International Journal of Chronic Obstructive Pulmonary Disease最新文献

{"title":"Cross-Trait Genome-Wide Association Study Identifies Shared Genetic Architecture Between COPD and Retinal Vascular Phenotypes.","authors":"Yuli Chen, Yibin Li, Yijiao Tang, XinQi Yuan, Rui Chen","doi":"10.2147/COPD.S624726","DOIUrl":"10.2147/COPD.S624726","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is accompanied by systemic vascular dysfunction and microcirculatory impairment. Retinal vascular traits provide a non-invasive window into microvascular characteristics, although their shared genetic architecture with COPD remains unclear.</p><p><strong>Methods: </strong>We integrated genome-wide association study summary statistics for COPD and 17 retinal vascular traits in individuals of European ancestry. Genome-wide genetic correlations were evaluated using linkage disequilibrium score regression and high-definition likelihood. Shared pleiotropic variants were identified using pleiotropic analysis under a composite null hypothesis, followed by functional mapping and annotation, Bayesian colocalization, multi-marker analysis of genomic annotation, and functional enrichment analyses. Smoking-adjusted analyses were further conducted using genome-wide association study-by-subtraction based on genomic structural equation modeling.</p><p><strong>Results: </strong>Genetic correlation analyses identified significant associations between COPD and 10 retinal vascular traits after false discovery rate correction, with consistent directions across both methods; high-definition likelihood identified one additional trait. Positive correlations were observed for vascular bifurcation and density traits, whereas venous caliber traits showed negative correlations. Pleiotropic analysis identified 3,846 significant single-nucleotide polymorphisms across 10 trait pairs, corresponding to 2,246 unique variants and 56 unique loci. Recurrent signals were observed at 8p23.1, 15q25.1, 20q13.33, 4q31.21, and 6q24.1. Bayesian colocalization provided strong evidence for shared local genetic signals at six loci, particularly 8p23.1 and 20q13.33. Smoking-adjusted analyses showed that several genome-wide and locus-level associations remained detectable, whereas nicotinic receptor-related signals, especially at 15q25.1, were attenuated.</p><p><strong>Conclusion: </strong>COPD and retinal vascular traits show evidence of shared genetic architecture involving vascular branching, density, and venous caliber. These findings support retinal vascular traits as candidate research phenotypes for investigating systemic microvascular involvement in COPD. Further validation across diverse populations and functional studies is required.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"624726"},"PeriodicalIF":4.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhaled Therapy Adherence in COPD:A COM-B-Based Narrative Review of Determinants and Intervention Strategies.","authors":"Yayue Zhang, Wen Shen, Qingdie Zhao, Zhenyan Li, Yue Chen","doi":"10.2147/COPD.S619942","DOIUrl":"10.2147/COPD.S619942","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Medication adherence is defined as the extent to which patients take medications as prescribed by their healthcare providers, encompassing three critical dimensions: initiation (starting the prescribed therapy), implementation (taking doses correctly as scheduled), and persistence (continuing treatment for the recommended duration). Long-term management of chronic obstructive pulmonary disease (COPD) relies heavily on inhalation therapy; however, real-world adherence remains suboptimal, with reported medication possession ratios (MPR) typically ranging from 40% to 60% in observational studies. Poor adherence is associated with increased exacerbation frequency, accelerated lung function decline, and substantial healthcare costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Based on the Capability-Opportunity-Motivation-Behaviour (COM-B) model, this narrative review aims to summarize and conceptually organize existing literature on measurement methods, epidemiological status, influencing factors, and intervention strategies for inhalation medication adherence in COPD patients, with particular emphasis on adherence differences between single-inhaler triple therapy (SITT) and multiple-inhaler triple therapy (MITT).