International Journal Of Chronic Obstructive Pulmonary Disease[JOURNAL]
Sun
200 papers
Reliability of Pulmonary Function Tests in Patients with Chronic Obstructive Pulmonary Disease.
Arslan F, Şen E, Şirin B … +12 more , Köktürk N, Ulubay G, Aydogan Eroglu S, Gemicioglu B, Sönmez Ö, Şerifoğlu İ, Dilektasli AG, Öztürk Şahin B, Doğan İ, Gürhan N, Günen H, Ensen N
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41924249 · Full text
INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is frequently underdiagnosed due to limited use and suboptimal quality of spirometry. METHODS: This multicenter, prospective observational study aimed to assess...
INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is frequently underdiagnosed due to limited use and suboptimal quality of spirometry. METHODS: This multicenter, prospective observational study aimed to assess the quality of spirometry tests in COPD patients across six tertiary care centers in Turkey. A total of 560 spirometry tests were independently evaluated by two pulmonologists, and inter-rater reliability was analyzed using Cohen's Kappa. RESULTS: The study included 124 women and 436 men, with a mean age of 65.9±10.2 years. Spirometry patterns were interpreted as obstructive in 79.1% of tests, restrictive in 5.7%, mixed in 2.7%, normal in 6.7%, inconclusive in 5.5%, and as upper airway obstruction in 0.18% of cases (=0.890). Routine post-bronchodilator testing was performed in 87.14% of the cases, while 12.85% were post-reversibility tests. Graphical data included volume-time curves (88.5%), flow-volume loops (99.6%), and inspiratory limbs (98.7%). Reference values were predominantly based on ECSC (86.4%), followed by GLI (8.9%) and NHANES (0.25%). Mean spirometric values included FEV1 (% predicted) 57.2%, FVC (% predicted) 72.7%, and FEV1/FVC 61.9%. Cough in the first second of FVC was observed in 17 (3%) (=0.677), variable or insufficient effort 13.4% (=0.563), mouth leak 1.8% (=0.305), mouthpiece obstruction 0.5% (=0.332), rapid expiration 1.8% (=0.354), increased concavity 83% (=0.683), and small airway obstruction 87% (=0.709) were reported by interpreters. CONCLUSION: Spirometry reports frequently lack key information such as preliminary diagnoses, test indication, technician, and device details. ECSC is the most commonly used reference. Rates of inconclusive and erroneous tests-due to variable or insufficient effort, mouth leak, mouthpiece obstruction, and rapid expiration-are low.
LAMC2 Drives Airway Remodeling in COPD via EMT Regulation Through the AKT Pathway.
Wang Z, Shi J, Zhang Y … +5 more , Luo Y, Rao Y, Qu J, Gai X, Sun Y
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41924248 · Full text
PURPOSE: Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation, largely driven by airway remodeling. Epithelial-mesenchymal transition (EMT) is a key mechanism underlying this p...
PURPOSE: Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation, largely driven by airway remodeling. Epithelial-mesenchymal transition (EMT) is a key mechanism underlying this process. Laminin subunit gamma-2 (LAMC2) is implicated in fibrosis and EMT, but its role in COPD-associated airway remodeling remains unclear. METHODS: Differential expression analysis was performed using airway epithelial cell datasets from COPD patients and TGF-β1-induced EMT models. Findings were validated in COPD patient lung tissues, smoke-exposed mice, and in vitro experiments. In vivo, chronic smoke-exposed mice were pre-treated intratracheally with adeno-associated virus (AAV)-shLAMC2. Functional assays involved siRNA knockdown or plasmid overexpression of LAMC2 in bronchial epithelial cells. RNA sequencing and pathway analyses were conducted to explore underlying mechanisms. RESULTS: LAMC2 was significantly upregulated in COPD patient and murine airway epithelia. AAV-shLAMC2 administration alleviated airway remodeling and restored epithelial E-cadherin while reducing mesenchymal markers (N-cadherin, fibronectin), indicating attenuation of EMT. In vitro, LAMC2 was upregulated in TGF-β1-stimulated epithelial cells, and its modulation significantly influenced EMT progression. Transcriptomic analysis suggested that AKT signaling as a potential downstream of LAMC2, supported by functional assays. CONCLUSION: LAMC2 is upregulated in COPD airway epithelium and promotes airway remodeling by regulating EMT, potentially through AKT signaling. These findings suggest that targeting LAMC2 may represent a potential strategy for mitigating COPD-associated airway remodeling.
Kinesiophobia in Patients with Chronic Obstructive Pulmonary Disease: A Concept Analysis.
Yin H, Li R, Hu Y … +1 more , Huang L
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41918764 · Full text
BACKGROUND: Kinesiophobia (fear of movement) is a significant barrier to pulmonary rehabilitation and functional recovery in patients with Chronic Obstructive Pulmonary Disease (COPD). Despite its considerable impact on...
