Chronic obstructive pulmonary disease (COPD) can have a profound impact on patient quality of life (QOL), with airflow limitations creating a negative feedback loop that ultimately causes increased disease burden. COPD has implications for patients’ physical and emotional well-being, but new agents offer promise, especially when paired with nonpharmacologic interventions.

COPD impacts patient QOL in multifaceted ways. We think about dyspnea as the primary symptom of COPD—and it certainly is—but the lungs are interconnected with the brain, and the sensation of dyspnea drives anxiety. It can become a negative feedback loop, where the shorter of breath patients become, the faster they breathe, the more their lungs become hyperinflated, the worse their dyspnea gets, and the more anxious they become.

There are many other ways in which COPD impacts QOL. Chronic cough and mucus production can be frustrating for patients because these have a social impact. Nobody wants to be the person coughing in public, particularly after the COVID-19 pandemic. Additionally, our patients with COPD lose the ability to do the things they used to do, and they may no longer be able to keep up with their peers. This, combined with concerns about infection, can create social isolation.

Exacerbations cause the most acute worsening of QOL. There can be permanent lung function decrements that lead to further debility, particularly if patients are hospitalized for the event(s). There is also a comorbidity component. Other disorders, such as cardiovascular disease and osteoporosis, are more common among patients with COPD. Rates of both anxiety and depression are also higher among patients with the disease. COPD is a disease of multimorbidity. When we add everything up, the QOL impact can be quite profound.

Interestingly, there is some research suggesting that, when comparing patients with similar lung function, QOL is worse in younger patients with COPD than in older patients. This may be related to lifestyle expectations for someone in their 80s vs someone in their 40s. We do not fully understand the difference in QOL yet, but it may represent a slight silver lining: lung function impairment may not hit quite as hard in our older patients with COPD as it does in our younger patients.

The good news is that we have interventions to help improve COPD symptoms, lung function, and QOL. This is an area of active research, with some new US Food and Drug Administration (FDA) drug approvals over the past 2 years, and I am optimistic about our progress. Traditionally, we have used inhalers that include LABAs, LAMAs, and corticosteroids. In patients with severe disease, the combination of all 3 seems to have the biggest impact on improvements in lung function and QOL, as well as exacerbation reduction. New classes of agents have become available, such as biologics targeting type 2 inflammation, which help with exacerbation reduction. Another new class, nebulized PDE3/4 inhibitors, has been shown to improve symptoms, lung function, and QOL.

Finally, it is important to remember the value of nonpharmacologic interventions for COPD, such as pulmonary rehabilitation, which can have a profound impact on symptoms and physical capacity. There are also more advanced interventions for appropriate patients, such as lung volume reduction surgery or endobronchial valve therapy. However, for the majority of our patients with COPD, pharmacologic interventions in conjunction with pulmonary rehabilitation can significantly improve outcomes.