Search Results (561)

Background/Objectives: Treatment for laryngeal cancer often impacts voice, swallowing, communication, and quality of life. Patient-reported outcome measures (PROMs) are increasingly used to evaluate survivorship, but their application and connection with objective functional measures vary widely. The objective was to explore how PROMs are used in laryngeal cancer research, identify the functional areas they assess, analyze their link with objective clinical outcomes, and identify methodological gaps in current studies. Methods: This scoping review followed PRISMA-ScR guidelines. Searches were conducted in PubMed/MEDLINE, Scopus, and Web of Science from their start until April 2026. Included studies involved adults with laryngeal cancer reporting PROMs and/or objective functional outcomes. Data on study features, PROM tools, evaluated domains, and how PROMs relate to objective outcomes were extracted and summarized descriptively. Results: Ninety-five studies with 10,807 participants were included. Most were observational (84.2%) and conducted at a single center (72.6%). Voice-related outcomes were the most common (86.3%), followed by psychological (72.6%) and swallowing outcomes (65.3%). Less frequently assessed were nutritional (22.1%) and supportive care domains (41.1%). The Voice Handicap Index family was the most used PROM group (30.5%). Over half the studies reported PROMs and objective measures separately without statistical integration (51.6%), while only 13.7% performed analytical integration, and none used predictive multivariable models. Significant variation existed in PROM choices, assessed domains, and integration approaches. Conclusions: PROM use in laryngeal cancer survivorship research is heterogeneous and predominantly focused on voice-related outcomes. Limited analytical integration with objective measures hampers a comprehensive understanding of recovery. There is a need for standardized, multidimensional assessment frameworks that include functional, nutritional, psychosocial, and objective outcomes to effectively support patient-centered survivorship care and rehabilitation planning. Full article

Pulmonary hypertension (PH) is a progressive, multifactorial syndrome characterized by elevated pulmonary arterial pressure and right heart dysfunction, associated with significant morbidity, impaired quality of life, and poor prognosis. Advances in classification, hemodynamic definitions, and targeted pharmacotherapies have improved understanding and management, yet therapeutic challenges persist across the five World Health Organization groups of PH. Historically, exercise was discouraged due to concerns about adverse hemodynamic effects, but growing evidence has suggested that structured, supervised training is safe and beneficial. Randomized trials and meta-analyses show improvements in six-minute walk distance, peak oxygen uptake, right ventricular function, ventilatory efficiency, and health-related quality of life, with a low incidence of adverse events. Physiological adaptations include favorable cardiac remodeling, enhanced endothelial function, improved skeletal and respiratory muscle performance, and improved neurohormonal activity. Despite this evidence, barriers such as patient fears, limited clinical expertise, and restricted access to specialized rehabilitation programs hinder widespread implementation. Current guidelines recommend supervised exercise as part of pulmonary rehabilitation for patients with stable PH, supporting its role as an adjunct to pharmacotherapy. This descriptive review briefly summarizes the pathophysiology of PH, phenotype-related differences and current therapeutic approaches, and the beneficial adaptations to exercise training, with the aim of informing exercise specialists and supporting safer, more effective integration of exercise-based rehabilitation into patient care. Full article

Background: Sarcopenia and frailty are highly prevalent extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD) and are strongly associated with reduced exercise tolerance, exacerbation risk, hospitalizations, and mortality. Beyond inflammation, oxidative stress, and physical inactivity, emerging evidence highlights nutrition as a major modifiable driver of muscle deterioration in COPD. Nutritional deficits impair anabolic signaling, exacerbate proteolysis, worsen mitochondrial dysfunction, and contribute to frailty progression. Methods: This narrative review synthesizes evidence from PubMed, Embase, Scopus, and Web of Science up to 2025, integrating mechanistic, metabolic, nutritional, and biomarker-related pathways underlying muscle dysfunction in COPD. Studies examining inflammation, hypoxemia, oxidative stress, hormonal imbalance, nutrition, and emerging biomarkers were included. Results: COPD-related sarcopenia results from converging inflammatory (TNF-α, IL-6), catabolic (FOXO, UPS), metabolic, and vascular mechanisms, compounded by energy deficiency, protein insufficiency, and micronutrient deficits. Inadequate intake of protein, vitamin D, antioxidants, and omega-3 fatty acids increase anabolic resistance, enhance muscle catabolism, and worsen frailty. Nutritional interventions, particularly high-protein supplementation, leucine-enriched formulas, vitamin D repletion, omega-3 fatty acids, and multimodal nutrition–exercise programs, demonstrate benefits in muscle mass, strength, and physical performance. Biomarkers such as GDF-15, CAF22, and specific microRNAs reflect nutritional status and correlate with muscle health in COPD. Conclusions: Sarcopenia and frailty in COPD arise from a complex interplay of inflammatory, metabolic, nutritional, and lifestyle-related factors. Integrating nutritional assessment and targeted dietary interventions with exercise and pulmonary rehabilitation is essential to counteract anabolic resistance and improve functional outcomes. Advances in biomarker research may support earlier diagnosis and personalized nutrition-based therapeutic strategies. Full article

