International Journal Of Chronic Obstructive Pulmonary Disease[JOURNAL]
Sun
200 papers
Real-World Long-Term Outcomes of Triple Therapy Following Hospitalization for Acute Exacerbation of COPD: A Retrospective Cohort Study.
Su WL, Lan CC, Yang MC … +2 more , Huang CY, Wu YK
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42158232 · Full text
PURPOSE: Chronic obstructive pulmonary disease (COPD) exacerbations significantly accelerate disease progression and increase mortality and healthcare utilization. While triple therapy (inhaled corticosteroids/long-actin...
PURPOSE: Chronic obstructive pulmonary disease (COPD) exacerbations significantly accelerate disease progression and increase mortality and healthcare utilization. While triple therapy (inhaled corticosteroids/long-acting β-agonist/long-acting muscarinic antagonist [ICS/LABA/LAMA]) is commonly prescribed to manage COPD, its long-term real-world effectiveness following hospitalization for acute exacerbation of COPD remains unclear. PATIENTS AND METHODS: This retrospective cohort study included 500 patients hospitalized for severe COPD exacerbations at a tertiary hospital (2015-2023). Patients were classified as receiving triple therapy (ICS/LABA/LAMA) during or within 7 days after the index hospitalization or not. Primary outcomes were COPD-related readmission and all-cause mortality within three years; secondary analyses were stratified by prior exacerbation frequency, baseline FEV % predicted, and eosinophil count. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models, with Kaplan-Meier methods for survival. RESULTS: Among the study population, 329 patients (65.8%) received triple therapy. Overall, no significant differences were observed in three-year COPD-related readmission rates (adjusted hazard ratio [aHR]: 0.95, 95% confidence interval [CI]: 0.66-1.35) or all-cause mortality (aHR: 0.88, 95% CI: 0.57-1.36) between the groups. However, stratified analyses demonstrated significant benefits of triple therapy in patients with ≥2 exacerbations within one year prior to the index hospitalization (aHR for readmission: 0.14; aHR for mortality: 0.24) and showed numerically lower risks among those with baseline FEV ≥50% predicted (aHR for readmission: 0.57; aHR for mortality: 0.43). CONCLUSION: Triple therapy was not associated with improved outcomes in the overall cohort but may be associated with better outcomes in selected high-risk subgroups. These findings should be interpreted with caution given the observational design and potential residual confounding. Further studies are warranted to confirm these findings and refine patient selection for triple therapy.
Bu-Fei Yi-Shen Formula Alleviates Oxidative Stress and Improves Airway Epithelial Barrier Dysfunction in COPD.
Li G, Li Y, Fan Z … +6 more , Han D, Shen T, Han B, Ma L, Shen Z, Li S
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42153136 · Full text
OBJECTIVE: This study aims to investigate the potential of Bu-Fei Yi-Shen Formula (BYF) in ameliorating airway epithelial barrier dysfunction in chronic obstructive pulmonary disease (COPD) and to elucidate the underlyin...
OBJECTIVE: This study aims to investigate the potential of Bu-Fei Yi-Shen Formula (BYF) in ameliorating airway epithelial barrier dysfunction in chronic obstructive pulmonary disease (COPD) and to elucidate the underlying mechanisms. METHODS: By establishing both in vivo and in vitro models of COPD, this study examined lung function, lung tissue pathology, inflammatory cytokines levels, cellular apoptosis rate, oxidative stress intensity, and TEER. Concurrently, it quantified the expression levels of proteins relevant to apical junctions, apoptosis, and the Nrf2 signaling pathway. These exhaustive analyses were undertaken to decipher the intricate mechanisms by which BYF ameliorates the disruption of airway epithelial barrier integrity in COPD. RESULTS: BYF significantly improved lung function, attenuated lung tissue pathological damage, reduced inflammatory cytokines levels, inhibited cellular apoptosis, upregulated the expression of apical junctional proteins, and alleviated oxidative stress injury in a COPD rat model. In vitro, BYF restored the CSE-induced decreases in TEER values and apical junctional protein expression in BEAS-2B cells, while reducing airway epithelial cell apoptosis apoptosis and oxidative stress injury. Furthermore, BYF counteracted the inhibitory effects of CSE on Nrf2, facilitating the expression of HO-1, a downstream protein of Nrf2. The addition of ML385 exacerbated the apoptosis, oxidative stress, and barrier dysfunction induced by CSE; however, the co-administration of ML385 and BYF reversed the inhibitory effects of ML385. CONCLUSION: These findings underscore that BYF ameliorates airway epithelial barrier dysfunction in COPD by activating the Nrf2/HO-1 signaling pathway.
Association of Cardiovascular Disease and Its Subtypes with Prognosis in Hospitalized Patients with AECOPD: A Retrospective Cohort Study.
Jiang M, Yang Y, Zhao W … +5 more , Zhang J, Wei Y, Liu J, Huang D, Rui M
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42153135 · Full text
OBJECTIVE: Cardiovascular diseases (CVDs) are common in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), yet the prognostic impact of specific CVD subtypes remains unclear....
