Tuberculosis and Respiratory Diseases最新文献

{"title":"Imaging in Chronic Obstructive Pulmonary Disease: Ready for Prime Time?","authors":"Hyeon-Kyoung Koo, Surya P Bhatt","doi":"10.4046/trd.2025.0202","DOIUrl":"10.4046/trd.2025.0202","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a major global health burden, affecting over 392 million individuals and causing approximately 3.3 million deaths annually. Although spirometry remains the cornerstone for diagnosing airflow limitation, it incompletely reflects the structural and biological heterogeneity of the disease, and many smokers with preserved spirometry exhibit substantial parenchymal and airway abnormalities. Advances in imaging-particularly quantitative computed tomography (QCT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-enable comprehensive assessment of structural, functional, and inflammatory processes in COPD. QCT-derived emphysema metrics, including the 15th percentile lung density, mean lung density, and low attenuation area percentage, are reproducible, sensitive to progression, and widely used as outcome measures. Small airway disease can be characterized using parametric response mapping and complementary voxel-based indices that detect subclinical gas trapping and regional volume changes. The concept of mechanically affected lung highlights functionally impaired regions adjacent to emphysema that contribute to disease progression and mortality. Airway remodeling metrics, such as Pi10, PiSlope, tapering slope, and airway fractal dimension, further provide prognostic information. Mucus plug burden independently predicts mortality and represents a potential surrogate endpoint in therapeutic trials. Advanced MRI techniques and 18F-fluorodeoxyglucose PET offer radiation-free or inflammatory insights, respectively. Current evidence supports that imaging is ready to evolve from an adjunct to a core element of COPD research and care.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"143-153"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Utility of Impulse Oscillometry Parameters in Predicting Asthma Exacerbations.","authors":"Jeong-Woong Park","doi":"10.4046/trd.2025.0162","DOIUrl":"10.4046/trd.2025.0162","url":null,"abstract":"<p><strong>Background: </strong>Impulse oscillometry (IOS) provides an effort-independent assessment of respiratory mechanics and is particularly sensitive to small airway dysfunction. Although IOS has been shown to complement spirometry in asthma, its association with exacerbation risk and its relationship with type 2 inflammatory biomarkers remain incompletely understood.</p><p><strong>Methods: </strong>In this retrospective cross-sectional study, 128 adult patients with physician-diagnosed asthma who underwent both spirometry and IOS at a tertiary hospital between January 2023 and July 2024 were analyzed. Exacerbation events during 1-year follow-up were identified from medical records. IOS parameters included resistance at 5 and 20 Hz (R5 and R20), reactance at 5 Hz (X5), resonant frequency (Fres), area under the reactance curve (AX), and frequency dependence of resistance between R5 and R20 (R5-R20). Correlations between spirometric indices and IOS parameters were assessed. Diagnostic performance for exacerbation events was evaluated using receiver operating characteristic (ROC) analysis. Exploratory analyses examined associations between IOS indices, fractional exhaled nitric oxide (FeNO), and blood eosinophil counts.</p><p><strong>Results: </strong>Thirty-three patients (25.8%) experienced exacerbations. AX showed the strongest correlations with forced expiratory volume in 1 second (FEV₁)% predicted (r=-0.51, p&lt;0.001) and FEF25-75% predicted (r=-0.42, p&lt;0.001). Patients with exacerbations exhibited significantly higher R5, Fres, AX, and R5-R20 compared with those without exacerbations, with AX demonstrating the largest effect size (Cohen's d=0.91). In ROC analysis, AX showed the highest discriminative ability for exacerbation events (area under the curve=0.673). FeNO and blood eosinophil counts were not significantly correlated with IOS parameters and showed limited predictive performance when used alone; however, inclusion of AX significantly improved model discrimination.</p><p><strong>Conclusion: </strong>IOS parameters, particularly AX, are significantly associated with asthma exacerbations and capture mechanical aspects of small airway dysfunction that are not fully reflected by spirometry or type 2 inflammatory biomarkers. IOS may provide clinically meaningful complementary information for risk stratification in asthma.