World COPD Day 2025: A Governance Wake‑Up Call for Nigeria’s Silent Respiratory Epidemic
By Prof. Chiwuike Uba, Chairman of Board, Amaka Chiwuike‑Uba Foundation (ACUF)
As the world marks World COPD Day on Nov. 19, 2025, Nigeria stands at a critical juncture. Chronic Obstructive Pulmonary Disease (COPD), a chronic, progressive, and preventable respiratory illness, is quietly imposing a heavy burden on health, society, and the national economy. Yet, it remains inadequately understood, underdiagnosed, and under-prioritised in public policy discourse.
On this day, the Global Allergy & Airways Patient Platform (GAAPP) and the Amaka Chiwuike‑Uba Foundation (ACUF) remind us that COPD is not just a medical issue; it is a governance challenge that demands urgent, coordinated action.
COPD’s burden in Nigeria is more than theoretical. A systematic review of eight epidemiological studies, found that when measured via spirometry, the gold standard for diagnosis, the median prevalence is approximately 9.2 per cent, with an interquartile range of 7.6 to 10.0 per cent.
In contrast, studies using non-spirometric definitions, such as clinical diagnosis or British Medical Research Council criteria, reported a lower but widely varying median prevalence of 5.1 percent, with an interquartile range of 2.2 to 15.4 per cent. These figures are neither marginal nor insignificant; they point to a silent epidemic affecting millions.
Even more striking is the pattern across geographic and demographic lines. Spirometry-based studies reveal that rural dwellers have a median COPD prevalence of about 9.5 per cent, nearly identical to the 9.0 per cent reported among urban dwellers.
This suggests that COPD in Nigeria is not solely a disease of city smokers; it is deeply rooted in widespread environmental exposures, including household air pollution, pervasive use of biomass fuel, and poverty-driven risk factors. By gender, men have a higher prevalence, approximately 8.6 per cent, than women, approximately 6.3 per cent, reflecting differences in exposure, behavior, and possibly healthcare access.
Certain subpopulations face even higher risks. Among HIV-positive adults, a study applying the Global Initiative for Chronic Obstructive Lung Disease (GOLD), criteria found a COPD prevalence of about 15.4 per cent, highlighting the devastating synergy between infectious and non-communicable disease in Nigeria.
As part of the Burden of Obstructive Lung Disease study, investigators used Global Lung Function Initiative equations to define chronic airflow obstruction by post-bronchodilator FEV₁/FVC ratios below the lower limit of normal and found a prevalence of 7.7 per cent. In tertiary-care settings, the burden is even more acute. At the chest clinic of University of Ilorin, among 338 newly referred respiratory patients over 2017 to 2018, 24.3 per cent were diagnosed with COPD. These numbers are not just epidemiological footnotes; they are evidence of a disease entrenched in vulnerable populations.
The human toll of COPD extends beyond mere numbers. Between 2006 and 2008, 6.25 per cent of respiratory-related deaths were attributed to acute exacerbations of COPD.
More broadly, a recent national report estimates that around 1.8 million Nigerians were living with COPD as of 2021, and the disease exacted an annual economic cost of US$ 5.5 billion, when both direct healthcare expenses and lost productivity are considered. These staggering costs underscore that COPD is not only a health crisis; it is a development and economic issue.
Understanding why COPD is so common in Nigeria requires unpacking its risk factors. Systematic evidence points to indoor air pollution from biomass fuel, poor nutrition, prior respiratory infections, HIV, and tuberculosis as key contributors. In the HIV–COPD study, 37.9 per cent of participants reported biomass exposure, and 17.1 per cent had ever smoked, emphasizing that non-smoking risks are prominent.
Meanwhile, the GOLD cohort identified prior tuberculosis, a history of asthma, and low education as significant predictors of airflow obstruction. Interestingly, in that population, biomass exposure measured as firewood use was not significantly associated with obstruction, suggesting a complex interplay of social, biological and environmental determinants.
Despite this growing evidence, our understanding remains limited by substantial data gaps. The majority of prevalence studies come from southern Nigeria, leaving large parts of the north, both rural and urban, poorly characterized. Diagnostic criteria vary across studies, with some relying on spirometry and others on clinical assessments, which complicates meaningful comparison.
