Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 13, Issue 1 - 2026

Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation is an open access, peer-reviewed medical/scientific journal dedicated to publishing original research, reviews, and communications related to COPD. Following peer review and editorial acceptance, manuscripts are published online as quickly as possible as Articles in Press.  These accepted manuscripts are then aggregated into journal issues 6 times per year (January, March, May, July, September, and November) and made available to the COPD medical/research community at no charge, without a required subscription fee. The Journal is indexed by PubMed, PubMed Central, Scopus and Web of Science.

Original Research:

The Long-Term Effects of Cost-Related Nonadherence on COPD Outcomes and Progression in the COPDGene Study Cohort

Rajat Suri, MD, MS1 Amy Non, PhD2 Jacob Bailey, MD, MA1 Doug Conrad, MD1

Author Affiliations

  1. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, United States
  2. Department of Anthropology, University of California San Diego, La Jolla, California, United States

Address correspondence to:

Rajat Suri
9500 Campus Point Drive, MC 7381
La Jolla, CA 92037-7381
Email: rsuri@health.ucsd.edu

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease with a high prevalence and cost burden on the health care system. Overall, adherence to prescribed therapies is low and associated with worse outcomes.

Objective: Cost-related nonadherence (CRN) is a type of nonadherence that could be addressed through policy. We evaluated the long-term association of CRN on COPD outcomes in a well-profiled cohort.

Methods: We identified 2521 participants with baseline COPD who answered the social and economic questionnaire in the COPD Genetic Epidemiology study cohort. Of these, 408 participants endorsed experiencing CRN. Multivariable regression models were utilized to assess the association of experiencing CRN and COPD outcomes including functional status, health status, and progression of disease.

Results: Experiencing CRN is associated with worse functional status by the 6-minute walk distance, symptom burden by the COPD Assessment Test score, and health status by the St George’s Respiratory Questionnaire. Longitudinal analysis revealed an association of CRN with faster lung function decline and an increased risk of COPD exacerbations.

Conclusion: Policy changes to address out-of-pocket medication costs may improve COPD outcomes and potentially lead to long-term cost savings.

Citation

Citation: Suri R, Non A, Bailey J, Conrad D. The long-term effects of cost-related nonadherence on COPD outcomes and progression in the COPDGene study cohort. Chronic Obstr Pulm Dis. 2026; 13(1): 1-7. doi: http://dx.doi.org/10.15326/jcopdf.2025.0689

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Upper and Lower Limb Skeletal Muscle Mass Index as a Novel Evaluation Index in Patients With Chronic Obstructive Pulmonary Disease

Junpei Oba, RPT, MHS1,2 Shota Kotani, RPT, PhD3 Satoshi Kubo, RPT1 Jun Horie, RPT, PhD2

Author Affiliations

  1. Department of Rehabilitation, Osaka Anti-Tuberculosis Association, Osaka Fukujuji Hospital, Neyagawa, Osaka, Japan
  2. Graduate School of Health Sciences, Kyoto Tachibana University, Yamashina, Kyoto, Japan
  3. Faculty of Rehabilitation, Department of Physical Therapy, Kobe International University, Kobe, Hyōgo, Japan

Address correspondence to:

Junpei Oba, RPT, MHS
Department of Rehabilitation
Osaka Anti-tuberculosis Association, Osaka Fukujuji Hospital
3-10 Uchiagetakatsukacho
Neyagawa, Osaka, 572-0854, Japan
Phone: +81-72-821-4781
Email: obajun1007@gmail.com

Abstract

Objective: The objective of this study was to examine the relationships and usefulness of physical activity, physical performance, and physical function in patients with chronic obstructive pulmonary disease (COPD), focusing on 2 newly proposed skeletal muscle indices: the upper limb skeletal muscle mass index (USMI) and lower limb skeletal muscle mass index (LSMI).

