whether ACE2 bronchial epithelial expression is increased in COPD patients who have overweight compared with those who do not was investigated by RNA sequencing.
Results
Increased ACE2 expression was observed in patients with COPD with overweight (mean BMI, 29 kg/m2) compared with those without overweight (mean BMI, 21 kg/m2) (P = 0.004).
Conclusions
Increased ACE2 expression may cause increased severe acute respiratory syndrome coronavirus 2 infection of the respiratory tract. Overweight COPD patients may be at greater risk for developing severe COVID‐19.
The 2019 coronavirus disease (COVID-19) pandemic is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Clinical outcomes, including mortality, are worse in males, older ...individuals and patients with comorbidities. COPD patients are included in shielding strategies due to their susceptibility to virus-induced exacerbations, compromised pulmonary function and high prevalence of associated comorbidities. Using evidence from basic science and cohort studies, this review addresses key questions concerning COVID-19 and COPD. First, are there mechanisms by which COPD patients are more susceptible to SARS-CoV-2 infection? Secondly, do inhaled corticosteroids offer protection against COVID-19? And, thirdly, what is the evidence regarding clinical outcomes from COVID-19 in COPD patients? This up-to-date review tackles some of the key issues which have significant impact on the long-term outlook for COPD patients in the context of COVID-19.
Small airways disease (SAD) is a cardinal feature of chronic obstructive pulmonary disease (COPD) first recognized in the nineteenth century. The diverse histopathological features associated with ...SAD underpin the heterogeneous nature of COPD. Our understanding of the key molecular mechanisms which drive the pathological changes are not complete. In this article we will provide a historical overview of key histopathological studies which have helped shape our understanding of SAD and discuss the hallmark features of airway remodelling, mucous plugging and inflammation. We focus on the relationship between SAD and emphysema, SAD in the early stages of COPD, and the mechanisms which cause SAD progression, including bacterial colonization and exacerbations. We discuss the need to specifically target SAD to attenuate the progression of COPD.
Early clinical data from studies of the NVX-CoV2373 vaccine (Novavax), a recombinant nanoparticle vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that contains the ...full-length spike glycoprotein of the prototype strain plus Matrix-M adjuvant, showed that the vaccine was safe and associated with a robust immune response in healthy adult participants. Additional data were needed regarding the efficacy, immunogenicity, and safety of this vaccine in a larger population.
In this phase 3, randomized, observer-blinded, placebo-controlled trial conducted at 33 sites in the United Kingdom, we assigned adults between the ages of 18 and 84 years in a 1:1 ratio to receive two intramuscular 5-μg doses of NVX-CoV2373 or placebo administered 21 days apart. The primary efficacy end point was virologically confirmed mild, moderate, or severe SARS-CoV-2 infection with an onset at least 7 days after the second injection in participants who were serologically negative at baseline.
A total of 15,187 participants underwent randomization, and 14,039 were included in the per-protocol efficacy population. Of the participants, 27.9% were 65 years of age or older, and 44.6% had coexisting illnesses. Infections were reported in 10 participants in the vaccine group and in 96 in the placebo group, with a symptom onset of at least 7 days after the second injection, for a vaccine efficacy of 89.7% (95% confidence interval CI, 80.2 to 94.6). No hospitalizations or deaths were reported among the 10 cases in the vaccine group. Five cases of severe infection were reported, all of which were in the placebo group. A post hoc analysis showed an efficacy of 86.3% (95% CI, 71.3 to 93.5) against the B.1.1.7 (or alpha) variant and 96.4% (95% CI, 73.8 to 99.5) against non-B.1.1.7 variants. Reactogenicity was generally mild and transient. The incidence of serious adverse events was low and similar in the two groups.
A two-dose regimen of the NVX-CoV2373 vaccine administered to adult participants conferred 89.7% protection against SARS-CoV-2 infection and showed high efficacy against the B.1.1.7 variant. (Funded by Novavax; EudraCT number, 2020-004123-16.).
The aim of this study was to obtain a nuanced, in-depth insight into sport psychology consultants' (SPCs') experiences of working with cases of maltreatment in sport, and their practice ...recommendations to address this behavior. Semi-structured interviews were conducted with five HCPC-registered SPCs in the UK. Data were analyzed in line with the principles of Interpretative Phenomenological Analysis. Four group experiential themes emerged, centered around the participants searching for meaning, fighting the system, ingrained acceptance, and tackling the problem of maltreatment in sport. Specifically, the participants referred to how the sporting context influenced their understanding of maltreatment. They also discussed the inherent difficulties with reporting this behavior, and a lack of support in this process, whilst also alluding to how sporting institutions normalized abusive practices in pursuit of performance outcomes. To address the issue of maltreatment in sports, the participants discussed a variety of recommendations including organizations being accountable, the need for organizations to be more representative, and for SPCs to work with contextual intelligence. The findings from the present study provide important implications for sporting organizations, SPCs, and the professional bodies who support practitioners around the need to further understand maltreatment in sport, and to tackle this issue.