Background: Near-infrared spectroscopy (NIRS)-based wearable devices offer non-invasive, continuous monitoring of muscle oxygenation, providing direct microvascular and metabolic information that complements indirect indices of intensity such as heart rate and accelerometry. Their clinical applicability in chronic non-communicable diseases (NCDs) remains under active development. Methods: A structured narrative review was conducted in PubMed, Scopus, Web of Science, and IEEE Xplore (January 2010–January 2026) using pre-specified search strings combining NIRS, muscle oxygenation, SmO₂, StO₂, wearable, exercise intensity, ventilatory/lactate threshold, and individual chronic disease terms. Eligible studies addressed technical validation of wearable NIRS, NIRS-derived exercise intensity estimation, clinical applications in NCDs, or rehabilitation implementation. Evidence was synthesized thematically; quality of validation studies was appraised against AMSTAR-2-informed, COSMIN-informed, or Cochrane RoB-2 criteria. Results: Wearable continuous-wave NIRS shows acceptable concurrent validity with frequency-domain laboratory systems (r = 0.79; range 0.69–0.88; ±8% SmO₂ agreement in 95% of measurements) and good test–retest reliability for moderate-to-severe domains (ICC 0.72–0.91). NIRS-derived breakpoints align more reliably with the second ventilatory/lactate threshold (ICC = 0.80) than with the first (ICC = 0.53), constraining its use for prescribing lower-intensity domains. In chronic obstructive pulmonary disease, peripheral arterial disease, chronic respiratory failure and selected cardiovascular conditions, wearable NIRS detects disease-specific patterns of muscle deoxygenation and post-exercise reoxygenation that track responses to rehabilitation. Conclusions: Current evidence supports wearable NIRS as a complementary, intensity-aware monitoring tool—particularly for delineating the heavy/severe-intensity boundary and detecting peripheral metabolic limitations—rather than as a stand-alone replacement for ventilatory or lactate thresholds. Because much of the evidence derives from small, single-sex or athlete-only cohorts, these findings should be regarded as a promising basis requiring further validation in broader NCD populations. Implementation in NCDs requires standardized placement and calibration protocols, sex- and body composition-stratified reference values, motion-artifact mitigation, and adequately powered longitudinal trials in clinical populations. Full article

