International Journal Of Chronic Obstructive Pulmonary Disease[JOURNAL]
Sun
200 papers
Response to the Letter to the Editor by Zambelli et al for In Silico Lung Deposition Profiles of Three Single-Inhaler Triple Therapies in Patients With COPD Using Functional Respiratory Imaging [Response To Letter].
Singh D, Roche N, Wu L … +4 more , Sadafi H, De Backer J, Monshi Tousi N, Marshall J
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41799993 · Full text
Abstract loading — click title to view on PubMed.
The Role of Programmed Cell Death-Related Genes in Asthma, Chronic Obstructive Pulmonary Disease, and Lung Function: A Multi-Omics Mendelian Randomization Study.
Ji T, Lv Y, Gu J
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41788971 · Full text
PURPOSE: Programmed cell death (PCD) has been linked to asthma, chronic obstructive pulmonary disease (COPD) and lung function, but the underlying genetic determinants remain unclear. PATIENTS AND METHODS: A comprehensiv...
PURPOSE: Programmed cell death (PCD) has been linked to asthma, chronic obstructive pulmonary disease (COPD) and lung function, but the underlying genetic determinants remain unclear. PATIENTS AND METHODS: A comprehensive multi-omics analysis was conducted by integrating genome-wide association studies (GWAS) with methylation quantitative trait loci (mQTL), expression quantitative trait loci (eQTL), and protein quantitative trait loci (pQTL) data. To determine the causality between exposures and respiratory traits, Summary Data-Based Mendelian Randomization (SMR) and colocalization analyses were applied. External validation was performed using replication cohorts, along with transcriptome-wide association studies (TWAS), gene-based analysis, and tissue-specific analysis. Additionally, enrichment analysis was carried out to identify biological pathways linked to respiratory traits. To explore potential therapeutic targets, drug prediction and molecular docking analyses were employed to assess the pharmacological feasibility of candidate compounds. RESULTS: Through the integration of multi-omics analysis, we identified six PCD-related genes associated with respiratory traits. ERBB3, SFRP1, and FGFR1 demonstrated tier 1 evidence, linking them to COPD in never-smokers, forced expiratory volume in 1 second (FEV1), and FEV1/forced vital capacity (FVC), respectively. Additionally, HSPA1B and MAPK3 were classified as tier 2 genes, associated with non-allergic asthma risk and overall COPD risk, respectively. IDUA, categorized as a tier 3 gene, was related to overall asthma. These genes play critical roles in apoptotic signaling, mesenchymal development, and molecular binding processes, emphasizing their biological significance. Additionally, molecular docking demonstrated stable binding for candidate drugs and proteins encoded by identified genes. CONCLUSION: Our study offers critical insights into the genetic basis of asthma, COPD, and lung function by identifying six genes as potential biomarkers and therapeutic targets, contributing to the development of more effective interventions for these respiratory traits.
Integrated Care for COPD in the Elderly: Impact on Healthcare Utilization Across Healthcare Settings.
Lin PC, Cheng YY, Chen CH … +4 more , Shih YM, Huang KY, Hung CT, Lin CH
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41783342 · Full text
BACKGROUND: Elderly COPD patients present unique challenges due to multimorbidity and diminished self-management capacity. Taiwan's COPD integrated disease management (IDM) program-comprising multidisciplinary care, pati...
BACKGROUND: Elderly COPD patients present unique challenges due to multimorbidity and diminished self-management capacity. Taiwan's COPD integrated disease management (IDM) program-comprising multidisciplinary care, patient education, and routine follow-up-has exerted a positive net effect on reducing COPD exacerbations. Whether similar benefits extend to elderly patients across different healthcare settings remain unclear. This study evaluated pre-post changes in ED visits and hospitalizations across four healthcare setting. METHODS: A retrospective cohort study was conducted using data from the Taiwan COPD Pay-for-Performance registry and National Health Insurance claims database. Elderly COPD patients (≥65 years) enrolled in the IDM program were included. COPD severity was classified according to GOLD grade based on FEV% predicted. Patients were stratified by healthcare level (medical centers, regional hospitals, district hospitals, and primary care clinics). Primary outcomes were pre-post changes in ED visits and hospitalizations within one year. Generalized estimating equations (GEE) were used to assess changes in healthcare utilization. Multivariable logistic regression was performed to identify factors associated with improvement. RESULTS: A total of 1454 elderly COPD patients were analyzed (mean age 74.8±6.3 years; 90.7% male, mean Post-BD FEV1/FVC 56.95±11.00). District hospitals demonstrated the most significant reduction in both COPD-related ED visits (from 35.2% to 25.1%; p = 0.011) and hospitalizations (from 28.6% to 22.5%; p = 0.002) compared with primary care clinics. In contrast, medical centers showed increased hospitalizations rates (from 18.1% to 18.9%; p = 0.008). Factors independently associated with significantly greater reductions in the rate of both ED visits and hospitalizations included advanced age and greater COPD severity. CONCLUSION: Integrated COPD care reduced ED visits and hospitalizations most significantly at district hospitals. Patients with GOLD 3 and GOLD 4 grades, disproportionately represented at district hospitals, showed significantly greater reductions. These findings demonstrate that benefit magnitude varies across healthcare settings based on patient severity profiles.
PulmoClass-3DAtt: A Self-Attention Network for Classification of COPD, PRISm and Normal.