OBJECTIVE: Cardiovascular diseases (CVDs) are common in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), yet the prognostic impact of specific CVD subtypes remains unclear. METHODS: This retrospective study included 977 patients with AECOPD admitted to Hebei Yanda Hospital. Baseline characteristics were compared between patients with and without CVDs. After adjustment for relevant potential confounders identified in the univariable analysis, multivariable logistic regression assessed associations with adverse in-hospital outcomes, and Cox proportional hazards models evaluated one-year readmission. Additional analyses were performed for CVD subtypes-heart failure (HF), ischemic heart disease (IHD), atrial fibrillation (AF), and stroke-and across clinical subgroups. RESULTS: Among the included patients, 341 (34.9%) had CVDs. These patients were older and had higher heart rate, blood pressure, inflammatory markers, and lower hemoglobin and lymphocyte ( < 0.05). After multivariable adjustment, CVDs were associated with adverse in-hospital outcomes (adjusted OR 1.43, 95% CI 1.05-1.94, = 0.023) and a higher risk of 1-year readmission (adjusted HR 1.57, 95% CI 1.21-2.05, = 0.001). Subtype analyses showed that HF and IHD were significantly associated with adverse in-hospital outcomes, while HF and AF predicted higher 1-year readmission risk ( <0.05). Kaplan-Meier curves showed a higher readmission risk in patients with CVDs ( < 0.001). These associations were generally consistent across subgroups, with a significant interaction observed only for HF in patients younger than 70 years. CONCLUSION: CVDs were common and were associated with worse in-hospital outcomes and higher 1-year readmission risk. CVD subtypes should be considered in risk stratification and clinical management. Further studies with more detailed treatment and follow-up data are needed to better define the role of CVD-specific management in improving outcomes.
Bu-Fei Formula Ameliorates Inflammation in a Preclinical COPD-Like Model by Targeting Mitochondrial Hyperactivity to Inhibit the NLRP3 Inflammasome.
Yang T, Liu Y, Sun X … +4 more , Liu G, Ning J, Liu L, Ou J
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42145862 · Full text
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent airflow limitation and chronic airway inflammation. While the traditional Chinese medicine Bu-Fei Formula (BFF) effectively ameliora...
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent airflow limitation and chronic airway inflammation. While the traditional Chinese medicine Bu-Fei Formula (BFF) effectively ameliorates COPD symptoms clinically, however, the precise molecular mechanisms underlying its therapeutic effects remain a knowledge gap. METHODS: The therapeutic effects and anti-inflammatory mechanisms of BFF in COPD were investigated using cigarette smoke + LPS-induced COPD-like rats and CSE-stimulated macrophages. BFF treatment was administered in both models for 8 weeks in a dose-dependent manner. Lung injury, collagen deposition, and macrophage ultrastructure were assessed by H&E, Masson's staining, and TEM. The evaluation of IL-1β, IL-18, NLRP3, ASC, and Caspase-1 p20 expression was performed via ELISA, IHC, IF, and Western blot. Oxidative stress (MDA, SOD) and mitochondrial function (complexes I-V, ATP, ROS) were also evaluated. RESULTS: BFF treatment produced a pronounced improvement in lung pathology of COPD-like rats, characterized by alleviation of tissue damage, suppression of inflammatory and alveolar degeneration, and reduction of collagen accumulation in the interstitium. It also ameliorated inflammatory injury at the cellular level by inhibiting macrophage pyroptosis. Mechanistically, BFF suppressed the overexpression of mitochondrial respiratory chain complexes I-V. It reduced the levels of ROS, ATP, MDA, NLRP3, ASC, Caspase-1 p20, IL-1β, and IL-18, while enhancing SOD activity. These findings suggest that BFF mitigates the inflammatory damage in COPD by suppressing the hyperactivation of mitochondrial energy metabolism, enhancing the efficiency of the oxidative respiratory chain, and reducing ROS production, and suppressing the NLRP3 inflammasome response.
The Association Between Stomach Disease and Chronic Obstructive Pulmonary Disease: A Cross-Sectional Analysis of the 2018 China Health and Retirement Longitudinal Study (CHARLS).
Wang H, Sun YZ, Li SY
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42145861 · Full text
PURPOSE: Chronic obstructive pulmonary disease (COPD) has become a global epidemic and is the third leading cause of death worldwide. However, its diagnostic rate is low. Based on the 2018 wave of China Health and Retire...
PURPOSE: Chronic obstructive pulmonary disease (COPD) has become a global epidemic and is the third leading cause of death worldwide. However, its diagnostic rate is low. Based on the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS) database, this cross-sectional study aimed to investigate the association between stomach disease and COPD using a nationally representative sample. PATIENTS AND METHODS: A total of 9119 CHARLS subjects were divided into COPD and non-COPD groups using the DA007_5 questionnaire. Both COPD and stomach disease were identified based on participants' self-reported physician diagnoses from the standardized CHARLS questionnaire. Baseline characteristics were compared between groups, and multivariate logistic regression analysis was used to analyze the association between stomach diseases and COPD. Receiver operating characteristic (ROC) curve assessment of Model 3's predictive capacity for COPD and stratified analysis verified correlation stability. RESULTS: In baseline comparisons, multiple covariates differed significantly between COPD and non-COPD groups (p<0.05). However, the core regression analysis showed that stomach disease was significantly associated with COPD in Model 3 (OR = 1.95, 95% CI = 1.46-2.57, p = 3.61E-06), after full adjustment for potential confounders. Model 1 (odds ratio (OR) = 3.12, 95% confidence interval (CI) = 2.43-3.98, p = 1.95E-19), Model 2 (OR = 3.21, 95% CI = 2.49-4.1, p = 3.65E-20), and Model 3 (OR = 1.95, 95% CI = 1.46-2.57, p =3.61E-06) revealed that stomach disease was a risk factor for COPD. Furthermore, the ROC curve indicated a good prediction performance for Model 3. Stomach disease remained significantly associated with COPD in all three models (P < 0.05). In addition to stomach disease, sex (male), health status, dyslipidemia, liver disease, heart attack, kidney disease, and asthma were significantly associated with COPD. CONCLUSION: In this cross-sectional analysis of a nationally representative Chinese cohort, stomach disease was significantly associated with COPD, extending prior evidence and suggesting its role in risk assessment. Causality cannot be inferred; prospective spirometry-confirmed studies are needed.