Background/Objectives: Short-term functional outcomes after outpatient pulmonary rehabilitation are heterogeneous. We examined whether a study-derived cardio-nutrition-inflammation-oxygen (CNIO) index integrating echocardiographic filling pressure, nutritional status, inflammation, and oxygen requirement was associated with 3-month functional outcomes in chronic respiratory disease. Methods: This single-center retrospective cohort study included 60 adults with chronic obstructive pulmonary disease, interstitial lung disease, or bronchiectasis who completed outpatient pulmonary rehabilitation and had baseline and 3-month functional assessments. The CNIO index was calculated as standardized E/e′ plus standardized ln(neutrophil-to-lymphocyte ratio) plus standardized resting oxygen flow rate minus standardized Geriatric Nutritional Risk Index, and the summed score was then standardized to mean 0 and SD 1. The primary outcome was 3-month 6 min walk test (6MWT) distance, and the exploratory secondary outcome was 3-month Short Physical Performance Battery (SPPB) score. The primary 6MWT analysis used multivariable analysis of covariance adjusted for baseline 6MWT, age, sex, body mass index, and diagnosis, whereas the exploratory SPPB analysis used ordinal logistic regression adjusted for baseline SPPB and the same covariates. Results: Mean 6MWT increased from 340.3 ± 61.0 m to 368.0 ± 102.0 m, corresponding to a mean change of 27.7 ± 90.3 m. Each 1-SD increase in CNIO was associated with a lower 3-month 6MWT distance (β = −43.42 m; 95% confidence interval [CI], −77.55 to −9.30; p = 0.014). In the exploratory ordinal logistic regression model for SPPB, each 1-SD increase in CNIO was associated with lower odds of being in a higher 3-month SPPB category, although the estimate was fragile and the confidence interval was close to the null (odds ratio = 0.39; 95% CI, 0.15 to 0.99; p = 0.048). Bootstrap internal stability analysis for the primary 6MWT model showed a wide percentile bootstrap 95% CI of −76.05 to −13.97 m per 1-SD increase in CNIO, supporting the need for cautious interpretation. Conclusions: In this hypothesis-generating derivation study, a higher standardized CNIO index was associated with lower 3-month 6MWT distance among adults with chronic respiratory disease who completed outpatient pulmonary rehabilitation. The association with SPPB was weaker and should be interpreted cautiously. These findings are not generalizable to patients who discontinue rehabilitation or are hospitalized for exacerbation during follow-up, and prospective external validation in larger, diagnostically stratified cohorts is required before CNIO can be considered for clinical risk stratification or rehabilitation planning. Full article

Background/Objectives: Cystic fibrosis is a chronic multisystem disease in which pulmonary involvement is the main determinant of morbidity and mortality. Chest computed tomography is the reference standard for assessing structural lung damage, but its repeated use is limited by cumulative radiation exposure. Lung ultrasound has emerged as a radiation-free alternative; however, its role in adult patients remains incompletely defined. This study aimed to evaluate the correlation between CT-derived structural lung damage and ultrasound findings, and to assess the complementary role of these imaging modalities. Methods: A prospective cohort study was conducted including adult patients with cystic fibrosis who underwent both chest computed tomography and lung ultrasound during the same clinical episode. Structural lung involvement was assessed using the Bhalla score, while lung aeration was evaluated using the Lung Ultrasound Score. Correlation analyses, severity stratification, regression modeling, and longitudinal comparisons were performed. Results: Thirteen patients contributed 24 imaging evaluations. A strong positive correlation between Bhalla score and ultrasound findings was observed in the cross-sectional analysis and remained consistent when all examinations were included. Ultrasound scores increased significantly across CT-defined severity groups, and regression analysis confirmed a significant association between the two methods. Exploratory analysis showed stronger associations for peripheral and aeration-related abnormalities, while weaker associations were observed for deeper airway changes. No significant correlation was identified in longitudinal analysis. Conclusions: Lung ultrasound correlates well with CT-derived structural lung damage and may serve as a complementary, radiation-free tool for disease assessment in adult cystic fibrosis. However, its limited sensitivity in detecting temporal changes highlights the continued importance of CT in selected clinical scenarios. Full article

Background: Cancer-Related Fatigue (CRF) significantly impairs physical performance and quality of life (QoL) in patients with non-small-cell lung cancer (NSCLC). The OVER-CRF study evaluated the feasibility, safety, and preliminary efficacy of a personalized pulmonary rehabilitation (PR) program combining supervised exercise and education during active treatment. Methods: Patients with stage II–III NSCLC were randomized to Early-PR (initiated at the start of anticancer therapy) or Delayed-PR (initiated three months later). The 3-month intervention included two educational sessions and eight supervised exercise sessions. The primary outcome was adherence; secondary outcomes included safety, CRF (FACIT-FS), QoL (EORTC-QLQ-C30), and physical performance (6MWT). Results: Thirty-one patients were randomized (mean age 67.4 years). Adherence was excellent (Early: 86.7%; Delayed: 91.7%), exceeding feasibility thresholds. No exercise-related adverse events occurred. At 12 months, 50% of participants showed clinically meaningful CRF improvements. While both groups improved 6MWT performance during the intervention, the Delayed-PR group demonstrated more sustained QoL improvements from T1 through T3 compared to the Early-PR group. The dropout rate (25.8%) was consistent with the existing literature. Conclusions: Personalized PR is feasible and safe for NSCLC patients undergoing multimodal therapy. While early intervention provides immediate benefits, initiation timing may influence long-term QoL trajectories. These findings support integrating exercise and education into standard oncological care pathways. Full article