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A narrative review methodology was employed, utilizing purposing literature search combined with citation back-tracking. Observational studies and randomized controlled trials from PubMed, CNKI, and other databases (up to December 2024) were included, with influencing factors categorized according to COM-B dimensions. Quantitative estimates reported in this review are derived from individual observational studies with heterogeneous designs and populations, and should be interpreted as illustrative ranges rather than pooled or definitive values. Quantitative estimates are derived from heterogeneous observational studies and should be interpreted as illustrative rather than pooled values. The non-systematic, purposing nature of this review limits comprehensive generalizability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Across the heterogeneous observational studies included in this review, MPR ≥80% was achieved by approximately 30% to 50% of patients in reported cohorts, while inhalation technique error rates were reported as illustrative ranges of 30% to 50%. The COM-B framework suggests that adherence deficits arise from the interplay of capability limitations (operational skill deficits), opportunity constraints (with the MITT associated with an illustrative range of approximately 12% to 14% lower MPR compared with SITT in reported real-world studies), and motivational barriers (with depression and anxiety associated with approximately 20% to 25% reductions in adherence in individual cohorts). In observational data, higher adherence has been associated with a reported 51% reduction in exacerbation-related hospitalization risk and an attenuation of forced expiratory volume in 1 second (FEV&lt;sub&gt;1&lt;/su","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"619942"},"PeriodicalIF":4.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioral Phenotypes of Inhaler Technique and Adherence in COPD: A Cross-Sectional Study.","authors":"Jiahui Xiang, Jiachen Li, Yining Zhang, Liang Dong, Jici Niu, Yi Zhang, Shuqin Wang, Chenxi Shi, Yanrui Jia","doi":"10.2147/COPD.S629907","DOIUrl":"10.2147/COPD.S629907","url":null,"abstract":"<p><strong>Purpose: </strong>Inhaler technique and treatment adherence are both determinants of clinical outcomes in chronic obstructive pulmonary disease (COPD), yet they are typically assessed in isolation. This study classified COPD patients into behavioral phenotypes based on the joint assessment of both dimensions and identified factors associated with phenotype membership.</p><p><strong>Methods: </strong>This cross-sectional study enrolled 700 COPD outpatients at Beijing Chao-Yang Hospital, China, between January and December 2025. Inhaler technique was assessed with a validated 10-step checklist (a perfect score defined as correct), and adherence with the Test of Adherence to Inhalers (a score ≥46 defined as good adherence). Patients were classified into four phenotypes by the 2×2 combination of technique and adherence. Baseline characteristics were compared across phenotypes, and Firth penalized logistic regression with a prespecified covariate set was used to identify factors associated with phenotype membership.</p><p><strong>Results: </strong>Only 25.3% of patients demonstrated fully correct technique and 59.0% met the threshold for good adherence. Four phenotypes were identified: Standard and Adherent (n=145, 20.7%), Non-adherent but Standard (n=32, 4.6%), Adherent but Non-standard (n=268, 38.3%), and Non-standard and Non-adherent (n=255, 36.4%). Inhaler technique and treatment adherence were frequently discordant. After adjustment, a higher disease-knowledge score was the factor most consistently associated with phenotype membership, being associated with lower odds of the two technique-deficient phenotypes (Group 3 vs 1: OR 0.35, 95% CI 0.27-0.44; Group 4 vs 1: OR 0.30, 95% CI 0.23-0.39) and with lower odds of non-adherence within GOLD assessment groups A and E. Longer disease duration was associated with the adherence dimension in opposite directions across phenotypes. Most other characteristics were not independently associated with phenotype membership.</p><p><strong>Conclusion: </strong>Inhaler technique and treatment adherence are frequently discordant in COPD, yielding four behavioral phenotypes. Disease-specific knowledge was the factor most consistently associated with these phenotypes, supporting assessing technique and adherence as two separate behavioral targets rather than a single construct.