Towards the elimination of COPD

A summary of a commission article published in The Lancet

A new article has suggested that we need to rethink how we approach COPD. To pave the way for prevention and, ultimately, to eliminate the disease.

The commission article, published in The Lancet, is written by leading experts from across the world and provides recommendations for improving COPD care and changing health policy.

The authors advocate for several things:

  • A broader understanding of risk factors, including the effect of global poverty, and what measures we can take to prevent these.
  • Changes to the way COPD is diagnosed. So that it does not only rely on airflow measurements, but also looks at earlier changes in the lungs that could be reversed.
  • Grouping COPD into different types that share similarities, as this could lead to new prevention and treatment strategies for each subtype.
  • New approaches to the diagnosis and assessment of COPD exacerbations that focus on how the disease is affecting the body.
  • Coordinated plans to tackle the disease through extra funding, policy interventions and system reform to create a path towards prevention and cure rather than crisis management.

The authors also call for a ban of smoking in all its forms and a wider understanding of the risk factors not linked to tobacco. These include preterm birth or low birthweight, early-life infections, and indoor and outdoor pollution.

Pippa Powell, Director of the European Lung Foundation, and an author of the paper, said:

“The Lancet Commission has proposed some radical steps towards better understanding and eliminating COPD and improving the lives of people living with the condition. We need to reset people’s concept of COPD and remove the stigma, change conversations around it and promote lung health from the moment of conception and throughout our lives. We hope this paper will act as a catalyst for change and that people living with the disease will be at the heart of that change.”

Recommendations for the elimination of COPD


Practical goals

Prohibit all kinds of smoking including—but not restricted to—cigarette smoking, water-pipe smoking, e-cigarette smoking (vaping), cannabis smoking, and smoking of other combustible substances

50% of countries to ban smoking by 2035

Eliminate environmental exposures to anything but clean air, including indoor and outdoor pollution, wildfire smoke, and occupational exposures to toxic fumes and gasses; regulatory authorities should strengthen legislation governing acceptable levels of exposure to inhalable particulate matter and ozone

50% of countries to introduce annual limits (lower than those recommended by WHO) for exposure to inhalable particulate matter <2·5 μm in diameter, particulate matter <10 μm in diameter, and ozone

Support measures associated with improved and sustained general health, including reductions in global poverty and improvements in nutrition, vaccination, prenatal care, physical activity, and mental health

At least a 50% reduction in people living below the poverty-line by 2035; all countries should provide free vaccinations and mobilise educational campaigns to inform at-risk individuals; free or low-cost health care for all

Diagnose COPD based on expanded criteria, including the presence of respiratory symptoms, personal history of risk factors, and persistent airflow limitation or ventilatory heterogeneity (as assessed by spirometry, other pulmonary function testing, or CT)

By 2035, the proportion of patients diagnosed with mild spirometric airflow obstruction should increase to at least 50% of the total

Research and development should focus on treatment of early disease

By 2030, 75% of published clinical trials should be focused on patients with early or mild disease

COPD should be classified into one of five types on the basis of the predominant risk factor present to increase awareness of risk factors, improve detection of people with non-smoking-related COPD and those with early disease, and foster research into therapies targeting specific disease mechanisms

COPD diagnosis by type should be included in the International Classification of Diseases coding system

By 2035, at least one specific pharmacological or non-pharmacological therapy should be approved for each type of COPD

Diagnosis of exacerbations should be based on a standard assessment confirmed by evidence of worsening airflow limitation or ventilatory heterogeneity, airways or systemic inflammation, or lung infection in a patient with increased respiratory symptoms (after exclusion of other disorders that mimic this presentation)

Exacerbation frequency should be similar worldwide by 2035 as a result of the establishment of a standard definition and assessment

Effective pharmacological and non-pharmacological therapies should be made available worldwide; development of new therapies should focus on underlying pathophysiology and take into account disease heterogeneity (including COPD type)

By 2035, at least 80% of patients with COPD should have disease control, as evidenced by the absence of respiratory symptoms and exacerbations and normal or near-normal quality of life, exercise capacity, and life expectancy

Definitions of treatment effectiveness should take patient-reported outcomes into account

By 2030, 75% of studies should include a patient-centred outcome as a primary outcome

Regulatory agencies should regularly revisit and update endpoints for clinical trials of treatments for different COPD types

By 2035, 75% of new therapies should be approved on the basis of non-spirometric criteria

Funding agencies should increase financial investments to adapt to the worldwide burden of COPD

By 2030, the total public and private global research and development expenditures for COPD should increase by 50%

Further reading

Read the original research paper:

Title: Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission