COPD in the UK

CureQuest x MediQuills UK

I. Introduction

Chronic obstructive pulmonary disease (COPD) is a long-term, progressive respiratory condition characterised by persistent airflow limitation that is not fully reversible (Global Initiative for Chronic Obstructive Lung Disease (GOLD, 2024). The term COPD primarily includes chronic bronchitis, which involves chronic airway inflammation and mucus hypersecretion, and emphysema, which is defined by destruction of alveolar walls and reduced elastic recoil of the lungs (NICE, 2019).

COPD is a progressive disease, with lung function declining over time, particularly when exposure to risk factors such as smoking continues. Unlike asthma, the airflow limitation seen in COPD is largely irreversible, making early prevention and intervention essential (WHO, 2023). Patients often experience exacerbations, which are acute episodes of symptom worsening that accelerate disease progression and increase hospital admissions and mortality (GOLD, 2024).

COPD represents a major public health challenge in both the UK and globally. The disease contributes significantly to morbidity, premature mortality and healthcare expenditure, and disproportionately affects socioeconomically deprived populations. High rates of underdiagnosis further compound the burden, highlighting the need for improved awareness, early detection and effective management strategies (Asthma+Lung UK, 2022).

II. Epidemiology in the UK

COPD is one of the most prevalent chronic respiratory diseases in the UK. It is estimated that approximately 1.2 million people have a diagnosed form of COPD, while an additional 2 million individuals remain undiagnosed, indicating a substantial hidden disease burden (Asthma+Lung UK, 2022).

The prevalence of COPD increases with age and is most commonly diagnosed in individuals over the age of 40. Historically, the disease has been more common in men due to higher smoking rates; however, this gender difference has narrowed as smoking prevalence among women has increased over time (NICE, 2019).

Regional variation in COPD prevalence is evident across the UK, with higher rates observed in urban and post-industrial areas, particularly in the North of England. These disparities are closely linked to socioeconomic deprivation, historical smoking patterns and environmental pollution (NHS Confederation, 2025). Globally, similar trends are observed, with COPD prevalence rising due to aging populations, ongoing tobacco exposure and increasing air pollution, especially in low- and middle-income countries (WHO, 2023).

III. Risk Factors

Tobacco smoking is the leading risk factor for COPD and accounts for the majority of cases in the UK. Smoking causes chronic inflammation of the airways, increased mucus production and irreversible structural damage to lung tissue. Evidence suggests that up to one in four smokers may develop COPD, although disease severity varies depending on cumulative exposure and individual susceptibility (Fresh and Balance, 2025).

Air pollution, both indoor and outdoor, is also a major contributor to COPD development and progression. Long-term exposure to pollutants such as particulate matter and nitrogen dioxide has been associated with reduced lung function and increased respiratory morbidity (Smith & Bolton, 2025).

Additional contributing factors include occupational exposure to dust, fumes and chemicals, particularly in industries such as construction and manufacturing. Genetic predispositions, such as alpha-1 antitrypsin deficiency, significantly increase the risk of early-onset COPD. Furthermore, childhood respiratory infections and impaired lung development may reduce maximal lung function, increasing vulnerability to COPD in later life (GOLD, 2024).

IV. Disease Burden

COPD places a significant burden on individuals and healthcare systems. Morbidity associated with the disease includes chronic breathlessness, reduced exercise capacity and frequent hospital admissions, particularly during acute exacerbations (NICE, 2019).

COPD is a leading cause of mortality in the UK, accounting for thousands of deaths each year, many of which are preventable through early diagnosis and effective management (WHO, 2023). The economic burden of COPD is substantial, driven by inpatient care, long-term medication use and productivity losses due to disability and early retirement (Asthma+Lung UK, 2022).

Beyond physical symptoms, COPD has a profound impact on quality of life, limiting daily activities and contributing to mental health conditions such as anxiety and depression. The progressive nature of the disease often leads to social isolation and reduced independence, affecting both patients and their carers (NHS Confederation, 2025).

