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Ameera Patel, chief executive of TidalSense, writes that while cancer research gets £419 million a year, all of respiratory disease gets only £16 million.
Respiratory disease has long been neglected by governments around the world. Conditions like chronic obstructive pulmonary disease (COPD) and asthma affect roughly one in five people in the UK, but receive only 2% of the total health research expenditure. As a result, care pathways are woefully underdeveloped compared to other chronic disease areas like cardiovascular disease or cancer.
COPD doesn’t cause sudden dramatic deaths like heart attacks and doesn’t possess the adversary narrative that cancer does. It just silently kills you over several decades while your quality of life gradually declines to the point where you can’t even dress yourself anymore. While the majority of asthma is managed with inhalers, it remains one of the leading causes of preventable death in children and young people in the UK.
COPD has always had stigma attached to it and been branded as a ‘smoker’s disease’. COPD’s causes should be seen as a criminal act of the tobacco industry and widespread medical ignorance for decades. Instead, patients are left carrying the blame for having inflicted it on themselves. Even as a trainee doctor, this was indoctrinated into me. I’d see the odd patient who was so nicotine addicted that they had to smoke out of the tracheostomy tube in their neck, and it was really difficult to feel sorry for them. This moralising logic then incorrectly latches itself onto the 25% of patients who have COPD but have never smoked. Globally, the major causes of COPD are indoor biomass fuel cooking and air pollution, which disproportionately impact people from the developing world and from poorer socioeconomic backgrounds. But the ‘smoker’s disease’ narrative is so ingrained in common parlance that these non-smoking causes of COPD are largely ignored, and these patients are often misdiagnosed for years because even some clinicians make the incorrect cognitive shortcut that you have to have smoked to get COPD.
The funding narrative
The funding narrative follows a similar story. Cancer Research UK (the UK’s main cancer research charity) raised £715 million in 2024/2025 and invested £419 million into cancer research, infrastructure and grants. By contrast, Asthma + Lung UK, the UK’s main respiratory charity, raised £16.1 million over the same period and invested £1.4 million into respiratory research in 2025. The biggest allocation of that is to asthma. The annual reports make for interesting reading. Even though cardiovascular disease is also caused by smoking (among other things), and type 2 diabetes by poor diet, we do not deny funding to these areas. The 30-year mortality trend for cancer and cardiovascular disease has dropped by >50% due to sustained investment in research and development. COPD mortality has stayed the same and even increased in some areas. Is the underfunding of COPD compared with cardiovascular disease and cancer actually because COPD patients tend to be older and almost never die suddenly? Is it because, with fewer people able to empathise with the patients, it’s simply a less emotive subject? Or is it because people assume we already have adequate treatments in inhalers?
COPD and asthma also disproportionately impact patients from poorer socioeconomic backgrounds. Nearly 90% of COPD deaths in people under 70 occur in people from low- and middle-income countries. These patients are less likely to access care, and the care they do get is often lower quality. Data from the Taskforce for Lung Health and Asthma + Lung UK identified that individuals living in the UK’s most deprived 10% of neighbourhoods are twice as likely to develop a chronic respiratory condition and seven times more likely to die from one compared to those in the least deprived 10%. It’s not a revelation that diseases of the poor are understudied and underfunded. COPD is another example of what health economists call the 10/90 gap – less than 10% of global health research funding goes towards conditions that account for 90% of the world’s most preventable disease burden. The gap is driven by multi-faceted system failure.
Chicken and egg
So how do we fix this? It’s a chicken-and-egg problem. Without the cultural shifts, the hard economic changes won’t happen and vice versa. Or you wait for the condition to hit a crisis point, at which point governments have to pay attention.
This is what has effectively happened in China after the publication of the China Pulmonary Health study in the Lancet that revealed that 99.9 million adults in China (8.6% of the population) had COPD, rising to 13.7% among those over 40. That’s not a viable solution for population health management because change takes decades. While I could make a case for increased availability of cheap diagnostic testing in countries that have poor access to specialist equipment and staff, or for supporting risk-lowering in COPD clinical trials (which are notoriously long, expensive and prone to failure), I think the most important first step is a cultural change.
Without this, nothing else will work.
That’s not to minimise the importance of policy and regulation – ultimately there’s not one most important thing, and everything has to be done together – but without the softer cultural shifts, nothing is going to change. There are very few people lobbying for increased investment into COPD and asthma research. There are no wealthy people or celebrities attached to it. Nobody talks about respiratory disease. Most people don’t even know what COPD is.
I’d challenge you to find someone who doesn’t know what cancer or a heart attack is. In a culture of heavy online consumption, the awareness of issues is increasingly promoted through social media, movies and documentaries that play on emotive subjects. If we could ensure that everyone has heard of COPD and we are able to reverse the stigma associated with it, that will be the critical foundation for systemic change needed in the COPD investment landscape.
