Beyond smoking: the role of social determinants in the progression of COPD

A recent study published in the journal Thorax highlighted how social determinants of health (SDOH) can significantly influence lung function and the risk of developing chronic obstructive pulmonary disease (COPD).

Factors such as socioeconomic status, access to healthcare services, education, housing conditions and environmental exposure can contribute to the development and progression of the disease, in addition to traditional risk factors such as cigarette smoking.

These findings suggest that the prevention and management of COPD should integrate not only clinical and pharmacological approaches, but also public health strategies targeting social and environmental inequalities.

COPD: a complex disease

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. It is characterised by persistent airflow limitation associated with a chronic inflammatory response in the airways.

Traditionally, COPD has been considered primarily a consequence of exposure to cigarette smoke, which remains the main risk factor in high-income countries. However, in recent years, there has been growing evidence that the disease has a multifactorial origin, in which environmental, biological and social factors interact to determine individual risk.

The role of social determinants of health

The term social determinants of health refers to the conditions in which people are born, grow up, live and work. These factors can profoundly influence the health status of a population.

In the case of chronic respiratory diseases, several factors can contribute to the development and progression of the disease, including:

1. socioeconomic status;
2. level of education;
3. access to healthcare services;
4. quality of the home and work environment;
5. exposure to air or household pollution;
6. housing conditions and population density.

The study published in Thorax suggests that these factors can significantly influence the decline in respiratory function over time, increasing the risk of developing COPD or more severe forms of the disease.

Social inequalities and respiratory health

Social inequalities can translate into significant differences in health outcomes.

People living in more disadvantaged socioeconomic conditions often have:

• greater exposure to environmental pollutants;
• a higher likelihood of harmful occupational exposures;
• less access to early diagnosis and specialist care;
• a higher prevalence of behavioural risk factors.

These factors may contribute not only to the development of the disease, but also to a more rapid progression of COPD.

Implications for COPD prevention

The results of this research indicate that COPD prevention cannot be based solely on reducing cigarette smoking.

Although tobacco control remains essential, broader strategies must also be considered, including:

• improving air quality;
• reducing harmful occupational exposures;
• increasing access to early diagnosis;
• health education programmes for at-risk populations.

An integrated approach that takes social determinants into account could help reduce the incidence of the disease and improve clinical outcomes in patients already affected by COPD.

In recent years, it has become increasingly clear that chronic respiratory diseases cannot be understood solely through biological or behavioural factors. Social determinants of health are a key element in shaping disease risk and its progression.

Integrating these dimensions into health research and policy could enable the development of more effective and targeted prevention strategies that reduce inequalities and improve the respiratory health of populations.

FAQ

Is COPD caused only by smoking?

No. Cigarette smoking is the main risk factor, but air pollution, occupational exposure and social determinants can also contribute to the development of the disease.

Can social factors affect respiratory health?

Yes. Disadvantaged socioeconomic conditions, polluted living environments and limited access to care can increase the risk of respiratory diseases.

Can pollution cause COPD?

Prolonged exposure to air pollution or irritants can contribute to the development or progression of COPD.

How can COPD be prevented?

Prevention includes smoking cessation, reducing exposure to environmental and occupational pollutants, and early access to diagnosis and treatment.

Prof. Luca Richeldi