Chronic obstructive pulmonary disease (COPD) is a common condition with an estimated global prevalence of almost 12 percent in adults over age 30 years [1-3]. Prior to the onset of the COVID-19 (coronavirus disease 2019) pandemic, COPD was the third leading cause of death worldwide.

For most patients with less severe COPD, symptoms and exacerbations can be controlled with interventions such as smoking cessation, vaccinations against influenza and pneumococcal infections, pulmonary rehabilitation, and one or more inhaled medications (ie, bronchodilators and glucocorticoids).

As the disease progresses, COPD symptoms and exacerbations may be persistent despite these interventions.

While refractory COPD has not been formally defined, the context for this diagnostic category is patients with severe, persistent symptoms or frequent exacerbations despite appropriate care.

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