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Incidence and Risk Factors for Progression from Pre-COPD to COPD: A Systematic Review and Meta‑analysis
Lili Qiao1, Xiucen Wu2, Guihua Chen3
1Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
International Journal of Chronic Obstructive Pulmonary Disease
|February 20, 2026
Summary
Pre-chronic obstructive pulmonary disease (Pre-COPD) progresses to COPD in 20% of cases. Key risk factors include age, smoking, asthma, and specific lung function impairments like PRISm and NOCB.
Area of Science:
- Pulmonary Medicine
- Epidemiology
- Respiratory Health
Background:
- Pre-chronic obstructive pulmonary disease (Pre-COPD) identifies individuals with respiratory symptoms or lung function abnormalities preceding a formal COPD diagnosis.
- Early identification of Pre-COPD is crucial for understanding disease progression and implementing timely interventions.
Purpose of the Study:
- To conduct a systematic review and meta-analysis to determine the incidence of progression from Pre-COPD to COPD.
- To identify significant risk factors associated with this progression.
Main Methods:
- A comprehensive search of ten databases was performed up to December 31, 2024.
- The Newcastle-Ottawa Scale (NOS) assessed study quality.
- Incidence rates and odds/hazard ratios (with 95% CIs) were extracted and pooled using fixed- and random-effects models.
Main Results:
- The pooled incidence of progression from Pre-COPD to COPD was 20% (95% CI: 15-26%).
- Significant risk factors identified include: preserved ratio impaired spirometry (PRISm) (OR=2.92), age (OR=1.09), smoking history (OR=4.08, HR=2.21), non-obstructive chronic bronchitis (NOCB) (OR=2.07, HR=2.46), and asthma (OR=2.50).
Conclusions:
- A substantial proportion of individuals with Pre-COPD progress to COPD, highlighting the need for proactive management.
- Incorporating identified risk factors (age, smoking, PRISm, NOCB, asthma) into risk-stratification tools can aid in early detection and targeted preventive strategies.
- Enhanced surveillance and interventions like smoking cessation and optimized asthma care are recommended for high-risk Pre-COPD patients to delay or prevent COPD onset.
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