International Journal Of Chronic Obstructive Pulmonary Disease[JOURNAL]
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200 papers
Construct Validity Matters: Are CAT and 5STS Surrogates of Exercise Capacity in COPD? [Letter].
Vera-Uribe R, Torres-Castro R, Otto-Yáñez M
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42095208 · Full text
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Impact of an Integrated Medical-Nursing Clinical Pathway on 30-Day Readmission and Long-Term Prognosis in Patients with Acute Exacerbation of COPD: A Retrospective Cohort Study Using Real-World Data.
Dou Y, Wang L, Wang Y … +5 more , Wang J, Qin H, Wang L, Li K, Li N
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42078912 · Full text
BACKGROUND: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is associated with high rates of hospital readmission and mortality. Traditional fragmented care often fails to address the complex needs o...
BACKGROUND: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is associated with high rates of hospital readmission and mortality. Traditional fragmented care often fails to address the complex needs of these patients. This study aimed to evaluate the impact of an Integrated Medical-Nursing Management (IMNM) model on readmission rates, mortality, and patient-centered outcomes in AECOPD patients. METHODS: A retrospective cohort study was conducted at the First Hospital of Hebei Medical University involving AECOPD patients admitted between January 2022 and January 2025. Patients were divided into a Control Group (standard care, Jan 2022-Jun 2023) and an Intervention Group (IMNM model, Aug 2023-Jan 2025). The IMNM model featured interdisciplinary rounds, joint discharge planning, and structured follow-up. Propensity Score Matching (PSM) was used to balance baseline covariates (1:1 matching). The primary outcome was hospital readmission rates at 30, 90, 180, and 365 days. Secondary outcomes included all-cause mortality, CAT scores, and treatment adherence. RESULTS: A total of 120 patients (60 per group) were included after PSM. The Intervention Group showed significantly lower readmission rates at 30 days (15.0% vs. 28.3%, P=0.046) and 365 days (26.7% vs. 51.7%, P<0.001). The hazard ratio for readmission-free survival favored the intervention (HR 0.38, 95% CI 0.21-0.70). All-cause mortality at 1 year was significantly lower in the Intervention Group (5.0% vs. 13.3%, P=0.041). Patients in the IMNM group also demonstrated improved CAT scores (MD -5.4, P<0.001) and higher medication adherence (80.0% vs. 53.3%, P=0.004). CONCLUSION: In conclusion, the Integrated Medical-Nursing Management model is associated with reduced hospital readmissions and mortality, as well as improved patient quality of life and treatment adherence in AECOPD patients. These findings provide actionable evidence for healthcare systems to adopt collaborative clinical pathways, thereby standardizing routine clinical practice to mitigate the burden of AECOPD.
A Predicted FEV1/FVC Model Based on a Simple Respiratory Questionnaire for Early Diagnosis of COPD in Shimane Cohort, Japan.
Nakao M, Okimoto T, Tanino A … +7 more , Amano Y, Hotta T, Hamaguchi M, Hamaguchi S, Tsubata Y, Kawamura T, Isobe T
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42078911 · Full text
PURPOSE: Early detection of chronic obstructive pulmonary disease (COPD) remains challenging in primary care settings where spirometry is not always available. We aimed to develop a simple questionnaire-based approach to...
PURPOSE: Early detection of chronic obstructive pulmonary disease (COPD) remains challenging in primary care settings where spirometry is not always available. We aimed to develop a simple questionnaire-based approach to estimate the forced expiratory volume in one second (FEV)/forced vital capacity (FVC) ratio for COPD screening. PATIENTS AND METHODS: This was a single-center retrospective observational study based on the Shimane cohort. From 2008 to 2014, respiratory questionnaires and spirometry were performed during health check-ups of individuals aged ≥40 years. Among 2230 participants who underwent spirometry, 727 current or former smokers without a history of bronchial asthma were included for model development. Multiple regression analysis was used to identify questionnaire items associated with FEV/FVC and to construct a simplified estimation model. RESULTS: Four variables-age, smoking intensity, exertional dyspnea, and paroxysmal dyspnea-were independently associated with FEV/FVC and were incorporated into the model. The model demonstrated modest explanatory power = 0.136), with no significant lack-of-fit (F = 1.152). Based on these variables, a simple four-item model enabled estimation of FEV/FVC and identification of individuals at risk for airflow limitation. CONCLUSION: We developed a simple questionnaire-based model to estimate FEV/FVC using four easily obtainable variables. Although the model is exploratory and requires external validation, it may serve as a practical screening tool to identify individuals at risk for COPD in settings where spirometry is not readily available.
Community-Based Case-Finding for Chronic Obstructive Pulmonary Disease and Self-Management Education in Partnership with Faith-Based Organizations.
Odhiambo LA, Joseph KM, Moore A … +8 more , Crafton B, Jackson LW, Ruffin A, Collier B, Islam KMM, Taskar V, Forseen C, Wright S
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42058957 · Full text
PURPOSE: Chronic obstructive pulmonary disease (COPD) is poorly diagnosed with millions unaware they have the condition, preventing or delaying treatment and behavioral changes. We partnered with faith-based organization...
