International Journal Of Chronic Obstructive Pulmonary Disease[JOURNAL]
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200 papers
Real-Life Effectiveness of Aclidinium/Formoterol on COPD Control: The REDACT Observational Study.
Kostikas K, Loukides S, Tzanakis N … +8 more , Porpodis K, Tryfon S, Katsoulis K, Hillas G, Gioldasi I, Delicha E, Gogali A, Miravitlles M
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42388523 · Full text
BACKGROUND: COPD control evaluates changes in patients' status based on clinical impact and stability. There are limited data on the effectiveness of dual bronchodilation on COPD control. METHODS: REDACT was a multicente...
BACKGROUND: COPD control evaluates changes in patients' status based on clinical impact and stability. There are limited data on the effectiveness of dual bronchodilation on COPD control. METHODS: REDACT was a multicenter, prospective, single-arm, longitudinal real-life observational study that evaluated COPD control in uncontrolled COPD patients after 12 weeks of treatment with aclidinium/formoterol (Duaklir Genuair). Eligible patients were previously receiving any inhaled medication except triple therapy (fixed or open combinations). The primary objective was to assess the proportion of patients who achieved COPD control after 12 weeks. Secondary aims included changes in COPD assessment test (CAT) and forced expiratory volume in 1 second (FEV). RESULTS: A total of 1038 patients with uncontrolled COPD, mean age 68.9 years, 69.6% male, were recruited and 1014 (97.7%) completed follow-up. The proportion of patients who achieved COPD control at 12 weeks was 83.7% (95% CI 81.3 to 86.0%). Low baseline FEV (% pred), history of moderate/severe exacerbation in the past year and history of cardiovascular disease were predictors of lack of control. Change from baseline in FEV was 124.8 mL (95% CI 108.7 to 141.0 mL, p<0.001) and in CAT score -7.6 points (95% CI -7.9 to 7.3 points, p<0.001). Proportions of patients that achieved the minimally clinically important difference of +100 mL in FEV and -2 points in the CAT score were 50.4% and 90.5%, respectively. CONCLUSION: After 12 weeks of treatment with aclidinium/formoterol, a significant proportion of uncontrolled COPD patients achieved COPD control, with significant improvements in lung function and health status.
Effective-Component Compatibility of Bufei Yishen Formula Alleviates Alveolar Epithelial Barrier Damage in COPD Through Inhibition of p38 MAPK Phosphorylation.
Shao X, Zhang L, Guo M … +6 more , Wang C, Chu H, Mo Y, Lu R, Zhao P, Tian Y
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42382600 · Full text
PURPOSE: Alveolar epithelial barrier (AEB) dysfunction drives the development of chronic obstructive pulmonary disease (COPD). This study aimed to investigate whether the effective-component compatibility of the Bufei Yi...
PURPOSE: Alveolar epithelial barrier (AEB) dysfunction drives the development of chronic obstructive pulmonary disease (COPD). This study aimed to investigate whether the effective-component compatibility of the Bufei Yishen formula (ECC-BYF) protects the AEB in COPD via anti-inflammatory mechanisms, and to elucidate the underlying pathways. METHODS: In vivo, a rat model of COPD was established via repeated bacterial infection and cigarette smoke exposure. Following treatment, we analyzed lung function, histopathology, epithelial ultrastructure, inflammatory factors, and AEB-related protein expression. In vitro, MLE-12 cells stimulated with TNF-α were pretreated with ECC-BYF to assess cell viability, inflammatory responses, and barrier protein expression. Additionally, network pharmacology was utilized to predict key therapeutic targets, and the involvement of the p38 MAPK signaling pathway was validated via Western blotting. RESULTS: In vivo, ECC-BYF improved pulmonary function and attenuated histopathological damage in COPD rats. Ultrastructural analysis showed that ECC-BYF improved the morphology of alveolar type 1 (AT1) and type 2 (AT2) cells and preserved intercellular junctions. Furthermore, ECC-BYF upregulated the expression of ZO-1, Occludin, SP-C, and SP-D proteins, increased Interleukin (IL)-10 in bronchoalveolar lavage fluid (BALF), and suppressed BALF levels of IL-6, IL-1β, and TNF-α. Network pharmacology identified TNF/IL-6 and MAPK signaling as key targets. In vitro, ECC-BYF reversed TNF-α-induced elevations in IL-6 and TNF-α mRNA, increased ZO-1, Occludin, and SP-C protein levels, and inhibited p38 MAPK phosphorylation. This reduction in p-p38 MAPK was concordantly observed in rat lung tissues. Critically, asiatic acid abrogated ECC-BYF's suppressive effects, demonstrating that p38 MAPK inhibition is central to its barrier-protective efficacy. CONCLUSION: ECC-BYF mitigates AEB disruption in COPD by inhibiting the p38 MAPK-mediated inflammatory response, highlighting a crucial mechanism for protecting barrier integrity.
Cardiopulmonary Exercise Testing and Quantitative Chest CT in COPD: The Stronger Association of Emphysema Over Airway Thickness with Functional Impairment.
Peng Y, Shi M, Yu C … +2 more , Yang T, Huang K
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42371567 · Full text
INTRODUCTION: The relationship between cardiopulmonary function and chest structure, particularly the square root of wall area of a hypothetical airway with a luminal perimeter of 10 mm (Pi10), in patients with chronic o...
