International Journal Of Chronic Obstructive Pulmonary Disease[JOURNAL]
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200 papers
Pulmonary-Intestinal Axis: Shared Genetic Basis and Mediating Factors Identified Through Multi-Omics Analysis.
Zhang Z, Liu H, Su Y … +7 more , Wang C, Wang W, Li Y, Zhang X, Gao C, Tian X, Zhao C
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41978582 · Full text
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a systemic condition with comorbidities beyond the lung (eg, cardiovascular and metabolic disorders), and gastrointestinal (GI) disorders are also common. The s...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a systemic condition with comorbidities beyond the lung (eg, cardiovascular and metabolic disorders), and gastrointestinal (GI) disorders are also common. The shared genetic basis of COPD-GI comorbidity and its mediating factors remain unclear. We hypothesized that COPD and GI diseases share pleiotropic genetic architecture implicating lipid-metabolic pathways, with smoking mediating part of the association. METHODS: We analyzed publicly available European-ancestry GWAS summary statistics for COPD (Global Biobank Meta-analysis Initiative), 15 GI diseases (FinnGen), and smoking phenotypes (UK Biobank). Genetic correlation was estimated using linkage disequilibrium score regression (LDSC) and high-definition likelihood (HDL). Multi-trait analysis of GWAS (MTAG) boosted COPD discovery by leveraging genetically correlated GI traits. We integrated locus-to-gene mapping with multi-tissue expression quantitative trait loci (eQTL) and plasma protein quantitative trait loci (pQTL) evidence to prioritize shared loci, genes, and proteins. Bidirectional two-sample Mendelian randomization (MR) tested causal directions, and two-step mediation MR evaluated smoking. RESULTS: COPD showed significant genetic correlation with nine GI diseases. We identified six comorbidity-associated loci (three with CADD > 12.37) and 13 unique candidate pleiotropic genes; APOE was supported by proteomic evidence. Enrichment analyses highlighted lipid-metabolism pathways. MR suggested COPD increases risk of gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), acute appendicitis, and gastric ulcer, while diverticular disease showed reverse causality toward COPD. Smoking partially mediated the COPD effect on GERD, acute appendicitis, and gastric ulcer. CONCLUSION: COPD and multiple GI disorders share a distributed pleiotropic genetic basis within the broader systemic comorbidity spectrum of COPD. Multi-omics evidence supports a genomic pulmonary-intestinal axis in which lipid metabolism and smoking-related mechanisms contribute to COPD and GI comorbidity, providing targets for risk stratification and potential intervention.
Beyond Reported Rates: Detection-Adjusted COPD Prevalence and Underdiagnosis Patterns in Colombia.
Ospina J, Garcia-Morales OM, Gaviria MC
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41973165 · Full text
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed in Colombia, especially in rural departments with limited access to spirometry. We conducted a department-level ecological study using agg...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed in Colombia, especially in rural departments with limited access to spirometry. We conducted a department-level ecological study using aggregated administrative data from 2020-2023 to generate diagnosis-based COPD prevalence estimates that explicitly account for regional disparities in diagnostic capacity and socioeconomic conditions. METHODS: We assembled department-year data from the Individual Registry of Health Services Delivery, national mortality statistics, and the National Quality of Life Survey. A Bayesian generalized additive model with a Gamma family and log link was fitted to a Composite Bias-Correction Multiplier that captured under-ascertainment as a function of spirometry utilization, COPD lethality, outpatient contact rates, multidimensional poverty, household fuel type, and age structure. Posterior estimates of this multiplier were applied to diagnosis-based COPD prevalence in adults aged ≥40 years to obtain detection-adjusted departmental and national estimates. Model performance was summarized using the Bayesian R (proportion of variability in the multiplier explained by the covariates) and the leave-one-out information criterion (LOOIC) as a measure of expected predictive fit. RESULTS: The model estimated a population-weighted national COPD prevalence of 2.22% (95% credible interval [CrI], 2.21-2.23). Detection-adjusted departmental prevalence ranged from 0.81% in Vichada to 3.50% in Caldas, whereas diagnosis-based prevalence ranged from 0.27% to 2.22%. Spirometry utilization correlated strongly with diagnosis-based prevalence (r = 0.85, p < 0.001), and departments with higher COPD lethality and greater multidimensional poverty required larger adjustment multipliers. The model explained most of the variability in the Composite Bias-Correction Multiplier (Bayesian R = 0.99) and showed good expected predictive performance (LOOIC = -461.1). CONCLUSION: COPD prevalence in Colombia shows marked regional heterogeneity driven by demographic risk and uneven diagnostic capacity. Detection-adjusted estimates indicate that the highest burden lies in Andean departments such as Caldas, Boyacá, and Risaralda, while remote Amazon and Orinoco territories experience substantial underdiagnosis. These findings support targeted expansion of spirometry and chronic respiratory care in underserved regions and illustrate how accounting for detection bias can improve chronic disease surveillance in low- and middle-income settings.
Understanding Nebulizer Utilization by Patients and Healthcare Providers: A COPD Foundation Nebulizer Consortium Survey Study.
Melamed KH, Martinez S, Cambridge L … +20 more , Christiani DC, Li J, Ohar J, Dhand R, Drummond MB, Ari A, Radonovich LJ, Tashkin D, Dartt M, Perera A, Schloss J, Cochran L, Mannino D, Locantore N, Johnson K, Lacy MK, Berlinski A, Gilchrist K, Barjaktarevic I, COPD Foundation Nebulizer Consortium
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41947785 · Full text
RATIONALE: Inhaled medications are the mainstay of chronic obstructive pulmonary disease (COPD) management. While consensus guidelines for pharmacological management in COPD are well-established, few guidelines exist reg...
