The role of artificial intelligence in predicting COPD exacerbations using multimodal data: a systematic review
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Graphical abstract Overview of the study. The graphical elements of this figure were created using Canva (Canva Pty Ltd., Sydney, Australia). EHR: electronic health record. http://www.w3.org/1999/xlink float portrait 01420-2025.GA01.jpg anchor GRAPHICAL ABSTRACT GA1 portrait graphical abstract-1 Background COPD remains a leading cause of global morbidity and mortality, with acute exacerbations driving disease progression and healthcare utilisation. Artificial intelligence (AI) offers new opportunities to predict exacerbation risk by integrating multimodal data such as electronic health records (EHRs), spirometry and wearable sensor inputs. Methods This systematic review, conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251165476), evaluated AI-based models developed for COPD exacerbation prediction using combined data modalities. Results Comprehensive searches of PubMed, Embase and Google Scholar identified 859 records, of which five studies published between 2021 and 2025 met inclusion criteria. Study designs ranged from prospective monitoring cohorts to EHR-based and hybrid datasets. Models applied diverse approaches including random forests, gradient boosting, convolutional neural networks and ensemble learning frameworks. Reported discriminative performance was moderate to high, with area under the curve values between 0.73 and 0.92 and accuracies up to 0.92. Most of these performance metrics were derived from internal validation, with
Abstract
Graphical abstract Overview of the study. The graphical elements of this figure were created using Canva (Canva Pty Ltd., Sydney, Australia). EHR: electronic health record. http://www.w3.org/1999/xlink float portrait 01420-2025.GA01.jpg anchor GRAPHICAL ABSTRACT GA1 portrait graphical abstract-1 Background COPD remains a leading cause of global morbidity and mortality, with acute exacerbations driving disease progression and healthcare utilisation. Artificial intelligence (AI) offers new opportunities to predict exacerbation risk by integrating multimodal data such as electronic health records (EHRs), spirometry and wearable sensor inputs. Methods This systematic review, conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251165476), evaluated AI-based models developed for COPD exacerbation prediction using combined data modalities. Results Comprehensive searches of PubMed, Embase and Google Scholar identified 859 records, of which five studies published between 2021 and 2025 met inclusion criteria. Study designs ranged from prospective monitoring cohorts to EHR-based and hybrid datasets. Models applied diverse approaches including random forests, gradient boosting, convolutional neural networks and ensemble learning frameworks. Reported discriminative performance was moderate to high, with area under the curve values between 0.73 and 0.92 and accuracies up to 0.92. Most of these performance metrics were derived from internal validation, with limited external testing, which restricts assumptions about generalisability. Sensitivity reached 0.94 in wearable-driven models, while only one study reported formal calibration assessment. Conclusions Despite encouraging performance, methodological heterogeneity, limited external validation and incomplete reporting of preprocessing and explainability methods restrict clinical translation. Current evidence supports the potential of multimodal AI to enhance early detection of COPD exacerbations, but future research must prioritise transparent reporting, external validation and integration into real-world care pathways. Shareable abstract Integrating multimodal data with artificial intelligence can enhance the prediction of COPD exacerbations, but greater methodological rigour and external validation are essential before clinical translation https://bit.ly/45l4jgW short abstract-2