The Development and Initial Psychometric Testing of a Patient-Reported Outcome Measure to Assess COPD-Related Emotional Distress.
Schmid-Mohler G, Hübsch C, Mueller M … +5 more , Imhof R, Jordan KD, Clarenbach C, Monsch GM, Yorke J
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42136914 · Full text
PURPOSE: Emotional distress is prevalent in patients with COPD and highly relevant to patients. Research in chronic disease indicates that illness-related emotional distress might be specific and sensitive enough to expl...
PURPOSE: Emotional distress is prevalent in patients with COPD and highly relevant to patients. Research in chronic disease indicates that illness-related emotional distress might be specific and sensitive enough to explain self-management behaviour. However, as no currently available instrument assesses COPD-related emotional distress (CRED), it has only been assessed regarding overall distress, using mainly anxiety and depression as outcomes. Therefore, this study aimed to develop and test a preliminary item list to measure CRED. PATIENTS AND METHODS: Following Food and Drug Administration (FDA) guidelines, a multistep mixed-method study was conducted. Based on an earlier qualitative study and literature review, a conceptual framework and item list were developed. The item list's content validity was assessed via patient interviews using cognitive debriefing techniques and a survey involving a panel of clinicians. Finally, its psychometric properties were tested in a cross-sectional study. Construct validity was established by comparing the CRED-V1 with established questionnaires like the COPD Assessment Test (CAT), the Hospital Anxiety and Depression Scale (HADS), and the modified Medical Research Counsel (mMRC) dyspnoea scale. RESULTS: The first German COPD-Related Emotional Distress questionnaire-version 1 (CRED-V1) contained 36 items. Its content validity was confirmed by nine patients and ten clinicians. Psychometric testing in 264 patients with COPD revealed two formative (symptom- and treatment-related) and four reflective (restricted mobility-, restricted relationship-, disease unpredictability- and stigma-related) subcategories. For all reflective subscales, Cronbach's alpha values were >0.8. Structural equation modelling was possible for 32 items: An R value of 0.656 allowed the calculation of a CRED total score (CRED-TS). A regression model using the CRED-TS as the outcome variable showed that the most important explanatory variables were the CAT and HADS depression scores. CONCLUSION: This work reports the initial development of a new innovative tool for the assessment of CRED in patients with COPD.
Comparative Effectiveness and Safety of Fluticasone-Umeclidinium-Vilanterol and Beclomethasone-Glycopyrronium-Formoterol Single-Inhaler Triple Therapies for COPD: Real-World Observational Study.
Cherian M, Dell'Aniello S, Suissa S
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42136913 · Full text
PURPOSE: Multiple guidelines recommend single-inhaler triple therapy (SITT) for some patients with COPD. The first two SITTs approved for COPD were beclomethasone-glycopyrronium-formoterol (BEGF, twice daily) and flutica...
PURPOSE: Multiple guidelines recommend single-inhaler triple therapy (SITT) for some patients with COPD. The first two SITTs approved for COPD were beclomethasone-glycopyrronium-formoterol (BEGF, twice daily) and fluticasone-umeclidinium-vilanterol (FUV, once daily). No study has compared the effectiveness and safety of these SITTs on major outcomes. PATIENTS AND METHODS: We identified a cohort of patients with COPD, 40 years of age or older, from the United Kingdom's Clinical Practice Research Datalink. The patients who initiated treatment with FUV or BEGF were compared on the incidence of moderate or severe COPD exacerbations, and of pneumonia, over one year, after balancing baseline characteristics by propensity score weighting. RESULTS: The study cohort included 34,825 initiators of FUV and 39,288 initiators of BEGF, well balanced after weighing. The adjusted hazard ratio (HR) of a first moderate or severe exacerbation with FUV compared with BEGF was 0.91 (95% CI: 0.89-0.93), while for severe exacerbation it was 0.92 (95% CI: 0.86-0.97), corresponding to 27.9 fewer subjects with a moderate or severe exacerbation and 1.0 fewer with a severe exacerbation per 100 treated with FUV for one year. The HR of pneumonia requiring hospitalisation, comparing FUV with BEGF, was 1.06 (95% CI 0.99-1.13), over all patients. It was 1.14 (95% CI 1.06-1.24) among those classified as GOLD Group E, and 1.10 (95% CI 1.02-1.19) among those with a blood eosinophil count ≤ 300 cells/µL, corresponding to increases of 1.7 and 1.0 more subjects with a severe pneumonia per 100 treated with FUV for one year, respectively. CONCLUSION: In a real-world clinical practice setting of COPD treatment, initiating triple therapy with FUV was associated with a lower incidence of moderate and severe exacerbations than with BEGF. On the other hand, the incidence of a severe pneumonia requiring hospitalisation was higher with FUV among GOLD Group E subjects or those whose blood eosinophil count is not elevated.