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"226-234"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Airway Dysfunction in Chronic Obstructive Pulmonary Disease Pathology: Assessment and Clinical Implications.","authors":"Jong Geol Jang, Hyonsoo Joo, Hyun Lee","doi":"10.4046/trd.2025.0197","DOIUrl":"10.4046/trd.2025.0197","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by airflow limitation and persistent respiratory symptoms. A key factor in the progression of COPD is small airway dysfunction (SAD), which originates in airways smaller than 2 mm in diameter. Chronic exposure to smoke and toxins leads to inflammatory remodeling and luminal obstruction, detectable through micro-computed tomography (CT) studies before spirometric airflow limitations become evident. SAD exacerbates COPD by increasing airway resistance and promoting dynamic airway collapse during exhalation. Clinically, SAD presents as gas trapping, hyperinflation, and exercise intolerance, which are associated with a rapid decline in lung function. Recent evidence indicates that SAD may be a modifiable and clinically significant trait in COPD, with management strategies including extrafine-particle inhalers, smoking cessation, pulmonary rehabilitation, and emerging biologic therapies. Various assessment methods, such as pulmonary function tests and CT imaging, are used to assess SAD. This review focuses on the role of SAD in the pathophysiology of COPD and the clinical implications of easily applicable measurements, including forced expiratory flow between 25% and 75% of forced vital capacity, impulse oscillometry, Pi10, and parametric response mapping, as well as potential treatment modalities for SAD in COPD.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"133-142"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cough Assessment in Chronic Respiratory Diseases (COASESS): Findings from a Prospective Multicenter Cross-Sectional Study.","authors":"Tai Joon An, Hyeon-Kyoung Koo, Chin Kook Rhee, Yee Hyung Kim, Sung-Kyoung Kim, Kyung Hoon Min, Deog Kyeom Kim, Jong-Wook Shin, Hyoung Kyu Yoon, Woo-Jung Song, Jin Woo Kim, Ji-Yong Moon","doi":"10.4046/trd.2025.0104","DOIUrl":"10.4046/trd.2025.0104","url":null,"abstract":"<p><strong>Background: </strong>Cough is a prominent symptom of chronic respiratory diseases, including asthma, idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease (COPD), and bronchiectasis (BE). Some patients develop chronic cough (CC), defined as lasting more than 8 weeks, yet its characteristics remain poorly understood. This study aimed to characterize CC across various chronic respiratory diseases using validated cough assessment tools.</p><p><strong>Methods: </strong>The Cough Assessment in Chronic Respiratory Diseases (COASESS) study, a multicenter, prospective cross-sectional study, was conducted at 10 university hospitals. CC was evaluated in terms of intensity (numeric rating scale [NRS]), frequency (cough symptom score [CSS]), and quality of life (using the cough assessment test [COAT] and Leicester cough questionnaire [LCQ]). Cough hypersensitivity was assessed with the cough hypersensitivity questionnaire (CHQ). Data on age, sex, and smoking status were also collected.</p><p><strong>Results: </strong>Among the 303 enrolled patients, 266 with chronic respiratory diseases were included in the analysis. Patients with asthma were younger, predominantly female, and non-smokers, whereas those with COPD and IPF were older males who had previously smoked (p&lt;0.001). Scores for COAT, LCQ, NRS, and CSS showed significant differences across the diseases, with asthma and IPF patients experiencing a greater symptom burden and lower quality of life compared to those with COPD or BE (p&lt;0.001). Although CHQ total scores were similar across groups, asthma patients more frequently reported triggers such as talking and post-nasal drip.</p><p><strong>Conclusion: </strong>This study revealed distinct characteristics of CC across different chronic respiratory diseases. Asthma and IPF were associated with a higher symptom burden, and cough hypersensitivity varied depending on the underlying condition. These findings highlight the necessity for disease-specific assessments and management strategies for CC.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"275-286"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145715957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Patients with Idiopathic Bronchiectasis in Comparison to Post-infectious Bronchiectasis in South Korea.","authors":"Seo-Young Hwang, Hyun Lee, Hayoung Choi, Seung Won Ra, Yeon-Mok Oh","doi":"10.4046/trd.2025.0055","DOIUrl":"10.4046/trd.2025.0055","url":null,"abstract":"<p><strong>Background: </strong>Bronchiectasis has a complex and heterogeneous pathogenesis, with various etiologies, the majority being idiopathic. This study aimed to examine the characteristics of patients with idiopathic bronchiectasis in comparison to those with post-infectious bronchiectasis.</p><p><strong>Methods: </strong>We analyzed data from patients with idiopathic and post-infectious bronchiectasis (including post-tuberculosis) from the Korean Multicenter Bronchiectasis Audit and Research Collaboration (KMBARC) registry, a prospective cohort study.