PURPOSE: Chronic obstructive pulmonary disease (COPD) is poorly diagnosed with millions unaware they have the condition, preventing or delaying treatment and behavioral changes. We partnered with faith-based organizations (FBOs) to raise awareness of COPD among Black Americans by facilitating diagnosis and offering self-management education in the community. METHODS: Cross-sectional and pre-post study designs were applied. Three churches identified representatives to serve as COPD liaisons (CLs). CLs received training on screening procedures and an overview of COPD. Case-finding was conducted at health fairs where CLs helped administer a screening tool (COPD-population screener (PS)) to identify high-risk individuals and refer those who scored ≥5 for spirometry performed by respiratory therapists (RTs). RTs referred those with high risk of having COPD (scores ≥5 and FEV1/FVC ~ 0.70) to discuss results with their provider, and those eligible (COPD high-risk, COPD diagnosed, caregivers, and current or former smokers), to attend bi-monthly educational sessions. Bristol COPD Knowledge Questionnaire was used to assess participants' knowledge pre-post intervention and CL training. CLs also completed a self-efficacy questionnaire. Independent -test, paired -test, and Chi-squared test or Fisher's Exact test were applied. RESULTS: We attended seven health fairs and engaged four CLs. CL self-efficacy was higher, while knowledge increased by 6.2% post-training then declined by 5%. Of the 170 people who completed the screening tool, 40 received spirometry, 3 (8.1%) and 9 (24.3%) had FEV1/FVC ratios of 0.70, and >0.70 to <0.80, respectively. Prevalence of COPD was approximately 12.6%, smoking history (former: 27.3%, current: 3.6%), and sleep apnea, 23.8%. About 11/38 people attended at least one educational session and knowledge scores increased significantly from baseline to post-session, 42% to 55% (t=-4.82, df=12, p=0.00). CONCLUSION: COPD case-finding implemented in partnership with FBOs can supplement efforts in primary care. Routine educational sessions in the community improved access to self-management education for people with COPD and their caregivers. Engaging CLs in addressing respiratory health inequities can lead to greater impact in minority populations.
COPD in Africa in the Post-COVID Era: A GBD 2023 Analysis of Trends, Demographic Drivers and Health-System Performance.
Shi B, Liu J, Zhou F … +2 more , Han B, Wang Y
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42058956 · Full text
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an emerging non-communicable priority in Africa, yet how the COVID-19 era has shaped COPD burden and its drivers across the continent remains unclear. METHODS:...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an emerging non-communicable priority in Africa, yet how the COVID-19 era has shaped COPD burden and its drivers across the continent remains unclear. METHODS: Using Global Burden of Disease (GBD) 2023 estimates, we quantified COPD incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for 52 African countries from 2019 to 2023. Age-standardised rates (ASRs) per 100,000 population were calculated using the GBD standard population. Trends were summarised using estimated annual percentage change (EAPC). Das Gupta decomposition partitioned changes in total DALYs into contributions from population growth, population ageing, and epidemiologic change (changes in age-specific DALY rates). Frontier analysis benchmarked 2023 age-standardised DALY rates against Socio-demographic Index (SDI)-expected values to identify over- and under-performing countries. Socioeconomic gradients were assessed using the Slope Index of Inequality (SII). RESULTS: From 2019 to 2023, incident COPD cases increased from 751,091 to 871,054 (+16.0%), prevalent cases from 10.99 to 12.70 million (+15.6%), DALYs from 3.56 to 3.86 million (+8.5%), and deaths from 119,371 to 125,680 (+5.3%). Median age-standardised DALY and mortality rates declined from 579.6 to 540.6 and from 23.2 to 21.2 per 100,000, respectively, whereas incidence and prevalence ASRs rose modestly in most countries. Men had higher age-specific incidence and prevalence than women, with substantially larger excesses in DALYs (~50-60%) and mortality (~70-80%) across adult age groups. Decomposition showed that the net increase of ~303,100 DALYs was driven mainly by population growth and ageing, while epidemiologic improvements offset ~60% of demographic pressure. Frontier analysis showed marked heterogeneity: about one-third of countries had DALY rates ≥20% above SDI-expected values, whereas another third achieved burdens at or below the frontier. CONCLUSION: In the immediate post-pandemic period, Africa has rising absolute COPD burden but improving age-standardised disability and mortality in most countries. Large sex disparities and wide performance gaps at similar SDI levels highlight opportunities for targeted tobacco control, clean-energy transitions, and strengthened chronic respiratory care.
Perceived Acceptability of SPACE for COPD© as a Maintenance Option Following Pulmonary Rehabilitation Discharge: A Qualitative Interview Study with Patients and Facilitators Using Framework Analysis.
Barradell AC, Alqahtani K, Hong A … +12 more , Lapworth J, Greenall K, Al-Naabi I, Szczepura A, Man WDC, Nolan CM, Doe G, Gardiner N, Gerlis C, Bourne C, Singh SJ, Houchen-Wolloff L
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42051375 · Full text
INTRODUCTION: Following completion of Pulmonary Rehabilitation (PR), the biopsychosocial benefits often decline. PR maintenance is recommended to extend the benefits; however, detail lacks on what this should entail. SPA...
