Biekšienė, Kristina

Background and Objectives: Dual bronchodilation in chronic obstructive pulmonary disease (COPD) has demonstrated beneficial effects on health-related quality of life (HRQoL) and exercise-related outcomes. Real-world evidence in treatment-naïve COPD remains limited. Materials and Methods: Forty-six COPD patients and 23 age-, gender-, BMI-, and cardiovascular comorbidity–matched controls underwent spirometry, plethysmography, symptom-limited incremental cardiopulmonary exercise testing (CPET), and the 36-item Short-Form Health Survey (SF-36). Following baseline assessment, COPD patients received tiotropium/olodaterol as part of routine practice. Thirty-two patients underwent repeated examinations at 12 weeks. Baseline differences between the COPD and control groups were assessed, and longitudinal changes in pulmonary function, CPET, and SF-36 were evaluated in COPD patients. Results: Compared with controls, COPD patients had lower peak oxygen uptake (VO2; 17.4 ± 4.4 vs. 22.8 ± 4.5 mL/kg/min, p < 0.001) and oxygen pulse (11.5 ± 3.5 vs. 14.0 ± 2.4 mL/beat, p = 0.003), failed to reach 80% of predicted values, and exhibited worse ventilatory efficiency (p < 0.001). SF-36 scores in the COPD group were lower across all domains. After 12 weeks of tiotropium/olodaterol, pulmonary function improved significantly. CPET was performed at comparable efforts at both visits. Peak VO2 increased from 70 ± 15 to 75 ± 16% predicted (p = 0.044), and peak oxygen pulse from 74 ± 16 to 79 ± 16% predicted (p = 0.015). VE/MVV decreased from 0.77 ± 0.23 to 0.69 ± 0.15 (p = 0.03). Higher baseline VE/MVV predicted a larger improvement after treatment (B = 0.71, p < 0.001), while beta-blocker use had no effect on the change of VE/MVV. SF-36 physical functioning and health change scores improved (both p < 0.01). Conclusions: At diagnosis, COPD was associated with impaired exercise physiology and reduced HRQoL. Dual bronchodilation improved exercise responses and perceived physical functioning. Beta-blocker use was not associated with changes in breathing reserve, supporting the use of cardioselective agents when indicated.

Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality, particularly in older adults and patients with chronic co-morbidities. Cytokine patterns and simple hematological indices may improve risk stratification beyond conventional clinical scores. In this prospective single-center study, 41 adults with CAP treated at Kaunas Hospital of Lithuanian University of Health Sciences between November 2024 and March 2025 were enrolled. Clinical data, pneumonia severity index (PSI), complete blood count-derived indices (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], systemic immune-inflammation index [SII]), and serum concentrations of interleukin (IL)-6, IL-8, interferon (IFN)-γ, and G-CSF were obtained on admission (Visit 1) and after 7 days of treatment (Visit 2). Patients were stratified by age (≤65 vs >65 years), co-morbidities, and PSI class. Non-parametric tests and Spearman correlations were applied. The results indicate that patients with co-morbidities and those > 65 years had significantly higher IL-6 levels than younger and non-comorbid patients. IL-6, IFNγ, and G-CSF concentrations were highest at admission and declined by day 7, particularly in PSI Class II patients. Higher PSI classes were associated with increased IL-8, IL-6, and IFNγ. NLR and SII were significantly higher in older patients and in PSI III-IV compared with PSI I-II. IL-6 and G-CSF showed strong positive correlations with NLR and SII, especially in elderly and comorbid patients, whereas PLR displayed weaker and less consistent associations. From these data, it is concluded that in CAP, serum IL-6, IFNγ, and G-CSF reflect age, co-morbidity burden, and disease severity, while NLR and SII closely mirror cytokine-driven systemic inflammation. These readily available indices may serve as cost-effective prognostic markers and, combined with cytokine profiling, could enhance early risk stratification and guide individualized management in CAP.

Severe asthma imposes a substantial burden on individuals' health-related quality of life (HRQoL), which might not be fully captured by generic instruments. The Severe Asthma Questionnaire (SAQ) is a validated disease-specific HRQoL instrument capturing the unique lived experience of people with severe asthma. However, the SAQ does not generate preference-based utility values required for health economic evaluations. This study aimed to develop and validate mapping algorithms from the SAQ to the EuroQol (EQ)-5D-5L, enabling estimation of utility values when EQ-5D data are unavailable.

