Abstract

Aim: to assess the degree and nature of the autoimmune orientation of systemic inflammation in patients with COPD.

Material and methods. Levels of interleukins 1ß,10,17 and TGF 1ß, pulmonary antibodies (LAT) and antinuclear antibodies (ANA) were determined in 114 COPD patients.

Results: Elevated LAT titers were noted in 93.6% among patients of severe and extremely severe stage and in 100% in persons with emphysematous phenotype. The presence of weak correlations between TNF-α and LAT (r=0.19), IL10 and LAT (r=0.18), as well as TNF-α/IL10 and LAT (r=0.20) is shown. Elevated levels of ANA reflecting a systemic autoimmune process were noted in 16.7% of COPD patients, more among patients with extremely severe stage (30.0%) and emphysematous phenotype of the disease (25.0%). An increase in the level of IL-17 was noted in 32% of patients. With the increasing severity of the disease, the proportion of people with an elevated level increases from 22.2% to 38.8% and mainly in patients with COPD of emphysematous phenotype. A weak correlation was noted between TGF 1ß and ANA (r=0.24).

Conclusion: The cytokine intensity of the immune response determines the likelihood of developing autoimmune processes, which is demonstrated by the frequency of high titers of tissue antibodies to lung tissue and ANA. Isolation of immune phenotypes dictates the possibility of other approaches to pathogenetic therapy.

Background

While renin-angiotensin system inhibitors (RASi) have shown benefits for people with both heart failure (HF) and chronic obstructive pulmonary disease (COPD), limited data exists on the use of angiotensin receptor-neprilysin inhibitors (ARNIs) in this population. This study compares the effectiveness of RASi and ARNIs in people with coexisting COPD and HF.

Methods

We identified individuals who started treatment with either ARNI or RASi since August 1, 2015. We assessed outcomes such as COPD exacerbations, acute respiratory failure, and lower respiratory tract infections (LRTIs) over 30 days to 3 years. Kaplan-Meier survival analysis and Cox regression models were applied to estimate survival probabilities and hazard ratios (HR).

Results

Among 9,071 ARNI users and 71,836 RASi users, the ARNI group has fewer respiratory complications. The ARNI group has a higher proportion of females compared to the RASi group (38.2% vs. 31.5%). Specifically, ARNI users have a lower incidence of COPD exacerbations (13.1% vs. 18.7%; HR, 0.84), acute respiratory failure (16.2% vs. 22.0%; HR, 0.90), and LRTIs (16.9% vs. 22.9%; HR, 0.91).

The minimal clinically important difference (MCID) defines to what extent change on a health status instrument is clinically relevant, which aids scientists and physicians in measuring therapy effects. This is the first study that aimed to establish the MCID of the Clinical chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ), the COPD Assessment Test (CAT) and the St George’s Respiratory Questionnaire (SGRQ) in the same pulmonary rehabilitation population using multiple approaches. In total, 451 COPD patients participated in a 3-week Pulmonary Rehabilitation (PR) programme (58 years, 65% male, 43 pack-years, GOLD stage II/III/IV 50/39/11%). Techniques used to assess the MCID were anchor-based approaches, including patient-referencing, criterion-referencing and questionnaire-referencing, and the distribution-based methods standard error of measurement (SEM), 1.96SEM and half standard deviation (0.5s.d.). Patient- and criterion-referencing led to MCID estimates of 0.56 and 0.62 (CCQ); 3.12 and 2.96 (CAT); and 8.40 and 9.28 (SGRQ). Questionnaire-referencing suggested MCID ranges of 0.28–0.61 (CCQ), 1.46–3.08 (CAT) and 6.86–9.47 (SGRQ). The SEM, 1.96SEM and 0.5s.d. were 0.29, 0.56 and 0.46 (CCQ); 3.28, 6.43 and 2.80 (CAT); 5.20, 10.19 and 6.06 (SGRQ). Pooled estimates were 0.52 (CCQ), 3.29 (CAT) and 7.91 (SGRQ) for improvement. MCID estimates differed depending on the method used. Pooled estimates suggest clinically relevant improvements needing to exceed 0.40 on the CCQ, 3.00 on the CAT and 7.00 on the SGRQ for moderate to very severe COPD patients. The MCIDs of the CAT and SGRQ in the literature might be too low, leading to overestimation of treatment effects for patients with COPD.

