Prevalence and clinical characteristics of fibromyalgia syndrome in individuals with chronic obstructive pulmonary disease: A cross-sectional study

Abstract

Objective

This study investigated the prevalence of fibromyalgia syndrome in individuals with chronic obstructive pulmonary disease and examined its association with the demographic and clinical variables of these individuals.

Methods

A cross-sectional design was used to compare 100 individuals with chronic obstructive pulmonary disease with 100 age- and sex-matched healthy controls. Fibromyalgia syndrome was diagnosed based on the 2016 American College of Rheumatology criteria.

Results

The prevalence of fibromyalgia syndrome was significantly greater in individuals with chronic obstructive pulmonary disease (16%) than in healthy controls (3%) (p = 0.048). In the chronic obstructive pulmonary disease group, female patients exhibited a markedly higher prevalence of fibromyalgia syndrome than male patients (31.6% vs. 6.4%, p = 0.035). No significant associations were found between the presence of fibromyalgia syndrome and patient age, disease duration, or chronic obstructive pulmonary disease severity. Patients with both chronic obstructive pulmonary disease and fibromyalgia syndrome frequently reported increased fatigue, sleep disturbances, and depressive symptoms.

Conclusions

These findings underscore the clinical relevance of fibromyalgia syndrome as a comorbidity in chronic obstructive pulmonary disease, particularly in women, and highlight the need for its routine screening in respiratory care. Incorporating fibromyalgia syndrome assessment may improve symptom management and support a more holistic approach to rehabilitation and disease management in chronic obstructive pulmonary disease patients.

Keywords

Comorbidity prevalence chronic pain inflammation quality of life risk factors

Introduction

Chronic obstructive pulmonary disease (COPD) is a complex and progressive respiratory condition that extends its impact beyond the pulmonary system, contributing to systemic complications and reduced functional capacity.¹ It is characterized by irreversible airflow limitation and sustained inflammation of the airways and remains one of the leading causes of morbidity and mortality worldwide.² Given the multifactorial nature of COPD, its effective management often requires collaboration across medical disciplines.³

Fibromyalgia syndrome (FMS) is a distinct chronic condition marked by generalized musculoskeletal pain, persistent fatigue, cognitive complaints, and nonrestorative sleep.⁴ In the general population, its estimated prevalence ranges from 2% to 4%, with a pronounced female predominance.^5,6 The condition is frequently diagnosed in individuals with other chronic diseases and is known to significantly impair health-related quality of life and physical functioning.⁷ FMS is frequently diagnosed alongside chronic pain conditions (temporomandibular disorders and chronic migraine), functional disorders (irritable bowel syndrome), chronic fatigue syndrome, psychiatric comorbidities (anxiety, depression, and post-traumatic stress disorder), and inflammatory rheumatic diseases (rheumatoid arthritis and systemic lupus erythematosus).^7–9

A notable overlap exists between the symptomatic profiles of individuals with COPD and those diagnosed with FMS.⁸ Although diffuse musculoskeletal pain is not a hallmark symptom of COPD, individuals with COPD often report chronic pain localized to the chest wall, upper back, and shoulders due to altered biomechanics, respiratory muscle overload, and systemic inflammation. These pain characteristics may overlap with FMS symptoms, contributing to the diagnostic complexity.^10,11 Common clinical manifestations such as chronic fatigue, diffuse pain, sleep disturbance, and mood alterations are observed in both conditions.⁴ This convergence suggests possible shared pathophysiological underpinnings, including systemic inflammation, central sensitization, and neuroendocrine dysregulation.¹² For instance, the heightened inflammatory cytokine activity documented in COPD may amplify pain perception mechanisms, contributing to the development of FMS-like symptoms.^10,11 Moreover, persistent low-grade systemic inflammation observed in COPD patients may amplify pain perception mechanisms. In addition, neuroendocrine dysregulation, including dysfunction of the hypothalamic–pituitary–adrenal axis, may contribute to central sensitization and the development of FMS-like symptoms.^13–15

Despite this clinical overlap, there is a lack of comprehensive data on the prevalence of FMS in individuals with COPD. In contrast to the extensive documentation on metabolic and cardiovascular comorbidities in COPD, only a few studies have explored the co-occurrence of FMS with other musculoskeletal disorders.^16,17 Moreover, the clinical implications of FMS in individuals with respiratory disease are not fully understood, potentially resulting in delayed diagnosis and suboptimal symptom management.

