Medical Bulletin 20/June/2025

Here are the top medical bulletins for the day:

Digital Inhalers May Predict COPD Flare-Ups: Study Finds

Digital inhalers may help predict impending acute exacerbations of chronic obstructive pulmonary disease (COPD), according to a new study published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.

Exacerbations, or flare-ups, can cause accelerated loss of lung function, a decrease in quality of life, and reduce a person’s physical function and activity. More than 50% of people with COPD experience at least one acute COPD exacerbation within four years of an initial COPD diagnosis. Increased respiratory rates and decreased lung volumes are early signs of an exacerbation.

The new study examined how digital inhalers using remote monitoring data can help predict and identify early or impending COPD exacerbations. It was an observational pilot study conducted virtually at two U.S. centers between March 2022 and February 2023. It included COPD patients with documented airflow limitation (FEV1/FVC <0.70 and FEV1 ≤80%) and a history of recent exacerbations. After virtual screening and verbal consent, participants received three ProAir Digihaler inhalers by mail and were instructed to use them as their primary short acting beta 2 agonist therapy. App onboarding was done via a central call center.

The digital inhaler used in this study measured peak inspiratory flow, inhalation volume, inhalation duration, time to peak inhalation, and inhaler use. The study examined whether the data collected by the digital inhaler could identify a possible early-stage exacerbation.

“While this study examined a small group of participants, the remote monitoring data showed people experienced significant decreases in the amount of air they inhaled and how long that inhalation lasted in the approximately two weeks prior to experiencing an exacerbation,” said M. Bradley Drummond, M.D., MHS, professor of medicine in the Division of Pulmonary Diseases and Critical Care Medicine at the University of North Carolina, Chapel Hill School of Medicine and lead author of the study. “As these remote monitoring technologies get more advanced, we can help both patients and health care providers identify exacerbations earlier, which allows us to provide better exacerbation management and improve health outcomes.”

Reference: Drummond MB, Hemphill CC, Hill T, Boe A, Yu D, Ohar JA. Use of a digital inhaler to assess COPD disease variability and identify impending acute COPD exacerbations: a pilot study. Chronic Obstr Pulm Dis. 2025; 12(3): 250-259. doi: http://doi.org/10.15326/jcopdf.2024.0555

New Blood Test May Detect Early Liver Transplant Rejection

A new study found a powerful new tool for monitoring liver transplant patients: a simple blood test that detected early signs of organ damage and identified its source. The findings, which could significantly improve transplant outcomes and reduce the need for invasive biopsies, were published in Nature Communications.

Liver transplants are high-risk, last-resort procedures performed when no other options exist, as there is no machine equivalent to support a failing liver.

The study describes how a "liquid biopsy" using circulating, cell-free methylated DNA can identify cellular injury across various compartments of the liver. The research involved analyzing DNA fragments left behind by dying cells found in the bloodstream. These fragments carry unique chemical signatures that reveal not only the type of cell but also its tissue of origin.

Currently, doctors rely on imaging or needle biopsies, which can miss affected areas and pose risks. “With needle biopsies, there’s always the potential for sampling bias, because you’re not sampling the whole liver,” said Alexander Kroemer, MD, PhD, co-author and transplant surgeon at MedStar Georgetown. This new blood test can be repeated frequently, making it a practical tool for close monitoring and early intervention.

The team is also exploring applications in other transplants, radiation therapy, and cancer treatment.

Reference: McNamara, M.E., Jain, S.S., Oza, K. et al. Circulating cell-free DNA methylation patterns indicate cellular sources of allograft injury after liver transplant. Nat Commun 16, 5310 (2025). https://doi.org/10.1038/s41467-025-60507-9

Clinical Trial Shows Combination Therapy May Benefit Teens with Type 1 Diabetes

A clinical trial has found that combining standard insulin therapy with the investigational drug dapagliflozin can improve kidney function, blood sugar control, and reduce weight gain in adolescents with type 1 diabetes (T1D). Published in Nature Medicine, the study points to a promising new direction for precision care in young people living with this chronic condition.

Type 1 diabetes is an autoimmune disorder that causes the pancreas to stop producing insulin, often beginning in childhood or adolescence. While insulin remains essential for treatment, long-term use can lead to complications such as chronic kidney disease and weight gain. This study, known as the ATTEMPT trial, was designed to evaluate whether a combination approach could reduce these risks in teens.

The trial enrolled 98 participants aged 12 to 18 years across three sites, testing the effects of dapagliflozin alongside insulin. Unlike prior research that focused primarily on adults, this trial was tailored to adolescents, who face unique challenges in diabetes management due to hormonal shifts and shared caregiving responsibilities.

“Our findings showed that adolescents who received this combination therapy were able to improve many symptoms typically associated with insulin-managed type one diabetes,” said Dr. Farid Mahmud, Associate Scientist in the Translational Medicine program and Staff Physician in the Division of Endocrinology, at The Hospital for Sick Children (SickKids). “This could inform a new early intervention strategy for the growing population of teenagers with type one diabetes.”

Reference: Mahmud, F.H., Bjornstad, P., Clarson, C. et al. Adjunct-to-insulin therapy using SGLT2 inhibitors in youth with type 1 diabetes: a randomized controlled trial. Nat Med (2025). https://doi.org/10.1038/s41591-025-03723-6