Background: Respiratory muscle dysfunction is a recognized complication of multiple sclerosis (MS) and may contribute to functional decline. Sarcopenia related to neurological impairment may further impair respiratory muscle performance in MS. This study aimed to investigate the association between sarcopenia and respiratory function, respiratory muscle strength, and respiratory muscle endurance in patients with MS. Methods: This study was designed as a cross-sectional observational study. In this study, 52 MS patients (26 sarcopenic, 26 non-sarcopenic) were evaluated. Sarcopenia was assessed using the SARC-F questionnaire, handgrip strength, bioelectrical impedance analysis, calf circumference, and walking speed (6-m walk test). Pulmonary function was evaluated using spirometry. Respiratory muscle strength was assessed using maximal inspiratory and expiratory pressures (MIP, MEP), and respiratory muscle endurance was evaluated using a constant-load test. Results: Respiratory muscle endurance (p < 0.001), inspiratory volume (p < 0.001), and forced vital capacity (p = 0.003) were significantly lower in sarcopenic MS patients in the primary analyses. However, inspiratory volume and respiratory muscle endurance remained significant after age adjustment, while all three parameters remained significant after EDSS adjustment. No significant differences were observed between groups in other respiratory function parameters or respiratory muscle strength including MIP, and MEP (p > 0.05). Conclusions: Sarcopenia is associated with reduced respiratory muscle endurance and respiratory capacity in patients with MS. These findings suggest that respiratory muscle endurance assessment may help identify sarcopenic MS patients who warrant further respiratory evaluation. Incorporating respiratory muscle endurance assessment into routine evaluation and rehabilitation strategies may be beneficial in sarcopenic MS patients. Full article

Chronic obstructive pulmonary disease (COPD) imposes a substantial physical and psychosocial burden, yet the role of loneliness remains under-recognised in clinical practice. Loneliness, defined as a subjective discrepancy between desired and actual social relationships, has emerged as a clinically relevant determinant of patient outcomes. This narrative review synthesises current evidence on the epidemiology, mechanisms, and clinical consequences of loneliness in COPD, and evaluates its implications for disease management. Available evidence indicates that loneliness affects a considerable proportion of individuals with COPD, with prevalence estimates ranging from approximately 18% to over 30%, particularly among patients with greater symptom burden, functional limitation, and oxygen dependence. Dyspnoea and advancing disease severity reduce social participation and increase vulnerability to perceived social disconnection. Loneliness influences COPD outcomes through interconnected behavioural, biological, and healthcare engagement pathways, including systemic inflammation, neuroendocrine stress responses, physical inactivity, impaired self-management, and reduced engagement with healthcare services. These mechanisms contribute to poorer clinical trajectories, as loneliness is consistently associated with reduced health-related quality of life, increased exacerbations, higher healthcare utilisation, greater risk of hospitalisation, and elevated mortality, independent of depression and anxiety. Despite this, loneliness is rarely assessed in routine respiratory care, and targeted interventions remain limited. Emerging strategies, including pulmonary rehabilitation, peer support, and digital health interventions, show promise in reducing loneliness and improving outcomes. Loneliness represents a modifiable and clinically actionable risk factor in COPD, and its integration into routine assessment and management may enhance patient engagement, optimise treatment effectiveness, and reduce healthcare burden. Addressing loneliness represents a critical opportunity to advance more effective and comprehensive COPD care. Full article

Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is highly prevalent worldwide and is the third leading cause of death. While some aspects of the disease were known since the Enlightenment, Laennec’s work in the 19th century began the process of our current understanding of this disease. In this narrative review, 13 clinicians and scientists with over three centuries of cumulative experience treating and studying COPD give their perspectives on the science underpinning our modern concept of this disease and its management. These include (1) the challenges of coming up with a name for what is a complex syndrome; (2) the evolution of our thinking on the natural history of the disease; (3) the importance of particulate matter inhalation in its pathogenesis; (4) the often-overlooked but important—and often treatable—systemic effects of the disease that contribute to its morbidity and mortality; (5) the changes in our perspective of not just addressing pathologic or physiologic abnormalities but also measuring outcomes, such as breathlessness or health-related quality of life, that are of considerable importance to the patient; (6) the role of pharmacologic therapy in not only providing symptomatic relief by increasing airway caliber but also in disease modification, especially by reducing exacerbation frequency; (7) lung hyperinflation as an essential feature of COPD pathophysiology, driving symptom burden, exercise limitation, and mortality risk; (8) long-term oxygen therapy, despite being demonstrated to prolong survival in a defined set of hypoxemic patients with COPD, still having unanswered questions regarding its application and delivery; and (9) pulmonary rehabilitation, a major component of the non-pharmacologic treatment of COPD patients and prominently situated in clinical guidelines for this disease. While this, by necessity, must be a brief review of a very complex disease, the perspectives of these esteemed clinicians and scientists should be of use to other clinicians in understanding and managing this disease. Full article