Considering these observations, the present study aimed to determine the prevalence of FMS in COPD patients, compare it with that in a healthy control group, and evaluate its associations with key demographic and clinical factors. These insights may inform more integrative assessment frameworks and promote holistic care strategies in COPD management.

Metabolic and cardiovascular comorbidities, such as diabetes mellitus, dyslipidemia, hypertension, and ischemic heart disease, are extensively documented in individuals with COPD and are known to significantly increase morbidity and mortality. The reported prevalence rates are up to 51% for hypertension, approximately 25%–27% for diabetes, and approximately 36% for dyslipidemia. The risk of ischemic heart disease in COPD patients is approximately twice that in those without COPD.^18–20 In addition, these individuals frequently described symptoms such as sleep disturbances, depressive mood, and in some cases, thoracic wall discomfort and breathing difficulties, which were not fully explained by spirometric impairment. Although thoracic pain and subjective dyspnea were not quantitatively assessed, they emerged as recurring themes in patient narratives. These overlapping symptoms may complicate clinical assessment and symptom attribution in individuals with COPD. Future studies incorporating structured measures of thoracic pain and perceived breathlessness are warranted to better understand their role in this comorbidity. The underdiagnosis of FMS in individuals with COPD may contribute to reduced participation of such patients in pulmonary rehabilitation programs. This could be primarily attributed to the presence of unrecognized FMS-related symptoms, such as chronic widespread pain, fatigue, nonrestorative sleep, and cognitive impairment, all of which can limit physical activity, decrease exercise tolerance, and impair overall engagement with rehabilitation efforts from the outset of care.²¹ Moreover, these core FMS-related symptoms can significantly reduce physical capacity, motivation, and adherence to structured exercise regimens.^22,23

The primary aim of this study was to determine the prevalence of FMS in COPD patients compared with that in healthy controls. Secondary aims included evaluating the demographic and clinical variables of FMS in the COPD population and exploring the potential relationship of FMS prevalence with age, disease duration, and COPD severity.

Motivation of the study

Given the clinical overlap in symptoms and the potential for shared inflammatory and neuropsychological pathways, the co-occurrence of COPD and FMS represents an important but insufficiently explored clinical issue. Failure to recognize FMS in individuals with COPD may result in inadequate pain management, diminished quality of life, and reduced participation in rehabilitation programs. This study was motivated by the need to fill this knowledge gap and promote early identification of underdiagnosed pain syndromes in patients with respiratory diseases.

Contribution of this study

This study aims to make the following contributions to the current literature:

It is one of the few studies to assess the prevalence of FMS using the validated American College of Rheumatology (ACR) 2016 criteria in individuals with COPD.

It provides sex-stratified prevalence data, highlighting the higher risk of FMS in female patients with COPD.

It examines the associations of FMS with age, disease duration, and COPD severity, which remain poorly understood.

It supports the need for integrating routine FMS screening into COPD assessment protocols.

It offers insights that may guide the development of multidisciplinary management strategies for patients with coexisting respiratory and chronic pain syndromes.

Materials and methods

Study design

This cross-sectional observational study was conducted between March 2018 and March 2021 in a private outpatient pulmonology clinic located in Düzce, Turkey. The study site was selected based on its consistent patient base and standardized diagnostic follow-up provided by the same specialist physician, ensuring uniform data collection. The primary aim was to determine the prevalence of FMS in individuals with COPD and compare the findings with a demographically matched control group without respiratory conditions.

Participant selection

In total, 200 participants were enrolled in the study, including 100 patients previously diagnosed with COPD and 100 healthy controls matched for age and sex. Participants were recruited consecutively from outpatient clinics. The diagnosis of COPD was confirmed through spirometry based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017–2018 guidelines, which were valid at the time of the study.²⁴ A forced expiratory volume in 1 second/forced vital capacity (FEV₁/FVC) ratio of <0.70 after bronchodilator administration was used to establish persistent airflow limitation. The severity of airflow obstruction was classified into four stages (GOLD stage I to IV) according to the percentage of predicted FEV₁ values.²⁵ Healthy individuals were selected from the local population and screened to confirm the absence of chronic illness, respiratory complaints, or long-term medication use. To select participants for the healthy control group, individuals were asked to self-report the presence of any known chronic diseases, including respiratory conditions. Only those who confirmed the absence of such conditions and did not report any relevant symptoms or ongoing treatments were included in the study. Recruitment was conducted via clinical appointment records and local community announcements. Eligibility was determined through initial telephone screening followed by in-person verification using a structured checklist. All participants provided written informed consent prior to inclusion in the study. Sample size calculation was not based on a priori power analysis; however, the group sizes (n = 100 each) were chosen to balance feasibility and statistical sensitivity to detect medium effect sizes. The groups were matched for age and sex to control for confounding in comparative analyses.