BACKGROUND: Kinesiophobia (fear of movement) is a significant barrier to pulmonary rehabilitation and functional recovery in patients with Chronic Obstructive Pulmonary Disease (COPD). Despite its considerable impact on clinical outcomes, this concept currently lacks a unified definition and comprehensive theoretical framework. OBJECTIVE: To clarify the concept of kinesiophobia in COPD by identifying its defining attributes, antecedents, and consequences, and to integrate these elements into a cohesive conceptual framework. METHODS: A comprehensive literature search was performed in CNKI, Wanfang, VIP, Web of Science, PubMed, CINAHL, and Cochrane Library databases from inception to April 1, 2025. Following Rodgers' evolutionary methodology, two researchers independently screened studies and conducted a systematic thematic synthesis. RESULTS: Twenty-nine studies met inclusion criteria. Kinesiophobia in COPD is characterized by four defining attributes: symptom hypervigilance, maladaptive cognition, complex emotional responses, and behavioral avoidance. These are influenced by sociodemographic, disease-related, and psychological antecedents, and lead to functional decline and reduced quality of life. CONCLUSION: This analysis synthesizes a unified conceptual framework that integrates dyspnea-related and pain-related kinesiophobia, addressing a critical gap in the literature. This framework provides the foundation for developing precise assessment tools and mechanism-based interventions tailored to specific fear subtypes, ultimately aiming to disrupt the debilitating cycle of fear and avoidance in COPD.
A Retrospective Controlled Study on the Effects of Four-Limb Linkage Training on Clinical Efficacy and Antioxidative Mechanisms in Patients with Chronic Obstructive Pulmonary Disease.
Liu X, Chen L, Wei Z … +3 more , Jiang J, Yu Y, Wang Z
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41913761 · Full text
OBJECTIVE: To investigate the effects of systematic four-limb linkage training on pulmonary function, exercise capacity, dyspnea, and quality of life in patients with chronic obstructive pulmonary disease (COPD), and to...
OBJECTIVE: To investigate the effects of systematic four-limb linkage training on pulmonary function, exercise capacity, dyspnea, and quality of life in patients with chronic obstructive pulmonary disease (COPD), and to explore its potential antioxidative mechanisms. METHODS: This retrospective controlled study included 114 patients with COPD admitted between August 2023 and April 2025. Patients were divided into a control group (n=57), receiving lower-limb cycling training, and an observation group (n=57), receiving four-limb linkage training. Both groups underwent continuous rehabilitation intervention for 8 weeks. Pulmonary function indices (FEV1, FVC, FEV1/FVC, FEV1%pred), dyspnea scores (modified Medical Research Council and Borg scales), exercise capacity (6-minute walking distance, 6MWD), disease severity (BODE index), quality of life (St. George's Respiratory Questionnaire, SGRQ), and oxidative stress markers [thioredoxin (TRX) and thioredoxin-interacting protein (TXNIP) at mRNA and protein levels] were assessed at Pre-intervention and Post 8-week intervention. RESULTS: At Post 8-week intervention, pulmonary function indices, exercise capacity, and quality-of-life scores were significantly improved, while dyspnea scores and BODE index were significantly reduced in both groups compared with Pre-intervention (P<0.05). The magnitude of improvement was significantly greater in the four-limb linkage training group than in the control group (P<0.05). In addition, TRX mRNA and protein expression levels were significantly increased, whereas TXNIP mRNA and protein expression levels were significantly decreased at Post 8-week intervention compared with Pre-intervention, with more pronounced changes observed in the observation group (P<0.05). CONCLUSION: Four-limb linkage training significantly improves pulmonary function, exercise capacity, dyspnea, and quality of life in patients with COPD. These benefits may be mediated, at least in part, by enhanced antioxidative activity through upregulation of TRX and suppression of TXNIP. Compared with lower-limb training alone, four-limb linkage training provides a more comprehensive rehabilitation strategy for COPD management.
Development of a Clinical Nomogram for Predicting Densitometric Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease Based on NHANES Data.
Jiang P, Chen T
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41913760 · Full text
OBJECTIVE: This study aimed to identify factors associated with densitometric osteoporosis (OP) in patients with Chronic Obstructive Pulmonary Disease (COPD) and develop a predictive model for OP. METHODS: Retrospective...
OBJECTIVE: This study aimed to identify factors associated with densitometric osteoporosis (OP) in patients with Chronic Obstructive Pulmonary Disease (COPD) and develop a predictive model for OP. METHODS: Retrospective analysis was conducted using data from COPD patients in the National Health and Nutrition Examination Survey database. OP was defined with a T-score of ≤ -2.5 at the lumbar spine or femoral neck. Variables with more than 25% missing values were excluded, while others were imputed. Collinearity analysis was performed, and data were randomly divided into a 7:3 train-test set ratio. The Least Absolute Shrinkage and Selection Operator and Boruta algorithms were used for feature selection. The selected variables were evaluated with Receiver Operating Characteristic (ROC) analysis to identify the optimal predictive model, which was then used to construct a nomogram. The nomogram's efficacy and stability were validated in the test set. RESULTS: Data from 1351 COPD patients were included. Age, weight, height, OP history of self-report, hemoglobin, and high-density lipoprotein cholesterol were identified as significant factors for OP. Those variables were combined into 7 different models. The ROC analysis results revealed that among the seven models, the model containing four variables was the optimal model. The nomogram, based on four variables (age, weight, height, and OP history of self-report), demonstrated good calibration and predictive performance (areas under curve: 0.841 in the train set, 0.833 in the test set). The nomogram showed high clinical net benefit and stability in subgroup analysis. CONCLUSION: Age, weight, height, and OP history of self-report are significantly associated with densitometric OP in COPD patients. The constructed nomogram, based on these factors, provides an effective and stable tool for early identification of high-risk OP patients in clinical practice.
