{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:13:08Z","timestamp":1785413588428,"version":"3.56.0"},"reference-count":61,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babe\u0219 University of Medicine and Pharmacy","award":["5\/4270\/04.03.2025"],"award-info":[{"award-number":["5\/4270\/04.03.2025"]}]},{"award":["5\/4270\/04.03.2025"],"award-info":[{"award-number":["5\/4270\/04.03.2025"]}],"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Context\/Objectives: In patients with COPD (chronic obstructive pulmonary disease), SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection represents an overlap of viral injury on a lung already affected by pathological mucus, altered mucociliary clearance, chronic inflammation, and impaired antiviral immunity. Methods: A focused narrative review (2020\u20132025) was conducted using clinical, experimental, and consensus evidence. The evidence was synthesized qualitatively, with priority given to cohort studies, meta-analyses, and mechanism-focused studies with clinical relevance. Results: Mucus obstruction (\u201cmucus plugs\u201d) is frequent in COPD (41\u201367%) and is associated with unfavorable outcomes. COPD also increases the risk of post-COVID respiratory sequelae. Bacterial coinfection at presentation is uncommon (3\u20135%), whereas secondary bacterial infections are more frequent (14\u201318%), especially in severe disease requiring intensive care, where VA-LRTI\/VAP (ventilator-associated lower respiratory tract infection\/ventilator-associated pneumonia) become predominant. Sepsis, whether viral or mixed, reflects disease severity and may contribute to functional decline and susceptibility to reinfections; however, the concept of a post-acute \u201csepsis legacy\u201d in COPD after COVID-19 should currently be regarded as a clinically plausible but still emerging hypothesis rather than an established COPD-specific outcome. During recovery, acute exacerbation risk rises to 5.6% versus 3.9%, peaking in the first 30 days after severe disease (aHR \u2248 8.14). Persistent dyspnea and reduced DLCO (diffusing capacity for carbon monoxide) suggest ARDS-related injury, tissue remodeling, and microvascular dysfunction. Conclusions: In COPD, post-COVID respiratory sequelae result from the interaction of mucus, immunity, and infectious\/sepsis-related complications. The first post-discharge month is a critical period requiring careful risk stratification and targeted follow-up.<\/jats:p>","DOI":"10.3390\/jcm15082890","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:20:16Z","timestamp":1775816416000},"page":"2890","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Post-COVID Respiratory Sequelae in COPD: Mucus Plugging, Infectious Complications, and Risk-Stratified Follow-Up"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7865-9915","authenticated-orcid":false,"given":"Florina Cristiana","family":"Lucaciu","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0749-8232","authenticated-orcid":false,"given":"Norbert","family":"Wellmann","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Center of Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6508-928X","authenticated-orcid":false,"given":"Ana Maria","family":"Mihai","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9042-9924","authenticated-orcid":false,"given":"Alexandra","family":"Sima","sequence":"additional","affiliation":[{"name":"Department of Diabetes, \u201cPius Brinzeu\u201d Emergency Hospital, 300723 Timisoara, Romania"},{"name":"Second Department of Internal Medicine, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8236-2205","authenticated-orcid":false,"given":"Ovidiu","family":"Rosca","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8387-7700","authenticated-orcid":false,"given":"Madalina-Ianca","family":"Suba","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrada","family":"Tarau","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4885-2163","authenticated-orcid":false,"given":"Alexandra","family":"Bosoanca","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1160-9164","authenticated-orcid":false,"given":"Monica","family":"Marc","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Center of Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1016\/S1473-3099(21)00703-9","article-title":"A Clinical Case Definition 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