The burden of COPD on European countries

COPD places a considerable burden on healthcare systems, with annual direct costs of €38.6 billion, corresponding to 56% of the total cost of treating respiratory diseases and 6% of total healthcare spending in the European Union [7]. Lung health programmes, including public health initiatives for early COPD detection and prevention, as well as comprehensive COPD care management plans, effectively reduce the burden of COPD by increasing early diagnosis and reducing mortality [8].

The direct and indirect costs associated with COPD have steadily increased over time, mainly driven by poor pharmacological and non-pharmacological management of the condition. Hospitalisation costs range from €1,316 for mild COPD to €8,472 for severe COPD [9]. Indirect costs, largely due to decreased productivity and early retirement of patients, outweigh direct costs by over 60%. In addition, hidden costs related to informal caregiving and out-of-pocket expenses further impact patients and families, particularly those with lower incomes.

The EFA report found that only a few countries implement effective strategies for reducing COPD costs, and often they exist only in certain regions within a country.

Disease awareness and Prevention

Limiting exposure to risk factors, primarily cigarette smoking and environmental pollutants, can largely prevent COPD.

Essential strategies include increasing access to smoking cessation programmes, incentivising primary care physicians to promote quitting, and implementing comprehensive smoke-free policies, also considering the rising threat of vaping among youth. Moreover, countries should adopt measures to improve outdoor and indoor air quality and mitigate the impact of climate change through legislation that promotes healthier indoor environments, pollution reduction measures and measures to protect at-risk individuals from the effects of climate change.

Early detection and diagnosis

Early diagnosis of COPD is essential for halting disease progression and improving long-term outcomes. Patients diagnosed with mild COPD may not experience a reduction in life expectancy compared to healthy people [10]. On the contrary, 75% of patients who were initially misdiagnosed went on to develop moderate to severe COPD, thereby increasing the risk of death [10] [11].

Unfortunately, COPD often remains undiagnosed due to a lack of awareness and limited access to simple diagnostic tests like spirometry.

National and regional policies should therefore establish proactive early detection policies that include public awareness campaigns and spirometry screening for people at risk.

Furthermore, research into the pathophysiology and biomarkers of COPD could further facilitate early diagnosis, especially for nonsmokers [12]. EU funding should prioritise research on the development trajectories of chronic lung disease and for the identification of new biomarkers for very early diagnosis.

Access to COPD care: A fragmented picture

Along with early diagnosis, access to optimal care for COPD patients is the second pillar to prevent the progression of COPD. Regional and local differences hinder access to care, with patients living in rural and less populated areas facing the highest inequality in receiving adequate healthcare compared to those in more urban or populated areas.

EFA’s report reveals profound health inequalities, as not all patients with COPD have guaranteed access to healthcare, including personalised management plans for all COPD patients and access to vaccination.

Active living and improving quality of life

Maintaining an active lifestyle is crucial for improving quality of life, yet many patients struggle with physical activity as a consequence of decreased lung function, this leads to worse disease control and negative effects on mental and physical health [13]. Patients’ organisations propose community-based programmes to promote active living, but they require more structured funding to support these initiatives.

Digital health solutions for patients with COPD

Digital health solutions have the potential to enhance access to care, treatment adherence, and empower COPD patients to take an active role in their own care.

Patients, particularly those of advanced age, are more comfortable using familiar technologies, such as smartphones [14]. Moreover, factors like digital literacy continue to impact access to telemedicine. Digital health initiatives should be designed to align with patients’ preferences and should not replace in-person interactions with healthcare professionals [15].

The impact of Covid-19 on the care of COPD patients

COPD patients are more vulnerable to developing severe respiratory infections. Moreover, the restrictions due to the pandemics increased the feeling of isolation and hindered access to follow-up visits. The main impact of the pandemic on COPD care was the delay in diagnoses, after the pandemic years, the number of newly registered COPD patients decreased by 44%. Moreover, as a consequence of the increased demand for pulmonary rehabilitation for patients recovering from Covid-19infection, COPD patients experienced restrictions in accessing such important therapy.