Comparison of Spirometric Parameters, Symptom Burden and Rehabilitation
Implications in Current and Former Smokers with Chronic Obstructive Pulmonary
Disease
Jul 2026· Romanian Journal of Physical Therapy· Vol 32, pp. 14-23· 0 citations· 9 references
TL;DR
Multidimensional assessment combining spirometry, CAT, mMRC, smoking exposure history, comorbidity screening, and individualized pulmonary rehabilitation is essential in COPD management.
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive, preventable,
and treatable respiratory disease strongly associated with tobacco exposure. Because its
clinical expression is heterogeneous, rehabilitation planning requires assessment beyond
spirometry. Methods and materials: This retrospective observational study included 767
patients with COPD evaluated between October 2014 and January 2021 in the Pneumology
Department of the "Victor Babes" Infectious Diseases Hospital, Timisoara, Romania. Patients
were divided according to smoking status into current smokers (n=337) and former smokers
(n=430). COPD diagnosis was based on specialist clinical assessment and spirometric
evidence of airflow obstruction; post-bronchodilator FEV1/FVC (reported as BPI in the
database) 0.70 was used as the reference criterion according to GOLD recommendations.
Demographic data, body mass index, spirometric parameters, CAT, mMRC, exacerbations,
and comorbidities were analysed. Results: The cohort included 593 men and 174 women,
aged 37-92 years. Mean age was 63.5 ± 9.5 years and mean BMI was 28.6 ± 6.7 kg/m2. Mean
forced vital capacity (FVC) was 2.78 ± 1.02 L, mean forced expiratory volume in one second
(FEV1) was 1.69 ± 0.72 L, and mean FEV1% was 58.87 ± 20.57%. Current smokers had slightly
higher mean FVC and FEV1 values than former smokers, without statistically significant
spirometric differences. Former smokers reported higher CAT scores (24.8 ± 6.9 vs. 23.1 ±
7.0; p 0.001) and mMRC scores (2.79 ± 0.66 vs. 2.63 ± 0.67; p 0.001), indicating a greater
symptom burden. Arterial hypertension was the most frequent comorbidity (n=514),
followed by heart failure (n=147), diabetes mellitus (n=120), and pulmonary neoplasm
(n=62). Exacerbations were present in 404 patients (53%). Conclusion: In this cohort, smoking
status was associated with small spirometric differences, whereas former smokers reported
greater symptom burden. Multidimensional assessment combining spirometry, CAT, mMRC,
smoking exposure history, comorbidity screening, and individualized pulmonary
rehabilitation is essential in COPD management.
Aims: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous condition with variable clinical presentation and disease progression. This study aimed to investigate the distribution of patients across defined COPD phenotypes and to compare their clinical, radiological, and functional characteristics.
Methods: This cross-sectional descriptive study included 96 patients diagnosed with COPD. Patients were classified into four phenotype groups: asthma–COPD overlap syndrome (ACOS), non-exacerbator (NE), frequent exacerbator with emphysema (FEE), and frequent exacerbator with chronic bronchitis (FECB). Demographic, clinical, and pulmonary function parameters were analyzed and compared among groups. Forced expiratory volume in one second (FEV1), body mass index (BMI), COPD Assessment Test (CAT), diffusing capacity for carbon monoxide (DLCO), and inspiratory capacity/total lung capacity (IC/TLC) ratio were evaluated.
Results: Of the patients, 83 (86.5%) were male and 13 (13.5%) were female, with a mean age of 65.22±7.85 years. The distribution of phenotypes was as follows: ACOS (9%), NE (53%), FEE (19%), and FECB (19%). The mean annual exacerbation rate was 1.27±1.2, and the mean FEV1 was 50.21±16.56%. The ACOS phenotype was characterized by a higher proportion of female patients, younger age, history of asthma and atopy, better clinical status, and relatively preserved lung function. In contrast, the FEE phenotype demonstrated a higher exacerbation frequency, poorer quality of life, and more severe airflow limitation. Patients in the FEE group had lower FEV1 and BMI, higher CAT scores, increased lung volumes and airway resistance, lower DLCO and partial pressure of oxygen (pO2), and an IC/TLC ratio below 25%.
Conclusion: Distinct COPD phenotypes, particularly ACOS and FEE, exhibit significant differences in clinical and functional characteristics. Recognition of these phenotypes may help guide individualized management strategies, including pulmonary rehabilitation, nutritional support, and optimization of pharmacological and interventional treatments.
