Effectiveness of application–based mobile health in reducing acute exacerbations among people with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Chronic obstructive pulmonary disease (COPD) management is increasingly supported by application-based mobile health (mHealth) interventions. However, their effects on acute exacerbation of COPD (AECOPD)-related hospitalization and other health outcomes remain uncertain. This systematic review and meta-analysis aimed to evaluate the effectiveness of application-based mHealth interventions in people with COPD. This review followed the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EMBASE, CINAHL Ultimate, CENTRAL, and Scopus were searched from inception to December 2025. Randomized controlled trials involving adults with COPD were included if the intervention was delivered through a mobile-device application and compared with usual care without application-based mHealth support. Risk of bias was assessed using the Cochrane risk of bias 2 tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Eighteen studies reported in 19 publications were included. Application-based mHealth interventions did not significantly reduce the number of participants with AECOPD-related hospitalization (RR = 0.97; 95% CI = 0.78 to 1.20) or improve quality of life measured by the Chronic Respiratory Questionnaire (MD = − 0.08; 95% CI = − 0.51 to 0.35) or St. George’s Respiratory Questionnaire (MD = − 2.90; 95% CI = − 7.24 to 1.43). In contrast, these interventions improved functional exercise capacity, as reflected by increased 6-minute walk distance (MD = 32.20 m; 95% CI = 13.44 to 50.96). Studies assessing psychological status using the Hospital Anxiety and Depression Scale reported no significant between-group differences. The certainty of evidence ranged from low to moderate. Current evidence does not clearly support application-based mHealth as an effective strategy for reducing AECOPD-related hospitalization or improving quality of life in people with COPD. However, it may have potential for improving functional exercise capacity. Future trials should more clearly define application functions, intervention frameworks, and target populations to determine when, for whom, and through which mechanisms application-based mHealth can improve clinically meaningful outcomes.