ackground & Objective: Chronic obstructive pulmonary disease (COPD) is a major health challenge in Iraq, where outcomes are shaped by both clinical factors and social determinants of health (SDOH) such as income, housing, environmental exposures, and healthcare access. This study aimed to explore respiratory physicians’ perspectives on how SDOH affect COPD management and outcomes in Baghdad, providing context-specific insights for future reforms.
 Materials & Methods: A qualitative phenomenological design was used. Semi-structured, face-to-face interviews were conducted with ten respiratory specialists (≥15 years’ experience) in Baghdad Medical City. Interviews were transcribed and analyzed using Braun and Clarke’s thematic analysis. Trustworthiness was ensured through peer debriefing, intercoder agreement, and reflexive documentation. Ethical approval was obtained from the University of Baghdad, College of Pharmacy and the Iraqi Ministry of Health.
Results:  Five major themes emerged: (1) Diagnostic and follow-up barriers, including delayed patient engagement and lack of structured recall systems; (2) Socioeconomic determinants—air pollution, financial hardship, peripheral residence, and poor housing—contributing to exacerbations and poor disease control; (3) System-level limitations such as medication shortages, inadequate access to care, and lack of SDOH documentation; (4) Recommendations for national COPD registries, improved data systems, and targeted public health interventions; (5) The need for integrated registries, equitable access, and policies incorporating SDOH into routine COPD management.
Conclusion:  COPD outcomes in Iraq are strongly shaped by social and structural determinants beyond clinical management. Addressing financial barriers, environmental exposures, and healthcare system gaps is essential for improving disease control and reducing exacerbations. Physicians’ insights highlight the urgent need for integrated registries, equitable access, and policies that incorporate SDOH, especially in conflict-affected LMICs.