Duygu Acar Karagül, S. Saryal· Journal of Pulmonology and I...· 0 citations
Introduction: COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production, and/or exacerbations) caused by abnormalities in the airways and/or alveoli, leading to persistent and progressive airflow limitation. The Aim: This study aimed to examine the association between smoking, airflow limitation severity, and the development of complications in 131 patients treated at the Clinic for Pulmonology, University Clinical Center Niš, from January 2024 to March 2026. Results: Of 131 patients, 85 (64.89%) were men (mean age 68.02±8.86 years) and 46 (35.11%) were women (mean age 66.89±8.55 years). Patients were classified as current smokers 55 (41.98%), former smokers 55 (41.98%), and non-smokers 21 (16.04%). Severe COPD was most common 55 (41.98%), followed by moderate COPD 39 (29.77%), very severe COPD 34 (25.95%), and mild COPD 3 (2.29%). The longest disease duration was in non-smokers with severe COPD (17.80±14.23 years), while the longest smoking history was in patients with moderate COPD (54.67±24.16 pack-years). Current and former smokers differed significantly in smoking history. The highest FEV1 (%) was observed in non-smokers with moderate COPD (59.19±7.25). The longest duration of respiratory insufficiency and chronic cor pulmonale was found in non-smokers with very severe COPD (4.50±3.32 years). The duration of respiratory insufficiency and chronic cor pulmonale was associated with non-smoking status. Conclusion: Smoking status did not significantly affect bronchial obstruction severity. However, obstruction severity correlated with smoking duration (pack-years). Smoking significantly influenced COPD progression through the development of respiratory insufficiency and chronic cor pulmonale.
Dragana Stojiljković, Emilija Videnović, Milan Radović et al.· Respiratio· 0 citations
Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition characterized by pulmonary
vascular changes and airflow obstruction. Pulmonary hypertension is a significant morbidity in COPD patients and can deteriorate
with progressive COPD.
Objective: To assess the relationship between forced expiratory volume in one second and pulmonary artery pressure in patients
with chronic obstructive pulmonary disease (COPD).
Methods: The cross-sectional study was carried out in the Pulmonology Unit, MTI Khyber Teaching Hospital, Peshawar, from
March 2025 to August 2025. The total number of patients enrolled using non-probability consecutive sampling was 73 COPD
patients. Demographic and clinical information were collected. Spirometry was used to measure FEV1, and a transthoracic
echocardiogram was used to assess pulmonary artery pressure. The data were analyzed using Pearson correlation.
Results: The mean age was 57.38 +/- 10.30 years. There are 73 patients, of whom 31 are male and 42 are female. The mean FEV1
percentage predicted was 58.38 +/- 23.52, and the mean pulmonary artery pressure was 47.71 +/- 20.11 mmHg. There was a
strong negative correlation between FEV1 and pulmonary artery pressure (r = -0.547, p < 0.001).
Conclusion: In COPD patients, reduced FEV1 was significantly associated with increased pulmonary artery pressure.
Sehrish Khan, Anila Anila, Shahid Zia et al.· International Journal of Dru...· 0 citations
Background/Objective: Smoking is considered to be a high risk for COPD. In this study we made anattempt to assess prevalence and correlates of COPD in a high-risk population.Material and Method: A total of 200 smokers (having history of >100 cigarette/bidi use) aged 18 years or above were enrolled after excluding patients with myocardial disease, unstable cardiovascular status or pulmonary embolus, thoracic, abdominal, or cerebral aneurysms, eye surgery, acute disease affecting pulmonary functions or recent surgery of thorax/abdomen. Smoking history of patients was obtained and noted in terms of pack years, symptoms (cough, sputum, dyspnea, wheeze) were noted. All the patients underwent pulmonary function test assessment using spirometry. Diagnosis and staging of COPD was done using GOLD criteria. Independent samples‘t’-and Chi-square tests were used to compare the data.Results: Mean age of patients was 52.11±13.90 years. All were males. Mean BMI was 23.52±3.05 kg/m2. Mean smoking pack years was 14.51±8.87. A total of 57 (28.5%) were symptomatic. Cough (28.5%), sputum (22.5%) and dyspnoea (21%) werethe most common symptoms. Prevalence of COPD was 34%. Stagewise, 8 (4%), 55 (27.5%) and 5 (2.5%) were Stage I, II and III patients. COPD was significantly associated with older age, higher pack years and symptomatic status (p<0.001). However, 17.6% of COPD patients were asymptomatic too.Conclusion: More than one-third of smokers had COPD. Older age, higher pack years and symptomatic state were significantly associated with COPD.
