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Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management—Second Edition
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Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management—Second Edition

A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Respiratory Medicine".

Deadline for manuscript submissions: 25 April 2027 | Viewed by 2747

Editors

Dr. Maurizio Marvisi

E-Mail Website
Guest Editor
Department of Internal Medicine, Istituto Figlie di San Camillo, Via Filzi 56, 26100 Cremona, Italy
Interests: lung; spirometry; lung diseases; airway obstruction; asthma management; ventilation; respiratory physiology; allergic diseases; diagnosis; inflammatory bowel disease
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Alfredo Antonio Chetta

E-Mail Website
Guest Editor
1. Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
2. Cardio-Thoracic and Vascular Department, University Hospital of Parma, 43126 Parma, Italy
Interests: asthma; lung; sputum; lung diseases; spirometry; airway obstruction; respiratory physiology; cystic fibrosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are delighted to launch the second edition of our Special Issue titled “Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management—Second Edition”. We invite you to visit our website to access the first volume of this Special Issue, available at https://www.mdpi.com/journal/jcm/special_issues/DFT93K98XY.

Chronic obstructive pulmonary disease (COPD) is a major global health problem due to its high prevalence (10% of the adult population), rising incidence, and very significant associated personal, social, and economic costs. The old view that COPD is a single disease caused by smoking and characterized by an accelerated rate of lung function decline that occurs in (mostly) older males is outdated and incomplete. Recent data support a different pathogenic paradigm that considers that COPD is a polygenic disease with a significant epigenetic component and multiple environmental risk factors that interact and accumulate through life in complex ways to determine the clinical manifestations. Although few novel treatments have been approved for COPD in the past 5 years, advances have been made in targeting specific subpopulations with existing therapies using new biomarker-based strategies. Additionally, COVID-19 has undeniably affected individuals with COPD, who are not only at higher risk for severe disease manifestations than healthy individuals but are also negatively affected by interruptions in healthcare delivery and social isolation. This Special Issue reviews COPD with an emphasis on recent advances in epidemiology, imaging, diagnosis, and treatment.

Dr. Maurizio Marvisi
Prof. Dr. Alfredo Antonio Chetta
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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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)
  • treatable traits
  • precision medicine
  • COPD comorbidities
  • COPD mortality

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Related Special Issue

Published Papers (3 papers)