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"629907"},"PeriodicalIF":4.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of ICS/LAMA/LABA versus LAMA/LABA Therapy on Cardiovascular Benefits in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study.","authors":"Yan-Qing Wang, Xin-Yi Feng, Ming-Jin Yang, Xue-Mei Ying, Shi-Yu Fan, Hai-Yun Dai","doi":"10.2147/COPD.S629129","DOIUrl":"10.2147/COPD.S629129","url":null,"abstract":"<p><strong>Purpose: </strong>Recent evidence suggests that inhaled formulations containing inhaled corticosteroids (ICS) provide greater cardiovascular benefits to patients with chronic obstructive pulmonary disease (COPD) compared to those without ICS. However, no study has yet compared the cardiovascular outcomes of these inhalers in COPD populations based on baseline cardiovascular risk stratification. This study aims to evaluate the association between ICS/LAMA/LABA versus LAMA/LABA therapy and major adverse cardiovascular events (MACEs) in COPD patients with different levels of baseline cardiovascular risk.</p><p><strong>Patients and methods: </strong>This study was conducted using data from the Hospital Information System (HIS) of the First Affiliated Hospital of Chongqing Medical University. Patients receiving ICS/LAMA/LABA were classified as the observation group, and those receiving LAMA/LABA as the control group. The primary outcome was MACEs. The primary analysis used an inverse probability of treatment-weighted Cox proportional hazards model.</p><p><strong>Results: </strong>Over a mean follow-up of 20.5 months, a total of 102 (19.2%) MACEs were recorded. Specifically, 53 events occurred in the LAMA/LABA group (22%), and 49 events occurred in the ICS/LAMA/LABA group (17%) (adjusted hazard ratio [HR] 0.481; 95% confidence interval [CI], 0.302-0.766; P=0.002). Cardiovascular risk stratification using the Framingham Risk Score showed that patients at high cardiovascular risk, triple therapy was associated with a significantly lower risk of MACEs compared with LAMA/LABA therapy (adjusted HR 0.435; 95% CI, 0.266-0.711; P < 0.001). Similarly, among patients with a history of cardiovascular disease (CVD), triple therapy was also associated with a lower risk of MACEs compared with LAMA/LABA therapy (adjusted HR 0.478; 95% CI, 0.282-0.808; P=0.006).</p><p><strong>Conclusion: </strong>Among COPD patients, ICS/LAMA/LABA was associated with a lower risk of MACEs than LAMA/LABA therapy, particularly among those with high baseline cardiovascular risk or established CVD. These results still need to be further verified in future prospective studies.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"629129"},"PeriodicalIF":4.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peak Inspiratory Flow in COPD Patients Treated with Pressurized Metered-Dose Inhalers and Spacers: Implications for Inhaler Selection. A Multicenter Cross-Sectional Study.","authors":"Lara Bravo Quiroga, Jose Miguel González-Moro Rodríguez, Francisco Javier Álvarez-Gutiérrez, Krasimira Baynova, Mariam de la Poza Abad, Jose Luis Izquierdo-Alonso","doi":"10.2147/COPD.S621909","DOIUrl":"10.2147/COPD.S621909","url":null,"abstract":"<p><strong>Background: </strong>Spacer devices are frequently prescribed with pressurized metered-dose inhalers (pMDIs) in patients with COPD for a variety of clinical and practical reasons, including concerns about inspiratory capacity, inhaler technique, and hand-breath coordination. However, inspiratory flow is rarely measured objectively.</p><p><strong>Purpose: </strong>To determine whether COPD patients treated with pMDIs and spacers can generate adequate peak inspiratory flow (PIF) for dry powder inhaler (DPI) use, to evaluate the impact of incomplete exhalation, and to examine patient perceptions of spacer use.</p><p><strong>Patients and methods: </strong>This multicenter, cross-sectional study included 273 clinically stable COPD patients treated with pMDIs and spacers across 70 Spanish centers. PIF was measured with the In-Check Dial at medium-low (R2) and medium-high (R4) resistance under both standard and suboptimal conditions. Patient knowledge, satisfaction, and perceived barriers were evaluated using structured study questionnaires.