Key result
Declining exercise tolerance in mild-to-moderate COPD is linked to ~1.3% greater annual air trapping progression.
Why the study?
Data on the longitudinal change in exercise tolerance and its association with disease progression in mild-to-moderate COPD remain scarce.
Is a longitudinal decrease in exercise tolerance associated with lung function decline and radiographic structural progression in mild-to-moderate COPD?
Cohort (n=213)
Is a longitudinal decrease in exercise tolerance associated with lung function decline and radiographic structural progression in mild-to-moderate COPD?
Effect estimate: adjusted difference 1.26 %/year (95% CI 0.41-1.84)
p-value: p=0.002
A longitudinal decrease in exercise tolerance over three years is associated with accelerated lung function decline and radiographic structural progression in mild-to-moderate COPD.
Declining exercise tolerance may flag faster air trapping progression; hypothesis-generating for longitudinal COPD phenotyping.
Rationale Exercise intolerance serves as a prognostic marker for poor respiratory outcomes in mild-to-moderate COPD. However, longitudinal change of exercise tolerance and its association with disease progression in mild-to-moderate COPD remain scarce. Objectives To explore the association of longitudinal decrease in exercise tolerance and respiratory outcomes in mild-to-moderate COPD. Methods A community-based, prospective cohort study was conducted in China over a 3-year period from 2019 to 2024. Participants completed questionnaire, spirometry, chest CT, and cardiopulmonary exercise testing (CPET) at baseline, and underwent acute exacerbation assessment and spirometry annually. Participants were categorized into two groups based on the longitudinal change in VO2peak from baseline to the 3-year follow-up: the non-declined exercise tolerance group and the declined exercise tolerance group. Measurements and Main Results A total of 213 patients with mild-to-moderate COPD who completed baseline and 3-year CPET were included. Among them, 131 (61.5%) were categorized into the declined exercise tolerance group. For every 5% longitudinal decrease in exercise tolerance, there was greater progression of air trapping (adjusted difference=0.18%/year, 95% CI: 0.01-0.34, P = 0.033), and a faster annual decline in postbronchodilator FEV1 (adjusted difference=-4.2 ml/year, 95% CI: -8.3 to -0.1 ml/year, P = 0.044). Compared with the non-declined exercise tolerance group, the declined exercise tolerance group demonstrated significantly greater progression of emphysema (adjusted difference=0.40 %/year, 95% CI: 0.10-0.69, P = 0.008) and air trapping (adjusted difference: 1.26 %/year, 95% CI: 0.41-1.84, P = 0.002). No significant association between the longitudinal decrease in exercise tolerance and the acute exacerbations risk. Conclusions A longitudinal decrease in exercise tolerance over three years is associated with an accelerated lung function decline and radiographic structural progression, which may serve as an early predictor of disease progression in mild-to-moderate COPD. This abstract is funded by: None
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Wan et al. (2026) conducted a cohort in mild-to-moderate COPD (n=213). Declined exercise tolerance vs. Non-declined exercise tolerance was evaluated on Progression of air trapping (adjusted difference 1.26 %/year, 95% CI 0.41-1.84, p=0.002). Declined exercise tolerance over 3 years in mild-to-moderate COPD was associated with greater progression of air trapping compared to non-declined tolerance (adjusted difference 1.26 %/year; P=0.002).
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