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Did you know? In a 2025 study of 9416 adults, a new COPD diagnostic schema using symptoms, CT imaging, and spirometry reclassified over 1000 individuals. Those newly diagnosed had 2x higher all-cause mortality, 3.6x higher respiratory-specific mortality, more frequent exacerbations, and faster FEV₁ decline—despite previously being missed by spirometry alone.

Could this broader diagnostic framework help uncover high-risk COPD earlier in symptomatic patients with normal spirometry?

NCCN Guidelines

Could this broader diagnostic framework help uncover high-risk COPD earlier in symptomatic patients with normal spirometry?

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Patients with COPD show significantly more alveolar macrophage carbon than smokers. This burden correlates with reduced FEV1%, enlarged immune cells, and heightened inflammatory signaling—highlighting carbon’s role in immune dysregulation and disease severity.

Compare immune disruption in COPD vs. smokers

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Emphysema progression risk in COPD using a localized foundational model of density evolution - PubMed

Emphysema progression risk in COPD using a localized foundational model of density evolution - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/40877584/

Emphysema progression in chronic obstructive pulmonary disease (COPD) presents a notable challenge due to its significant variability among individuals and the current lack of reliable prognostic markers. Given the limited...

A localized foundational model generates the LEP score to predict emphysema progression in COPD, correlating with mortality and clinical outcomes. This tool shows strong prognostic potential for early intervention and personalized care.

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The effect of different inhaled corticosteroid and long-acting bronchodilator combinations on the airway microbiome in patients with severe chronic obstructive pulmonary disease: A randomized trial (MUSIC) - PubMed

The effect of different inhaled corticosteroid and long-acting bronchodilator combinations on the airway microbiome in patients with severe chronic obstructive pulmonary disease: A randomized trial (MUSIC) - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/40841147/

Fluticasone/salmeterol 500 increased sputum but not upper airway bacterial loads. ICS withdrawal was poorly tolerated in severe COPD.

A randomized trial compared inhaled corticosteroid/long-acting bronchodilator combinations in severe COPD, revealing higher sputum bacterial loads with fluticasone/salmeterol 500 mcg versus budesonide/formoterol. Findings highlight microbiome effects, exacerbation risks, and ICS withdrawal challenges.

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case study

Patient Background: A 70-year-old Japanese man presented with recurrent fever, cough, and sputum. Initially treated for bacterial pneumonia, his symptoms persisted despite antibiotics. He had no smoking history or relevant past illnesses.

Family History: No family history of respiratory diseases or malignancies was reported.

Assessment and Diagnosis: Chest CT revealed a 40-mm hypovascular mass in the left lower bronchus with distal obstructive pneumonia. Bronchoscopy showed a smooth, vascularized tumour obstructing most of the left bronchus. Transbronchial biopsy (TBB) was non-diagnostic and suggested mucoepidermoid carcinoma. Following a left lower sleeve lobectomy, histopathology confirmed pleomorphic adenoma (PA), characterised by a polypoid mass containing glandular epithelial and myoepithelial cells, myxomatous degeneration, and cartilage-like stroma.

Suggested Treatment Plan and Patient education: Given the limitations of biopsy in diagnosing PA and the risk of recurrence or malignant transformation, complete surgical resection was recommended. Endoscopic resection was not feasible due to tumour size, distal spread, and obstructive pneumonia. The patient underwent successful sleeve lobectomy. Patients should be educated that although PA is usually benign, complete removal is essential to reduce recurrence risk and confirm diagnosis.

  1. What histological features confirm bronchial pleomorphic adenoma (PA) on surgical resection? Answer Key features include glandular epithelial and myoepithelial cells, myxomatous degeneration, and cartilage-like stroma—components often absent in limited biopsies.
  2. Which biopsy features may lead to misdiagnosis of PA as mucoepidermoid carcinoma (MEC)? Answer Luminal structures, mucous stromal changes, p40+ squamous-like cells, and squamous/adipocytic metaplasia may mimic MEC when cartilage-like or myxoid stroma is not present.