INTRODUCTION: The relationship between cardiopulmonary function and chest structure, particularly the square root of wall area of a hypothetical airway with a luminal perimeter of 10 mm (Pi10), in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aims to compare cardiopulmonary function across computed tomography (CT) phenotypes and to evaluate the association between emphysema, airway thickness and cardiopulmonary function, respectively. METHODS: Patients with stable COPD were recruited and underwent pulmonary function testing, CT, and cardiopulmonary exercise testing (CPET). Emphysema was assessed using the percentage of low attenuation areas < -950 Hounsfield units (%LAA-950), and airway wall thickness was evaluated with Pi10. Based on these two CT metrics, patients were categorized into four phenotypes: normal, emphysema-dominant (E-dominant), airway-dominant (A-dominant), and mixed. Pearson's correlation and Multiple linear regression were conducted to assess the relationship between %LAA-950, Pi10 and cardiopulmonary function. RESULTS: Ninety-three patients were enrolled in this study. Individuals with E-dominant phenotype and mixed phenotype had lower FEV1/FVC, and those with E-dominant phenotype had worse ventilatory efficiency (V/V and V/VCO slope). %LAA-950 showed negative correlations with VO (β = -0.288, = 0.004) and VO%pred (β = -0.244, = 0.027) and positive correlations with V/V (β = 0.272, = 0.017), V/VCO (β = 0.285, = 0.011) and V/VCO slope (β = 0.276, = 0.026). However, Pi10 exhibited no significant associations with the studied CPET variables. CONCLUSION: Patients with emphysema are more likely to have reduced exercise endurance and ventilatory efficiency during exercise. Emphysema may be a better indicator of cardiopulmonary function than airway thickness.
A Nomogram for Predicting Successful Weaning from Invasive Mechanical Ventilation Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Complicated by Respiratory Failure.
Bao H, Zhu T, Li C … +6 more , Huan J, Li L, Kong L, Chen Y, Shi L, Li C
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42371566 · Full text
OBJECTIVE: To develop and validate a practical nomogram for predicting the success rate of invasive mechanical ventilation (IMV) weaning in patients with chronic obstructive pulmonary disease (COPD) complicated by acute...
OBJECTIVE: To develop and validate a practical nomogram for predicting the success rate of invasive mechanical ventilation (IMV) weaning in patients with chronic obstructive pulmonary disease (COPD) complicated by acute hypercapnic respiratory failure. METHODS: A total of 159 eligible patients admitted between January 2020 and December 2024 were enrolled in this study, and they were randomly divided into a development cohort (n = 106) and a validation cohort (n = 53) at a 2:1 ratio. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were used to identify independent risk factors, which were used to construct a predictive nomogram. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA), as well as through risk stratification validation. RESULTS: LASSO regression identified 5 candidate variables, and multivariate analysis confirmed that anxiety, pneumothorax, vasoactive drug use, and NT-proBNP were independent risk factors for weaning failure (all P < 0.05). The nomogram achieved excellent discriminative ability, with areas under the ROC curve (AUCs) of 0.942 (95% CI: 0.868-1) in the development cohort and 0.982 (95% CI: 0.944-1) in the validation cohort. The calibration curves indicated good consistency between the predicted and actual probabilities, and DCA demonstrated a favorable net clinical benefit. Using a cutoff value of 0.3, patients were effectively stratified into low-risk and high-risk groups by the nomogram, with significantly different weaning success rates between the cohorts (both P < 0.0001). CONCLUSION: This study developed a simple, reliable, and clinically applicable nomogram for predicting IMV weaning success in COPD patients with respiratory failure. The nomogram might assist clinicians in implementing early risk stratification, optimizing weaning strategies, and improving clinical outcomes.
Diagnostic Value of miR-192-5p in the Progression of Chronic Obstructive Pulmonary Disease Complicated with Pulmonary Heart Disease.
Xiao L, Wang W, Hu L … +1 more , Tao H
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42371565 · Full text
PURPOSE: The development of chronic obstructive pulmonary disease (COPD) is often accompanied by pulmonary heart disease (PHD). However, PHD lacks effective diagnostic markers in its early stages, making it difficult to...
PURPOSE: The development of chronic obstructive pulmonary disease (COPD) is often accompanied by pulmonary heart disease (PHD). However, PHD lacks effective diagnostic markers in its early stages, making it difficult to detect. miR-192-5p is closely associated with respiratory diseases and may serve as an effective diagnostic biomarker. This study aims to investigate the diagnostic value of miR-192-5p in PHD. PATIENTS AND METHODS: This study included patients with COPD alone (n=120) and those with COPD complicated with PHD (n=140). Serum miR-192-5p levels were detected using RT-qPCR, while TNF-α and IL-6 concentrations were measured via ELISA kits. Hospitalization-related diagnostic indicators were concurrently collected for comparative analysis. The diagnostic value of miR-192-5p was assessed using receiver operating characteristic curve analysis, and risk factors were identified through logistic regression analysis. RESULTS: miR-192-5p level is significantly downregulated in serum samples from non-PHD and PHD patients. It demonstrates diagnostic performance for PHD with an AUC of 0.789 (78.6% sensitivity, 64.2% specificity) and distinguishes healthy from non-PHD with an AUC of 0.873 (90.0% sensitivity, 70.0% specificity). And its low expression is one of the primary risk factors for PHD development. Further analysis reveals that miR-192-5p levels show a significant negative correlation with inflammatory markers and are closely associated with patients' cardiopulmonary function indicators. CONCLUSION: miR-192-5p is significantly downregulated in PHD, and low levels of miR-192-5p represent one of the risk factors for PHD development. It can effectively distinguish between healthy individuals and non-PHD patients, and demonstrating moderate diagnostic accuracy in distinguishing between non-PHD patients and PHD patients, and is expected to become a viable diagnostic biomarker.
