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Advances in the Personalized Management of Chronic Obstructive Pulmonary Disease (COPD)

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

Deadline for manuscript submissions: 20 February 2027 | Viewed by 6585

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Editors

Dr. Athena Gogali

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Guest Editor

Respiratory Medicine Department, University of Ioannina, Stavrou Niarchou Avenue, 45500 Ioannina, Greece
Interests: COPD; severe asthma; interstitial lung disease
Special Issues, Collections and Topics in MDPI journals

Dr. Georgios Hillas

E-Mail Website
Guest Editor

2nd Respiratory Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
Interests: asthma; observational studies; lung diseases; bronchiectasis; airway obstruction

Special Issue Information

Dear Colleagues,

Chronic obstructive pulmonary disease (COPD) represents a major burden for healthcare systems worldwide. Potential reasons include underdiagnosis in multiple parts of the world and the need for novel treatments beyond the currently available inhaled combinations of long-acting muscarinic antagonists (LAMAs), long-acting β-agonists (LABAs), and inhaled corticosteroids (ICSs). Modern diagnostic techniques, including the use of artificial intelligence (AI) in spirometry, oscillometry, novel imaging techniques, and the use of biomarkers, have advanced the phenotyping and endotyping of COPD patients. The proper identification of individual characteristics of COPD patients represents the basis for proper personalized management. This includes the appropriate choice of inhalation devices, the optimal recommendation of pharmacotherapy and non-pharmacologic interventions, advanced interventional treatments (including bronchoscopic lung volume reduction), non-invasive ventilation, and the appropriate management of comorbidities. The recent approval of dupilumab as the first biologic indicated for the management of exacerbating COPD patients with type 2 inflammation represents the advent of potential new candidate biologics for COPD, targetting multiple inflammatory mediators and pathways, including IL-5, TSLP, IL-33, and the ST-2 pathway. This Special Issue welcomes original research and review papers on recent diagnostic and therapeutic options that may advance the personalized management of COPD patients.

Dr. Athena Gogali
Dr. Georgios Hillas
Guest Editors

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Keywords

artificial intelligence
biologics
biomarkers
diagnostics
oscillometry
COPD pharmacotherapy
imaging

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Published Papers (6 papers)

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Research

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20 pages, 1054 KB

Open AccessArticle

Low Body Mass Index Is Associated with a Long-Term Decline in Accelerometer-Measured Physical Activity in Patients with COPD: An Exploratory Analysis of Participants Co-Enrolled in Two Prospective Cohort Studies

by Yusuke Murakami, Yoshiaki Minakata, Yasushi Tanimoto, Keisuke Miki, Shinji Tamaki and Toshiyuki Kita

J. Clin. Med. 2026, 15(18), 7038; https://doi.org/10.3390/jcm15187038 - 11 Sep 2026

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Abstract

Background/Objectives: Reduced physical activity (PA) and increased sedentary behavior (SB) are associated with adverse outcomes in chronic obstructive pulmonary disease (COPD), but the factors underlying their long-term change are unclear; we investigated the baseline factors associated with these changes. Methods: Japanese outpatients with stable COPD co-enrolled in the SPACE (baseline) and E-PAC (follow-up) studies were analyzed retrospectively. Twenty-nine baseline clinical variables were assessed. PA and SB were measured with a waist-worn triaxial accelerometer and expressed in metabolic equivalents (METs). Annualized percentage changes (per year, relative to baseline) were analyzed by Spearman’s rank correlation and multiple linear regression. Results: Thirty-two participants (all men; median age 71.0 years; median follow-up 5.0 years) were analyzed. Lower baseline body weight, BMI, upper arm circumference, FEV1.0, FEV1.0/FVC, and lowest percutaneous oxygen saturation (SpO₂) during the 6 min walk test (6MWT) were correlated with greater annualized declines in PA. For SB, the annualized change was correlated only with the lowest SpO₂ during the 6MWT, FEV1.0/FVC, and the hemoglobin concentration. In multivariable models adjusted for FEV1.0 %pred and the lowest SpO₂ during the 6MWT, BMI remained associated with the declines in total PA and in the duration at ≥3.0 METs; the models for the step count and SB were not significant. Conclusions: In this exploratory analysis, nutrition-related anthropometric measures, poorer pulmonary function, and exercise-induced desaturation were associated with the long-term decline in PA, and a lower BMI remained associated after adjustment. For the change in SB, associations were found only in unadjusted correlation analysis and were not supported by the multivariable model. These hypothesis-generating findings require confirmation in a larger cohort. Full article

