A shock survey by charity Asthma + Lung UK reveals that more than 90% of people with COPD are receiving inadequate care, with those living in more deprived communities five times more likely to die from the condition
Chronic Obstructive Pulmonary Disease, or COPD, is one of the country’s leading causes of emergency hospital admissions. Still, it remains an illness shrouded in stigma with inextricable links to poverty and smoking. Levels of care for the chronic respiratory condition are now the worst ever recorded, according to Asthma + Lung UK’s annual Life with a Lung Condition survey, which is why it is time to put this much-neglected condition under the spotlight.
More than 1.7 million people in the UK have COPD, and an estimated 600,0001 more are experiencing symptoms without a diagnosis. Although COPD includes several incurable lung conditions such as emphysema and chronic bronchitis, public interest and urgency remain low. COPD is among the five leading causes of death in the UK: every 20 minutes, someone in the UK will die from COPD2, and it causes more than 30,000 deaths3 a year
Characterised by breathlessness, a constant cough, frequent chest infections, and wheezing, COPD occurs when the lungs become permanently damaged or inflamed by cigarette smoke, dust, fumes, or occupational chemicals. Unlike asthma, the breathlessness associated with COPD is constant and gets progressively worse, and is most common in people over 50.
Smoking is the biggest cause of COPD (between 70 to 90% of people with a diagnosis have a history of smoking), but poverty and poor housing are also key predictors and determinants of its progression. It is, after all, an illness seeped in deprivation and generational inequality – with someone from the poorest 20% of households at more than double the risk of a hospital admission for COPD than someone from the most affluent quintile4.
Former smoker Katy Brown, 66, from Bristol, has COPD and says her daily struggle to breathe has seen her go from an energetic nursery assistant who planned to spend her retirement travelling the world to someone who often needs a nap at 4 pm.
“I come from a working-class background, and everyone smoked when I was growing up. My mum died from COPD, and now I have the illness too. What is worse is that nobody seems to have heard of my condition or to really care about it. I had such a battle to get a diagnosis, and I am still fighting to get the right care and support. Not everyone with a chronic condition has the capacity to do this.”
Shockingly, given the tell-tale symptoms of COPD, many struggle to get a timely diagnosis. A report from Asthma + Lung UK5 revealed that one in eight (12%) people with COPD surveyed waited more than ten years for a diagnosis. Furthermore, Spirometry (the lung test used to diagnose the condition) is not available in all of England’s health systems6.
But even with a diagnosis, access to care is diabolically poor, and getting worse. According to the charity’s survey, only 8.8%7 of people surveyed were receiving the ‘five fundamentals’ of COPD care as prescribed by the National Institute for Clinical Excellence (NICE). This includes a personalised self-management plan, smoking cessation support, access to pulmonary rehabilitation (an exercise and breathing therapy), pneumococcal and flu vaccinations, and support for other chronic conditions.
Andrew McCracken, director of external affairs at Asthma + Lung UK, said: “Hundreds of thousands of people are fighting for breath and being rushed to hospital with life-threatening symptoms simply because they cannot get the basic care they need. The core elements of good COPD care are relatively inexpensive to provide and would improve patients’ lives, reduce pressure on the NHS, and boost the economy as more people are able to stay in employment. We know what works, it’s just not being implemented, and that’s why clinicians, patients, and charities like Asthma + Lung UK are calling for a dedicated national strategy to improve respiratory care.
“As well as better treating COPD, we also need to tackle its root causes. Without bold action to improve housing, reduce the effects of air pollution, and provide people who smoke with adequate support to stop, those living in poorer communities will continue to bear the brunt of this disease. It is a sorry state of affairs that in the twenty-first century, someone’s postcode and household income can have such a profound impact on their health – and these effects are felt more than ever over the winter when emergency admissions for breathing difficulties really soar.”
For more information on how to protect your lungs this winter, visit We’re with you this winter | Asthma + Lung UK
References:
2) Asthma + Lung UK’s report Delayed Diagnosis and Unequal Care: Delayed Diagnosis and Unequal Care | Asthma + Lung UK
3) NHS England hospital admissions data provided by HSJ Information
4) NICE COPD: How common is it?
5) Figure from Asthma + Lung UK’s 2022 report on COPD: Delayed diagnosis and unequal care, p1: https://www.asthmaandlung.org.uk/sites/default/files/2023-03/delayed-diagnosis-unequal-care-executive-summary.pdf
6) Asthma + Lung UK ICS Respiratory Review survey, October 2024 – 16 of 27 ICSs commissioning spirometry responded to say they did not have enough spirometry testing capacity to meet the demand in their area
7) Asthma + Lung UK’s Life with a Lung Condition survey 2025
