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Respiratory symptom profiles were identified through latent class analysis. Outcomes included exacerbation rates evaluated by zero-inflated negative binomial regressions, time-to-first exacerbation evaluated by Cox regression and longitudinal forced expiratory volume in 1\u2009second (FEV\n                      <jats:sub>1<\/jats:sub>\n                      ) decline evaluated by linear mixed-effects models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 954 participants with mild-to-moderate COPD, five distinct respiratory symptom profiles were identified. Compared with the \u2018minimal respiratory\u2019 profile, the \u2018productive cough\u2019 profile was associated with a higher rate of any respiratory exacerbations (relative ratio [RR] 1.84; 95% confidence interval [CI] 1.29 to 2.64) and severe respiratory exacerbations (RR 2.05; 95%\u2009CI 1.12 to 3.74). Similarly, the \u2018Wheeze\u2019 profile was associated with higher rates of any (RR 1.55; 95%\u2009CI 1.12 to 2.15) and severe exacerbations (RR 1.73; 95%\u2009CI 1.00 to 2.98). The \u2018nearly all respiratory symptoms\u2019 profile was associated with a higher rate of exacerbations (any exacerbation: RR 2.12; 95%\u2009CI 1.56 to 2.89; severe exacerbations: RR 2.07; 1.23 to 3.47) and an accelerated annual FEV\n                      <jats:sub>1<\/jats:sub>\n                      decline (\u221215.41\u2009mL\/year; 95%\u2009CI \u221230.33 to \u22120.51 mL\/year). The \u2018dry cough\u2019 profile exhibited the lowest FEV\n                      <jats:sub>1<\/jats:sub>\n                      trajectory despite a non-significant annual decline.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Respiratory symptom profiles identifies distinct prognostic outcomes in mild-to-moderate COPD. The productive cough is associated with increased exacerbation risk, while the dry cough is associated with a lower lung function trajectory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT0196934\">NCT0196934<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003643","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T05:50:22Z","timestamp":1764741022000},"page":"e003643","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Association of respiratory symptom profiles with future exacerbations and lung function decline in mild-to-moderate 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