Predictive Value of SAPS II for 28-Day All-Cause Mortality in AECOPD Patients Admitted to the ICU.
Yao S, Xu Y, Liu J … +7 more , Li R, Li Y, Ge S, Sun Y, Yao C, Yang X, Zhang M
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41909482 · Full text
BACKGROUND: The Simplified Acute Physiology Score II (SAPS II), which incorporates 12 physiological variables along with age, admission type and chronic health conditions, is widely used for assessing illness severity an...
BACKGROUND: The Simplified Acute Physiology Score II (SAPS II), which incorporates 12 physiological variables along with age, admission type and chronic health conditions, is widely used for assessing illness severity and predicting mortality risk in critically ill patients. However, its prognostic value in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains unclear. METHODS: A total of 1087 eligible AECOPD patients admitted to intensive care unit (ICU) were included from the Medical Information Mart for Intensive Care IV database. The clinical characteristics and 28-day all-cause mortality of these patients were collected. RESULTS: SAPS II was significantly higher in non-survivors than in survivors among the AECOPD patients admitted to ICU. For predicting 28-day all-cause mortality, SAPS II showed superior discriminative ability compared to the scores of Sequential Organ Failure Assessment, Oxford Acute Severity of Illness Score, and Logistic Organ Dysfunction System. The combination of SAPS II with these scoring systems did not significantly enhance the predictive value. Kaplan-Meier survival analysis identified SAPS II ≥ 37 as a significant cut-off value, with patients scoring above this threshold showing a significantly decreased 28-day cumulative survival rate. Cox regression confirmed SAPS II ≥ 37 as an independent mortality predictor. Restricted cubic spline analysis revealed a linear increase in 28-day all-cause mortality risk with elevated SAPS II. Subgroup analysis revealed that the association between SAPS II and mortality risk remained consistent across the most subgroups except for coronary heart disease. CONCLUSION: Our findings demonstrate that SAPS II is a significant predictor of 28-day all-cause mortality in AECOPD patients admitted to the ICU, with a score ≥ 37 serving as a robust indicator of poor clinical prognosis.
Disease Burden and Unmet Needs in Chinese Patients with Symptomatic and Exacerbating COPD While on Triple Inhaled Therapy: A Cross-Sectional Real-World Study.
Sun Y, Pennant T, Barrable FR
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41909481 · Full text
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common respiratory disease and a major cause of mortality and morbidity in China. Global studies have revealed a subgroup of patients who had COPD symptoms an...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common respiratory disease and a major cause of mortality and morbidity in China. Global studies have revealed a subgroup of patients who had COPD symptoms and frequent exacerbations while receiving triple inhaled therapy. This study aimed to describe the clinical characteristics and disease burden of this patient population in China. METHODS: This cross-sectional, real-world study drew data from the Adelphi COPD Disease Specific Programme (DSP)™ from July to November 2022 in China. Adult patients with a diagnosis of COPD and receiving triple therapy at survey date were included; among them, patients who had frequent productive cough and sputum, a history of smoking, ≥2 moderate or ≥1 severe exacerbation(s) in the prior 12 months and were receiving triple therapy were identified as the symptomatic SET cohort; all other patients were categorized as the triple therapy cohort. Disease-related characteristics and perceptions of disease control were described for both cohorts. RESULTS: Of the 135 patients receiving triple therapy, 39 (28.9%) were categorized into the symptomatic SET cohort and 96 (71.1%) into the triple therapy cohort. In the triple therapy and symptomatic SET cohorts, mean (SD) age was 65.9 (9.0) and 69.2 (8.7), respectively; mean (SD) number of exacerbations during the last 12 months was 1.3 (1.4) and 2.3 (1.3), respectively; mean (SD) CAT score was 21.0 (8.3) and 25.7 (7.1), respectively. According to physicians' perception, around 70% of patients in the symptomatic SET cohort had, at the minimum, somewhat controlled COPD (completely controlled: 2.6%; well controlled: 28.2%; somewhat controlled: 38.5%). Satisfactory COPD control was achieved in 33.3% and 38.5% of patients in the symptomatic SET cohort as perceived by physicians and patients, respectively. CONCLUSION: Substantial disease burden and large unmet needs existed among patients with symptomatic and exacerbating COPD while receiving triple inhaled therapy in clinical settings in China. Novel therapeutic options and improved guideline-directed disease management are needed.
Impact of Severe Vitamin D Deficiency on Antibiotic Use in Hospitalized COPD Patients with Exacerbations: A Retrospective Analysis.
Li B, Liu M, Ren B … +4 more , Wu H, Zhang Y, An Z, Huang K
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41909480 · Full text
BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (ECOPD) often require antibiotic treatment. Vitamin D deficiency has been implicated in influencing the outcomes of ECOPD; however, its role in antibioti...
BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (ECOPD) often require antibiotic treatment. Vitamin D deficiency has been implicated in influencing the outcomes of ECOPD; however, its role in antibiotic usage during hospitalization remains unclear. PATIENTS AND METHODS: We conducted a retrospective analysis of 125 hospitalized ECOPD patients, stratified into two groups based on the presence of severe vitamin D deficiency (SVDD, 25-hydroxyvitamin D < 10 ng/mL) and non-severe vitamin D deficiency (NSVDD). Clinical outcomes, including duration of antibiotic treatment, cumulative defined daily doses (cDDDs), hospital length of stay (LOS) and associated costs, were compared between subgroups. Multivariate linear regression was used to assess the association between 25-hydroxyvitamin D levels and antibiotic use, adjusting for demographic and clinical variables. RESULTS: Patients with SVDD exhibited significantly longer durations of antibiotic use (13.50 . 11.00 days, =0.023), higher cDDDs (16.16 vs. 12.00, =0.012) and longer LOS (15.00 .12.00, =0.026) compared to those with NSVDD. Patients with SVDD and pneumonia had more antibiotics use, longer LOS and higher cost than those with NSVDD and AECOPD (<0.05). Multivariate linear regression analysis revealed that lower 25-hydroxyvitamin D levels were independently associated with increased antibiotic duration (coefficient -0.20, 95% CI -0.32, -0.08, <0.001) and higher cDDDs (coefficient -0.24, 95% CI -0.46, -0.01, =0.041) after adjustment, although the magnitude was smaller than that observed for some other variables. CONCLUSION: SVDD is independently associated with antibiotic burden in hospitalized COPD patients with exacerbation. Prospective studies are warranted to further explore this potential relationship and its clinical implications.
Exosomal miR-2110 from PM2.5-Exposed Lung Epithelial Cells Targets SRSF1 to Promote M1 Macrophage Polarization and Inflammatory Responses in COPD.
Miao Y, Gu J, Li J … +1 more , Sheng D
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41909479 · Full text
PURPOSE: Exposure to PM2.5 is a known contributor to the development of chronic obstructive pulmonary disease (COPD). As direct targets of PM2.5, bronchial epithelial cells participate in intercellular communication with...
PURPOSE: Exposure to PM2.5 is a known contributor to the development of chronic obstructive pulmonary disease (COPD). As direct targets of PM2.5, bronchial epithelial cells participate in intercellular communication with macrophages and induce phenotypic changes in these immune cells. This study aimed to investigate the role and underly mechanism of epithelial cell-derived exosomes in regulating macrophage polarization. METHODS: Following PM2.5 exposure, exosomes were isolated from BEAS-2B cells and subsequently co-cultured with M0 macrophages. We measured the production of inflammatory cytokines and macrophage markers. The phenotypic effect of miR-2110 on macrophage polarization was examined in a COPD murine model, with subsequent exploration of relevant molecular pathways. The binding specificity of miR-2110 was assessed utilizing a luciferase reporter assay. RESULTS: In vitro analyses confirmed that P-Exo (PM2.5-exposed BEAS-2B cells exosomes) triggered M1 polarization, as evidenced by elevated expression of IL-6, TNF-α, and iNOS-2. Additionally, miR-2110 expression was upregulated in P-Exo. Inhibition of miR-2110 reduced M1 polarization and decreased inflammatory cytokine production both in vitro and in vivo. Luciferase assays confirmed that miR-2110 targeted SRSF1 expression. Overexpression of SRSF1 mitigated the regulatory role of miR-2110 in promoting M1 phenotype transition and pro-inflammatory cytokine production. CONCLUSION: This work clarifies that exosomal miR-2110, which is produced from lung epithelial cells treated with PM2.5, exacerbates COPD and might be a viable target for COPD prevention and therapy.
A Prospective Observational Study Evaluating the PRogression Of BronchiEctasis in COPD Patients - Results from the PROBE - COPD Study.
Venkitakrishnan R, Sudheendranath A, Vijay A … +4 more , Ramachandran D, Cleetus M, Somson HT, John S
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41909478 · Full text
BACKGROUND: Bronchiectasis is increasingly recognised in individuals suffering from chronic obstructive pulmonary disease (COPD) and is associated with adverse outcomes. However, data on its temporal course and risk fact...
BACKGROUND: Bronchiectasis is increasingly recognised in individuals suffering from chronic obstructive pulmonary disease (COPD) and is associated with adverse outcomes. However, data on its temporal course and risk factors for progression in advanced COPD remain limited. OBJECTIVE: The study aimed to assess the progression of bronchiectasis in stage E COPD patients over one-year, identify factors contributing to its advancement, and compare clinical outcomes between patients diagnosed with bronchiectasis and those without the condition. METHODS: Patients with stage E COPD underwent high-resolution CT (HRCT) and were classified according to whether bronchiectasis present or absent at baseline. All participants were followed for 12 months, with quarterly clinical evaluation, six-monthly sputum culture, spirometry, and repeat HRCT at one-year. Progression of bronchiectasis, decline in lung function, exacerbations, hospitalisations, and mortality were assessed. Predictors of progression were explored using univariate analysis. RESULTS: Of the 104 patients, 33 (31.7%) had bronchiectasis at baseline. At one-year, 22 of these (66.67%) showed radiological progression and 8 (24.2%) remained stable Among the 71 without bronchiectasis, new bronchiectasis developed in 37 (52.1%). Frequent exacerbations (≥2/year) occurred more often in patients with bronchiectasis compared to those without (84.8% vs. 75.8%, P=0.023). Hospitalisation rates were also higher in the bronchiectasis group (60.6% vs. 35.2%, P<0.001). CONCLUSION: Bronchiectasis was present in one-third of stage E COPD patients at baseline, and more than half of those without bronchiectasis developed new lesions during follow-up. COPD patients with bronchiectasis had higher exacerbation frequency, hospitalisations, and greater progression of disease, underscoring its role as a poor prognostic marker in advanced COPD.
