I am writing to express my perspectives on the systematic review titled Experiences of Individuals With Chronic Obstructive Pulmonary Disease and Their Caregivers During the Pandemic: A Systematic Review published in Nursing Open (2026). As a Deputy Chief Nurse in Internal Medicine with extensive clinical experience in managing chronic respiratory diseases, I highly appreciate the authors' rigorous work to systematically explore the COVID-19 pandemic-related experiences of individuals with COPD (IwCOPD) and their informal caregivers. This review fills an important evidence gap and provides valuable preliminary insights for clinical nursing practice. However, several critical issues require attention to further enhance its methodological rigour, clinical relevance, and practical guiding value for nursing care, particularly from a nursing perspective. The review explicitly aims to explore the experiences of both IwCOPD and their informal caregivers, a group pivotal to long-term home management. Yet, caregiver-related evidence is severely insufficient: among 24 included studies, only 2 incorporated caregiver participants (Mousing and Sørensen 2021; Volpato et al. 2021) with a total sample size of merely 26. This small, homogeneous sample fails to capture the diverse pandemic-related challenges faced by caregivers (e.g., aggravated burden, unmet mental health needs). The lack of robust caregiver data limits the review's ability to inform comprehensive nursing support strategies and renders conclusions on caregiver experiences lacking empirical basis, a key shortcoming given the review's stated aim. The review reports conflicting results regarding changes in COPD exacerbation levels during the pandemic but attributes discrepancies only to lockdown policies and data timelines, without analysing critical nursing-related confounding factors. Notably, the review documents widespread avoidance of hospital care by IwCOPD due to COVID-19 fear, which inevitably led to underreporting of exacerbations (typically based on hospital admissions). This is a key factor skewing results that is not sufficiently emphasized. Additionally, variations in regional nursing interventions (e.g., remote medication adjustment, telemonitoring) and patients' self-management abilities (e.g., inhaler use errors) likely contributed to divergent findings. Without exploring these factors, the review's conclusions on physical health impacts remain superficial and fail to provide clear, actionable guidance for nursing practice (e.g., optimizing inhaler training, identifying home-managed exacerbations). As a nursing-focused journal, Nursing Open prioritizes research advancing nursing practice. However, the review pays insufficient attention to nursing-specific interventions and nurses' unique role during the pandemic. Nurses play a central role in COPD care (medication education, pulmonary rehabilitation, telehealth), which became even more critical with reduced in-person care. While the review notes the rise of telemedicine, it does not explicitly analyse how nursing interventions mitigated identified challenges (e.g., poor inhaler use, social isolation). This omission limits the review's direct relevance to nursing practice and fails to highlight the value of nursing in pandemic care for IwCOPD and caregivers. In conclusion, this review makes a valuable contribution but is undermined by the above issues. I suggest the authors address these limitations in future work, particularly by expanding caregiver-focused research and systematically analysing nursing-specific interventions and the role of nurses to better align with Nursing Open's mission to advance evidence-based nursing care for this population. Thank you for considering my comments. Xingxia Peng: conceptualization, methodology, investigation, formal analysis, writing – original draft, writing – review and editing. The author has nothing to report. The author has nothing to report. The author declares no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Xingxia Peng (Sun,) studied this question.