The Overlap of COPD and Metabolic Syndrome: Pathophysiologi-cal Insights and Non-Pharmacological Strategies - A Narrative Re-view

Chronic obstructive pulmonary disease (COPD) frequently overlaps with metabolic syndrome (MetS), amplifying systemic inflammation, insulin resistance, and cardiovascular risk. This comorbidity contributes to worse prognosis and higher morbidity. We conducted a narrative review of studies indexed in PubMed, Web of Science, and Google Scholar up to July 2025. The search focused on COPD, MetS, systemic inflammation, and non-pharmacological management. Pulmonary rehabilitation (PR) improves dyspnea, exercise tolerance, and quality of life, while also reducing waist circumference and improving insulin sensitivity. Structured exercise programs enhance metabolic regulation but face adherence challenges. Nutritional interventions, including Mediterranean diet, adequate protein intake, and vitamin D supplementation, show promising anti-inflammatory and metabolic effects, though evidence from randomized trials in COPD–MetS cohorts remains limited. Vaccination prevents exacerbations and provides cardiovascular protection, yet real-world uptake is suboptimal due to access and hesitancy barriers. Non-pharmacological interventions complement pharmacological therapy by addressing shared respiratory and metabolic mechanisms. Multidisciplinary models integrating PR, exercise, nutrition, and vaccination are needed, alongside large pragmatic trials assessing both pulmonary and metabolic outcomes.