Let’s be honest: everyone dreads catching a cold or the flu. But when you have COPD, it’s more than just an inconvenience; it’s a direct threat. What might be a minor sniffle for someone else can quickly escalate into a serious lung infection (like pneumonia) or a dangerous COPD flare-up for you—the kind that can land you in the emergency room.

The reason is simple. Your lungs are already working overtime. Throwing a virus into the mix is like pouring gasoline on a smoldering fire. It causes massive inflammation, swelling in your airways, and a flood of thick mucus, making it nearly impossible to breathe.

But fear doesn’t have to be in the driver’s seat. You can fight back with a smart, proactive game plan.

Your First Line of Defense: Prevention is Everything

Vaccinate Like Your Life Depends On It (Because It Does):

The Flu Shot: This is your non-negotiable, number-one priority. Get it every year, as soon as it’s available.

Pneumonia Vaccine: Ask your doctor if you’ve had the pneumococcal vaccine to protect against a common cause of pneumonia.

COVID-19 Boosters: Stay up-to-date with the latest COVID-19 vaccinations and boosters.
Vaccines are your best shield. They may not guarantee you won’t get sick, but they dramatically reduce your risk of severe complications and hospitalization.

Become a Germ-Fighting Ninja:

Wash Your Hands frequently with soap and water. It’s the simplest and most effective tactic.

Carry Hand Sanitizer for when you can’t wash.

Keep Your Distance from people who are coughing and sneezing.

Avoid Touching Your Face, especially your eyes, nose, and mouth.

Your Sick-Day Action Plan: When the Bug Bites

Even with the best defenses, you might still get sick. The key is to act fast. Don’t wait it out.

Call Your Doctor at the First Sign. Don’t wait until you’re in crisis. Tell them you have COPD and describe your symptoms. They may prescribe antiviral medication (for the flu) or other treatments that work best when started early.

Know Your “Red Flag” Symptoms. These are signs that you need immediate medical attention:

Increased shortness of breath, even while resting.

A fever that is high or lasts more than a day.

A change in your mucus (it becomes yellow, green, bloody, or much thicker).

Confusion, dizziness, or severe drowsiness.

Feeling so breathless you can’t speak in full sentences.

Stick to Your COPD Regimen. It’s more important than ever to take your maintenance medications as prescribed. This will help keep your airways as open as possible.

Hydrate and Rest. Drink plenty of fluids (water, broth) to help thin mucus. Your body needs all its energy to fight the infection, so cancel your plans and rest.

Getting sick is a risk, but it’s not a guaranteed disaster. By having a clear game plan, you can protect yourself, act decisively, and get through cold and flu season with confidence. Your lungs are counting on you.

Introduction
Every day, you breathe approximately 20,000 times. This automatic process fuels your body with essential oxygen while removing waste carbon dioxide. Optimal respiratory function affects everything from your energy levels to your immune response. This comprehensive guide provides evidence-based strategies to enhance your breathing capacity and protect your respiratory health through simple, daily practices.

Foundations of Healthy Breathing

1. Understanding Respiratory Efficiency
   Your respiratory system’s efficiency depends on multiple factors: airway clarity, muscle strength, and environmental conditions. The average adult uses only about 70% of their total lung capacity during normal breathing. With proper techniques and habits, you can improve this percentage, delivering more oxygen to your body with less effort.
2. The Impact of Modern Living
   Sedentary lifestyles, poor posture, and environmental pollutants have made inefficient breathing increasingly common. Many people develop shallow breathing patterns, using only the upper portion of their lungs. This not only reduces oxygen intake but can contribute to anxiety, fatigue, and increased susceptibility to respiratory issues.

Daily Maintenance Routine

1. Morning Breathing Exercises
   Start each day with five minutes of conscious breathing:

• Sit comfortably with straight spine
• Inhale deeply through nose for 4 counts
• Hold breath for 2 counts
• Exhale completely through mouth for 6 counts
  This practice oxygenates your body, activates your diaphragm, and sets a healthy breathing pattern for the day.