Efficacy and Safety of Escitalopram in Alleviating Depression and Anxiety Symptoms in COPD Patients: A Randomized Double-Blind Placebo-Controlled Trial.
Gao Z, Tang S, Zhang W … +9 more , Zhang M, Wei Z, Long Z, Wang B, Qin H, Qian H, Yin Y, Wang G, He B
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41909477 · Full text
PURPOSE: Depression and anxiety negatively impact COPD prognosis, yet evidence for psychopharmacological interventions remains limited. This study evaluated the efficacy and safety of low-dose escitalopram for managing t...
PURPOSE: Depression and anxiety negatively impact COPD prognosis, yet evidence for psychopharmacological interventions remains limited. This study evaluated the efficacy and safety of low-dose escitalopram for managing these comorbidities in COPD patients. PATIENTS AND METHODS: In this double-blind, placebo-controlled trial, 150 COPD patients with moderate-to-severe anxiety and/or depression were randomized (1:1) to receive escitalopram (5-10 mg/day) or placebo for 4 weeks, followed by an 11-month observational follow-up without maintenance study medication. Primary endpoints were changes in HAMA-14 and HAMD-17 scores at Month 1. Secondary outcomes included CAT scores, mMRC ratings, and lung function (FEV% predicted) through Month 12. RESULTS: At Month 1, escitalopram demonstrated significantly greater reductions in HAMA-14 (-9.25 [95% CI -9.67 to -8.82] vs -2.20 [-2.46 to -1.95]) and HAMD-17 (-7.37 [-7.74 to -7.01] vs -1.37 [-1.72 to -1.01]) compared to placebo ( < 0.01). These improvements were sustained at Month 12 ( < 0.01). CAT scores improved significantly more in the escitalopram group (-6.20 [-6.68 to -5.72]) versus placebo (-2.79 [-3.02 to -2.55]) over the 12-month observational period ( < 0.01). No significant differences were observed for mMRC or FEV% predicted. Adverse events were mild and comparable between groups. CONCLUSION: Short-term treatment with low-dose escitalopram significantly alleviates depression and anxiety in COPD patients. Notably, this brief intervention initiated a sustained positive clinical trajectory over 12 months. Combined with a favorable safety profile, these findings support its potential integration into comprehensive COPD management protocols, pending multicenter validation. TRIAL REGISTRATION: ChiCTR1800017338 (https://www.chictr.org.cn/). Registered 25-July-2018.
Global Research Trends in Comorbidity Between Chronic Obstructive Pulmonary Disease and Gastro-Oesophageal Reflux Disease: A Bibliometric Study.
Wang J, Zhao Y, Zhang Y … +3 more , Chen J, Wu H, Fang H
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41909476 · Full text
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and gastro-oesophageal reflux disease (GERD) frequently coexist and exert bidirectional effects through inflammatory, mechanical, and neurogenic pathways. However,...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and gastro-oesophageal reflux disease (GERD) frequently coexist and exert bidirectional effects through inflammatory, mechanical, and neurogenic pathways. However, a systematic and integrative summary of global research trends and underlying mechanisms in this field remains lacking. METHODS: Relevant publications on the comorbidity of COPD and GERD published from database inception to 2025 were retrieved from the Web of Science Core Collection. After rigorous screening, bibliometric and visualisation analyses were conducted using VOSviewer and CiteSpace to evaluate publication trends, country and institutional distributions, author collaboration networks, and keyword evolution. Highly cited papers were further examined, and recent mechanistic studies were integrated to explore the pathological connections and clinical implications of the two diseases. RESULTS: A total of 208 relevant publications were included. The global number of publications has shown a continuous upward trend, with the United States and Europe leading in both productivity and academic influence, while Asian countries have demonstrated rapid growth. Research hotspots have shifted from epidemiological and symptom-based studies towards mechanistic investigations such as non-acid reflux, microaspiration, systemic inflammation, and Mendelian randomisation. Highly cited works, including Hurst JR (2010, NEJM) and Vogelmeier CF (2017, ERJ), have established the theoretical foundation for COPD exacerbation and comorbidity management. Mechanistically, GERD may exacerbate COPD through acid and bile reflux, oesophago-bronchial reflexes, and systemic inflammatory responses, whereas COPD-related respiratory mechanics alterations and chronic inflammation may in turn promote reflux development. CONCLUSION: Research on COPD-GERD comorbidity is currently evolving from clinical observation towards molecular and genetic mechanisms, reflecting a clear interdisciplinary trend. Multi-omics studies and integrated management strategies are expected to promote more precise disease phenotyping and personalised treatment. This study elucidates the developmental trajectory of COPD-GERD comorbidity research and provides a theoretical basis and research direction for the advancement of precision respiratory medicine.