V. Diagnosis & Screening

COPD commonly presents with chronic cough, sputum production and progressive breathlessness, symptoms that are frequently misattributed to smoking, ageing or recurrent chest infections. This contributes to delayed diagnosis and prolonged periods without treatment (Asthma+Lung UK, 2022).

Spirometry is the gold standard diagnostic tool for COPD and is used to confirm persistent airflow limitation by measuring forced expiratory volume (FEV₁) and forced vital capacity (FVC) (NICE, 2019). Additional investigations, including chest imaging and symptom assessments, may be used to support diagnosis and guide disease management.

Early detection remains challenging due to limited symptom awareness and inconsistent access to spirometry in primary care. To address this, the UK has introduced targeted lung health checks for high-risk populations, aiming to improve early diagnosis and reduce disease progression (NHS England, 2023).

VI. Treatment & Management

Management of COPD requires a comprehensive and individualized approach. Smoking cessation is the most effective intervention to slow disease progression and reduce mortality. Pulmonary rehabilitation, which combines exercise training and education, is recommended for patients experiencing breathlessness and functional limitation (Asthma+Lung UK, 2023).

Pharmacological management primarily involves bronchodilators, including short- and long-acting agents, to relieve airflow obstruction and improve symptoms. Inhaled corticosteroids may be prescribed for patients with frequent exacerbations, often as part of combination therapy (NICE, 2019).

For individuals with advanced disease, additional treatments such as long-term oxygen therapy and surgical interventions, including lung volume reduction or transplantation, may be considered. Overall, personalized care plans and regular clinical review are essential for optimizing outcomes and maintaining quality of life in patients with COPD (GOLD, 2024).

VII. Public Health Strategies in the UK

There are many national health campaigns for people with COPD in the UK, such as Every Breath which has raised awareness about smoking, a risk factor of COPD. From the results of one major study, at least 1 in 4 smokers may develop COPD, therefore Every Breath informs smokers that the early warning signs of feeling short of breath is an early sign of lung damage or COPD. The campaign primarily shares stories across news and social media to encourage people to quit smoking. Additionally, the campaign has been spread to cinemas in Yorkshire and the South West, in attempts to connect with audiences, helping them to better look after their health. As a result of the widespread campaigning, Every Breath has resulted in “one of the largest rises in quitting, the North East has ever seen through NHS Stop Smoking Services” (FB, 2025).

Another health campaign launched in the South East of England, Love your Lungs, shows people how to maintain healthy lungs and avoid hospital admissions. Overall, it encourages people to keep moving and stay hydrated no matter the weather or mood. Dr Richard Russell, the clinical lead for the South East Respiratory Network has shared that the campaign “captures real-life stories of those living with respiratory conditions daily, such as chronic obstructive pulmonary disease (COPD), who have told us that becoming fitter has helped them be more active while making their symptoms like breathing easier to manage.” (NHS SE, 2024). The program, which was launched during summer months (but is equally as important in the winter), encouraged people to build their strength and fitness and enjoy the great outdoors through social media, clinical advice, but especially hearing and witnessing personal accounts, which helped people to put their lives and respiratory health into perspective. 

Currently the prevalence of smoking in the UK has fallen drastically from 51% of men and 41% of women in 1972 to 15.1% of men and 11.5% of women in 2021 (RCP, 2016). However, the prevalence of smoking is much higher amongst certain sectors of the community, such as Bangladeshi, Irish and Pakistani men (PHE, 2015); Black Caribbean and Irish women (PHE, 2015); lesbian, gay and bisexual people (DH, 2017); people with serious mental health problems (PHE 2020); young people if they live with someone who smokes or if there is someone who smokes in their social environment (RCP, 2016). 

With the continuous goal of reducing smoking, there are many different initiatives throughout the country. Firstly, in the NHS Long Term Plan, smokers who are admitted to an acute or mental health hospital are to be offered NHS funded tobacco dependency treatment. This aids the patients during and after their hospital stay, as they are referred into community care for support to stop smoking when they are discharged. Clinical support through giving information to patients, referring and prescribing medications helps put together a goal-seeking plan for smokers, building their confidence to end their smoking era. 