Exercise Training Improves Depression and Anxiety in Patients with COPD: A Dose-Response Meta-Analysis of Randomized Controlled Trials.
Chen S, Shang B, Bi Y … +5 more , Xu R, Li Q, Zhang W, Yang Y, Hu S
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42117057 · Full text
OBJECTIVE: To evaluate the effects of exercise training on depressive and anxiety symptoms in patients with chronic obstructive pulmonary disease (COPD). METHODS: We searched PubMed, Embase, Cochrane Library, and Web of...
OBJECTIVE: To evaluate the effects of exercise training on depressive and anxiety symptoms in patients with chronic obstructive pulmonary disease (COPD). METHODS: We searched PubMed, Embase, Cochrane Library, and Web of Science from inception to May 7, 2025, for randomized controlled trials (RCTs) investigating exercise training for depression or anxiety in COPD patients. Two researchers independently screened literature, extracted data, and assessed methodological quality. To reduce measurement heterogeneity, only studies reporting the Hospital Anxiety and Depression Scale (HADS-D for depression, HADS-A for anxiety) were included as outcome indicators. Meta-analysis was performed using a random-effects model, and subgroup analysis explored the influence of cumulative intervention duration. RESULTS: Eleven RCTs involving 1208 COPD patients were included. Using HADS-D and HADS-A as outcome measures, exercise training significantly improved depressive symptoms [SMD = -0.35 (95% CI: -0.58, -0.12), < 0.05] and anxiety symptoms [SMD = -0.27 (95% CI: -0.53, -0.01), < 0.05]. Subgroup analysis indicated that improvement in depression was significant when cumulative intervention duration exceeded 1500 minutes ( < 0.05). For anxiety, although subgroup differences were not significant, the overall trend supported a positive effect. CONCLUSION: Exercise training is an effective non-pharmacological intervention for depression and anxiety in COPD patients. Integrating exercise into comprehensive COPD management is recommended, with exploratory evidence suggesting benefit when cumulative durations exceed 1500 minutes. More high-quality, long-term follow-up RCTs are needed to clarify optimal exercise regimens and mechanisms.
Research Progress and Comparative Evaluation of Three Cutting-Edge Chronic Obstructive Pulmonary Disease Treatment Strategies: Biologics, Bronchoscopic Lung Volume Reduction, and Stem Cell Therapies.
Qiu L, Liu X
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42117056 · Full text
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation, and traditional treatment regimens struggle to curb the progressive deterioration of lung function. Inspired by the principl...
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation, and traditional treatment regimens struggle to curb the progressive deterioration of lung function. Inspired by the principles of precision medicine, novel treatment strategies targeting specific disease phenotypes or key pathophysiological processes have opened new avenues for the management of COPD. This article comprehensively reviews and compares three classes of cutting-edge therapies with potential disease-modifying effects-targeted biologics, bronchoscopic lung volume reduction (BLVR), and stem cell therapy. It covers their mechanisms of action, clinical research evidence, patient selection criteria, efficacy and safety profiles, and health economic considerations. As a narrative review, this article synthesizes findings from key clinical trials and pivotal studies to provide a comparative perspective. By elucidating the advantages, limitations, and future directions of each therapy, this article aims to offer valuable guidance for treatment decisions and future research in clinical practice.
Regulatory T Cell-Related Gene Polymorphisms are Associated with Risk of Lung Cancer in Patients with COPD.
Zhang X, Chen F
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42117055 · Full text
BACKGROUND: The chronic inflammatory state of COPD can lead to an imbalance in immune cell subsets, specifically manifested as an increase in regulatory T cells (Tregs), which may promote tumor immune escape. However, fe...
BACKGROUND: The chronic inflammatory state of COPD can lead to an imbalance in immune cell subsets, specifically manifested as an increase in regulatory T cells (Tregs), which may promote tumor immune escape. However, few studies have reported the correlation between polymorphisms of Treg-related , and genes and the risk of lung cancer in COPD patients. METHODS: Six SNPs in , and were genotyped in 582 patients with COPD combined with lung cancer (the study group) and 603 patients with simple COPD (the control group) using a MassARRAY platform. RESULTS: By comparing the allele frequencies of the study group and the control group, three SNPs were found to be associated with the risk of lung cancer in patients with COPD, including -rs3761547, -rs2069762 and -rs4803455 ( < 0.0001). Genotype frequencies analysis revealed that -rs3761547-TC/CC, -rs2069762-AC/CC and -rs4803455-CA/AA genotypes were associated with increased risk of lung cancer in COPD patients ( < 0.0001). Moreover, genetic model analysis results showed that -rs3761547 had the highest risk of causing lung cancer in COPD patients in the recessive model, at 2.68 times ( < 0.0001). -rs2069762 and -rs4803455 had the highest pathogenic risks in the dominant model, at 2.11 and 3.27 times respectively ( < 0.0001). Additionally, stratified analyses showed that the three SNPs were significantly associated with the risk of lung cancer in both smoking and non-smoking COPD patients ( < 0.0001), and the risk of lung squamous cell carcinoma and lung adenocarcinoma in COPD patients ( < 0.001). CONCLUSION: Our results suggest that Treg-related genes polymorphisms may serve as susceptibility markers for lung cancer in the COPD population.
Development and External Validation of a Machine Learning Model for 90-Day Readmission in Hospitalized Older Patients with AECOPD: A Two-Center Study.
