From Salford to global insight: transforming COPD research

Chronic obstructive pulmonary disease (COPD) is one of the world's leading causes of death, yet how it disproportionately affects different communities remains poorly understood. Research led by The University of Manchester is addressing this gap. It builds on a landmark clinical trial to generate a clearer, more representative picture of COPD in everyday life, and challenge persistent respiratory health inequalities.

In the UK alone, around 1.4 million people live with COPD, yet diagnosis can take years - often more than a decade - by which point the disease has significantly progressed. The burden falls unevenly: people in more deprived communities are more likely to develop COPD and experience more severe symptoms.

The Salford Lung Study (SLS) was designed to confront this imbalance. Rather than relying on tightly controlled clinical environments, it embedded research directly into routine care, monitoring patients in real time within their own communities. Patients were randomised and followed through everyday GP practices without intensive researcher intervention.

By including groups often excluded from traditional trials, the study provided a more realistic understanding of how treatments perform in practice. This shift, from controlled settings to real-world conditions, has helped redefine how clinical trials can be designed, ensuring findings better reflect the patients most affected.

From local to global

Conventional COPD trials frequently exclude older people and those with multiple health conditions, limiting their relevance. The Salford Lung Study challenged this model by capturing the complexity of real patients within primary care.

While rooted in Salford, the study's implications extend far beyond the city. By revealing how COPD outcomes vary across populations, the study has brought longstanding health inequalities into sharper focus, and demonstrated the value of more inclusive research design.

Though complex to deliver, the model provides a blueprint for future trials - showing how research can better align with real-world patient experience and inform care at scale.

"This was the first time we showed you can run a randomised trial in real patients, in real life - not just in highly controlled settings," says Prof Jørgen Vestbo, Professor of Respiratory Medicine at Manchester.

The extended Salford Lung Study

The original study offered a powerful snapshot, but understanding COPD requires a longer view. To address this, Manchester researchers launched an extended follow-up, linking long-term health records with the original trial cohort.

This has created a uniquely rich dataset. It enables researchers to track disease progression over time, identify which treatments reduce hospital admissions, and pinpoint patients most at risk of deterioration.

By moving beyond short-term observation, the extended study strengthens the case for data-driven, longitudinal research that reflects the realities of chronic disease and the populations most affected by it.

New respiratory health challenges

COPD continues to be shaped by entrenched inequalities. Higher smoking rates and occupational exposures remain key drivers, disproportionately affecting more deprived communities.

At the same time, new challenges are emerging. Vaping is increasingly sustaining nicotine addiction, particularly among younger populations, raising concerns about future respiratory risk. Environmental pressures are also intensifying: climate change is extending pollen seasons, increasing exposure to airborne irritants, and contributing to rising rates of respiratory and fungal infections.

Together, these factors underline that respiratory health is not solely determined by individual behaviour, but by wider social and environmental conditions.

Looking ahead

While advances such as biologic therapies offer new treatment possibilities, Manchester researchers are clear that medication alone will not address COPD. Prevention, early intervention, and tackling the wider determinants of health are critical.

To shift the focus earlier in the disease pathway, researchers are leading the British Early COPD Network (BEACON) cohort, in collaboration with Imperial College London. Following more than 400 adult smokers with normal lung function, the study aims to identify the earliest biological and environmental triggers of COPD.

This marks a significant shift - from treating established disease to understanding and preventing its onset.

As this work continues, the challenge is not only to develop more effective interventions, but also to ensure they reach the communities most affected, closing the gap between innovation and impact.