Evidence on hospitalised COVID-19 patients during the Omicron BA.5 wave from Eastern European, vaccine-heterogeneous cohorts remains limited. We conducted a retrospective single-centre cohort study of 395 consecutive adults admitted with laboratory-confirmed COVID-19 to a tertiary infectious-diseases unit in western Romania between 1 July and 31 October 2022. Median age was 72 years (IQR 65–81); 33.2% were unvaccinated, 42.8% had documented prior SARS-CoV-2 infection, and 41.3% were obese. Multivariable logistic regression identified independent predictors of in-hospital mortality and post-acute symptom burden. In-hospital mortality was 15.7% (62/395). Vaccination was independently associated with lower mortality (adjusted odds ratio [aOR] 0.55, 95% CI 0.30–0.99; p = 0.048), as was each 1% increase in admission SpO₂ (aOR 0.83, 95% CI 0.76–0.92; p < 0.001), whereas COPD independently increased mortality risk (aOR 2.42, 95% CI 1.15–5.10; p = 0.020). Interleukin-6 was the most discriminating admission biomarker for in-hospital mortality (AUROC 0.70). Bloodstream bacterial co-infection, detected in 22.5% of patients tested on clinical suspicion, was dominated by gut-derived organisms with case-fatality ≥30%. At discharge, 90.1% reported persistent symptoms, most commonly cognitive (24.6%). Prior SARS-CoV-2 infection independently predicted post-acute symptom burden (aOR 2.96, 95% CI 1.75–5.01; p < 0.001), with a specific cardiopulmonary signature. In this BA.5 cohort, vaccination remained protective; IL-6 was the most informative admission biomarker; bloodstream infections suggested gut translocation; and prior infection was an independent determinant of early post-acute symptom burden. Full article

Background/Objectives: Sepsis is a dynamic clinical syndrome characterized by a rapidly evolving inflammatory response, where early identification of patients at risk for adverse outcomes remains a major challenge. While inflammatory biomarkers are widely used, their prognostic value at baseline is limited. This study aimed to evaluate whether early changes in inflammatory biomarkers, particularly the neutrophil-to-lymphocyte ratio (ΔNLR), provide additional prognostic value in predicting short-term outcomes in patients with sepsis. Methods: A retrospective longitudinal observational study was conducted, including 168 adult patients admitted with sepsis at a tertiary infectious diseases hospital. Inflammatory biomarkers (CRP, procalcitonin, leukocyte subpopulations, and NLR) were assessed at admission and at 48–72 h. Early changes (Δ values) were calculated and analyzed in relation to a composite adverse outcome, including ICU admission, vasopressor requirement, mechanical ventilation, or in-hospital mortality. Logistic regression and ROC curve analyses were used to evaluate predictive performance. Results: Patients with adverse outcomes had significantly higher baseline inflammatory markers and severity scores. Early reductions in CRP and NLR were more pronounced in survivors, whereas non-survivors showed persistently elevated or minimally decreasing values. In multivariate analysis, ΔNLR remained independently associated with in-hospital mortality (OR 0.91, 95% CI 0.84–0.98, p = 0.015), alongside Sequential Organ Failure Assessment (SOFA) score and septic shock. ΔNLR demonstrated better discriminative performance (AUC 0.74) compared to baseline markers and improved predictive accuracy when combined with SOFA score (AUC 0.81). Higher baseline NLR quartiles were associated with a stepwise increase in adverse outcomes. Conclusions: Early changes in inflammatory biomarkers, particularly ΔNLR, provide clinically relevant prognostic information beyond baseline measurements and severity scores in sepsis. Dynamic assessment of immune response may improve early risk stratification and support more individualized clinical decision-making. Full article

