IMPACT COPD Cohort (China)

Inclusion criteria

• Age 40-85 years;
• Diagnosis of chronic obstructive pulmonary disease (COPD) according to the 2025 GOLD criteria.

Exclusion criteria

• Acute exacerbation of COPD within the past 4 weeks;
• Presence of other pulmonary diseases causing chronic respiratory failure in addition to COPD, such as severe bronchiectasis, pneumoconiosis, post-tuberculosis destroyed lung, chest wall deformity, or neuromuscular disease;
• Cystic fibrosis or interstitial lung disease;
• Severe respiratory failure requiring long-term mechanical ventilation via tracheostomy;
• History of lung or other organ transplantation;
• Severe pleural disease or chest wall abnormalities that interfere with imaging or pulmonary function assessment;
• Lung cancer or other malignancy with widespread metastatic disease;
• Previous or current chemotherapy and/or radiotherapy that may affect pulmonary function or structural assessment;
• Uncontrolled rheumatic/autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus);
• HIV infection;
• Long-term use of immunosuppressive agents or systemic corticosteroids;
• Severe organ dysfunction, such as severe cardiac, hepatic, or renal failure, or severe pulmonary arterial hypertension;
• Hospitalization due to myocardial infarction, heart failure, or other cardiovascular events within the past 3 months;
• Major surgery involving the chest, abdomen, or eyes within the past 3 months;
• Presence of intrathoracic metallic foreign bodies or implants that interfere with imaging assessment (e.g., pacemaker, implantable cardioverter-defibrillator, metallic prosthetic valves, other metallic devices, or shrapnel);
• Allergy to any component of the investigational Chinese herbal compound formula(s);
• Allergy to any component of ICS+LABA+LAMA therapy or to inhaler propellants/excipients;
• Pregnant or breastfeeding women;
• Long-term bedridden status, loss of ability to perform activities of daily living, or life expectancy <1 year;
• Dementia or other cognitive impairment preventing informed consent and follow-up;
• Living far from the study center, or planned relocation within the next 3 years, making follow-up infeasible;
• Current participation in another interventional clinical trial involving the respiratory system;
• Refusal to provide written informed consent.