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Advances in Chronic Obstructive Pulmonary Disease (COPD)
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Advances in Chronic Obstructive Pulmonary Disease (COPD)

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Cell Biology and Pathology".

Deadline for manuscript submissions: 31 December 2026 | Viewed by 3591

Editors

Dr. Fabio Manzo

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Guest Editor
Fleming Clinical Laboratory, 81020 Casapulla, Italy
Interests: COPD; Epigenetics; HDAC; endothelial function; thrombosis; cardiovascular risk; biomarkers
Dr. Pasquale Ambrosino

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Guest Editor
Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
Interests: atherosclerosis; endothelial function; chronic obstructive pulmonary disease; cardiovascular risk; vascular medicine; nitric oxide; biomarkers; rehabilitation; disability
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Chronic Obstructive Pulmonary Disease (COPD) continues to represent a major global health challenge. Current projections from the World Health Organization indicate that COPD will rank among the leading causes of mortality worldwide by 2030. Its prevalence is steadily increasing, particularly in aging populations and in regions where exposure to tobacco smoke and environmental pollutants remains high. As the disease progresses, patients are prone to recurrent exacerbations that accelerate the decline in lung function and profoundly impair daily functioning and quality of life.

The clinical and socioeconomic burden of COPD is substantial. Hospitalizations, chronic pharmacological treatments, and ongoing outpatient management contribute significantly to healthcare expenditure, while disability and absenteeism further extend its impact at the societal level. In addition, COPD frequently coexists with complex comorbidities, including cardiovascular disease, osteoporosis, and mood disorders. These conditions complicate disease management and exacerbate morbidity and overall health deterioration.

Emerging evidence suggests that COPD is a heterogeneous disease with strong polygenic and epigenetic influences. Advances in molecular profiling and biomarker research have begun to refine patient stratification and guide individualized therapeutic strategies. However, challenges remain in improving early detection, predicting disease trajectories, and identifying targets capable of modifying disease progression.

This Special Issue, “Advances in Chronic Obstructive Pulmonary Disease (COPD)”, invites original research and comprehensive reviews focused on innovative diagnostic, mechanistic, and therapeutic perspectives. We particularly encourage submissions that deepen understanding of molecular and cellular pathways, elucidate phenotypic variability, or introduce novel approaches that may inform precision medicine strategies in COPD.

We look forward to contributions that may help reshape current paradigms and advance the field toward more effective and personalized patient care.

Dr. Fabio Manzo
Dr. Pasquale Ambrosino
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Biomedicines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • chronic obstructive pulmonary disease
  • COPD
  • emphysema
  • chronic bronchitis
  • chronic disease
  • disability
  • rehabilitation

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Published Papers (2 papers)

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Research

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15 pages, 6026 KB  
Article
Clinical and Radiological Characteristics of Symptomatic Emphysema Patients with PRISm and Pre-COPD Phenotypes: Possible Effects of Smoking Status
by Maşide Ari, Emrah Ari, Eray Çinar, Hakan Ertürk, Deniz Çelik, Murat Yildiz, Tarkan Özdemir, Mehmet Kayadelen, Derya Tüten Özdemir, Tunahan Dolmuş, Hasan İbiş, Esma Dolmuş and Ömer Faruk Tüten
Biomedicines 2026, 14(6), 1245; https://doi.org/10.3390/biomedicines14061245 - 30 May 2026
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Abstract
Background: Pre-Chronic Obstructive Pulmonary Disease (pre-COPD) and Preserved Ratio Impaired Spirometry (PRISm) phenotypes represent important components of the early obstructive lung disease spectrum, characterized by respiratory symptoms and structural lung abnormalities prior to the development of overt airflow limitation. Emphysema is considered one [...] Read more.
Background: Pre-Chronic Obstructive Pulmonary Disease (pre-COPD) and Preserved Ratio Impaired Spirometry (PRISm) phenotypes represent important components of the early obstructive lung disease spectrum, characterized by respiratory symptoms and structural lung abnormalities prior to the development of overt airflow limitation. Emphysema is considered one of the major structural phenotypes underlying airway disease and the COPD spectrum. Although cigarette smoking is the best recognized risk factor for these conditions, non-tobacco exposures may also contribute to early structural lung changes. In this study, we evaluated the radiological features, pulmonary function parameters, and dyspnea severity of CT-detected emphysema in symptomatic patients classified as having pre-COPD or PRISm, with particular attention paid to the potential influence of smoking status on disease characteristics. Methods: In this retrospective, single-center study, symptomatic patients aged 20–50 years classified as having pre-COPD or PRISm and in whom emphysema was detected on high-resolution computed tomography (HRCT) were evaluated. Only symptomatic patients who underwent HRCT for clinical indications and in whom emphysema was identified were included. Demographic characteristics, emphysema type and quantitative emphysema severity, pulmonary function parameters, and Modified Medical Research Council (mMRC) dyspnea scores were analyzed. The PRISm and pre-COPD groups were compared in terms of clinical and symptomatic characteristics. In addition, smoking-related clinical and radiological characteristics were also evaluated. Results: A total of 232 patients were included in the study. The median age was 43 years (38–48), and 84.1% of the participants were male. Among the study population, 68.5% were classified in the pre-COPD group and 31.5% in the PRISm group. The most frequently identified emphysema patterns were paraseptal (44.4%) and centrilobular (40.5%). The median total lung emphysema area was 18% (13–22). A weak negative correlation was observed between the degree of emphysema and FEV1 (r = −0.185; p = 0.005), whereas a weak positive correlation was found between emphysema extent and the mMRC dyspnea score (r = 0.214; p = 0.001). Dyspnea severity was significantly higher in the PRISm group compared with the pre-COPD group (p < 0.001). In the smoking-status subgroup analysis, ever-smokers demonstrated significantly greater dyspnea severity and lower FEV1 values, whereas never-smokers had a significantly higher proportion of emphysema extent > 18% (all p < 0.05). Conclusions: Radiologically detected emphysema in symptomatic patients without airflow limitation was associated with statistically significant but weak alterations in pulmonary function and dyspnea burden. Dyspnea severity was significantly higher in the PRISm phenotype. In a smoking-status subgroup analysis, ever-smokers had significantly greater dyspnea severity, whereas never-smokers showed a significantly higher proportion of extensive emphysema (>18%), despite similar functional impairment across groups. These findings underscore the importance of non-tobacco exposures in the development of emphysema within pre-obstructive spirometric phenotypes. Multicenter prospective studies incorporating healthy controls and systematic exposure documentation are needed to confirm these observations. Full article
(This article belongs to the Special Issue Advances in Chronic Obstructive Pulmonary Disease (COPD))
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Review