Local stop smoking services can be delivered for free as integrated lifestyle services, community pharmacies and also GP surgeries. They offer a choice of one-to-one or group behavioral support from a trained stop smoking advisor, together with pharmacotherapy (OHID, 2025). This helps build confidence in smokers to quit smoking through community or specialist support. 

There are also a wide range of stop smoking aids available, such as patches, sprays, lozenges and gum which are nicotine replacement therapy (NRT) products. There are also e-cigarettes (vapes) which are the most commonly used quit aids among smokers. It is even evidenced in the Cochrane review (Puhan MA, 2023) that e-cigarettes containing nicotine are twice as effective in supporting smokers as patches and gum. However, vapes are not licensed as medicines in the UK as they are tightly regulated for safety and quality because although the toxic levels of tar and carbon monoxide are high in tobacco smoke, they are still present in e-cigarettes, only at a lower level. An additional type of smoking aid are prescription tablets such as Varenicline (Champix) and Bupropion (Zyban), which are prescribed by a healthcare professional and doubles a smoker’s chance of quitting. 

Public campaigns also play a huge role in reducing smoking prevalence, especially the campaign, Stoptober, which was initially launched in 2012, encouraging thousands of smokers to quit smoking in the month of October. The campaign helps smokers to gain self-confidence which plays a huge role in quitting smoking. On an individual level, people will understand the impact of smoking on their health and how lung damage and COPD can be avoided, but on a national level, it can reduce NHS costs towards smoking, which otherwise estimates to around £2.4 billion a year, and improve the air quality in the UK.

Poor air quality is a major contributor to the development of COPD as well as other conditions regarding the public health of England. The air can be degraded through many pollutants, the common ones being sulfur dioxide, nitrogen oxides, particulate matter, ozone, non-methane volatile organic compounds (NMVOCs), heavy metals such as lead, arsenic, cadmium, mercury, nickel; polycyclic aromatic hydrocarbons (PAHs), benzene, 1,3-butadiene, carbon monoxide and  ammonia. These pollutants come from a range of natural and anthropogenic sources, which include combusting fossil fuels, incineration of waste, emissions from traffic, chemical and photochemical reactions. (Smith, 2025).

After the departure from the EU, the four parts of the UK, England, Scotland, Wales and Northern Ireland have agreed to work together through a non-legislative common framework, known as the “Air quality: provisional common framework”. This was published on 3rd February 2022 explaining ways in which the UK is going to implement strategies to reduce harmful emissions and concentrations of air pollutants through a coordinated governance approach (Smith, 2025). One example of this can include introducing clean transport zones in cities where charges may apply for more polluting vehicles, encouraging the uptake of cleaner vehicles or public transport. 

To educate patients about COPD and how to manage it, NHS England have included pulmonary rehabilitation (PR) as part of the NHS Long Term Plan. PR is an exercise and education program designed for people with lung disease who experience symptoms of breathlessness. It primarily focuses on physical exercise and information to better help patients to understand and manage their conditions. Most patients who go to PR are patients with COPD, as well as other long-term lung conditions such as bronchiectasis and pulmonary fibrosis. PR consists of sessions delivered in groups conducted by trained health professionals, such as physiotherapists, nurses and occupational therapists, who prescribe individual exercises, resistance training and lifestyle support. Consequently, this has resulted in patients feeling better about their breathlessness allowing them to accomplish higher activity and exercise levels, overall summing to an improved quality of life. (Asthma+Lung UK, 2023)

