Delivering the WHA lung health mandate for COPD

Chronic obstructive pulmonary disease (COPD) is the world’s third leading cause of death, yet remains overlooked in many low- and middle-income countries. Better risk identification and follow-up care can prevent severe events and save lives.

Delivering the Lung Health Resolution for COPD means organising around risk and continuity of care, elevating COPD as a national priority with focused funding and action. Photo: Azraq Al Rezoan

As global health leaders gather for the World Health Assembly, chronic obstructive pulmonary disease (COPD) risks remaining under-represented in policy discussions, despite being one of the leading causes of death worldwide.

The Lung Health Resolution adopted at WHA78 last year commits countries to prevent, detect, and manage respiratory diseases through integrated, system-wide approaches. The task now is to make that ambition real for COPD: nearly 400 million people live with it, facing heightened risks of cardiovascular disease and premature mortality. Yet in many low- and middle-income countries (LMICs), it receives far less policy attention than other non-communicable diseases (NCDs) of similar scale. In many LMICs, over 80% of COPD cases often go undiagnosed—and therefore, untreated.

The burden is both clinical and economic. Without course correction, COPD will cost the world economy US$4.326 trillion between 2020 and 2050—driven by emergency admissions, intensive care, and productivity losses that rarely appear in health accounts but have substantial impact.

This is not a problem without solutions. Clinical guidance, proven care models, and effective treatments already exist and can be delivered through better policy and planning. Progress has been slow for a different reason: a chronic lack of political will and investment. Without stronger policy, people, sometimes even after diagnosis, will continue to be treated too late, resulting in poor outcomes and costs that health systems simply cannot sustain.

Preventable cycle of crisis care

Even when diagnosed, many people still lack access to the treatment and care their condition demands, often leading to exacerbations. These events accelerate lung function decline, are linked with cardiac complications, and are strongly associated with premature death.

They also carry the heaviest price tag: a single severe exacerbation typically means an emergency visit and a hospital admission—often ICU for the sickest patients—making it among the most expensive events in COPD care. Data from studies such as the exacerbations of chronic obstructive lung disease and their outcomes (EXACOS) international study show that around one in five patients in LMIC settings experience at least one severe exacerbation each year, and nearly half will experience one over a five-year period—concentrating both harm and expenditure in the world's most vulnerable communities.

Primary care often lacks simple prompts to flag people at high risk, and incentives do not support access to care. Emergency departments treat the crisis, but the bridge back to long-term care is too often broken. Too many people leave hospital without a clear plan or timely follow-up. The result is a revolving door of avoidable admissions—harmful for patients and unaffordable for health systems.

From my experience within Egypt’s health system, these consequences of COPD are visible daily: patients often arrive at hospitals after repeated exacerbations, when the disease is advanced and harder to manage. Local evidence on the true burden of COPD is often lacking yet needed to guide policy priorities and planning. Therefore, to inform action on this issue, I am part of a leading group of experts from around the world assessing the burden of COPD on health systems, society, and patients.

Turning global commitments into action

The Lung Health Resolution provides both mandate and method. It calls on countries to integrate lung health into primary care and national strategies; prevent disease by tackling risk factors such as tobacco and air pollution; enable earlier detection; connect primary, specialist, and community care through clear pathways; and ensure access to essential treatments that keep people well. Delivering this for COPD means organising around risk and continuity of care, elevating COPD as a national priority with focused funding and action.

None of this is out of reach for LMIC health systems. Much can be achieved with existing facilities and workforce if policies set expectations, align incentives, and measure progress.

We are calling on governments to use the Lung Health Resolution now: align funding and performance metrics with reductions in readmissions and mortality. Strong public policy can save more lives than any individual clinician. All the tools exist; what has been missing is political will and investment. This World Health Assembly is the moment to change that, so that people at greatest risk are found, protected, and kept alive and well.

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This op-ed draws on AstraZeneca-supported COPD advocacy around the WHA Resolution. The opinions expressed are those of the author and do not necessarily reflect the position of Re:solve Global Health.

Professor Hossam Hosny is a distinguished medical professional and highly respected leader in the healthcare sector, holding several prominent positions within Egypt's Ministry of Health and other esteemed organisations. With a career dedicated to advancing clinical excellence and ethical practices in healthcare, he brings unparalleled expertise and dedication to his roles.