INTRODUCTION: Following completion of Pulmonary Rehabilitation (PR), the biopsychosocial benefits often decline. PR maintenance is recommended to extend the benefits; however, detail lacks on what this should entail. SPACE for COPD© is a light touch, evidenced-based self-management intervention which we tested as a maintenance strategy during the COVID-19 pandemic. We explored the acceptability of SPACE for COPD© as a maintenance option following PR for both patients and facilitators using qualitative research methods. METHODS: We conducted semi-structured interviews and focus groups with patients and intervention facilitators involved in the SPACE for COPD© maintenance study. These were audio recorded, transcribed verbatim and analysed using Framework Analysis. RESULTS: Seventeen patients were interviewed; 13 (76.5%) of which were programme completers: five (29.4%) received a group-based intervention, four (23.5%) received one-to-one, and eight (47.1%) received hybrid. Two focus groups were conducted with eight facilitators; six (75%) were physiotherapists, one (12.5%) was a nurse, and one (12.5%) was a health psychologist. Analysis generated six themes: (1) the changing structure of maintenance SPACE for COPD©; (2) the integral role of the facilitator; (3) engagement with the manual required time and commitment from patients; (4) staying active on maintenance SPACE for COPD© was facilitated by goal setting and exercise; (5) biopsychosocial outcomes of maintenance SPACE for COPD©; and (6) the future of maintenance SPACE for COPD©. CONCLUSION: Maintenance SPACE for COPD© was acceptable and could be implemented into the PR healthcare pathway during the COVID-19 pandemic. It helped patients to adopt and integrate new exercise habits if they could adapt and personalise these to their home lives. Adaptions made during the COVID-19 pandemic created a menu of options. Building upon this personalisation is required to ensure the intervention is accessible and patient-centred.
A Quarter-Century of Chronic Obstructive Pulmonary Disease in the Intensive Care Unit (2000-2025): A Bibliometric Roadmap of Thematic Evolution and Future Frontiers.
Chen Y, Wang W
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42051374 · Full text
BACKGROUND: Research on Chronic Obstructive Pulmonary Disease (COPD) in the Intensive Care Unit (ICU) has expanded rapidly, yet a comprehensive, longitudinal bibliometric analysis mapping its is scientific evolution lack...
BACKGROUND: Research on Chronic Obstructive Pulmonary Disease (COPD) in the Intensive Care Unit (ICU) has expanded rapidly, yet a comprehensive, longitudinal bibliometric analysis mapping its is scientific evolution lacking. METHODS: We conducted a bibliometric analysis of 2,512 publications from the Web of Science Core Collection (2000-2025). A preliminary literature search confirmed no prior bibliometric study has specifically and systematically mapped this entire domain. Using VOSviewer and CiteSpace, we analyzed publication trends, collaborations, co-citation networks, and keyword bursts. RESULTS: Annual publications show a consistent upward trajectory, with accelerated growth post-2019. The United States, China, and France are leading contributors, with robust international collaboration. The intellectual structure has evolved from foundational mechanical ventilation research to integrated management and prognostic modeling. Current research frontiers emphasize non-invasive ventilation, acute exacerbation management, and outcomes in multi-organ failure. CONCLUSION: This study provides the first quarter-century roadmap of ICU-focused COPD research, demonstrating its maturation toward data-driven and personalized care. By delineating the thematic evolution and identifying emergent interdisciplinary frontiers, such as data science integration and post-ICU recovery, this analysis offers a strategic guide for prioritizing research and optimizing care for this vulnerable population.
Nicotine Metabolism and Chronic Obstructive Pulmonary Disease: Mendelian Randomization and Phenotypic Characterization Analysis.
Ji TF, Song SW, Xie Y … +9 more , Liu Z, Gao YM, Cheng AQ, Zhou XM, Wang M, Dai HP, Zhao L, Xiao D, Wang C
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42051373 · Full text
BACKGROUND: Smokers with similar smoking exposure show markedly different risks of chronic obstructive pulmonary disease (COPD), and it remains unclear whether genetically determined nicotine metabolism, measured by the...
BACKGROUND: Smokers with similar smoking exposure show markedly different risks of chronic obstructive pulmonary disease (COPD), and it remains unclear whether genetically determined nicotine metabolism, measured by the nicotine metabolite ratio (NMR), is independently associated with COPD beyond smoking exposure. METHODS: This study integrated genetic evidence and population-based phenotypic analyses. First, two-sample Mendelian randomization (MR) analyses were conducted using genome-wide association study summary statistics to evaluate the causal effect of the NMR on COPD, with colocalization analyses to assess shared causal genetic variants. Second, phenotypic analyses in the China National Tobacco Cessation Cohort Study were conducted in a cross-sectional setting to compare COPD prevalence across metabolic phenotypes under comparable smoking exposure, with mediation analyses evaluating the contribution of smoking behavior. RESULTS: MR analysis showed a causal association between a higher NMR and increased risk of COPD (OR = 1.06, 95% CI: 1.05-1.08). Colocalization analyses identified shared causal variants. Population-based phenotypic analyses showed that COPD prevalence was consistently higher in normal metabolizers (NMR ≥ 0.31) than slow metabolizers (NMR < 0.31), regardless of smoking exposure strata, and more importantly, remained higher within comparable levels of cumulative smoking. Mediation analysis showed that smoking behavior partially mediated this association (indirect effect β = 0.0049, P < 0.001), accounting for 14.5% of the total effect. CONCLUSION: Nicotine metabolism, as captured by NMR, is causally associated with COPD susceptibility. These findings suggest that incorporating nicotine metabolism into smoking exposure assessment may have potential value in improving COPD risk stratification.