The phenotypic nature of multimorbidity in severe asthma is poorly understood. Our aims in this study were to define multimorbidity phenotypes and their characteristics in severe asthma across Europe by identifying and characterising co-aggregation of comorbidities.

Aim of the study: This study aimed to assess inflammatory mar- kers in patients with community-acquired pneumonia (CAP) to identify targets for clinical and therapeutic interventions. Methods: 40 patients with confirmed CAP were included. IL-6, IL-8, IFNγ, and G-CSF concentrations were measured using the Invitrogen Procarta Plex kit on a Luminex 200 system. Statistical analysis was performed with IBM SPSS v. 30.0 using non-para- metric tests (Mann–Whitney U, Kruskal–Wallis, Wilcoxon Sig- ned-Rank) according to distribution. Results were presented as the median and interquartile range (M(IQR)). Results:Typical bacterial pathogens compared to atypical etiological agents were found in more elderly patients (71.5 (27) vs. 41 (41) years, p=0.03). The IFNγ concentration was significantly higher in patients with atypical pneumonia compared to those with an unk- nown etiology (4998.5(20913) vs. 0.7 (1222.6) pg/mL, p=0.029). The IFNγ concentration after 7-days of treatment significantly de- creased compared to the concentration found on the 1st day (2445 (5877.9) vs. 0.83 (2444.3) pg/mL, p=0.004). IL-8 andG-CSF con- centrations were associated with the treatment setting: higher con- centrations were found in inpatient care compared to outpatient clinic patients (34763.5 (38799.5) vs. 27964 (36832.5) pg/mL, p=0.001; 14696.5 (24524.5) vs. 7.0 (20470) pg/mL, p=0.013). IL-6 concentrations after 7-days of treatment were significantly higher in patients treated in the hospital compared to ambulatory patients (3653.5 (10066.8) vs. 727.6 (2744) pg/mL, p=0.029). Conclusions: The inflammatory markersIL-6, IL-8,IFNγ and G- CSF can be helpful in the management of CAP.

Background: Real-world responses to biologics were assessed by cigarette smoking exposure.

Methods: Clinical and functional data from 3,689 severe asthmatics in the ERS SHARP (Severe Heterogeneous Asthma Research-Patient Centred) registry were analyzed using the OMOP Common Data Model at baseline and after 1-year of treatment with biologics.

Results: Among 2,282 never smokers, 505 ex-smokers (<10 pack-years [py]), 766 (≥10 py), and 136 current smokers, respectively, symptom control (ACT≥20/ACQ≤1.5) improved (+220%, +215%, +200%), frequent exacerbations (>2/year) decreased (-67%, -65%, -61%), AQLQ improved (+18%, +23%, +118%), and FEV1 pre-BD (%pred) increased (+10%, +9%, +6%) with no significant differences vs. never smokers, except for AQLQ for which current smokers experienced greatest improvement (Table 1). Survey of physicians showed that 25% oppose prescription of biologics to current smokers and >50% were dissatisfied with current treatment guidelines.

Conclusion: Former/current smokers respond as well as never smokers to biologics, with AQLQ improving most in current smokers. Management disparities identified across Europe need for inclusive, evidence-based guidelines.

RATIONALE Patient reported outcome measures (PROs) are used for assessment of response to biological treatment (Khaleva et al, 2023). AIM To assess if the improvement of PRO data collected in SHARP registry at 3 months follow-up could predicted response to biologics.

METODS and RESULTS We included 51 patients (29% female, mean age 53 (SD 15)) who started biologics 0-4 months before including to SHARP boa study and 112 patients (49% female, mean age 56 (SD 12)) who have biologics longer than 1 year. 51% (26 patients) have improvement in ACQ-6 already at 3-months, 15 (29%) of them have decreased ACQ-6>0,5 and 11 (22%) have ACQ-6<1.5 from start, without increase. This improvement remained at 6-months after start of biologics indicating a good response to biologics. ACQ-6 strongly correlated with SAQ-score (Fig 1). 78% patients treated with biologics longer than 1 years had good control over time of asthma according to ACQ-6 and are suggested to be in remission.