Association Between Chronic Obstructive Pulmonary Disease and Survival in Patients with Lung Cancer: A Nationwide Cohort Study.
Chan KH, Liu WC, Chang YC … +3 more , Konara Mudiyanselage SP, Chuang TJ, Tsai YT
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42371564 · Full text
PURPOSE: Chronic obstructive pulmonary disease (COPD) frequently co-occurs with lung cancer and may adversely influence survival through reduced respiratory reserve, systemic inflammation, immune dysregulation, and impai...
PURPOSE: Chronic obstructive pulmonary disease (COPD) frequently co-occurs with lung cancer and may adversely influence survival through reduced respiratory reserve, systemic inflammation, immune dysregulation, and impaired treatment tolerance. However, its independent prognostic impact in large real-world lung cancer populations remains uncertain. This nationwide cohort study examined the association between pre-existing COPD and four-year all-cause mortality among patients with newly diagnosed lung cancer. METHODS: We conducted a nationwide retrospective cohort study using linked data from Taiwan's National Health Insurance Research Database, Cancer Registry, and Death Registry. Adults newly diagnosed with lung cancer between 2011 and 2019 were included and followed until death or the end of 2023. COPD was defined using diagnostic codes recorded before or at cancer diagnosis. Propensity score matching at a 1:3 ratio was used to balance baseline characteristics. Survival was assessed using Kaplan-Meier methods and Cox proportional hazards models. RESULTS: The matched cohort included 34,832 patients, including 8,708 with COPD and 26,124 without COPD. Four-year survival was lower among patients with COPD than among those without COPD, 31.6% versus 36.8%, respectively; log-rank < 0.001. Mortality rates were 29.91 and 25.44 per 100 person-years in the COPD and non-COPD groups, respectively. After multivariable adjustment, COPD was independently associated with higher mortality, hazard ratio 1.13; 95% confidence interval 1.09-1.16. This association was consistent across subgroups and was particularly evident among men, older adults, patients with advanced-stage disease, and those receiving immunotherapy. CONCLUSION: Using nationwide linked claims, cancer registry, and mortality data, this study provides population-level evidence that pre-existing COPD is an independent host-related prognostic factor for poorer four-year survival among patients with newly diagnosed lung cancer. Integrating COPD identification, pulmonary optimization, and multidisciplinary pulmonary-oncology care into routine lung cancer management may support risk stratification and improve long-term outcomes.
Breathlessness Matters - Australian Cohort Study Evaluating the Impact of a Multidisciplinary, Home-Based Breathlessness Intervention Service Targeting Patients with Chronic Obstructive Pulmonary Disease (COPD).
Cochrane B, Akhunji MZ, Xuan W … +6 more , Lee JS, Smith TA, Smith SM, Foo SW, Garcia L, Kemp TA
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42367347 · Full text
BACKGROUND AND OBJECTIVES: Chronic breathlessness causes reduced quality of life (QoL) and high healthcare costs. Accumulating evidence shows that multidisciplinary breathlessness services can ameliorate breathlessness w...
BACKGROUND AND OBJECTIVES: Chronic breathlessness causes reduced quality of life (QoL) and high healthcare costs. Accumulating evidence shows that multidisciplinary breathlessness services can ameliorate breathlessness which persists despite guideline-directed treatments. Current literature largely reflects trials of interventions in European settings applied to cancer-predominant populations, raising doubt about broad applicability. The research objective was to evaluate whether Macarthur Breathless Clinic (MBC), a bespoke health service intervention, could reduce the impact of chronic breathlessness for a cohort of Australians with COPD. METHODS: The MBC intervention was tested in a prospective, single-arm cohort study, targeting recruitment of 92 patients. Eligible patients had chronic breathlessness impacting QoL and at least moderately severe COPD, defined by spirometry. Following detailed case review to ensure optimal medical therapy, an individualized program was developed and implemented by MBC's multidisciplinary team during a nine-week program. Questionnaires assessing breathlessness burden, mental health and QoL were administered at baseline, repeated on program completion and again at 12 months. RESULTS: Eighty-nine eligible subjects were mean age 71 years, 65% female and 10% Aboriginal Australian with 18% reporting breathlessness at rest. Mean FEV1 was 37% predicted. Compared with baseline, the primary outcome, Chronic Respiratory Questionnaire - Mastery Subscale improved after program completion (0.5 at nine and 0.8 at 52 weeks, p<0.0001). Measures of confidence, COPD symptom burden and breathlessness also yielded durable positive results at 12 months. CONCLUSION: Clinically relevant gains seen after MBC were retained or even increased at 12 months and more reflected enhanced coping skills and confidence than reduced breathlessness intensity.
Chronic Obstructive Pulmonary Disease Influence on Lung Cancer Risk Through Blood Metabolite Mediation: A Two-Sample Mendelian Randomisation and Mediation Analysis.
Cao YN, Wang L, Fan HS … +1 more , Zhang ZJ
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42367346 · Full text
PURPOSE: Lung cancer (LC) risk is increased by chronic obstructive pulmonary disease (COPD) through metabolic and inflammatory processes. In addition to identifying possible inflammatory or blood metabolite mediators, th...