Pharmacist-Driven Outcomes in Asthma and COPD: A Meta-Analysis of Clinical Outcomes and Medication Adherence.
Xie W, Zhang X, Wei W … +4 more , Li N, He X, Shi Z, Wang Y
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42046773 · Full text
PURPOSE: This meta-analysis aimed to evaluate the effectiveness of pharmaceutical care in managing asthma and chronic obstructive pulmonary disease (COPD), focusing on clinical outcomes, medication adherence, and quality...
PURPOSE: This meta-analysis aimed to evaluate the effectiveness of pharmaceutical care in managing asthma and chronic obstructive pulmonary disease (COPD), focusing on clinical outcomes, medication adherence, and quality of life. PATIENTS AND METHODS: Randomized controlled trials comparing asthma or COPD patients who received pharmaceutical care intervention on the basis of the original treatment and the control group who only received the original treatment were included. The main results include Asthma Control Test (ACT); COPD Assessment Test (CAT); modified Medical Research Council (mMRC) dyspnea scale. Secondary outcomes were medication adherence; correct rate of inhaler technique; emergency room visit; hospitalization; Asthma Quality of Life Questionnaire (AQLQ); Peak Expiratory Flow Rate (PEFR, L/min). All analyses used a random - effects model. RESULTS: A total of 18 randomized controlled trials involving 4173 patients were included. The results showed that in the pharmaceutical care group, the mean correct inhalation technique rate (OR = 6.53, 95% CI: [3.19, 13.37], P < 0.001), medication adherence (OR = 1.45, 95% CI: [1.03, 2.03], P = 0.031), and the number of patients with better asthma control as indicated by ACT results (OR = 2.51, 95% CI: [2.51, 4.35], P < 0.01) were significantly better than those in the control group. The emergency room visit rate (OR = 0.44, 95% CI: [0.29, 0.67], P < 0.001) and hospital admissions rate (OR = 0.27, 95% CI: [0.19, 0.39], P < 0.001) were significantly lower. The PEFR of patients was better (SMD = 0.37, 95% CI: [0.09, 0.6], P < 0.01). However, no significant changes were observed in CAT, AQLQ, or mMRC. CONCLUSION: Pharmacists' interventions exert a positive effect on asthma and COPD management outcomes, though improved research design and quality are still needed.
Re-Evaluating the Relationship Between Insulin Resistance and Chronic Obstructive Pulmonary Disease: Evidence from NHANES and Mendelian Randomization.
Jiang N, Jin Q, Xu W … +1 more , Huang F
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42040645 · Full text
BACKGROUND AND PURPOSE: Observational studies suggest an association between insulin resistance (IR) and chronic obstructive pulmonary disease (COPD), but this link is susceptible to confounding and reverse causality. Th...
BACKGROUND AND PURPOSE: Observational studies suggest an association between insulin resistance (IR) and chronic obstructive pulmonary disease (COPD), but this link is susceptible to confounding and reverse causality. This study integrated cross-sectional analysis with Mendelian Randomization (MR) to systematically evaluate their potential causal relationship. METHODS: Using NHANES data, we employed complex sampling weighting and multivariable logistic regression to assess the observational association between IR (measured by HOMA-IR) and COPD. For genetic analysis, genetic variants strongly associated with IR were selected as instrumental variables from GWAS summary data. Two-sample MR analyses were conducted using inverse-variance weighted (IVW), weighted median, and MR-Egger regression, with rigorous testing for pleiotropy and heterogeneity. RESULTS: Observational analysis showed no significant association before confounder adjustment (P=0.166). After adjustment, moderate IR levels (third quintile) were associated with increased COPD risk (OR=2.24, 95% CI: 1.15-4.37, P=0.018). MR analysis revealed inconsistent estimates: IVW suggested a weak risk effect (OR=1.009, P<0.001), while MR-Egger indicated a protective effect (OR=0.998, P=1.54e-05). The MR-Egger intercept test detected significant horizontal pleiotropy (P<2e-16), indicating that genetic instruments influence COPD through pathways independent of IR, violating a key MR assumption. The genetic effect sizes were extremely small and not clinically meaningful. CONCLUSION: This integrated analysis does not support an independent causal role of IR in COPD. The observational association is confounded and non-linear, while genetic evidence is undermined by substantial pleiotropy. Therefore, IR should be regarded as a comorbid risk marker reflecting a systemic metabolic-inflammatory state rather than a direct causal target. For COPD patients with comorbid IR, clinical management should shift from targeting a single metabolic parameter toward a comprehensive strategy grounded in smoking cessation and pulmonary rehabilitation, alongside active management of obesity and dyslipidemia. Future research should prioritize elucidating the common upstream mechanisms linking metabolic dysregulation and lung function decline.
