Politics Home Article | Targeted COPD case finding: a practical next step for the UK

This article has been developed and funded by Chiesi UK&I

The true burden of COPD

COPD affects around three million people in the UK, yet nearly two million remain undiagnosed.¹ Symptoms such as breathlessness, fatigue and persistent cough are often dismissed as ageing or lifestyle-related, meaning many are only diagnosed once their condition is advanced. COPD exacerbations are the second leading cause of emergency hospital admissions in the UK and a major contributor to winter pressures on the NHS,^2,3 costing the NHS approximately £1.9bn annually.⁴

The burden of COPD is not evenly distributed, with health constituency data showing that the highest prevalence is concentrated in the North of England,⁵ and likely higher due to the number of people living with undiagnosed COPD.

Rethinking the case for COPD screening

The UK has a strong track record of delivering targeted screening programmes in areas of high need. Three national cancer screening programmes exist for bowel, cervical and breast cancers, and now a lung cancer screening programme is being rolled out across England.

The UK NSC is currently reviewing screening for COPD in the general adult population. Given the breadth of the NSC’s review, it is unsurprising that the committee recommends against population-wide screening for COPD.

This is not a new position. In 2018, the UK NSC determined that population-wide screening did not meet the recommendation criteria, citing uncertainty around cost-effectiveness and clinical benefit.⁶ Whilst that assessment remains reasonable, population screening is not the only option to achieve improved outcomes for people living with COPD symptoms but who are undiagnosed and potentially untreated.

Importantly, the committee has expanded its remit to consider targeted screening, mirroring the approach in lung cancer, where the NHS does not screen the entire population but instead focuses on defined high-risk groups such as people aged 55-74 with a history of smoking.^7,8 The Welsh Government has also committed to introducing a similar national targeted lung cancer screening programme, confirming this will include standardised protocols for managing incidental findings of other conditions, such as COPD.⁹ The current consultation represents a timely opportunity to evaluate how a targeted approach could improve COPD outcomes.

Learning from lung cancer screening

In England, the NHS Lung Cancer Screening Programme is identifying large numbers of people with suspected COPD through incidental CT scan findings, which are detailed scans that can help identify problems in the lungs.¹⁰ Of the approximately 1.2 million lung health checks completed to date, over 7,000 lung cancers were diagnosed, and, incidentally, over 100,000 cases of emphysema were also found.¹¹ While people with lung cancer entered specific care pathways, no consistent pathway exists for diagnosing and managing suspected COPD. This means that for every patient receiving a lung cancer diagnosis and treatment, 13.5 people with emphysema are not getting the opportunity for the same level of care.

A strong case for targeted screening

Recognising the challenges with timely COPD diagnosis, Chiesi is working with the NHS to understand the feasibility and value of targeted case finding in high risk groups through hospital-based and neighbourhood programmes. One example is our FRONTIER Hull programme, a collaborative working project with Hull University Teaching Hospitals NHS Trust, which invites individuals identified through the NHS Lung Cancer Screening back for COPD assessment.

Nearly 50 per cent of people assessed were diagnosed with COPD.¹² Health economic modelling also suggests that targeted COPD case finding could save the NHS an estimated £33m over 10 years.^13,14 Beyond cost savings, earlier identification enables earlier intervention, shifting care from avoidable exacerbations and emergency admissions towards prevention, proactive management and improved outcomes.

“Data generated as part of our FRONTIER Hull project clearly demonstrate that case-finding among high-risk individuals with features of disease, rather than population screening, identifies a significant number of people with undiagnosed COPD. COPD is a progressive disease that becomes highly debilitating over time – these patients are often unable to work and struggle with simple day-to-day activities such as walking up the stairs. Earlier identification and diagnosis can enable people to access evidence-based treatments to improve their outcomes.”  

– 

Professor Michael Crooks, Consultant in Respiratory Medicine at NHS Humber Health Partnership and Professor of Respiratory Medicine, Hull York Medical School, University of Hull.

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Looking forward

This approach doesn’t require new systems. As the FRONTIER Hull project demonstrates, COPD assessment can be integrated into existing services, with other community models also emerging.

As Lung Cancer Screening and Community Diagnostic Centres expand, we have a pivotal opportunity to align respiratory care with the NHS shifts from hospital to community and from sickness to prevention. The question isn’t whether to screen everyone, but how to scale targeted approaches for those most at risk.

This consultation offers a timely chance for the UK NSC to refocus by conducting a new evidence map that explores targeted screening over a population-wide approach.

Find out more about FRONTIER Hull here.

March 2026                                                                                             UK-CHI-2600116

References

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2. The Health Foundation. Variation in patient pathways and hospital admissions for exacerbations of COPD: linking the National Asthma and COPD Audit with CPRD data. Available at: https://www.health.org.uk/funding-and-fellowships/projects/variation-in-patient-pathways-and-hospital-admissions-for. Last accessed: March 2026.
3. NHS England. Respiratory disease. Available at: https://www.england.nhs.uk/ourwork/clinical-policy/respiratory-disease/. Last accessed: March 2026.
4. NHS England. Respiratory high impact interventions: Available at: https://www.england.nhs.uk/ourwork/prevention/secondary-prevention/respiratory-high-impact-interventions/#:~:text=The%20annual%20economic%20burden%20of,the%20UK%20%C2%A311billion%20annually. Last accessed: March 2026.
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6. UK National Screening Committee. (June 2018) Screening for chronic obstructive pulmonary disease (COPD) in the general adult population: External review against programme appraisal criteria for the UK National Screening Committee. Solutions for Public Health. Available at: https://view-health-screening-recommendations.service.gov.uk/document/86cb8a05-d1d5-4dcd-84ec-e848631bb4ba/download
7. UK National Screening Committee. Updated definition of targeted screening will help clarify remit of expanded UK NSC. Available at: https://nationalscreening.blog.gov.uk/2022/05/26/updated-definition-of-targeted-screening-will-help-clarify-remit-of-expanded-uk-nsc/. Last accessed: March 2026.
8. NHS. Lung cancer screening. Available at: https://www.nhs.uk/tests-and-treatments/lung-cancer-screening/. Last accessed: March 2026.
9. Welsh Government (2025). Written Statement: A National Lung Screening Programme for Wales. Available at: https://www.gov.wales/written-statement-national-lung-screening-programme-wales. Last accessed: March 2026.
10. NHS. Chronic obstructive pulmonary disease (COPD): Diagnosis. Available at: https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/diagnosis/. Last accessed: March 2026.
11. UK Parliament. Written question 67321: Lung Cancer: Screening (answered 25 July 2025). Available at: https://questions-statements.parliament.uk/written-questions/detail/2025-07-14/67321. Last accessed: March 2026.
12. Chiesi Ltd. FRONTIER Hull data reveals 50% diagnosis rate in COPD case‑finding programme… Available at: https://www.chiesi.uk.com/media/press-releases/frontier-hull-data-reveals-diagnosis-rate-in-copd
13. Brindle K, Watkins K, Gilroy-Cheetham J, Maxted C, Niazi-Ali S, Crooks M (2025). The burden of undiagnosed COPD among lung cancer screening participants. Presented at the European Respiratory Society (ERS) Congress 2025.
14. Chiesi UK and Ireland. Data on File.