PURPOSE: Lung cancer (LC) risk is increased by chronic obstructive pulmonary disease (COPD) through metabolic and inflammatory processes. In addition to identifying possible inflammatory or blood metabolite mediators, this study explores the causal link between LC and COPD. PATIENTS AND METHODS: To determine whether COPD and LC are causally related, as well as whether inflammatory variables and blood metabolites mediate this relationship, we used two-sample and two-step Mendelian randomization (MR) analyses based on summary data from published genome-wide association studies (GWAS). Directionality and robustness were investigated using reverse MR and sensitivity analyses, primarily using the inverse variance weighted (IVW) method. RESULTS: Two-sample MR analyses revealed that COPD was a risk factor for the occurrence of LC ( = 0.002, OR = 1.114 [1.042-1.191]). Moreover, 113 blood metabolites and six inflammatory factors showed nominally significant causal associations with LC risk ( < 0.05). Conversely, LC had no casual effect on COPD, while LC had significant causal associations with six blood metabolites. Mediation analysis demonstrated that three blood metabolites enhanced the promoted effect of COPD on the occurrence of LC, namely 1-stearoyl-2-arachidonoyl-gpc (18:0/20:4) levels, Epiandrosterone sulfate levels, and 1-palmitoyl-2-arachidonoyl-gpc (16:0/20:4n6) levels. However, there was no casual effect of COPD on inflammatory factors. Sensitivity analyses confirmed that all results were reliable. CONCLUSION: These findings shed light on the underlying mechanisms that link COPD and LC and highlight the fact that COPD is a risk factor for the development of LC, with blood metabolites partially mediating this effect.
The Disproportionate Burden of Cardiovascular Disease in Mild-to-Moderate COPD.
Zhang W, Wen J, Chew SY … +7 more , Hao Y, Liao F, Koh MS, Xu Z, Wang G, Wang X, Tiew PY
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42367345 · Full text
BACKGROUND: Cardiovascular disease (CVD) is a major comorbidity in chronic obstructive pulmonary disease (COPD). However, whether cardiovascular burden increases with the severity of COPD requires more nuanced investigat...
BACKGROUND: Cardiovascular disease (CVD) is a major comorbidity in chronic obstructive pulmonary disease (COPD). However, whether cardiovascular burden increases with the severity of COPD requires more nuanced investigation. This study investigated the association between COPD severity and CVD prevalence, and evaluated their independent and joint effects on long-term survival. METHODS: This multicenter cohort study included 553 stable COPD patients. Disease severity was stratified by GOLD grades and the multidimensional BODEx index. Logistic regression and Cox proportional hazards models were used to evaluate CVD prevalence across severity stages and identify predictors of all-cause mortality. RESULTS: Patients were classified as mild-to-moderate (GOLD 1-2; 57.7%) or severe-to-very severe (GOLD 3-4; 42.3%). A clear paradox emerged: CVD prevalence was significantly lower in severe-to-very severe COPD compared to mild-to-moderate disease (45.7% vs. 59.6%, P=0.001). Adjusted analysis indicated that severe airflow limitation was independently associated with lower odds of CVD (OR 0.68, P=0.038). Notably, CVD was a significant mortality predictor only in early-stage disease. Conversely, in advanced COPD, the multidimensional BODEx score >4 emerged as the strongest independent predictor of mortality (HR 2.19, P<0.001), rendering CVD history statistically non-significant (P=0.10). CONCLUSION: CVD burden is highest in mild-to-moderate stages, where it significantly drives mortality. In advanced disease, overall multidimensional severity (BODEx index) supersedes CVD to determine survival. These findings emphasize prioritizing early cardiovascular screening in mild COPD while utilizing multidimensional indices for advanced prognosis.
β2-Microglobulin Induces Mitochondrial Dysfunction Accompanied by Bronchial Epithelial Cell Senescence.
Gu Y, Yuan W, Xie XF … +3 more , Dong HM, Wei B, Wang JY
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42367344 · Full text
PURPOSE: β2-microglobulin (β2m) is the light-chain subunit of major histocompatibility complex class I (MHC I) molecules. Our group previously showed that β2m contributes to emphysema development by inducing epithelial c...
PURPOSE: β2-microglobulin (β2m) is the light-chain subunit of major histocompatibility complex class I (MHC I) molecules. Our group previously showed that β2m contributes to emphysema development by inducing epithelial cell senescence. However, the mechanism linking β2m to epithelial senescence remains unclear. Previous studies have reported mitochondrial dysfunction in senescent lung cells from patients with emphysema, suggesting a potential mechanistic pathway. This in vitro study used BEAS-2B human bronchial epithelial cells to evaluate whether exposure to β2m is associated with mitochondrial dysfunction and a senescent phenotype. METHODS: Human bronchial epithelial BEAS-2B cells were exposed in vitro for 48 hours to recombinant human β2m or cigarette smoke extract (CSE). Cellular senescence was assessed by senescence-associated β-galactosidase (SA-β-gal) staining. Mitochondrial dysfunction was evaluated by measuring mitochondrial membrane potential (MMP), reactive oxygen species (ROS), mitochondrial ROS (mtROS), oxygen consumption rate (OCR), and real-time adenosine triphosphate (ATP) production rate. Cell proliferation and apoptosis were assessed using CCK-8 and Annexin V-FITC/PI assays, respectively. RESULTS: β2m and CSE increased SA-β-gal staining in BEAS-2B cells, indicating enhanced cellular senescence. β2m and CSE also decreased MMP, increased ROS and mtROS levels, and reduced OCR, indicating mitochondrial dysfunction. In addition, β2m and CSE reduced BEAS-2B cell proliferation and increased apoptosis. CONCLUSION: β2m exposure was associated with mitochondrial dysfunction and a senescent phenotype in BEAS-2B cells, accompanied by reduced proliferation and increased apoptosis. These findings suggest that β2m may contribute to epithelial aging in COPD/emphysema, although further mechanistic investigation and in vivo validation are required.
Profiles and Disease Burden of Patients with COPD Initiating Triple Therapy in China.
