An estimated 1.2 million people in the UK live with diagnosed COPD (chronic obstructive pulmonary disease) – making it one of the country’s biggest health challenges. The first national-level research (carried out in Scotland and Wales) has shed light on the impact of the pandemic and  lockdowns, revealing significant falls in COPD-related emergency department attendances, emergency admissions and primary care consultations for acute COPD exacerbations.


With NHS services under pressure and a possible reluctance among patients to seek healthcare in the way they normally would, there were many unanswered questions about the pandemic’s impact on COPD patients and their care.

Evidence had emerged that lockdown was associated with poorer outcomes for patients with other illnesses, such as cardiovascular disease and cancers. At the same time there were other changes, such as falls in the air pollution and the spread of other viruses that can trigger acute COPD exacerbations.

Getting to understand the effects of the pandemic on COPD patients was not only important in helping provide appropriate care and services for the future but also in providing insights into the factors that lead to acute events.


An analysis led by Swansea University Medical School clinical data scientist Dr Mohammad A Alsallakh (and supported by the HDR UK BREATHE hub) used patient data from Public Health Scotland and SAIL (Secure Anonymised Information Linkage Databank) in Wales to investigate weekly counts of  health care utilisation and COPD deaths in the initial 30 weeks of 2020 and compare them with the previous five years.

Their approach benefited from using objective measures rather than relying on patient reported outcomes or questionnaires. It also benefited from scale and scope, as they were based on whole populations of 5,463,300 (Scotland) and 3,152,900 (Wales).

Lessons learnt

The research (published in BMC Medicine) found that lockdown was associated with the most substantial reductions in COPD exacerbations ever seen across Scotland and Wales (including a 48% pooled fall in emergency admissions for COPD in both countries) with no corresponding increase in COPD deaths.

Put alongside studies from elsewhere in the world it gives weight to the thesis that there could be benefits from shielding certain COPD patients against the risk of respiratory infections. Similarly the authors believe the reduction in acute COPD exacerbations may well be linked to the lower traffic levels during lockdown.

Impact and outcomes

The research team hope that the work will help prompt new approaches to air pollution policy and to advances preventative treatment for some patients.

Insights from the Impact Committee

The HDR UK Impact Committee judged the paper to be one that has significant impact and demonstrates the value of HDR UK in its mission to apply the UK’s health data to make discoveries that improve people’s lives.