IMPACT COPD Cohort (China)

Inclusion Criteria: * Age 40-85 years; * Diagnosis of chronic obstructive pulmonary disease (COPD) according to the 2025 GOLD criteria. Exclusion Criteria: * Acute exacerbation of COPD within the past 4 weeks; * Presence of other pulmonary diseases causing chronic respiratory failure in addition to COPD, such as severe bronchiectasis, pneumoconiosis, post-tuberculosis destroyed lung, chest wall deformity, or neuromuscular disease; * Cystic fibrosis or interstitial lung disease; * Severe respiratory failure requiring long-term mechanical ventilation via tracheostomy; * History of lung or other organ transplantation; * Severe pleural disease or chest wall abnormalities that interfere with imaging or pulmonary function assessment; * Lung cancer or other malignancy with widespread metastatic disease; * Previous or current chemotherapy and/or radiotherapy that may affect pulmonary function or structural assessment; * Uncontrolled rheumatic/autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus); * HIV infection; * Long-term use of immunosuppressive agents or systemic corticosteroids; * Severe organ dysfunction, such as severe cardiac, hepatic, or renal failure, or severe pulmonary arterial hypertension; * Hospitalization due to myocardial infarction, heart failure, or other cardiovascular events within the past 3 months; * Major surgery involving the chest, abdomen, or eyes within the past 3 months; * Presence of intrathoracic metallic foreign bodies or implants that interfere with imaging assessment (e.g., pacemaker, implantable cardioverter-defibrillator, metallic prosthetic valves, other metallic devices, or shrapnel); * Allergy to any component of the investigational Chinese herbal compound formula(s); * Allergy to any component of ICS+LABA+LAMA therapy or to inhaler propellants/excipients; * Pregnant or breastfeeding women; * Long-term bedridden status, loss of ability to perform activities of daily living, or life expectancy \<1 year; * Dementia or other cognitive impairment preventing informed consent and follow-up; * Living far from the study center, or planned relocation within the next 3 years, making follow-up infeasible; * Current participation in another interventional clinical trial involving the respiratory system; * Refusal to provide written informed consent.