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16 pages, 1164 KB  
Review
Mucus Plugging as a Treatable Trait Across the Asthma–COPD Spectrum: The Role of Type 2 Cytokine Blockade and Quantitative Imaging
by Pier-Valerio Mari, Alberto Ricci, Angelo Coppola, Davide Onofrio Fontana, David Selvaggio, Lorenzo Carriera, Simone Ielo, Matteo Siciliano, Loreta Di Michele and Veronica Ojetti
Biomedicines 2026, 14(4), 891; https://doi.org/10.3390/biomedicines14040891 - 14 Apr 2026
Cited by 4 | Viewed by 2632
Abstract
Background: Airway mucus plugging is a key but long-overlooked mechanism of persistent airflow obstruction in both asthma and chronic obstructive pulmonary disease (COPD). Type 2 (T2) cytokines, particularly interleukin (IL)-4 and IL-13, drive goblet cell metaplasia, MUC5AC overexpression, and impaired mucociliary clearance, while [...] Read more.
Background: Airway mucus plugging is a key but long-overlooked mechanism of persistent airflow obstruction in both asthma and chronic obstructive pulmonary disease (COPD). Type 2 (T2) cytokines, particularly interleukin (IL)-4 and IL-13, drive goblet cell metaplasia, MUC5AC overexpression, and impaired mucociliary clearance, while eosinophil-derived products increase mucus viscosity and promote plug persistence. Methods: A comprehensive narrative review was conducted by searching PubMed and ClinicalTrials.gov databases from inception to February 2026. Search terms included “mucus plugs,” “mucus plugging,” “biologics,” “dupilumab,” “tezepelumab,” “mepolizumab,” “benralizumab,” “IL-4,” “IL-13,” “MUC5AC,” “quantitative CT,” “functional respiratory imaging,” “asthma,” and “COPD.” Studies were included if they reported original data or systematic evidence on mucus plug quantification, biologic-mediated changes in mucus plug scores, or imaging modalities for mucus assessment in asthma or COPD. Editorials, case reports with fewer than three patients, and studies not available in English were excluded. Two authors (P.-V.M. and A.C.) independently screened titles and abstracts; discrepancies were resolved by consensus. Randomized controlled trials, observational studies, and preclinical studies evaluating mucus plug outcomes and T2-targeted therapies were included. Reference lists of retrieved articles were hand-searched for additional relevant publications. Results: A recent systematic review identified multiple randomized controlled trials and observational studies that showed CT-assessed mucus plug scores go down with biologic therapies targeting the T2 pathway in asthma. Observational data extend this evidence to anti-IL-5/IL-5Rα agents. The VESTIGE trial provided the first functional respiratory imaging evidence of mucus plug resolution with dupilumab. In COPD, the BOREAS/NOTUS and MATINEE trials established the efficacy of dupilumab and mepolizumab in eosinophilic phenotypes; however, differences in inclusion criteria—particularly regarding FeNO thresholds and prior exacerbation burden—may explain divergent effects on lung function endpoints. Mucus plug outcomes have not been evaluated in COPD biologic trials. Quantitative imaging modalities, including HRCT mucus plug scoring, functional respiratory imaging, and hyperpolarized gas MRI, now enable objective assessment of mucus burden. Conclusions: Mucus plugging meets the definition of a treatable trait: it can be measured with CT scoring, it matters clinically, and it responds to T2 cytokine blockade. Adding mucus plug assessment to routine clinical evaluation, together with mucolytic strategies where needed, could move treatment decisions from empirical to biology-based across the asthma–COPD spectrum. Further studies are needed to confirm that mucus plug scoring works as a biomarker of treatment response in COPD and to test whether combining biologics with mucolytics improves outcomes. Full article
(This article belongs to the Special Issue Advances in Chronic Obstructive Pulmonary Disease (COPD))
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