Aquarius Population Health

Chronic obstructive pulmonary disease (COPD) is a preventable, progressive respiratory disease, characterized by irreversible airflow limitation and symptoms such as dyspnoea, persistent cough, and sputum production. COPD was the third leading cause of mortality worldwide in 2019 (1), responsible for 3.23 million deaths (2).

Despite the availability of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations for COPD management (3), there remains uncertainty around how care is currently delivered within individual countries and what barriers exist to the optimal delivery of COPD care. Improved understanding of the common barriers to care delivery could inform international approaches to improving care standards and patient outcomes.

Our recent paper published in the International Journal of COPD used Evidenced Care Pathways (ECPs) to bring to life the story of how COPD care is currently delivered. Data from the literature and clinician interviews (twenty-four respiratory healthcare professionals in primary and secondary care) were used to inform and validate the ECPs.

We found that the ECPs showed broad consistency across the countries. Three key themes relating to barriers in optimal COPD management were identified across the clinician interviews: journey to diagnosis, treatment and management, and the impact of COVID-19. The common barriers to optimal COPD care identified across the four studied countries highlight the continued need for strategies to optimise COPD care, particularly as the burden of COPD continues to grow.

The use of ECPs is a valuable communications tool in healthcare evaluation that can facilitate evidence-based decision-making on interventions and policies to improve care and outcomes for patients and reduce unnecessary resource use and associated costs for the healthcare provider/payer.

The Evidenced Care Pathways for the four countries can be downloaded here. Please download this document and open it in a PDF reader such as Adobe for full functionality.

This study was funded and commissioned by AstraZeneca.

Meiwald A, Gara-Adams R, Rowlandson A, Ma Y, et al. Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care. Int J Chron Obstruct Pulmon Dis. 2022;17:1507-1521.


1. WHO. The top 10 causes of death. Accessed October 22, 2021.

2. WHO. Chronic obstructive pulmonary disease (COPD) fact sheet. Published 2021. Accessed August 18, 2021.

3. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2020 Report