Zhang G, Wang D, Chen H … +4 more , Dai W, Fan X, Liu Y, Jiang L
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42117054 · Full text
BACKGROUND: Short-term readmission after hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is common in older adults, yet early risk stratification remains limited. We aimed to deve...
BACKGROUND: Short-term readmission after hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is common in older adults, yet early risk stratification remains limited. We aimed to develop and validate a 90-day readmission model using early admission data. METHODS: This retrospective two-center study used a development cohort from the Affiliated Hospital of North Sichuan Medical College and an external validation cohort from Dazhou Integrated Traditional Chinese and Western Medicine Hospital. Predictors were limited to early admission variables harmonized across sites. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were derived, with component blood counts removed to reduce collinearity. Feature selection used stability selection with Elastic Net regularization. Five models were trained and compared: multivariable logistic regression, naïve Bayes (NB), linear discriminant analysis (LDA), gradient boosting machine (GBM), and extreme gradient boosting (XGBoost). Discrimination was assessed by area under the receiver operating characteristic curve (AUC), with internal validation using bootstrap-derived optimism-corrected AUC and Brier score for overall error. Interpretability was examined with Shapley additive explanations (SHAP). RESULTS: A total of 692 patients were included (development, n=513; external validation, n=179). Six predictors were retained: NLR, SII, D-dimer, frequent exacerbations (FE), body mass index (BMI), and albumin (ALB). No strong multicollinearity was detected (|r|<0.90; variance inflation factors (VIFs) <5). XGBoost showed the best discrimination in the development cohort (AUC=0.892) and remained stable after internal validation (optimism corrected AUC=0.864). In the external cohort, XGBoost again achieved the highest AUC (0.847) with a lower Brier score than alternative models. SHAP analyses indicated D-dimer, NLR, and FE as major contributors and suggested non-linear effects. CONCLUSION: Using early admission data, we developed and externally validated a 90-day readmission prediction model for older adults hospitalized with AECOPD. XGBoost showed stable performance and clinically interpretable risk patterns, supporting its potential for early risk stratification.
Analysis of Respiratory Microbiota Characteristics in Patients with COPD and High-Risk Populations Using 16S rRNA Technology.
Yu Y, Huang P, Hu X … +4 more , Yang S, Feng J, Zhang M, Jie Z
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42117053 · Full text
OBJECTIVE: To compare respiratory microbiota across patients with COPD, individuals at high risk for COPD, and healthy controls, and to assess associations with COPD severity. METHODS: From January 2022 to December 2023,...
OBJECTIVE: To compare respiratory microbiota across patients with COPD, individuals at high risk for COPD, and healthy controls, and to assess associations with COPD severity. METHODS: From January 2022 to December 2023, participants were enrolled into four groups: previously diagnosed COPD (PVD-COPD, n=16), newly diagnosed COPD (PLD-COPD, n=16), high-risk individuals (HR, n=20), and healthy controls (HP, n=20). Sputum and saliva samples underwent 16S rRNA gene sequencing. Microbial diversity and taxonomic composition were compared among groups. In patients with COPD, correlations between sputum microbiota features and GOLD grade were analyzed. RESULTS: Seventy-two subjects were included. Alpha diversity (Ace and Chao1) and beta diversity differed significantly among groups (all P<0.05). Dominant phyla were similar across groups (Firmicutes, Proteobacteria, Bacteroidetes, Actinobacteria, and Fusobacteria), whereas genus-level profiles differed, with 10 genera showing significant between-group differences (mean abundance >1%). Within the COPD cohort, Ace and Chao1 were positively correlated with GOLD grade (r=0.3659, P=0.0394). A -dominant pattern was more frequent in GOLD 1-2, while a -dominant pattern was more frequent in GOLD 3-4. CONCLUSION: Respiratory microbiota composition differs across healthy controls, high-risk individuals, and COPD patients. In COPD, microbiota diversity and dominant genera are associated with disease severity, supporting a link between respiratory microbiota structure and COPD progression.
Arterial Stiffness in Pre-COPD/PRISm, and COPD Stages: A Cross-Sectional Assessment of Hemodynamic Determinants.
Şimşek ŞM, Gök G, Cörüt R … +1 more , Kılıç N
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42117052 · Full text
PURPOSE: Arterial stiffness is associated with increased cardiovascular risk in chronic obstructive pulmonary disease (COPD). However, whether this increase reflects disease-specific vascular effects or is primarily driv...
PURPOSE: Arterial stiffness is associated with increased cardiovascular risk in chronic obstructive pulmonary disease (COPD). However, whether this increase reflects disease-specific vascular effects or is primarily driven by age and hemodynamic factors remains unclear, particularly in early disease states such as pre-COPD and preserved ratio impaired spirometry (PRISm). This study aimed to evaluate arterial stiffness across the COPD spectrum and to determine the independent predictors of pulse wave velocity (PWV). PATIENTS AND METHODS: This cross-sectional study included healthy controls (n=60), a combined pre-COPD/PRISm group (n=121), and COPD patients (n=120) classified according to spirometric criteria. Arterial stiffness was assessed noninvasively using brachial oscillometric PWV. Clinical characteristics, smoking exposure, spirometric parameters, symptom scores, and hemodynamic measurements were recorded. Correlation analyses and hierarchical multivariate linear regression were performed to identify independent determinants of PWV. RESULTS: PWV values were significantly higher in the pre-COPD/PRISm and COPD groups than in healthy controls, with the highest levels observed in COPD patients at GOLD stage E (p<0.001). Although PWV showed significant correlations with spirometric parameters and symptom scores in unadjusted analyses, these associations lost significance after adjustment for age and smoking exposure. In contrast, mean arterial pressure and central pulse pressure remained strongly associated with PWV (p<0.001). In multivariate analysis, age was the strongest independent predictor of PWV, followed by mean arterial pressure and body surface area, while FEV1% was not a significant contributor. CONCLUSION: Arterial stiffness is increased not only in COPD but also in individuals with pre-COPD/PRISm. However, this increase appears to be primarily driven by age-related and hemodynamic factors rather than disease-specific airflow limitation. These findings highlight the importance of early cardiovascular risk assessment focusing on hemodynamic parameters.
