{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T15:15:37Z","timestamp":1788880537694,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,7,3]],"date-time":"2023-07-03T00:00:00Z","timestamp":1688342400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objective<\/jats:title><jats:p>Raised blood lactate secondary to high dose \u03b2<jats:sub>2<\/jats:sub>\u2010agonist treatment has been reported in asthma exacerbations but has not been investigated during acute exacerbations of COPD (AECOPD). We explored associations of blood lactate measurements with disease outcomes and \u03b2<jats:sub>2<\/jats:sub>\u2010agonist treatments during AECOPD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective (<jats:italic>n<\/jats:italic>\u2009=\u2009199) and prospective studies (<jats:italic>n<\/jats:italic>\u2009=\u2009142) of patients hospitalized with AECOPD were conducted. The retrospective cohort was identified via medical records and the prospective cohort was recruited during hospitalization for AECOPD. Baseline demographics, comorbidities, \u03b2<jats:sub>2<\/jats:sub>\u2010agonist treatment, biochemical measurements and clinical outcomes were compared between patients with normal (\u22642.0\u2009mmol\/L) versus elevated lactate (&gt;2.0\u2009mmol\/L). Regression analyses examined associations of lactate measurements with \u03b2<jats:sub>2<\/jats:sub>\u2010agonist dosages.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Demographic data and comorbidities were similar between high versus normal lactate groups in both cohorts. The populations were elderly (mean &gt;70\u2009years), predominantly male (&gt;60%) with reduced FEV<jats:sub>1<\/jats:sub> (%) 48.2\u2009\u00b1\u200919 (prospective cohort). Lactate was elevated in approximately 50% of patients during AECOPD and not related to evidence of sepsis. In the prospective cohort, patients with high lactate had more tachypnoea, tachycardia, acidosis and hyperglycaemia (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) and received more non\u2010invasive ventilation (37% vs. 9.7%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, prospective cohort). There was a trend to longer hospitalization (6 vs. 5\u2009days, <jats:italic>p<\/jats:italic>\u2009=\u20090.06, prospective cohort). Higher cumulative \u03b2<jats:sub>2<\/jats:sub>\u2010agonist dosages were linked to elevated lactate levels (OR 1.04, <jats:italic>p<\/jats:italic>\u2009=\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Elevated lactate during AECOPD was common, unrelated to sepsis and correlated with high cumulative doses of \u03b2<jats:sub>2<\/jats:sub>\u2010agonists. Raised lactate may indicate excessive \u03b2<jats:sub>2<\/jats:sub>\u2010agonist treatment and should now be investigated as a possible biomarker.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.14534","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T00:20:52Z","timestamp":1688430052000},"page":"860-868","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Elevated blood lactate in <scp>COPD<\/scp> exacerbations associates with adverse clinical outcomes and signals excessive treatment with \u03b2<sub>2<\/sub>\u2010agonists"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1138-0590","authenticated-orcid":false,"given":"Martin I.","family":"MacDonald","sequence":"first","affiliation":[{"name":"Monash Lung and Sleep Monash Health  Melbourne Victoria Australia"},{"name":"Department of Medicine Monash University  Melbourne Victoria 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