Moreover, the limited availability of spirometry equipment, coupled with low awareness of COPD among primary care providers, likely contributes to widespread underdiagnosis. Many people with the disease may never be correctly identified, and there has been no nationally representative, spirometry-based survey to paint a full picture of COPD in Nigeria.
These limitations reflect deeper governance failures. Without a reliable, nationally representative evidence base, it is difficult for policymakers to allocate resources appropriately or plan for future health system needs. In the absence of data, COPD risks being sidelined as a secondary concern despite its clear burden.
The governance challenge deepens when we examine national policy-level data. According to Nigeria’s National Multi-Sectoral Action Plan for NCDs 2019 to 2025, COPD prevalence is estimated at 6.9 per cent, with a possible range from 5.1 to 8.7 per cent.
That same national plan notes that men, at 7.9 percent, are more affected than women, at 5.3 percent. Crucially, the plan identifies limited diagnostic capacity, especially in rural regions, and poor access to care for chronic respiratory diseases, including COPD, as major systemic challenges.
On the ground, the health system struggles to respond. The 2024 “State of COPD in Nigeria” report paints a stark picture. There is approximately one respiratory specialist for every 2.3 million Nigerians, and fewer than 30 percent of tertiary hospitals reportedly have spirometers for diagnosis. Vaccination programs for adults, particularly for pneumonia and influenza, which are crucial in preventing COPD exacerbations, are weak or inconsistent. Clinician training in COPD is often inadequate, and rehabilitation services remain sparse.
The research landscape further complicates policy-making. A 2022 meta-synthesis underscored the paucity of high-quality, representative studies. Only eight epidemiological works met inclusion criteria, and they were geographically concentrated in the south. A more recent cross-sectional study from Lagos University Teaching Hospital, published in 2025, revealed that patients with COPD had a mean age of about 63 years.
Almost half, 46.8 per cent, had a history of asthma, 27.8 per cent had ever smoked, 19 per cent reported occupational exposure, 6.6 per cent reported biomass exposure, and 3.8 per cent had a history of tuberculosis. Perhaps most strikingly, 74.7 per cent of the cohort exhibited Asthma–COPD Overlap (ACO), and 73.4 per cent scored above 10 on the COPD Assessment Test (CAT), indicating a very high symptom burden. These data suggest that the nature of COPD in Nigeria may differ significantly from the “classic” smoking-driven phenotype seen in many high-income settings.
When it comes to access to treatment, the gaps are equally alarming. A nationwide survey covering 128 pharmacies across Nigeria’s six geopolitical zones found severely limited availability of essential inhaled COPD medicines in public pharmacies. Not a single public pharmacy surveyed stocked inhaled corticosteroid-containing medicines, despite their recommendation in international guidelines. Where inhalers were available, the cost was often higher than a day’s wage for a 30-day supply, making treatment prohibitively expensive for many Nigerians.
The clinical management of COPD also reflects systemic shortfalls. In a 2024 study, many healthcare professionals demonstrated low familiarity with GOLD guidelines, and the standard of physiotherapy-based care was poor. On top of this, awareness of COPD itself remains low. An editorial in an African respiratory medicine journal argued that COPD awareness across the continent, including in Nigeria, is still minimal, calling for stronger public health efforts to elevate the disease in national consciousness.
From a research and policy perspective, the dearth of interventional studies is a major concern. A 2023 systematic review published in the Journal of the COPD Foundation found very few randomized controlled trials conducted in African countries, highlighting how little evidence exists on what works in local contexts.
Without clinical trials tailored to African or Nigerian populations, addressing phenotypes such as ACO or biomass-exposure COPD, policymakers must rely on evidence generated in entirely different settings, limiting the relevance and effectiveness of interventions.
Looking ahead, global and regional projections add urgency to Nigeria’s COPD challenge. Modeling studies published in leading journals such as JAMA Network Open predict that by 2050, the burden of COPD in sub-Saharan Africa could nearly double, with tens of millions more people affected in some scenarios.
Parallel economic models project that global direct medical costs of COPD will surge between 2025 and 2050 if no action is taken. According to data collated by Statista, sub-Saharan Africa is projected to have one of the highest regional COPD prevalence by mid-century.