Wu Q, Li R, Guo H … +4 more , Han J, Zhang Z, Jingesi A, Kang S
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41783341 · Full text
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, making its accurate diagnosis critical. It is difficult to distinguish COPD from preserved ratio impaired spirometry...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, making its accurate diagnosis critical. It is difficult to distinguish COPD from preserved ratio impaired spirometry (PRISm), due to their shared small-airway pathology. This study develops a novel deep-learning framework that combines chest CT images with clinical variables to discriminate between COPD, PRISm, and normal categories. METHODS: In this retrospective study, consecutive subjects were enrolled from a university-affiliated tertiary hospital between January 2018 and June 2024. After random split at an 8:2 ratio, the training cohort was used to develop a convolutional encoder that extracts imaging features and simultaneously predicts five spirometric parameters (FEV, FVC, FEV/FVC, FEV %pred, FVC %pred). The extracted features were then fed into the self-attention deep-learning model PulmoClass-3DAtt, which was trained and fine-tuned through ten-fold cross-validation to classify disease status. Classification performance was quantified by the area under the receiver-operating-characteristic curve (AUC), overall accuracy (ACC), precision (Pre), sensitivity (Se) and specificity (Sp). Regression performance for spirometric indices was assessed with mean-squared error (MSE), mean absolute error (MAE) and concordance correlation coefficient (CCC). RESULTS: The cohort comprised 1918 participants (1362 COPD, 174 PRISm, 382 normal controls). The model achieved robust overall performance (AUC = 0.86, ACC = 0.87). For COPD, Normal and PRISm the respective values are ACC 0.87, 0.88, 0.87; Se 0.90, 0.88, 0.42; Sp 0.84, 0.88, 0.97; Pre 0.85, 0.79, 0.72; and F1-score 0.88, 0.85, 0.53. In the validation set, the five spirometric metrics were predicted with MSE 0.03-0.35, MAE 0.14-0.46 and CCC 0.56-0.83. CONCLUSION: By integrating multimodal imaging-function data through a self-attention framework, PulmoClass-3DAtt reliably discriminates among COPD, PRISm and normal status, providing an immediately applicable tool for clinical decision support and the delivery of precision pulmonary medicine.
Co-Design of an Electronic Patient Record-Integrated COPD Self-Management App: The My Lung Health Coach Companion.
Farrer C, Manankil D, Thuringer K … +4 more , Ahmed K, Man K, Tohob SA, Kouri A
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41778214 · Full text
PURPOSE: Digital self-management interventions can improve outcomes in COPD, but many are standalone applications that lack care integration, limiting usability, adoption, and sustainability. Embedding such tools within...
PURPOSE: Digital self-management interventions can improve outcomes in COPD, but many are standalone applications that lack care integration, limiting usability, adoption, and sustainability. Embedding such tools within electronic patient records (EPRs) may overcome these barriers, but few COPD interventions have taken this approach. PATIENTS AND METHODS: We used a user-centred design process to develop and refine a companion application for the My Lung Health Coach COPD self-management program within the Epic Care Companion platform. First, we developed and face validated a prototype with respirologists and program managers. Next, we iteratively improved the app following focus group and stakeholder evaluations, using a Plan-Do-Study-Act (PDSA) approach. Usability was assessed using the System Usability Scale (SUS) and Likert-style ratings, with qualitative feedback analyzed thematically and mapped to design changes. RESULTS: Four focus groups (n=7) and two stakeholder meetings were conducted iteratively across six PDSA cycles. Initial usability was low but improved following iterative modifications, reaching "excellent" levels. Likert ratings indicated high satisfaction with functionality and content. Thematic analysis identified key adoption enablers: readability, simplicity, supportive tone, clinician endorsement, and training. Specific modifications included enlarging text, simplifying navigation, rephrasing judgmental language, and clarifying wording. To facilitate use in a future clinical trial, a training module was developed. Integration into Epic ensured data security, workflow alignment, and future scalability. CONCLUSION: Through iterative co-design, we developed an EPR-integrated COPD app with sustained usability improvements. Embedding patient and stakeholder feedback throughout development produced a clinically aligned and highly usable tool to complement virtual COPD self-management. This approach addresses longstanding limitations of standalone digital health tools and provides a scalable model for integrating patient-facing digital interventions into routine chronic disease care.
Underrepresentation of Women in COPD Pharmacologic Trials Relative to Disease Burden: A Systematic Review and Meta-Analysis.
Umer M, Jagra AS, Al Seidi J … +5 more , Ahmad A, Touza M, Emehinola O, Surani S, Hanif FM
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41773232 · Full text
BACKGROUND: Although chronic obstructive pulmonary disease (COPD) increasingly affects women, they remain under-represented in randomized controlled trials (RCTs). Understanding enrollment patterns is essential to ensure...
BACKGROUND: Although chronic obstructive pulmonary disease (COPD) increasingly affects women, they remain under-represented in randomized controlled trials (RCTs). Understanding enrollment patterns is essential to ensure the generalizability of COPD therapeutic evidence. METHODS: We systematically identified RCTs of pharmacologic interventions for COPD published between 2010 and 2024. For each trial, we calculated the Enrollment Disparity Difference (EDD)-defined as the trial's percentage of women minus the Global Burden of Disease (GBD) sex-specific prevalence. Random-effects meta-analyses were conducted to pool EDD across trials; heterogeneity was explored using subgroup analyses (region, sample size, therapy class, age group, funding source) and meta-regression models. Temporal trends were evaluated, and a weighted annual EDD trajectory with forecasted values through 2026 was generated. RESULTS: A total of 190 RCTs were included. Women comprised 31.7% of enrolled participants. Pooled EDD was -0.21 (95% CI, -0.22 to -0.19), indicating relative underrepresentation. Heterogeneity was very high (I = 100%). Underrepresentation varied significantly across regions, with the greatest gaps observed in Asia and Africa and the smallest in North and South America. Age was a significant moderator (β = -0.0070 per year, p = 0.0006), with greater disparities in trials enrolling older patients. Industry funding, sample size, and therapy class were not significant predictors. A continuous-year meta-regression demonstrated an improvement in female representation over time (β = 0.0068 per year, p = 0.0269). CONCLUSION: Women remain underrepresented in COPD RCTs. Although modest improvements have occurred, significant gaps persist. Ensuring equitable representation is essential for generating evidence that reflects the COPD population.
Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease in Kazakhstan in a Nationwide Population-Based Epidemiological Study.
Vinnikov D, Mukatova I, Tulekov Z … +3 more , Raushanova A, Romanova Z, Sadibekova M
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41769365 · Full text
PURPOSE: Until recently, reports on chronic obstructive pulmonary disease (COPD) in Kazakhstan have been sporadic and reflected the disease burden in only one largest city, Almaty. We, therefore, aimed to characterize th...
PURPOSE: Until recently, reports on chronic obstructive pulmonary disease (COPD) in Kazakhstan have been sporadic and reflected the disease burden in only one largest city, Almaty. We, therefore, aimed to characterize the prevalence and risk factors of COPD confirmed with a high-quality spirometry in a nationwide population-based study. PATIENTS AND METHODS: We enrolled 5058 subjects, and hereinafter analyzed complete data for 4626 (age 47; interquartile range (IQR) 31;60 years) participants from the general population from five cities in Kazakhstan representing the West, North, South, East and the central part to fill in a questionnaire and undergo spirometry with bronchodilation. COPD was confirmed when post-bronchodilation forced expiratory volume in one second (FEV)/forced vital capacity (FVC) was below -1.64 z-scores. The association of selected predictors with COPD was tested in multivariate regression models. RESULTS: Seven percent of the entire group (9% in men vs 6% in women) had COPD. The corresponding prevalence in the group 40 years and older was 10.7% (14.5% in men and 7.6% in women). For ΔFVC, 78% could achieve A or B quality, whereas 83% could attain A or B quality for ΔFEV. Only 30% of COPD patients were told they had it before. Ever-smoking (OR 2.44; 95% CI 1.81;3.33), low educational level (OR 1.80; 95% CI 1.42;2.28), exposure to vapors, gases, dusts and fumes (VGDF) (OR 1.41; 95% CI 1.10;1.82) and tuberculosis in the past (OR 4.12. 95% CI 2.19;7.45), adjusted for each other, age, sex and physical activity put subjects at risk for COPD. CONCLUSION: COPD in Kazakhstan remains a highly underdiagnosed disease. Most COPD patients do not yet have a timely diagnosis and remain untreated. Smoking, occupational exposures and even tuberculosis in the past significantly increase the risk of this disease.
Healthcare Costs and Trends of Multimorbidity in COPD Patients: A Population-Based Study in Singapore.
Juang YR, Lim LHM, Chotirmall SH … +9 more , Abisheganaden J, Koh MS, Tsai MJ, Liew MF, Yii ACA, Tiew PY, Price D, Tan KB, Chen W
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41737607 · Full text
PURPOSE: Chronic obstructive pulmonary disease (COPD) and its comorbidities impose substantial economic burdens on healthcare systems, but evidence remains scarce in Asian countries where patients exhibit distinct clinic...
PURPOSE: Chronic obstructive pulmonary disease (COPD) and its comorbidities impose substantial economic burdens on healthcare systems, but evidence remains scarce in Asian countries where patients exhibit distinct clinical and inflammatory phenotypes, as well as policy and health system differences. This study aimed to estimate direct medical costs of COPD multimorbidity, comparing to non-COPD patients in Singapore, and identify high-cost users. PATIENTS AND METHODS: Using Singapore's health administrative data (2012-2019), we created a propensity score-matched COPD and non-COPD cohort and applied generalised linear models to estimate all-cause, index disease- and comorbidity-attributable costs. All costs were measured in patient-years (PYs) in 2023 Singaporean dollars (SGD$1=US$0.76=₤0.60=€0.69). Patient characteristics and comorbidity prevalence were compared across patients incurring top 10%, 11%-50%, and bottom 50% of average annualised costs. RESULTS: The study included 18,866 patients from each group (83% males, 17% females). Average annual direct medical costs were significantly higher among COPD patients ($5,290.9/PY; 95% confidence interval [CI]: 5,242.9-5,350.1) than non-COPD patients ($1,110.4/PY; 95% CI: 1,085.9-1,135.9). 33.8% of total costs were COPD-attributable, with major contributions from other respiratory (15.0%), circulatory (14.9%), metabolic (7.8%), and digestive (4.7%) diseases. From 2012 to 2019, hospitalisation costs declined (-$59.0/year), while primary care (polyclinic) costs increased sharply (+$148.8/year). Indian patients comprised 67% of the top 10 cost percentile and experienced frequent hospitalisations (≥2/year). CONCLUSION: In Singapore's multi-ethnic Asian context, COPD patients incurred substantial multimorbidity costs, particularly from respiratory, circulatory, and metabolic diseases, underscoring distinct Asian multimorbidity patterns and highlighting the need for integrated, multimorbidity-focused care models. Disproportionately high costs among Indian patients and low female prevalence warrant further investigation.
