Treatable Traits-Oriented Management in Pre-COPD With Severe Obstructive Sleep Apnea: A Case Report of Symptomatic and Spirometric Improvement After Integrated Therapy.

Pre-chronic obstructive pulmonary disease (pre-COPD) is an early disease state characterised by respiratory symptoms and/or structural abnormalities without established airflow limitation. We report a woman in her 40s with cough, exertional dyspnoea, preserved spirometry, mild emphysematous change and severe obstructive sleep apnea (apnea-hypopnea index, 88.1 events/h). Integrated management with inhaled fluticasone furoate/umeclidinium/vilanterol and continuous positive airway pressure was initiated. After 12 weeks, FEV1 increased from 2.27 to 2.73 L and FEV1/FVC from 82.5% to 86.9%, while the COPD Assessment Test score decreased from 12 to 3. The patient continued smoking and body weight remained essentially stable. Systemic inflammatory markers showed no clear overall improvement. Eosinophilic asthma was considered less likely because bronchodilator responsiveness was negative, blood eosinophils and total IgE were low, sputum eosinophils were negative, and sputum cytology showed neutrophilic inflammation. This case is hypothesis-generating and suggests that selected pre-COPD patients may benefit from multifactorial trait-oriented management.