Breathless Britain

Health inequalities in the UK are well documented. But few conditions expose their scale as clearly as chronic obstructive pulmonary disease (COPD).

COPD is a serious, progressive lung disease affecting around 1.4 million people in the UK, with a further estimated two million living undiagnosed. 

Yet its story is not simply one of clinical need. It is shaped by where people live, the air they breathe, the work they do, and the opportunities available to them.

Seen through this lens, respiratory health becomes more than a medical issue, it becomes a barometer of inequality, offering a clear and measurable way to understand how disadvantage is distributed across society. 

There is a clear social gradient: people in more deprived areas are more likely to develop the disease earlier and experience worse outcomes. For example, those in the most deprived communities are more than twice as likely to be admitted to hospital for respiratory conditions, including COPD, as those in the least deprived. 

This reflects a clustering of risk factors, including higher smoking rates, poorer air quality, and exposure to harmful housing and working conditions. Geography reinforces this pattern, with higher rates often seen in post-industrial towns and coastal communities, areas that have long faced economic and social challenges. These patterns show that inequality is not abstract, it is visible, measurable, and deeply entrenched in place.

COPD captures both cause and consequence. The same factors that increase risk also shape how early the disease is diagnosed and how well it is managed. Ultimately, how long people live.

However, its impact extends far beyond health. COPD contributes significantly to long-term sickness, which in turn impacts workforce inactivity, particularly in areas already facing economic challenges and lower employment opportunities.

More than 2.5 million people in the UK are currently out of work due to long-term sickness, the highest level on record. 

One in four of the estimated 3.4 million people living with COPD are of working age, and the condition is estimated to cost the UK economy around £1.9bn each year through lost productivity, healthcare use and informal care, with COPD accounting for 24 million lost working days each year.

This creates a damaging cycle. Poor health limits people’s ability to work, reducing income and opportunity, which in turn reinforces deprivation and increases exposure to the drivers of ill health.

At a system level, the consequences are profound. Workforce inactivity constrains productivity, slows local growth, and increases pressure on public services. Improving respiratory health is not just a clinical priority, but an important driver of productivity and a critical tool for supporting  inclusive economic growth.

Those most affected by COPD are often those already underserved by the health system. They face barriers to early diagnosis, access to care and effective long-term management, meaning many are diagnosed later, when disease is more advanced. 

This worsens outcomes and drives avoidable pressure on the NHS; COPD accounts for 130,000 hospital admissions per year, equivalent to the population of a town like Exeter, making it the second most common cause for hospital admissions in England each year. 

Without targeted intervention, these inequalities will widen as the underlying drivers of deprivation, environmental exposure and unequal access to care persist.

There is growing recognition of the need to address place-based inequality, particularly in communities that feel economically and socially left behind. Respiratory health should be central to this agenda, offering a clear opportunity to improve health while supporting a stronger workforce and economy.

COPD provides a measurable way to identify where inequality is most acute and where action is most urgently needed.

Encouragingly, some parts of the country are already demonstrating what is possible. In some regions, targeted case-finding and community diagnostic centres are enabling earlier diagnosis and reducing hospital admissions. 

One example is the Respiratory Transformation Partnership (RTP) – a new national coalition – bringing together the NHS, the Office for Life Sciences, health innovation networks, patient groups and four major industry partners including Sanofi. 

This initiative represents a deliberate, system-level investment in how respiratory care is designed, delivered and scaled across the NHS. Together, these examples show that inequality is not inevitable, it can be reduced with the right focus, investment and coordination.

The challenge now is to scale what works, ensuring that best practice is not confined to pockets of the system, but delivered consistently across the country. 

Addressing COPD will require action at multiple levels. A step change is needed in how the condition is identified and managed, alongside improved access to treatment and support.

A key priority is improving diagnosis, particularly in areas with higher prevalence and where patients are more likely to be diagnosed later. Access to testing must be consistent nationwide, supported by a proactive approach to identifying those at risk and greater support for primary care to improve diagnostic accuracy.

There is also growing interest in how data and digital tools, including artificial intelligence, could help address this. Used responsibly, these tools could support clinicians to identify people at risk earlier and target interventions more effectively. 

Their value lies in helping the system act sooner and more consistently, reducing avoidable hospital admissions and variation in care. They should support clinical judgement, not replace it.

This needs to be matched by a stronger focus on helping people stay well for longer. Access to pulmonary rehabilitation and core care remains uneven, with too many patients lacking the support needed to manage their condition effectively outside hospital. 

Expanding community-based services, strengthening self-management and prioritising prevention will be critical.

At the same time, access to specialist care should become timelier and more consistent. Closer integration between primary and secondary care, alongside greater use of community, mobile and virtual services, can help reduce delays and ensure patients receive the right care at the right time, regardless of where they live. 

Without a coordinated approach across the pathway, existing inequalities in access and outcomes will continue to persist and grow.

Yet, clinical care alone is not enough. The wider drivers of respiratory health such as smoking, air quality, housing and occupational exposure, must also be addressed through coordinated action across government, the NHS, local authorities and industry.

A more targeted, place-based approach will be key, directing resources to areas with the greatest need and using data to track progress and outcomes. COPD is more than a disease. 

It is a signal of where inequality is most deeply rooted. Improving respiratory health offers a tangible opportunity to reduce inequality, support workforce participation, and drive more inclusive economic growth.

The question is not whether we can afford to act; it is whether we can afford not to. 

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