Methods: A total of 80 stable patients with COPD who participated in outpatient pulmonary rehabilitation at Osaka Fukujuji Hospital were enrolled. The primary measurements were the USMI, LSMI, and skeletal muscle index (SMI). The explanatory measurements included physical activity, incremental shuttle walking distance (ISWD), quadriceps strength, handgrip strength, the Nagasaki University Respiratory Activities of Daily Living Questionnaire, and pulmonary function. Pearson’s correlation coefficient and stepwise multiple regression analysis were used for the statistical analyses.

Results: USMI showed no significant correlations with physical activity parameters or ISWD. In contrast, LSMI was significantly correlated with weekly exercise volume (r=0.42, p<0.01), daily exercise volume (r=0.42, p<0.01), time spent in activities ≥3 metabolic equivalents of task (r=0.40, p<0.01), and ISWD (r=0.46, p<0.01). Multiple regression analysis identified ISWD as an independent factor for USMI, LSMI, and SMI.

Conclusions: This study demonstrated that LSMI, similar to SMI, was associated with physical activity and exercise capacity in patients with COPD. These findings highlight the importance of evaluating, maintaining, and strengthening lower limb skeletal muscle mass and suggest that LSMI may serve as a useful clinical evaluation index.

Citation

Citation: Oba J, Kotani S, Kubo S, Horie J. Upper and lower limb skeletal muscle mass index as a novel evaluation index in patients with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2026; 13(1): 8-16. doi: http://dx.doi.org/10.15326/jcopdf.2025.0698

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Rationale and Design of the Roflumilast or Azithromycin to Prevent COPD Exacerbations Clinical Trial

Jerry A. Krishnan, MD, PhD1 Janet T. Holbrook, PhD2 Elizabeth A. Sugar, PhD2 Richard Albert, MD3 Steve Rennard, MD4 Nina Bracken, APRN1 Jiaxian He, MS2 Marie Bradley, PhD, MSc PH, MPharm5 Kevin Coughlin, MA6 Candace C. Fuller, PhD, MPH6 Bradley Hammill, DrPH, MA7 Elisha Malanga, BS8 Vincent M. Malanga, BS8 David Mannino, MD, MPH8 Richard A. Mularski, MD, MCR, MSHS9 Hugh Musick, MBA1 Jean Rommes, PhD8 Julie DeLisa, MA1 Sengwee Toh, ScD6 Robert A. Wise, MD2

Author Affiliations

  1. Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States
  2. Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
  3. Department of Medicine, University of Colorado Anschutz, Aurora, Colorado, United States
  4. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
  5. U.S. Food and Drug Administration, Silver Spring, Maryland, United States
  6. Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
  7. Department of Population Health Sciences, Duke University, Durham, North Carolina, United States
  8. COPD Foundation, Miami, Florida, United States
  9. Center for Health Research, Kaiser Permanente Northwest, Washington, D.C., United States

Address correspondence to:

Jerry A. Krishnan, MD, PhD
Mile Square Health Center
1220 S. Wood Street
University of Illinois Chicago
Chicago, IL 60608
Phone: (312) 413-0637
Email: jakris@uic.edu

Abstract

Rationale: Chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization and death, particularly among patients with chronic bronchitis and frequent exacerbations. Results of placebo-controlled clinical trials indicate that treatment escalation with either long-term oral roflumilast or azithromycin can reduce COPD exacerbations. However, head-to-head comparative data from clinical trials are lacking, so the relative harms and benefits of these treatments are unclear.

Objective: The RofLumilast or Azithromycin to preveNt COPD Exacerbations (RELIANCE) study is an investigator-initiated, multicenter, randomized, pragmatic clinical trial embedded in clinical practice to evaluate the effectiveness of treatment escalation with long-term azithromycin versus roflumilast in patients with COPD and chronic bronchitis.