Research Hotspots and Future Trends of Oxygen Therapy for COPD: A Bibliometric and Visualization Analysis from 1973 to 2024.
Ni J, Xu P, Lu W
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41737606 · Full text
BACKGROUND: Oxygen therapy is fundamental in the management of chronic obstructive pulmonary disease (COPD), and its utilization has expanded significantly in recent years. This study aimed to explore global research tre...
BACKGROUND: Oxygen therapy is fundamental in the management of chronic obstructive pulmonary disease (COPD), and its utilization has expanded significantly in recent years. This study aimed to explore global research trends, key contributors, and emerging topics in oxygen therapy for COPD. METHODS: Publications concerning oxygen therapy for COPD from 1973 to 2024 were retrieved from the Web of Science Core Collection. A bibliometric analysis was conducted employing VOSviewer, CiteSpace, and R 4.3.3. The contributions of countries, institutions, authors, and journals were systematically assessed. RESULTS: A total of 1,977 publications were analyzed, indicating an annual growth rate of 8.43%. The USA led with 359 publications (18.2%), followed by China with 167 (8.4%) and Italy with 115 (5.8%). The leading institution was Assistance Publique Hôpitaux de Paris, which produced 98 publications. Key journals in this field included , leading with 149 publications, followed by (96) and (87). Prominent authors included Maltais François, who contributed 25 publications and received 795 citations. Core keywords encompassed terms such as "mortality" (201 occurrences), "survival" (151 occurrences), and "therapy" (182 occurrences). Burst keyword analysis highlighted a recent emphasis on "interstitial lung disease" (2020-2024) and "high-flow nasal cannula" (2022-2024). CONCLUSION: Oxygen therapy research for COPD has grown steadily since 1973. Keyword burst and temporal analyses indicate a recent shift of research focus from general oxygen supplementation toward modality-specific and context-specific strategies, including HFNC, exacerbation-related oxygen use, comorbidity-oriented management (eg, COPD-ILD overlap), and respiratory failure-related care, reflecting an increasing emphasis on precision and individualized oxygen therapy.
Predictors of Acute Exacerbations in COPD: A Systematic Review.
Chamaon D, Lenferink A, Bucsán C … +5 more , Van Dijk SHB, Van Beurden WJC, van der Valk PDLPM, van der Palen J, Brusse-Keizer MGJ
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41728062 · Full text
BACKGROUND: COPD is characterized by acute exacerbations (AECOPD), which drive its progression and burden. AECOPD can be caused by various factors. Better prediction of AECOPD provides opportunity for initiating preventi...
BACKGROUND: COPD is characterized by acute exacerbations (AECOPD), which drive its progression and burden. AECOPD can be caused by various factors. Better prediction of AECOPD provides opportunity for initiating preventive treatment. METHODS: This systematic review provides an evidence-based overview of clinical predictors of moderate, severe AECOPD and relapse of moderate and severe AECOPD (≤28 days of a previous AECOPD). Cohort studies, case-control studies, or (cluster) randomized controlled trials published in English between January 2011-December 2023 in PubMed, CINAHL, Embase, Web of Science and the Cochrane library were assessed. Eligible studies included patients diagnosed with COPD, aged ≥40 years, and who were current or ex-smokers. Predictors of AECOPD were categorized into: patient characteristics, symptoms, biomarkers, lung function test results, and composite scores. Critical appraisal was performed with the QUIPS-tool. RESULTS: Out of 1261 screened articles, 30 were included. Sixty-one distinct possible predictors of AECOPD were assessed, of which 37 were statistically significant (P < 0.05). Age, AECOPD history, fibrinogen, FEV, bronchodilator response, health status measured with the COPD specific St. George's Respiratory Questionnaire (SGRQ-C) score, and COPD GOLD classification (2-4, B-D) were significant predictors of severe and/or moderate AECOPD in more than one article. Only 11 out of the 30 included studies had a low risk of bias. DISCUSSION: Based on the highest relative statistical significance, combined with the best overall risk of bias, the most promising predictors of AECOPD are history of ≥1 AECOPD, higher SGRQ-C scores, elevated fibrinogen levels, and worse COPD GOLD (2-4, B-D). Future research should focus on standardization of AECOPD and predictor definitions, including the use of clearly defined cut-off values. Given the complexity and heterogeneity of COPD, combining diverse predictor domains into composite measures may enhance predictive accuracy of AECOPD, and the integration of such composites is promising for advancing COPD management in clinical practice.
Incidence and Risk Factors for Progression from Pre-COPD to COPD: A Systematic Review and Meta‑analysis.
Qiao L, Wu X, Chen G … +2 more , Tang H, Shen H
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41717212 · Full text
OBJECTIVE: Pre-chronic obstructive pulmonary disease (Pre-COPD) refers to individuals who do not meet traditional diagnostic criteria for COPD but already show respiratory symptoms, abnormal lung function, or imaging cha...