(This article belongs to the Special Issue Advances in the Personalized Management of Chronic Obstructive Pulmonary Disease (COPD))

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17 pages, 935 KB

Open AccessArticle

Comparative Real-World Effectiveness of Fixed-Dose Triple Therapy Regimens in COPD: A Retrospective Cohort Study

by Rushi Patel, Jacob Thompson, Namra Patel, Abhi C. Lohana, Fnu Versha, Subhash Chander, Viral Patel and Juan Iribarren

J. Clin. Med. 2026, 15(14), 5650; https://doi.org/10.3390/jcm15145650 - 18 Jul 2026

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Abstract

Background/Objectives: Fixed-dose triple therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) at high risk of exacerbations; however, direct comparative effectiveness data between available triple therapy regimens remain limited. We compared real-world clinical outcomes among adults with COPD receiving fluticasone furoate/vilanterol/umeclidinium (FF/VI/UMEC) or budesonide/glycopyrrolate/formoterol (BUD/GLY/FOR). Methods: We conducted a retrospective propensity score-matched cohort study using the TriNetX Research Network. Adults with a spirometrically confirmed diagnosis of COPD who received fluticasone furoate/vilanterol/umeclidinium (FF/VI/UMEC) or budesonide/glycopyrrolate/formoterol (BUD/GLY/FOR) between July 2020 and August 2024 were included in the analysis. A 365-day landmark period was applied to establish maintenance therapy, with outcome follow-up beginning 1 year after treatment initiation. Patients were followed for outcomes through August 2025, the date of database analysis. After 1:1 propensity score matching, treatment groups were compared for COPD exacerbations, acute respiratory failure (ARF), hospitalization, and all-cause mortality using RR and Cox proportional hazards analyses. Results: In matched cohorts, FF/VI/UMEC was associated with a significantly higher risk of COPD exacerbations (5.6% vs. 3.9%; RR 1.44; 95% CI 1.30–1.59; p < 0.001) and ARF (2.5% vs. 1.9%; RR 1.28; 95% CI 1.11–1.46; p < 0.001) compared with BUD/GLY/FOR. Time-to-event analyses demonstrated lower event-free probability for exacerbations (HR 1.35; (95% CI 1.21–1.50) and ARF (HR 1.15; (95% CI 1.00–1.32))). All-cause mortality was numerically higher in the FF/VI/UMEC cohort (5.2% vs. 4.7%; RR 1.09; 95% CI 1.00–1.19; p = 0.050); however, time-to-event analysis did not demonstrate a statistically significant difference. Hospitalization rates were similar between groups. Conclusions: In this large propensity score-matched real-world cohort study, patients receiving BUD/GLY/FOR experienced lower rates of COPD exacerbations and acute respiratory failure than those receiving FF/VI/UMEC. Because of the retrospective observational nature of the analysis, these findings should be considered hypothesis-generating and require confirmation in prospective comparative effectiveness studies. Full article

(This article belongs to the Special Issue Advances in the Personalized Management of Chronic Obstructive Pulmonary Disease (COPD))