Accurate Asthma-COPD Overlap Classification via Deep Transfer Learning in Medical Image Segmentation.
Ye W, Mo D, Yang Y
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42040644 · Full text
Differentiating asthma from chronic obstructive pulmonary disease (COPD) remains challenging in clinical practice, and asthma-COPD overlap (ACO) lacks universally accepted diagnostic criteria. In this study, we propose a...
Differentiating asthma from chronic obstructive pulmonary disease (COPD) remains challenging in clinical practice, and asthma-COPD overlap (ACO) lacks universally accepted diagnostic criteria. In this study, we propose a chest computed tomography (CT) image segmentation framework based on deep transfer learning to support imaging-assisted ACO-related classification as a proof-of-concept approach. Experiments were performed in a single-center cohort of patients with asthma, COPD, and ACO. Model performance was evaluated using classification accuracy and segmentation Dice similarity coefficient against expert-annotated reference masks. In addition, lung function parameters, inflammatory biomarkers, and ACT/CAT scores were summarized to characterize cohort profiles and assist clinical interpretation; these variables were not predicted by the AI model. The proposed approach achieved the highest ACO classification accuracy (93.21%), outperforming NUS-PSL (85.43%) and PRE-1000C (86.92%). These findings suggest potential utility for imaging-assisted ACO-related classification within this internal single-center evaluation. Further multi-center external validation and robustness analyses are warranted before conclusions regarding stability and generalizability can be made.
Differences in Clinical Characteristics of AECOPD Patients with or without Isolation from the Lower Respiratory Tract.
Wei X, Li X, Deng J … +7 more , Wu X, Zhang Y, Liu R, Liang Q, Wu C, Zhang H, Zhang J
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42040643 · Full text
BACKGROUND: species are frequently found in the lower respiratory tract (LRT) of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), but the clinical significance is uncertain. This study...
BACKGROUND: species are frequently found in the lower respiratory tract (LRT) of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), but the clinical significance is uncertain. This study compared the clinical differences between AECOPD patients with and without in their LRT and assessed the impact on disease outcomes. METHODS: We conducted a retrospective case-control study on AECOPD patients hospitalized at the First Affiliated Hospital of Guangxi Medical University. Demographic characteristics, clinical data, and follow-up data were compared between AECOPD patients with and without isolated from their LRT. Univariate and multivariate logistic regression analyses were performed to identify risk factors for AECOPD. Survival curves for the patients with and without -positive LRT samples were calculated using the Kaplan-Meier method. RESULTS: A total of 225 hospitalized AECOPD patients were included in the study, 88 of whom had isolated from their LRT, while 137 did not. The -positive group had a greater pack-year history and higher COPD Assessment Test (CAT) scores compared to the -negative group. The proportion of patients with Modified Medical Research Council (mMRC) grade 4, Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) grade 4 and hospitalizations for AECOPD in the past year were higher in the -positive group. Peripheral blood lymphocytes, CD8 T-lymphocytes and percent predicted forced expiratory volume in 1 s (FEV) were significantly lower in the -positive group ( < 0.05). Patients without survived significantly longer than those with ( < 0.001). The presence of and mMRC grade 4 were independent risk factors for both acute exacerbation and hospitalization in the past year. CONCLUSION: Positive C isolation and mMRC grade 4 are independent risk factors for AECOPD. in the LRT of COPD patients may predict more severe clinical symptoms, greater airflow limitation, and poorer survival outcomes.
Beyond the Lungs: A Narrative Review of Cardiopulmonary Risk Reduction and Management Perspectives in Thai COPD Patients.
Maneechotesuwan K, Juthong S, Sangsayunh P … +6 more , Ratanawatkul P, Vathesatogkit P, Yingchoncharoen T, Chirakarnjanakorn S, Wong CK, Sriprasart T
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42028156 · Full text
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide and results in chronic lung damage and airway obstruction, significantly impacting individual health. Apart from increased all-c...
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide and results in chronic lung damage and airway obstruction, significantly impacting individual health. Apart from increased all-cause mortality, COPD exacerbations are associated with higher rates of cardiovascular (CV) events-driven by shared risk factors and pathophysiological mechanisms-with peaks in the first 30 days of post-exacerbation. Therefore, cardiopulmonary risk management is essential during this vulnerable period. This narrative review was developed through an evaluation of clinical studies, guideline recommendations and Thailand-specific data to outline cardiopulmonary linkage in COPD and propose post-COPD exacerbation management. Patient management strategies include optimized pharmacological and non-pharmacological therapies, integrated cardiopulmonary care and CV risk assessment to reduce exacerbations, mortality and CV-related events, particularly in COPD patients with established or suspected CV diseases. Furthermore, implementation of these concepts should emphasize strengthening multidisciplinary awareness among pulmonary and cardiology through professional education, continuing-development activities and integration of collaborative care into national guidelines.
Pharmacist-Led Integrated Management for Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.
