Abstract

Background: Early diagnosis and treatment of COPD can improve symptoms, reduce exacerbations and slow lung function decline. However, COPD remains substantially underdiagnosed, with almost one in four patients reporting over five years’ wait before diagnosis. Spirometry is central to diagnosis, yet access is variable and diagnostic pathways have changed considerably, including new delivery models such as Community Diagnostic Centres (CDCs).
Aims/Objectives: To map current UK pathways for diagnosing suspected COPD and identify barriers and facilitators in diagnostic service provision.
Methods: A UK-wide online survey of health care professionals involved in COPD diagnosis was conducted between August and December 2025. Participants were recruited through professional networks and conferences.
Survey questions explored local diagnostic pathways and barriers and facilitators to spirometry delivery. Data were analysed descriptively.
Results: 233 eligible responses were analysed. Respondents predominantly included nurses (n=101, 43%), GPs (n=73, 31%) and respiratory consultants (n=29, 12%).
Almost all respondents (n=209, 94%) believed there are currently delays to COPD diagnosis. Leading causes of delay include patients delaying assessment (n=196; 93%), presenting symptoms being treated without consideration of COPD (n194; 93%), long wait to see a specialist (n=173; 83%), and long waits for diagnostic testing (n=167; 81%).
Spirometry pathways varied considerably. Almost half of respondents reported spirometry being available in-house within GP practices (n=82, 49%), but other options included hubs, CDCs or secondary care services, all generally associated with longer waiting times. Some described very limited local spirometry provision and waiting times exceeding one year.
Over half of those no longer providing spirometry within GP practices had stopped during the COVID-19 pandemic and not restarted (n=34/60, 57%). The leading barriers to providing spirometry were inadequate funding/financial incentives (n=114; 80%); limited staff capacity (n=103; 60%); and high-level training requirements (n=96; 56%).
Implications: Healthcare professionals perceived substantial delays in COPD diagnosis and described marked variation in access to spirometry across the UK. While inadequate funding was the most frequently identified barrier, workforce capacity, training requirements and the lasting impact of COVID-19-related service disruption were also important challenges. Improving access to high-quality COPD diagnosis will require service models that address these interconnected barriers rather than funding alone.