A cohort study found that COPD is associated with substantial loss of life expectancy, ranging from less than a year for those with mild disease to more than seven years for those with very severe disease.1
“Despite COPD being a leading cause of death, robust general population estimates of life expectancy and years of life lost have been lacking,” said study lead author Surya P. Bhatt, MD, MSPH. “Prior studies relied on small or nonrepresentative samples, and no prior study has quantified life expectancy in patients with COPD and no smoking history, a group that comprises roughly a quarter of US adults with the disease.”
Published in JAMA Internal Medicine, the study evaluated data from 45,886 participants enrolled in eight US general population-based epidemiologic cohorts included in the National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohort Study. Participants enrolled from 1983 to 2011 were followed up longitudinally through 2020.
After adjusting for demographic and clinical covariates, the investigators found higher rates of years of life lost with higher Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Specifically, the rate of years of life lost increased with GOLD stage: 0.7 for stage 1; 2.6 for stage 2; 5.1 for stage 3; and 7.1 for stage 4. Importantly, the loss was similar in patients with and without a history of smoking, indicating that airflow obstruction itself carries prognostic weight independent of tobacco exposure. For moderate to very severe COPD, years of life lost were comparable to those associated with hypertension and diabetes.
Dr. Bhatt, a Professor of Medicine at the University of Alabama at Birmingham, said these findings may have important implications for people living with COPD.
“Patients with COPD often ask us how long they can expect to live. This study helps provide estimates that can help patients plan their future[s] and also potentially make interventions that may help change their disease course,” Dr. Bhatt said.
However, because the study evaluated the presence of disease at one time point and estimated prognosis over time, it could not account for the development of new COPD during follow-up. The life expectancies reported in the study therefore may be underestimated. The study could not identify the exact onset of COPD, which may have led to overestimation of years lost in mild disease and underestimation in severe disease. Furthermore, the study did not adjust for COPD medications. However, no available therapy during the observation period was shown to improve survival.
“We need therapies that meaningfully improve survival in COPD, as the current portfolio is largely limited to smoking cessation, oxygen, and lung volume reduction in select patients,” Dr. Bhatt said. “Whether newer approaches such as biologics or early-disease interventions can recover lost years remains unknown. The biology and optimal treatment of COPD in patients who have never smoked is poorly understood and deserves dedicated studies.”
References
1. Bhatt SP, Sun Y, Wang Y, et al. Life expectancy in chronic obstructive pulmonary disease. JAMA Intern Med. 2026;186(7):852-860. doi:10.1001/jamainternmed.2026.0207
