{
  "abstract": "Background and study aim Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common metabolic and liver condition that leads to systemic inflammation. Obstructive airway diseases (OADs) are characterised by chronic airway inflammation, with small airway dysfunction (SAD) regarded as an early indicator. However, it is unknown whether MASLD contributes to SAD or the risk of acute exacerbation (AE) in OAD.Methods In this retrospective cohort study, 2572 patients who underwent spirometry, impulse oscillometry (IOS) and abdominal CT scans were enrolled. Patients were divided according to MASLD status to compare their pulmonary function and clinical outcomes, including OAD AE over a follow-up period of up to 6 years.Results 349 patients exhibited MASLD (13.6%). The peripheral airway resistance measured by IOS is significantly higher in MASLD patients (X5 values: −0.14 vs −0.16 kPa/(L/s), p=0.002; AX: 0.76 vs 0.89, p=0.044). After 6 years of follow-up, patients with both MASLD and SAD exhibited the highest rate of OAD AE (34.8%, p=0.016) of all groups, and the coexistence of MASLD and SAD remained an independent predictor of exacerbations after adjustment by logistic regression. Hepatic steatosis was also identified as a potential contributing factor of OAD AE.Conclusion MASLD is associated with a higher risk of SAD, and together they markedly increase OAD AE risk. Hepatic steatosis appears to be a major driver of this risk. These findings highlight the need for integrated management of patients with MASLD, addressing both liver and respiratory health to improve outcomes.",
  "authors": [
    {
      "affiliations": [
        "Department of Medical Education, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan"
      ],
      "name": "Che-Hao Tseng"
    },
    {
      "affiliations": [
        "Department of Medical Education, Taipei Veterans General Hospital, Taipei City, Taiwan"
      ],
      "name": "Bor-Yang Jou"
    },
    {
      "affiliations": [
        "Department of Medical Education, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Hsiao-Chin Shen"
    },
    {
      "affiliations": [
        "Department of Medical Education, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Hsiao-Yun Yeh"
    },
    {
      "affiliations": [
        "Department of Biotechnology and Laboratory Science in Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Shiao-Ya Hong"
    },
    {
      "affiliations": [
        "Department of Medical Education, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Yi-Hsuan Lin"
    },
    {
      "affiliations": [
        "Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Hung-Cheng Tsai"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei City, Taiwan",
        "Fu Jen Catholic University, New Taipei, Taiwan"
      ],
      "name": "Tzu-Hao Li"
    },
    {
      "affiliations": [
        "Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Chien-Wei Su"
    },
    {
      "affiliations": [
        "Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Kun-Ta Chou"
    },
    {
      "affiliations": [
        "Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Diahn Warng Perng"
    },
    {
      "affiliations": [
        "Department of Medical Education, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Ying-Ying Yang"
    },
    {
      "affiliations": [
        "Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan",
        "School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Ming-Chih Hou"
    }
  ],
  "title": "Increased risk of acute exacerbation in obstructive airway disease: the impact of metabolic dysfunction-associated steatotic liver disease and small airway dysfunction",
  "uid": "4c0b705a-22aa-52cc-8f47-9511b99a1e99"
}