Pulmonology

Eosinophilic AE-COPD Linked to Lower 1-Year MACE and Mortality Risk

This large TriNetX cohort compared cardiovascular outcomes after eosinophilic vs non-eosinophilic acute COPD exacerbations in adults ≥40 years. Eosinophilic exacerbations (≥300/μL) had lower 1-year major adverse cardiovascular events than non-eosinophilic events (HR 1.22 for non-eosinophilic; 95% CI 1.17–1.26). Non-eosinophilic exacerbations also carried higher risks of heart failure, myocardial infarction, stroke, arrhythmia, and all-cause mortality. Findings were robust across alternative eosinophil cutoffs and landmark analyses, supporting eosinophil count as a simple long-term cardiovascular risk marker in AE-COPD. 1

Low-Dose Theophylline Gives Minimal FEV1 Gain Without Fewer Exacerbations in Mild–Moderate COPD

This double-blind multicenter trial randomized mild–moderate COPD patients 2:1 to low-dose theophylline 100 mg twice daily or placebo for 12 months. Theophylline modestly improved pre-bronchodilator FEV1 vs placebo by about 30 mL at 12 months, with borderline annualized change. Annual exacerbation rates were similar with theophylline and placebo, with no meaningful reduction in events. Adverse event profiles were comparable, suggesting good tolerability but limited clinical benefit for routine use in this population. 2

COVID-19–Related COPD Exacerbations Greatly Increase 28-Day CV Events and Mortality

This Swedish registry emulated a target trial comparing 28-day outcomes after COVID-19–related vs non-COVID COPD exacerbations from 2020–2023. Among 266,273 exacerbations, 2% were COVID-19–related, mostly moderate events treated with systemic steroids ± antibiotics. For moderate exacerbations, COVID-19 association increased pulmonary embolism (aHR 2.26), overall cardiovascular events (1.94), MACE (1.88), and all-cause mortality (4.58). Severe COVID-19–related exacerbations mainly showed higher mortality (aHR 1.46), with cardiovascular risk elevations less pronounced. Risks were highest in pre-Alpha and Delta periods, underscoring the need for aggressive cardiovascular and thromboembolic vigilance during viral surges. 3

Routine Prophylactic HFNC After Cardiac Surgery Does Not Improve Days Alive at Home

This multicenter randomized trial compared prophylactic high-flow nasal oxygen therapy vs standard oxygen after nonemergent cardiac surgery in high pulmonary-risk adults. HFNC or standard oxygen was applied for at least 16 hours immediately after extubation, with 90-day follow-up. Median days alive and at home without increased support were identical between groups, with no significant difference (P = .75). Secondary outcomes, including days alive at home regardless of support, were also similar, arguing against routine prophylactic HFNC use post–cardiac surgery. 4