2. Postural Awareness
   Your breathing capacity directly relates to your posture. Implement these habits:

• Set reminders to check your posture hourly
• Use ergonomic chairs that support spinal curves
• Position computer screens at eye level
• Practice shoulder roll exercises every two hours

3. Hydration Strategy
   Proper hydration maintains the thin mucus layer that traps pathogens and irritants. Drink water consistently throughout the day rather than consuming large volumes at once. Herbal teas and broth-based soups also contribute to fluid intake while providing additional antioxidants.

Environmental Optimization

1. Home Environment Enhancements
   Create a respiratory-friendly home environment:

• Maintain humidity levels between 30-50%
• Use vacuum cleaners with HEPA filters
• Choose natural cleaning products
• Ensure proper ventilation in bathrooms and kitchens
• Consider salt lamps which may help reduce airborne irritants

2. Workplace Considerations
   Improve your work breathing environment:

• Position your desk away from air vents
• Use a small desktop air purifier
• Incorporate plants that improve air quality
• Take regular breathing breaks away from your desk

Nutritional Support

1. Essential Nutrients for Respiratory Health
   Incorporate these powerhouse foods:

• Apples (contain quercetin, a natural antihistamine)
• Ginger and turmeric (natural anti-inflammatories)
• Garlic and onions (sulfur compounds that support immunity)
• Green tea (contains antioxidants that protect lung tissue)
• Pumpkin seeds (rich in magnesium for bronchial health)

2. Meal Timing and Composition
   Eat smaller, more frequent meals to prevent abdominal fullness that can restrict diaphragm movement. Avoid heavy meals before periods of physical activity or bedtime.

Exercise and Activity

1. Cardiovascular Training
   Regular aerobic exercise is the most effective way to strengthen respiratory muscles. The key is consistency rather than intensity. Find activities you enjoy and can maintain long-term.
2. Strength Training
   Don’t neglect strength training for your upper body. Strong chest, back, and shoulder muscles provide better support for respiratory mechanics.
3. Breathing During Exercise
   Practice coordinating your breathing with movement. Generally, exhale during the exertion phase of exercises and inhale during the recovery phase.

Special Considerations

1. Seasonal Challenges
   Prepare for seasonal changes:

• Spring: Manage allergies with local honey and air purification
• Summer: Avoid outdoor exercise during high ozone alerts
• Fall: Boost immunity as weather changes
• Winter: Protect against dry indoor air with humidification

2. Travel Tips
   Maintain respiratory health while traveling:

• Stay hydrated during flights
• Use saline nasal sprays in dry aircraft cabins
• Choose window seats away from high-traffic aisles
• Practice breathing exercises to reduce travel stress

Monitoring and Maintenance

1. Self-Assessment
   Regularly check in with your breathing:

• Notice if you’re breathing through your mouth or nose
• Monitor for increased breathlessness during routine activities
• Pay attention to changes in your cough threshold
• Notice patterns in your energy levels

2. Professional Care
   Schedule regular check-ups and discuss any respiratory changes with your healthcare provider. Consider periodic pulmonary function testing if you have risk factors or concerns.

Conclusion
Healthy breathing is a skill that can be developed and maintained through conscious practice. By implementing these strategies—from daily breathing exercises and postural corrections to environmental adjustments and proper nutrition—you can significantly enhance your respiratory wellness. Remember that improvement comes through consistent practice. Start with one or two changes, master them, then gradually incorporate additional strategies. Your breath is your most constant companion—make each one count toward better health.

Introduction
Breathing is the most fundamental process of life, yet we often take it for granted until problems arise. Maintaining healthy respiratory function is crucial for overall wellness, energy levels, and quality of life. This guide explores practical, daily habits that can help you breathe more efficiently and protect your respiratory health for years to come.

Understanding Your Respiratory System
Your respiratory system is a complex network designed to deliver oxygen to your body while removing carbon dioxide. The diaphragm, your primary breathing muscle, works with intercostal muscles between your ribs to facilitate breathing. When these muscles are strong and your airways are clear, breathing requires minimal effort. However, pollution, poor posture, and unhealthy habits can compromise this efficiency.

