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Respiratory disease in people with bipolar disorder: a systematic review and meta-analysis

Molecular Psychiatry volume 30, pages 777–785 (2025)Cite this article

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Abstract

People with bipolar disorder (BD) have an increased risk of premature mortality and the respiratory mortality rate is higher than those of the general population. To date, however, the evidence on respiratory disease in this population has not been meta-analyzed. We systematically review and meta-analyze the frequency of respiratory diseases in patients with BD and to compare prevalence and odds ratio (OR) with the general population. The systematic literature search was conducted in Pubmed, PsycINFO, Scielo and Scopus, with snowball search of reference and citation lists. Inclusion criteria were studies reporting diagnoses of respiratory diseases (asthma, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer and tuberculosis) in people with BD according to operationalized criteria and where possible, control group. Of the 2158 articles screened, 20 including 962,352 people with BD and 37,340,405 control group, met the inclusion criteria. In people with BD, the prevalence of COPD was 9.14% (95%CI: 6.61–12.5%), asthma 6.4% (95%CI: 4.56–8.91%), pneumonia 2.78% (95%CI: 2.51–3.08%) and lung cancer 0.44% (95%CI:0.23–0.84%). Compared to the general population, people with BD had significantly higher rates of COPD (OR: 1.73; 95% CI: 1.40–2.14), showing an increased rate in younger and female patients; asthma (OR: 1.91, 95% CI: 1.25–2.94), with a greater rate in younger patients; and pneumonia (OR: 2.82, 95% CI: 1.33–5.99). In the first meta-analysis on the topic, BD was associated with an increased risk of respiratory illness versus the general population. In COPD and asthma, young people and women are at particular risk. Prevention programs are urgently needed.

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Acknowledgements

We would like to thank María P. Pata for her invaluable support in data analysis.

Funding

This study received founding by the Instituto de Salud Carlos III (PI20/01657) and the European Union via the European Regional Development Fund (ERDF), “Una manera de hacer Europa”. Funders were not involved in any stage of project.

Author information

Author notes

  1. These authors contributed equally: David Laguna-Muñoz, Ana Jiménez-Peinado.

Authors and Affiliations

  1. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain

    David Laguna-Muñoz, Ana Jiménez-Peinado, María José Jaén-Moreno, Cristina Camacho-Rodríguez, Gloria Isabel del Pozo, Javier Caballero-Villarraso & Fernando Sarramea

  2. Reina Sofia University Hospital, Córdoba, Spain

    David Laguna-Muñoz, Ana Jiménez-Peinado, María José Jaén-Moreno, Gloria Isabel del Pozo, Javier Caballero-Villarraso & Fernando Sarramea

  3. University of Cordoba, Department of Morphological and Sociosanitary Science, Córdoba, Spain

    David Laguna-Muñoz, Ana Jiménez-Peinado, María José Jaén-Moreno, Gloria Isabel del Pozo & Fernando Sarramea

  4. Department of Medicine, School of Medicine & Health Sciences, University of Barcelona (UB), 143 Casanova st., 08036, Barcelona, Catalonia, Spain

    Eduard Vieta

  5. Bipolar and Depressive Disorders Unit, Hospìtal Clinic, 170 Villarroel st., 08036, Barcelona, Catalonia, Spain

    Eduard Vieta

  6. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 170 Villarroel st., 08036, Barcelona, Catalonia, Spain

    Eduard Vieta

  7. Institute of Neurosciences (UBNeuro), Barcelona, Catalonia, Spain

    Eduard Vieta

  8. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain

    Eduard Vieta & Fernando Sarramea

  9. Department of Biochemistry and Molecular Biology & UGC Clinical Analyses, University of Córdoba, Córdoba, Spain

    Javier Caballero-Villarraso

  10. University of Kentucky College of Medicine, Lexington, KY, USA

    Muhammad Ijlal Khan

  11. Instituto de Neurociencias, Universidad de Granada, 18100, Granada, Spain

    Fernando Rico-Villademoros

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  1. David Laguna-Muñoz
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Contributions

Study concept and design: FS, MJJ-M, DL-M, AJ-P, JC-V. Acquisition, analysis, or interpretation of data: DL-M, AJ-P, MJJ-M, CC-R, MIK. Drafting the manuscript: FS, AJ-P, DL-M. Critical revision of the manuscript for important intellectual content: EV, JC-V, FR-V. Statistical analysis: DL-M, AJ-P, AJ-M, FS, CC-R. Administrative, technical, or material support: GIdP, CC-R, MIK. Study supervision: FS, MJJ-M, JC-V.

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Correspondence to Eduard Vieta.

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Competing interests

EV has received grants and served as consultant, advisor or CME speaker for the following entities: AB-Biotics, AbbVie, Adamed, Angelini, Biogen, Beckley-Psytech, Biohaven, Boehringer-Ingelheim, Celon Pharma, Compass, Dainippon Sumitomo Pharma, Ethypharm, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, HMNC, Idorsia, Johnson & Johnson, Lundbeck, Luye Pharma, Medincell, Merck, Newron, Novartis, Orion Corporation, Organon, Otsuka, Roche, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda, Teva, and Viatris, outside the submitted work. FS during the last 5 years has been speaker for Rovi and Janssen-Cilag. DL-M during the last 5 years has been speaker for Lundbeck. All other authors report no biomedical financial interests or potential conflicts of interests related with this manuscript.

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Laguna-Muñoz, D., Jiménez-Peinado, A., Jaén-Moreno, M.J. et al. Respiratory disease in people with bipolar disorder: a systematic review and meta-analysis. Mol Psychiatry 30, 777–785 (2025). https://doi.org/10.1038/s41380-024-02793-1

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