The flowchart of participant inclusion throughout the study, including the screening, exclusion, and allocation processes, is detailed in Figure 1.

Figure 1.

Flowchart illustrating the process of participant recruitment, exclusion criteria, group allocation (COPD and control groups), and FMS screening. COPD: chronic obstructive pulmonary disease; FMS: fibromyalgia syndrome.

Exclusion criteria

To minimize confounding factors, individuals with known musculoskeletal, neurological, rheumatological (e.g. systemic lupus erythematosus and rheumatoid arthritis), endocrine (e.g. diabetes mellitus and thyroid disorders), infectious, or neoplastic diseases were excluded. Additionally, patients who were using medications that could influence musculoskeletal function, such as corticosteroids or statins, were excluded from the sample.

Data collection procedures

Sociodemographic variables such as age, sex, marital status, occupation, and residence were documented using structured interviews. All participants underwent pulmonary function testing, including the assessment of FEV₁, FVC, and FEV₁/FVC ratios. Pulmonary function tests were performed using a calibrated spirometer (Jaeger MasterScreen™, CareFusion, Hoechberg, Germany) following ATS/ERS guidelines.²⁶

FMS diagnosis and scoring

FMS was assessed using the 2016 ACR diagnostic criteria, administered during the same visit when spirometry was performed.²⁷ The assessment included two components:

Widespread Pain Index (WPI): Participants identified painful regions across 19 body areas using a standardized body map chart.

Symptom Severity Scale (SSS): Participants rated fatigue, unrefreshed sleep, cognitive symptoms, and somatic complaints (e.g. headaches, abdominal pain, and depression) on a 0–3 scale. The total score ranged from 0 to 12, with higher scores indicating greater symptom burden.²⁷

Total FMS severity scores were calculated by summing the WPI (0–19) and SSS (0–12) scores, yielding a maximum score of 31. A physician blinded to the COPD/control status reviewed the responses to confirm eligibility as per ACR thresholds (WPI ≥7 with SSS score ≥5 or WPI 4–6 with SSS score ≥9). Fatigue, cognitive symptoms, and sleep disturbances were assessed using standardized 0–3 Likert-type ordinal scales, as outlined in the 2016 ACR criteria, to reduce subjectivity.¹⁶ This format rates each symptom from 0 (no problem) to 3 (severe, life-threatening problems) and has been widely used in previous validation studies.²⁷

Statistical analysis

Statistical analyses were conducted using IBM Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize the data. Continuous variables were presented as means and standard deviations (SD), while categorical variables were expressed as frequencies and percentages. To assess group differences in continuous variables (e.g. age), the independent samples t-test was applied after verifying normality assumptions. The chi-square (χ²) test was used to compare proportions between categorical variables (e.g. FMS prevalence between groups, sex distribution). A two-tailed p-value ≤0.05 was considered statistically significant in all analyses. No imputation methods were required, as there were no missing data in the dataset.

Ethical approval

Ethical approval was obtained from the Non-Interventional Research Ethics Committee of Sakarya University Faculty of Medicine (Approval code: 71522473/050.01.04/58, 21.02.2017). This study was conducted in accordance with the principles of the Declaration of Helsinki, as revised in 2024. All participant data were fully anonymized before analysis to protect confidentiality, and no identifiable information has been included in the study materials or results. The reporting of this study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.²⁸

Results

In total, 200 individuals participated in the study, including 100 with COPD and 100 healthy controls. The mean disease duration in the COPD group was 6.2 ± 3.4 years. Most participants (70%) were in GOLD stage II, 22% in stage III, and 8% in stage I. The demographic characteristics of both groups were similar. In the COPD group, 62% of the participants were men (n = 62) and 38% were women (n = 38), while the control group included 61 men and 39 women. The average age of COPD patients was 55.74 ± 6.2 years, while that of the healthy controls was 58.30 ± 7.2 years (Table 1). Statistical analysis revealed no significant differences in age (p = 0.703) or sex distribution (p = 0.720) between the two groups.

Table 1.

Demographic characteristics, clinical characteristics, and medication use of the study participants.

