{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:13:39Z","timestamp":1786115619682,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by psychological distress, but the relationship between GOLD stage, dyspnea, functional limitation, and depression\/anxiety symptoms remains incompletely defined. This study examined clinical and psychological profiles across GOLD stages, with particular attention to GOLD stages 3 and 4. Methods: This multicenter observational study included 285 adults with spirometry-confirmed COPD evaluated in Romania between 2023 and 2026. COPD severity was classified according to GOLD stages. Clinical assessment included FEV1, peripheral oxygen saturation, smoking exposure, the COPD Assessment Test (CAT), and the modified Medical Research Council dyspnea scale (mMRC). Psychological and well-being measures included DASS depression, anxiety, and stress scores; WHO-5; major depressive disorder score, and generalized anxiety disorder score. Descriptive analyses were performed across GOLD stages, and GOLD 3 was directly compared with GOLD 4. Results: GOLD 3 was the largest subgroup (n = 106, 37.2%), followed by GOLD 4 (n = 81, 28.4%), GOLD 2 (n = 69, 24.2%), and GOLD 1 (n = 29, 10.2%). GOLD 3 patients showed marked dyspnea and symptom burden, with mean mMRC = 2.92 and CAT = 24.44. DASS depression, anxiety, and stress scores were higher in GOLD 3 than GOLD 2, but did not increase further in GOLD 4. Direct GOLD 3 versus GOLD 4 comparisons showed no significant differences in DASS depression or DASS anxiety, whereas GOLD 4 had a significantly higher mMRC, major depressive disorder score, and generalized anxiety disorder score. Conclusions: GOLD 3 COPD was associated with substantial dyspnea, functional limitation, and measurable psychological distress. However, depression and anxiety patterns varied by instrument, suggesting that psychological burden in COPD is multidimensional and not explained by spirometric severity alone.<\/jats:p>","DOI":"10.3390\/medicina62081500","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:42:36Z","timestamp":1785850956000},"page":"1500","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Spirometry: Dyspnea, Functional Limitation, and Psychological Distress Across GOLD Stages in COPD\u2014A Multicenter Observational Study"],"prefix":"10.3390","volume":"62","author":[{"given":"Adina","family":"Deliu","sequence":"first","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luana","family":"Alexandrescu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"},{"name":"Department of Internal Medicine, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Cimpineanu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Nephrology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana Cristina","family":"Arghir","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Faculty of Psychology and Educational Sciences, \u201cOvidius\u201d University, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanda","family":"Jurja","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioan Tiberiu","family":"Tofolean","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7483-5092","authenticated-orcid":false,"given":"Rodica Gabriela","family":"Enache","sequence":"additional","affiliation":[{"name":"Faculty of Psychology and Educational Sciences, \u201cOvidius\u201d University, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Gherghisan","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Pneumology Department, Pneumophtisiology Hospital Palazu Mare, 40 Santinelei Street, 900002 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ionela","family":"Preotesoiu","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9701-4438","authenticated-orcid":false,"given":"Ionut Valentin","family":"Stanciu","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Pneumology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5872-4381","authenticated-orcid":false,"given":"Andreea Nelson","family":"Twakor","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Herlo","sequence":"additional","affiliation":[{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daria Maria","family":"Alexandrescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Titu Maiorescu University, 040051 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doina Ecaterina","family":"Tofolean","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Pneumology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1164\/rccm.202204-0671PP","article-title":"Definition and Nomenclature of Chronic Obstructive Pulmonary Disease: Time for Its Revision","volume":"206","author":"Celli","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1164\/rccm.202208-1508LE","article-title":"Chronic Obstructive Pulmonary Disease Definition: Is It Time to Incorporate the Concept of Failure of Lung Regeneration?","volume":"207","author":"Confalonieri","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Siraj, R.A. (2025). 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