The stark and significant disparity in funding of respiratory conditions is inadequate but not new, nor is it only a UK problem. Globally, 75% of funding is for non-communicable diseases and only 2% goes to respiratory conditions, putting it 13th, below MSK, sense organs and genitourinary disease and four times less than cardiovascular research (Respiratory research funding is inadequate, inequitable, and a missed opportunity — The Lancet Respiratory Medicine).
In the UK, more than five years ago, it was highlighted that while respiratory disease is the third most common cause of death in the UK, almost equal to that of cancers and cardiovascular disease above them, the total spend by all government agencies and national charities on respiratory research (£96m) was nearly 20% less than that of a single charity alone on cardiovascular research (BHF, £115m). In the largest funding bodies, only 2.5–4.5% of total research spending was for respiratory conditions (The current state of respiratory research in the UK | Thorax). This has hardly improved in the last half decade.
In part, the current COVID-19 pandemic has highlighted how impactful this gulf in research can be, but we wait to see if and how this will be addressed.
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State of Respiratory Research Funding
Asthma UK made a commendable step in encouraging more research funding into asthma with the Asthma Health Technology Fund (AHTF), which paired funding from the charity with existing UK government funding mechanisms through NIHR and EPSRC.
Unfortunately, only 1 (14%) asthma-related Stage 1 applications submitted to the AHTF-linked funding call were invited to produce a full application for Stage 2, compared to 15 (33%) of non-asthma proposals in that NIHR call (NIHR PDA Minutes).
The Asthma Health Technology Fund is an excellent initiative that encouraged a good response from applicants and therefore it is disheartening that it only produced one potential project that could benefit people with asthma. Asthma UK was not involved in the selection process and therefore likely also disappointed in this result.
It is further disappointing that there continues to be a deficiency of funding for asthma, COPD, and other respiratory conditions. The recent SBRI call mentioned respiratory conditions in the first paragraph of their brief for their call in Urgent and Emergency Care, stating:
“Children and young people have a significantly higher inappropriate/non-urgent attendance at ED than adults and the proportion of those of all ages with respiratory conditions has grown rapidly over the past few years.”
No other condition was mentioned in the Executive Summary (SBRI A&E Challenge Brief) and yet zero respiratory projects were successful. Three projects were successful that are all developing point-of-care tests for troponin for heart attacks. While worthy problems justify funding multiple potential solutions as not all will succeed, it is incomprehensible that respiratory conditions were specifically highlighted as a priority in the briefing document, yet every respiratory proposal was ranked lower than the 3rd best troponin-for-heart-attacks project (Urgent and Emergency Care | SBRI Healthcare).
There are 100,000 hospital admissions per year due to heart attacks, where respiratory conditions account for seven times that. In fact, respiratory conditions account for approximately the same as all cardiovascular conditions and are increasing at a much faster rate.
Why Funding is Unequitable?
Respiratory conditions have long been challenging to address. There have been many factors highlighted as to why this is true, and why this may have facilitated unequitable funding. A discussion as to how this dynamic has been perpetuated is welcome.
A. Respiratory diseases lack a single easy to administer and interpret objective test
B. There is no single or objective treatment
C. Respiratory conditions are unpredictable, time-variant and volatile
D. Asthma and COPD are increasingly viewed as umbrella terms for a collection of sub-types. Like there is not one cancer, there is not one asthma
E. Respiratory conditions often do not exist in a silo, people have co-morbidities, especially allergies and heart conditions that interlink with the lung symptoms and function
F. Public awareness on the massive burden of asthma and COPD is low — COPD is the 3rd leading cause of death, but many have not even heard of the condition
G. There have been many previous failures and stagnation in respiratory innovation
H. There are high levels of patient-blame
For these reasons, and many others, challenges exist for funding bodies to take a consistent, targeted approach to supporting respiratory research.
R&D funding favours innovations that improve patient outcomes in a self-contained way. Take everything as it is today, add this one change, and get a direct improvement in care quality or costs: A diagnostic test that says if someone has COVID-19 or not; a surgical implant that props open a clogged artery; a short course of a drug which reverses a disease.
Unfortunately, the nature of chronic respiratory conditions does not lend itself to such solutions.
It is unlikely a single diagnostic test at a single time point being able to diagnose asthma or COPD, let alone the sub-types of these conditions. Similarly, there is not yet a clear path to a “cure” or “vaccine” for asthma or COPD.
Instead, the wide ranges of asthmas and COPDs, along with the time varying nature of these conditions, need approaches that respond to these complexities. It requires a more holistic and pathway-orientated and system wide solution.
This can come with perceived challenges of aligning patient pathways that respond to changes in the patient’s condition, smoothly transfer the patient between health care teams, and balance the health economic incentives of these different stakeholders.
What Can Be Done?
Much can be achieved through encouraging funding bodies to value innovations supporting those living with respiratory conditions through their whole pathway. They should promote personalised care and a holistically improved quality of life, reduced exacerbations, and keeping people out of hospital.
More can be done to narrow the gap of respiratory funding. Through increasing the value placed on this perspective, we can also align with the NHS’s Long-Term Plan and the growing number of people living with respiratory conditions (NHS Long Term Plan).
The perspective outlined, challenges and solutions are not new and have previously been articulated in effective ways, for example The Invisible Epidemic of COPD TEDxCharlotte by Jean Wright, MD.
A major part of what is needed is for people affected by respiratory conditions to take a deep breath and raise their voice to end this silent epidemic.
Quality of care and the development of better technologies for respiratory conditions will only happen with awareness and pressure from the people struggling from these conditions.
As both a person living with a respiratory condition and as a founder working to alleviate these challenges, I am excited by the potential to innovate and bring forward solutions, and I hope the unequal and unequitable research funding allocation will be recognised and reduced.
Graeham Douglas
Person with Asthma
Founder of Arete Medical Technologies