COPD AND THE MISSING MILLIONS
Chronic obstructive pulmonary disease (COPD) affects an estimated three million people in the UK, yet nearly two million remain undiagnosed, representing the UK’s “missing millions”.1
Since COPD is a progressive disease, early intervention is needed to help reduce the risk of permanent lung damage and exacerbations.2,3 With symptoms such as breathlessness, fatigue and persistent cough often dismissed as ageing or lifestyle-related, many people are only diagnosed once their condition is already advanced.2 This leads to avoidable hospital admissions and poorer health outcomes, with COPD exacerbations now the second most common cause of emergency hospital admissions in the UK.1
The key diagnostic gateway for COPD is currently spirometry, yet its availability remains patchy.4 Spirometry services were paused in the UK during the COVID-19 pandemic and many areas are struggling to restore capacity, leading to ongoing backlogs and variation in access.5 Workforce shortages, limited numbers of ARTP-accredited clinicians, and lack of confidence in interpreting results, all bring challenges that directly undermine the ambition in the NHS Long Term Plan for earlier, more accurate respiratory diagnoses.4,5
Explore our projects designed to help find the 'missing millions' below.
FRONTIER HULL
FRONTIER Hull (Finding the hidden millions: restoration of early COPD diagnosis for Hull Lung Cancer Screening Programme participants to optimise treatment and improve outcomes) was a collaborative working project between Chiesi and Hull University Teaching Hospitals NHS Trust (now part of NHS Humber Health Partnership).
The project explored how targeted approaches could help address gaps in COPD diagnosis and share learning with the NHS. Through a one‑stop diagnostic clinic, offering symptom assessment and lung function testing to over 1,000 people, over 50% of people assessed were diagnosed with COPD after previously attending the NHS Lung Cancer Screening Programme.6
FRONTIER Hull demonstrated that targeted diagnostic pathways can improve access to testing, support earlier diagnosis and enable more timely care. With COPD affecting around three million people in the UK and costing the NHS approximately £1.9 billion each year, the project provides a scalable, evidence‑based approach that could help reduce avoidable exacerbations and pressure on emergency care.3
Watch the video below to learn more about the project:
“Our project highlights the burden of undiagnosed COPD among those attending the Lung Health Check programme in Hull. Many of those diagnosed with COPD during FRONTIER were living with daily symptoms but had not been able to access treatment due to a lack of diagnosis. We were shocked at how many patients we were diagnosing with severe symptoms since previous barriers to COPD screening has been the argument that many people of those found would be living without symptoms or fairly minimal symptoms. Identifying people who are at high risk of COPD and offering diagnostic testing enables access to evidence-based COPD care that has potential to significantly improve health 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
The FRONTIER Hull project is now complete.
Read the FRONTIER Hull output report
Please click here to read the executive summary of the FRONTIER Hull project.
FRONTIER 2
FRONTIER 2 is a collaborative working project between Chiesi and Hull University Teaching Hospitals NHS Trust, building on the success of FRONTIER by bringing COPD care closer to home.
Following the impact delivered in the previous project - which diagnosed over 500 patients in an outpatient hospital setting, we’ve evolved this model to take care into the community.6
FRONTIER 2 delivers the same one-stop diagnostic clinic approach via Community Diagnostic Centres (CDCs), supporting the NHS Long Term Plan of bringing healthcare closer to home. As part of our aim to test the viability of a feasible targeted case finding solution that could be taken up by the NHS in future, it is important to assess different models and how they could be implemented.
FRONTIER 2 will take place between December 2025 and January 2027. Read more about the project by visiting the executive summary and check back regularly as we will update this section as further insights become available.
Please click here to read executive summary of the project.
COMET
COPD is closely linked to socioeconomic deprivation, and in the Wirral, its prevalence is 2.6% - significantly higher than the England average of 1.8%. Research by the Cheshire and Merseyside Integrated Care Board (ICB) highlights a pressing issue: there are approximately 5,000 people in the region living with undiagnosed COPD, missing out on vital treatment and support.7
COMET (COPD Targeted Management, Early Intervention and Treatment) is a collaborative working project between Chiesi and Wirral Primary Care Collaborative to ensure timely COPD diagnosis. The partnership focuses on preserving lung health and preventing further decline in patients identified through the NHS Lung Cancer Screening Programme on the Wirral. The project provides targeted diagnostics for people at high-risk of COPD. This includes diagnosis using spirometry and follow-up care in the community, offering tailored treatment plans.
The COMET project is currently under way. We will update this section when further insights become available.
Read the COMET output report
Please check back from time to time and click here to read the executive summary of the project.
BREATHE
BREATHE (the Best Respiratory Evaluations And Treatments in Healthcare Efficiency) was a collaborative working project between Chiesi and Fuller and Forbes Healthcare Group, dedicated to strengthening diagnostic infrastructure in primary care. This initiative aimed to enhance diagnostic capabilities for people who are awaiting a COPD diagnosis. By expanding the capacity for spirometry and other diagnostics at the primary care level, reliance on secondary care services and diagnostic hubs is reduced, empowering and upskilling primary care staff to provide more effective, timely care.
The collaborative working project was implemented across 17 primary care practices within the Fuller and Forbes Healthcare Group.
The BREATHE project is now complete.
Read the BREATHE output report
Please click here to read the executive summary of the project.
References
- National Institute for Health and Care Excellence. Chronic Obstructive Pulmonary Disease: How Common Is It? NICE. 2025. Available at: https://cks.nice.org.uk/topics/chronic-obstructive-pulmonary-disease/background-information/prevalence-incidence/
- NHS. Chronic obstructive pulmonary disease (COPD). Available at: https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/
- 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
- Asthma + Lung UK. ICS respiratory review – spirometry. Available at: https://www.asthmaandlung.org.uk/healthcare-professionals/ics-respiratory-review/spirometry
- Doe G, Taylor SJC, Marko Topalović, Russell R, Evans RA, Maes J, et al. Challenges and opportunities in resuming spirometry services in England post-pandemic with potential to adopt Artificial Intelligence decision support software: a qualitative study. British Journal of General Practice. 2023 Jul 6;73(737):BJGP.2022.0608–8. Available at: https://bjgp.org/content/bjgp/73/737/e915.full.pdf
- Chiesi data on file.
- Data on file.
UK-CHI-2600289 | July 2026