Characteristic	COPD group (n = 100)	Control group (n = 60)
Age (years), mean ± SD	55.7 ± 6.2	64.8 ± 7.9
Female sex, n (%)	38 (38.0%)	32 (53.3%)
BMI (kg/m²), mean ± SD	27.5 ± 4.6	26.8 ± 3.9
Marital status
Married n (%)	80 (80.0%)	50 (83.3%)
Smoking history
Current smoker, n (%)	30 (30.0%)	5 (8.3%)
Former smoker, n (%)	55 (55.0%)	10 (16.7%)
Never smoker, n (%)	15 (15.0%)	45 (75.0%)
Disease duration (years), mean ± SD	6.2 ± 3.4	–
GOLD stage, n (%)	I: 8 (8%)II: 70 (70%)III: 22 (22%)	–
ICS, n (%)	74 (74.0%)	–
LABA, n (%)	68 (68.0%)	–
LAMA, n (%)	61 (61.0%)	–
Combined LABA/LAMA or LABA/ICS, n (%)	49 (49.0%)	–
Systemic corticosteroids (chronic), n (%)	5 (5.0%)	–
Antidepressant use, n (%)	12 (12.0%)	–
Statin use, n (%)	17 (17.0%)	–

COPD: chronic obstructive pulmonary disease; BMI: body mass index; ICS: inhaled corticosteroids; LABA: long-acting β2-agonists; LAMA: long-acting muscarinic antagonists.

Note: Medication use was based on patient self-report and medical record verification.

FMS was diagnosed in 16 COPD patients (16%) and 3 healthy controls (3%). This difference in prevalence rates was statistically significant (p = 0.048), indicating that COPD patients are more likely to exhibit symptoms consistent with FMS. Figure 2 presents the prevalence of FMS among COPD patients and healthy controls.

Figure 2.

Bar chart comparing the prevalence of FMS between individuals diagnosed with COPD and healthy control participants. FMS: fibromyalgia syndrome; COPD: chronic obstructive pulmonary disease.

In the COPD group, patients with FMS reported significantly higher fatigue scores and lower physical activity levels during the structured interview. Additionally, these individuals were more likely to report sleep disturbances and depressive mood. Although these outcomes were not quantitatively measured, they were identified as recurrent themes in patient self-reports and deserve attention in future studies. These observations were based on self-reported responses during structured clinical interviews and were not assessed using standardized scales.

Subgroup analysis by sex indicated a higher prevalence of FMS among female COPD patients. Of the 38 women in the COPD group, 12 (31.6%) were diagnosed with FMS. In contrast, only 4 of the 62 men (6.4%) in the same group were diagnosed with FMS. This disparity was statistically significant (p = 0.035), suggesting a sex-specific vulnerability. Figure 3 illustrates the sex-based distribution of FMS prevalence in COPD patients.

Figure 3.

Bar chart illustrating the sex-specific prevalence of FMS among individuals with COPD. FMS: fibromyalgia syndrome; COPD: chronic obstructive pulmonary disease.

Subgroup analysis

Among the 38 women in the COPD group, 12 (31.6%) were diagnosed with FMS. Among the 62 men in the COPD group, only 4 (6.4%) were diagnosed with FMS. The association between sex and the presence of FMS was statistically significant (p = 0.035).

When examining the relationship between FMS and other variables such as age, disease duration, and COPD severity, no significant associations were identified. Spearman’s rho coefficients indicated weak and nonsignificant correlations between the FMS status and age (ρ = 0.07, p = 0.716), disease duration (ρ = 0.13, p = 0.157), and GOLD stage (ρ = 0.14, p = 0.171), suggesting no meaningful linear relationships. These findings suggest that factors such as patient age or clinical course of COPD may not independently predict the presence of FMS (Figure 4).

Figure 4.

Comparison of (a) age, (b) disease duration, and (c) GOLD stage distribution between individuals with and without FMS. FMS: fibromyalgia syndrome; GOLD: Global Initiative for Chronic Obstructive Lung Disease.

Data integrity

All participant data were complete and included in the final statistical analysis. No missing data were recorded, ensuring the robustness of the dataset.

Discussion

The present study aimed to investigate the prevalence of FMS in COPD patients and explore its associations with key demographic and clinical factors. The findings indicate that FMS is significantly more common in COPD patients (16%) than in healthy controls (3%). A significantly higher prevalence of FMS was found in female COPD patients than in male COPD patients, indicating a sex-based difference in FMS occurrence within this population.

