Nigeria is at a turning point as the globe observes globe COPD Day on November 19, 2025. The long-term, progressive, and avoidable respiratory condition known as chronic obstructive pulmonary disease (COPD) is subtly placing a significant strain on society, the economy, and health. In public policy discourse, however, it continues to be underdiagnosed, underprioritized, and poorly understood.
On this day, the Amaka Chiwuike-Uba Foundation (ACUF) and the Global Allergy & Airways Patient Platform (GAAPP) remind us that COPD is not only a medical problem but also a governance crisis that necessitates immediate, concerted action.
The impact of COPD in Nigeria is more than just hypothetical. Using spirometry, the gold standard for diagnosis, a comprehensive evaluation of eight epidemiological studies revealed that the median prevalence is roughly 9.2%, with an interquartile range of 7.6 to 10.0%.
Studies employing non-spirometric definitions, such as clinical diagnosis or British Medical Research Council standards, on the other hand, revealed a lower but very variable median prevalence of 5.1 percent, with an interquartile range of 2.2 to 15.4%. These numbers indicate a quiet epidemic that affects millions of people; they are not minor nor unimportant.
The pattern across demographic and geographic boundaries is even more startling. The median prevalence of COPD among rural residents is approximately 9.5%, which is almost the same as the 9.0% recorded among urban residents, according to spirometry-based research.
This implies that COPD in Nigeria is not just 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 have a higher prevalence (around 8.6%) than women (about 6.3%), which may be due to variations in exposure, behavior, and access to healthcare.
There are subpopulations that are even more vulnerable. A study using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria indicated that the prevalence of COPD among HIV-positive persons was around 15.4%, underscoring the terrible synergy between infectious and non-communicable diseases in Nigeria.
In the Burden of Obstructive Lung Disease study, researchers determined a prevalence of 7.7% by using Global Lung Function Initiative equations to identify chronic airflow obstruction by post-bronchodilator FEV₁/FVC ratios below the lower limit of normal. The load is much more severe in settings involving tertiary care. Between 2017 and 2018, 24.3% of 338 newly referred respiratory patients at the University of Ilorin’s chest clinic received a COPD diagnosis. These figures represent proof of a sickness ingrained in susceptible groups, not merely epidemiological footnotes.
The human cost of COPD is not just quantifiable. Acute COPD exacerbations were responsible for 6.25 percent of respiratory-related deaths between 2006 and 2008.
More generally, according to a recent national survey, 1.8 million Nigerians were estimated to have COPD as of 2021. When direct medical costs and lost productivity are taken into account, the disease costs the country $5.5 billion annually. These astounding expenses highlight the fact that COPD is a development and economic problem in addition to a health one.
It is necessary to examine the risk factors for COPD in order to comprehend why the disease is so prevalent there. Indoor air pollution from biomass fuel, poor nutrition, past respiratory illnesses, HIV, and tuberculosis are major causes, according to systematic data. The HIV-COPD study found that 17.1% of subjects had ever smoked and 37.9% reported biomass exposure, highlighting the significant dangers associated with non-smoking.
In the meanwhile, the GOLD cohort found that low education, a history of asthma, and past TB were significant predictors of airflow restriction. It’s interesting to note that blockage in that population was not substantially correlated with biomass exposure as assessed by firewood use, indicating a complicated interaction between environmental, biological, and social factors.
Our comprehension is nevertheless constrained by significant data gaps despite this mounting evidence. Large portions of northern Nigeria, both rural and urban, are poorly described because most prevalence surveys are conducted in southern Nigeria. Meaningful comparison is complicated 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 caused by the scarcity of spirometry equipment and the insufficient knowledge of COPD among primary care physicians. There hasn’t been a nationally representative, spirometry-based survey to provide a complete picture of COPD in Nigeria, and many individuals with the illness may never be accurately diagnosed.
Deeper governance shortcomings are reflected in these restrictions. It is challenging for policymakers to prepare for future health system requirements or allocate resources correctly in the absence of a solid, nationally representative evidence base. Despite its obvious cost, COPD runs the risk of being ignored as a secondary issue in the absence of evidence.
When we look at national policy-level data, the governance problem becomes more complex. Nigeria’s National Multi-Sectoral Action Plan for NCDs 2019 to 2025 estimates the prevalence of COPD at 6.9%, with a probable range of 5.1 to 8.7%.
According to the same national plan, men are more affected than women, at 7.9 percent versus 5.3 percent. Importantly, the plan lists low access to care for chronic respiratory conditions, such as COPD, and insufficient diagnostic capability, particularly in remote areas, as significant systemic issues.
The health system is unable to react on the ground. A dire picture is presented in the 2024 “State of COPD in Nigeria” study. Less than thirty percent of tertiary hospitals are said to have spirometers for diagnosis, and there is about one respiratory expert for every 2.3 million Nigerians. Adult vaccination programs are inadequate or inconsistent, especially when it comes to influenza and pneumonia, which are critical in preventing exacerbations of COPD. Rehabilitation programs are still limited, and clinician training in COPD is sometimes insufficient.
Making policies is further complicated by the state of research. A meta-synthesis from 2022 highlighted the dearth of representative, high-quality studies. Only eight epidemiological studies, all of which were geographically centered in the South, satisfied the inclusion criteria. According to a more recent cross-sectional study from Lagos University Teaching Hospital, which was published 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% had biomass exposure, and 3.8% had a history of tuberculosis. Most remarkably, 73.4% of the cohort scored above 10 on the COPD Assessment Test (CAT), indicating a very high symptom load, and 74.7% of the group displayed Asthma–COPD Overlap (ACO). The nature of COPD in Nigeria may be very different from the “classic” smoking-driven phenotype observed in many high-income environments, according to these studies.