Li X, Ma X, Qin W … +3 more , Shi C, Liu L, Wang C
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42021780 · Full text
PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, and suboptimal medication management contributes to exacerbations and preventable healthcare utilization. Pha...
PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, and suboptimal medication management contributes to exacerbations and preventable healthcare utilization. Pharmacist-led integrated care has the potential to improve medication use and clinical outcomes. We conducted a systematic review and meta-analysis to evaluate the effects of pharmacist-led interventions in COPD. METHODS: This systematic review and meta-analysis was conducted and reported in accordance with PRISMA 2020. We searched PubMed, Embase, and Web of Science from inception until June 23, 2025. Randomized controlled trials (RCTs) assessing the effects of pharmaceutical care on clinical outcomes in COPD patients were included. A random-effects model was used to estimate pooled relative risks (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias was assessed using the Cochrane Risk of Bias tool. RESULTS: A total of 11 randomized controlled trials involving 2313 participants were included. Pharmacist-led interventions were associated with a lower risk of exacerbation-related hospital admissions (RR = 0.43, 95% CI: 0.33-0.55). Improvements in medication adherence and higher smoking cessation rates were also observed. Improvements in health-related quality of life were reported; however, substantial heterogeneity was present. In contrast, effects on COPD Assessment Test scores and objective disease measures, including lung function, were non-significant. Overall study quality was variable, with many trials being small and at high risk of bias. CONCLUSION: Pharmacist-led interventions in COPD may improve selected medication-related and patient-centered outcomes; however, the available evidence is heterogeneous and limited by study quality and inconsistent effects across outcomes. These findings should be interpreted cautiously, and well-designed, adequately powered trials with standardized outcomes are needed before robust conclusions regarding clinical effectiveness can be drawn.
Comparison of Tools for Nutrition Assessment in Stable Subjects with Chronic Obstructive Pulmonary Disease: Which is the Best Mortality Predictor in Real Clinical Practice?
Nishimura K, Kusunose M, Shibayama A … +1 more , Nakayasu K
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42021779 · Full text
PURPOSE: Malnutrition is associated with poor outcomes in chronic obstructive pulmonary disease (COPD), but the prognostic value of different nutritional assessment tools in outpatient settings remains unclear. We aimed...
PURPOSE: Malnutrition is associated with poor outcomes in chronic obstructive pulmonary disease (COPD), but the prognostic value of different nutritional assessment tools in outpatient settings remains unclear. We aimed to identify which of five commonly used nutritional indicators best predicts all-cause mortality in stable COPD in real-world clinical practice. PATIENTS AND METHODS: This secondary analysis of a prospective, hospital-based observational cohort included 141 outpatients with stable COPD. Nutritional status was assessed using body mass index (BMI), percent ideal body weight (%IBW), geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) score. Patients were categorized as malnourished or well-nourished according to established cut-off values, including PNI <45 as a widely used threshold for malnutrition. Associations with all-cause mortality over a median follow-up of 54 months were examined using Cox proportional hazards models. Multivariate analyses adjusted for age, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, and COPD Assessment Test (CAT) score, and model fit was compared using Akaike's Information Criterion (AIC). RESULTS: During follow-up, 29 deaths (20.6%) occurred. The proportion classified as malnourished ranged from 7.8% (PNI <45) to 25.5% (CONUT ≥2). In multivariate analyses, only PNI <45 remained significantly associated with mortality (adjusted hazard ratio 3.85; 95% confidence interval 1.33-11.13; p = 0.013) and provided the best AIC among the five tools. Kaplan-Meier curves demonstrated significantly poorer survival in the low PNI group (log-rank p < 0.001). CONCLUSION: Among five simple nutritional assessment tools, only PNI independently predicted long-term mortality in stable COPD. Given its simplicity, objectivity, and reliance on routinely available laboratory parameters, PNI appears to be a practical marker to support risk stratification and guide proactive management in outpatient COPD care.
Mendelian Randomization Study in East Asian Populations Supports the Causal Relationship Between Blood Metabolites and COPD: Insights from Amino Acids, Phospholipids, Vitamin D, and Trace Elements.