Essential Daily Practices

1. Master Breathing Techniques
   Proper breathing techniques can significantly improve your respiratory efficiency. Practice diaphragmatic breathing by lying on your back with knees bent. Place one hand on your chest, the other on your abdomen. Inhale slowly through your nose, ensuring your abdomen rises more than your chest. Exhale through pursed lips. This technique strengthens your diaphragm and promotes more complete oxygen exchange.

Pursed-lip breathing is another valuable technique. Inhale through your nose for two counts, then exhale slowly through pursed lips for four counts. This method helps keep airways open longer, particularly beneficial during physical exertion or when feeling breathless.

2. Maintain Good Posture
   Your posture directly impacts your breathing capacity. Slouching compresses your chest cavity, restricting full lung expansion. Make a conscious effort to:

• Sit and stand with shoulders back
• Keep your head aligned with your spine
• Avoid prolonged periods of slouching
• Take regular stretch breaks if you sit for work

3. Stay Active
   Regular exercise is vital for respiratory health. Aerobic activities like walking, swimming, or cycling improve cardiovascular fitness and strengthen respiratory muscles. Aim for at least 30 minutes of moderate activity most days. Even simple activities like taking the stairs or walking during phone calls can make a difference.

Environmental Considerations

1. Improve Indoor Air Quality
   Indoor air can be more polluted than outdoor air. Enhance your environment by:

• Using air purifiers with HEPA filters
• Regularly replacing HVAC filters
• Introducing air-purifying plants like peace lilies or spider plants
• Avoiding synthetic air fresheners
• Ensuring proper ventilation when cooking

2. Protect Against Outdoor Pollutants
   Check air quality indexes before outdoor activities. On high-pollution days:

• Limit outdoor exercise
• Plan activities for early morning when pollution levels are typically lower
• Wear a mask if air quality is particularly poor
• Choose walking routes away from heavy traffic

Nutrition and Hydration

1. Eat for Respiratory Health
   Certain nutrients specifically support respiratory function:

• Antioxidant-rich foods (berries, leafy greens) protect against cellular damage
• Omega-3 fatty acids (fatty fish, walnuts) reduce inflammation
• Magnesium-rich foods (nuts, seeds, legumes) support bronchial relaxation
• Vitamin C sources (citrus, bell peppers) boost immunity

2. Stay Hydrated
   Adequate hydration keeps mucosal linings in respiratory passages moist, helping to trap and eliminate irritants. Aim for 6-8 glasses of water daily, more if you’re active or in dry environments.

Preventive Measures

1. Practice Good Hygiene
   Wash hands regularly to prevent respiratory infections. Avoid touching your face with unwashed hands, and clean frequently touched surfaces regularly.
2. Stay Updated on Vaccinations
   Keep current with recommended vaccinations, including annual flu shots and pneumonia vaccines if recommended by your healthcare provider.
3. Avoid Respiratory Irritants
   If you smoke, seek help to quit. Avoid secondhand smoke exposure, and limit contact with other respiratory irritants like strong chemical fumes or dust.

When to Seek Help
Consult a healthcare professional if you experience:

• Persistent cough lasting more than three weeks
• Shortness of breath during routine activities
• Wheezing or chest tightness
• Frequent respiratory infections

Conclusion
Healthy breathing habits contribute significantly to overall wellness. By incorporating these practices into your daily routine—proper breathing techniques, regular exercise, good posture, and environmental awareness—you can maintain optimal respiratory function. Remember that consistency is key; small, regular efforts yield the most significant long-term benefits for your breathing health.

Abstract

Chronic obstructive pulmonary disease (COPD) is a common disease and among the top causes of mortality worldwide but can be prevented and treated. This study aims to estimate the awareness of COPD among the Syrian population. A cross-sectional anonymous self-administered online survey was conducted by using Google Forms on Social Media platforms. The questionnaire included demographic, smoke-related and COPD-related questions. This study included 1607 participants with 930 (57.8%) females, 40% aging 21–25 years old, more than 90% being university students/graduates and 67.8% living in cities. Around half were either active smokers or had second-hand smoke exposure. After excluding participants in health-related fields who were 950 participants, only 25.4% of the remaining had ever heard of the term COPD. Knowing about COPD was not associated with reported smoking habits. No significant differences in awareness were seen between city and countryside dwellers, governate groups, genders, or age groups. Being in a health-related field was a major factor of being aware of COPD. COPD awareness in Syria is low, even amongst the well-educated group. Moreover, COPD risk factors of smoking and exposure to indoor and outdoor pollutants are common. Raising awareness is crucial in the Syrian community as COPD is highly prevalence.