A Phenomenological Qualitative Study of Primary Informal Caregiver of Chinese Patients with Advanced Stage COPD: An In-Depth Exploration of Experiences and Needs.
Ren X, Li F, Gao T … +5 more , Xu X, Sun L, Liu S, Liu Y, Wang F
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41884755 · Full text
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder. It poses significant challenges in its advanced stages and requires frequent hospitalizations and complex care strategies. T...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder. It poses significant challenges in its advanced stages and requires frequent hospitalizations and complex care strategies. The burden on informal caregivers, who play a crucial role in managing the disease, is profound and multifaceted, involving physical, emotional, and social challenges. OBJECTIVE: This study aimed to explore the lived experiences and needs of primary informal caregivers for patients with advanced COPD in China, with a focus on their emotional, physical, and social challenges and coping strategies. METHODS: A phenomenological qualitative approach was employed to provide an in-depth understanding of caregiver experiences. Data were collected through face-to-face semi-structured interviews with 15 primary informal caregivers of advanced COPD patients from Central China. The interviews were analyzed using Colaizzi's method to extract key themes. RESULTS: Caregivers reported significant emotional burdens, including anxiety and fear related to the patient's health and future. Physical challenges were prevalent, with many caregivers experiencing fatigue and health deterioration due to the demands of caregiving. Social isolation was also a critical issue, as caregiving responsibilities limited personal time and social interactions. Despite these challenges, caregivers employed various coping strategies, though these were often insufficient to fully mitigate the stress of caregiving. CONCLUSION: Informal caregivers of patients with advanced COPD often face intense physical and psychological burdens and need comprehensive support systems. Enhancements in caregiver education, the development of targeted psychological supports, and the integration of caregivers into formal care plans are essential to improve the health outcomes of both caregivers and patients.
Associations Between Albumin-Corrected Anion Gap and Mortality in Heart Failure Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study.
Wu G, Ke H, Jin Z … +2 more , Shen Z, Tong Z
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41884754 · Full text
BACKGROUND: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common comorbidities in intensive care unit (ICU) patients. The albumin-corrected anion gap (ACAG) has shown utility in predicting morta...
BACKGROUND: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common comorbidities in intensive care unit (ICU) patients. The albumin-corrected anion gap (ACAG) has shown utility in predicting mortality across various populations; however, its impact on HF patients with COPD remains unclear. This study investigated the relationship between ACAG and mortality in this population. METHODS: We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care (MIMIC)-IV database. A total of 1283 patients with heart failure and chronic obstructive pulmonary disease were included from the MIMIC-IV database. ACAG levels were assessed within 24 hours of admission. The association between ACAG and in-hospital and 30-day mortality was analyzed using Kaplan-Meier analysis, multivariate Cox regression, restricted cubic spline (RCS) analysis, subgroup analysis, and receiver operating characteristic (ROC) curve analysis. RESULTS: Among 1283 HF patients with COPD (54.6% male), in-hospital and 30-day mortality rates were 11.2% and 13.7%, respectively. Kaplan-Meier analysis demonstrated significantly increased mortality risk in patients with higher ACAG levels (log-rank P<0.001). In fully adjusted Cox models, compared to the lowest ACAG group (T1), the highest group (T3) showed hazard ratios of 2.04 (95% CI: 1.18-3.54; p=0.011) for in-hospital mortality and 1.83 (95% CI: 1.12-2.97; p=0.015) for 30-day mortality. RCS analysis revealed a linear relationship between ACAG and mortality risk, consistent across subgroups. ROC analysis demonstrated superior discriminatory ability of ACAG for in-hospital mortality (AUC=0.693) compared to anion gap (AUC=0.571) and albumin (AUC=0.640), with similar findings for 30-day mortality. CONCLUSION: ACAG is closely associated with the risk of mortality in HF patients with COPD. It appears to be a potential prognostic predictor for HF patients with COPD, aiding in risk stratification for this population. However, further prospective studies are needed to consolidate our findings.
In silico Lung Deposition Profiles of Three Single-Inhaler Triple Therapies in Patients with COPD Using Functional Respiratory Imaging [Letter].
Zambelli E, Warner L, Richards J … +2 more , Malone R, Piraino A
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41884753 · Full text
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The Role of Advanced Lung Cancer Inflammation Index in Predicting COPD Exacerbation Risks.
Kwok WC, Leung SHI, Tam TCC … +3 more , Chau CH, Lam FM, Ho JCM
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41878304 · Full text
BACKGROUND: The role of the Advanced Lung Cancer Inflammation Index (ALI) in chronic obstructive pulmonary disease (COPD) remains unclear, although it has been utilized to investigate various non-malignant conditions. ME...