Guo S, Li Z, Wei M … +6 more , Hu L, Jiang S, Yang F, Yang Z, Zhu X, Shen X
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42016165 · Full text
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the most common respiratory disease among middle-aged and older adults worldwide, and its etiology remains incompletely understood. As intermediate products of...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the most common respiratory disease among middle-aged and older adults worldwide, and its etiology remains incompletely understood. As intermediate products of biochemical reactions, blood metabolites have a debated role in the pathogenesis of COPD, with observational studies yielding conflicting results. Most existing genetic studies are based on European cohorts, whereas East Asian populations differ substantially in genetic architecture and environmental exposures, limiting the generalizability of current findings. METHODS: We performed two-sample Mendelian randomization (MR) leveraging the most recently released summary statistics from large-scale genome-wide association studies (GWAS) in East Asian populations. Independent SNPs significantly associated with circulating metabolite levels were selected from multiple East Asian datasets as instrumental variables (3432 Chinese participants, 2022). Outcome data were obtained from two independent East Asian COPD GWAS cohorts: ebi-a-GCST90018587 (4017 cases, 162,653 controls, BioBank Japan, 2021) and bbj-a-103 (3315 cases, 201,592 controls, BioBank Japan, 2019). Inverse-variance weighting (IVW) served as the primary estimator, with sensitivity analyses conducted using MR-Egger regression, the weighted median, and additional complementary approaches. RESULTS: Seven blood metabolites showed suggestive causal links with COPD. In the ebi-a-GCST90018587 cohort, genetically predicted platelet count was positively associated with COPD risk (OR = 1.51, 95% CI 1.01-2.27, = 0.0467), and in the bbj-a-103 cohort higher genetically predicted manganese levels likewise indicated increased risk (OR = 1.27, 95% CI 1.00-1.62, = 0.0460). Conversely, higher genetically predicted levels of leucine (OR = 0.56, 95% CI 0.34-0.91, = 0.0197), alpha-aminoadipic acid (OR = 0.75, 95% CI 0.59-0.96, = 0.0208), serum-alanine-transaminase (ALT)(OR = 0.87, 95% CI 0.76-0.99, = 0.0345), phosphoethanolamine (OR=0.75, 95% CI 0.56-1.00, = 0.0500), and 25-hydroxyvitamin-D2 (OR = 0.81, 95% CI 0.70-0.94, = 0.0045) were associated with lower COPD risk, with phosphoethanolamine and 25-hydroxyvitamin-D2 showing concordant directions and comparable effect sizes across the two independent COPD GWAS cohorts. For all exposures, Cochran's Q tests and MR-Egger intercepts indicated no significant heterogeneity (), and Steiger directionality tests () did not suggest reverse causation. CONCLUSION: Leveraging large East Asian cohorts, this study provides MR evidence implicating amino-acid metabolism, phospholipid metabolism, vitamin D status, and selected trace elements in COPD pathophysiology. The replicated protective signals for phosphoethanolamine and 25(OH)D, and the risk signals for platelet count and manganese, offer East Asian-specific genetic support for metabolically oriented prevention and precision interventions.
Predictive Value of the COPD Assessment Test Combined with Five-Repetition Sit-to-Stand Test for Impaired Exercise Tolerance in Primary Care COPD Patients: A Comparative Study with Cardiopulmonary Exercise Testing.
Yang T, Qumu S, Ren X … +6 more , Yu C, Duan R, Wang S, Wang X, Yang T, Jiang S
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42016164 · Full text
PURPOSE: This study aimed to determine the longitudinal trends of impaired exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) and to evaluate the predictive value, agreement, and longitudina...
PURPOSE: This study aimed to determine the longitudinal trends of impaired exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) and to evaluate the predictive value, agreement, and longitudinal stability of the COPD Assessment Test (CAT) combined with the the Five-Repetition Sit-to-Stand Test (5STS) in relation to cardiopulmonary exercise testing. PATIENTS AND METHODS: This exploratory, prospective, 12-month cohort study consecutively enrolled 100 patients with stable COPD who attended the outpatient clinic of the Department of Respiratory and Critical Care Medicine at China-Japan Friendship Hospital from January 2021 to October 2025. Impaired exercise tolerance group was defined as a predicted percentage of peak oxygen uptake (peak VO) < 85%, as measured by CPET. Patients were evaluated for Physical Fitness at baseline and 12 months using the following tools: modified Medical Research Council (mMRC) questionnaire, CAT score, 5STS, Hand Grip Strength (HGS), Timed Up and Go (TUG) test, and Quadriceps maximal voluntary contraction (QMVC). RESULTS: At baseline, 58% of COPD patients exhibited impaired exercise tolerance. A statistically significant difference (P < 0.05) was observed in CAT score and 5STS results between the impaired exercise tolerance group and the normal exercise tolerance group. The combined CAT score and 5STS demonstrated a sensitivity of 52.5%, a specificity of 92.7%, and an area under the receiver operating characteristic curve (AUC) of 0.759 (95% CI: 0.666-0.852, P < 0.001) for identifying impaired exercise tolerance, indicating that this combination is most effective for ruling in the impairment. Agreement analysis with peak VO demonstrated that the CAT score and 5STS showed fair agreement, with consistently moderate predictive value across all time points. CONCLUSION: The combined application of the CAT score and the 5STS provides both screening and longitudinal monitoring capabilities, indicating potential for identifying patients with COPD at high risk of impaired exercise tolerance in primary care.
Mechanical Forces and Mechanotransduction in COPD: Pathogenesis, Clinical Phenotypes, and Therapeutic Implications.
Li J, Qin E, Zhang C … +5 more , Yu Y, Liu L, Sun J, Pu G, Tang J
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42006599 · Full text
Chronic obstructive pulmonary disease (COPD) remains a leading cause of global morbidity and mortality. Despite advances in therapy, its complex pathogenesis involves mechanisms beyond the traditional paradigms of inflam...
