Korea has started screening older adults nationwide for chronic obstructive pulmonary disease (COPD), becoming what respiratory specialists say is one of the first countries to fold lung-function testing into a national health screening program.
Doctors say the move could uncover a huge population of elderly patients who have spent years living with a progressive lung disease without knowing it.
They also say the country’s healthcare system is still not built to manage what happens after those patients are found.
Rhee Chin-kook, a pulmonologist at Konkuk University Medical Center, speaks at the French Embassy in Seoul. (Courtesy of the French Embassy in Korea)
The warning surfaced on Wednesday at a health policy seminar at the French Embassy in Seoul marking 140 years of diplomatic relations between Korea and France.
Pulmonologists, infectious disease specialists and government officials said Korea’s rapid aging is exposing gaps in how the country handles chronic respiratory disease -- from specialist consultation time to access to newer drugs for severe patients.
“What I’m starting to see in clinic is that screening is beginning to make a difference,” said Rhee Chin-kook, a professor in the Division of Pulmonary, Allergy and Critical Care Medicine at Konkuk University Medical Center.
On the morning of the seminar, Rhee said, he saw a patient who had just been identified through the new national screening program.
The patient had COPD and had not known it.
“It will not change everything in one or two years,” Rhee said. “But if this keeps building, in five or 10 years, many of the patients hidden under the surface may finally be diagnosed.”
COPD gradually damages the lungs and narrows the airways, often after years of smoking or exposure to polluted air. The disease is already one of the world’s leading causes of death, but doctors at the seminar said it remains badly underestimated in Korea because many older people mistake worsening breathlessness for normal aging.
Rhee said roughly one in two Korean men over 65 is estimated to have COPD. Yet among people who meet the disease criteria on lung-function testing, only 2.4 percent know they have it and only 2.2 percent are being treated.
“If you are a man over 65, there is almost a coin-flip chance you have this disease,” Rhee said. “But people do not think that way.”
That matters more now because Korea is aging faster than almost any other wealthy country. More than 20 percent of the population is already over 65.
Doctors at the seminar argued that COPD and influenza are becoming less of a specialist issue and more of a long-term economic and healthcare problem for a country trying to keep older adults out of hospitals and nursing homes.
The pressure is most visible when COPD suddenly worsens.
A flare-up triggered by flu, RSV or bacterial infection can push patients into severe breathing failure, sometimes leaving them dependent on oxygen or unable to live independently afterward.
Newer drugs have changed expectations for some severe patients. Dupixent (dupilumab), a biologic made by Sanofi, was approved in Korea last year for certain COPD patients after studies showed it reduced moderate or severe flare-ups.
But the treatment is still not reimbursed through Korea’s national insurance system.
Rhee said the drug costs about 1.5 million won ($1,000), a month without coverage.
“Bahrain, Kuwait and Qatar reimburse this drug,” he said. “But Korean COPD patients effectively cannot use it.”
The reimbursement application is currently under review by Korea’s Health Insurance Review and Assessment Service (HIRA).
Doctors also raised another concern that sounded smaller but carried broader implications for an aging society: older patients often cannot use inhalers correctly.
Unlike tablets, inhalers require training. Some patients inhale too weakly. Others mistime the device. Some swallow the medicine instead of breathing it into their lungs.
But doctors in Korea are generally not paid separately for inhaler education, even though respiratory specialists say proper instruction can significantly improve disease control.
Lee Won-ui, an official at the Ministry of Health and Welfare (MOHW)’s Division of Health Insurance Benefits, said the government is reviewing whether longer consultations and counseling for chronic respiratory diseases should receive stronger reimbursement.
Flu policy faces similar pressure
Kim Chang-oh, a geriatric medicine professor at Severance Hospital, warned that influenza in older adults can trigger long-term functional decline even after the infection itself improves. (Courtesy of the French Embassy in Korea)
The discussion around influenza exposed a similar concern: Korea has succeeded in vaccinating older adults, but doctors are increasingly questioning whether the country is still using the right vaccines for rapidly aging immune systems.
Kim Hong-bin, chair of the Korean Society of Infectious Diseases (KSID), said Korea’s vaccination strategy had focused heavily on coverage rates for years.
“If we focused on quantitative growth until now, we need to think about qualitative growth from here,” Kim said.
Older adults face higher risks from flu because immune aging weakens vaccine responses and increases the chances of severe complications.
Professor Kim Chang-oh of Severance Hospital’s geriatrics division said flu in elderly patients can trigger pneumonia, heart attacks, strokes and sudden functional decline.
He described a 76-year-old patient who arrived at hospital unconscious and with dangerously low oxygen levels. Doctors initially suspected a neurological disorder before discovering the cause was influenza-related pneumonia.
“Older patients do not always come in with fever or muscle pain,” Kim said. “They can come in with atypical symptoms, and diagnosis can be delayed.”
Even after the infection improves, he said, some patients never fully regain the independence they had before hospitalization.
“We treat the pneumonia. The fever comes down. The inflammation improves,” Kim said. “Then we go to discharge the patient, but the family says they cannot go home. After lying in bed for one or two weeks, the illness has improved, but the older person’s function has dropped sharply.”
Several specialists at the seminar called for Korea to consider introducing stronger high-dose or high-immunogenicity flu vaccines for older adults, similar to policies already used in countries including the United States and Britain.
The Korea Disease Control and Prevention Agency (KDCA) signaled it was open to reviewing the idea.
Lee Hye-rim, director of the Immunization Management Division at KDCA, said stronger vaccines appear to offer additional protection for older adults, but she said the government would still need to weigh cost, supply and target populations before expanding the national immunization program.
Kim Ji-hye
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