Pathogenesis, Diagnostic Advances, and Therapeutic Management of Chronic Obstructive Pulmonary Disease: A Narrative Review.
Wang S, Han H, Hu X … +1 more , Hong K
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42117051 · Full text
Chronic obstructive pulmonary disease (COPD) is a leading global cause of morbidity and mortality, now recognized as a complex, heterogeneous disorder driven by environmental exposures, genetic susceptibility, immune dys...
Chronic obstructive pulmonary disease (COPD) is a leading global cause of morbidity and mortality, now recognized as a complex, heterogeneous disorder driven by environmental exposures, genetic susceptibility, immune dysregulation, and accelerated lung aging rather than solely by airflow limitation. This shift in understanding has fundamentally altered perspectives on its development and treatment. This narrative review synthesizes recent advances from 141 studies identified through a structured literature search of PubMed and Web of Science. It explores the molecular and cellular mechanisms of COPD pathogenesis and the resulting structural and functional lung changes. The review highlights innovations in diagnostics, including advanced imaging, physiological assessments, and biomarkers that enable more precise patient classification beyond spirometry. Progress in pharmacotherapy includes personalized inhaled therapies and targeted anti-inflammatory agents, while non-pharmacological approaches such as pulmonary rehabilitation and digital health technologies are increasingly integral to comprehensive management. Despite these advances, challenges persist, including inconsistent early detection, a lack of disease-modifying treatments, and significant variability in disease course and treatment response. This review provides a cohesive overview of current knowledge, identifies ongoing research needs, and outlines priorities for advancing personalized, mechanism-based care for COPD patients.
Severity-Stratified Pulmonary Rehabilitation Modulates Diaphragm Function and Oxidative Stress in Hospitalized AECOPD Patients: A Randomized Controlled Trial.
Zeng H, Ran H, Wang Y … +10 more , Chen Y, Zhang L, Zhao D, Fu D, Yang N, Li C, Ma L, Luo J, Hu Q, Huang L
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42110507 · Full text
OBJECTIVE: Diaphragmatic dysfunction and oxidative stress are central pathophysiological alterations in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Evidence is lacking...
OBJECTIVE: Diaphragmatic dysfunction and oxidative stress are central pathophysiological alterations in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Evidence is lacking regarding early pulmonary rehabilitation protocols stratified by objective disease severity and their physiological effects. This study aimed to evaluate the impact of an individualized, severity-graded exercise rehabilitation program on diaphragmatic function and oxidative stress biomarkers in these patients. METHODS: In this single-center randomized controlled trial, 132 AECOPD patients were first stratified into three severity grades (I, II, III) based on predefined clinical and physiological criteria, then randomly assigned to either a study group (n=66, receiving severity-graded rehabilitation) or a control group (n=66, receiving conventional rehabilitation).Diaphragmatic function was assessed by bedside ultrasonography measuring excursion (DE), end-inspiratory thickness (DTei), and end-expiratory thickness (DTee). Serum levels of malondialdehyde (MDA), superoxide dismutase (SOD), and total antioxidant capacity (TAOC) were determined. All measurements were taken before and after the intervention. The trial was registered with the Chinese Clinical Trial Registry (ChiCTR2500106687). RESULTS: Compared to the control group, the study group showed significant improvements in all diaphragmatic function parameters (all <0.001). Furthermore, increases in SOD and TAOC levels were significantly greater in the study group (p=0.005 and p=0.025, respectively). Subgroup analysis revealed that patients with mild disease exhibited the most pronounced improvement in DE (p=0.044), and oxidative stress responses were heterogeneous across severity grades. Partial correlation analysis indicated that improvements in DE were significantly negatively correlated with improvements in all oxidative stress biomarkers only in the study group (r range: -0.314 to -0.331, all <0.05). CONCLUSION: Severity-graded exercise rehabilitation effectively improves diaphragmatic function and enhances endogenous antioxidant capacity in hospitalized AECOPD patients. The improvement in diaphragmatic excursion was significantly correlated with favorable changes in oxidative stress biomarkers, suggesting a potential physiological association. These findings support the efficacy of severity-graded rehabilitation but warrant further mechanistic studies.
Development and Validation of a Predictive Nomogram for Progression from Pre-COPD to Spirometric COPD: A Multicenter Retrospective Cohort Study.
Wu J, Zhang H, Yang L … +7 more , Gan J, Wang G, Tang X, Xian J, Zhu L, Li Y, Li W
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42110506 · Full text
BACKGROUND: Early identification of Pre-chronic obstructive pulmonary disease (pre-COPD) is vital for preventing irreversible lung damage. However, despite its high prevalence, there is a lack of practical tools to predi...
