On November 19, 2025, which is World COPD Day, Nigeria is at a pivotal point. The long-term, progressive, and avoidable respiratory condition known as chronic obstructive pulmonary disease (COPD) is quietly placing a significant strain on the country’s economy, society, and health. However, it continues to be poorly recognized, underdiagnosed, and underprioritized in discussions of public policy.
On this day, the Amaka Chiwuike-Uba Foundation (ACUF) and the Global Allergy & Airways Patient Platform (GAAPP) remind us that COPD is a governance challenge that requires immediate, coordinated action in addition to being a medical problem.
In Nigeria, the burden of COPD is more than hypothetical. The gold standard for diagnosis, spirometry, has a median prevalence of about 9.2% with an interquartile range of 7.6 to 10.0%, according to a comprehensive evaluation of eight epidemiological studies.
On the other hand, research employing non-spirometric definitions, including clinical diagnosis or British Medical Research Council standards, revealed a median prevalence of 5.1 percent, with an interquartile range of 2.2 to 15.4 percent, which was lower but varied greatly. These numbers indicate a quiet epidemic that affects millions of people and are neither marginal nor insignificant.
The pattern is even more remarkable across demographic and geographic boundaries. The median COPD prevalence among rural residents is approximately 9.5%, which is almost the same as the 9.0% observed among urban residents, according to spirometry-based research.
This implies that COPD in Nigeria is not only a condition that affects city smokers; rather, it is a result of numerous environmental exposures, such as household air pollution, the extensive use of biomass fuel, and risk factors associated with poverty. Men are more likely than women to have it (around 8.6% versus 6.3%), which may be due to variations in exposure, behavior, and access to healthcare.
Some subgroups are at even greater danger. A study using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria revealed a COPD prevalence of approximately 15.4% among HIV-positive persons, underscoring the terrible synergy between infectious and non-communicable diseases in Nigeria.
Researchers used Global Lung Function Initiative equations to characterize chronic airflow obstruction by post-bronchodilator FEV₁/FVC ratios below the lower limit of normal as part of the Burden of Obstructive Lung Disease study. They discovered a prevalence of 7.7%. The load is significantly greater in settings that provide tertiary care. Of the 338 newly referred respiratory patients at the University of Ilorin’s chest clinic between 2017 and 2018, 24.3% had a COPD diagnosis. These figures demonstrate an illness that is deeply ingrained in susceptible groups; they are more than just epidemiological details.
Beyond just numbers, COPD has a human cost. Between 2006 and 2008, acute COPD exacerbations were responsible for 6.25 percent of respiratory-related deaths.
More generally, according to a recent national study, 1.8 million Nigerians were estimated to have COPD as of 2021. When direct medical costs and lost productivity are taken into account, the illness costs the country $5.5 billion annually. These enormous expenses highlight the fact that COPD is not just a medical emergency but also a development and financial problem.
In order to comprehend why COPD is so prevalent in Nigeria, it is necessary to examine its risk factors. HIV, tuberculosis, past respiratory illnesses, poor nutrition, and indoor air pollution from biomass fuel are all major causes, according to systematic data. 37.9% of patients in the HIV-COPD research had biomass exposure, and 17.1% had ever smoked, highlighting the significant dangers associated with non-smoking.
In the meanwhile, the GOLD cohort found that low education, a history of asthma, and past tuberculosis were important indicators of airflow restriction. It’s interesting to note that blockage in that population was not significantly correlated with biomass exposure as assessed by firewood use, indicating a complex interaction of biological, social, and environmental factors.
Despite this mounting evidence, significant data gaps continue to hinder our comprehension. Large portions of northern Nigeria, both rural and urban, are inadequately described because most prevalence data are from southern Nigeria. Meaningful comparison is made more difficult by the fact that different studies have different diagnostic criteria, with some depending on spirometry and others on clinical evaluations.
Furthermore, significant underdiagnosis is probably a result of primary care physicians’ lack of knowledge about COPD and the scarcity of spirometry equipment. There hasn’t been a nationally representative, spirometry-based survey to provide a complete picture of COPD in Nigeria, and many patients with the illness might never be properly recognized.
