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Volume 15
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Article

Obesity in Chronic Obstructive Pulmonary Disease (COPD): Effects on Inflammation, Immune System, Susceptibility to Viral Infections, and Mortality

by
Laura Vitiello
1,2,
Stefania Proietti
3,
Dolores Limongi
1,4,
Carla Prezioso
1,4,
Caterina Mammi
5,
Massimiliano Caprio
1,5,
Fabrizio Maggi
6,
Guido Antonelli
7,8,
Stefano Bonassi
1,2 and
Patrizia Russo
1,2,*
1
Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy
2
Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Via di Val Cannuta 247, 00166 Rome, Italy
3
AgEA Coordinating Body, 00185 Rome, Italy
4
Laboratory of Microbiology, IRCCS San Raffaele Roma, Via di Val Cannuta 247, 00166 Rome, Italy
5
Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Roma, Via di Val Cannuta 247, 00166 Rome, Italy
6
National Institute for Infectious Diseases “Lazzaro Spallanzani”-INMI IRCCS, Via Portuense 292, 00149 Rome, Italy
7
Department of Molecular Medicine, Sapienza University, 00185 Rome, Italy
8
Microbiology and Virology Unit, Sapienza University Hospital Policlinico Umberto I, 00186 Rome, Italy
*
Author to whom correspondence should be addressed.
Pathogens 2026, 15(7), 664; https://doi.org/10.3390/pathogens15070664 (registering DOI)
Submission received: 5 May 2026 / Revised: 16 June 2026 / Accepted: 18 June 2026 / Published: 23 June 2026
(This article belongs to the Section Viral Pathogens)
Review Reports Versions Notes

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by systemic inflammation, immune dysregulation, and increased susceptibility to infections. Obesity may influence these processes and has been proposed as a potential contributor to the so-called “obesity paradox”, although its effects on immune competence, viral burden, and survival are not yet fully understood. Seventy patients with severe to very severe COPD (GOLD stage 3–4) were stratified according to BMI (<30 vs. ≥30 kg/m2). Clinical and functional parameters were assessed together with biomarkers of oxidative stress, DNA damage, systemic inflammation, and T-cell subsets. A comprehensive viral panel, including Torque Teno virus (TTV), was also analyzed. Five-year survival was evaluated using Kaplan–Meier curves and Cox regression models. Patients with BMI ≥ 30 showed higher lymphocyte counts and increased CD4+ and CD8+ T-cell levels, accompanied by lower systemic inflammatory indices. No significant differences were observed in oxidative stress or DNA damage markers. In addition, TTV viremia (≥4 log10 copies/mL) was more frequently observed among patients with lower BMI. Despite these differences, five-year survival did not significantly differ between the two groups. These findings suggest that BMI alone may have limited value as a predictor of outcomes in patients with advanced COPD. Conversely, immune-inflammatory indices and viral burden, particularly TTV viremia, could provide complementary information for risk assessment and may deserve further investigation as potential tools for personalized patient stratification.
Keywords: COPD; obesity paradox; systemic inflammation; T-cell immunity; Torque Teno virus (TTV); viral biomarkers; oxidative markers; rehabilitation COPD; obesity paradox; systemic inflammation; T-cell immunity; Torque Teno virus (TTV); viral biomarkers; oxidative markers; rehabilitation

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MDPI and ACS Style

Vitiello, L.; Proietti, S.; Limongi, D.; Prezioso, C.; Mammi, C.; Caprio, M.; Maggi, F.; Antonelli, G.; Bonassi, S.; Russo, P. Obesity in Chronic Obstructive Pulmonary Disease (COPD): Effects on Inflammation, Immune System, Susceptibility to Viral Infections, and Mortality. Pathogens 2026, 15, 664. https://doi.org/10.3390/pathogens15070664

AMA Style

Vitiello L, Proietti S, Limongi D, Prezioso C, Mammi C, Caprio M, Maggi F, Antonelli G, Bonassi S, Russo P. Obesity in Chronic Obstructive Pulmonary Disease (COPD): Effects on Inflammation, Immune System, Susceptibility to Viral Infections, and Mortality. Pathogens. 2026; 15(7):664. https://doi.org/10.3390/pathogens15070664

Chicago/Turabian Style

Vitiello, Laura, Stefania Proietti, Dolores Limongi, Carla Prezioso, Caterina Mammi, Massimiliano Caprio, Fabrizio Maggi, Guido Antonelli, Stefano Bonassi, and Patrizia Russo. 2026. "Obesity in Chronic Obstructive Pulmonary Disease (COPD): Effects on Inflammation, Immune System, Susceptibility to Viral Infections, and Mortality" Pathogens 15, no. 7: 664. https://doi.org/10.3390/pathogens15070664

APA Style

Vitiello, L., Proietti, S., Limongi, D., Prezioso, C., Mammi, C., Caprio, M., Maggi, F., Antonelli, G., Bonassi, S., & Russo, P. (2026). Obesity in Chronic Obstructive Pulmonary Disease (COPD): Effects on Inflammation, Immune System, Susceptibility to Viral Infections, and Mortality. Pathogens, 15(7), 664. https://doi.org/10.3390/pathogens15070664

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