Finding the ‘missing millions’ of patients with COPD has become a mantra of health policy. In the UK, 1.4 million people have a diagnosis of COPD but it is estimated that 50%–65% of people living with COPD are undiagnosed. This has been made worse by the COVID pandemic when new diagnosis rates fell by over half. In a recent survey of patients with COPD, 22% reported waiting 5 years or more for a diagnosis after noticing symptoms.1 In many cases, they had problems accessing diagnostic testing with spirometry; however, one in three said it was because they had waited a year or more before seeking help. The report concluded that getting a diagnosis, was ‘often the culmination of a protracted period of deteriorating symptoms and missed opportunities’.1

Case finding among high-risk groups to identify COPD is recommended2 3 and adding spirometry to lung health checks (LHC) in current or ex-smokers seems an obvious way of finding some of the missing millions. In this issue, Bradley et al report their experience of Incorporating pre-bronchodilator spirometry into LHC with low-dose CT screening for lung cancer in Yorkshire.4 Although uptake of the screening programme itself was low, most people who did participate agreed to perform spirometry. A total …