By Debbie Bunch
November 17, 2025
COPD Plus CRF Ups Risk for Cardiovascular Diseases
COPD patients who also suffer from chronic respiratory failure (CRF) may be at greater risk of developing cardiovascular diseases than COPD patients without CRF, report Italian researchers publishing in Respiratory Medicine.
The finding comes from a 15-year study that followed 246,712 adults with COPD in the TriNetX database, half of whom had CRF and half of whom did not. The participants were matched according to age and other key factors, and the investigators specifically looked at the incidence of ischemic heart disease (IHD), congestive heart failure (CHF), and cardiac atrial arrhythmia (CAA).
COPD patients with CRF were significantly less likely to avoid these heart conditions than those with COPD without CRF. Overall, only 38.5% of those with CRF remained free of ILD, 27.9% escaped CHF, and 57.6% avoided CAA. Among COPD patients without CRF, those percentages were 42.5%, 43.5%, and 65.9%, respectively.
The researchers found cardiovascular complications occurred at an earlier age in the patients with COPD and CRF, as well.
The authors call for additional studies on the therapeutic management and the prevalence of comorbid conditions in COPD patients with CRF. They believe COPD treatment goals should address not just therapies aimed at preventing COPD exacerbations and slowing the progression of the disease to CRF, but also comorbidity risk assessment and the implementation of preventive and/or treatment options.
“Targeted screening and monitoring in this population is desirable,” they wrote.
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Poor Sleep Linked to Increased Pediatric Asthma Exacerbations
Fostering better sleep in kids with asthma — especially boys — might be a good way to lower their risk for asthma exacerbations, finds a study conducted by investigators from the Indiana University School of Medicine.
The researchers analyzed data on 161 children with moderate or severe asthma who had undergone sleep studies. While no increased risk of exacerbations was seen in girls who slept poorly, boys with fragmented sleep were at increased risk for asthma exacerbations regardless of how well their asthma was controlled.
The risk of severe asthma exacerbations was also linked to an elevated sleep arousal index among male children, use of ICS plus LABA, and untreated sleep disturbance.
However, kids who had been prescribed medications to help with their sleep had a lower risk for exacerbations.
The investigators believe these findings point up the importance of including sleep assessments in the care of children with asthma. These assessments should include a detailed sleep history that focuses on difficulties falling asleep or staying asleep, as well as symptoms such as snoring or nighttime coughing.
“To our knowledge, this is the first study to examine real-world associations between measures of poor sleep and the risk of severe childhood asthma exacerbations,” wrote the authors. “This is also the first study to evaluate the prognostic utility of sleep measures to identify at-risk children who can be targeted for early preventive intervention to reduce the rate of excess acute health care utilization for asthma management.”
The study was supported by the National Institutes of Health and published by Pediatric Allergy and Immunology.
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ATS Publishes New Guideline on CAP
A new clinical practice guideline (CPG) from the American Thoracic Society offers updated guidance on the management of community-acquired pneumonia (CAP). The guideline expands on recommendations released by the ATS in 2019 and focuses on these key diagnostic and treatment areas:
- For adults with suspected CAP, the guideline suggests lung ultrasound is an acceptable alternative to chest x-ray in medical centers where appropriate clinical expertise exists (conditional recommendation, low-quality evidence).
- For adult outpatients without co-morbidities who have clinical and imaging evidence of CAP and who test positive for a respiratory virus, the guideline suggests not prescribing empiric antibiotics (conditional recommendation, very low-quality evidence).
- For adult outpatients with CAP who reach clinical stability, the guideline suggests less than five days of antibiotics (minimum of three days duration), rather than five or more days of antibiotics (conditional recommendation, low-quality evidence).
- For adult inpatients with non-severe CAP, the guideline recommends NOT administering systemic corticosteroids (strong recommendation, low-quality evidence).
- For adult inpatients with severe CAP, the guideline suggests systemic corticosteroids (conditional recommendation, low-quality evidence).
The guideline was developed by a multidisciplinary panel using the Grading of Recommendations, Assessment, Development and Evaluation framework.
Barbara Jones, MD, MS, co-lead of the guideline panel, notes that the guideline also includes a table that provides a framework for individualization of the recommendations, given most of them are conditional. She believes the table should be “accompanied by support to clinicians to individualize to specific patients and their circumstances.”
The CPG published by the American Journal of Respiratory and Critical Care Medicine.
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