Dr. Gautam Singh, Dr. Ashutosh Chaturvedi, Dr. Manish Kumar et al.· Asian Journal of Medical Res...· 0 citations
BACKGROUND
Osteoporosis is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD). However, most previous studies have been conducted in European populations. This study aims to explore whether patients with COPD are at increased risk of osteoporosis and osteoporosis-related fractures compared to a propensity score-matched (PSM) cohort of non-COPD patients in the TriNetX US Collaborative Network de-identified electronic health record (EHR) database.
STUDY DESIGN AND METHODS
Adult patients aged 40-65 with a COPD diagnosis (ICD-10: J44.0-J44.9), confirmed by spirometry (FEV1/FVC <70%), and a minimum follow-up of 10 years (3,650 days) were included. Both the ICD-10 code and spirometry criterion were required for COPD diagnosis. A 1:1 propensity score matching (PSM) was conducted to match non-COPD controls based on age, sex, BMI, smoking status, comorbidities, and medication use (including systemic corticosteroids, inhaled corticosteroids, and bone-active medications). The primary outcome was osteoporosis (ICD-10: M81.0). Secondary outcomes included osteoporosis with pathological fracture (M80) and pathological fractures (M84.4, M84.7). Cox proportional hazards models were used to estimate the hazard of osteoporosis after adjusting for confounding variables.
RESULTS
Following PSM, 2,682 COPD patients were compared with 2,682 non-COPD controls. COPD patients exhibited a significantly increased risk of osteoporosis [HR: 1.95 (1.37-2.77), p = 0.0002]. Underweight status (BMI <18.5 kg/m2) further elevated osteoporosis risk [HR: 3.95 (2.19-7.13), p<0.0001], while male sex was highly protective [HR: 0.15 (0.14-0.16), p<0.0001]. Age-stratified analysis showed progressively increasing risk across older age groups, peaking at ages 61-65 [HR: 20.01 (18.77-21.33), p < 0.0001].
INTERPRETATION
COPD is independently associated with an increased risk of osteoporosis. These findings highlight the importance of systematic osteoporosis screening and monitoring as part of comprehensive COPD management, particularly in high-risk subgroups (older adults, females, and those with low BMI).
A. Lohana, U. Akbar, S. Chander et al.· Respiratory Medicine· 0 citations
Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by psychological distress, but the relationship between GOLD stage, dyspnea, functional limitation, and depression/anxiety symptoms remains incompletely defined. This study examined clinical and psychological profiles across GOLD stages, with particular attention to GOLD stages 3 and 4. Methods: This multicenter observational study included 285 adults with spirometry-confirmed COPD evaluated in Romania between 2023 and 2026. COPD severity was classified according to GOLD stages. Clinical assessment included FEV1, peripheral oxygen saturation, smoking exposure, the COPD Assessment Test (CAT), and the modified Medical Research Council dyspnea scale (mMRC). Psychological and well-being measures included DASS depression, anxiety, and stress scores; WHO-5; major depressive disorder score, and generalized anxiety disorder score. Descriptive analyses were performed across GOLD stages, and GOLD 3 was directly compared with GOLD 4. Results: GOLD 3 was the largest subgroup (n = 106, 37.2%), followed by GOLD 4 (n = 81, 28.4%), GOLD 2 (n = 69, 24.2%), and GOLD 1 (n = 29, 10.2%). GOLD 3 patients showed marked dyspnea and symptom burden, with mean mMRC = 2.92 and CAT = 24.44. DASS depression, anxiety, and stress scores were higher in GOLD 3 than GOLD 2, but did not increase further in GOLD 4. Direct GOLD 3 versus GOLD 4 comparisons showed no significant differences in DASS depression or DASS anxiety, whereas GOLD 4 had a significantly higher mMRC, major depressive disorder score, and generalized anxiety disorder score. Conclusions: GOLD 3 COPD was associated with substantial dyspnea, functional limitation, and measurable psychological distress. However, depression and anxiety patterns varied by instrument, suggesting that psychological burden in COPD is multidimensional and not explained by spirometric severity alone.