Moreover, in the Nottinghamshire Healthcare NHS Foundation Trust the newly-launched program, CHEST, is set to support COPD patients to manage their condition. CHEST stands for COPD, Heath, Education, Self-management, Treatment and is a program delivered as a group session by respiratory nurse specialists in Bull Farm Primary Care Centre, Mansfield. The program aims to provide education and support to newly-diagnosed COPD patients, or patients who need more support with self management. It plans to empower patients and carers to understand how to effectively manage their health, as well as making informed choices about their lifestyle. This program is carried out through structured educational sessions, ultimately leading to an improved quality of life for patients. Additionally, it aims to address mental health management during COPD, educating patients to maintain a healthy and active life and mind. (NT NHS, 2025)

VIII. Research & Innovation

Recent advances in biologic therapies have shown a particular promise in dupilumab, a monoclonal antibody treatment that targets interleukin-4 and interleukin-13 signalling pathways involved in type 2 inflammation. Clinical evidence shows that dupilumab can reduce exacerbations and improve lung function and quality of life in selected patients with COPD. The drug has been granted marketing authorization by the Medicines and Healthcare products Regulatory Agency (MHRA) and been approved as an add-on maintenance treatment for adults with uncontrolled COPD, which is characterized by raised blood eosinophils levels. This represents a significant milestone in COPD management in the UK for a defined subgroup of people with COPD, as it is a much more personalized, phenotype-driven approach to treatment (Harvey, 2024). 

In addition to biologic therapies, regenerative medicine aims to address underlying structural and functional damage seen in COPD by repairing or replacing tissue lost due to damage, aging or disrupted development (Hind, 2011). Research in this field has primarily focused on the regeneration of alveolar tissue and alveolar ducts, which are essential for effective gas exchange. The advances in stem cell research shows that pluripotent embryonic stem cells have raised the possibility of promoting lung repair and regeneration. Current regenerative strategies can be broadly categorized into extrinsic cell therapy, which involves the administration of exogenous cells, and intrinsic cell therapy, which aims to stimulate endogenous repair mechanisms within the lung. While these approaches remain largely experimental, they offer potential future avenues for disease-modifying treatment in COPD.

Digital health interventions are increasingly being used to support monitoring and the self-management of COPD, effectively improving patient outcomes while reducing the pressure on GP services and busy local hospitals. By enabling remote monitoring and promoting adherence to treatment and symptom tracking, digital health technologies can empower patients to take greater control of their condition.

One example of a UK-based digital scheme is the Living Well program, launched by Healthier Together, the Integrated Care System in Bristol, North Somerset and South Gloucestershire (NB, 2024). The pilot program is designed to support approximately 9,500 people with COPD to manage their condition at home through a tiered model of care. At tiers one and two are for people with milder disease, who can be supported using my mhealth’s myCOPD app. Tier three is for people at a higher risk of hospital admission, therefore are provided with remote monitoring equipment overseen by clinical staff and health coaches using digital health platforms. Finally, tier four is for people whose COPD control is at the highest risk of deterioration and hospital admission who receive specialist support through digital monitoring and face-to-face interventions to keep people well at home (NB, 2024). A gentleman named Richard, from Bristol, in his 70s, living with COPD mentioned that he has had “a lot more input” since he signed up to the program. From feeling “a bit abandoned” to now feeling “a lot better” and “grateful”, Richard is one example of how Living Well can help patients manage their COPD safely and effectively. 

Approximately 65 million people suffer from severe chronic airway diseases worldwide, highlighting the need for improved COPD management strategies. One example of a digital health research study in the UK is the INCLINE study, which aims to monitor 42 patients with COPD from their own homes, using inhalers with digital sensors and a mobile app. The study also seeks to predict future COPD exacerbations, helping researchers and clinicians better understand how patients use medication, the factors that influence usage and the impact of inhaled therapy on inflammatory biomarkers. Conducted over a two-year period, the study uses ‘smart’ inhalers and a mobile app, called Atom 5, to allow clinical teams at NIHR Leicester BRC to monitor patients’ conditions remotely (NIHR, 2023).

