Missing Millions With <scp>COPD</scp>

There are an estimated 400 million people in the world living with chronic obstructive pulmonary disease (COPD). Most live in the Global South, and most remain undiagnosed (and so untreated). That said, wherever you live in the world, underdiagnosis of COPD leading to avoidable ill-health and preventable early death, with consequent economic implications for society and health services, is a considerable problem. The British Lung Foundation (now Asthma + Lung UK) referred to this group as the ‘missing millions’ and they are hiding in plain sight: in clinics for other long-term conditions, in those presenting with recurrent chest infections, and in those with risk factors such as tobacco-smoke exposure. And yet still the diagnosis is not made. Changing this is a challenge that the respiratory community must rise to, and two reports have recently been released which help us here. Close to home, for me at least, is the excellent ‘COPD Voices: A matter of life and breath’ report developed in the UK by colleagues at Kings College London (https://www.kcl.ac.uk/sims/assets/copd-voices-final-29042025.pdf). If we really want to do better for people with COPD we should listen to their lived experience, and the report makes sobering reading. It also has useful recommendations, which include the need for prompt and accurate diagnosis, and providing comprehensive information about COPD at the point of diagnosis (as would happen with other conditions such as diabetes). Simple things, done well can make a big difference. At a global scale, the recent 78th World Health Assembly adopted a Lung Health resolution (https://www.who.int/news/item/23-05-2025-seventy-eighth-world-health-assembly---daily-update--23-may-2025). It is broad and ambitious, considering COPD and other non-communicable lung diseases, lung infections such as pneumonia and TB, smoking and air pollution. This means that WHO and member states should be considering national context and priorities and developing or strengthening integrated approaches to lung health. Quite rightly, the focus is on primary care. Our challenge as a respiratory community is to affect change in policy and clinical practice. For those of us trained as clinicians and scientists, this is not our natural habitat. But if we really want to make a difference for people with lung health problems, we need to be better at speaking to, and influencing policy makers, be that at a local, national, or international level. I'm not suggesting we all need to be scholars of rhetoric, in the classical sense, but some of the principles of rhetoric, using pathos (appealing to the emotions of the audience) and logos (using evidence) can be a really helpful start to becoming more confident in having these conversations. Bring your ethos too! At a personal level, the most impactful conversations I've seen are where clinicians and those living with COPD stand together with one voice. Right now, where you work, there's a lot of undiagnosed COPD out there (wherever you work). Ask yourself this: what more can I do, not just for the patients I see, but for those undiagnosed: let's find the missing millions. The author's team were involved in supporting a regional workshop in London for the ‘COPD Voices’ report.