Li X, Cao J, Hao S … +5 more , Noorduyn SG, Tang Z, Ismaila AS, Chen I, Ding J
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42367343 · Full text
PURPOSE: To describe the patient profile and disease burden for patients with chronic obstructive pulmonary disease (COPD) in China who initiated triple therapy. METHODS: This retrospective, observational cohort study us...
PURPOSE: To describe the patient profile and disease burden for patients with chronic obstructive pulmonary disease (COPD) in China who initiated triple therapy. METHODS: This retrospective, observational cohort study used real-world data from the Tianjin database to identify patients with COPD who initiated triple therapy between 1 January 2019 and 30 June 2023. Index date was the first prescription for single-inhaler triple therapy (SITT; fluticasone furoate/umeclidinium/vilanterol or budesonide/glycopyrronium/formoterol fumarate) or multiple-inhaler triple therapy (MITT). Patient demographics, clinical characteristics, baseline medications, healthcare resource utilisation and costs were described. RESULTS: In total, 7871 patients were included; 3582 received MITT and 4289 received SITT. In the overall population, the mean age was 65.8 years and 64.8% of patients were male. Most patients were non-smokers (95.6%) and had a visit to a Tier 3 hospital at index (89.8%). Hypertension (36.8%) and asthma (33.0%) were the most common comorbidities at index. Inhaled corticosteroid/long-acting β2-agonist (19.3%) was the most used treatment prior to initiating triple therapy. The median (interquartile range) number of COPD-related emergency department visits, inpatient admissions and outpatient admissions in the year prior to and including the index date was 1 (1), 1 (0) and 3 (5), respectively. The median COPD-related total direct medical costs were 2068 Renminbi per patient. The mean proportion of days covered (PDC) for baseline medications was 0.35. The median eosinophil count was 120 cells/μL. CONCLUSION: These results provide an overview of the profiles of patients with COPD in China. The high rates of COPD-related healthcare resource utilization and costs demonstrate the considerable burden of COPD in China, whilst the PDC results indicate medication adherence needs to be improved. These findings could help reduce the burden of COPD in China by supporting the planning and adjustment of patients' treatment strategies.
Endoscopic Lung Volume Reduction with Valves Improves Cardiovascular Adaptability and 6-MWT Performance in Severely Limited COPD Patients.
Farber L, Pappe E, Sgarbossa T … +4 more , Neumann K, Witzenrath M, Hübner RH, Saccomanno J
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42343914 · Full text
BACKGROUND: The 6-minute walk test (6-MWT) assesses exercise capacity in patients with chronic obstructive pulmonary disease. A recent study revealed that selected patients with an advanced emphysema and a baseline walki...
BACKGROUND: The 6-minute walk test (6-MWT) assesses exercise capacity in patients with chronic obstructive pulmonary disease. A recent study revealed that selected patients with an advanced emphysema and a baseline walking distance of ≤140 m in 6-MWT benefit from endoscopic lung volume reduction with valves (ELVR) with a remarkable improvement in walking distance. However, the reasons for these improvements remain unexplained. STUDY DESIGN AND METHODS: We retrospectively analyzed 54 patients with severe emphysema undergoing ELVR at Charité-Universitaetsmedizin Berlin. Patients were stratified into 2 groups by baseline walking distance: those with 6-MWT ≤140 m and those with 6-MWT 140-450 m. Changes in lung function, quality of life, and 6-MWT parameters (peripheral oxygen saturation (SpO), heart rate (HR), and walking distance) were evaluated using Generalized Estimating Equations (GEE). RESULTS: While lung function and quality of life improved comparably in both groups, patients with 6-MWT ≤140 m showed a significantly greater improvement in walking distance versus the 6-MWT 140-450 m group (105.6 ± 123.2 m versus 12.1 ± 80.8 m, p=0.027). GEE analysis indicated that this improvement was accompanied by a significantly greater reduction in ΔHR from baseline to follow-up compared to the 6-MWT 140-450 m group (p=0.023), while changes in SpO were similar. CONCLUSION: Patients with very limited exercise capacity (≤140 m) improved their walking distance disproportionately after ELVR. The concomitant decrease in HR suggests an associated cardiovascular benefit in this subgroup. Therefore, a 6-MWT of ≤140 m should not be considered an exclusion criterion for ELVR, as these patients can achieve meaningful clinical improvements.
Association Between Improvement in Institutional COPD Quality Assessment Grade and Risk of Acute Exacerbations in Primary and Secondary Care: A Nationwide Claims-Based Study.
Moon SW, Lee H, Kim Y … +3 more , Kim K, Rhee CK, Moon JY
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42343913 · Full text
BACKGROUND: The Health Insurance Review and Assessment Service (HIRA) in South Korea assesses and grades primary and secondary healthcare institutions according to their management of chronic obstructive pulmonary diseas...