These restrictions are a reflection of more serious governance flaws. It is challenging for policymakers to plan for future health system demands or allocate resources effectively in the absence of a solid, nationally representative evidence base. Despite its obvious cost, COPD runs the risk of being disregarded as a secondary problem in the absence of data.
When we look at data at the national policy level, the governance issue becomes more complex. Nigeria’s National Multi-Sectoral Action Plan for NCDs 2019 to 2025 estimates that the prevalence of COPD is 6.9%, with a probable range of 5.1 to 8.7%.
According to the same national plan, men are more affected than women (5.3 percent versus 7.9 percent). Importantly, the strategy emphasizes low access to care for chronic respiratory disorders, including COPD, and insufficient diagnostic capacity, particularly in rural areas, as significant systemic issues.
On the ground, the health system is unable to react. A grim picture is presented in the 2024 “State of COPD in Nigeria” study. For every 2.3 million Nigerians, there is about one respiratory expert, and less than 30% of tertiary hospitals are said to have spirometers for diagnosis. Adult vaccination programs are inadequate or irregular, especially for influenza and pneumonia, which are critical in preventing exacerbations of COPD. Rehabilitation programs are very limited, and clinicians are sometimes not adequately trained in COPD.
Policy-making is made more difficult by the state of research. A meta-synthesis published in 2022 highlighted the dearth of representative, high-quality research. The eight epidemiological studies that satisfied the inclusion criteria were mostly found in the southern region. According to a more recent cross-sectional study from Lagos University Teaching Hospital, which was released in 2025, the average age of COPD patients was roughly 63.
Nearly half (46.8%) had a history of asthma, 27.8% had ever smoked, 19% reported occupational exposure, 6.6% reported biomass exposure, and 3.8% had a history of tuberculosis. Most remarkably, 73.4% of the cohort scored higher than 10 on the COPD Assessment Test (CAT), suggesting a very high symptom load, and 74.7% of the group showed Asthma–COPD Overlap (ACO). These findings imply that the “classic” smoking-driven phenotype of COPD observed in many high-income settings may not be the same as the disease in Nigeria.
Equally concerning are the disparities in therapeutic access. Essential inhaled COPD medications are extremely scarce in public pharmacies, according to a statewide assessment that covered 128 pharmacies throughout Nigeria’s six geopolitical zones. Despite international guidelines recommending inhaled corticosteroid-containing medications, not a single public pharmacy surveyed carried them. When inhalers were available, the price of a 30-day supply was frequently more than a day’s income, making treatment unaffordable for a large number of Nigerians.
Systemic deficiencies are also evident in the therapeutic treatment of COPD. According to a 2024 study, the quality of physiotherapy-based care was subpar, and many medical practitioners showed little awareness with GOLD recommendations. Furthermore, there is still a lack of knowledge about COPD. Stronger public health initiatives are needed to raise awareness of COPD in Nigeria and throughout the continent, according to an editorial in a journal of African respiratory medicine.
A significant issue from the standpoint of research and policy is the lack of interventional studies. Very few randomized controlled studies were carried out in African nations, according to a 2023 systematic review published in the Journal of the COPD Foundation, underscoring the paucity of data regarding what is effective in regional settings.
In the absence of African or Nigerian-specific clinical studies that address characteristics like ACO or biomass-exposure COPD, policymakers are forced to rely on data produced in very different contexts, which restricts the applicability and efficacy of interventions.
Future regional and worldwide forecasts make Nigeria’s COPD problem even more pressing. According to modeling studies published in prestigious journals like JAMA Network Open, the prevalence of COPD in sub-Saharan Africa may almost double by 2050, affecting tens of millions more individuals in certain scenarios.
According to parallel economic projections, if nothing is done, the direct medical expenditures of COPD will rise globally between 2025 and 2050. Sub-Saharan Africa is expected to have one of the highest regional COPD prevalence rates by the middle of the century, according to research compiled by Statista.