Background: The pediatric population with chronic suppurative lung diseases (CSLDs) presents with a clinical profile of persistent productive cough and impaired airway clearance, which leads to reduced exercise capacity and physical activity (PA). The main objective of this research is to evaluate the effect of a 12-week intervention that combines airway clearance techniques (ACTs) and exercise training delivered through synchronous (videoconferencing) and asynchronous implementation at home, supported by an informative, specially designed website and supervised by a physiotherapist on exercise capacity. The secondary objective is to assess adherence to the ACT performance. The hypothesis of the study is that this hybrid tele-rehabilitation program will improve functional and exercise capacity, as well as compliance with ACTs, compared to the usual care. Methods: Thirty-two children with CSLDs (other than cystic fibrosis) will be randomly assigned to either the intervention group (home-based, synchronous, and asynchronous ACTs and exercise training) or the control group (usual care). An assessor blind to group allocation will measure the modified shuttle walk test, 6-minute walking test, Chester step test, respiratory muscle strength, handgrip, pulmonary function, PA, sedentary behavior, and quality of life at baseline, at the end of the intervention (3 months), and 6 months after completion. Discussion: This study introduces a hybrid (synchronous and asynchronous) tele-rehabilitation program, aiming to improve physical capacity and adherence to physiotherapy management for pediatric CSLD populations. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) management increasingly relies on patient self-management; however, medication non-adherence, inhaler misuse, delayed exacerbation recognition, and suboptimal engagement in pulmonary rehabilitation remain highly prevalent across disease stages. Cognitive impairment is increasingly recognised in this population, particularly in moderate-to-severe disease and in those with greater systemic burden, yet it is most often treated as a descriptive comorbidity rather than a determinant of disease control. Methods: This conceptual narrative review synthesises biological, neuropsychological, and clinical evidence to examine the extent to which cognitive impairment contributes to variability in self-management performance and clinical outcomes, and to propose a structured framework linking disease burden, neurocognitive vulnerability, behavioural execution, and downstream outcomes. Results: COPD-related processes—including chronic hypoxaemia, hypercapnia, systemic inflammation, oxidative stress, vascular comorbidity, and recurrent exacerbations—provide biologically plausible pathways to neurocognitive vulnerability. Reported deficits in executive function, attention, working memory, processing speed, and visuomotor integration may affect the execution of cognitively demanding tasks central to disease management, including inhaler technique, medication adherence, symptom appraisal, and sustained participation in pulmonary rehabilitation. Across studies, cognitive impairment is consistently associated with inhaler errors, reduced adherence and independence, rehabilitation dropout, impaired symptom recognition, increased healthcare utilisation, functional decline, and mortality. Conclusions: Collectively, these findings support the interpretation that cognitive vulnerability may act as an intermediary mechanism through which disease burden translates into behavioural instability and adverse outcomes. Although this framework remains hypothesis-generating, it provides a coherent basis for future longitudinal and interventional studies to formally evaluate the mediating role of cognition in disease management and outcome trajectories. Full article

This study presents a pilot cost–benefit analysis of a nature-based therapy (NBT) for Chronic Obstructive Pulmonary Disease (COPD) in Austria. Within the framework of a randomised controlled trial, we identify cost categories, quantify the costs and benefits, and synthesise findings through a partial economic evaluation. Costs were estimated for two scenarios: the trial setting and a hypothetical roll out. Benefits were valued using contingent valuation to estimate willingness to pay (WTP). The trial scenario costs were €326.27 per patient per day, while the roll out scenario estimated was €171.84 per patient per day. Cost component analysis revealed accommodation and staff as the highest contributors in both scenarios. Marginal WTP was estimated at between €25–€35 per day, indicating patients’ perceived added value of NBT over standard clinic-based rehabilitation. These exploratory findings suggest NBT could be financially viable if marginal costs are lower than the estimated WTP. This study provides important preliminary evidence on the economic aspects of NBT, highlighting its potential as a sustainable alternative to standard COPD therapy. We recommend that future research expand upon our initial findings and incorporate economic assessments from the early trial design stage to enable more comprehensive cost–benefit analyses, thus facilitating informed decision-making on the implementation of such programmes. Full article