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Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 5660

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Dr. Maurizio Marvisi

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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

Prof. Dr. Alfredo Chetta

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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 Issue Information

Dear Colleagues,

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by smoking and characterized by an accelerated rate of lung function decline that occurs in (mostly) older males is outdated and incomplete.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 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, pathophysiology, imaging, diagnosis, and treatment.

Dr. Maurizio Marvisi
Prof. Dr. Alfredo Antonio Chetta
Guest Editors

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Keywords

COPD
treatable traits
precision medicine
COPD comorbidities
COPD mortality

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Published Papers (5 papers)

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Research

13 pages, 2121 KiB

Open AccessArticle

Mortality Predictors in Patients with Severe COPD Exacerbation

by Elena Cojocaru, Raluca Ecaterina Haliga, Gianina-Valentina Băcescu Ene and Cristian Cojocaru

J. Clin. Med. 2025, 14(9), 3028; https://doi.org/10.3390/jcm14093028 - 27 Apr 2025

Viewed by 407

Abstract

Background: Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of intensive care unit (ICU) admissions and in-hospital mortality. Several hematological inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), derived NLR (dNLR), and systemic immune-inflammation index (SII), have been proposed as markers of disease severity and mortality. Methods: A retrospective study was conducted on 104 ICU patients with AECOPD over a two-year period. We collected and analyzed clinical, demographic, and laboratory data. The hematological indices of the two groups—survivors (n = 39) and non-survivors (n = 65)—were compared to assess differences. We used t-tests, ANOVA, chi-square tests, and Mann–Whitney U tests to compare the groups. The factors that independently predicted mortality were identified using multivariate logistic regression. We examined survival differences using Kaplan–Meier analysis, and ROC curves were utilized to evaluate the predictive power of each biomarker. Results: Mortality was substantially predicted by higher SII (OR: 1.92, 95% CI: 1.24–3.08, p = 0.002) and NLR (OR: 2.89, 95% CI: 1.72–4.82, p < 0.001). Patients with NLR > 8.0 and SII > 1800 had significantly lower survival rates (log-rank p < 0.001), according to Kaplan–Meier analysis. SII (AUC = 0.79) and NLR (AUC = 0.82) were the best predictors of death, according to ROC analysis. Conclusions: In ICU-admitted AECOPD patients, NLR, MLR, PLR, dNLR, and SII are independent predictors of mortality. Due to their ease of evaluation and predictive capabilities, they should be included in ICU risk models for early interventions. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management)

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13 pages, 242 KiB

Open AccessArticle

Unmasking Cardiovascular Risk in Patients with COPD at Primary Care Settings: The Critical Role of Age, Sex, and Smoking

by Claire Young, Aaron Courtenay, Kingston Rajiah and Ahmed Abuelhana

J. Clin. Med. 2025, 14(5), 1444; https://doi.org/10.3390/jcm14051444 - 21 Feb 2025

Viewed by 570

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition frequently associated with cardiovascular comorbidities, including ischemic heart disease (IHD), heart failure (HF), and atrial fibrillation (AF). These conditions significantly impact patient outcomes, yet their prevalence and risk factors remain underexplored in primary care settings. This study investigates the role of age, sex, and smoking status in the prevalence of IHD, HF, and AF among patients with COPD managed in general practice settings. Methods: A retrospective analysis was conducted using de-identified electronic health records from eleven general practitioner (GP) practices in Northern Ireland. Patients with COPD were identified through the Quality and Outcomes Framework (QOF) register, and the presence of IHD, HF, and AF was recorded. Statistical analyses included chi-square tests and independent t-tests to examine associations between cardiovascular comorbidities and patient demographics, with significance set at p < 0.05. Results: Among the total registered population of 77,797, there were 1575 patients with COPD, of whom 335 had IHD, 211 had AF, and 116 had HF. Patients with COPD had a significantly higher prevalence of IHD, AF, and HF compared to those without COPD. Age was a strong determinant, with older age groups, particularly those over 75 years, showing a markedly higher prevalence of all three conditions. Sex analysis revealed that male patients with COPD were significantly more likely to have IHD, AF, and HF than females. However, the association between smoking status and the presence of HF, IHD, or AF was not significantly different between current/ex-smokers and non-smokers. Conclusions: The findings highlight the high burden of cardiovascular comorbidities among patients with COPD in primary care and emphasise the need for routine cardiovascular screening. Given the strong influence of age and sex, targeted risk assessment and management strategies should be prioritised for older and male patients with COPD. The lack of association between smoking and cardiovascular comorbidities suggests that additional risk factors should be considered in cardiovascular risk assessment. A more integrated approach to managing COPD and cardiovascular conditions within general practice settings is essential to improve patient outcomes. Future research should focus on evaluating interventions that enhance early detection and multidisciplinary management of cardiovascular comorbidities in patients with COPD. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management)

13 pages, 635 KiB

Open AccessFeature PaperArticle

Pain and Dyspnea During Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Documentation Audit 2019–2020

by Stephanie Y. Clarke, Marie T. Williams, Kylie N. Johnston and Annemarie L. Lee