BACKGROUND: The Health Insurance Review and Assessment Service (HIRA) in South Korea assesses and grades primary and secondary healthcare institutions according to their management of chronic obstructive pulmonary disease (COPD). This study examined whether changes in institutional quality assessment grades were associated with variations in the concurrent risk of acute COPD exacerbations. METHODS: Using national HIRA claims data, we identified 36,218 patients with COPD treated at 873 non-tertiary medical institutions between May 2016 and April 2018. Institutions were stratified into three groups based on their grade trajectories from the 3rd (May 2016-April 2017) to the 4th (May 2017-April 2018) assessment periods: the 158 improved-grade (n=5,118), 526 maintained-grade (n=25,286), and 189 declined-grade (n=5,814) institution groups. We compared the incidence and severity of exacerbations among these groups during the 4th assessment period. Incidence rate ratios (IRRs) for exacerbations were estimated using multivariable negative binomial regression models to adjust for potential confounders. RESULTS: At baseline, improved-grade institutions exhibited significantly higher rates of pulmonary function testing (56.3% vs. 41.9%) and greater prescription of long-acting muscarinic antagonists (29.0% vs. 14.6%) compared with declined-grade institutions (p<0.001). During the 1-year outcome period (May 2017-April 2018), the incidence of moderate-to-severe COPD exacerbations was considerably higher in the declined-grade group (29.2%) than in the improved-grade group (26.1%) (p=0.008). In the negative binomial regression analyses using the maintained-grade group as the reference category, patients treated at improved-grade institutions had a significantly lower risk of exacerbations (adjusted IRR 0.864, 95% CI 0.795-0.939, p<0.001). CONCLUSION: This analysis of nationwide real-world claims data demonstrated that institutional improvement in COPD quality assessment grades was associated with a reduced concurrent risk of acute exacerbations in both primary and secondary care settings. These findings indicate that institutional indicators of guideline-aligned COPD care may correspond to clinically meaningful differences in patient-level outcomes.
Development and Validation of an Explainable Machine Learning Model for Identification of Dysphagia in Patients with COPD.
Zhou C, Hong S, Fang J … +5 more , Yan X, Zang M, Tang N, Bao L, Pan H
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42338670 · Full text
PURPOSE: Dysphagia is a common yet often overlooked complication in Chronic Obstructive Pulmonary Disease (COPD) patients, who are prone due to abnormal breathing patterns, impaired airway protection, and generalized fra...
PURPOSE: Dysphagia is a common yet often overlooked complication in Chronic Obstructive Pulmonary Disease (COPD) patients, who are prone due to abnormal breathing patterns, impaired airway protection, and generalized frailty. This not only predisposes them to aspiration pneumonia but also serves as a key trigger for acute exacerbations of COPD, substantially increasing the risk of adverse outcomes. Early identification of dysphagia is essential for improving prognosis in COPD. However, research on early detection is limited, particularly regarding machine learning prediction. This study aimed to develop and validate a machine learning based risk assessment model for dysphagia in COPD and deploy it as a user-friendly web-based clinical tool to assist clinicians in risk identification and early intervention. PATIENTS AND METHODS: Retrospective medical records from 710 COPD patients admitted between February 2025 and January 2026 were analyzed. Swallowing function was assessed using the Water-Swallowing Test. Univariate and multivariate logistic regression identified independent risk factors, which were used to develop and compare eight machine learning models. Model performance was evaluated using ROC, calibration, and decision curves with Bootstrap internal validation. Key variables were interpreted via Shapley Additive Explanations, and the final model was deployed online. RESULTS: Dysphagia prevalence was 29.3%. Multivariate regression identified five key risk factors: disease duration, BMI, history of tracheal intubation, muscle strength, and the modified Medical Research Council (mMRC) score for dyspnea severity. Among eight machine learning models, the XGBoost model showed the best performance in the training set (AUC 0.921, 95% CI 0.901-0.940) and demonstrated good calibration and highest clinical net benefit. The model was deployed online (https://dysphagiamodel.shinyapps.io/COPD-DP/). CONCLUSION: We developed and validated an online machine learning-based dysphagia risk assessment tool for COPD, demonstrating discrimination, calibration, and clinical utility for risk stratification and clinical decision-making.
Chronic Obstructive Pulmonary Disease in Singapore: Current Perspectives on Prevalence, Disease Burden, and Treatment.
Yii A, Maldonado Sanchez Y, Lai Q … +1 more , Chen W
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42338669 · Full text
Chronic obstructive pulmonary disease (COPD) represents a significant global health challenge, affecting millions worldwide, with an estimated prevalence of 5.9% specifically for Singapore, and a projected increase drive...
Chronic obstructive pulmonary disease (COPD) represents a significant global health challenge, affecting millions worldwide, with an estimated prevalence of 5.9% specifically for Singapore, and a projected increase driven by population aging. Despite comprehensive healthcare infrastructure, COPD remains underdiagnosed and undertreated in Singapore. Real-world evidence indicates that most patients present with moderate-to-severe disease and exhibit high rates of comorbidities, including cardiovascular disorders, diabetes, and bronchiectasis, which complicate COPD management and increase healthcare utilization. Smoking remains the predominant risk factor, although non-smoking phenotypes linked to prior tuberculosis, biomass exposure, and environmental allergens are increasingly recognized. COPD imposes a significant economic burden, primarily driven by hospitalizations, and disproportionately affects certain ethnic groups, underscoring the need for culturally tailored interventions. Current treatment strategies for moderate-to-severe COPD emphasize smoking cessation, pulmonary rehabilitation, and inhaled bronchodilator therapy; however, substantial gaps persist, with frequent exacerbations despite triple therapy (long-acting β2-agonists and long-acting muscarinic antagonists along with inhaled corticosteroids) and inappropriate oral corticosteroid use contributing to adverse outcomes. Recent advances in biologic therapies targeting type 2 inflammation, notably dupilumab, approved in Singapore in 2025 offer promising options for patients with uncontrolled COPD characterized by elevated blood eosinophils. Emerging biomarkers, such as fractional exhaled nitric oxide, may further refine patient selection for precision therapy. This review focuses on the current evidence on COPD epidemiology, clinical characteristics, risk factors, treatment patterns, and evolving therapeutic approaches in Singapore, highlighting opportunities to optimize patient care through early diagnosis and adoption of novel biologics to improve outcomes in this heterogeneous population.
