Driving change in COPD

We need to unite to drive change in COPD globally, writes Professor John Hurst.
Professor John Hurst | Source: AstraZeneca

By Professor John Hurst

John Hurst is Professor of Respiratory Medicine at University College London and Co-Chair of the COPD Global Policy Steering Committee.

01 Mar 2021

Working as a respiratory specialist during the current COVID-19 pandemic, never has my area of work been at the centre of global attention more. But most respiratory diseases, such as Chronic Obstructive Pulmonary Disease (COPD), continue to be overlooked.

COPD is a progressive condition that is characterised by persistent symptoms including chronic coughing and shortness of breath. Despite COPD being the third leading cause of death globally, responsible for more deaths than cancer each year and affecting an estimated 384 million people worldwide, it still does not receive the same level of recognition and prioritisation in clinical care, healthcare policy and research.

This has a devastating impact on people living with COPD. A lack of symptom and risk factor awareness often results in patients being diagnosed late when the disease severity has increased; an approach that would be unthinkable in other areas of medicine. Between 49 percent and ~74 percent of patients experience a worsening of symptoms, known as an exacerbation or ‘flare up’, at least once within three years of their diagnosis, with just one of these exacerbations able to significantly reduce a patient’s life expectancy. This particularly affects those with advanced disease, as they experience exacerbations more frequently.

Non-pharmacological and pharmacological therapies are clinically proven to reduce mortality, symptoms, and the frequency of acute exacerbations. However, barriers in global health systems, such as non-adherence to guidelines,, staffing levels, inadequate follow-up after hospital discharge, and the availability and quality of a key exercise and education programme called pulmonary rehabilitation, are currently impacting timely and appropriate access to therapies. Sadly, the effect of this has been felt during COVID-19 where patients have been particularly vulnerable, facing a 60 percent increased mortality risk versus non-COPD patients.

To address these worrying trends, we urgently call on policymakers and health providers to prioritise support for access to both pharmacological and non-pharmacological therapies for people living with COPD. The use of pharmacological therapies, in line with the latest global treatment guidelines published by GOLD, should be prioritised to improve clinical outcomes, health related quality of life and slow disease progression for COPD patients.

“Despite COPD being the third leading cause of death globally… it still does not receive the same level of recognition and prioritisation in clinical care, healthcare policy and research”

Earlier and accurate diagnosis of chronic respiratory diseases is critical. For this, better processes to identify those most at risk must be adopted globally to reduce variation in diagnosis rates, and public health bodies should work to increase awareness of common COPD risk factors and symptoms in the general public, so patients are informed and empowered to seek diagnosis.

Finally, the management of exacerbations should be optimised as part of care provision policies such that acute exacerbations are recognised as an opportunity for accelerated management.

These key principles of care are outlined in the recent global Patient Charter I co-authored, which aims to drive better standards of care for all people living with COPD. Just like COVID-19, it is only as a united global community can we drive change and ultimately save lives.


Organised and funded by AstraZeneca