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12 pages, 489 KB

Open AccessArticle

Association Between Phase Angle, Muscle Mass Distribution, and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

by Lyazat Ibrayeva, Irina Bacheva and Malika Sadibekova

J. Clin. Med. 2026, 15(10), 3839; https://doi.org/10.3390/jcm15103839 - 16 May 2026

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Abstract

Background: Chronic obstructive pulmonary disease (COPD) is associated with systemic alterations in body composition, including muscle mass loss and fat redistribution, which may influence patient-reported outcomes. However, the independent contribution of bioimpedance-derived parameters, particularly phase angle, to quality of life (QoL) remains unclear. Methods: This exploratory pilot study included 75 clinically stable patients with moderate-to-severe COPD (GOLD stages II–III). Body composition was assessed using segmental multi-frequency bioelectrical impedance analysis with the InBody 770 system. Evaluated parameters included fat-free mass (FFM), skeletal muscle mass (SMM), percent body fat (PBF), visceral fat area (VFA), extracellular water-to-total body water ratio (ECW/TBW), bone mineral content (BMC), and phase angle (PhA). Quality of life was assessed using the WHOQOL-BREF questionnaire. Associations between body composition parameters and QoL domains were analyzed using Spearman correlation analysis and multivariable linear regression models. Results: Despite a median body mass index (BMI) within the normal range (23.4 kg/m²), body fat mass exceeded reference values in both men and women. Fat-free mass and skeletal muscle mass were located near the lower range of expected values. Correlation analysis demonstrated predominantly weak associations between body composition parameters and QoL domains. Significant positive correlations were identified between the psychological QoL domain and fat-free mass (ρ = 0.238, p = 0.041), skeletal muscle mass (ρ = 0.240, p = 0.040), basal metabolic rate (ρ = 0.236, p = 0.043), and bone mineral content (ρ = 0.249, p = 0.033). In multivariable regression models, fat-free mass and skeletal muscle mass demonstrated consistent positive associations with both physical and psychological QoL domains. Whole-body and segmental phase angle parameters did not demonstrate significant associations with QoL outcomes. Conclusions: In patients with COPD, BMI alone may inadequately reflect underlying alterations in body composition. Muscle-related parameters, particularly fat-free mass and skeletal muscle mass, demonstrated more consistent associations with physical and psychological aspects of quality of life than obesity-related indicators. These findings suggest that bioelectrical impedance analysis may provide additional clinically relevant information beyond BMI when assessing body composition and quality of life in patients with COPD. Full article

(This article belongs to the Special Issue Advances in the Personalized Management of Chronic Obstructive Pulmonary Disease (COPD))

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11 pages, 689 KB

Open AccessArticle

Cerebrovascular Reactivity to Acetazolamide in Stable COPD Patients

by Péter Siró, Regina Szabó-Szűcs, Viktória Dudás, Ildikó Horváth, Béla Fülesdi and Attila Vaskó

J. Clin. Med. 2025, 14(23), 8535; https://doi.org/10.3390/jcm14238535 - 1 Dec 2025

Cited by 1 | Viewed by 710

Abstract

Background: COPD patients may be prone to cerebral small vessel disease resulting in perivascular white matter lesions and consequent cognitive decline. The pathophysiological background of these observations is not completely understood. It is hypothesized that COPD may involve systemic vascular dysfunction extending to the brain. The present study aimed to assess whether acetazolamide-induced cerebral vasoreactivity and cerebrovascular reserve capacity are impaired in patients with COPD. Methods: A total of 17 patients with COPD and 20 healthy control subjects underwent transcranial Doppler monitoring before and after IV administration of 15 mg/kgBW acetazolamide for 20 min. Cerebrovascular reactivity (CVR) was defined as a percent increase in blood flow velocity in the middle cerebral artery (MBFV) after acetazolamide. Cerebrovascular reserve capacity (CVRC) was defined as the maximal percent change in MBFV during the entire registration. Results: Administration of acetazolamide resulted in a slight decrease in pH and a mild increase in PaCO₂ (both p < 0.001) in COPD patients. Absolute MBFV values were consequently higher, and pulsatility indices were lower in control subjects compared to those measured in patients with COPD. The CVR at different time points after acetazolamide and CVRC did not show any difference between COPD patients and control subjects. Conclusions: In the present study, in normocapnic mild and normocapnic moderate COPD patients, cerebrovascular reactivity is not impaired, indicating that in mild stages, cerebral arteriolar function is preserved. Further studies, using patient selection based on different severity stages of the disease, may show whether alteration of the cerebral arteriolar function is responsible for the white matter lesions and cognitive decline observed in severe COPD patients. Full article

