Exacerbations of chronic obstructive pulmonary disease (COPD) are an increasing cause of hospitalisations and are associated with accelerated progression of airflow obstruction. Approximately half of COPD exacerbations are associated with bacteria and many patients have lower airways colonisation. This suggests that bacterial infection in COPD could be due to reduced pathogen removal. This study investigated whether bacterial clearance by macrophages is defective in COPD.Phagocytosis of fluorescently labelled polystyrene beads and Haemophillus influenzae and Streptococcus pneumoniae by alveolar macrophages and monocyte-derived macrophages (MDM) was assessed by fluorimetry and flow cytometry. Receptor expression was measured by flow cytometry.Alveolar macrophages and MDM phagocytosed polystyrene beads similarly. There was no difference in phagocytosis of beads by MDM from COPD patients compared with cells from smokers and nonsmokers. MDM from COPD patients showed reduced phagocytic responses to S. pneumoniae and H. influenzae compared with nonsmokers and smokers. This was not associated with alterations in cell surface receptor expression of toll-like receptor (TLR)2, TLR4, macrophage receptor with collagenous structure, cluster of differentiation (CD)163, CD36 or mannose receptor. Budesonide, formoterol or azithromycin did not suppress phagocytosis suggesting that reduced responses in COPD MDM were not due to medications.COPD macrophage innate responses are suppressed and may lead to bacterial colonisation and increased exacerbation frequency.

IntroductionReductions in exacerbation and hospitalisations are the outcomes rated as most important by people with chronic obstructive pulmonary disease (COPD). Most COPD management is currently based on a reactive approach, and delays in recognising treatable opportunities underpin COPD care quality gaps. Innovations that empower COPD self-management, facilitate integrated clinical care and support delivery of evidence-based treatment interventions are urgently required.Methods and analysisThe Remote-Management of COPD: Evaluating the Implementation of Digital Innovation to Enable Routine Care trial is a prospective observational cohort hybrid implementation and effectiveness study that will explore the adoption of a digital service model for people with ‘high-risk’ COPD and evaluate the feasibility of this approach versus current standards of care. People with COPD, who have had recent severe exacerbation and/or COPD–obstructive sleep apnoea overlap or chronic hypercapnic respiratory failure requiring home non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP), with internet access will be recruited into the study and enrolled into the digital service.Study endpoints will examine participant utilisation, clinical service impact and clinical outcomes compared with historical and contemporary control patient data. The digital infrastructure will also provide a foundation to explore the feasibility of approaches to predict outcomes and exacerbation in people with COPD through machine learning analysis.Ethics and disseminationEthical approval for this clinical trial has been obtained from the West of Scotland Research Ethics Service. The trial will commence in September 2019 for a duration of 2 years. Results will be presented at local, national and international meetings, as well as submission for publication to peer-reviewed journals.Trial registration numberNCT04240353.

Self-management approaches towards stroke rehabilitation are gaining more attention due to emerging evidence of their impact on patient outcomes. This mixed methods study explored the attitudes of healthcare professionals (HCPs) towards stroke selfmanagement. The Bridges Stroke Self-Management Programme (Bridges SSMP) training was delivered to 51 HCPs in New Zealand. Questionnaires were completed by consenting participants (n=43) prior to administration of the Bridges SSMP training. In-depth, semi-structured interviews were conducted with three participants. The General Inductive Approach was used for thematic analysis of the qualitative data. The resulting overarching theme was "integrating the self-management concept into practice", which encompasses organisational, contextual and individual factors that HCPs feel are challenges when applying self-management. Two contributors to this theme -"education" and "facilitating empowerment" -emerged as barriers or enablers, respectively, to putting self-management into practice. Questionnaire data showed HCPs were confident in their capability of self-management concepts yet did not frequently use them in practice. Healthcare professionals were mostly positive about the concept of self-management but challenges and barriers were evident when applying this to practice. Hence, they may require a deeper understanding of the principles of self-management and become more familiar with the process by applying the principles of self-management in their own lives.Taylor, A., Monsanto, X., Kilgour, H., Smith, C., & Hale, L. (2019). Attitudes of healthcare professionals towards selfmanagement for patients with stroke.

The porphyrinic metal−organic framework, PCN-222, exhibits anisotropic growth behavior to form nanorods and microrods with aspect ratios 3 < x < 94. Control of microrod aspect ratios has been demonstrated through the identification of several factors that dictate crystal growth, particularly the concentrations of a ligand, a modulator, and an exogenous base. An increase in the local concentration of a deprotonated ligand, which is proportional to the nucleation rate, is associated with smaller crystals, while increased modulator concentration leads to longer microrods. Addition of a deprotonating agent not only contributes to higher aspect ratios but also results in an improvement to particle dispersity. Here, we report acid−base co-modulation methods with difluoroacetic acid and triethylamine to effectively tune PCN-222 aspect ratios. A series of mechanisms is identified for the growth of PCN-222: (1) ligand deprotonation, (2) nucleation, (3) oriented attachment, (4) Ostwald ripening, and (5) dissolution−recrystallization. Time trials of co-modulated samples revealed three separate ripening growth events, with each resulting in larger and more monodisperse crystals. With an understanding of these crystal growth factors and mechanisms, the highest aspect ratio, non-templated metal−organic frameworks were synthesized (94 ± 9).

Chronic obstructive pulmonary disease (COPD) is a global healthcare challenge. It is highly prevalent in low-income countries, causes 3 million death per year and is projected to be the leading cause of death globally by 2030. Challenges in COPD management result in care quality gaps which impair timely and accurate diagnosis and limit patient stratification and provision of evidence-based interventions. COPD exacerbations are responsible for a large proportion of the disease-burden, adverse outcomes and healthcare costs. There is a requirement to re-orientate COPD exacerbation care from failure-driven reactive approach to one based on proactive preventative management. Service model adaptation supported by artificial intelligence (AI) tools offer the prospect of addressing these care-quality gaps and achieving this practice re-orientation. Progress with clinical applications of AI for COPD is accelerating. Evidence available demonstrates the potential of AI techniques to facilitate early and precise COPD case-finding and diagnosis, allow stratification with clinical decision support to prioritise management, and achieve accurate exacerbation detection/prediction to allow proactive interventions. In this narrative review, we will summarise current evidence for the application of AI to these COPD challenges, outline the barriers to implementation of AI models and present our opinion on the required next steps to realise the potential role for AI in COPD management.