OBJECTIVE: Pre-chronic obstructive pulmonary disease (Pre-COPD) refers to individuals who do not meet traditional diagnostic criteria for COPD but already show respiratory symptoms, abnormal lung function, or imaging changes. The purpose of this study was to complete a systematic review and meta‑analysis of the incidence and risk factors for progression from pre‑COPD to COPD. METHODS: We searched ten databases through December 31, 2024. The Newcastle-Ottawa Scale (NOS) was applied to assess the methodological quality of the eligible studies. We extracted incidence to quantify progression from pre-COPD to COPD and odds ratios (ORs) and hazard ratios (HRs) with their 95% confidence intervals (CIs) to identify associated risk factors. Effect sizes were pooled using fixed-effects and random-effects models. RESULTS: Among 5289 articles, 21 were eligible, and 13 reported incidence. The pooled incidence of progression from pre-COPD to COPD was 20% (n = 13, 95% CI 15-26%). We identified five statistically significant factors linked to clinical development in pre-COPD: preserved ratio impaired spirometry (PRISm) (ORs=2.92, 95% CI 1.79-4.74), age (ORs=1.09, 95% CI 1.03-1.15), smoking history (ORs=4.08, 95% CI 2.14-7.18, HRs=2.21, 95% CI 1.59-3.07), non-obstructive chronic bronchitis (NOCB) (ORs=2.07, 95% CI 1.32-3.24, HRs=2.46, 95% CI 1.61-3.75), and asthma (ORs=2.50, 95% CI 1.93-3.24). CONCLUSION: This meta-analysis indicates a high incidence of progression from pre-COPD to COPD. Moreover, age, smoking history, NOCB, PRISm, and asthma were significantly associated with an increased risk of clinical progression in individuals with pre-COPD. Integrating these risk factors into clinical risk-stratification tools and follow-up strategies may help clinicians identify high-risk individuals with pre-COPD, facilitating enhanced surveillance, targeted smoking cessation interventions, optimized asthma management, and other preventive interventions to delay or prevent COPD onset.
Patterns and Adherence to GOLD-Recommended Inhaled Therapy in Chronic Obstructive Pulmonary Disease (COPD) Patients with Acute Exacerbation History in Primary Care in China.
Pei H, Su Y, Jing G … +12 more , Su Q, Xu J, Jin X, Hao J, Xu J, Chen J, Li X, Ma J, Wang Y, Ye J, Yao M, Chi C
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41717211 · Full text
PURPOSE: The standardized treatment of chronic obstructive pulmonary disease (COPD) in primary care settings in China remains suboptimal. This study aims to investigate the inhaled medication patterns among COPD patients...
PURPOSE: The standardized treatment of chronic obstructive pulmonary disease (COPD) in primary care settings in China remains suboptimal. This study aims to investigate the inhaled medication patterns among COPD patients with a history of acute exacerbations in primary care settings and to analyze the prescription adherence of inhaled medication for those COPD patients to the Global Strategy for Prevention, Diagnosis and Management of COPD (2023). PATIENTS AND METHODS: A cross-sectional analysis of the baseline data from a multicenter, prospective cohort of COPD participants was performed. Patients diagnosed with COPD and had at least one mild, moderate or severe acute exacerbation in the previous 12 months were enrolled from 12 primary care clinics in two cities in China (Beijing and Chengdu). Sociodemographic information, symptoms and quality of life, pulmonary function results and inhaled therapy types were collected. Inhaled therapy distributions and adherence to GOLD recommendations were described and visualized, proportions were summarized descriptively. RESULTS: Six hundred and forty-six participants were included in the analysis. 82.7% of the patients were men, mean age 68.7 years. Group A, B, and E accounted for 12.1%, 13.7%, and 66.1%, respectively. 33.4% of the participants received No inhaled therapy. The most frequently used regimen was LABA/ICS (29.9%), followed by LABA/LAMA/ICS (26.0%). Adherence to GOLD strategy was the lowest in group B (4.2%), highest in group E (33.5%). Based on GOLD 2023 recommendation, 35.3% of the group A participants and 32.3% of the group B participants showed inhaled medication underuse, whereas 55.3% and 63.5% showed inhaled medication overuse in group A and B, respectively. CONCLUSION: Among the COPD patients with a history of acute exacerbations at primary care, prescribing frequently diverged from GOLD 2023 recommendations, characterized by high rates of No inhaled therapy and widespread use of ICS-containing regimens in groups A and B, necessitating improved prescription guideline adherence in the future to facilitate the implementation of standardized COPD management.
Opinion and Knowledge of Pulmonologists, Primary Care Physicians, and Nurses About Inhaled Therapy in COPD. Inhal-Epoc Survey.
De Miguel-Díez J, Giner Donaire J, Gómez Sáenz JT … +4 more , Trigueros Carrero JA, Artigas Feliu R, Cruz Culebra N, Plaza V
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41710326 · Full text
PURPOSE: Despite the efforts made to improve inhalation technique by both patients and healthcare professionals, significant deficiencies were found in critical aspects of inhaler use and device selection. The aim of thi...
PURPOSE: Despite the efforts made to improve inhalation technique by both patients and healthcare professionals, significant deficiencies were found in critical aspects of inhaler use and device selection. The aim of this study is to know the current opinion and knowledge of pulmonologists, primary care physicians, and nurses about inhaled therapy in chronic obstructive pulmonary disease (COPD). METHODS: Survey conducted between April-July 2023 by a committee of experts formed by 2 pulmonologists, 2 primary care physicians, and one nurse specialist in inhaled therapy. It consisted of 27 questions and was sent by e-mail to professionals throughout Spain with experience in the management of COPD with inhaled therapy. RESULTS: A total of 554 experts from all over Spain participated. Thirty-one percent and 43.5% of the respondents could not identify, respectively, which were the critical steps for correct inhalation of the pressurized metered-dose inhaler (pMDI) and the multidose dry powder inhaler (DPI). Conventional pMDIs were considered to be the devices that provide greater oropharyngeal deposition and less pulmonary deposition. The majority of respondents considered essential or important to take into account the patients' opinion in selecting the inhaler, and preferred to review the inhalation technique rather than change the device. The main criteria for the choice of inhaler in COPD patients were their previous experience, preference, and severity. With a wide dispersion of results, Ellypta®, pMDI with chamber, Genuair®, Respimat®, and conventional pMDI were preferred in that order. CONCLUSION: Knowledge about inhaled therapy in COPD remains insufficient. There is a significant and important lack of knowledge in key aspects of the use of inhaler devices, such as the critical steps for correct inhalation and the selection criteria for inhalation devices. It is necessary to continue promoting training programs for both patients and healthcare personnel in inhalers and inhalation techniques.