Another example of UK clinical research aiming to reduce the effects of COPD is the AIRFLOW-1 clinical trial being conducted at Royal Brompton and Chelsea Westminster hospitals, where researchers are testing a novel, minimally-invasive procedure called targeted lung denervation (TLD). This technique uses electrodes to destroy branches of the vagus nerve in the lungs. The vagus nerve is typically overactive in COPD patients, as result of damage from smoking and constant mucus secretion, which leads to airway obstruction. (RBH, 2016) This, in turn, causes symptoms such as cough, shortness of breath, wheeze and tightness of the chest. By blocking the actions of the vagus nerve it is hoped to relieve the patient’s symptoms, improve lung function and enhance quality of life in people with moderate to severe COPD. Early patients in the clinical trial have received the procedure as part of efforts to evaluate its safety and potential clinical benefits, demonstrating how UK centers are participating in pioneering COPD research. 

Beyond individual trials, the UK benefits from a strong national research infrastructure supporting COPD studies, including the National Institute for Health and Care Research (NIHR) and specialist respiratory research centers. These initiatives enable large-scale real-world studies, digital health innovation and early-phase clinical trials, with the aim of reducing exacerbations, hospital admissions and healthcare costs associated with COPD. Collectively, this research demonstrates the UK’s significant contribution to advancing COPD diagnosis, monitoring and treatment.

IX. Challenges & Gaps

The current delay in diagnosis of COPD has directly resulted in a large undiagnosed population in the UK which was evident in the 2011 National Institute for Health and Care Excellence (NICE) study. Here, it was estimated that as many as 2 million people in the UK live with undiagnosed and untreated COPD and therefore struggle with its symptoms daily. Furthermore, NHS England reported that 58% of patients with COPD presented with symptoms over 5 years before receiving a diagnosis, leading to worsening conditions as these patients lived with no treatment for a long period of time. This delay has caused 1 in 8 of these respondents to wait for more than 10 years for a diagnosis: an issue that was exacerbated by the similarity of the symptoms to other diseases, like chest infections, resulting in misdiagnosis. Not only this, but the impact on mental health can be substantial as patients can become frustrated with the NHS system and the inability to obtain a diagnosis quickly which can create distrust with healthcare professions in addition to the deterioration in health both physically and mentally. 

Access to care can differ substantially depending on many demographic factors including patients’ economic conditions. Those living in poorer, rural areas may find it more difficult to access primary services due to geographical barriers. The issue of digital exclusion also plays a large role in these areas as it can hinder patients’ access to healthcare, widening the disparity between affluent and deprived communities. This is especially relevant as evidence reveals that a person from the poorest 10% of households is 2 ½ times more likely to develop COPD than someone from the most affluent 10% of households due to added risk factors like smoking and air pollution. As a result, those in deprived areas are likely to need greater access to care for treatment. In addition, the inability to access care is also interlinked with late diagnosis, as mentioned previously, with it lengthening the period of time patients wait to be seen for diagnosis and therefore treatment. 

Adherence to treatment
Adherence to treatment regarding COPD is paramount in reducing hospitalization risk and in improving overall quality of life. Unfortunately, an average of 50% of patients with COPD in the UK do not fully adhere to the prescribed regimen which can potentially cause fatal complications like respiratory failure. This non-adherence can come in 3 types: underuse, overuse and improper use. Underuse and overuse is using too little or too much of the standard dose of a medication while improper use refers to whether the prescribed drugs are effective and whether drugs and aids like inhalers are administered properly. Not adhering to treatment appropriately can mean that symptoms can stay constant or worsen over time which can negatively impact the patient’s standard of living. From an economic point of view, non-adherence can sometimes mean unnecessarily using medications and treatments, draining NHS resources. This is especially relevant with the current strain on NHS funding and resources, therefore, all medications and treatments are valuable and must be allocated and utilized efficiently.

Integration of care between primary and secondary services
Integrated disease management is vital to ensure holistic care is provided to patients with COPD resulting in improved quality of life and better patient outcomes. A less integrated system can present via slower referral pathways and shortages in specialists which can worsen the problem of late diagnosis. The current difficulty in reaching secondary care has led to patients being demotivated to seek out primary care and therefore decide to live with their condition causing potential complications from a lack of treatment. 