RATIONALE: Inhaled medications are the mainstay of chronic obstructive pulmonary disease (COPD) management. While consensus guidelines for pharmacological management in COPD are well-established, few guidelines exist regarding inhaled medication delivery systems. The COPD Foundation Nebulizer Consortium conducted a cross-sectional survey of patients with COPD and healthcare providers to understand their perceptions and utilization of nebulized medications. METHODS: An online survey was conducted from February 7 through April 9, 2024. Patients completed a 42-question survey, including demographic information, tobacco use, symptoms severity, and the role of nebulizers in their treatment. Healthcare providers responded to a 17-question survey about their clinical experience with nebulized medications. RESULTS: We analyzed responses from 347 patients and 39 healthcare providers. Among patients, 76.4% (265/347) were ≥65 years old, 72.0% (250/347) were female, 93.4% (324/347) were white, 90.5% (314/347) had a current or former smoking history, 77.6% (263/339) reported at least one exacerbation in the past year, and 70.8% (240/339) used some form of supplemental oxygen. Nebulizer use was reported by 84.1% (292/347) of patients. Among nebulizer users, 94.5% (276/292) used short-acting while only 22.3% (65/292) used long-acting nebulized medications. Patients reported that hand-held inhaler devices were easier to use (69.8%, 171/245), but nebulized therapy led to better symptom control (64.9%, 159/245) and had lower copays (67.8%, 166/245). Among prescribers surveyed, most (82.1%, 32/39) believed nebulizers were preferable for patients experiencing exacerbations. Impediments to wider use of nebulizers included difficulties with insurance coverage (69.2%, 27/39), cost (53.8%, 21/39), and lack of combination nebulized drugs (46.2%, 18/39). Two-thirds of providers thought that nebulizers were underused. CONCLUSION: We demonstrate that while patients and providers both perceive nebulizers as preferred in clinical management of COPD, there is discordance between patient and provider perception of nebulizer use on the basis of cost and feasibility of use.
Participation of miRNA-23a-3p in Pulmonary Tuberculosis Through Macrophages via the JAK-STAT Pathway.
Chang W, Li Z, Liang Q … +2 more , Liu T, Li F
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41947784 · Full text
BACKGROUND: This study investigated the role of miR-23a-3p in the pathogenesis of tuberculosis (TB)-associated obstructive pulmonary disease (TOPD) and its regulatory impact on THP-1 macrophages via the Janus kinase (JAK...
BACKGROUND: This study investigated the role of miR-23a-3p in the pathogenesis of tuberculosis (TB)-associated obstructive pulmonary disease (TOPD) and its regulatory impact on THP-1 macrophages via the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) signaling pathway. METHODS: Patients with TOPD, TB patients without airflow obstruction (only TB), and healthy controls were recruited. Peripheral blood mononuclear cells were isolated, followed by RNA-seq analysis to identify differentially expressed microRNAs. Gene set enrichment analysis was used to identify enriched biological pathways. Additionally, enzyme-linked immunosorbent assays, Western blot, and flow cytometry were used to explore the miR-23a-3p-mediated modulation in macrophages (such as apoptosis and polarization) via the JAK-STAT pathway. RESULTS: RNA-seq analysis identified miR-23a-3p as being significantly upregulated in TOPD patients. Bioinformatics analysis indicated that miR-23a-3p targets regulation of the JAK-STAT pathway. Overexpression of miR-23a-3p in macrophages led to decreased JAK1 protein expression and reduced levels of phosphorylated JAK1 and STAT1. Functional assays revealed that miR-23a-3p mitigates macrophage apoptosis and macrophage polarization as well as influences inflammatory cytokine production. CONCLUSION: miR-23a-3p regulates TOPD pathogenesis by modulating macrophage inflammation, apoptosis, and differentiation via the JAK-STAT pathway, making it a promising immunotherapeutic target for future treatments.
Pulmonary Rehabilitation with Airway Clearance Techniques Improves Mucus Hypersecretion and Clinical Outcomes in COPD: A Retrospective Study.
Li H, Li M, Liu W … +1 more , Wang D
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41947783 · Full text
OBJECTIVE: To evaluate the effects of a pulmonary rehabilitation (PR) program incorporating airway clearance techniques Active Cycle of Breathing Technique (ACBT) and Oscillatory Positive Expiratory Pressure (OPEP) on mu...