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Research

19 pages, 2731 KB  
Article
Prediction of Prolonged Length of Hospital Stay in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: An Interpretable Machine Learning Tool
by Jingjing Xiong, Lian Liu, Zhenni Chen, Weiling Cai, Jianjun Luo, Suli Liu, Jiangyue Qin, Fangying Chen, Xiaohua Li, Zhixin Qiu and Yongchun Shen
J. Clin. Med. 2026, 15(15), 6127; https://doi.org/10.3390/jcm15156127 - 6 Aug 2026
Viewed by 393
Abstract
Objective: Reducing the length of hospital stay (LOS) is a core objective in the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study aimed to develop an interpretable and clinically applicable machine learning tool for predicting prolonged LOS in this [...] Read more.
Objective: Reducing the length of hospital stay (LOS) is a core objective in the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study aimed to develop an interpretable and clinically applicable machine learning tool for predicting prolonged LOS in this population. Methods: This retrospective three-center study enrolled 1342 patients, who were randomly allocated to a training set (70%) and a test set (30%). Candidate predictors were screened using least absolute shrinkage and selection operator (LASSO) regression, and six machine learning models were developed and compared: logistic regression, random forest, gradient boosting machine, CatBoost, support vector machine, and neural network. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. Model interpretability was achieved through SHapley Additive exPlanations (SHAP) and subgroup analyses. Results: Prolonged LOS, defined as >10 days (the median LOS in the training set), occurred in 42.0% of patients. Nine predictors were identified, including daily inhaled medication use, sputum microbiological examination, antibiotic administration, corticosteroid therapy, diuretic use, ICU admission, oxygenation index, platelet count, and neutrophil count. The random forest model demonstrated superior and consistent discriminative performance, achieving an AUC of 0.778 (95% CI: 0.748–0.807) in the training set and 0.721 (95% CI: 0.672–0.771) in the test set. SHAP analysis ranked diuretic use, daily inhaled medication use, corticosteroid therapy, sputum microbiological examination, and antibiotic administration as the five most influential features, revealing treatment-related variables associated with prolonged LOS. Subgroup analyses indicated better predictive performance in lower-risk patients (age ≤ 65 years with eGFR 1–2 stage). Conclusions: Random Forest may enable to promptly identify prolonged LOS high-risk patients, enhancing clinical vigilance and optimizing healthcare resource allocation in AECOPD patients. Full article
(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management—Second Edition)
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14 pages, 1420 KB  
Article
An Evidence-Informed Clinical Pathway for COPD Exacerbations in Emergency Departments: Diagnostic Assessment, Severity Stratification, and Individualized Management
by Rafael Suarez del Villar Carrero, Santiago Toranzo-Nieto and Laura Álvarez Santin
J. Clin. Med. 2026, 15(15), 6119; https://doi.org/10.3390/jcm15156119 - 6 Aug 2026
Viewed by 622
Abstract
Background/Objectives: Exacerbations of chronic obstructive pulmonary disease (COPD) are a common reason for emergency department (ED) attendance and hospital admission. Acute respiratory worsening is non-specific, and previous spirometric confirmation may be unavailable at presentation. We aimed to translate current recommendations into an ED-specific [...] Read more.
Background/Objectives: Exacerbations of chronic obstructive pulmonary disease (COPD) are a common reason for emergency department (ED) attendance and hospital admission. Acute respiratory worsening is non-specific, and previous spirometric confirmation may be unavailable at presentation. We aimed to translate current recommendations into an ED-specific clinical pathway that standardizes safety-critical steps without replacing individualized clinical judgment. Methods: We performed a targeted synthesis of international and Spanish guidance and key studies relevant to ED diagnosis, severity assessment, pharmacological treatment, respiratory support, antimicrobial stewardship, and disposition. The evidence base was updated in June 2026, and the pathway was reviewed by a multidisciplinary clinical group. Results: The revised pathway comprises four stages: (1) verify previous COPD confirmation, identify an acute exacerbation-like syndrome, and assess alternative or concomitant diagnoses; (2) grade acute severity using point-of-care variables and separately assess patient vulnerability; (3) provide severity-adjusted treatment with early reassessment; and (4) determine disposition and follow-up. It incorporates controlled oxygen, individualized bronchodilator delivery, explicit criteria for systemic corticosteroids and antibiotics, assessment of risk for Pseudomonas aeruginosa, non-invasive ventilation (NIV), and a defined adjunctive role for high-flow nasal cannula (HFNC). Patients without previous post-bronchodilator spirometry are classified as having suspected COPD and require confirmation after recovery. Conclusions: This evidence-informed pathway is a preliminary clinical framework, not a diagnostic rule or validated decision instrument. It is intended to support, rather than replace, professional judgment. Feasibility, acceptability, diagnostic safety, and clinical impact require prospective evaluation, beginning with a pilot implementation study. Full article
(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management—Second Edition)
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13 pages, 600 KB  
Article
The Efficacy of High-Flow Nasal Cannula (HFNC) Treatment in Patients with Chronic Type II Respiratory Failure Secondary to COPD
by Raffaella Pagliaro, Vittorio Simeon, Luca Notizia, Stefania Arena, Domenica Francesca Mariniello, Giulia Maria Stella, Andrea Bianco, Fabio Perrotta and Luigi Aronne
J. Clin. Med. 2026, 15(5), 1924; https://doi.org/10.3390/jcm15051924 - 3 Mar 2026
Cited by 1 | Viewed by 1250
Abstract
Background: The use of HFNC (High Flow Nasal Cannula) in the management of acute respiratory failure has been fully established in clinical practice. Conversely, less data is available supporting its use in chronic hypoxemic–hypercapnic respiratory failure. The aim of the present study is [...] Read more.
Background: The use of HFNC (High Flow Nasal Cannula) in the management of acute respiratory failure has been fully established in clinical practice. Conversely, less data is available supporting its use in chronic hypoxemic–hypercapnic respiratory failure. The aim of the present study is to evaluate the efficacy of HFNC in chronic hypercapnic respiratory failure associated with stable COPD. Methods: In this retrospective single-center longitudinal observational study, 40 patients treated with HFNC at home followed at the COPD Clinic of Respiratory Diseases (University of Campania L. Vanvitelli Monaldi Hospital, Naples) were included. All patients are re-assessed at our clinic at T0, T3, T6 and T12 months through functional respiratory tests and blood gas analysis. Results: After 12 months, significant reductions in pCO2 (arterial partial pressure of carbon dioxide) (from 58.5 to 48.0 mmHg) and lactates (from 1.60 to 0.90 mmol/L) were observed, and MIP and MEP improved significantly. Patients receiving HFNC flows ≥50 L/min experienced greater reductions in pCO2 and fewer exacerbations. Multivariate analysis identified HFNC flow rate (p = 0.0046), hours of use/day (p = 0.0157), lactate levels (p = 0.0301), and FEV1 (forced expiratory volume in 1 s) (p = 0.0491) as independent predictors of reduction in PaCO2. Higher BMI and greater airway obstruction were associated with a reduced response. Conclusions: Treatment with HFNC represents a reasonable therapeutic choice to reduce AEs-COPD and reduce PaCO2 and lactates in stable COPD patients. Full article
(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management—Second Edition)
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