Chronic obstructive pulmonary disease, or COPD, caused 141,733 deaths in the United States in 2023 – the latest data that has been reported. That number reflects not just the effects of smoking, but a broader set of medical and social factors that shape who survives.

As of early 2026, COPD remains the fifth-leading cause of death nationwide and carries a substantial economic burden, with annual medical costs estimated at US$24 billion among adults ages 45 and older. COPD is a progressive condition that limits airflow, making it increasingly difficult to breathe and carry out everyday activities.

Nearly 16 million U.S. adults live with COPD, and many more remain undiagnosed.

COPD also encompasses chronic bronchitis, which inflames the airways, and emphysema, a condition that damages the air sacs in the lungs. Both conditions limit the flow of air in and out of the lungs.

I am a physician and doctoral researcher in public health who studies chronic disease outcomes using nationally representative U.S. data. In my research examining long-term mortality among adults living with COPD, one pattern stands out clearly: My colleagues and I found that both current and former smokers had a higher risk of death compared with those who never smoked, highlighting that smoking increases mortality risk – but it does not act alone.

How smoking and COPD are intertwined

Smoking has been recognized for over five decades as the primary cause of COPD. It is a major........

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