From a mechanistic standpoint, systemic inflammation appears to be a shared pathway in both conditions. Elevation in inflammatory markers, such as interleukin-6 and C-reactive protein, has been consistently reported in COPD patients.^29,30 These cytokines promote peripheral and central sensitization through the activation of glial cells and nociceptive pathways—mechanisms that have also been implicated in FMS pathophysiology.^31,32 Furthermore, dysregulation of the hypothalamic–pituitary–adrenal axis has been observed in FMS patients, suggesting an impaired stress response that may exacerbate pain and fatigue.³³ This mechanistic overlap supports the hypothesis that persistent systemic inflammation in COPD may predispose patients to FMS-like symptoms even in the absence of progressive lung function decline.

An increasing number of studies have reported fatigue and chronic pain in COPD patients; however, FMS remains relatively underdiagnosed in this population.^34–36 Although FMS has a general population prevalence of approximately 2%–4%,⁶ this rate may be considerably higher in subpopulations with chronic systemic inflammation and altered pain processing mechanisms, as seen in COPD.¹⁴ The current findings support this hypothesis and further suggest that the inflammatory and neurobiological changes characteristic of COPD may contribute to the development of central sensitization and widespread pain, both of which are hallmarks of FMS.¹³

Interestingly, the study did not find significant correlations between the presence of FMS and variables such as age, disease duration, and COPD severity. This suggests that FMS in this context is not merely a consequence of disease progression or physiological decline but may rather be influenced by central nervous system sensitization, inflammatory biomarkers, or psychosocial stressors.³⁷

The strong association found between female sex and FMS aligns with established epidemiological patterns. It is well-documented that women are disproportionately affected by FMS, possibly due to hormonal, psychosocial, and neuroendocrine factors.⁵ Therefore, heightened clinical attention should be directed toward pain and fatigue symptoms in female COPD patients because these may indicate undiagnosed FMS. The occurrence of FMS in COPD patients may be modulated by central sensitization, chronic systemic inflammation, or psychosocial distress rather than by progressive respiratory decline alone.³⁸

The coexistence of COPD and FMS presents a multifaceted clinical challenge because both conditions involve complex pathophysiological mechanisms and are often accompanied with various comorbidities. Despite their individual disease burdens, limited literature exists on the overlapping presentation of COPD and FMS, making it a relatively unexplored area of clinical research. Understanding this comorbidity is critical because it significantly affects individualized patient management, treatment outcomes, and quality of life.

The overlap of COPD and FMS also encompasses behavioral and lifestyle dimensions. Chronic pain and fatigue often result in decreased physical activity, which in turn contributes to deconditioning, a critical issue in both diseases. Chronic pain and fatigue are particularly prevalent in FMS patients and are known to reduce physical activity levels, leading to deconditioning that further exacerbates both respiratory and musculoskeletal symptoms.³⁹ Reduced physical capacity can exacerbate respiratory limitations while worsening musculoskeletal symptoms.⁴⁰ Although some studies have found no direct correlation between COPD severity and FMS symptoms, chronic pain in COPD patients remains a significant clinical concern.^40,41

From a mechanistic standpoint, systemic inflammation appears to be a shared pathway in both conditions. Elevated inflammatory markers have been documented in COPD patients.²³ This overlap suggests that targeting inflammation might offer therapeutic benefit across both domains. Integrated care models that consider both pulmonary and musculoskeletal aspects could thus be particularly advantageous for these patients. Moreover, the high prevalence of psychological factors such as depression and anxiety in COPD patients may trigger the development of FMS or exacerbate its existing symptoms.⁴² This study contributes to the limited but growing body of evidence suggesting that FMS is an underrecognized comorbidity in COPD. Recognizing this coexistence is vital for optimizing clinical management, as untreated FMS can compound symptom burden, impair daily functioning, and reduce adherence to pulmonary rehabilitation programs. Integrating expertise from various healthcare professionals, such as those specializing in respiratory care, physical rehabilitation, psychological support, and pain management, could enhance the overall treatment approach by simultaneously targeting both respiratory and chronic pain-related complaints. Routine screening for FMS-related symptoms, particularly diffuse pain, persistent fatigue, and nonrestorative sleep, may be beneficial during outpatient follow-up visits for female COPD patients. Such screening could be integrated into pulmonary rehabilitation intake assessments and conducted by physiotherapists, pulmonologists, or trained nurses using standardized questionnaires such as the Fibromyalgia Rapid Screening Tool or the WPI and SSS components of the ACR criteria.