OBJECTIVE: To evaluate the effects of a pulmonary rehabilitation (PR) program incorporating airway clearance techniques Active Cycle of Breathing Technique (ACBT) and Oscillatory Positive Expiratory Pressure (OPEP) on mucus hypersecretion, pulmonary function, and quality of life in patients with chronic obstructive pulmonary disease (COPD). METHODS: This single-center, retrospective observational study included 118 hospitalized patients with stable moderate COPD and sputum hypersecretion between April 2024 and July 2025. Patients received either PR combined with ACBT and OPEP (PR+ACBT/OPEP, n = 56) or conventional PR with basic breathing training (n = 62). Primary outcomes were sputum volume, sputum viscosity, and responder rate (≥20% viscosity reduction). Secondary outcomes included pulmonary function parameters, symptom burden assessed by the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) scale, and treatment adherence. RESULTS: Baseline characteristics were comparable between groups. Adherence was high in both groups, and no serious adverse events were observed. At discharge, the PR+ACBT/OPEP group demonstrated significantly greater reductions in sputum volume (-6.8 mL; P < 0.001) and viscosity (-46 mPa·s; P < 0.001) than controls, with a higher responder rate (69.6% vs. 29.0%). Improvements in pulmonary function were more pronounced in the PR+ACBT/OPEP group, including FEV, FEV%pred, and small-airway indices. Symptom burden was also reduced, with greater declines in CAT scores and a higher proportion of patients achieving the minimal clinically important difference. The mMRC grade improved in the PR+ACBT/OPEP group but remained unchanged in controls. CONCLUSION: In this retrospective, single-center study, the integration of ACBT and OPEP into pulmonary rehabilitation was associated with improved mucus clearance, lung function parameters, and patient-reported outcomes in COPD patients with chronic sputum hypersecretion. These findings should be interpreted as exploratory and hypothesis-generating, supporting the potential role of airway clearance techniques within pulmonary rehabilitation and warranting confirmation in prospective, multicenter studies.
Prognostic Value of Impaired Spirometry in Patients with Myocardial Infarction: A Longitudinal Study of Two European Cohorts.
Sundh J, Parker WAE, Oldgren J … +20 more , Andell P, Reitan C, Jernberg T, Hofmann R, Mohammad MA, Erlinge D, Åkerblom A, Sederholm Lawesson S, Konstantinidis KV, Lindbäck J, Janson C, Björkenheim A, Elamin N, McMellon H, Moyle B, Patel M, El Khoury J, Surujbally R, James S, Storey RF
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41947782 · Full text
PURPOSE: The study aimed to investigate the associations between impaired spirometry such as obstructive pattern and preserved ratio impaired spirometry (PRISm) and occurrent cardiovascular events and deaths in patients...
PURPOSE: The study aimed to investigate the associations between impaired spirometry such as obstructive pattern and preserved ratio impaired spirometry (PRISm) and occurrent cardiovascular events and deaths in patients with acute myocardial infarction. PATIENTS AND METHODS: Cohort study of 517 patients with age ≥40 years and ≥10 pack-years of smoking, hospitalized for myocardial infarction at eight sites in Sweden and the United Kingdom. The Vitalograph COPD-6 device was used to assess the ratio of forced expiratory volume in 1 and 6 seconds (FEV/FEV) and FEV as a percentage of the predicted value (FEV%pred). Obstructive pattern was defined as FEV/FEV <0.7, PRISm as FEV/FEV >0.7 and FEV%pred <80, and normal findings as FEV/FEV ≥0.7 and FEV%pred ≥80. Follow-up data were obtained from national registers or follow-up visits. Multivariable Cox regression was used to analyze the associations of obstructive pattern and PRISm with the incidence of acute ischemic cardiovascular events or major adverse cardiovascular events (MACE), respectively, within one year. RESULTS: Obstructive pattern was found in 95 (18%), PRISm in 192 (37%) and normal spirometry in 230 (45%) patients. A cardiovascular event occurred in 21 (4%) and MACE in 28 (5%). Compared with normal spirometry, PRISm was independently associated with both new cardiovascular events (HR (95% CI) 3.44 (1.07-11.0)) and MACE (4.94 (1.63 to 15.0)), and obstructive pattern with MACE (3.87 (1.08-13.8)). Further adjustment for cardiac or COPD treatment did not substantially change the results. CONCLUSION: About half of patients with acute myocardial infarction and a ≥10 pack-year smoking history have abnormal spirometry findings. Both obstructive pattern and PRISm are independently associated with increased risk for MACE within one year. We suggest that spirometry should be considered as a routine assessment in patients with smoking history and recent myocardial infarction.
Cardiopulmonary Exercise Testing for Prognostic Assessment of Clinical Outcomes in COPD: A Systematic Review and Meta-Analysis.
Staes M, Dong J, Gyselinck I … +2 more , Everaerts S, Janssens W
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41947781 · Full text
Chronic obstructive pulmonary disease (COPD) is a heterogeneous, progressive lung disorder. Despite its high prevalence, predicting clinical outcomes remains challenging. Various cardiopulmonary exercise testing (CPET) v...
Chronic obstructive pulmonary disease (COPD) is a heterogeneous, progressive lung disorder. Despite its high prevalence, predicting clinical outcomes remains challenging. Various cardiopulmonary exercise testing (CPET) variables have been suggested as prognostic markers in COPD, but their role in clinical practice remains unclear. After registration in PROSPERO (ID CRD42024569879), a literature search of the Pubmed, Embase, Web of Science, Cochrane library and Scopus databases was carried out in August 2024. Study selection followed the PRISMA guidelines. Prospective and retrospective cohort studies evaluating associations between CPET variables and clinical outcomes in patients with COPD were included. Risk of bias was evaluated using the QUIPS tool. Data were extracted and synthesized narratively. A random-effects meta-analysis was planned if multiple studies reported comparable CPET variables, outcomes, and effect measures. Sixteen articles were included, three of which had an overall high risk of bias. Peak oxygen uptake (VOpeak) was consistently associated with mortality in univariate analyses, but its independent prognostic value in multivariable models was inconsistent. A random-effects meta-analysis of three studies evaluating VOpeak expressed as mL/kg/min did not demonstrate a statistically significant independent association with mortality (pooled HR 0.94, 95% CI 0.87-1.00; I = 63%). Ventilatory efficiency (VE/VCO) was identified as a significant prognostic marker in multiple studies. Other CPET-derived variables failed to show an independent association with mortality, although heterogeneity in metrics and adjustment strategies limited comparability. Evidence for other CPET-derived variables and for predicting severe acute exacerbations of COPD (AECOPD) or hospitalization was limited and inconsistent. CPET-derived variables, particularly VOpeak and VE/VCO, are associated with mortality in COPD, but evidence for their independent prognostic value and incremental benefit over established composite indices remains limited. Current data do not support routine use of CPET variables for prognostic stratification in COPD, apart from VOpeak as a marker of exercise capacity within the modified BODE index.