Severe COPD Exacerbators Requiring Multiple ICU Admissions Over Time: Insights of a French Cohort.
Ferré A, Sahki N, Puechoultres P … +3 more , Diop S, Abi-Abdallah G, Legriel S
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42338668 · Full text
INTRODUCTION: Data on COPD patients who experience multiple intensive care unit (ICU) admissions for severe acute exacerbations (AECOPD) are scarce. We aimed to describe and compare patients' characteristics by recurrent...
INTRODUCTION: Data on COPD patients who experience multiple intensive care unit (ICU) admissions for severe acute exacerbations (AECOPD) are scarce. We aimed to describe and compare patients' characteristics by recurrent admission status and to identify factors associated with recurrent ICU-level exacerbations. METHODS: We conducted a single-centre, retrospective cohort study including all patients admitted to our ICU between 2015 and 2022 for a severe AECOPD. Patients with more than one ICU admission during the study period were classified as "recurrent exacerbator" phenotype. Multivariable regression and competing-risk models were used. RESULTS: We included 328 patients who had a total of 445 admissions. Seventy-two (22.0%) patients had multiple ICU admissions. Compared with non-recurrent patients, recurrent exacerbators were younger (median 67 vs 70 years, p=0.037), had a lower prevalence of impaired Performance Status (13.9% vs 25.8%, p=0.035), and had higher blood eosinophil counts (0.06 vs 0.04 G/L, p=0.025). One-year mortality was similar between groups (18.1% vs 18.4%, p=0.95). In multivariate model, factors independently associated with recurrent severe exacerbation were long-term oxygen therapy (HR = 1.79, p=0.045) and initial blood eosinophil count (HR per +0.1 G/L = 1.10, p<0.001). A Performance Status ≥3 was inversely associated with recurrence (HR per point = 0.41, p=0.030). CONCLUSION: Patients with recurrent ICU admission for severe COPD exacerbations were younger and had higher blood eosinophil counts than those with a single admission. These findings may suggest that phenotyping-including blood eosinophils-could help stratify the risk of recurrent severe exacerbations and personalised treatment.
Construction and Validation of Active Case-Finding Tool in Community Participants with Chronic Obstructive Pulmonary Disease Using an Interpretable Machine Learning Approach.
Tian H, Wu F, Sun C … +3 more , Deng Z, Zhou Y, Ran P
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42333377 · Full text
PURPOSE: Early diagnosis is an effective strategy in chronic obstructive pulmonary disease (COPD) prevention. Active case-finding is an effective approach, but traditional tools such as COPD-SQ are limited by outdated da...
PURPOSE: Early diagnosis is an effective strategy in chronic obstructive pulmonary disease (COPD) prevention. Active case-finding is an effective approach, but traditional tools such as COPD-SQ are limited by outdated data, poor extrapolation, and singular binary prediction. This study aimed to develop an updated, convenient, and interpretable machine learning tool for COPD screening in community participants. PATIENTS AND METHODS: Data for model training and external validation were obtained from two community-based studies in Guangdong, China. PyCaret and R programming language were used to develop machine learning models. Thirty original items, including demographic data, clinical features, and risk factor data, were initially used. Eleven machine learning classification models were compared, and the least absolute shrinkage and selection operator was further used to shrink predictors. Model performance was evaluated using ROC, AUC, accuracy, sensitivity, specificity, and other metrics. Shapley Additive exPlanations were used to interpret the models. RESULTS: A total of 5381 and 2456 participants from the training and external validation cohorts were included, respectively. In predicting COPD, the AdaBoost model showed the best performance, with an accuracy of 0.846 and an AUC of 0.848. For GOLD classification prediction, the model achieved an overall accuracy of 0.822 and an AUC of 0.816, and identified 83% of moderate-to-severe COPD in the community. In regression analysis, the gradient boosting regression model showed good consistency between predicted and measured FEV %pred and FEV/FVC values. The models also demonstrated good performance in the external validation cohort and were deployed online. CONCLUSION: We constructed an active case-finding tool with integrated machine learning models for predicting COPD, COPD severity, and lung function parameters using limited clinical data. This tool may help prioritize high-risk individuals for confirmatory spirometry in community settings. Future implementation studies should evaluate its effect on referral efficiency, diagnostic yield, treatment uptake, and long-term outcomes.
From China's Multicenter Prospective Cohort: Right Ventricular Afterload and Prognosis in Hospitalized Patients with Acute Exacerbation of COPD.
Gao A, Liu X, Jiao X … +7 more , Ding Y, Gao Z, Gao Y, Zhang J, Yang J, Yang S, Yang Y
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42333376 · Full text
PURPOSE: The relationship between increased right ventricular (RV) afterload (moderate-to-high suspicion of pulmonary hypertension indicated by echocardiography) and the prognosis of patients hospitalized with acute exac...