Chronic obstructive pulmonary disease (COPD) remains a leading cause of global morbidity and mortality. Despite advances in therapy, its complex pathogenesis involves mechanisms beyond the traditional paradigms of inflammation and protease-antiprotease imbalance. Emerging evidence indicates that COPD is also shaped by important mechanobiological processes, in which altered airway mechanics, parenchymal destruction, and respiratory muscle dysfunction create a pathological physical environment. In this narrative review, we synthesize current knowledge on how abnormal mechanical forces are sensed by key mechanosensors-including integrins, Piezo channels, and YAP/TAZ-and transduced into biochemical signals that drive chronic inflammation, fibrosis, and defective repair. We further discuss how these mechanotransduction feedback loops perpetuate structural injury and may help explain the clinical heterogeneity observed across airflow obstruction, emphysema, and exacerbation-prone phenotypes. Furthermore, we discuss therapeutic strategies, positioning pulmonary rehabilitation, lung volume reduction, and ventilation as interventions that restore mechanical homeostasis. Finally, we highlight the emerging possibility of targeting mechanosensitive pathways (e.g. ROCK and YAP/TAZ inhibitors) and utilizing mechanobiology-informed regenerative medicine. By integrating biomechanics with clinical management, this review provides a conceptual framework that may inform future efforts to move beyond symptomatic palliation toward more mechanism-based and potentially disease-modifying strategies in COPD.
A Nomogram for Predicting 5-Year Risk of New-Onset Type 2 Diabetes in Patients with COPD: A Two-Center Retrospective Cohort Study.
Pan J, Chen F, Liao W … +9 more , Ye W, Chen B, Lu T, Li K, Liu F, Deng X, Sun T, Chen R, Yao W
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 42006598 · Full text
PURPOSE: Type 2 diabetes mellitus (T2DM) often coexists with chronic obstructive pulmonary disease (COPD) and is accompanied by adverse outcomes, including high mortality. We developed and externally validated a nomogram...
PURPOSE: Type 2 diabetes mellitus (T2DM) often coexists with chronic obstructive pulmonary disease (COPD) and is accompanied by adverse outcomes, including high mortality. We developed and externally validated a nomogram to predict the 5-year new-onset T2DM risk in COPD patients without prior diabetes. PATIENTS AND METHODS: Patients hospitalized for COPD between May 2018 and December 2019 were enrolled and followed until December 2024. The development cohort was randomly divided into training and internal validation sets at a 7:3 ratio. In the training set, predictors were selected via least absolute shrinkage and selection operator (LASSO) regression and used to construct a nomogram. Model discrimination was evaluated by the receiver operating characteristic (ROC) curve with the area under the curve (AUC). Calibration curves and decision curve analysis (DCA) were used to assess calibration and clinical utility. RESULTS: A total of 998 patients in our development cohort, 153 (15.3%) developed new-onset T2DM during follow-up. The final nomogram contained four predictors: Triglyceride-glucose index (TyG), hypertension (HTN), cardiovascular disease (CVD), and high-density lipoprotein (HDL). The AUCs in the training and internal validation sets were 0.749 and 0.758. External validation in an independent cohort of 1,018 patients, including 132 incident T2DM cases, produced an AUC of 0.798. DCA plots showed net clinical benefit across clinically relevant thresholds. CONCLUSION: This nomogram demonstrated good discrimination and calibration, and may facilitate risk stratification for T2DM among COPD patients.
A Proposed Checklist for Optimizing COPD Patient Discharge Processes in Italian Internal Medicine Wards.
Benetti A, Fiorelli EM, Grassi D … +1 more , Montano N
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41988433 · Full text
Chronic obstructive pulmonary disease (COPD) is a major cause of hospital admissions and readmissions, particularly following acute exacerbations. The immediate post-discharge period is a vulnerable phase, often marked b...
Chronic obstructive pulmonary disease (COPD) is a major cause of hospital admissions and readmissions, particularly following acute exacerbations. The immediate post-discharge period is a vulnerable phase, often marked by clinical instability, poor adherence, and unaddressed needs related to inhaler use, comorbidities and rehabilitation. Despite guideline recommendations, key evidence-based interventions are often overlooked in hospital discharge processes, particularly in internal medicine wards where COPD may not be the primary focus. We conducted a targeted literature search using Medline/PubMed, screening approximately 240 relevant articles that support interventions across key domains of COPD discharge care. Building on this evidence, this narrative review and expert opinion aims to raise awareness and prompt systematic implementation of essential post-discharge care components and propose a structured COPD discharge checklist aimed at standardizing care and improving post-discharge outcomes. These include initiation of smoking cessation support, optimization of maintenance therapy, assessment and correction of inhaler technique, evaluation of vaccination status, referral to pulmonary rehabilitation, scheduling of early follow-up visits, and structured patient education on self-management strategies. The checklist is grounded in current evidence demonstrating that comprehensive discharge bundles reduce 30-day readmissions, enhance quality of life, and prevent further clinical deterioration. Early pulmonary rehabilitation, particularly within 3 weeks post-discharge, and timely initiation of appropriate pharmacotherapy, including triple inhaled therapy when indicated, further reduce exacerbation risk and healthcare utilization. By integrating these elements into a concise and actionable format, the checklist aims to support internists in delivering high-quality, standardized COPD care during hospital discharge. Broad adoption may improve care transitions, promote adherence to best practices, and ultimately enhance outcomes for patients with COPD.
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