BACKGROUND: The role of the Advanced Lung Cancer Inflammation Index (ALI) in chronic obstructive pulmonary disease (COPD) remains unclear, although it has been utilized to investigate various non-malignant conditions. METHODS: A prospective study involving Chinese patients with COPD was carried out in Hong Kong to examine the relationship between baseline ALI levels and the risk of acute exacerbations of COPD (AECOPD). ALI was evaluated across quartiles. Patients were prospectively recruited from respiratory clinic in Queen Mary Hospital and Grantham Hospital in 2021, follow up with patients was done until 8th March 2025 or the death date, whichever is earlier. RESULTS: Among 272 Chinese COPD patients recruited, 138 of them had moderate to severe AECOPD and 66 patients died in the follow-up period. Those in the Q1 ALI, when compared with Q4 (highest quartile), had significantly shorter time to moderate to severe AECOPD with adjusted hazard ratio of (aHR) 2.17 (95% CI = 1.29-3.65, p = 0.011), severe AECOPD (aHR 2.05, 95% CI = 1.18-3.55, p = 0.011) and overall survival (aHR 2.73, 95% CI = 1.21-6.15, p = 0.015). The same phenomenon was also observed in the patient subgroup with baseline blood eosinophil counts <300 cells/μL. CONCLUSION: In this prospective study, it suggested that ALI can serve as a biomarker to predict the risk of moderate to severe AECOPD, as well as severe AECOPD and mortality. The phenomenon was also observed in the non-eosinophilic subgroup. This can allow clinicians to use this simple and repeatable biomarker as a way to prognosticate COPD patients and estimate AECOPD risks.
Gut-Lung Axis in COPD: Investigating the Impact of Dietary Fiber Intake on Systemic Inflammation and Lung Function Decline.
Lu L, Xu J, Wang J … +1 more , Cai YL
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41878303 · Full text
OBJECTIVE: The gut-lung axis represents a promising therapeutic target in chronic obstructive pulmonary disease (COPD). This study investigated whether dietary fiber intake differs between COPD patients and healthy contr...
OBJECTIVE: The gut-lung axis represents a promising therapeutic target in chronic obstructive pulmonary disease (COPD). This study investigated whether dietary fiber intake differs between COPD patients and healthy controls, and examined its association with systemic inflammation and lung function. METHODS: A case-control study was conducted including 100 COPD patients (cases) and 100 age- and sex-matched healthy controls. Dietary fiber intake was assessed using a validated food frequency questionnaire. Systemic inflammatory markers (CRP, IL-6) were measured by ELISA. Lung function parameters (FEV, FEV/FVC, DLCO) were evaluated according to ATS/ERS guidelines. Logistic regression analysis was performed to assess the association between dietary fiber intake and COPD risk. RESULTS: COPD patients had significantly lower dietary fiber intake (18.30 ± 6.20 g/day) compared to controls (28.70 ± 8.10 g/day, < 0.001). Inflammatory markers were significantly elevated in COPD patients: CRP (5.80 ± 3.20 vs. 1.20 ± 0.80 mg/L), IL-6 (8.40 ± 4.10 vs. 2.10 ± 1.30 pg/mL) (all < 0.001). In COPD patients, dietary fiber intake was inversely correlated with CRP ( = -0.52), IL-6 ( = -0.48), and positively correlated with FEV ( = 0.41) and DLCO ( = 0.38) (all < 0.001). After adjusting for confounders, low dietary fiber intake (<20 g/day) was associated with 3.2-fold increased odds of COPD (OR = 3.24, 95% CI: 1.86-5.65, < 0.001). CONCLUSION: Low dietary fiber intake is significantly associated with COPD and correlates with increased systemic inflammation and reduced lung function. These findings support the potential role of the gut-lung axis in COPD pathophysiology. However, causality cannot be established due to the limitations of the cross-sectional case-control design. Prospective interventional studies are warranted to confirm these associations and evaluate whether dietary fiber modification can improve clinical outcomes in COPD patients.
COPD Action Plans: Gaps in Development Methods, Content, and Format.
Yusup I, Tang R, Kouri A … +3 more , Sin DD, Marciniuk DD, Gupta S
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41878302 · Full text
PURPOSE: COPD action plans (APs) are integral to self-management and recommended across clinical practice guidelines, but primary care provider and patient usage remain low. Given that uptake is influenced by content, fo...
PURPOSE: COPD action plans (APs) are integral to self-management and recommended across clinical practice guidelines, but primary care provider and patient usage remain low. Given that uptake is influenced by content, format, and development methods, we sought to collect a broad sample of existing COPD APs and to analyze these characteristics. MATERIALS AND METHODS: We collected English language COPD APs from: 1) an internet search; 2) international COPD guidelines; 3) pulmonary/COPD organizations and experts; and 4) published randomized controlled trials (RCTs) evaluating COPD APs. For each AP, we described background information, development methods and any available evaluation data. We used guideline-based and inductively-derived criteria for AP content analysis. For format analysis, we applied recognized evidence-based formatting standards for printed educational material. We also calculated the Flesch-Kincaid readability scores. RESULTS: We identified 63 unique COPD APs from seven countries. Information on the development methods was available in only seven (11%) APs, and only one included patients in development. 4/58 (7%) APs identified from sources other than RCTs had been formally evaluated (all as part of larger complex interventions). In AP content, we found inconsistency in definitions for the action point requiring treatment, in treatment instructions (eg medication options, doses, and duration), and in lifestyle/behavior change cues. Formatting across APs was also variable, and APs met a mean of only 5.4 ± 1.2 out of 8 core formatting principles for printed education material design. The average Flesch-Kincaid grade level was 6.5 ± 1.6. CONCLUSION: COPD APs are recommended across guidelines but are seldom implemented. Our novel analysis of internationally available COPD APs reveals that there are several intrinsic factors related to their development, evaluation, content, and format that may be contributing to this care gap. A uniform user preference-based COPD AP with expert consensus on content, and with usability/format optimization should be developed and evaluated.