</p><p><strong>Results: </strong>Overall, 96.0% of patients achieved a PIF ≥30 L/min at R4, whereas 61.9% reached ≥60 L/min. Incomplete exhalation had only a limited effect on inspiratory performance, with 94.1% of patients maintaining a PIF ≥30 L/min at R4. Lower PIF was associated with greater dyspnea and more severe airflow limitation in bivariate analyses. Spacer prescription was seldom based on objective PIF assessment. Most patients reported practical limitations associated with spacer use and expressed a preference for simpler inhaler devices.</p><p><strong>Conclusion: </strong>Most COPD patients treated with pMDIs and spacers appear to have sufficient inspiratory capacity to use medium- to high-resistance DPIs. Routine objective assessment of PIF may help optimize individualized inhaler selection and identify patients who could benefit from alternative inhaler devices.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"621909"},"PeriodicalIF":4.1,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-Month Adherence to Home Non-Invasive Ventilation in Stable Hypercapnic COPD: Associations with BMI and Bicarbonate Levels.","authors":"Nezihe Ciftaslan Goksenoglu, Zuhal Karakurt, Sinem Gungor, Ozlem Yazıcıoglu Mocin, Huriye Berk Takır, Emine Aksoy, Birsen Ocaklı, Gokay Gungor, Nalan Adıguzel","doi":"10.2147/COPD.S618144","DOIUrl":"10.2147/COPD.S618144","url":null,"abstract":"<p><strong>Introduction: </strong>Long-term home non-invasive mechanical ventilation (NIV) is widely used in patients with hypercapnic chronic obstructive pulmonary disease (COPD). However, its efficacy is heavily dependent on patient adherence. Body mass index (BMI) can influence tolerance and ventilatory load, but its impact on adherence remains unclear. Additionally, NIV for later use at home is frequently initiated during hospitalization to facilitate early discharge, and its ongoing necessity varies.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with stable hypercapnic COPD prescribed home NIV between 2017 and 2025 at a tertiary respiratory intensive care unit outpatient clinic. Demographics, arterial blood gases, spirometry, ventilator settings, and first-month NIV usage data were extracted from the patients' medical records. We used correlation analyses and Poisson regression modeling to evaluate factors associated with daily hours of NIV use.</p><p><strong>Results: </strong>A total of 413 patients were included. The mean partial pressure of carbon dioxide was 48 ± 7 mmHg. The mean forced expiratory volume in the first second was 28%, indicating severe airflow limitation. Overall adherence was very poor, with approximately 80% of patients using NIV for <4 hours a day, regardless of their BMI category. We found no significant linear correlation between BMI and NIV adherence. A large proportion of the low-adherence group had elevated bicarbonate (HCO₃ ^-) levels (≥27 mmol/L), suggesting chronic compensated hypercapnia. Multivariable analysis found BMI to predict slightly higher adherence (risk ratio [RR] 1.01; <i>p</i> = 0.050), whereas higher HCO₃ ^- was associated with lower adherence (RR 0.96; <i>p</i> = 0.020).</p><p><strong>Discussion: </strong>BMI was not a major determinant of first-month NIV adherence, whereas elevated HCO₃ ^- levels may help identify patients at increased risk of poor early NIV adherence.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"618144"},"PeriodicalIF":4.1,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Butyrate Regulating Inflammatory Responses in Chronic Obstructive Pulmonary Disease via the Gut-Lung Axis.","authors":"Qiang Liu, Qian Fu, Caiyuan Sun, Chanli Liu, Chan Xiong, Mei Chen","doi":"10.2147/COPD.S621848","DOIUrl":"10.2147/COPD.S621848","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) poses a major global health challenge, yet current pulmonary-directed therapies offer only symptomatic relief without modifying the underlying systemic inflammatory pathology. The gut-lung axis has emerged as a pivotal cross-organ regulatory circuit in COPD progression, and butyrate-a key microbial short-chain fatty acid derived from dietary fibre fermentation-mediates pleiotropic immunomodulatory effects that bridge intestinal homeostasis and pulmonary inflammation. This narrative review synthesises preclinical and limited clinical evidence to elucidate the regulatory functions of butyrate in COPD inflammation via the gut-lung axis, organising its core mechanisms into four major modules: strengthening intestinal mucosal barrier integrity, suppressing type 2 innate lymphoid cell overactivation, restoring