Living with schizophrenia is already a profound challenge. Now research shows that people with the disorder face a sharply higher risk of developing chronic obstructive pulmonary disease (COPD), one of the leading causes of death worldwide.
A review published June 10, 2025 in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation concludes that the link is not explained by smoking alone. Instead, shared genetic factors, socioeconomic disadvantages, medication side effects, and lack of adequate medical care may converge to drive what researchers call a syndemic relationship between the two conditions.
Two Conditions That Shorten Lives
COPD, which includes emphysema and chronic bronchitis, affects about 30 million Americans. Half do not know they have it. Schizophrenia, typically diagnosed in early adulthood, already reduces life expectancy by decades. Together, the diseases compound disability, isolation, and mortality.
Population studies in the United States, United Kingdom, Sweden, and Taiwan show that people with schizophrenia are nearly twice as likely to develop COPD as those without the disorder, even after adjusting for smoking. In some cohorts, one in four hospitalized patients with schizophrenia had COPD, compared to fewer than one in six among peers without the diagnosis.
Why the Risk Is Higher
The reasons are complex. Many people with schizophrenia smoke, often heavily, and smoking cessation rates remain low. But the review emphasizes that tobacco cannot fully explain the disparity. Inflammatory pathways implicated in schizophrenia, such as elevated interleukin-6 and TNF-α, are also central in COPD. Antipsychotic medications, particularly newer second-generation agents, increase the risk of pneumonia and acute respiratory failure. Sedation and weight gain worsen respiratory health. And social factors from poverty and housing insecurity to barriers in accessing primary care further magnify the danger.
“We need to ensure primary care providers are aware that people with schizophrenia are at higher risk of developing COPD. Patients should have regular physical health checks, and those with schizophrenia and COPD should be offered comprehensive care,” said Professor David M.G. Halpin of the University of Exeter (Exeter Medical School).
Stigma and Missed Diagnoses
Underdiagnosis is rampant. In one Australian study, 60 percent of patients with COPD symptoms and schizophrenia had never been formally diagnosed. Clinicians sometimes misinterpret breathlessness or chronic cough as psychosomatic. Annual health checks are recommended but rarely performed, with fewer than a quarter of U.K. patients receiving all guideline-based assessments. The World Health Organization urges physical health screening for people with severe mental illness, but COPD is not yet included in standard protocols.
Building Integrated Care
The review calls for schizophrenia itself to be treated as a risk factor for COPD, just as it is for cardiovascular disease. Integrated care models linking psychiatric nurses, case managers, and primary care can improve screening, vaccination rates, and smoking cessation support. Telerehabilitation and digital reminders may also help patients engage in treatment and pulmonary rehabilitation. Yet stigma remains a profound barrier, with some clinicians underestimating patients’ ability to follow through on care plans.
Key Findings
- Sample size: Data synthesized from multiple population cohorts, including more than 269,000 hospital admissions in the U.S. and national registries in the U.K., Sweden, and Taiwan.
- Prevalence: COPD rates of 26.6% in U.S. hospitalized patients with schizophrenia versus 15.6% without; adjusted relative risk up to 1.83 in Taiwan.
- Mortality: Swedish study found hazard ratios for COPD death of 5.50 in men and 2.78 in women with schizophrenia, even after smoking adjustment.
- Mechanisms: Shared inflammatory pathways (IL-6, TNF-α), high smoking prevalence, antipsychotic side effects, socioeconomic deprivation.
- Care gaps: Up to 60% of patients with COPD symptoms and schizophrenia had no diagnosis; fewer than 25% received complete physical health checks.
- Location: Evidence spans the United States, United Kingdom, Sweden, Australia, and Taiwan.
Takeaway
People with schizophrenia are significantly more likely to develop COPD, and the connection goes beyond smoking. Biological, social, and medical care factors combine to worsen outcomes. Recognizing schizophrenia as a risk factor for COPD, and integrating physical and mental health care, could reduce premature deaths in this vulnerable population.
Journal: Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation
DOI: 10.15326/jcopdf.2025.0631
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