Non-Pharmacological Interventions for Emotional Symptoms in COPD Centered on Anxiety and Depression: An Evidence Synthesis Study.
Yu J, Fu J, Zhao S … +4 more , Zhang S, Huang R, Li T, Li Y
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41710325 · Full text
Emotional symptoms, particularly anxiety and depression, are common in COPD patients but are often under-managed. This study aimed to synthesize evidence on non-pharmacological interventions for these symptoms in COPD. A...
Emotional symptoms, particularly anxiety and depression, are common in COPD patients but are often under-managed. This study aimed to synthesize evidence on non-pharmacological interventions for these symptoms in COPD. An umbrella review of guidelines, systematic reviews, and expert consensus was conducted. Literature searches were performed in databases including PubMed, Embase, Cochrane Library, CINAHL, Web of Science, CNKI, Wan Fang Data, and VIP, as well as guideline repositories (eg, GIN, NICE, GOLD) from January 1, 2000, to August 3, 2025. Inclusion criteria focused on moderate-to-severe COPD patients with anxiety/depression, non-pharmacological interventions, and evidence-based literature types (guidelines, systematic reviews, expert consensus). Literature quality was assessed using AGREE II for guidelines, AMSTAR 2 for systematic reviews, and JBI tools for expert consensus. Evidence was summarized and graded using the JBI evidence pre-grading system (2014). From 1812 identified records, 13 articles (4 guidelines, 2 expert consensuses, 7 systematic reviews) were included. Physical exercise training was the most strongly recommended intervention (Level 1a evidence, strong recommendation). Pulmonary rehabilitation, cognitive-behavioral therapy (including group, individual, and telephone-based formats), and psycho-educational interventions also showed consistent benefits (Level 1a-5b, strong recommendations). Evidence for mindfulness and relaxation techniques was less consistent. A total of 26 evidence statements were synthesized across six domains: psychological assessment, psychological interventions, exercise/nutrition, management models, special interventions, and other methods. A range of non-pharmacological interventions, particularly exercise and structured psychological therapies, can be effective for anxiety and depression in COPD and should be considered for integration into comprehensive care. Future research should address long-term effectiveness and cost-effectiveness.
Ensifentrine Added on to Dual Bronchodilator or Triple Therapy Demonstrates Clinically Meaningful Improvement in CAT Score in Symptomatic Patients with Chronic Obstructive Pulmonary Disease.
Siler TM, Rheault T, Reyner D … +3 more , MacDonald-Berko M, Davidson J, Rickard K
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41710324 · Full text
BACKGROUND: Many patients with chronic obstructive pulmonary disease (COPD) remain symptomatic despite the use of available maintenance therapies. Ensifentrine is a novel, selective, dual inhibitor of phosphodiesterase (...
BACKGROUND: Many patients with chronic obstructive pulmonary disease (COPD) remain symptomatic despite the use of available maintenance therapies. Ensifentrine is a novel, selective, dual inhibitor of phosphodiesterase (PDE)3 and PDE4 approved for use as a maintenance therapy in adult patients with COPD. This study evaluated the effect of ensifentrine added on to dual or triple therapy on symptoms and health status in symptomatic patients with COPD using the COPD Assessment Test™ (CAT). METHODS: In this single-center, Phase 3b, open-label study, patients aged 40 to 80 years with symptomatic (modified Medical Research Council Dyspnea Scale ≥2; CAT ≥10), moderate to severe COPD on stable dual bronchodilator or triple therapy received 3 mg twice-daily nebulized ensifentrine for 12 weeks. CAT scores were assessed at baseline, week 6, and week 12. RESULTS: Twenty eligible patients received ensifentrine. Patients with ≥1 postdose assessment (n=18) were analyzed. After 12 weeks, ensifentrine improved CAT scores by ≥2 units in 67.0% (95% CI, 38.0%, 100.0%) of patients. Mean change from baseline was -2.3 units (95% CI, -4.0, -0.6), exceeding the clinically important difference of -2 units. At week 6, 44.4% (95% CI, 22.0%, 89.5%) of patients were CAT responders; the mean change from baseline in CAT score was -1.5 units (95% CI, -4.0, 1.1). No adverse events were reported. CONCLUSION: Ensifentrine provided clinically meaningful improvement in health status measured by CAT score in two-thirds of symptomatic patients with COPD taking dual bronchodilator or triple therapy in a real-world setting. CLINICAL TRIAL REGISTRATION NUMBER: Clinical trial registered on June 10, 2024, with Clinicaltrials.gov (Identifier: NCT06460493).
Prediction Score of Isolation in Acute Exacerbations of Chronic Obstructive Pulmonary Disease.
Morasert T, Tantiyavarong P
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41710323 · Full text
BACKGROUND: () is an important pathogen in acute exacerbations of chronic obstructive pulmonary disease (AECOPD), yet empirical anti- coverage is often prescribed inappropriately. Accurate prediction tools are needed to...