J. Clin. Med. 2025, 14(1), 252; https://doi.org/10.3390/jcm14010252 - 3 Jan 2025

Viewed by 907

Abstract

Background/Objectives: Patient-reported outcome measures (PROMs) assess the severity and impact of both pain and dyspnea in those with acute exacerbations of chronic obstructive pulmonary disease (COPD), but their frequency of use in clinical practice is unknown. This study aimed to determine the point prevalence of pain and dyspnea assessment in patients hospitalized with an acute exacerbation of COPD and the measurement tools applied for this purpose in clinical practice. Methods: Clinical notes and observation charts of patients admitted with acute exacerbations of COPD to a metropolitan hospital in 2019 and 2020 were retrospectively audited to identify the point prevalence of pain and dyspnea assessment, the PROMs applied, and their associated focal periods. Results: Pain and dyspnea were assessed using a PROM in 99% and 8% of cases of acute exacerbation of COPD, respectively. All PROMs used measured symptom intensity. Focal periods were rarely reported in the assessment of pain; in the dyspnea assessment, timeframes predominantly reflected the impact of exertion. Conclusions: At this single health service site, in people hospitalized with an acute exacerbation of COPD, pain was more frequently assessed using a PROM than dyspnea. Understanding factors influencing clinicians’ choice of assessment tools may inform future recommendations for the assessment of these symptoms in people hospitalized with exacerbations of COPD. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management)

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19 pages, 1488 KiB

Open AccessArticle

Systemic Manifestations of COPD and the Impact of Dual Bronchodilation with Tiotropium/Olodaterol on Cardiac Function and Autonomic Integrity

by Ieva Dimiene, Deimante Hoppenot, Donatas Vajauskas, Lina Padervinskiene, Airidas Rimkunas, Marius Zemaitis, Diana Barkauskiene, Tomas Lapinskas, Egle Ereminiene and Skaidrius Miliauskas

J. Clin. Med. 2024, 13(10), 2937; https://doi.org/10.3390/jcm13102937 - 16 May 2024

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Abstract

Background: Chronic obstructive pulmonary disease (COPD) has significant systemic manifestations, including cardiovascular morbidity. The main aim of our study was to evaluate the effect of short-term COPD treatment with tiotropium/olodaterol (TIO/OLO) 5/5 μg on cardiac function and autonomic integrity. Methods: Twenty-nine patients with newly diagnosed moderate-to-severe COPD were enrolled. We performed pulmonary function tests, cardiac magnetic resonance, cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging and analysis of blood biomarkers on our study subjects. The correlations between the tests’ results were evaluated at baseline. The changes in pulmonary and cardiac parameters from baseline through 12 weeks were assessed. Results: Significant associations between pulmonary function tests’ results and high-sensitivity C-reactive protein (hs-CRP), as well as interleukin-22 (IL-22), were observed at baseline. Treatment with TIO/OLO significantly improved lung function as measured by spirometry and body plethysmography. Moreover, we found that the cardiac index increased from 2.89 (interquartile range (IQR) 1.09) to 3.21 L/min/m² (IQR 0.78) (p = 0.013; N = 18) and the late heart-to-mediastinum ratio improved from 1.88 (IQR 0.37) to 2 (IQR 0.41) (p = 0.026; N = 16) after 12 weeks of treatment. Conclusions: Treatment with TIO/OLO improves lung function and positively impacts cardiac function and autonomic integrity, suggesting that dual bronchodilation might have a potential in decreasing the risk for cardiac events in COPD. Hs-CRP and IL-22 might be beneficial in determining the intensity of systemic inflammation in COPD. Further research with a larger cohort is needed to enhance the initial results of this study. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management)

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11 pages, 3031 KiB

Open AccessArticle

Alpha-1 Antitrypsin PI M Heterozygotes with Rare Variants: Do They Need a Clinical and Functional Follow-Up?

by Anna Annunziata, Giuseppe Fiorentino, Marco Balestrino, Roberto Rega, Sara Spinelli, Lidia Atripaldi, Alessio Sola, Federica Massaro and Cecilia Calabrese

J. Clin. Med. 2024, 13(4), 1084; https://doi.org/10.3390/jcm13041084 - 14 Feb 2024

Cited by 1 | Viewed by 1267

Abstract

(1) Background: Few data are available on the risk of airway dysfunction in protease inhibitor (PI*) M heterozygotes carrying rare null or deficient allelic variants of the gene SERPINA-1 (PI*MR). (2) Methods: In this observational study, in a cohort of PI*MR heterozygotes, we evaluated respiratory functional parameters at baseline and at one-year follow-up. Moreover, we compared such parameters with those of the PI*MZ and PI*MS patients. (3) Results: A total of 60 patients were recruited; 35 PI*MR, 11 PI*MZ and 14 PI*MS. At the annual follow-up, the PI*MR and PI*MZ patients demonstrated a significantly higher FEV₁ decline than the PI*MS group (p = 0.04 and p = 0.018, respectively). The PI*MR patients showed a significant increase in DLCO annual decline in comparison with the PI*MS group (p = 0.02). At baseline, the PI*MR smoking patients, compared with nonsmokers, showed statistically significant lower values of FEV₁, FEV₁/FVC and DLCO (p = 0.0004, p < 0.0001, p = 0.007, respectively) and, at the one-year follow-up, they displayed a significantly higher FEV₁ and DLCO decline (p = 0.0022, p = 0.011, respectively). PI*MR heterozygotes with COPD showed a significantly higher FEV₁, FEV₁/FVC and DLCO annual decline in comparison with healthy PI*MR (p = 0.0083, p = 0.043, p = 0.041). (4) Conclusions: These results suggest that PI*MR heterozygotes, particularly smokers with COPD, have a greater annual decline in respiratory functional parameters and need to be monitored. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management)

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