The coexistence of COPD and FMS may significantly impair a patient’s quality of life and complicate disease management due to overlapping symptoms such as chronic pain, fatigue, and sleep disturbances. The overlapping symptoms of the two conditions can pose challenges by obscuring diagnosis, impairing diagnostic clarity, and delaying appropriate treatment, particularly when healthcare professionals are unfamiliar with comorbid FMS in the context of respiratory diseases.⁴³ Therefore, it is important to consider FMS-related symptoms during the clinical evaluation of COPD patients and adopt a multidisciplinary approach. In particular, holistic treatment management strategies and collaborative assessments are crucial for the effective management of symptoms in this patient population. Incorporating physiotherapy, psychological support, and pharmacologic pain control may enhance treatment outcomes in this population.

One of the major strengths of this study is its contribution to the limited literature on COPD–FMS comorbidity and its exploration of demographic factors such as sex. Nonetheless, certain study limitations must be acknowledged. The cross-sectional nature of the study prevents causal inferences, and the relatively small sample size may limit generalizability. Additionally, in this study, FMS diagnosis relied on subjective symptom reporting, which, although standardized using the ACR criteria, remains vulnerable to variability in patient perception. Future studies employing longitudinal designs and incorporating objective biomarkers or functional assessments are needed to validate and extend these findings.

Future longitudinal studies are warranted to better understand how fibromyalgia affects disease progression, physical function, and rehabilitation outcomes in COPD patients. Incorporating objective assessments such as actigraphy for sleep, quality of life indices, and inflammatory biomarkers may improve the understanding of how these conditions interact.

Clinical interpretation and ground realities

The current findings underscore the clinical complexity of managing individuals with comorbid COPD, especially those with FMS. From a practical standpoint, the overlap of dyspnea and diffuse musculoskeletal pain may confound symptom reporting, potentially leading to misinterpretation of disease progression or treatment failure. For instance, individuals diagnosed with FMS often reported breathing discomfort alongside persistent fatigue and diffuse muscle pain. Fatigue may complicate symptom interpretation during routine clinical evaluations, making it difficult to distinguish between respiratory and nonrespiratory causes. This convergence of symptoms may complicate the clinical interpretation of disease severity and hinder accurate symptom attribution during routine evaluations. Moreover, although not formally evaluated, several patients anecdotally reported reduced participation in pulmonary rehabilitation due to pain and sleep issues, suggesting that comorbid FMS directly impacts adherence to treatment and related outcomes. These real-world challenges reflect the importance of integrating pain-screening tools and multidisciplinary management into COPD care, especially for female patients who appear to be disproportionately affected by COPD. Finally, this study highlights the necessity of further trials with longitudinal designs, objective pain assessment tools, symptom-specific screening tools, and interventions tailored to COPD–FMS comanagement.

Although treatment adherence or participation in pulmonary rehabilitation programs was not assessed in this study, the presence of widespread pain and poor sleep quality may have influenced rehabilitation engagement. Future studies employing validated adherence metrics and longitudinal designs are warranted to explore this hypothesis.

Given the observed sex-based disparity in FMS prevalence among COPD patients, implementing multidisciplinary screening, particularly for pain, fatigue, and sleep disturbances, may enhance clinical care. Collaborative approaches involving pulmonologists, physiotherapists, and mental health professionals could improve outcomes by addressing both respiratory and musculoskeletal symptom burdens.

Conclusions

This study provides novel evidence showing that the prevalence of FMS is notably higher in COPD patients than in their healthy counterparts. The observed comorbidity was especially pronounced among female patients, underscoring the importance of considering sex-related differences in the clinical assessment of COPD populations.

The presence of FMS in COPD patients may amplify the symptom burden through additional contributions such as chronic pain, fatigue, sleep disturbances, and psychological distress, which are already prevalent among these patients. The lack of significant associations with age, disease duration, and severity further suggests that FMS may develop independently of pulmonary function decline and might instead be linked to systemic processes such as inflammation, neuroendocrine dysregulation, and emotional stress.

Given these findings, clinicians managing COPD patients should maintain a high index of suspicion for FMS, especially among women reporting diffuse musculoskeletal pain and unrefreshing sleep. Integrating routine screening for FMS into standard COPD evaluation protocols may enhance diagnostic accuracy and support the implementation of comprehensive, individualized treatment plans.

Addressing this frequently neglected comorbidity may significantly improve the quality of life and rehabilitation outcomes in COPD patients. Future studies should investigate the longitudinal impact of dual-diagnosis management and assess whether treating FMS in this context results in meaningful improvements in pulmonary rehabilitation outcomes and daily functioning. This study highlights a significantly higher prevalence of FMS in COPD patients, particularly among women. The comorbidity may exacerbate the symptom burden through additional factors such as pain, fatigue, and psychological distress, despite being unrelated to age or disease severity. These findings suggest a role of systemic mechanisms rather than pulmonary decline in the development of FMS. Clinicians should consider routine screening for FMS in COPD care to enhance diagnostic accuracy and support holistic treatment strategies. Future research should explore whether addressing this comorbidity improves clinical outcomes.