BACKGROUND: () is an important pathogen in acute exacerbations of chronic obstructive pulmonary disease (AECOPD), yet empirical anti- coverage is often prescribed inappropriately. Accurate prediction tools are needed to guide targeted therapy. METHODS: We conducted a retrospective cohort study of hospitalized AECOPD patients at a regional referral hospital in Thailand (2015-2018). Clinical, radiographic, and laboratory data were analyzed to identify independent predictors of isolation. Multivariable logistic regression was used to develop a prediction score, which was internally validated using bootstrap resampling. Model performance was assessed by the area under the receiver operating characteristic curve (AuROC). RESULTS: Among 1,348 admissions (771 patients), was isolated in 167 cases (12.4%). A simplified prediction score was developed based on four independent predictors: home nebulizer use, prior anti- antibiotic exposure within 1 year, radiographic consolidation, and elevated serum bicarbonate. The prediction score achieved an AuROC of 0.66 (95% CI 0.62-0.70) with good calibration after internal validation. Risk groups were defined as low (0-1 points, <12% risk), intermediate (2-3 points, 16-23% risk), and high (4-6 points, ≥32% risk). CONCLUSION: This simplified prediction score, developed in hospitalized AECOPD patients, may aid clinicians in guiding empirical antibiotic selection by reducing unnecessary anti- coverage in low-risk cases while ensuring timely treatment for those at high risk.
An Interpretable AdaBoost Model for 1-Year Readmission Risk Prediction in AECOPD Patients with Hypertension.
Zhang X, He M, Zhang J … +2 more , Zhao L, Liu D
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41527668 · Full text
BACKGROUND: Chronic obstructive pulmonary disease (COPD) complicated by hypertension imposes a substantial global health burden, with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) significantly inc...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) complicated by hypertension imposes a substantial global health burden, with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) significantly increasing 1-year readmission risk. This study aimed to develop and validate an interpretable machine learning (ML) model that predicts 1-year readmission risk in AECOPD patients complicated by hypertension using real-world data. METHODS: This retrospective cohort study enrolled 2042 patients with AECOPD complicated by hypertension from the First Affiliated Hospital of Shihezi University between 2015 and 2024. The data were split into training and test sets at a 7:3 ratio. Feature selection was performed based on machine learning methods. Eight ML models were trained and tested to construct predictive models. Model performance was evaluated by the area under the receiver operating characteristic curve (AUC), accuracy, recall, specificity, and F1-score. The Shapley additive explanation method (SHAP) was used to rank the feature importance and explain the final model. An online risk prediction tool was developed based on the optimal model to facilitate clinical application. RESULTS: The 1-year readmission rate of patients with AECOPD complicated by hypertension was 37.5%. Seven independent predictors, including times of inhospitalization, procalcitonin, total protein, international normalized ratio (INR), prothrombin time, D-dimer, and hypoproteinemia, were identified as the most valuable features for establishing the models. The AdaBoost model showed optimal performance, with an AUC of 0.884 in the test set and an average AUC of 0.889 in 5-fold cross-validation. SHAP analysis confirmed that times of inhospitalization were the strongest predictor, followed by INR and total protein. An online calculator was deployed (https://fast.statsape.com/tool/detail?id=17) for clinical use. CONCLUSION: This study developed an interpretable AdaBoost-based online calculator for 1-year readmission risk assessment in AECOPD patients by hypertension. The tool highlight the importance of addressing hypercoagulability and nutritional status to reduce readmission risk. Further external multi-center validation is needed to enhance its generalizability.
Respiratory Muscle Strength and Mortality in Patients with COPD: A Systematic Review and Meta-Analysis.
Mizusawa H, Okura K, Shiraishi M … +2 more , Noguchi M, Higashimoto Y
Int J Chron Obstruct Pulmon Dis · 2025 · PMID 41497970 · Full text
PURPOSE: Respiratory muscle weakness is common in chronic obstructive pulmonary disease (COPD), potentially carrying prognostic information beyond airflow limitation; however, clinical testing remains variably standardiz...
PURPOSE: Respiratory muscle weakness is common in chronic obstructive pulmonary disease (COPD), potentially carrying prognostic information beyond airflow limitation; however, clinical testing remains variably standardized, and its independent association with survival is uncertain. We evaluated whether respiratory muscle strength is associated with survival in patients with COPD, and summarized implementation-relevant evidence for other indices. METHODS: We systematically searched PubMed/MEDLINE, CENTRAL, and Web of Science from January 1, 1990 to September 30, 2025, screened observational cohorts and baseline-prognosis analyses in patients with COPD, appraised risk of bias, and meta-analyzed time-to-event estimates using random-effects where ≥2 comparable studies were available. Eligible studies enrolled patients with COPD with observational cohorts or baseline-prognosis analyses reporting all-cause mortality as outcome. RESULTS: Of the six eligible studies, two permitted pooling for inspiratory strength versus all-cause mortality. Lower inspiratory strength was associated with higher mortality (pooled hazard ratio 0.97, 95% confidence interval 0.95-0.99; I=58%). In severity-restricted cohorts, frequently reported cut-offs were maximal inspiratory strength (MIP) ≤55 cmHO and maximal expiratory strength (MEP) ≤80 cmHO; all-cause mortality in these groups was approximately 46.6-54.4% at 42-60 months. However, in broader-severity samples, 2-year and 12-45-month mortality rates were 9.4-14.7% and 8.4-33.6%, respectively. Peak inspiratory flow rate (PIFR) <60 L/min repeatedly aligned with exacerbations and 90-day readmission. Conversely, the prognostic signal for MEP was directionally inconsistent, and sniff nasal inspiratory pressure associations frequently attenuated after adjustment. CONCLUSION: MIP shows a consistent directional association with survival in patients with COPD, although magnitude estimates vary with measurement protocols and confounder control. We propose a minimum reporting set (posture, starting lung volume, trials/repeatability, device/calibration, cmHO units, and prespecified confounders) and immediate clinical actions: standardized MIP during stable visits for risk stratification and PIFR screening to guide inhaler selection.