Biomarker-Defined Iron Deficiency in Heavy Smokers with and without COPD and/or Emphysema.
Hardang IM, Neumann K, Gjønnes GT … +3 more , Strand TE, Ashraf H, Einvik G
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41947780 · Full text
PURPOSE: Assess whether iron deficiency prevalence in heavy smokers is higher in presence of COPD and/or emphysema, how the prevalence of iron deficiency is impacted by the biomarker used to define it, and examine the pr...
PURPOSE: Assess whether iron deficiency prevalence in heavy smokers is higher in presence of COPD and/or emphysema, how the prevalence of iron deficiency is impacted by the biomarker used to define it, and examine the prevalence of anemia and polycythemia in heavy smokers with or without COPD. PATIENTS AND METHODS: A cross-sectional analysis was conducted on 1002 participants from the Norwegian Early Lung Cancer Screening study. All participants underwent chest CT scans, spirometry, and venous blood sampling to analyze iron-related parameters, C-reactive protein (CRP), and hemoglobin. Iron deficiency was defined using transferrin saturation (TSat) <20%, ferritin < cutoff (CRP-dependent), or a combination of both. RESULTS: The prevalence of iron deficiency varied from 3% to 30%, being highest when defined by TSat <20%, and was more prevalent in participants with COPD. Emphysema was not associated with iron deficiency. Decreasing hemoglobin, increasing soluble transferrin receptor (sTfR) and CRP were associated with TSat <20%. COPD was not independently associated with iron deficiency. Increasing age and sTfR, along with female sex, were associated with ferritin < cutoff. Anemia was more common than polycythemia, with approximately one-third of anemia cases attributable to iron deficiency. CONCLUSION: Iron deficiency was more prevalent in heavy smokers with COPD than in those without, but not in individuals with emphysema. TSat <20% identified significantly more cases of iron deficiency than ferritin < cutoff. Eight percent of participants had anemia, while four percent had polycythemia, with neither condition related to COPD or emphysema.
Optimizing COPD Care in Belgium: A Multidisciplinary Expert Consensus on Cardiopulmonary Risk Management.
Michotte N, Demeure F, Guiot J … +17 more , Trenson S, Vanfleteren MJEGW, Lahousse L, Raskin J, Cataldo D, Lapperre T, Marchand E, Leys M, Janssens W, Bruyneel M, Vanfleteren LEGW, Vanderhelst E, Goeminne P, Teughels S, Lins M, Van Rossem I, Peché R
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41939929 · Full text
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) represents a major health and economic challenge in Belgium, affecting approximately 800,000 individuals, half of whom remain undiagnosed. Beyond respiratory mor...
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) represents a major health and economic challenge in Belgium, affecting approximately 800,000 individuals, half of whom remain undiagnosed. Beyond respiratory morbidity, COPD patients face substantial cardiopulmonary (CP) risk-encompassing severe exacerbations and cardiovascular (CV) events-that is often under-recognized and insufficiently addressed due to limited clinical awareness, fragmented care, and the absence of national guidance. METHODS: A multidisciplinary Belgian taskforce (general practitioners, pulmonologists, cardiologists, pharmacists, epidemiologists) convened through structured workshops and iterative consensus-building to develop a pragmatic, evidence-informed care pathway. The recommendations focus on COPD patients with at least one moderate or severe exacerbation, who are at heightened CP risk. RESULTS: This consensus introduces an integrated, stepwise framework that positions CP risk as a central component of COPD management after exacerbation and operationalizes it across primary care, hospitalization, and post-exacerbation follow-up. Core elements include systematic and proactive CP risk identification in primary care, standardized diagnostic workups during hospitalization, and multidisciplinary discharge planning. Pharmacological strategies combine eosinophil-guided inhaler therapy with guideline-directed CV treatment, while non-pharmacological measures reinforce smoking cessation, vaccination, physical activity, and pulmonary rehabilitation. Clear referral thresholds between primary care, pulmonology, and cardiology are defined, supported by patient education and digital monitoring tools. CONCLUSION: This Belgian consensus complements international guidelines by consolidating fragmented recommendations into coherent, actionable algorithms that bridge gaps in routine practice. Its contribution lies in translating emerging evidence into structured, real-world pathways that integrate respiratory and cardiac care. Adoption of this framework may help reduce exacerbations, improve CV outcomes, and support multidisciplinary COPD care in Belgium.
A Systematic Review and Meta-Analysis of Immunogenicity and Safety of the Influenza Vaccine in COPD Patients, and Its Relevance with Real-World Effectiveness.
Yudhawati R, Aini FN, Wicaksono NF
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41939928 · Full text
OBJECTIVE: A systematic review and meta-analysis was conducted to evaluate the immunogenicity and adverse events of influenza vaccines in patients with chronic obstructive pulmonary disease (COPD) and explored their rele...
