Associations between changes in inflammatory markers and clinical outcomes following pulmonary rehabilitation in COPD: a prospective observational study

Abstract

Aims: Pulmonary rehabilitation (PR) is a cornerstone non-pharmacological intervention in chronic obstructive pulmonary disease (COPD), improving symptoms and functional capacity. However, the relationship between PR-related clinical improvement and routinely available systemic inflammatory markers remains incompletely understood. This study aimed to exploratorily evaluate associations between changes in inflammatory markers and clinical outcomes following PR in patients with COPD.Methods: This single-arm, prospective, before-and-after observational study was conducted between May and November 2025. Patients with COPD completed a six-week cardiopulmonary rehabilitation program. Clinical outcomes included the Modified Medical Research Council (mMRC) Dyspnea Scale, COPD assessment test (CAT), body-mass index, Airflow Obstruction, Dyspnea, and Exercise Capacity (BODE) Index, and six-minute walk test (6MWT). Laboratory assessments comprised complete blood count parameters, C-reactive protein (CRP), erythrocyte sedimentation rate, albumin, total protein, and selected derived inflammatory indices. Pre- and post-rehabilitation changes in clinical and inflammatory parameters were analyzed.Results: Thirty-six participants completed the rehabilitation program. Significant improvements were observed in mMRC, CAT, BODE Index, and 6MWT distance (all p