This article was developed and funded by Chiesi.
The UK National Screening Committee (NSC) is currently reconsidering whether population screening for chronic obstructive pulmonary disease (COPD) should be introduced. It is a prime opportunity to evaluate how, as a nation, we can improve respiratory outcomes.
From our work, data and clinical consensus appears to be clear: population screening for a condition like COPD is unlikely to represent good value for the NHS. However, targeted screening, or case finding, among those at high risk, most certainly does. Rather than focusing on blanket screening, there is an opportunity to implement targeted approaches that can improve outcomes and help address health inequalities.
The impact of COPD
COPD affects an estimated 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 people are only diagnosed once their condition is already advanced. 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 and respiratory disease a major contributor to winter pressures on the NHS.[2],[3] COPD costs the NHS approximately £1.9 billion annually.[4]
The burden of COPD is also not evenly distributed, with social inequalities contributing both to the development of COPD and to disparities in the quality-of-care and outcomes people experience.[5]
The UK NSC has previously concluded that population-wide screening for COPD does not meet the criteria for recommendation due to uncertainties around cost-effectiveness and clinical benefit.[6] While this assessment, on the face of it, is reasonable, a population approach is not the only option available to the NSC. They now have an expanded remit to look at the value targeted screening could bring to patients, the NHS and society.
A useful precedent is 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 to 74 with a history of smoking.[7] 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.[8] This targeted model actively seeks out those most likely to benefit and brings them in for assessment. We believe that the same principle can, and should, be applied to COPD.
Increasingly, evidence supports a shift towards targeted case finding, proactively identifying those at high risk to enable earlier diagnosis and timely intervention.
Real-world evidence: the case for targeted screening
Recognising the significant challenges associated with timely COPD diagnosis, Chiesi is working collaboratively with the NHS to understand the feasibility and value of targeting those at high risk of COPD via various hospital-based and neighbourhood programmes.
One of which is FRONTIER Hull, a collaborative working project with NHS Humber Health Partnership, in which we’re inviting those who went through NHS Lung Cancer Screening as part of the cancer pathway, back in for assessment if they showed signs and symptoms of COPD. Data from the project has demonstrated that around half of people assessed were diagnosed with COPD.[9]
Health economic modelling also developed as part of the project suggests that implementing targeted COPD case finding could save the NHS an estimated £33 million over 10 years.[10],[11] Beyond the financial case, the principle is clear: earlier identification enables earlier intervention, shifting care away 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.
A practical and cost-effective way forward
Importantly, this approach doesn’t necessarily require new systems or technologies. As shown through the FRONTIER Hull project, assessment can be integrated into existing services, with other community models also emerging.
With Lung Cancer Screening and Community Diagnostic Centres expanding, there’s a real opportunity to move respiratory care away from the hospital. The question isn’t whether to screen everyone, but how to scale targeted approaches for those most at risk.
The current consultation offers a timely chance to refocus on the right priorities.
Find out more about FRONTIER Hull here.
March 2026 l UK-CHI-2600115
[1] NICE Clinical Knowledge Summaries. Chronic obstructive pulmonary disease: Prevalence and incidence. Available at: https://cks.nice.org.uk/topics/chronic-obstructive-pulmonary-disease/background-information/prevalence-incidence/. Last accessed: March 2026.
[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.
[5] Philip K, Gaduzo S, Rogers J, et al. 2019. Patient experience of COPD care: outcomes from the British Lung Foundation Patient Passport. BMJ Open Respir Res.
[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] NHS. Lung cancer screening. Available at: https://www.nhs.uk/tests-and-treatments/lung-cancer-screening/. Last accessed: March 2026.
[8] 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.
[9] 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. Last accessed: March 2026.
[10] 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.
[11] Chiesi UK and Ireland. Data on File.
