Status of COPD in Saudi Arabia: challenges, gaps, and opportunities for health system transformation.

Chronic obstructive pulmonary disease (COPD) is a serious public health problem and unfortunately, policies and health system structures in Saudi Arabia remain inadequate to address its rising healthcare burden. This review aims to map and critically analyze the existing evidence on COPD management in Saudi Arabia and to propose a framework to guide clinical practice and improve patient outcomes. Globally and particularly in Saudi Arabia, COPD remains significantly underdiagnosed despite the availability of well-established clinical guidelines. Based on the current analysis, this is primarily due to a lack of public awareness, inconsistent application of spirometry in primary care settings, and delayed patient presentation. Notable policy deficiencies remain, including the lack of a unified national COPD strategy, inadequate implementation of tobacco control measures, and the absence of established protocols for long-term treatment, pulmonary rehabilitation, and home-based respiratory care. Challenges within the health system exacerbate these disparities, including inconsistent access to pulmonary rehabilitation, a shortage of specialist respiratory care providers, disjointed digital health integration, and inconsistent coverage for home oxygen and sophisticated respiratory equipment. The absence of national COPD registries and the lack of dedicated funding for COPD-related projects hinder effective monitoring and delay data-driven planning and leadership. For better COPD outcomes, it is essential to implement coordinated national policies, strengthen workforce capacity, and expand rehabilitative and community-based programs. These efforts should be supported by a robust digital and data infrastructure to ensure integrated, high-quality COPD care across the Kingdom.