Methods/Design: We solicited preferences from patients, clinicians, and other stakeholders during the design and implementation phases of the study, including feedback that informed modifications related to the COVID-19 pandemic. Eligibility criteria did not require assessments outside of clinical practice, with exclusions principally for safety. The composite endpoint of first all-cause hospitalization or death served as the primary outcome. Enrollment was initially through university-affiliated clinical centers but was subsequently expanded to recruit patients in community-based practices who might not otherwise participate in research. We employed human-centered design principles to improve the usability of study activities from the perspective of participants, study staff, and treating clinicians.

Final Design: The final study design offered the option for patients with COPD and chronic bronchitis at high-risk of hospitalization or death to be remotely consented, prescribed a medication according to the randomized treatment allocation, and complete virtual follow-up study visits in a decentralized clinical trial.

Citation

Citation: Krishnan JA, Holbrook JT, Sugar EA, et al. Rationale and design of the roflumilast or azithromycin to prevent COPD exacerbations clinical trial. Chronic Obstr Pulm Dis. 2026; 13(1): 17-28. doi: http://dx.doi.org/10.15326/jcopdf.2025.0669

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Lung Cancer in Patients With COPD: Predictors of Surgery and Long-Term Survival Following Lung Resection

Arianne Tardif, MD1 Claudia LeBlanc, MD1 Pascalin Roy1 Marie Parizeault1 Catherine Labbé, MD1 Frédéric Nicodème, MD, PhD1 Emma Roy, MD, MSc1 Gabriel Chouinard, MD1 Éliane Pelletier, MD, MSc1 Marie-Christine Blais, MD1 Sabrina Biardel1 Mélanie Gaudreault, MD1 Serge Simard, MSc1 Yves Lacasse, MD, MSc1 François Maltais, MD1

Author Affiliations

  1. Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada

Address correspondence to:

François Maltais
Centre de Pneumologie
Institut Universitaire de Cardiologie et de Pneumologie de Québec
2725 chemin Ste-Foy, QC
Québec, Canada
G1V 4G5
Phone: (418) 656-4747
Email: francois.maltais@med.ulaval.ca

Abstract

Background: Lung resection is the preferred treatment option for lung cancer. Patients with chronic obstructive pulmonary disease (COPD) may be denied surgery due to lung function impairment or other comorbidities.

Objective: We aimed to describe the predictors of lung resection and long-term survival in patients with COPD with early-stage nonsmall cell lung cancer (NSCLC).

Study Design and Methods: This is a retrospective cohort study of patients with COPD who were treated for resectable NSCLC between 2009 and 2019 in a tertiary care hospital. The decision to operate or not followed a thorough clinical evaluation. Survival status was obtained from a provincial registry. A multivariable logistic regression analysis was used to determine predictors of surgery. A propensity score technique was used to control for confounding by indication. Hazard ratios for survival were estimated from a Cox regression model, adjusted for measured baseline confounders and propensity score as covariates.

Results: A total of 1307 patients with COPD were included, including 918 who underwent surgery. Of those, 147 (38%) did not have surgery and were treated with stereotactic body radiotherapy, 86 (22%) were treated with conventional radiotherapy, and 156 (40%) did not receive any active treatment. Predictors of surgery included age, forced expiratory volume in 1 second, adenocarcinoma versus squamous cell carcinoma, and stage 2A versus stage 1A. Propensity score-adjusted survival was significantly reduced with nonsurgical versus surgical approaches.

Interpretation: Lung resection was associated with better survival in patients with COPD and resectable lung cancer compared to nonsurgical approaches.

