Background

What is COPD?

Chronic obstructive pulmonary disease (COPD) describes a group of lung conditions that cause breathing difficulties. It includes:

  • Emphysema – damage to the air sacs in the lungs
  • Chronic bronchitis – long-term inflammation of the airways

The NHS webpage on chronic obstructive pulmonary disease explains that COPD is a common condition that mainly affects middle-aged or older adults who smoke, and that many people do not realise they have it.

According to the NHS, the main symptoms are:

  • Increasing breathlessness, particularly when you’re active
  • A persistent chesty cough with phlegm – some people may dismiss this as just a “smoker’s cough”
  • Frequent chest infections
  • Persistent wheezing

The NHS further explains that the outlook for COPD varies from person to person:

“The condition cannot be cured or reversed, but for many people, treatment can help keep it under control so it does not severely limit their daily activities.

But in some people, COPD may continue to get worse despite treatment, eventually having a significant impact on their quality of life and leading to life-threatening problems.”

The NHS also explain that symptoms usually get progressively worse without treatment. People with COPD may also find that their symptoms get suddenly worse- this is called a flare-up or exacerbation.

What causes COPD?

The main cause of COPD is smoking, and the NHS say it is thought to be responsible for around 9 in every 10 cases.

COPD can also affect people who have never smoked. Some cases of COPD are caused by long-term exposure to harmful fumes or dust. The Health and Safety Executive has published information on occupational causes of COPD.

Research has suggested exposure to air pollution over a long period could increase your risk of COPD but the NHS note that the “link between air pollution and COPD is not conclusive” and research is continuing.

Genetics also play a role. The NHS webpage Causes of COPD says “around 1 in 100 people with COPD has a genetic tendency to develop the condition, called alpha-1-antitrypsin deficiency. Alpha-1-antitrypsin is a substance that protects your lungs. Without it, the lungs are more vulnerable to damage”.

How many people in the UK have been diagnosed with COPD?

Information last updated by the National Institute for Health and Care Excellence (NICE) in 2016 says an estimated 3 million people have COPD in the UK, “of whom 2 million are undiagnosed”.

Prevalence increases with age and most people are not diagnosed until they are in their 50s. There is no single diagnostic test for COPD.

NICE outline how “there are significant geographic variations in the prevalence of COPD, and it is closely associated with levels of deprivation. Unlike many other common chronic diseases, the prevalence of COPD has not declined in recent years”.

NHS Digital data shows that in 2020/21, approximately 1.17 million people in England have been diagnosed with COPD, which is around 1.9% of the population. You can browse this data on Public Health England’s Fingertips dashboard.  You also can view prevalence estimates for constituencies on our constituency health conditions dashboard.

Prevalence is higher in the north of England and in deprived areas – it is estimated that prevalence in the most deprived 10% of areas is almost double that of the least deprived 10%.

Treatment and management of COPD

There is currently no cure for COPD, but treatment can help slow the progression of the condition and control the symptoms.

Treatment options are outlined in the NICE guideline for Chronic obstructive pulmonary disease in over 16s: diagnosis and management.

The NHS have summarised the treatment options available:

  • “Stopping smoking – if you have COPD and you smoke, this is the most important thing you can do
  • Inhalers and tablets – to help make breathing easier
  • Pulmonary rehabilitation – a specialised programme of exercise and education
  • Surgery or a lung transplant – although this is only an option for a very small number of people”

The NHS Long-Term Plan (published in 2019) includes commitments related to respiratory disease, including to  detect and diagnose respiratory problems earlier and increase access to pulmonary rehabilitation.

