B74-19 Integrative Genomic and Prakruthi-Phenotype Predictors of Pulmonary Rehabilitation Response in COPD: A Prospective Multi-Modal Cohort

Background Chronic Obstructive Pulmonary Disease (COPD) is characterized by marked heterogeneity in progression and rehabilitation response. Conventional models based on spirometry or clinical scores fail to capture biological and constitutional diversity influencing outcomes. This study explores an integrative predictive model combining genomic expression, Prakruthi profiling, & physiologic response to identify individualized recovery patterns in COPD. Methodology Consecutive cohort of 15 COPD patients underwent a 6-week continuous integrated pulmonary rehabilitation program. Data included demographics, lung function (FEV1, FVC, DLCO, RV/TLC, FRC), oxygen saturation (rest/exertion), Prakruthi endotyping (Vata, Pitta, Kapha) using questionnaire, & genomic profiling of 11 target genes (peripheral blood) involved in inflammatory, metabolic, & remodelling pathways. Pre- and post-rehabilitation changes were analysed using Wilcoxon signed-rank test; correlations & regression analyses explored relationships between genomics, Prakruthi, & physiologic improvement. Results A total of 13 COPD patients (mean age = 68.5 ± 7.1years; 61% male) completed the 6-week integrative pulmonary rehabilitation program. Using Wilcoxon signed-rank test, significant improvements were observed. Oxygenation & Exercise Capacity: Resting oxygen saturation increased significantly (p = 0.015) and post-exertional saturation improved (p = 0.028). Cardiorespiratory endurance showed large effect size (p = 0.001), and strength performance also improved significantly from baseline to week 6 (p = 0.001). Diffusion capacity (DLCO) increased post-rehabilitation (p = 0.028), while respiratory rate declined (p < 0.05), reflecting improved ventilatory efficiency. Genomic and Phenotypic Correlations: No significant associations were found between genomic profiles & Prakruthi types, or between genomic markers & COPD stage. However, gene-physiology cross-analysis revealed that CHRNA3 expression correlated positively with DLCO improvement (p = 0.01), & IREB2 expression correlated inversely with reduction in RV/TLC (p = 0.02). Prakruthi Associations: The Vata-Kapha constitutional type showed a notable association with Stage IV COPD (χ² p = 0.04). Additionally, Prakruthi correlated positively with changes in FRC (p = 0.03) and RV/TLC (p = 0.04). Discussion and Conclusion While genome-Prakruthi and genome-stage associations were nonsignificant, the gene-specific trends (CHRNA3-DLCO, IREB2-RV/TLC) highlight molecular contributors to recovery. These genes are linked to cholinergic signalling and iron metabolism, both implicated in emphysematous remodelling and hypoxemia. The observed Prakruthi-stage and Prakruthi-functional correlations suggest that constitutional assessment may help predict recovery potential. Despite the small cohort, the findings underscore the need for larger, multi-omics datasets to validate gene-response interactions, routine inclusion of Prakruthi assessment in baseline evaluations, and genomic biomarker panels to enhance prognostication and personalize COPD rehabilitation.