Chronic Obstructive Pulmonary Disease Health Literacy and Recognition of Early Warning Symptoms Among Adults in Northern Saudi Arabia: A Community-Based Cross-Sectional Survey

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading preventable cause of morbidity and mortality, and limited public recognition of its risk factors and early symptoms may delay smoking cessation, timely care seeking, and clinical assessment. This community-based cross-sectional survey quantified COPD knowledge and recognition of early warning symptoms among adults in the Northern Border Region of Saudi Arabia and examined characteristics associated with higher scores. Methods: Adults aged 18 years or older were recruited between 23 January and 5 July 2026 through convenience and snowball sampling on social-media platforms and completed a structured, self-administered Arabic questionnaire. A 20-item COPD knowledge subscale and a 7-item early warning symptom-recognition subscale were combined to produce a 27-item COPD health-literacy score; the composite is an operational summary measure rather than a validated scale. Multivariable linear regression modeled the continuous score, and logistic regression modeled a study-specific operational threshold of at least 16 of 27 points (59.3% of the maximum score), which was adopted for analytical convenience and does not represent a validated clinical cut-off. Results: Among 671 participants, 63.8% were never smokers, 26.5% were current smokers, and 9.7% were former smokers; the mean age was 31.8 years (SD, 12.2). The mean overall score was 12.92 out of 27 (SD, 7.03), corresponding to 47.9% of the maximum score, and 36.8% of participants scored at or above the operational threshold. Scores did not differ significantly by smoking status. Prior COPD awareness was associated with higher odds of scoring at or above the threshold (adjusted odds ratio, 8.87; 95% confidence interval, 5.43–14.47; p < 0.001), as were physician-reported and social-media-reported sources of COPD information. These estimates were stable in sensitivity analyses that excluded two items with contestable wording (Spearman ρ = 0.999 between the 25- and 27-item scores) and in models additionally adjusted for educational level and monthly income (adjusted odds ratio for prior awareness, 7.03; 95% confidence interval, 4.38–11.30). Conclusions: COPD knowledge and recognition of early warning symptoms were limited among the surveyed adults. Because non-probability online sampling was used, the findings describe the surveyed sample and are not population-representative. Community-based education, smoking-cessation support, and symptom-focused assessment in primary care may help address the knowledge gaps identified here.