Wan Q; Institute of Respiratory Health, Guangzhou, China
Deng Z; Wu F; Zhou K; Tang G; et al

Respiratory Medicine. 261:109021, 2026 Sep.

INTRODUCTION: Exercise intolerance serves as a prognostic marker for poor
respiratory outcomes in mild-to-moderate COPD. However, the longitudinal
change in exercise tolerance and its association with disease progression
remains unknown. We aimed to explore the association of longitudinal
change in exercise tolerance with disease progression in mild-to-moderate
COPD.

METHODS: This community-based, prospective cohort study was conducted in
China from 2019 to 2024. The participants completed baseline
questionnaires, spirometry, chest computed tomography, and cardiopulmonary
exercise testing (CPET), and underwent annual acute exacerbation
assessment and spirometry over 3 years. Participants were categorized by
the longitudinal change in peak oxygen uptake from baseline to 3 years
into groups with non-declined or declined exercise tolerance.

RESULTS: Overall, 213 participants with mild-to-moderate COPD who
completed baseline and 3-year CPET were analyzed, including 131 (61.5%)
with exercise tolerance decline. 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
decline in postbronchodilator FEV1 (adjusted difference=-4.2ml/year, 95%
CI -8.3 to -0.1, P=0.044). Compared with the non-declined exercise
tolerance group, the group with exercise tolerance decline demonstrated
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).

CONCLUSIONS: The longitudinal decrease in exercise tolerance over 3 years
was associated with accelerated lung function decline and air trapping
progression, suggesting it may be a marker associated with disease
progression in mild-to-moderate COPD.