“Silent scandal” of missing lung diagnostics in England’s most deprived areas—where respiratory disease is most prevalent

The BMJ has found that patients in some of the most deprived areas of the UK, where respiratory conditions including chronic obstructive pulmonary disease (COPD) and asthma are twice as prevalent,1 have limited or no access to crucial respiratory diagnostics.

GPs in some of the worst affected areas say the fact they have no means of referring patients for tests, including spirometry and fractional exhaled nitric oxide (FeNO) analysis, is “troubling” and “a silent scandal”—despite NHS England trumpeting its rollout of “one stop shop” community diagnostic centres (CDCs),2 some of which will be run by private providers.3

London GP (and BMJ columnist) Rammya Mathew says COPD is a “known disease of deprivation and a key focus of Core20PLUS5”—the NHS England initiative launched in 2021 to reduce healthcare inequalities at both national and system level.

In response to The BMJ’s findings, Sarah MacFadyen, head of policy and external affairs at charity Asthma + Lung UK, says, “It’s concerning that spirometry provision is so patchy across England and that so many people with COPD are missing out on this vital test to confirm their diagnosis. While some areas are finding innovative ways to provide testing, many integrated care boards (ICBs) are not commissioning spirometry, and others have no record of how or if tests are being provided.”

John Hurst, professor of respiratory medicine at UCL, tells The BMJ that inequity in access to spirometry is a “national scandal.”