Lay summary: In this study, SPCs shared their experiences of how they understand maltreatment in the sporting context. They also discussed their battles with the sporting system, and how maltreatment can be inherent to sports culture. These findings provide valuable insight into how maltreatment can be tackled in sport.
Accountability for the cycle of maltreatment across sporting domains needs to be taken at both the micro, meso, and macrosystem levels.
Greater efforts need to be made for the continued education of SPCs concerning maltreatment in sport.
Organizations need to provide greater support, and autonomy to individuals who are tasked with safeguarding individuals' welfare in sport.
Inhaled corticosteroids (ICS) are the most commonly used anti-inflammatory drugs for the treatment of COPD. COPD has been previously described as a “corticosteroid-resistant” condition, but current ...clinical trial evidence shows that selected COPD patients, namely those with increased exacerbation risk plus higher blood eosinophil count (BEC), can benefit from ICS treatment. This review describes the components of inflammation modulated by ICS in COPD and the reasons for the variation in response to ICS between individuals. There are corticosteroid-insensitive inflammatory pathways in COPD, such as bacteria-induced macrophage interleukin-8 production and resultant neutrophil recruitment, but also corticosteroid-sensitive pathways including the reduction of type 2 markers and mast cell numbers. The review also describes the mechanisms whereby ICS can skew the lung microbiome, with reduced diversity and increased relative abundance, towards an excess of proteobacteria. BEC is a biomarker used to enable the selective use of ICS in COPD, but the clinical outcome in an individual is decided by a complex interacting network involving the microbiome and airway inflammation.
Football coaches have disclosed how their work environment is unpredictable and demanding, comprising a multitude of stressors which can impede well-being. Additionally, the masculine culture within ...football often promotes suppression of voice, causing internalisation of thoughts and isolation. Due to professional football head coaches being a seldom-heard group, little is known about how they experience well-being within their given context (i.e., ecological niche). The present study utilised football docuseries and a bioecological framework to explore how four male professional head coaches experienced well-being whilst working in one of the top European football leagues (Premier League, La Liga). Four docuseries were sampled and resulted in the analysis of 31 episodes (Mduration = 46.6 min, SD = 4.5 min). The study implemented an adapted interpretative phenomenological analysis approach to illuminate convergences and divergences in contextual accounts. These accounts resulted in five group experiential themes: ‘I belong to the game’; ‘he belongs to the game’; ‘you need the right people around you’; ‘it’s difficult to describe the manager without describing the person’; and ‘people are trying to stab you’. The findings indicate that football coaches may experience identity conflicts and become deeply absorbed in their work. This impacts not only their well-being but also their family’s, who they often turn to for social support. Consequently, by unveiling nuanced challenges to coaches’ well-being, organisations may be better informed to offer more aligned and bespoke well-being support systems.
•Docuseries granted access to male professional head football coaches.•A bioecological framework holistically conceptualises well-being.•An adapted interpretative phenomenological analysis approach was implemented.•Five group experiential themes relating to well-being were established.•Docuseries represent a useful way to explore intra and interpersonal well-being over a season.
Electronic cigarettes (e-cigs) are used to help smoking cessation. However, these devices contain harmful chemicals, and there are safety concerns. We have investigated the effects of e-cigs on the ...inflammatory response and viability of COPD bronchial epithelial cells (BECs).
BECs from COPD patients and controls were exposed to e-cig vapor extract (ECVE) and the levels of interleukin (IL)-6, C-X-C motif ligand 8 (CXCL8), and lactate dehydrogenase release were measured. We also examined the effect of ECVE pretreatment on polyinosinic:polycytidylic acid (poly I:C)-stimulated cytokine release from BECs. Parallel experiments using Calu-3 cells were performed. Comparisons were made with cigarette smoke extract (CSE).
ECVE and CSE caused an increase in the release of IL-6 and CXCL8 from Calu-3 cells. ECVE only caused toxicity in BECs and Calu-3 cells. Furthermore, ECVE and CSE dampened poly I:C-stimulated C-X-C motif ligand 10 release from both cell culture models, reaching statistical significance for CSE at an optical density of 0.3.
ECVE caused toxicity and reduced the antiviral response to poly I:C. This raises concerns over the safety of e-cig use.
High FENO can occur despite low blood eosinophil counts in ex-smokers, while a minority of current smokers have elevated FENO that is not related to eosinophil counts. FENO levels may be related to ...noneosinophilic mechanisms in a subgroup of COPD. https://bit.ly/3PSWvM2.
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