CONCLUSION We suggest that prospective PROs data recording could be useful information for early assessment of response to biological treatment in patients in severe asthma. Long-term recording of PROs may also help to monitor remission, whereas lost asthma control indicates the need for a change in treatment.

Rationale The Severe Asthma Questionnaire (SAQ) provides insight into patients' perceptions of severe asthma. However, policy makers often prefer preference-based measures (PBMs) as the EuroQol-5D-5L (EQ5D5L) to estimate health-related quality of life for use in health-economic evaluations.

Aim To develop mapping algorithms based on the SAQ score and SAQ domains for the EQ5D5L health utility scores.

Methods We included all 316 patients with EQ5D5L data (7 countries, 55% female, mean age 54 (SD 13)) years, 77% on biologics, mean ACQ6 score 1.7 (SD 1.3), mean SAQ score 5.1 (SD 1.6) from the Severe Heterogeneous Asthma Research collaboration Patient-centred (SHARP) registry. Direct mapping of the EQ5D5L index (OLS, betamix regression) or indirect mapping (oprobit) of the 5 dimensions: mobility; self-care; usual activities; pain/discomfort; anxiety/depression) was based on the SAQ score and SAQ domains (my life: impact on life activities; my mind: emotional impact; my body: impact on extra-pulmonary symptoms and side effects). Model performance was based on the mean (SD), (lowest) root mean square error (RMSE) and the explained variance (R2).

Results CONCLUSION In the absence of the preference-based EQ5D5L, the indirect mapping of SAQ domains-based algorithm provides a good alternative for predicting the health utility in patients with severe asthma for use in health-economic evaluations.

Introduction: Severe asthma is an heterogeneous disease. The impact of aging on severe asthma features is poorly understood. The real-world data from SHARP collaboration, provides a unique opportunity to study how asthma evolves with age.

Aims: 1)To analyze age distribution and related characteristics in severe asthmatics addressed to biologics. 2)To explore biologic prescription rates across different ages.

Methods: We conducted a cross-sectional analysis of severe asthma patients in SHARP Central database. Patients were grouped by age and baseline demographics, pulmonary function, comorbidities, drugs use, and inflammatory markers were analyzed. A summary of selected results is hereby presented.

Results: Overall, 4116 patients were included. 887(21.5%) were in group 18-44, 929(23%) in 45-54, 2215(54%) in 55-79 and 85(2%) in group 80+. No age-related differences were observed in T2 markers. The 80+ had less patients addressed to biologics compared to the others.

Conclusion: Older severe asthmatics are less represented and receive fewer biologics than younger ones despite similar inflammation, suggesting age may be a barrier to biologics’ prescription. These findings emphasize the need for optimizing their care.

Background: Aspergillus fumigatus sensitisation (AFS) is more common in severe asthma (SA) than in mild asthma. While AFS is linked to poor outcomes in asthma, its clinical relevance within SA remains unclear due to limited large-scale real-world data.

Aims: To compare clinical, functional, inflammatory, and radiographic characteristics between AFS and non-AFS patients in a large SA cohort.

Methods: We performed a cross-sectional analysis on data from 1954 SA patients across 11 European countries in SHARP. Data were compared between AFS (skin prick test/specific IgE >0.35 kU/L) and non-AFS patients.

Results: AFS was found in 441 (22.6%) patients. Clinical characteristics differed between AFS and non-AFS patients (Table 1). There were no differences between groups in number of exacerbations per year (0.72±1.9 vs 0.94±1.9, p=0.55), FEV1 (69.7±21.9% vs 69.9±22.4%, p=0.88) and daily oral corticosteroid (OCS) dose (11.3±9.9 vs 11.1± 9.8 mg, p=0.91).

Conclusion: Real-world data show that Aspergillus fumigatus sensitisation (AFS) in severe asthma is associated with prolonged asthma duration and suggests increased airway damage (e.g., bronchiectasis). However, AFS does not appear to correlate with higher exacerbation rates and OCS use within severe asthma population. Whether AFS is relevant for biologic treatment response remains to be determined.