BACKGROUND: Early identification of Pre-chronic obstructive pulmonary disease (pre-COPD) is vital for preventing irreversible lung damage. However, despite its high prevalence, there is a lack of practical tools to predict which individuals will progress to spirometry-defined COPD. This study aimed to identify independent risk factors and develop a clinical nomogram to quantify the risk of disease progression in a pre-COPD population. METHODS: We conducted a multicenter, retrospective cohort study in Southwest China (2019-2023), enrolling 1088 participants with pre-COPD. Baseline data, including demographic information, smoking status, comorbidities, lung function, and hematological and biochemical indicators, were analyzed. Independent predictors were identified via multivariate logistic regression, and a risk-prediction nomogram was constructed and validated. RESULTS: During follow-up, 54.6% of participants progressed to COPD. The final prediction model identified six independent risk factors: age (OR=1.043), hypertension (OR=2.331), diabetes (OR=2.412), hemoglobin level (OR=1.016), lymphocyte count (OR=0.639), and basophil count (OR=1.411). The nomogram demonstrated robust discriminative ability, with an AUC of 0.758 in the training set and 0.718 in the validation set. Calibration curves showed high consistency, and Decision Curve Analysis (DCA) confirmed significant clinical net benefit. CONCLUSION: Progression from pre-COPD to spirometry-defined COPD is highly prevalent and driven by age, comorbidities, and systemic inflammatory markers. Our validated nomogram provides a precise, non-invasive tool for clinicians to identify high-risk individuals, enabling targeted early intervention and optimized resource allocation in COPD prevention.
Potential Benefits of Gut Microbiota Modulation in Chronic Obstructive Pulmonary Disease.
Li J, Zhang H, Zhang P … +1 more , Hu J
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42110505 · Full text
BACKGROUND: The gut-lung axis is increasingly recognized. This study aimed to find out whether and how the gut microbiome involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). METHODS: Gut microbi...
BACKGROUND: The gut-lung axis is increasingly recognized. This study aimed to find out whether and how the gut microbiome involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). METHODS: Gut microbiota was characterized via 16S rRNA gene sequencing in COPD patients and a smoking-induced mouse model. Gut dysbiosis was induced by antibiotic cocktail (ABX) and restored by fecal microbiota transplantation (FMT). Plasma metabolomics was conducted using liquid chromatography-mass spectrometry (LC-MS), and pathway analysis was performed with MetaboAnalyst 5.0. Differentially expressed genes were identified by RNA sequencing and functionally interpreted through gene set enrichment analysis (GSEA). RESULTS: Both COPD patients and mice showed altered gut microbiota, characterized by a unique microbial composition and reduced diversity. ABX induced gut dysbiosis exacerbated pathological lung changes, impaired lung function, and promoted Treg cell exhaustion in COPD mice. Restoration of gut homeostasis via FMT attenuated these alterations. Higher plasma levels of acetylcholine (ACh) were observed in COPD mice, while the highest ACh levels were found in ABX treated COPD mice compared to controls. Notably, ACh levels correlated positively with genus , which was more abundant in COPD mice, and inversely with genera Saccharimonas and , which were predominant in control mice. Metabolomic pathways analysis revealed enrichment in unsaturated fatty acids biosynthesis and purine metabolism in COPD mice relative to controls. CONCLUSION: These findings highlight the involvement of the gut microbiome in COPD development and suggest that maintaining gut homeostasis may represent a novel therapeutic strategy for COPD.
Validation and Clinical Analysis of the Quantitative COPD Exacerbation Recognition Tool (Q-CERT): Diagnostic Performance and Association with Lung Function Impairment.
Zhao X, Zhou C, Liu Y … +4 more , Cui K, Jones P, An Y, Zhang X
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42110504 · Full text
OBJECTIVE: There is a need for a patient-centered tool that can quantitatively identify acute exacerbations of COPD. This study aims to develop and validate a digital tool that enables such care by providing a quantifiab...
OBJECTIVE: There is a need for a patient-centered tool that can quantitatively identify acute exacerbations of COPD. This study aims to develop and validate a digital tool that enables such care by providing a quantifiable severity score. METHODS: A total of 161 AECOPD patients and 130 stable COPD patients from Henan Provincial People's Hospital were enrolled. Demographics, clinical symptoms, pulmonary function parameters and admission laboratory data for patients were collected. The COPD Exacerbation Recognition Tool (CERT) was quantified using a 4-point Likert scale (0-3) to derive the Quantitative-CERT (Q-CERT) score. Effectiveness of the CERT and Q-CERT in identifying AECOPD was assessed. RESULTS: The CERT demonstrated strong diagnostic performance for recognizing AECOPD, with a sensitivity of 85.7%, specificity of 80.8%, and accuracy of 83.5%. The quantitative Q-CERT score further optimized diagnostic accuracy. At a cutoff of 5 points, the Q-CERT provided optimal sensitivity (89.4%) and specificity (83.8%) combination, with an AUC of 0.956 (95% CI: 0.937-0.976, < 0.001). Q-CERT scores were significantly higher in patients with AECOPD than in those with stable COPD (8 vs. 0 points, < 0.001). Furthermore, elevated Q-CERT scores correlated negatively with pulmonary function parameters, including FEV1%pred, FEV1/FVC, MEF75%pred, MEF50%pred, and MMEF%pred (r = -0.406 to -0.358, all < 0.001), with the strongest associations observed in small airway metrics. Conversely, higher Q-CERT scores showed positive correlations with the neutrophil-to-lymphocyte ratio (NLR) (r = 0.181, <0.05) and platelet-to-lymphocyte ratio (PLR) (r = 0.245, <0.05). CONCLUSION: Q-CERT enhanced the original CERT's ability to identify AECOPD. And total score was correlated with pulmonary function impairment and systemic inflammation, making it an efficient and reliable tool for clinical practice.