Remarkably, Nigeria-specific projections remain elusive. The 2024 “State of COPD in Nigeria” report does not offer a detailed model projecting future case numbers, mortality, or cost, and the systematic reviews to date do not provide a peer-reviewed projection for Nigeria through 2030 or 2040. This gap in forecasting capacity undermines long-term strategic planning by both health and economic policymakers.
The implications of these findings are profound. With a baseline COPD prevalence of around 9 per cent, in a country of over 200 million, millions more Nigerians are at risk than official estimates suggest. The similar prevalence between rural and urban areas challenges narratives that chronic respiratory disease is solely a result of urbanization or smoking; instead, it highlights structural inequities in exposure to risk, such as household air pollution and poverty.
Underdiagnosis is likely rampant, as the limited availability of spirometry and trained personnel means many cases may go unrecognized or misclassified as asthma or other respiratory illnesses. On the policy front, the enormity of COPD’s economic burden, measured in billions of U.S. dollars, positions it firmly as a development issue, not just a health concern.
Confronting this challenge requires bold governance and policy reforms. Nigeria must urgently scale up diagnostic capacity, ensuring that spirometry is more widely available across primary, secondary, and tertiary healthcare facilities. Clinician training in COPD diagnosis, management, and follow-up, anchored in the GOLD guidelines, must be expanded. It is equally vital to invest in rehabilitation services, including physiotherapy, as part of standard care for persons living with COPD.
Access to essential inhaled medications is another critical bottleneck. Policymakers should explore procurement and subsidy mechanisms that guarantee these lifesaving medicines are available in public facilities and affordable to patients. A patient-focused civil society voice, championed by GAAPP and ACUF, can be instrumental in advocating for policies that ensure equitable access to inhalers.
But diagnosing and treating COPD is only part of the solution. Because major risk factors lie outside the health sector, Nigeria must adopt a multisectoral response. Energy, housing, environmental, and social policy must align to reduce indoor air pollution and limit exposure to biomass fuel. At the same time, chronic respiratory disease prevention should be integrated into existing infectious disease platforms. HIV and tuberculosis programs must routinely screen for and manage COPD. Vaccination strategies for pneumonia and influenza need strengthening to reduce exacerbations in a population already grappling with respiratory vulnerability.
Robust data and research must underpin this policy shift. Nigeria needs nationally representative, spirometry-based COPD surveys that span all regions, including the underserved north. Projection models that combine demographic trends, risk exposures, and cost data are essential to inform resource planning and health financing. Equally important is investment in locally relevant clinical research, including randomized controlled trials testing interventions suited to Nigerian COPD phenotypes, such as ACO or biomass-linked disease.
Public awareness is fundamental. If Nigerians are largely unaware of COPD’s signs and risks, late diagnosis and poor adherence to treatment will continue. Civil society organizations like GAAPP, with their global reach, and ACUF, rooted in the Nigerian patient community, are uniquely positioned to amplify the voices of people living with COPD, educate the public, and press for policy change.
Crucially, COPD offers a powerful lens through which to examine health system governance in Nigeria. Its burden reveals glaring inequities: insufficient specialists, scarce diagnostics, unaffordable medicines, and weak surveillance. Yet, its potential for advocacy is equally significant. When patient organizations such as GAAPP and ACUF demand better care, they not only push for improved health services but also drive accountability, transparency, and equity in national policymaking.
On this World COPD Day, Nigeria faces a choice. It can treat COPD as a peripheral problem, relegated to clinical silos and overlooked by policymakers. Or it can recognize COPD for what it truly is: a strategic development issue, a marker of systemic governance failure, and a call to action for cross-sector collaboration. The path forward demands that government, civil society, and international partners unite to mobilize resources, build capacity, and elevate the voices of people living with COPD.
When we empower patients, strengthen health systems, and embrace governance reforms, the silent epidemic of COPD will no longer be invisible. Instead, it will become a national priority. On this day, GAAPP and ACUF urge every Nigerian policymaker, health professional, and citizen to stand up, speak out, and act. Only then can we turn the page on COPD’s quiet devastation and begin building a healthier, fairer future for all.