Footnotes

Acknowledgments

The authors would like to thank the editor and reviewers for their insightful comments and suggestions. This article is a revised and expanded version of a paper entitled “Prevalence of COPD and Fibromyalgia Syndrome,” which was presented at the National Lung Health Congress, held in Antalya, Turkey, on 15–19 March 2017. AI tools were used for grammar and language editing purposes only.

Author contributions

Conceptualization, S.K. and A.N.; methodology, S.K., A.N., and E.Ö.; formal analysis, S.K. and A.Ö.; investigation, A.N. and S.K.; data curation, A.N. and A.Ö.; writing–original draft preparation, S.K., E.Ö., and A.Ö.; writing–review and editing, A.Ö.; visualization, A.N.; supervision, S.K. All authors have read and agreed to the published version of the manuscript.

Data availability statement

The identified datasets analyzed during the current study are available from the corresponding author on reasonable request.

Declaration of conflicting interests

The authors declare no conflicts of interest.

Funding

This research received no external funding.

Institutional review board statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Non-Interventional Research Ethics Committee of Sakarya University Faculty of Medicine (protocol code 71522473/050.01.04/58, 2017).

ORCID iD

Alp Özel

References

Lopez

Shibuya

Rao

, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27: 397–412.

Chen

Curtis

Chen

Twenty years of changes in the definition of early chronic obstructive pulmonary disease. Chin Med J Pulm Crit Care Med 2023; 1: 84–93.

Xiang

Huang

Fang

, et al. Physical activity and chronic obstructive pulmonary disease: a scoping review. BMC Pulm Med 2022; 22: 301.

Siracusa

Paola

Cuzzocrea

, et al. Fibromyalgia: pathogenesis, mechanisms, diagnosis and treatment options update. Int J Mol Sci 2021; 22: 3891.

Erdrich

Hawrelak

Myers

, et al. Determining the association between fibromyalgia, the gut microbiome and its biomarkers: a systematic review. BMC Musculoskelet Disord 2020; 21: 181.

Jones

Atzeni

Beasley

, et al. The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis Rheumatol 2015; 67: 568–575.

Winslow

Vandal

Dang

Fibromyalgia: diagnosis and management. Am Fam Physician 2023; 107: 137–144.

Liao

Chen

Chronic pain syndrome—fibromyalgia. TUMJ 2023; 17: S5–S10.

D’Amuri

Greco

Pagani

, et al. Common non-rheumatic medical conditions mimicking fibromyalgia: a simple framework for differential diagnosis. Diagnostics 2024; 14: 1758.

10.

Latiers

Vandenabeele

Poncin

, et al. Prevalence and risk factors of musculoskeletal pain in patients with chronic obstructive pulmonary disease: a systematic review. Clin Respir J 2021; 15: 1286–1301.

11.

Cheng

Duan

, et al. Prevalence and characteristics of pain in patients of chronic obstructive pulmonary disease: a cross-sectional study in China. Chronic Obstr Pulm Dis 2020; 17: 90–100.

12.

She

Zhu

, et al. Chronic pain and comorbid emotional disorders: neural circuitry and neuroimmunity pathways. Int J Mol Sci 2025; 26: 436.

13.

Pinto

Geenen

Wager

, et al. Emotion regulation and the salience network: a hypothetical integrative model of fibromyalgia. Nat Rev Rheumatol 2023; 19: 44–60.

14.

HajGhanbari

Holsti

Road

, et al. Pain in people with chronic obstructive pulmonary disease (COPD). Respir Med 2012; 106: 998–1005.

15.

Anghel

Ciubară

Patraș

, et al. Chronic obstructive pulmonary disease and type 2 diabetes mellitus: complex interactions and clinical implications. J Clin Med 2025; 14: 1809.

16.

Fekete

Szollosi

Tarantini

, et al. Metabolic syndrome in patients with COPD: causes and pathophysiological consequences. Physiol Int 2022; 109: 90–105.

17.

Mariniello

D’Agnano

Cennamo

, et al. Comorbidities in COPD: current and future treatment challenges. J Clin Med 2024; 13: 743.

18.

Chen

Thomas

Sadatsafavi

, et al. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med 2015; 3: 631–639.

19.