Reports

Healthcare Quality Improvement Partnership, Chronic Obstructive Pulmonary Disease – Outcomes Report 2020, 9 July 2020

National Asthma and COPD Audit Programme (NACAP), Pulmonary rehabilitation clinical audit interim report, 9 July 2020

National COPD Audit Programme, COPD in England – Finding the measure of success, November 2016

Websites

British Lung Foundation: COPD (chronic obstructive pulmonary disease)

Chronic obstructive pulmonary disease (COPD) statistics

NHS RightCare » Chronic Obstructive Pulmonary Disease (COPD) Pathway

Chronic obstructive pulmonary disease | Topic | NICE

Increasing our understanding of the state of care for people with lung conditions will help shape care in the future | British Lung Foundation

Managing my COPD | British Lung Foundation

COPD flare-ups | British Lung Foundation

Welfare benefits | British Lung Foundation

Caring for someone with a lung condition | British Lung Foundation

End of life | British Lung Foundation

Parliamentary Questions

Lung Diseases: Research

28 Oct 2021 | HL3174

Asked by: Lord McKenzie of Luton

To ask Her Majesty’s Government what support and funding they are providing for research into respiratory diseases.

Answering member: Lord Callanan | Department: Department for Business, Energy and Industrial Strategy

Over the last 5 years (2016/17 to 2020/21), UK Research and Innovation (UKRI)’s Medical Research Council (MRC) has spent over £155.6 million on research relevant to respiratory health and disease.

This figure includes just under £142 million spent on research specifically relevant to respiratory disease (including areas such as Asthma, Pulmonary Tuberculosis, Pneumonia and other respiratory Infections, Cancer, and Chronic Obstructive Pulmonary Disease). Figures do not include spend on research relating to Covid-19.

Lung Diseases: Health Services

01 Sep 2021 | HL2069

Asked by: Lord Hunt of Kings Heath

To ask Her Majesty’s Government what early intervention measures and improvements to ‘continuity of care’ for patients with chronic respiratory conditions were adopted between 2010 and 2019 in England.

Answering member: Lord Bethell | Department: Department of Health and Social Care

A series of early intervention measures and improvements to continuity of care were adopted between 2010 and 2019.

In 2011, the Department’s outcomes strategy for chronic obstructive pulmonary disease (COPD) and asthma set out an objective to reduce the number of people with COPD who die prematurely. This was through a proactive approach to early identification, diagnosis and intervention, and proactive care and management at all stages of the disease. The outcomes strategy for COPD and asthma is attached.

In 2013, a guide to performing quality assured diagnostic spirometry was produced. The foreword of the guide says that around a quarter of people on general practice COPD registers did not meet the diagnostic criteria for COPD, and it could be that misdiagnosis occurred because much of the diagnostic spirometry performed failed to meet the essential quality standards. The guide was published to support accurate diagnosis of respiratory conditions. This guide is attached.

Developed in 2017, the NHS RightCare COPD pathway defines the core components of an optimal service for people with COPD. This includes timely access to Pulmonary Rehabilitation as part of the optimal treatment pathway and timely diagnosis as part of the pathway which help with early intervention measures.

The final measure adopted in this period was The National Asthma and COPD Audit Programme which was launched in March 2018 and is led by the Royal College of Physicians. The aims of this programme are to improve quality of care, services, and clinical outcomes for patients with asthma and COPD by collecting and providing data on a range of quality improvement indicators.

Lung Diseases: Rehabilitation

08 Jan 2021 | HL10356

Asked by: Baroness Masham of Ilton

To ask Her Majesty’s Government what steps they are taking to improve pulmonary rehabilitation services; and what funding has been allocated to any such work in the 2020/21 financial year.

Answering member: Lord Bethell | Department: Department of Health and Social Care

Respiratory disease is a national clinical priority in the NHS Long Term Plan and increasing access to pulmonary rehabilitation is part of this. NHS England and NHS Improvement working in close partnership with patients and partners, including the British Lung Foundation, are developing and implementing policy on provisions of pulmonary rehabilitation services in England.

The National Respiratory Programme is part of the wider Cardiovascular Disease and Respiratory programme which was allocated £15 million of NHS Long Term Plan funding for 2020/21.


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