the Th17/Treg homeostatic balance, and interrupting pathological endothelial-macrophage inflammatory crosstalk. Importantly, the therapeutic potential of butyrate is phenotype-restricted; its anti-inflammatory actions are primarily validated in the type 2 inflammatory COPD subtype, which affects only 20-40% of patients, whereas robust evidence for efficacy in the predominant neutrophilic phenotype remains scarce. Translational hurdles further impede clinical application, including poor oral bioavailability due to first-pass hepatic metabolism, insufficient human clinical verification, and the theoretical risk of excessive immunosuppression at elevated concentrations. Moreover, most mechanistic inferences are drawn from in vitro studies and cigarette smoke-induced animal models that incompletely recapitulate the heterogeneous pathophysiology of human COPD. This review critically appraises the current theoretical framework of butyrate-mediated gut-lung co-regulation, delineates the applicable patient subsets and core limitations of butyrate intervention, and highlights priority research directions encompassing phenotype-stratified clinical trials, optimised targeted delivery systems, and comparative analyses of multiple short-chain fatty acids. Although butyrate offers a promising theoretical foundation for developing novel gut-lung coordinated disease-modifying strategies, rigorous stratified clinical validation remains essential to ascertain its genuine therapeutic value in practice.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"621848"},"PeriodicalIF":4.1,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy and Safety of Inhaled Maintenance Therapy Strategies for Quality of Life in COPD: A Systematic Review and Bayesian Network Meta-Analysis.","authors":"Jie Jiang, Wei Feng, Xinlin Yu","doi":"10.2147/COPD.S632653","DOIUrl":"10.2147/COPD.S632653","url":null,"abstract":"<p><strong>Background: </strong>Inhaled maintenance therapies are central to the long-term management of chronic obstructive pulmonary disease (COPD), but their comparative effects on health-related quality of life across the treatment-escalation pathway remain unclear. This systematic review and Bayesian network meta-analysis compared major inhaled treatment strategies using change in St. George's Respiratory Questionnaire (SGRQ) total score as the primary outcome, with exploratory assessment of safety.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, Web of Science, and Scopus were searched from inception to May 21, 2025, with supplementary citation tracking and ClinicalTrials.gov screening. Randomized controlled trials in stable COPD comparing placebo, long-acting muscarinic antagonists (LAMA), long-acting beta-2 agonists (LABA), inhaled corticosteroid plus LABA (ICS+LABA), LABA plus LAMA (LABA+LAMA), or triple therapy were included. Bayesian random-effects network meta-analysis was performed. Transcriptomic analyses were conducted only as exploratory mechanistic contextualization and were not treated as primary clinical endpoints.</p><p><strong>Results: </strong>Fourteen randomized trials were included. Triple therapy showed the greatest improvement in SGRQ total score versus placebo (mean difference [MD] -3.99; 95% credible interval [CrI] -5.86 to -2.16) and ranked highest by surface under the cumulative ranking curve. Compared with LABA+LAMA, triple therapy was associated with greater improvement in SGRQ total score (MD -1.42; 95% CrI -2.62 to -0.16), whereas differences among other active regimens were generally small. In connected safety networks, no clear differences versus placebo were observed for adverse events, serious adverse events, discontinuation due to adverse events, or death. Direct meta-analysis of four trials showed increased pneumonia risk with triple therapy versus LABA+LAMA (odds ratio 1.50; 95% confidence interval 1.16-1.93).</p><p><strong>Conclusion: </strong>Triple therapy was associated with the greatest average improvement in SGRQ total score in stable COPD, but its incremental benefit over dual bronchodilation was modest and below the conventional SGRQ minimal clinically important difference. Treatment escalation should therefore be individualized, balancing potential quality-of-life gains against pneumonia risk with ICS-containing regimens.</p><p><strong>Registration: </strong>PROSPERO CRD420261407792.