The discrepancies in access to therapy are just as concerning. Essential inhaled COPD medications were found to be extremely scarce in public pharmacies, according to a statewide assessment that covered 128 pharmacies in Nigeria’s six geographical zones. Despite being advised by international recommendations, not a single public drugstore examined carried inhaled corticosteroid-containing medications. Many Nigerians found treatment to be unaffordable because, in cases when inhalers were accessible, the cost of a 30-day supply was frequently more than a day’s income.
Systemic deficiencies are also reflected 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 little knowledge on COPD. Stronger public health initiatives are needed to raise awareness of COPD in Nigeria and throughout the continent, according to an editorial in an African journal of respiratory medicine.
The lack of interventional trials is a significant issue from a scientific and policy standpoint. 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 on what is effective in regional settings.
In the absence of African or Nigerian-specific clinical studies addressing traits like ACO or biomass-exposure COPD, policymakers are forced to rely on data produced in very different contexts, which reduces the applicability and efficacy of interventions.
Nigeria’s COPD problem is becoming more urgent because to regional and worldwide estimates. 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 some scenarios.
According to parallel economic estimates, if nothing is done, the direct medical expenses associated with COPD will increase globally between 2025 and 2050. By the middle of the century, sub-Saharan Africa is expected to have one of the highest regional prevalences of COPD, according to data compiled by Statista.
Surprisingly, predictions 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 conducted thus far have not produced a peer-reviewed estimate for Nigeria through 2030 or 2040. Both health and economic officials’ long-term strategic planning is threatened by this forecasting capacity imbalance.
These results have far-reaching ramifications. In a nation with nearly 200 million people, the baseline prevalence of COPD is approximately 9%, meaning that millions more Nigerians are at risk than government statistics indicate. The comparable incidence in rural and urban areas casts doubt on the notion that smoking or urbanization are the only causes of chronic respiratory disease; rather, it draws attention to structural disparities in risk exposure, such as poverty and home air pollution.
Underdiagnosis is probably widespread since many instances may go undiagnosed or be mistakenly diagnosed as asthma or other respiratory conditions due to a lack of spirometry and qualified people. From a policy perspective, COPD is firmly positioned as a development issue rather than only a health concern due to its enormous economic burden, which is measured in billions of US dollars.
It will take audacious governance and policy changes to address this issue. In order to make spirometry more accessible in elementary, secondary, and tertiary healthcare facilities, Nigeria urgently needs to increase its diagnostic capability. It is necessary to increase clinician education in COPD diagnosis, treatment, and follow-up that is based on the GOLD criteria. Investing in rehabilitation treatments, such as physiotherapy, as part of regular care for those with COPD is equally important.
Another major obstacle is the availability of necessary inhalation medicines. at order to ensure that these life-saving medications are accessible at public institutions and cheap for patients, policymakers should investigate procurement and subsidy procedures. Advocating for policies that guarantee fair access to inhalers can be greatly aided by the patient-focused civil society voice that GAAPP and ACUF are promoting.
However, COPD diagnosis and treatment are only a portion of the answer. Nigeria needs to use a multisectoral approach because the main risk factors are not related to the health sector. Reducing indoor air pollution and limiting exposure to biomass fuel requires coordination of energy, housing, environmental, and social policy. At the same time, current infectious disease platforms should incorporate chronic respiratory illness prevention. COPD must be regularly screened for and managed in HIV and TB programs. To prevent exacerbations in a population already struggling with respiratory fragility, vaccination efforts for influenza and pneumonia must be strengthened.
This change in policy needs to be supported by solid facts and research. Spirometry-based COPD surveys that are nationally representative and cover all of Nigeria’s regions—including the underserved north—are required. Resource planning and health financing depend on projection models that incorporate cost information, risk exposures, and demographic patterns. Investing in locally pertinent clinical research, such as randomized controlled trials evaluating therapies appropriate for Nigerian COPD subtypes like ACO or biomass-linked illness, is equally crucial.
It is essential to raise public awareness. Treatment noncompliance and delayed diagnosis will persist if Nigerians are mostly ignorant of the warning signals and dangers of COPD. Civil society groups like ACUF, which has its roots in the Nigerian patient community, and GAAPP, which has a global reach, are in a unique position to raise awareness, advocate for policy change, and amplify the voices of those who live with COPD.
Most importantly, COPD provides an effective lens for analyzing Nigeria’s health system governance. Its load exposes obvious injustices, such as a lack of specialists, a lack of diagnostics, expensive medications, and inadequate surveillance. Its potential for advocacy, however, is just as important. In addition to advocating for better health services, patient organizations like GAAPP and ACUF also promote equity, accountability, and openness in national policymaking.
Nigeria is presented with an option on this World COPD Day. It can treat COPD as an incidental issue, confined to clinical silos, and ignored by decision-makers. Alternatively, it can acknowledge COPD as 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 foreign partners must work together to mobilize resources, increase capacity, and raise the voices of COPD patients in order to move forward.
The secret COPD epidemic will become visible until we empower people, fortify health systems, and adopt governance reforms. Rather, it will take on national significance. GAAPP and ACUF call on all Nigerian citizens, legislators, and medical professionals to take action on this day. Only then will we be able to move past the silent destruction caused by COPD and start constructing a more equitable and healthy future for everybody.