</p><p><strong>Results: </strong>Among the 866 patients enrolled in the study, 346 (40.0%) were classified as having idiopathic bronchiectasis, while 363 (41.9%) had post-infectious bronchiectasis. The idiopathic group demonstrated a shorter disease duration, a higher body mass index (BMI), a lower prevalence of chronic obstructive pulmonary disease (COPD), a higher prevalence of rhinosinusitis, a predominance of lower lobe distribution, less frequent use of regular respiratory treatments, better pulmonary function, and a statistically lower bronchiectasis severity index compared to the post-infectious group. A multivariable logistic regression analysis was conducted, considering factors such as gender, age, BMI, history of asthma, COPD, rhinosinusitis, rheumatoid arthritis, gastroesophageal reflux disease, and smoking status. A higher BMI (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04 to 1.15) and a history of rhinosinusitis (OR, 3.10; 95% CI, 1.57 to 6.14) were associated with idiopathic bronchiectasis. In contrast, a history of COPD was linked to post-infectious bronchiectasis (OR, 0.57; 95% CI, 0.41 to 0.80).</p><p><strong>Conclusion: </strong>Patients with idiopathic bronchiectasis are characterized by a higher BMI and a history of rhinosinusitis compared to those with post-infectious bronchiectasis. These findings may provide exploratory insights into underlying systemic or non-pulmonary factors. Further research is necessary to clarify the clinical significance of these associations.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"321-331"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and Controversies in Perioperative Immunotherapy in Early-Stage Non-small Cell Lung Cancer: An Optimistic Perspective.","authors":"Duk-Ki Kim, Jeong Eun Lee","doi":"10.4046/trd.2025.0111","DOIUrl":"10.4046/trd.2025.0111","url":null,"abstract":"<p><p>Immune checkpoint inhibitors have transformed the treatment landscape of non-small cell lung cancer (NSCLC), extending their role from metastatic to resectable disease. While neoadjuvant and adjuvant immunotherapies have each shown clinical value, recent evidence suggests that a perioperative strategy-incorporating both preoperative and postoperative immune-based treatment-may provide more consistent and durable survival benefits, especially in stage IIIA and high programmed death-ligand 1 (PD-L1)-expressing tumors. Despite concerns about feasibility and immune-related adverse events, phase III trials such as CheckMate 816, KEYNOTE-671, and AEGEAN have demonstrated that perioperative chemoimmunotherapy is both effective and tolerable in real-world practice. This review examines the rationale, clinical trial data, patient selection criteria, and safety profile of perioperative immunotherapy, and argues for its increasing adoption as a strategic standard in eligible NSCLC patients. Additionally, emerging biomarkers and circulating tumor DNA-based minimal residual disease surveillance hold promise for refining precision of perioperative treatment. Taken together, the evidence supports perioperative immunotherapy as a forward-looking, evidence-based approach to improving outcomes in resectable NSCLC.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"184-192"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibroneer Trials: More than Meets the Eye.","authors":"Felicia S W Teo, Jin Woo Song","doi":"10.4046/trd.2025.0186","DOIUrl":"10.4046/trd.2025.0186","url":null,"abstract":"","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"344-346"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial KL-6 Changes in PD-1/PD-L1 Inhibitor-Related Pneumonitis in Non-small Cell Lung Cancer: A Single-Center Prospective Pilot Study.","authors":"Jae Kyeom Sim, Juwhan Choi, Sung Won Chang, Sang Hyuk Kim, Jee Youn Oh, Kyung Hoon Min, Gyu Young Hur, Hwan Seok Yong, Jae Jeong Shim, Sung Yong Lee","doi":"10.4046/trd.2025.0133","DOIUrl":"10.4046/trd.2025.0133","url":null,"abstract":"<p><strong>Background: </strong>Programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitors are effective treatments for non-small cell lung cancer (NSCLC), but their use can lead to severe pneumonitis. This study aims to evaluate the utility of Krebs von den Lungen-6 (KL-6) for predicting and diagnosing PD-1/PD-L1 inhibitor-related pneumonitis in NSCLC patients.</p><p><strong>Methods: </strong>We conducted a prospective observational study at a university-affiliated tertiary hospital in Korea from February 2022 to June 2023. Baseline KL-6 levels were measured immediately before initiating PD-1/PD-L1 inhibitor therapy. In patients who developed pneumonitis, KL-6 levels were monitored every 1-2 weeks from the onset of pneumonitis. For patients without pneumonitis, KL-6 levels were measured every 6 weeks. We compared clinical characteristics and serial KL-6 levels between the pneumonitis and non-pneumonitis groups.</p><p><strong>Results: </strong>Eighteen patients were enrolled, with 11 developing pneumonitis. Baseline KL-6 levels did not significantly differ between the two groups (261 U/mL in the pneumonitis group vs. 373 U/mL in the non-pneumonitis group, p=0.375). In the pneumonitis group, KL-6 levels generally showed an upward trend, with a median of 412 U/mL at pneumonitis onset. Conversely, KL-6 levels in the non-pneumonitis group showed no clear overall change.