What happened to asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD) during—and after—the pandemic?
That’s a question we tackled in our recent paper, where we investigated incidence and prevalence trends in three major chronic lung conditions across England, Wales, Scotland, and Northern Ireland. Our study spanned two decades, from 2004 to 2023, using harmonised electronic health records. We explored how diagnoses changed over time and examined disparities by sex, region, deprivation, and ethnicity. Our findings highlighted the sharp drop in diagnoses during the COVID-19 pandemic—along with early signs of recovery by mid-2023.
Now, with an additional two years of data from England, extending our analyses to March 2025, we’ve been able to revisit these trends and ask whether diagnosis rates have returned to pre-pandemic levels and whether inequalities persist. These updated analyses, supported by the British Heart Foundation Data Science Centre and carried out within NHS England’s Secure Data Environment, allow us to explore what has changed since the pandemic—and, just as importantly, what hasn’t. It is important to note that for March 2025, the data were not complete which explains the significant drop in rates across all conditions and groups.
Our new data confirm that diagnosis rates for asthma, COPD, and ILD increased after the initial disruption to routine care. However, that recovery has not been equal across all population groups.
- Men remain more likely to be diagnosed with both COPD and ILD, while asthma continues to be more common in boys (under 18) and in adult women (Figure 1).
- People living in more socioeconomically deprived areas continue to experience higher rates of all three conditions. These inequalities have remained stable across 2023 to 2025, with no clear signs of narrowing (Figure 2).
- When examining differences by ethnicity, White and Asian individuals show higher ILD incidence. COPD remains most common among White individuals, while asthma incidence is highest in those of White, Asian, and Mixed ethnic backgrounds (Figure 3).
- Regional variation also persists. The North East and North West of England consistently report the highest incidence of COPD and ILD. Interestingly, there is some evidence of a narrowing regional gap for COPD but a potential widening for ILD (Figure 4).
These trends raise critical questions about access to care, environmental exposures, and the long-term impact of delayed diagnoses. While routine healthcare services have largely resumed since the COVID-19 pandemic, our findings indicate that the impact of the pandemic on these services and population health may linger for years.
So, what’s next? We hope this updates data prompts further questions and action. We need to think seriously about how we can close the diagnostic gap and ensure that healthcare and management of chronic respiratory diseases is equitable. We will be exploring these issues in greater depth in our upcoming work and welcome collaboration with others in this space.
If you would like to read more, you can find our original work published in Thorax here and aggregate data for the diagnosis rates illustrated in our figures are available here.
If you would like to hear about upcoming related work, or explore opportunities to collaborate, please get in touch.