Almagro

Soler-Cataluña

Huerta

; CLAVE Study Investigatorset al. Impact of comorbidities in COPD clinical control criteria. The CLAVE study. BMC Pulm Med 2024; 24: 6.

20.

Alrabbaie

Al-Wardat

Etoom

, et al. The prevalence of metabolic syndrome in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Chron Respir Dis 2025; 22: 14799731251346194.

21.

Han

Wang

, et al. Adherence to ACSM exercise guidelines and its influence on fibromyalgia treatment outcomes: a meta-analysis of randomized controlled trials. Front Physiol 2024; 15: 1413038.

22.

Couto

Monteiro

Cid

, et al. Effect of different types of exercise in adult subjects with fibromyalgia: a systematic review and meta-analysis of randomised clinical trials. Sci Rep 2022; 12: 10391.

23.

Häuser

Sarzi-Puttini

Fitzcharles

MA.

Fibromyalgia syndrome: under-, over- and misdiagnosis. Clin Exp Rheumatol 2019; 37: 90–97.

24.

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (GOLD 2018 Report), https://goldcopd.org/archived-reports/ (2018, accessed 4 July 2025).

25.

Vogelmeier

Criner

Martinez

, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017; 195: 557–582.

26.

Graham

Steenbruggen

Miller

, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med 2019; 200: e70–e88.

27.

Wolfe

Clauw

Fitzcharles

, et al. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016; 46: 319–329.

28.

Von Elm

Altman

Egger

; STROBE Initiativeet al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344–349.

29.

Fahyim

SMM

AbdelHalim

Hassan

ESSM.

Association between serum interleukin-6 concentrations, chronic obstructive pulmonary disease, and its relation to severity, acute exacerbation, and its effect on pulmonary function test. Egypt J Bronchol 2025; 19: 1–7.

30.

Hussein

FGM

Mohammed

Khattab

, et al. Serum interleukin-6 in chronic obstructive pulmonary disease patients and its relation to severity and acute exacerbation. Egypt J Bronchol 2022; 16: 1–11.

31.

Sanabria-Mazo

Colomer-Carbonell

Carmona-Cervelló

, et al. Immune-inflammatory and hypothalamic-pituitary-adrenal axis biomarkers are altered in patients with non-specific low back pain: a systematic review. Front Immunol 2022; 13: 945513.

32.

González-Álvarez

Riquelme-Aguado

González-Pérez

, et al. Association between systemic neuroinflammation, pain perception and clinical status in fibromyalgia patients: cross-sectional study. Cells 2024; 13: 1719.

33.

Sedda

Cadoni

MPL

Medici

, et al. Fibromyalgia, depression, and autoimmune disorders: an interconnected web of inflammation. Biomedicines 2025; 13: 503.

34.

Ebadi

Goërtz

Van Herck

, et al. The prevalence and related factors of fatigue in patients with COPD: a systematic review. Eur Respir Rev 2021; 30: 200298.

35.

Szymanska-Chabowska

Juzwiszyn

Tański

, et al. The fatigue and quality of life in patients with chronic pulmonary diseases. Sci Prog 2021; 104: 368504211044034.

36.

Arinze

Verhamme

Luik

, et al. The interrelatedness of chronic cough and chronic pain. Eur Respir J 2021; 57: 2002651.

37.

Tselebis

Kosmas

Bratis

, et al. Prevalence of alexithymia and its association with anxiety and depression in a sample of Greek chronic obstructive pulmonary disease (COPD) outpatients. Ann Gen Psychiatry 2010; 9: 16.

38.

Thomas

Lawrence

AB1205 medical and psychological comorbidities in fibromyalgia: a cross sectional study. Ann Rheum Dis 2022; 81: 1717–1718.

39.

Häuser

Ablin

Fitzcharles

, et al. Fibromyalgia. Nat Rev Dis Primers 2015; 1: 15022.

40.

Benzo-Iglesias

Rocamora-Pérez

Valverde-Martínez

, et al. Effectiveness of water-based exercise in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis. Sensors 2023; 23: 8557.

41.

Ghafil

Dananah

Hassan

, et al. Comorbidities in patients with chronic obstructive pulmonary disease: a comprehensive study. J Med Life 2023; 16: 1013–1016.

42.

Aldhahi

Baattaiah

Nazer

, et al. Impact of psychological factors on functional performance among patients with chronic obstructive pulmonary disease. Int J Environ Res Public Health 2023; 20: 1285.

43.

Sarzi-Puttini

Giorgi

Marotto

, et al. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol 2020; 16: 645–660.