OBJECTIVE: A systematic review and meta-analysis was conducted to evaluate the immunogenicity and adverse events of influenza vaccines in patients with chronic obstructive pulmonary disease (COPD) and explored their relevance to real-world vaccine effectiveness (VE). METHODS: A systematic search of PubMed, Cochrane Library (Wiley), Google Scholar, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform using keywords of "influenza vaccine", "immunogenicity", "COPD", and "Chronic Obstructive Pulmonary Disease" to identify relevant studies published up to April 24, 2024. These are randomized controlled trials and cross-sectional, prospective, and observational studies that included COPD patients, particularly those aged ≥50 years, which assessed the immunogenicity of inactivated trivalent and quadrivalent, split-virion influenza vaccines. The outcomes were geometric mean titer (GMT), seroprotection rate (SPR), seroconversion rate (SCR), and safety. RESULTS: Six studies involving 672 participants were retrieved. The pooled SCR in the intradermal subgroup was highest for A/H1N1 (68.6% [95% CI = 48.6-83.5%]) and A/H3N2 (65.8% [95% CI = 57.9-73.0%]). SPR was highest via subcutaneous route, reaching 96.0% for A/H3N2 however only one study was available, hence the findings should be interpreted with caution. The pooled mean difference in GMT was higher for intradermal than intramuscular vaccination, particularly for the A/H1N1 strain (8.38 vs 7.98) and A/H3N2 (7.97 vs 7.44). Local adverse events were more frequent with intradermal vaccination, particularly erythema (31.5%) and swelling (28.7%), while systemic events such as fever were rare (<5%). CONCLUSION: The GMT, SPR, and SCR of influenza vaccination in COPD patients were more robust in laboratory settings than in real-world VE, indicating a gap between antibody responses in real-world clinical practice and laboratory settings.
Inflammation Levels and the Health Impact of Anti-Inflammatory Diets on Chronic Obstructive Pulmonary Disease: An NHANES Study.
Feng T, Yu W
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41939927 · Full text
BACKGROUND: Chronic obstructive pulmonary disease (COPD), the third leading cause of death globally, is closely associated with systemic inflammation in its pathophysiological mechanisms. Previous studies have primarily...
BACKGROUND: Chronic obstructive pulmonary disease (COPD), the third leading cause of death globally, is closely associated with systemic inflammation in its pathophysiological mechanisms. Previous studies have primarily focused on localized airway inflammation, while the relationship between systemic inflammation markers such as the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI)and COPD remains controversial. Additionally, the role of the composite dietary antioxidant index (CDAI) in modulating COPD risk requires further investigation. METHODS: This cross-sectional study used data from NHANES (2007-2012) to investigate the association between systemic inflammation levels and COPD prevalence. SII and SIRI levels were stratified by interquartile range (IQR). Generalized linear models (GLM) combined with logistic regression models were used to analyze the association between SII, SIRI, and COPD risk. Interaction analysis was used to evaluate the modulating effects of CDAI on inflammation levels and COPD risk. RESULTS: A total of 8,601 participants were included in the study, among whom 881 were COPD patients. The analysis revealed that for each 1 IQR increase in SII and SIRI, the OR for COPD prevalence significantly increased by 1.28 (95% CI: 1.12-1.47) and 1.45 (95% CI: 1.26-1.67), respectively. Compared to the lowest SII group (Q1), the prevalence of COPD in the other groups increased by 1.01%, 1.43%, and 3.53%, respectively. Similarly, compared to the lowest SIRI group (Q1), the prevalence of COPD in the other groups increased by 1.54%, 4.08%, and 7.42%, respectively. In the low CDAI population, the risk of COPD associated with SII and SIRI was even higher, with ORs of 1.24 (95% CI: 1.01-1.52) and 1.34 (95% CI: 1.09-1.64), respectively. CONCLUSION: SII and SIRI, as systemic inflammation markers, are closely associated with the risk of COPD. Adjusting dietary patterns may have significant potential to slow the onset and progression of COPD.
Level of Awareness About Chronic Obstructive Pulmonary Disease Among Active Smokers.
Al-Otaibi HM, Homoud MM, Alqarni MM … +3 more , Alsobhi GJ, Al-Otaibi GZ, Alnahdi NA
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41939926 · Full text
BACKGROUND: Smoking is considered the primary cause of chronic obstructive pulmonary disease (COPD). It has been shown that approximately half of smokers develop COPD at some point in their lives. Several studies have ex...