X. Global Health Perspective

Currently the UK government is taking a Big Society approach to tackling COPD, with a focus on strengthening the relationship between people with COPD and healthcare professionals. This ensures that patients are prioritized and empowered to become central in the decisions about their health and care. This can assist in patients’ abilities to adhere to treatments as they are likely to be more well-informed on their health needs. The NHS also aims to collaborate with other organizations, for example Asthma UK and the British Lung Foundation, to raise awareness and to raise money for research. By doing this, patients minimize risk of misdiagnosis as they may be able to spot symptoms more easily and raise concerns with their doctor. 

Currently in the UK, comprehensive lung health checks are offered to patients at high risk of lung diseases, taking a preventative approach. Similarly, in Brazil, early detection of respiratory diseases using spirometry is common, however, it has been effectively implemented in primary healthcare facilities in lower-income cities, revealing their greater focus on deprived communities.

An example in which patients with COPD were prioritized was in Spain during COVID-19 when restrictions were lifted to allow prescriptions of an inhaler that delivers multiple medicines for COPD, leading to significant improvement in flare-ups, survival and healthcare resource use. In Canada the Best Care COPD integrated disease management programme was implemented where certified respiratory educators (CREs) are embedded in primary care allowing collaboration between clinicians and patients, optimising treatment regimes. This has been linked to a progressive reduction in COPD-related hospitalisations, revealing the importance of primary care and spotting symptoms and diagnosing in order to progress towards effective treatment and therefore outcomes.

Globally, the UK has an important role in COPD research and policy. Researchers in the UK have made major contributions to understand COPD epidemiology, risk factors and disease progression. This has been done via large- scale population studies and longitudinal cohort data to help shape global perspectives on preventing and diagnosing COPD early. Respiratory research from the UK has been influential in redefining COPD as a condition linked to social deprivation, environmental exposure and health issues, rather than just smoking. From a political perspective, the UK has had significant influence internationally by developing the clinical guidelines produced by the National Institute for Health and Care Excellence (NICE). These guidelines are widely regarded as a standard for evidence-based management of COPD. These guidelines have shaped clinical practice beyond the UK and contributed to COPD care internationally. The UK has played a role in moulding the global recommendations by collaboration in the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Their strategy reports are used worldwide to help diagnose, treat and classify the disease. In addition, the UK contributes to global COPD policy by engaging with international public health authorities focused on non-communicable diseases, tobacco control and improvement of air quality. They have supported the importance of early detection and prevention focused strategies.

XI. Conclusion

Chronic obstructive pulmonary disease (COPD) remains a major health challenge in the UK and globally. It significantly contributes to morbidity, death and healthcare costs. This article highlights the burden of COPD in the UK, a condition driven by preventable risk factors such as smoking, air pollution and occupational exposures. In addition to this, it has caused persistent inequalities in diagnosis, access to care and health outcomes. Despite the advances in treatment and management, patient’s quality of life has been impacted due to delayed diagnosis and underdiagnosis. These factors limit the effectiveness of interventions. 

The importance of prevention and early detection has been emphasized throughout the article, particularly through smoking cessation initiatives, air quality improvement policies and the use of spirometry. Some evidence based treatment strategies include: pharmacological therapies, pulmonary rehabilitation and integrated care models. These play a vital role in reducing hospital admissions and the progression of the disease. Public health campaigns and community-based support programs strengthen patient engagement and adherence to treatments. 

At a global level, the UK plays an influential role in shaping COPD research and policies. This is through high-quality research and collaborations with international organisations. Investments in preventative strategies, early diagnosis and integrated care pathways is essential to reduce the effects of COPD worldwide. To continue further development, correlated actions from healthcare providers and patients is required to improve outcomes and ensure sustainable, high quality care for individuals living with COPD.

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Credits

Arwa Tueger

Bhanu Nandini Dahiya 

Rukshitha Arasakone 

Ketaki Paranjape