Citation

Citation: Tardif A, LeBlanc C, Roy P, et al. Lung cancer in patients with COPD: predictors of surgery and long-term survival following lung resection. Chronic Obstr Pulm Dis. 2026; 13(1): 29-38. doi: http://dx.doi.org/10.15326/jcopdf.2025.0643

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Census Tract Variability in COPD Emergency Department, Hospitalization, and Readmission Rates in Travis County, Texas

Trisha M. Parekh, DO, MSPH1 Peter Dunphy, MS, PhD2 Emily M. Hall, MPH3 Sarah Chambliss, PhD3 Rebecca A. Zarate, PhD3 Mark T. Dransfield, MD4 Paul J. Rathouz, PhD3† Elizabeth C. Matsui, MD, MHS3

Author Affiliations

  1. Division of Pulmonary and Critical Care, Dell Medical School, University of Texas at Austin, Austin, Texas, United States
  2. Department of Government, University of Texas at Austin, Austin, Texas, United States
  3. Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Texas, United States
  4. Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, United States
†deceased

Address correspondence to:

Trisha M. Parekh, DO, MSPH
Division of Pulmonary and Critical Care
Dell Medical School
University of Texas
1601 Trinity Street Building A
Austin, TX 78712
Email: trisha.parekh@austin.utexas.edu
Phone: (713) 504-7709

Abstract

Rationale: The variation of chronic obstructive pulmonary disease (COPD) population-level exacerbation rates at fine spatial scales is unclear but is important for understanding the potential role of neighborhood-level factors in risk for COPD exacerbations. We aim to describe the spatial distribution of emergency department (ED) visits, hospitalizations, and readmissions for acute exacerbations of COPD (AECOPDs) across census tracts in Travis County, Texas, and understand the neighborhood characteristics that may contribute to census tract-level morbidity.

Methods: We used the Texas Health Care Information Collection data set and the U.S. Census Bureau’s 2019 American Community Survey to calculate census tract-specific population-based incidence rates (PBIRs) and readmission rates from January 2016 through December 2020. Conditional autoregressive models were used to map estimated PBIRs of acute care use outcomes across census tracts. We then examined associations of neighborhood characteristics with census tract-level rates of acute care use.

Results: Census tract-level incidence rates of COPD-related ED visits and hospital admissions exhibited spatial patterning across Travis County. In contrast, there was less spatial patterning of census tract-level readmission rates across census tracts. Several census tract demographic, socioeconomic, and built environment characteristics were associated with census tract-level COPD-related ED visit and hospitalization rates, but not with COPD readmission rates.

Conclusion: There is a spatial pattern of ED visit and hospitalization PBIRs for AECOPDs within Travis County and several associations with neighborhood characteristics. Readmission rates did not exhibit clear spatial patterning across census tracts and did not have similar associations with neighborhood characteristics.

Citation

Citation: Parekh TM, Dunphy P, Hall EM, et al. Census tract variability in COPD emergency department, hospitalization, and readmission rates in Travis County, Texas. Chronic Obstr Pulm Dis. 2026; 13(1): 39-48. doi: http://dx.doi.org/10.15326/jcopdf.2025.0663

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The Impact of Treated and Untreated COPD Exacerbations on Long-Term Health-Related Quality of Life

Nicholas Wang, MD1 Emily R. Locke, MPH2 Tracy Simpson, PhD3,4 Erik R. Swensen, MD5 Jeffrey Edelman, MD1,2 Ranak B. Trivedi, PhD6,7 Vincent S. Fan, MD, MPH1,2

Author Affiliations

  1. Department of Medicine, University of Washington, Seattle, Washington, United States
  2. Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, United States
  3. Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, United States
  4. Department of Psychiatry, University of Washington, Seattle, Washington, United States
  5. Department of Medicine, Dartmouth College, Hanover, New Hampshire, United States
  6. VA Palo Alto Health Care System, Palo Alto, California, United States
  7. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States

Address correspondence to:

Nicholas Wang, MD
Department of Medicine
University of Washington
Seattle, Washington
Phone: (206) 668-1500
Email: nfw506@uw.edu

Abstract

Objective: Untreated chronic obstructive pulmonary disease (COPD) exacerbations are associated with short-term changes in lung function and decreased health-related quality of life (HRQoL). This study aims to examine the association between untreated exacerbations and long-term HRQoL, as well as differences in characteristics between treated and untreated exacerbations.

Methods: A secondary analysis was performed using data from a prospective observational cohort study of participants with COPD. Participants’ HRQoL was measured using the Chronic Respiratory Questionnaire (CRQ) at baseline and at 12 months. Exacerbations were ascertained with phone calls every 2 weeks, with detailed information regarding exacerbations obtained by research staff. Exacerbations were considered treated if participants took prednisone or antibiotics. Mixed models were used to analyze differences in treated and untreated exacerbation characteristics. Linear and logistic regression models were used to examine the association between the number of treated and untreated exacerbations and a change in CRQ at 12 months.

Results: Among 410 participants, 355 experienced 1097 exacerbations during the 12-month study period, of which 460 (42%) were treated. Treated exacerbations were more severe and lasted longer (25.5 versus 19.9 days, p<0.001) compared to untreated exacerbations. Each additional untreated exacerbation experienced was associated with a significant worsening of long-term HRQoL scores compared to those without exacerbations: CRQ dyspnea (adjusted b= -0.10; 95% confidence interval -0.18 to -0.03), CRQ fatigue (b= -0.07; -0.14 to -0.01), and CRQ emotional function (b= -0.08; -0.14 to -0.02).

Conclusion: Untreated COPD exacerbations occurred frequently and were associated with worse long-term HRQoL, despite being shorter and less severe than treated exacerbations.

Citation

Citation: Wang N, Locke ER, Simpson T, et al. The impact of treated and untreated COPD exacerbations on long-term health-related quality of life. Chronic Obstr Pulm Dis. 2026; 13(1): 49-58. doi: http://dx.doi.org/10.15326/jcopdf.2025.0665

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25-Hydroxyvitamin D Deficiency Elevates the Risk of COPD Incidence and Mortality: A Large Population-Based Prospective Cohort Study

Ying Zhu, PhD, MD1,2* Shengjie Zhao, PhD, MD3* Chen Zhu, PhD4* Jianzheng Zhang, PhD, MD5 Qiang Tong, PhD, MD6,7

Author Affiliations

  1. Senior Department of Pulmonary and Critical Care Medicine, the Eighth Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
  2. Department of Pulmonary and Critical Care Medicine, the Seventh Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
  3. Department of Neurology, School of Rehabilitation Medicine, Capital Medical University, China Rehabilitation Research Center, Beijing, China
  4. College of Economics and Management, China Agricultural University, Beijing, China
  5. Faculty of Orthopedics, National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese People’s Liberation Army General Hospital, Beijing, China
  6. Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  7. Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
*Co-first authors

Address correspondence to:

Qiang Tong, PhD, MD
Department of Rheumatology and Immunology
Shanghai Sixth People's Hospital Affiliated
Shanghai Jiao Tong University School of Medicine,
Shanghai, China
Email: jasontong1985@outlook.com
Jianzheng Zhang, PhD, MD
Senior Department of Orthopedics
Fourth Medical Center
PLA General Hospital
Beijing, China
Email: drzhangjianzheng@126.com

Abstract

Background: The association between 25-hydroxyvitamin D (25(OH)D) levels and chronic obstructive pulmonary disease (COPD) remains unclear. The study aims to investigate the association between 25(OH)D concentrations and the incidence and survival of COPD in the U.K. Biobank cohort.

Methods: We conducted a cross-sectional analysis using U.K. Biobank data from 328,855 participants with complete 25-Hydroxyvitamin D (25(OH)D). This analysis examined the association between 25(OH)D levels and COPD prevalence via logistic regression. Additionally, we prospectively followed a cohort of 327,871 individuals without baseline COPD. We assessed the risk of incident COPD and survival outcomes in this cohort using multivariable-adjusted Cox proportional hazards models. Kaplan-Meier estimates were used to generate survival curves.

Results: The prevalence of COPD was significantly higher in individuals with 25(OH)D deficiency compared to those with a normal level, as evidenced by an adjusted odds ratio (95% confidence interval [CI]) of 1.266(1.206–1.330) for COPD. During the median follow-up period of 15 years (interquartile range: 14–16 years), the overall COPD incidence was 262.3 per 10,000 person years, with higher rates among those with 25(OH)D deficiency (345.2 per 10,000 person years) compared to normal levels (232.6 per 10,000 person years) (p<0.001). In fully adjusted models, 25(OH)D deficiency was significantly associated with increased COPD incidence (hazard ratio [HR] 1.874, 95% CI 1.659 to 2.117) and mortality (HR 1.598, 95% CI 1.406–1.816). Subgroup analyses revealed stronger associations with COPD incidence among men, current smokers, and individuals not taking vitamin D supplements, as well as an increased COPD mortality risk among patients with depression (p for interaction <0.05).

Conclusions: Our study suggests that 25(OH)D deficiency is associated with COPD incidence and survival, providing a basis for preventive strategies and interventions.

Citation

Citation: Zhu Y, Zhao S, Zhu C, Zhang J, Tong Q. 25-Hydroxyvitamin D deficiency elevates the risk of COPD incidence and mortality: a large population-based prospective cohort study. Chronic Obstr Pulm Dis. 2026; 13(1): 59-72. doi: http://dx.doi.org/10.15326/jcopdf.2025.0638

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Determinants of Medication Nonadherence Among Diverse Adults With Chronic Obstructive Pulmonary Disease

Stephanie L. LaBedz, MD1 Ebere M. Okpara, BPharm2 Archit V. Potharazu, MD3 Min J. Joo, MD, MPH1,4 Valerie G. Press, MD5 Lisa K. Sharp, MA, PhD6

Author Affiliations

  1. Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States
  2. Department of Pharmacy Systems Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, United States
  3. Osler Medical Training Program, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
  4. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois, United States
  5. Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States
  6. Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, United States

Address correspondence to:

Stephanie L. LaBedz, MD
840 South Wood Street
Room 920-N CSB
Chicago, IL 60612Chicago, IL 60612

Email: slabedz@uic.edu

 

Abstract

Introduction: High rates of medication nonadherence contribute to poor outcomes in chronic obstructive pulmonary disease (COPD), but the mechanisms driving nonadherence remain poorly understood.

Methods: We conducted qualitative semistructured interviews to evaluate barriers and facilitators of inhaler adherence. The Capability, Opportunity, and Motivation model of Behavior informed the semistructured interview guide and analysis.

Results: Short-term lapses in inhaler use commonly resulted from inhaler unaffordability, not possessing the inhaler, forgetfulness, and geographical or logistical issues accessing health care services. Participants overcame these barriers by requesting more affordable inhalers, keeping inhalers in strategic locations, routinizing inhaler use, utilizing reminders or cues, having extra inhalers, and leaning on social support. Nearly half of participants reported using their inhalers differently than prescribed because of insufficient knowledge, skills, or complex motivational barriers. Participants who reported using an incorrect dosage schedule or poor inhaler technique were unaware of their inhaler misuse. Although participants collectively saw some benefit to using inhalers, many were intentionally nonadherent due to conflicting motivational factors. Common motivational barriers to adherence included beliefs that inhalers were not always necessary, nonadherence carried little risk, their self-identity conflicted with having COPD, and emotional distress related to numerous medications. There were strong interactions between reinforcement and other motivational factors that created feedback loops which strengthened or weakened adherence.

Conclusions: Barriers to medication adherence were common and varied by individual. Knowledge and skills barriers are well-suited for interventions that utilize instruction or enablement, whereas motivational barriers could be addressed through reinforcement or interventions tailored at the individual level.

Citation

Citation: LaBedz SL, Okpara EM, Potharazu AV, Joo MJ, Press VG, Sharp LK. Determinants of medication nonadherence among diverse adults with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2026; 13(1): 73-83. doi: http://dx.doi.org/10.15326/jcopdf.2025.0673

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