Characterization of Patients with COPD and GOLD E Classification in the United States.
Bhatt SP, Zhang Y, White J … +7 more , Stanford RH, Mayen Herrera E, Cunoosamy D, Djandji M, Soliman M, Qureshi T, Subramaniam A
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41878301 · Full text
BACKGROUND: The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) update reclassified patients with chronic obstructive pulmonary disease (COPD) into group E based solely on exacerbation history, regardl...
BACKGROUND: The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) update reclassified patients with chronic obstructive pulmonary disease (COPD) into group E based solely on exacerbation history, regardless of symptom burden. However, there are limited real-world descriptions of these patients at high risk of future exacerbation. This study therefore characterized patients in GOLD E, including subgroups based on blood eosinophil count (BEC), triple inhaler therapy use, and smoking status. METHODS: Retrospective analysis of administrative claims and electronic health records obtained from Optum's Market Clarity Dataset between 2016 and 2021. Adults aged 40-80 years with COPD and continuous enrollment were observed for three years. Year 1 (baseline) included the earliest evidence of COPD. GOLD E status was defined as ≥ 2 moderate or ≥ 1 severe exacerbation during baseline. RESULTS: Of 145,341 patients with COPD, 38,648 (26.6%) met GOLD E criteria. Patients in GOLD E had a higher prevalence of comorbidities (including cardiovascular-related conditions), elevated BEC (≥ 300 cells/μL), triple inhaler use, and former smoking status, compared with non-GOLD E. Approximately 58.2% of patients in GOLD E had evidence of a BEC test. Despite treatment recommendations, only 14.2% of patients in GOLD E with elevated BEC used triple inhalers. Notably, 34.8% of GOLD E had no evidence of any maintenance medication use. Of those with known smoking status (65.6%), current smokers had fewer severe exacerbations than never or former smokers. However, current smokers were 4.5-5.5 years younger, had lower prevalences of obesity and cardiovascular comorbidities, and the highest use of rescue medications-factors that help explain this unexpected result. CONCLUSION: Many patients in the United States with COPD in GOLD E were not treated according to recommendations, and BEC testing remains underutilized. Exacerbation rates were high, even among never or former smokers with COPD.
Difference in Respiratory Function Between GOLD Stage 1 and Preserved Ratio Impaired Spirometry as Assessed by Impulse Oscillometry and Spirometry.
Shimizu A, Hino M, Kubota K … +4 more , Yoshikawa A, Kamio K, Tanaka Y, Seike M
Int J Chron Obstruct Pulmon Dis · 2026 · PMID 41878300 · Full text
PURPOSE: Preserved ratio impaired spirometry (PRISm) is heterogeneous, and its physiological relationship to early COPD remains unclear. We compared respiratory-mechanical patterns between non-restrictive PRISm (NrP) and...
PURPOSE: Preserved ratio impaired spirometry (PRISm) is heterogeneous, and its physiological relationship to early COPD remains unclear. We compared respiratory-mechanical patterns between non-restrictive PRISm (NrP) and GOLD stage 1 COPD (GOLD 1) using impulse oscillometry (IOS) and spirometry and explored longitudinal changes in a trackable subset. PATIENTS AND METHODS: We retrospectively analyzed 1,139 adults who underwent post-bronchodilator spirometry in 2013; IOS was available for a subset. PRISm was defined by FEV/FVC ≥ LLN with %FEV <80%. GOLD 1 was defined per GOLD criteria (FEV/FVC <0.70; %FEV ≥80%). Longitudinal analyses were restricted to individuals with >10 pack-years, IgE <170 U/L, eosinophils <300/µL, and ≥2 examinations to minimize Th2-high asthma confounding. RESULTS: Among PRISm cases, 18 met NrP criteria, and 127 met GOLD 1 criteria; IOS was available for all 18 NrP and for 39 GOLD 1 participants cross-sectionally. IOS indicated greater peripheral airway dysfunction in NrP than in GOLD 1, with higher R5-R20 and Fres and more negative X5, despite relatively preserved spirometric indices. In the longitudinal subset (39 GOLD 1; 8 NrP), annual changes in spirometry and IOS exhibited wide variability and did not differ meaningfully between groups. These analyses were limited by small NrP sample size and incomplete IOS availability. CONCLUSION: PRISm and GOLD 1 demonstrated distinct respiratory-mechanical patterns despite partially overlapping spirometric profiles. IOS identified peripheral airway abnormalities in PRISm that were not evident on spirometry, suggesting potential value for characterizing early or atypical airway dysfunction. However, sample-size limitations and major confounding factors-including age, smoking status, and bronchodilator exposure-preclude causal inference. Findings should be considered descriptive and hypothesis-generating. Larger prospective studies with balanced treatment exposure and comprehensive imaging and lung-volume assessment are needed to clarify the clinical relevance of IOS patterns in PRISm.
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