The transition from hospital to home after a COPD-related hospitalization is marked by fragmented care, recurrent hospital use, and difficulty sustaining self-management. Nurse-led transitional care is intended to bridge this gap, but its effects on major clinical and patient-centred outcomes remain uncertain. PubMed, Europe PMC, Embase, CENTRAL, Web of Science, and CINAHL were searched from inception to 22 June 2026 without language restrictions. Trial-registry and conference records retrieved through database exports were screened for publication linkage, but ClinicalTrials.gov and WHO ICTRP were not searched separately. Eligible randomized trials enrolled adults with COPD receiving nurse-led or nurse-coordinated care initiated during hospitalization, at discharge, or shortly thereafter and extending into home or community care. Primary outcomes were readmission and all-cause mortality. Random-effects models used restricted maximum likelihood with modified Hartung-Knapp confidence intervals. RoB 2 and GRADE were used. The protocol was retrospectively registered in PROSPERO on 22 June 2026 (CRD42026143005). Twenty-two reports representing 21 trials and 3143 participants were included. Five trials (627 participants) contributed patient-level readmission data; nurse-led transitional care showed no clear difference from usual care (risk ratio [RR] 1.12, 95% confidence interval [CI] 0.83 to 1.51; I²=0%; very-low-certainty evidence). Seven trials (1051 participants) contributed mortality data, also without a clear difference (RR 0.83, 95% CI 0.52 to 1.30; I²=0%; low-certainty evidence). Sensitivity analyses did not materially alter either result. Several trials reported better dyspnoea, COPD health status, exercise capacity, self-efficacy, psychological outcomes, or selected quality-of-life domains, but these outcomes were not pooled because instruments, follow-up periods, and effect definitions differed substantially. Current randomized evidence does not establish that nurse-led hospital-to-home transitional care reduces readmission or mortality among adults with COPD. Selected patient-centred outcomes may improve, but the magnitude and durability of benefit remain uncertain. Future trials require concealed allocation, complete outcome ascertainment, prespecified core outcomes, and sufficient power to evaluate hospital use and mortality.
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