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"632653"},"PeriodicalIF":4.1,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coexisting Sarcopenia and Osteoporosis in COPD: Integrated Identification, Risk-Oriented Assessment, and Comprehensive Management-A Structured Narrative Review.","authors":"Shuting Meng, Yu Shi, Dongxing Zhang, Yuming Hou, Xiaogang Jing","doi":"10.2147/COPD.S621875","DOIUrl":"10.2147/COPD.S621875","url":null,"abstract":"<p><p>Sarcopenia and osteoporosis are common but underrecognized extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD). When they coexist, functional limitation, falls, fractures, hospitalization, and mortality may be amplified. This structured narrative review synthesizes evidence available through April 1, 2026, focusing on shared mechanisms, clinical identification, diagnostic interpretation, and management. Coexisting muscle-bone impairment is plausibly driven by systemic inflammation, hypoxia and oxidative stress, physical inactivity, malnutrition, exacerbation-related catabolism, and systemic glucocorticoid exposure, with additional but incompletely validated myokine-osteokine signaling. Integrated assessment is most relevant for patients with systemic wasting, recurrent exacerbations or substantial systemic glucocorticoid exposure, marked activity limitation, falls or fragility fractures, or planned pulmonary rehabilitation. A stepwise pathway links low-burden functional screening with consensus-based muscle assessment and formal bone evaluation; opportunistic computed tomography (CT) and musculoskeletal ultrasound may add complementary information but lack universal COPD-specific thresholds. Management should combine individualized endurance, resistance, and balance training with nutritional support, fracture-risk management, and serial reassessment. Prospective multicenter studies are needed to determine whether this approach reduces fractures, rehospitalization, or mortality.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"621875"},"PeriodicalIF":4.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Air Pollution and Hospitalization of Patients with Chronic Obstructive Pulmonary Disease in Kashi, China: A Time-Stratified Case-Crossover Study.","authors":"Li Li, Ayiguli Alimu, Jingran Xu, Hui Gong, Zulipikaer Abudureheman, Xuemei Zhong, Lexin Xue, Xiuqi Lu, Boyi Yang, Xiaohong Yang","doi":"10.2147/COPD.S617521","DOIUrl":"10.2147/COPD.S617521","url":null,"abstract":"<p><strong>Objective: </strong>To investigate associations between air pollutants and hospitalization of patients with chronic obstructive pulmonary disease (COPD) in Kashi, and to identify susceptible populations.</p><p><strong>Methods: </strong>We conducted a retrospective study of COPD patients in Kashi between 2012 and 2022. Daily pollutant concentrations were matched to residential addresses for individual exposure assessment. A time-stratified case-crossover design with conditional logistic regression was used to evaluate associations between pollutants and COPD hospitalization. Stratified analyses were performed by age, gender, smoking history and hospitalization season. Sensitivity analysis was conducted by excluding hospitalizations during the COVID-19 pandemic to test result robustness.</p><p><strong>Results: </strong>A total of 68,482 patients were included. The strongest significant association between particulate matter (PM₁₀) and COPD hospitalization was identified at lag day 4, particulate matter (PM_2.5), PM₁₀, nitrogen dioxide (NO2) and carbon monoxide (CO) exposures generally had relationships of COPD hospitalization [OR (95% CI): 1.015 (1.002-1.032), 1.008 (1.002-1.016), 1.034 (1.008-1.067), and 1.034 (1.005-1.065), respectively]. Individuals who are young, patients with a history of severe acute exacerbations, farmers, smokers, and individuals admitted in cooler seasons may be particularly susceptible. Sensitivity analyses omitting COVID-19 cases showed barely significant associations for PM_2.5, PM₁₀ and NO₂, with CO displaying only a faint, non-significant relationship.</p><p><strong>Conclusion: </strong>PM_2.5, PM₁₀, NO₂, and CO exposures were associated with COPD hospitalization in Kashi, precautionary measures should be taken with a focus on vulnerable subgroups, to control hospitalization for COPD associated with air pollutants.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"21 ","pages":"617521"},"PeriodicalIF":4.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}