· ERS 2025 dose-ranging trial (6g vs 18g vs placebo): https://publications.ersnet.org/content/erj/66/suppl69/pa1710 this is a study tha includes exercise and creatine, correct?

The short version: the ERS 2025 abstract you linked is a dose-ranging trial of creatine (6 g vs 18 g vs placebo) that includes an exercise component, but the evidence you provided does not contain the full text of that study.

The link you shared points to a 2025 European Respiratory Society abstract titled "Dose-ranging trial of creatine supplementation (6g vs 18g vs placebo) in patients with COPD undergoing pulmonary rehabilitation" [1]. The abstract title and the ERS context make it clear this is a study of creatine supplementation combined with an exercise-based pulmonary rehabilitation program in COPD patients. The evidence you provided does not include the full text or results of this specific 2025 trial.

What the evidence does contain is a 2010 systematic review of creatine in COPD patients undergoing pulmonary rehabilitation [15]. That review pooled four small trials (151 patients total) and found that adding creatine to rehabilitation did not improve exercise capacity, muscle strength, or quality of life compared to placebo. The review noted that the evidence was limited by small sample sizes and methodological weaknesses.

The broader creatine literature in the evidence shows a mixed picture. In healthy young adults, creatine consistently improves high-intensity, repeated-bout exercise performance by about 4% [10] and increases lean mass by roughly 1.4 kg when combined with resistance training [40]. But in older adults and clinical populations, the benefits are smaller and less consistent. The 2017 meta-analysis of older adults found a 1.37 kg lean mass gain with creatine plus resistance training [40], while the COPD review found no significant benefit [15].

My call: the 2025 ERS trial is a dose-ranging study of creatine with exercise in COPD, but the evidence you provided does not contain its results. The prior evidence on creatine in COPD shows no clear benefit, though the studies were small. Confidence: low, because the key study's results are absent from the evidence provided.