Factors Associated with Influenza and Pneumococcal Vaccine Hesitancy Among Patients with AECOPD: A Cross-Sectional Study in China Using the 3C Model.
Xin Y, He R, Ren X … +3 more , Yang T, Wang Y, Su X
Int J Chron Obstruct Pulmon Dis · 2025 · PMID 41488397 · Full text
BACKGROUND AND AIMS: COPD patients are prioritized for influenza and pneumococcal vaccines, yet vaccination rates remain low, indicating vaccine hesitancy. This study aimed to investigate the vaccination rates and the un...
BACKGROUND AND AIMS: COPD patients are prioritized for influenza and pneumococcal vaccines, yet vaccination rates remain low, indicating vaccine hesitancy. This study aimed to investigate the vaccination rates and the underlying determinants of vaccine hesitancy, as the primary behavioral driver of low coverage, among patients hospitalized for Acute Exacerbation of COPD (AECOPD). METHODS: From September 2022 to October 2023, 536 patients hospitalized due to AECOPD from eight hospitals in China were surveyed on their vaccination status (influenza or pneumococcal). Data on vaccination status and a structured 3C model (confidence, complacency, convenience) questionnaire were collected. Logistic regression identified factors associated with vaccination behavior, while structural equation modeling (SEM) elucidated the pathways through which the 3C components directly influence vaccine hesitancy. RESULTS: The overall vaccination rate was 16.8% (90/536). Key factors associated with the vaccination behavior included high CAT score (aOR=5.64), pulmonary infection (aOR=2.28), former smoking (aOR=0.35), regular inhaled medication (aOR=0.47), high mMRC score (aOR=0.29), and bronchiectasis (aOR=0.40). Critically, the SEM analysis revealed that vaccine hesitancy was primarily driven by complacency, manifesting as a "lack of perceived need" (78%). This complacency was significantly influenced by a lack of confidence in vaccine safety and effectiveness, and compounded by convenience barriers like geographical inaccessibility and financial costs. The 3C model analysis quantified these relationships, with convenience (path coefficient=0.896) and confidence (0.375) positively impacting vaccination, while complacency showed a slight negative effect (-0.002). CONCLUSION: Low vaccination rates in AECOPD patients were mainly due to perceived lack of necessity, linked to vaccine hesitancy. This hesitancy was mainly driven by underestimation of disease severity. Integrated interventions are essential to improve vaccination uptake in this at-risk group.
All-Cause and Cause-Specific Mortality in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.
Zhao G, Wang L, Lei S … +3 more , Li Y, Li J, Feng Z
Int J Chron Obstruct Pulmon Dis · 2025 · PMID 41488396 · Full text
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major global cause of death, imposing substantial socioeconomic and healthcare burdens. This meta-analysis synthesizes evidence on all-cause and cause-specifi...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major global cause of death, imposing substantial socioeconomic and healthcare burdens. This meta-analysis synthesizes evidence on all-cause and cause-specific mortality risks in COPD populations to identify high-risk subgroups and guide precision management strategies. METHODS: We searched PubMed, Embase, Web of Science, and Cochrane Library for cohort studies reporting death risks in COPD from database inception to April 10, 2025. Study screening, data extraction, and quality assessment were independently performed by two investigators. Meta-analyses pooled risks for all-cause and cause-specific mortality. Sensitivity analyses tested robustness; publication bias was assessed via funnel plots and Egger's test. RESULTS: Twenty-seven studies covering 286,314 showed COPD patients had significantly higher all-cause mortality versus non-COPD individuals (HR, 1.80; 95% CI: 1.40-2.30). Mortality risk exhibited a graded increase with COPD severity compared to non-COPD individuals: mild (HR, 1.32; 95% CI: 1.19-1.47), moderate (HR, 1.62; 95% CI: 1.45-1.81), severe (HR, 2.18; 95% CI: 1.59-2.99), and very severe (HR, 2.94; 95% CI: 1.78-4.85). When stratified by smoking status, COPD patients had consistently higher mortality than their non-COPD counterparts within each subgroup: never-smokers (HR, 1.41; 95% CI: 1.27-1.56), former smokers (HR, 1.37; 95% CI: 1.30-1.45), and current smokers (HR, 1.48; 95% CI: 1.25-1.76). The presence of comorbidities further amplified mortality risks in COPD patients versus non-COPD individuals, particularly in those with respiratory diseases (HR, 3.64; 95% CI: 3.10-4.27), cardiovascular diseases (HR, 1.29; 95% CI: 1.10-1.50), and all-cancers (HR, 1.69; 95% CI: 1.37-2.10), especially lung cancer (HR, 2.57; 95% CI: 2.04-3.24). CONCLUSION: COPD patients have significantly higher death risks than non-COPD individuals, worsening with disease severity. Independent determinants of COPD-attributable mortality risk comprise smoking, coexisting respiratory diseases, cardiovascular diseases, and cancer (particularly lung cancer). These findings provide an evidence-based foundation for developing targeted intervention strategies to mitigate COPD-related mortality.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe