When Breathing Gets Harder (COPD and Pneumonia)

Chronic Obstructive Pulmonary Disease (COPD) and pneumonia are two respiratory conditions that often show up together, and when they do, the results can be deadly. For Black Americans, who already face systemic barriers to healthcare, this pairing is especially dangerous. Stats only scratch the surface. It’s the lived realities within our community that we need to talk about.

What Is COPD and Why Does It Matter

COPD is an umbrella term for lung diseases like emphysema and chronic bronchitis. It makes breathing harder over time, and there’s no cure.

• Emphysema damages the air sacs in the lungs, making it harder to take in oxygen.
• Chronic bronchitis causes swelling and mucus buildup in the airways, leading to a persistent cough and breathing difficulties.

In 2023, COPD was the fifth leading cause of death in the U.S., claiming over 141,000 lives, as reported by the CDC in its 2025 Data Brief.

To make matters worse, Black Americans are less likely to be diagnosed with COPD, even when they have symptoms. That means fewer chances for early treatment and more risk when pneumonia enters the picture.

The Dangerous Duo: COPD and Pneumonia

Pneumonia is an infection that inflames the air sacs in the lungs. For someone with COPD, pneumonia can be life-threatening. The lungs are already compromised, and the infection adds fuel to the fire. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2025 report, pneumonia is one of the most common causes of hospitalization and death among people with COPD.

The pneumonia vaccine is an essential tool for managing COPD, yet it’s not reaching our community equally. That shortfall leads to more complications and more loss, as documented by the CHEST Foundation in 2023.

A Look at the Numbers

In 2023, the age-adjusted prevalence of COPD among Black adults was 3.5%, compared to 4.4% in White adults, according to the CDC. At first glance, that might seem like good news. But experts warn that underdiagnosis is a major issue in Black communities. A study published by the Journal of the COPD Foundation found that race and gender disparities are evident across all severities of airflow obstruction. In plain terms? Too many Black patients with COPD are left undiagnosed and unheard. And when pneumonia hits someone with undiagnosed COPD, the outcome can be devastating.

These disparities reflect systems that haven’t been built with Black communities in mind. The gaps in care, diagnosis, and trust are real and reinforced in everyday clinical settings.

• Delayed diagnosis: Black patients are less likely to be referred for lung function tests. Symptoms are overlooked. Screenings get skipped. The result is missed opportunities for early treatment and a higher risk during flare-ups.
• Lower vaccination rates: Pneumonia and flu vaccines are essential for COPD management, but they are reaching Black adults at lower rates. That shortfall increases complications and leads to more hospital visits.
• Barriers to care access: Limited insurance coverage, long commutes to clinics, and under-resourced neighborhoods make accessing basic care more challenging. And once patients do reach the doctor, they often face shorter appointments, fewer referrals, and lower chances of seeing a specialist. As reported by Healthgrades, Black Americans with COPD are less likely to see a pulmonologist and more likely to be managed solely by primary care providers, where only 19% recommend pulmonary rehab, compared to 54% of specialists.
• Broken trust with health systems: Black patients have endured dismissal, bias, and neglect within medical spaces for decades. That history shows up in rushed visits, poor follow-up, and misdiagnoses. The system has earned mistrust. Rebuilding trust means delivering care that’s culturally competent, designed with equity in mind, and backed by accountability.

CHEST also reports that, over the last two decades, Black Americans have experienced the smallest decline in COPD mortality, just 0.7 per 100,000, compared to 5.5 among White Americans.

Spotting Pneumonia in COPD

COPD and pneumonia share similar symptoms, including cough, shortness of breath, and fatigue; however, they’re not interchangeable. For someone living with COPD, pneumonia can slip in, disguised as a routine flare-up. But sure signs stand out:

• Fever or chills: COPD rarely causes fever or chills. If it spikes, think infection.
• Sharp chest pain when breathing: Not typical of COPD alone.
• Sudden changes in mucus color or volume: Green or yellow may indicate an infection.
• Rapid breathing or heart rate: A sign the body’s under stress.
• Nausea, vomiting, or dizziness: Red flags like these often indicate that it’s more than just COPD.

Spirometry, also known as a lung function test, is often overlooked or misread in primary care. A 2024 study published in PLOS ONE found that many patients diagnosed with COPD were actually dealing with asthma or had normal lung function. At the same time, people who truly have COPD often go undiagnosed and face their symptoms without medical support, which raises the risk of serious complications like pneumonia being mistaken for a routine flare-up.

For caregivers and loved ones, noticing these changes can be the difference between early treatment and a dangerous spiral. You don’t need a medical degree, just awareness and trust in your instincts.

What You Can Do

If you or someone you love has a chronic cough, shortness of breath, or frequent respiratory infections, take it seriously. Ask your doctor about COPD and ensure that lung function testing is part of the conversation. Misdiagnosis can delay treatment and put lives at risk, especially when pneumonia is mistaken for something less urgent.

Get vaccinated against pneumonia and the flu, and lean on trusted resources like community clinics and health fairs for support. COPD and pneumonia continue to disproportionately affect our community. With awareness and advocacy, that reality can change. Breathing is a biological right, but too often it’s treated like a resource only some can afford to protect. Striving to know more is the first step in the right direction.

Resources

Products – Data Briefs – Number 528 – April 2025

2025 GOLD Report – Global Initiative for Chronic Obstructive Lung Disease – GOLD

Partnering With the African American Community to Curb COPD – American College of Chest Physicians

Chronic Obstructive Pulmonary Diseases | Journal of the COPD Foundation

COPD in Black Americans | Black People and COPD

Exploring the causes of COPD misdiagnosis in primary care: A mixed methods study | PLOS One