(This article belongs to the Special Issue Advances in the Personalized Management of Chronic Obstructive Pulmonary Disease (COPD))

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Review

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20 pages, 481 KB

Open AccessReview

CPET Characteristics in HFrEF, HFpEF and COPD

by Yuqing Zhou, Guimei Wang and Xiaohong Wu

J. Clin. Med. 2026, 15(14), 5580; https://doi.org/10.3390/jcm15145580 - 16 Jul 2026

Viewed by 472

Abstract

Chronic obstructive pulmonary disease (COPD) frequently occurs alongside heart failure (HF), including heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), creating a diagnostic dilemma due to overlapping clinical manifestations such as exertional dyspnea and reduced exercise tolerance. Static diagnostic modalities are often insufficient to distinguish these entities or their overlapping syndromes (HFrEF-COPD and HFpEF-COPD). Cardiopulmonary exercise testing (CPET) uniquely provides a dynamic, integrated assessment of the respiratory, cardiovascular, and peripheral muscle systems during incremental exercise, enabling quantitative characterization of the pathophysiological mechanisms underlying exercise limitation. This review comprehensively summarizes the characteristic CPET profiles of isolated HFrEF, isolated HFpEF, isolated COPD, HFrEF-COPD, and HFpEF-COPD. Integration of CPET parameters with pulmonary function testing results in a comprehensive assessment of the cardiopulmonary system, facilitating accurate diagnosis and prognostic stratification in this complex patient population. Finally, we address current limitations in standardization and outline future directions for advancing precision medicine in this complex clinical landscape. Full article

(This article belongs to the Special Issue Advances in the Personalized Management of Chronic Obstructive Pulmonary Disease (COPD))

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22 pages, 707 KB

Open AccessReview

Cardiometabolic Comorbidities in COPD: Focus on Diabetes, GLP-1 Receptor Agonists, SGLT-2 Inhibitors and Antidiabetic Drugs

by Maria Kallieri, Georgios Hillas, Stelios Loukides, Konstantinos Kostikas and Athena Gogali

J. Clin. Med. 2026, 15(5), 2082; https://doi.org/10.3390/jcm15052082 - 9 Mar 2026

Cited by 2 | Viewed by 1663

Abstract

Background/Objectives: The coexistence of chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2D) poses significant clinical challenges due to overlapping mechanisms of systemic inflammation, oxidative stress, hypoxia, and metabolic dysregulation. Patients with both conditions face higher risks of exacerbations, prolonged hospitalizations, cardiovascular events, and reduced quality of life. This review aims to summarize current evidence on the pathophysiological interplay between COPD and T2D and to evaluate the impact of lifestyle and pharmacologic interventions. Methods: A narrative review of the literature was conducted to evaluate the pathophysiological links between COPD and T2D, assess the effects of pharmacologic and lifestyle interventions, and highlight key gaps and priorities for future research, with an emphasis on integrated, evidence-based management for this high-risk population. Results: Lifestyle interventions, including smoking cessation and structured physical activity, remain foundational to management. Emerging evidence indicates that antidiabetic therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium–glucose cotransporter-2 inhibitors (SGLT-2is), may confer additional pulmonary, metabolic, and cardiovascular benefits. These agents modulate systemic inflammation, oxidative stress, endothelial function, and insulin sensitivity, potentially reducing COPD exacerbations, improving lung function, and enhancing survival. Safety concerns, including glucocorticoid-induced hyperglycaemia and hypoxia-related metabolic complications, underscore the need for careful monitoring and individualized therapy COPD patients. Conclusions: Optimal care requires a multidisciplinary, patient-centred approach integrating pulmonology, endocrinology, primary care, nutrition, and rehabilitation, alongside shared decision-making and patient education. Despite promising findings, critical knowledge gaps remain. Large, well-designed randomized controlled trials and standardized definitions are needed to guide personalized therapeutic strategies. Full article

(This article belongs to the Special Issue Advances in the Personalized Management of Chronic Obstructive Pulmonary Disease (COPD))

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