Introduction

Chronic obstructive pulmonary disease (COPD) is a common condition that has a high prevalence worldwide but it is preventable and can be managed1. It manifests as a partially reversible airflow limitation due to chronic inflammation that most commonly occurs due to exposure to particles and gases, mostly from cigarettes. It is often associated with symptoms of shortness of breath, mainly on exertion, chronic cough, and chronic sputum production1,2,3. In addition to cigarette smoking, COPD may arise from certain occupational or environmental exposures such as coal mining4. Pulmonary function tests (PFT) are essential to document airflow obstruction and confirm COPD diagnosis. Post bronchodilator airflow obstruction is defined as a ratio of forced expiratory volume in the first second to the forced vital capacity (FEV1/FVC) below 0.71,4.

COPD represents a major health concern and ranks as the 3rd leading cause of mortality globally, killing 3.23 million people in 2019, which was approximately 20% of the total deaths occurred in high-income countries5. COPD prevalence varies from one country to another1. Unfortunately, Syria is estimated to have one of the highest COPD prevalence among the Middle Eastern countries as it reached 17.2% compared to 14.3% in other countries in the Middle East and North Africa, adjusted by age and gender using symptoms of persistent coughing or breathlessness6,7 (Fig. 1). COPD is often underdiagnosed until it reaches moderate or severe stages or when the patient is hospitalized due to disease exacerbation8.

Poor public awareness about COPD and its symptoms is a major concern9. Research papers in numerous countries studied the level of knowledge related to COPD among the population and emphasised on the importance of increasing awareness10,11,12,13, especially to help increase smoking cessation and prevent smoking initiation. This is particularly important as governments around the world spend billions combat COPD and its complications, which is particularly important in low-income countries due to the high burden of COPD6. This study aimed to measure the knowledge related to COPD in Syrian population in light of its high prevalence6 and the high prevalence of tobacco and shisha smoking in Syria14.

Methods

A cross-sectional anonymous self-administered online survey was conducted between 9 and 26 August 2021 among Syrian adults (age ≥ 18) through various social media platforms (WhatsApp and Facebook). It was posted daily and assured confidentiality on all participants. People had access to the link of the survey 24/7 and can access it using any device. The survey’s first page was confidentiality statement, explain the goals of the research and the reasons for the questionnaire.

The survey was originally developed following reviewing relevant literature, designed using the Google forms tool, and consists of 24 questions that were completed within 5 min. The questionnaire was split into several sections which were: demographic characteristics such as age, gender, education level, smoking habits, and basic knowledge about COPD such as its prevalence, definition, symptoms, and diagnostic test.

We confirm that all methods were performed in accordance with the relevant guidelines and regulations and in accordance with the Declaration of Helsinki.

All variables are presented as frequency and percentages. Chi-square test was used to determine statistical significance between proportions and differences were statistically significant when p values were ≤ 0.05. SPSS version 25 was used to analyse the data.

Ethics approval and consent to participate

Online informed consent was taken before proceeding with the survey for participating in the research, and for using and publishing the data. We ensure confidentiality was maintained and asked no questions that might reveal any individual’s identity. No subjects were under the age of 18 years. Our study protocol and ethical aspects were reviewed and approved by Damascus University Faculty of Pharmacy, Damascus, Syria.

Results

Demographic characteristics
A total of 1619 Syrian adults started the survey, 1607 of them completed it fully, with 930 (57.8%) being females, and about 40% were in the age range of 21–25 years. In our study, 950 (59.1%) participants were either health-related field university students or graduates. Overall, 703 (43.7%) were university graduates. A total of 657 (40.9%) of respondents were of non-medical background and 67.8% of the total were living in Syrian cities. Demographics of the participants are shown in (Table 1).