</p><p><strong>Conclusion: </strong>In this pilot study, baseline KL-6 was not clearly linked to PD-1/PD-L1 inhibitor-related pneumonitis in NSCLC patients. However, increases in KL-6 levels post-baseline were more frequently observed in patients who developed pneumonitis, including cases of all-cause pneumonitis.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"257-265"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endobronchial Ultrasonography Features in Tuberculous Mediastinal Lymphadenopathy.","authors":"Ginanjar Arum Desianti, Menaldi Rasmin, Lisnawati Lisnawati, Erlina Burhan, Muchtaruddin Mansyur, Jacub Pandelaki, Anis Karuniawati, Sita Laksmi Andarini, Ferry Dwi Kurniawan","doi":"10.4046/trd.2025.0119","DOIUrl":"10.4046/trd.2025.0119","url":null,"abstract":"<p><strong>Background: </strong>Mediastinal lymphadenopathy indicates an intrathoracic pathological process. Tuberculous mediastinal lymphadenopathy (TML) can be an early sign of tuberculosis infection, particularly in developing countries. Its incidence is often unclear due to underdiagnosis and limited access to diagnostic tools. Timely diagnosis is essential, as delayed treatment can result in severe complications. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a reliable method for obtaining samples and establishing a diagnosis, although its use is constrained by various factors. This study aims to clarify the role of EBUS features in assessing TML.</p><p><strong>Methods: </strong>This is a cross-sectional study that recruited ≥18 years old patients with suspected TML who underwent EBUS-TBNA. Mediastinal lymph nodes were systematically evaluated EBUS, with a focus on the largest nodes for further characteristic analysis. A TBNA was performed, and the retracted samples were assessed for pathology, acid-fast bacilli, Mycobacterium tuberculosis (MTB) culture, and Xpert Ultra examinations.</p><p><strong>Results: </strong>One hundred patients were recruited for the study. Fifty-three of these patients were ultimately diagnosed with TML. Significant associations were found between TML and several factors: short-axis size (p&lt;0.001), oval-shaped lymph nodes (p=0.034), indistinct margins (p&lt;0.001), central hilar presentation (p&lt;0.001), internal echoes (p&lt;0.049), thin layer echogenicity (p=0.033), and nodal matting (p&lt;0.001). Among the diagnostic modalities, Xpert Ultra demonstrated the highest sensitivity for TML at 71.7%.</p><p><strong>Conclusion: </strong>Endobronchial ultrasonographic features such as small size, round shape, indistinct margin, central hilar presentation, internal echo, thin layer echogenicity, and nodal matting are indicative of TML.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"332-343"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Low Physical Activity in Chronic Obstructive Pulmonary Disease: The Importance of Patients' Symptom Perception.","authors":"Sungmin Zo, Danbee Kang, Sung A Kong, Sun Hye Shin, Jiseon Lee, Jong Geol Do, Hye Yun Park","doi":"10.4046/trd.2025.0121","DOIUrl":"10.4046/trd.2025.0121","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary rehabilitation (PR) is a key intervention for chronic obstructive pulmonary disease (COPD); however, adherence remains suboptimal, particularly in patients with low physical activity (PA) despite preserved physical capacity (PC). This study aimed to identify factors associated with low PA, with a focus on patient-reported outcomes (PROs).</p><p><strong>Methods: </strong>In this prospective study, COPD patients were categorized according to daily moderate-to-vigorous PA measured using Fitbit devices: ≥30 minutes/day ('Do do') and &lt;30 minutes/day ('Don't do'). Baseline characteristics, pulmonary function, and exercise capacity assessed by 6-minute walk distance (6MWD) were evaluated. PROs included the modified Medical Research Council (mMRC) dyspnea scale, COPD Assessment Test (CAT), and Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was performed to identify factors independently associated with low PA.</p><p><strong>Results: </strong>Among 96 patients, 44 were classified as 'Do do' and 52 as 'Don't do.' The 'Don't do' group showed significantly lower 6MWD (424 m vs. 488 m, p=0.005) and lower forced expiratory volume in 1 second (46.73% vs. 54.48%, p=0.005). They also reported higher dyspnea scores (mMRC 1.77 vs. 1.30, p=0.019). Greater breathlessness measured by CAT was independently associated with low PA (odds ratio, 1.31; 95% confidence interval, 1.06 to 1.62), even after adjustment for 6MWD and pulmonary function. This association persisted in patients with preserved PC.</p><p><strong>Conclusion: </strong>Low PA in COPD is influenced not only by objective physical limitations but also by subjective symptom burden, particularly dyspnea. Integrating PROs into PR assessment may facilitate identification of barriers and improve adherence to rehabilitation programs.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"235-244"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}