BACKGROUND: Smoking is considered the primary cause of chronic obstructive pulmonary disease (COPD). It has been shown that approximately half of smokers develop COPD at some point in their lives. Several studies have examined COPD awareness in the general population. However, data on awareness among active smokers remain limited. This study aims to assess the level of COPD awareness among current smokers. METHODS: A cross-sectional study was conducted among active smokers. Recruitment was performed via non-probability convenience sampling through commonly used social media platforms. An online survey was utilized to collect data on sociodemographic characteristics, health status, COPD awareness levels, and smokers' perceptions after learning about COPD. Multivariable logistic regression was performed to identify determinants of COPD awareness. RESULTS: The total number of respondents was 455 active smokers. Of those, 342 (75%) were male. The mean age of participants was 35 ± 11 years. Although COPD-related symptoms were reported by 324 participants (71.2% of the total sample), only 91 participants (20%) indicated being aware of COPD. The most common symptoms reported were sputum production (209 participants, 46%), shortness of breath (167 participants, 36.7%), and cough (166 participants, 36.4%). Multivariable logistic regression analysis for determinants of COPD awareness showed that none of the predictors (sex, years of smoking, level of education, and COPD-related symptoms) were statistically significant. Among COPD-related symptoms, coughing (adjusted odds ratio (aOR) = 0.62, 95% confidence interval (CI): 0.35-1.08, p = 0.089) and sputum production (aOR = 1.48, 95% CI: 0.86-2.55, p = 0.160) showed trends toward association with COPD awareness but were still not statistically significant. The most common sources of knowledge about COPD were healthcare providers (34%) and social media platforms (31.8%). CONCLUSION: The level of COPD awareness is low among active smokers, which might hinder early diagnosis and delay timely interventions. Healthcare providers and social media may promote awareness. Therefore, the advocacy role of healthcare providers may need encouragement, and Social media platforms may support culturally tailored COPD awareness campaigns.
Construction and Validation of a Prediction Model for Sustained Smoking Cessation in Patients with Chronic Obstructive Pulmonary Disease.
Tong H, Tian Z, Zhang N … +4 more , Liu X, Zhu H, Jing L, Wang L
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41939925 · Full text
OBJECTIVE: To identify factors associated with smoking relapse or non-attempt within one year in COPD patients and to develop a predictive model for early identification of high-risk individuals to guide targeted interve...
OBJECTIVE: To identify factors associated with smoking relapse or non-attempt within one year in COPD patients and to develop a predictive model for early identification of high-risk individuals to guide targeted interventions. METHODS: Based on the health ecology model, a questionnaire integrating factors affecting smoking cessation was developed. We enrolled 221 COPD patients from a tertiary hospital in Tianjin and categorized them into smoking cessation success or failure groups. Mann-Whitney -tests, -tests, and logistic regression were used to identify predictors. A nomogram prediction model was developed using significant factors. Model performance was evaluated via calibration plot, Hosmer-Lemeshow test, concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC). RESULTS: Among 221 patients, 92 successfully quit smoking and 129 failed. Multivariate analysis identified age (OR = 0.922, P < 0.001), GOLD grade (OR = 0.257, P < 0.001), and death anxiety score (OR = 0.930, P = 0.001) as protective factors against cessation failure, while depression score (OR = 1.107, P < 0.001) and quit-smoking partner complaints score (OR = 1.075, P < 0.001) were risk factors. The prediction model demonstrated good discrimination (C-index = 0.876) and calibration (Hosmer-Lemeshow test P = 0.350). DCA and CIC confirmed the model's clinical utility. CONCLUSION: Younger age, mild/moderate GOLD grade, higher depression score, lower death anxiety, and higher partner complaints increase the risk of smoking cessation failure in COPD patients. The developed model facilitates early identification of high-risk patients for targeted intervention to improve quit rates.
Predicting COPD Exacerbations: From Data Mining to Clinical Decision-Making.
Bellou V
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41939924 · Full text
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Pulmonary Function Decline in Alpha-1 Antitrypsin Deficiency: A Systematic Review and Meta-Analysis.
Turner AM, Wittkopf P, von Wilamowitz-Moellendorff C … +7 more , Fahrbach K, Farraia M, Hagiwara M, Marins EG, Wyman AE, Wang L, Park S
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41939923 · Full text
BACKGROUND: Limited data exist on pulmonary function decline in patients with alpha-1 antitrypsin deficiency (AATD)-associated lung and/or liver disease. This study aimed to conduct a systematic literature review (SLR) a...
BACKGROUND: Limited data exist on pulmonary function decline in patients with alpha-1 antitrypsin deficiency (AATD)-associated lung and/or liver disease. This study aimed to conduct a systematic literature review (SLR) and meta-analysis of pulmonary function decline and associated risk factors, clinical outcomes, and health-related quality of life (HRQoL) in patients with AATD-associated lung and/or liver disease. METHODS: Following PRISMA guidelines, studies were identified from MEDLINE/Embase (2003-2023) using Population, Intervention, Comparison, Outcomes, and Study criteria; key congresses were hand-searched (2021-2023). For each publication, two independent reviewers determined eligibility for inclusion and quality was assessed using relevant JBI tools. Meta-analyses were conducted on select outcomes that were deemed appropriate. RESULTS: Overall, 77 publications were included in the SLR and 32 reported pulmonary function decline in patients with AATD-associated lung and/or liver disease. Eight publications that evaluated forced expiratory volume in 1 second (FEV1) in mL, five that evaluated FEV1% predicted and four that evaluated HRQoL (as measured by St. George's Respiratory Questionnaire [SGRQ]) were deemed eligible for meta-analysis. In patients with AATD-associated lung disease, based on the random effects model, annualized change (95% confidence interval) in FEV1 was -39.1 (-45.2, -32.9) mL/year and -1.1 (-1.2, -0.9) %/year, and there was a slight worsening in SGRQ score (1.3 [0.6, 1.9] points/year). Data in patients with AATD-associated liver disease with or without comorbid lung disease were too limited to calculate an annualized rate of decline in pulmonary function or SGRQ. CONCLUSION: This comprehensive SLR and meta-analysis provides an estimate for annual pulmonary function decline in patients with AATD-associated lung disease and highlights an evidence gap in patients with AATD-associated liver disease with or without comorbid lung disease. Further insights into risk factors or potential biomarkers of pulmonary function decline may support clinical strategies for optimizing treatment.