PURPOSE: The relationship between increased right ventricular (RV) afterload (moderate-to-high suspicion of pulmonary hypertension indicated by echocardiography) and the prognosis of patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not yet well understood. PATIENTS AND METHODS: This prospective cohort study was conducted in 11 hospitals from 2017 to 2020, involving patients hospitalized with AECOPD. Echocardiography was performed within 48 hours of admission. Patients were classified into two groups: those with increased RV afterload (n=237) and those with normal RV afterload (n=415). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression analysis to evaluate the impact of RV afterload on patient outcomes. Kaplan-Meier survival curves were employed to assess the association between RV afterload and 3-year all-cause mortality. RESULTS: Kaplan-Meier survival curves demonstrated that the 3-year all-cause mortality rates were 22.8% in AECOPD patients with increased RV afterload and 9.5% in those with normal RV afterload. Cox regression analysis indicated that increased RV afterload is an independent predictor of poor prognosis in hospitalized AECOPD patients, significantly increasing the risk of 3-year all-cause mortality (HR=2.172, 95% CI: 1.384-3.411; <0.001). Additionally, elevated brain natriuretic peptide (BNP) or n-terminal pro-brain natriuretic peptide (NT-proBNP) (HR=2.694, 95% CI: 1.724-4.209; <0.001), and lower body mass index (BMI) (HR=0.880, 95% CI: 0.833-0.930; <0.001) were independent risk factors for mortality. CONCLUSION: Increased RV afterload is associated with a significant increase in the risk of 3-year all-cause mortality in patients hospitalized with AECOPD, posing a 2.2-fold higher risk compared to those with normal RV afterload. It also stands as an independent risk factor for mortality. Elevated BNP or NT-proBNP levels and reduced BMI are additional independent risk factors of mortality. Early detection of these three risk factors could play a role in stratifying high-risk patients, guiding clinical decision-making, and improving patient outcomes in AECOPD.
Identification of ERN1 as a Potential Context-Dependent Biomarker in Chronic Obstructive Pulmonary Disease Based on Bioinformatics Analysis of GSE57148 Dataset.
Peng Q, Yang M, Fan D … +1 more , Zhou P
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42333375 · Full text
PURPOSE: To identify an endoplasmic-reticulum-stress-related candidate gene in chronic obstructive pulmonary disease (COPD) lung tissue and assess its internal discriminative performance and cross-cohort reproducibility....
PURPOSE: To identify an endoplasmic-reticulum-stress-related candidate gene in chronic obstructive pulmonary disease (COPD) lung tissue and assess its internal discriminative performance and cross-cohort reproducibility. PATIENTS AND METHODS: This bioinformatics study used the GSE57148 lung tissue dataset (98 COPD and 91 subjects with normal-spirometry; all male smokers undergoing lung resection). Differential expression was analyzed using limma on log2 (fragments per kilobase of transcript per million mapped reads [FPKM] + 1), followed by enrichment and protein-protein interaction analyses. Endoplasmic reticulum to nucleus signaling 1 (ERN1) was prioritized using a literature-informed post hoc multi-criteria framework. Internal discrimination was evaluated by receiver operating characteristic (ROC) analysis with repeated stratified 10-fold cross-validation and bootstrap optimism correction. External sensitivity analyses were performed in independent cohorts. RESULTS: A total of 308 differentially expressed genes were identified. ERN1 was significantly upregulated in COPD (log2FC = 0.75, adjusted P = 1.98 x 10^-15). In the discovery cohort, ERN1 showed internal discrimination (area under the ROC curve [AUC] = 0.853; cross-validated AUC = 0.848). However, external replication was heterogeneous; in the largest mixed-sex cohort (GSE47460), discrimination was limited (AUC = 0.477), and adjusted external models remained non-significant. CONCLUSION: ERN1 is upregulated in COPD lung tissue in GSE57148 and represents an endoplasmic-reticulum-stress-related, context-dependent candidate signal. Current evidence is preliminary and requires prospective validation in independent, sex-balanced cohorts and clinically accessible biospecimens.
Development and Psychometric Evaluation of a Pulmonary Rehabilitation Information Needs Scale for Patients with Chronic Obstructive Pulmonary Disease.
Tang Y, Zhao X, Huang Z … +7 more , Kaminga AC, Li Z, Xiong Y, Liu Z, Huang Y, Yang G, Yi Q
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42328421 · Full text
PURPOSE: This study aimed to develop and validate a pulmonary rehabilitation information needs scale for patients with chronic obstructive pulmonary disease (COPD) using both classical test theory (CTT) and item response...
PURPOSE: This study aimed to develop and validate a pulmonary rehabilitation information needs scale for patients with chronic obstructive pulmonary disease (COPD) using both classical test theory (CTT) and item response theory (IRT). METHODS: Guided by Alderfer's ERG theory and Kochen's information needs theory, the initial item pool was developed through a literature review and semi-structured interviews with 12 COPD patients undergoing pulmonary rehabilitation. Using the Delphi method, 35 experts were consulted to refine the questionnaire into its first draft. A pilot test with 20 COPD patients was then conducted to revise item wording. Data were collected from a convenience sample of 300 COPD patients from February to December 2024 at five hospitals in Changsha, China. Participants had a mean age of 71.01±9.38 years, and 85.3% were male. Validity and reliability were evaluated using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency, and item analysis based on CTT and IRT. RESULTS: The final questionnaire contains a total of 6 dimensions and 39 items. EFA identified six factors, with all items having factor loadings greater than 0.40 within their respective factors. CFA supported the proposed six-factor structure, with all standardized factor loadings at acceptable levels and the model demonstrating an acceptable fit to the data (χ/df = 1.804, CFI = 0.984, TLI = 0.983, RMSEA = 0.052, SRMR = 0.065). The content validity index (S-CVI) was 0.935 and the Cronbach's α coefficient of the scale was 0.936. IRT analysis showed that all items had good discrimination parameters (a > 1.0) and threshold parameters within an appropriate range (b = -4 to 4). CONCLUSION: To our knowledge, the scale is the first tool designed to assess pulmonary rehabilitation-specific information needs in COPD. It demonstrated acceptable validity and reliability for assessing the information needs of patients with COPD who are preparing to participate in or are undergoing pulmonary rehabilitation. The instrument may provide a useful and feasible instrument for supporting clinical assessment and the planning of individualized pulmonary rehabilitation education and support.
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