For this HGPI seminar, we welcomed Dr. Shigeo Muro from the Department of Respiratory Medicine, Nara Medical University, to give a lecture on the theme of Chronic Obstructive Pulmonary Disease (COPD). Dr. Muro shared insights regarding the disease burden of COPD, the barriers to early detection, and the early detection models and community collaborations aimed at reducing COPD mortality by 2032.

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• COPD is a highly prevalent disease that develops and progresses primarily by smoking and air pollution. It is associated not only with impaired lung function, but also with frailty and an increased risk of cardiovascular disease, placing a significant burden on both society and healthcare systems.
• The high reserve capacity of the lungs and because patients unconsciously adjust their behavior to avoid breathlessness, the symptoms of COPD are often difficult to recognize. These are major factors hindering early detection, resulting in many patients already showing signs of frailty at the time of diagnosis.
• The Japanese Respiratory Society’s “COMORE-by2032” project promotes practical early detection strategies aimed at reducing COPD mortality by 2032. Examples include the use of screening questionnaires (COPD-PS), analysis of existing CT images, and the identification of undiagnosed patients through multidisciplinary collaboration.
• In order to advance COPD countermeasures within Japan, it is important to strengthen the policy framework, including the improvement of health checkup items and providing financial support for multidisciplinary care models. In addition, respiratory medicine should be recognized as a major policy priority alongside cardiovascular and metabolic diseases.

Health Japan 21 (the third term) and the Current Situation Surrounding COPD

The “National Health Promotion Movement” launched by the former Ministry of Health and Welfare in 1978 has evolved over time in response to an aging population and changes in disease patterns. COPD was first recognized as a major respiratory disease in 2013 during the second term of Health Japan 21. However, at that time public awareness of COPD was extremely low, and the main focus of the activity was therefore to just increase awareness.

In the third term of Health Japan 21 launched in FY2024, the targets were significantly strengthened, with a specific goal of reducing COPD-related mortality. This shift reflects the substantial progress made over de past decade, including the development of new treatments and the accumulation of clinical evidence demonstrating that appropriate interventions can prevent disease progression and mortality. This revision introduced in the third term shows a shift in how COPD is positioned from an individual health issue to a major public health challenge that should be addressed by society as a whole.

Characteristics of COPD and Its Social Burden

COPD is primarily caused by long-term smoking and exposure to air pollutants. It is a disease characterized by alveolar destruction (emphysema) and airway inflammation, which is often progressive. A large-scale epidemiological study conducted in Japan (the NICE study) shows a prevalence of 8.6% among adults aged 40 and older, rising to 24.4% among individuals in their 70s. Among individuals with a history of smoking, approximately 15-16% are estimated to develop COPD, representing an extremely large number of patients. Furthermore, smokers who develop COPD have a significantly higher risk of arteriosclerosis and heart failure compared to smokers without COPD. This suggests that people with COPD are more vulnerable to the harmful effects of smoking. In this way, COPD is not merely a lung disease but is associated to a wide range of health issues throughout the body, resulting in a substantial burden on both society and healthcare systems.

Despite its severity, early detection of COPD is extremely challenging because of the high reserve volume of the lungs. In addition, people tend to unconsciously adjust their behavior, such as reducing walking time, before experiencing noticeable discomfort, thereby avoiding symptoms. This often leads to the misconception that symptoms are simply caused by aging or lack of exercise. Moreover, it is difficult to feel short of breath unless the lungs lose nearly half of their function. As a result, by the time COPD is diagnosed, frailty has often already progressed, creating a negative cycle. However, with early diagnosis and intervention, outcomes can be improved. Interventions such as smoking cessation support, increased physical activity, and nutritional support can help improve prognosis by addressing underlying lifestyle factors.

The COMORE-by2032 Project and Early Detection Models

The Project for COPD MOrtality REduction By 2032 (COMORE-By2032), led by the Japanese Respiratory Society, presents a realistic approach to reducing COPD-related mortality by 2032. The systematic accumulation and utilization of real-world clinical data are essential for accurately estimating the number of undiagnosed patients and translating findings into policy. In addition to leveraging existing datasets, establishing a continuous data collection system to better understand the actual burden of COPD remains a key priority.

Particular important is to appropriately narrow down the target population before performing spirometry, which is currently used for COPD diagnosis. Specific early detection approaches include the use of a simple five-item screening questionnaire (COPD-PS) to assess risk, as well as methods that evaluate early-stage emphysema using CT images originally obtained for lung cancer screening.

Another key pillar of the COMORE-by2032 project is multidisciplinary collaboration beyond pulmonologists. For example, the “Clinical Practice Guide for COPD and Cardiovascular Diseases” developed for cardiologists outlines collaborative pathways for the early detection of COPD in patients with conditions such as heart failure. In addition, with support from the Ministry of Health, Labour and Welfare’s research funding, a system is planned to be established that enables the identification of undiagnosed COPD patients at the regional through collaboration among local governments, pharmacists, and medical associations.

In Nara Prefecture, tobacco control measures led by local governments are already being implemented. In some areas, a COPD consultation hotline directly connecting community clinics to university hospitals has been established. Moving forward, further integrated efforts involving pharmacists, medical associations, and public health centers will be essential to strengthen a community-wide approach.

Future Prospects and Policy Expectations

Early detection and early intervention for COPD contribute to both extending healthy life expectancy and optimizing medical costs. However, compared with cancer and cardiovascular diseases, policy support and legal frameworks for respiratory diseases remain insufficient.

In order to develop initiatives currently being implemented in clinical settings into nationwide measures, institutional and financial support for early detection and disease progression prevention models, particularly those based on multidisciplinary collaboration is essential. Looking ahead, strengthening the policy foundation for COPD control in Japan will require continued dialogue between healthcare providers and policymakers.

 

[Event Overview]

• Speaker:
  Dr. Shigeo Muro (Professor, Department of Respiratory Medicine, Nara Medical University / Vice Director, Nara Medical University Hospital)
• Date & Time: Tuesday, January 27, 2026, 18:00-19:15 JST
• Format: Online (Zoom webinar)
• Language: Japanese
• Participation Fee: Free
• Capacity: 500 participants

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■Profile:

Dr. Shigeo Muro (Professor, Department of Respiratory Medicine, Nara Medical University)

Professor Muro graduated from Kyoto University Faculty of Medicine in 1989 and worked at Tazuke Kofukai Kitano Hospital before completing his doctoral program at Kyoto University Graduate School in 1998 (Ph.D. in Medicine). After serving as a research fellow at McGill University Meakins-Christie Laboratories and as lecturer and associate professor at Kyoto University, he assumed his current position in 2018. He serves as Executive Director and Chair of the Insurance Committee of the Japanese Respiratory Society. He served as Chief Editor and Vice-Chair for the 5th through 7th editions of the society’s ‘Guidelines for the Diagnosis and Treatment of COPD’ and as Chair for the 2nd edition of ‘Guidelines for the Diagnosis and Treatment of Asthma and COPD Overlap’ (published in 2024). He is also actively involved in ‘Komorebi 2032,’ the society’s project aimed at reducing COPD mortality rates. He received the 1st Prize of the 42nd Baelz Award (2005) and the Japanese Respiratory Society Kumagai Award (2014).

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