Global Trends in COPD Self-Management Research: A Dual-Perspective Bibliometric Analysis (January 2005-July 2025).
Huang X, Feng J, Gan X … +4 more , Wu R, Su C, Zheng L, Deng R
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41939922 · Full text
PURPOSE: We looked at research articles published from January 2005 to July 1, 2025. We focused on global trends and key research topics in COPD self-management. PATIENTS AND METHODS: We searched the Web of Science datab...
PURPOSE: We looked at research articles published from January 2005 to July 1, 2025. We focused on global trends and key research topics in COPD self-management. PATIENTS AND METHODS: We searched the Web of Science database thoroughly using the keywords "COPD (Chronic Obstructive Pulmonary Disease)" and "self-management". Most previous meta-analyses and systematic reviews focused only on mediating effects. This study is different. We use a dual-perspective bibliometric method. Apply CiteSpace for co-citation network analysis, and VOSviewer for collaborative structure mapping. This study will look into how regional research affects self-management practices for COPD. It will closely explore the main gaps in the academic community. RESULTS: We reviewed roughly 426 papers and observed that this research area has expanded consistently, peaking between 2020 and 2021. Keyword co-occurrence analysis shows a research framework focused on "chronic obstructive pulmonary disease" and "self-management" We statistically reviewed main author groups and identified 76 prolific researchers with consistent relevant outputs. This number aligns with the field's growing research interest in recent years. Geographically, European and Australian teams prioritize research quality-their work is methodologically rigorous and clinically useful. US, UK and Dutch institutions have more publications and greater academic influence. CONCLUSION: Over the past two decades, the field of COPD self-management has made significant progress. This is due to the long-term work of core authors and the collaboration between top research institutions. This study gives key information to optimize COPD self-management strategies, and points out key areas for future research.
Assessing Lifestyle Goal Setting in Patients with COPD.
Born CDC, Beijers RJHCG, van Iersel LEJ … +8 more , Muijrers IHMJE, Schuurman LT, Gerards SMPL, Simons SO, Gosker HR, van Helvoort A, Schols AMWJ, Crutzen R
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41939921 · Full text
PURPOSE: Healthy lifestyle changes can reduce symptoms and slow disease progression in patients with chronic obstructive pulmonary disease (COPD). To tailor strategies supporting long-term behavior change, this study inv...
PURPOSE: Healthy lifestyle changes can reduce symptoms and slow disease progression in patients with chronic obstructive pulmonary disease (COPD). To tailor strategies supporting long-term behavior change, this study investigated patients' willingness to set lifestyle goals during personalized counseling. Goal focus and content, goal adjustments over time, reasons for unwillingness, barriers and facilitators, and differences between goal setters and non-goal setters were also examined. PATIENTS AND METHODS: As part of an ongoing randomized controlled trial (NCT03807310), patients received monthly phone calls over 12 months, offering lifestyle counseling on diet and physical activity (PA) using motivational interviewing. Data were analyzed for a subset of patients who had completed the trial by 12 February 2025. Baseline trial data were used for patient characterization, and counseling notes were analyzed to assess willingness and factors affecting goal setting. RESULTS: Data from 103 patients (61.2% male, mean age 68.3±6.5 years, body mass index 26.3±4.9 kg/m, FEV1 56.6±18.1% predicted), were analyzed. Overall, 71% were willing to set lifestyle goals, most often focused on PA. About one-quarter adjusted their goals during follow-up due to achievement or health complaints (PA) and previous unsuccessful attempts (diet). Patients unwilling to set goals mainly reported satisfaction with current habits or no perceived need for change. Experienced facilitators included accountability and favorable weather (PA) and visual reminders, social support, and seasonal influences (diet). Barriers were mainly health complaints (PA) and low motivation (diet). No differences were found between goal setters and non-goal setters in demographic, physiological, lifestyle or motivational characteristics. CONCLUSION: A majority of patients with COPD were willing to set lifestyle goals, particularly related to PA, but satisfaction with current behaviors and health-related barriers often limited engagement. These findings provide input for the design of future interventions to support sustainable lifestyle change in COPD care.
Identification of Risk Factors for 30-Day and Frequent One-Year Readmissions in Chronic Obstructive Pulmonary Disease Patients Following Acute Exacerbation.
Ran C, Lian M, Dilixiati N … +4 more , Lin R, Song J, Yang J, Wang J
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41939920 · Full text
OBJECTIVE: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of hospitalization and readmission, severely impacting patients' quality of life and long-term prognosis. This study aimed...
OBJECTIVE: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of hospitalization and readmission, severely impacting patients' quality of life and long-term prognosis. This study aimed to identify risk factors for both 30-day and frequent readmissions within one year following hospitalization for an acute exacerbation of COPD. METHODS: We conducted a retrospective analysis of 1,208 patients hospitalized for acute COPD exacerbations. Patients were categorized based on readmission within 30 days or multiple readmissions in the subsequent year. Univariate and multivariate logistic regression analyses were employed to identify independent risk factors. A predictive nomogram model was developed and internally validated using bootstrapping techniques. RESULTS: For 30-day readmissions, age was identified as an independent risk factor (OR=1.044, 95% CI: 1.008-1.081). For frequent one-year readmissions, multivariate analysis revealed age (OR=1.025, 95% CI: 1.008-1.042) and Anthonisen classification Type I/II (OR=1.556, 95% CI: 1.021-2.369) as independent risk factors, while creatine kinase (CK) acted as a protective factor (OR=0.998, 95% CI: 0.996-1.000). The nomogram demonstrated good predictive performance, with a C-index of 0.730 and an AUC of 0.730 upon internal validation. CONCLUSION: This study identifies age and Anthonisen classification as key risk factors, and CK as a protective factor for readmissions in COPD patients following acute exacerbation. The validated nomogram provides a practical clinical tool for predicting readmission risks, enabling early identification of high-risk patients during hospitalization or at discharge. This risk stratification approach can facilitate implementation of personalized management strategies, such as intensified follow-up or targeted interventions, to reduce readmission rates and improve patient outcomes.