Surprisingly, estimates specific to Nigeria are still unattainable. The “State of COPD in Nigeria” study from 2024 lacks a comprehensive model that projects future case numbers, mortality, or costs, and the systematic assessments that have been conducted thus far have not produced a peer-reviewed estimate for Nigeria through 2030 or 2040. Long-term strategic planning by health and economic policymakers is compromised by this forecasting capacity mismatch.
These findings have far-reaching consequences. With a baseline prevalence of almost 9% in a nation of more than 200 million people, millions more Nigerians are at danger than government figures indicate. The comparable incidence in rural and urban areas casts doubt on theories that attribute chronic respiratory diseases just to smoking or urbanization; rather, it draws attention to structural disparities in risk exposure, such as poverty and household air pollution.
Underdiagnosis is probably widespread since many instances may go undiagnosed or mistakenly labeled as asthma or other respiratory ailments due to the lack of spirometry and qualified workers. On the policy front, COPD is firmly positioned as a development issue rather than only a health concern due to its massive economic burden, which is measured in billions of US dollars.
It will take audacious policy and governance changes to meet this challenge. It is imperative that Nigeria increase its diagnostic capability and make spirometry more accessible in elementary, secondary, and tertiary healthcare facilities. The GOLD guidelines-based training for clinicians in COPD diagnosis, treatment, and follow-up has to be increased. Investing in rehabilitation treatments, such as physical therapy, as part of routine care for those with COPD is equally important.
Another major obstacle is access to necessary inhalation drugs. at order to ensure that these life-saving medications are accessible at public facilities and reasonably priced for patients, policymakers ought to investigate procurement and subsidy procedures. Advocating for laws that guarantee fair access to inhalers can be greatly aided by a patient-focused civil society voice, which is supported by GAAPP and ACUF.
However, identifying and managing COPD is only a portion of the answer. Nigeria needs to use a multisectoral approach because the health sector is not the primary source of risk. To minimize exposure to biomass fuel and reduce indoor air pollution, housing, energy, environmental, and social policies must be coordinated. The prevention of chronic respiratory diseases should also be incorporated into the current platforms for infectious diseases. COPD screening and treatment must be a regular part of HIV and TB treatments. To lessen exacerbations in a population already struggling with respiratory fragility, vaccination efforts for influenza and pneumonia must be strengthened.
Research and solid facts must support this change in policy. Spirometry-based, nationally representative COPD surveys are needed in Nigeria, covering all areas, especially the underprivileged north. Resource planning and health funding need the use of projection models that integrate demographic trends, risk exposures, and cost data. Investing in regionally relevant clinical research, such as randomized controlled trials evaluating treatments appropriate for Nigerian COPD subtypes as ACO or biomass-linked illness, is equally crucial.
Awareness among the public is essential. If Nigerians remain mostly ignorant of the symptoms and dangers of COPD, treatment noncompliance and delayed diagnosis will persist. Civil society organizations like ACUF, which has its roots in the Nigerian patient community, and GAAPP, which has a global reach, are in a unique position to educate the public, advocate for policy change, and amplify the voices of individuals living with COPD.
Most importantly, COPD provides an effective lens through which to study Nigeria’s health system administration. Its load exposes obvious injustices, including a lack of specialists, a lack of diagnostic tools, expensive medications, and inadequate surveillance. However, it has equally important advocacy potential. In addition to advocating for better health services, patient organizations like GAAPP and ACUF also advance accountability, openness, and equity in national policymaking.
On this World COPD Day, Nigeria must make a decision. Policymakers may miss it and treat COPD as a peripheral issue that is confined to clinical silos. Alternatively, it can identify COPD for what it really is: a call to action for cross-sector cooperation, a sign of systemic governance failure, and a strategic development challenge. Government, civic society, and international partners must work together to mobilize resources, develop capacity, and raise the voices of COPD patients in order to move forward.
The silent epidemic of COPD will become obvious until we empower individuals, bolster health institutions, and adopt governance reforms. Rather, it will be prioritized nationally. GAAPP and ACUF encourage all Nigerian citizens, policymakers, and health professionals to take action on this day. Then and only then will we be able to stop the silent destruction caused by COPD and start constructing a more equitable and healthy future for everybody.
