Clinical and prognostic differences in mild to moderate AECOPD with and without emphysema: a 3-year multicenter prospective study

The study analyzed data from 5,713 patients hospitalized with mild to moderate acute exacerbation of COPD (AECOPD), of which 79.8% had emphysema. After propensity score matching, the emphysema group demonstrated more severe acute disease with higher rates of respiratory failure (12.1% versus 3.4%) and elevated inflammatory markers. However, the emphysema group showed lower 3-year mortality (24.8% versus 30.2%). The non-emphysema group had higher prevalence of cardiovascular comorbidities, including hypertension (41.5% versus 32.7%) and heart failure (18.7% versus 13.6%). The results suggest that the emphysema phenotype predicts higher acute morbidity but lower long-term mortality.