VE-VCO2 Slope During Cardiopulmonary Exercise Test Predicts Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study.
Li X, Lin F, Wu J … +8 more , Zhang J, Liu S, Qiu M, Yuan W, Nie S, Yan F, Xu B, Li Y
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41929909 · Full text
BACKGROUND: Cardiopulmonary Exercise Test (CPET) serves as an integrative assessment tool to evaluate cardiac function, respiratory responses, and neuromuscular capacity in patients with chronic obstructive pulmonary dis...
BACKGROUND: Cardiopulmonary Exercise Test (CPET) serves as an integrative assessment tool to evaluate cardiac function, respiratory responses, and neuromuscular capacity in patients with chronic obstructive pulmonary disease (COPD) during incremental cycling exercise. VE-VCO2 slope during CPET was not fully understood in predicting acute exacerbations of COPD (AECOPD). This study aims to establish a predictive model for AECOPD based on the VE-VCO2 slope. METHODS: In total, 79 patients with COPD were recruited between 2013 and 2019. All participants underwent baseline pulmonary function tests and CPET and were followed up for 5 years thereafter. Independent two-sample -tests and Chi-square tests were used to compare AECOPD and Non-AECOPD groups. Univariate and multivariate Cox regression analyses were utilized to identify predictive factors for AECOPD. The diagnostic performance of these variables was evaluated by receiver operating characteristic (ROC) curve analysis. The optimal cutoff values calculated by Youden's index. Kaplan-Meier survival analysis between subgroups was based on the optimal cutoff values. Generating Forest plots to visualize Cox regression analysis results. RESULTS: The AECOPD group contains 62 participants and the Non-AECOPD group contains 17 participants. Groups comparisons revealed significant differences in VE-VCO2 slope, age, BMI, FEV1%predicted, FEV1/FVC ratio, and EqCO2. Multivariate Cox regression analysis identified VE-VCO2 slope (OR = 1.19, 95% CI: 1.09-1.29, p < 0.001), age (OR = 1.05, 95% CI: 1.02-1.09, p = 0.005), and FEV1%predicted (OR = 0.96, 95% CI : 0.94-0.99, p = 0.015) as significant predictors of AECOPD. The ROC curve analysis results about the above predictors found that the AUC of VE-VCO2 slope is highest independently in 1 year, 3 years and 5 years, with the optimal cutoff values = 28.42 in 5 years (hazard ratio = 3.18, 95% CI: 1.639-6.2, p < 0.001). CONCLUSION: The stratification of VE-VCO2 slope ≥28.42 was an independent predictor of AECOPD. Our study established VE-VCO2 slope as a novel stratified clinical biomarker for predicting AECOPD.
Association of FeNO Decline Rate with Symptom Improvement in COPD: A Real-World Observational Study.
Li B, Liu M, Shi H … +3 more , Wang Y, Meng X, An Z
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41924250 · Full text
BACKGROUND: The association between relative changes in fractional exhaled nitric oxide (FeNO) in chronic obstructive pulmonary disease (COPD) with patient-reported symptoms improvements remains uncertain. OBJECTIVE: To...
BACKGROUND: The association between relative changes in fractional exhaled nitric oxide (FeNO) in chronic obstructive pulmonary disease (COPD) with patient-reported symptoms improvements remains uncertain. OBJECTIVE: To assess the association of the rate of FeNO decline with the achievement of the minimum clinically important difference (MCID) in COPD Assessment Test (CAT) score. METHODS: We conducted a single-center, retrospective real-world study involving 111 adults with COPD. Patients were classified into two groups: those with symptom improvement (CAT decline ≥2 points) and those with no improvement (CAT decline <2 points). Logistic regression evaluated associations between FeNO decline rate and CAT MCID, adjusting for clinically relevant covariates. Receiver operating characteristic (ROC) curve analysis estimated the discriminatory performances of it. RESULTS: Of 111 patients, 53 (47.7%) achieved the CAT MCID. Multivariate logistic regression found that the rate of FeNO decline was independently associated with symptom improvement (adjusted OR 2.08, 95% CI 1.01-4.29, =0.047). Baseline CAT also showed association with symptom improvement (adjusted OR 1.06, 95% CI 1.00-1.12, =0.034). BMI showed a positive trend but without statistical significance (adjusted OR 1.13, 95% CI 1.00-1.29, =0.056). AUC of FeNO decline rate, baseline CAT, combined with BMI in discriminating CAT MCID were 0.713 (95% CI 0.617, 0.809). CONCLUSION: The rate of FeNO decline was significantly associated with clinically meaningful CAT improvement in this study, which indicated dynamic measures of type-2 inflammation can complement blood eosinophil counts to refine phenotyping and inform precision management in COPD.
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