Identification of as a Potential Biomarker Relating to PANoptosis in Chronic Obstructive Pulmonary Disease.
Fu X, Dong J, Yang J … +5 more , Zhang X, Cai S, Zhang Y, Lv S, Zhang M
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42099899 · Full text
BACKGROUND: The processes of pyroptosis, apoptosis, and necroptosis (PANoptosis) play a crucial role in the development of chronic obstructive pulmonary disease (COPD). Our objective is to explore potential PANoptosis-re...
BACKGROUND: The processes of pyroptosis, apoptosis, and necroptosis (PANoptosis) play a crucial role in the development of chronic obstructive pulmonary disease (COPD). Our objective is to explore potential PANoptosis-related genes in COPD. METHODS: Human COPD-related transcriptomic datasets (GSE8545, GSE20257, GSE11784 and GSE1650) were retrieved from the Gene Expression Omnibus (GEO). First, based on GSE8545 dataset, candidate genes were identified using differentially expressed gene (DEG) analysis, Weighted Gene Co-expression Network Analysis (WGCNA), Least Absolute Shrinkage and Selection Operator (LASSO) regression, and Support Vector Machine-Recursive Feature Elimination (SVM-RFE). Subsequently, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted for the relevant genes. was identified as a diagnostic biomarker through validation across independent human cohorts (GSE20257 and GSE11784). CIBERSORT was employed to evaluate immune infiltration differences between expression groups. Finally, potential therapeutic drugs for were predicted using the Drug-Gene Interaction Database (DGIdb). RESULTS: Three PANoptosis-related hub genes (, and ) were defined in this study. KEGG enrichment analysis revealed that these genes were significantly enriched in the "Apoptosis - multiple species" signaling pathway. Validation across multiple independent human datasets identified as the key gene. exhibited significantly elevated expression in the lung tissues of COPD patients (P < 0.001). Immune infiltration analysis indicated that expression levels were significantly negatively correlated with resting mast cells and positively correlated with monocytes. Receiver Operating Characteristic curve analysis confirmed the robust diagnostic performance and stability of , with Area Under the Curve values of 0.756, 0.702, 0.703, and 0.732 in the GSE8545, GSE20257, GSE11784, and GSE1650 datasets, respectively. Furthermore, three potential therapeutic agents targeting -VB-201, LOVASTATIN, and IC143-were predicted. CONCLUSION: We identified as a marker gene associating with PANoptosis in COPD, providing new ideas for clinical diagnosis and drug design of COPD.
The Feasibility and Acceptability of Culturally Appropriate Pulmonary Rehabilitation for Adults with Chronic Obstructive Pulmonary Disease in Sri Lanka: Randomized Controlled Trial.
Jayamaha AR, Perera CH, Orme MW … +12 more , Karunatillake RS, Fernando A, Barton A, Steiner MC, Matheson J, Manifield J, Barradell AC, Chathurantha S, Dias RR, Amarasekara TD, Wimalasekera SW, Singh SJ
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42095209 · Full text
PURPOSE: Pulmonary rehabilitation (PR) is recommended internationally for individuals with chronic obstructive pulmonary disease (COPD), but there is limited evidence and practice of PR in Sri Lanka. Key challenges for P...
PURPOSE: Pulmonary rehabilitation (PR) is recommended internationally for individuals with chronic obstructive pulmonary disease (COPD), but there is limited evidence and practice of PR in Sri Lanka. Key challenges for PR such as poor accessibility, uptake and completion need to be addressed when designing and delivering new PR programmes. Accordingly, this study determined the feasibility and acceptability of culturally adapted PR for adults with COPD in Sri Lanka. PATIENTS AND METHODS: A randomized controlled feasibility trial was conducted with 50 adults living with COPD in Colombo, Sri Lanka. A culturally adapted PR comprised a 6-week rolling programme with sessions conducted twice every week. Sessions involved endurance and resistance exercise training, education and cultural adaptations of nutritional support and group singing. The control group received usual care, which did not include any form of PR or exercise training. Feasibility was determined by uptake (≥60% of eligible participants consented) and completion (≥70% of recruited participants). Acceptability was explored by focus group discussions (FGDs) analysed thematically. RESULTS: Seventy-nine eligible individuals (94% of screened) were referred in order to recruit 50 participants (63% uptake). The majority of participants in both intervention (72%, n=18) and control (64%, n=16) groups completed the study. Based on qualitative focus group discussions four themes emerged: (1) Increased knowledge following PR, including dispelling misbeliefs about COPD and improving medication adherence; (2) Perceived improvements in health following PR, including improved walking ability and reduced breathlessness (3) Enjoyment and benefits of cultural adaptations to PR, and (4) Challenges during PR, including adherence to exercise and travel requirements. CONCLUSION: Culturally adapted PR was feasible and acceptable to adults with COPD in Sri Lanka. A fully powered trial is warranted for evaluating clinical and cost-effectiveness of culturally adapted PR.
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