The FRONTIER Project: Transforming COPD diagnosis in Hull

This work is part of a collaborative working project in conjunction with Hull University Teaching Hospital and Chiesi Limited.

Hull has some of the highest rates of Chronic Obstructive Pulmonary Disease (COPD) and subsequent mortality in the UK.^[1] From our 15 years of respiratory nursing, we’ve seen firsthand the devastating impact of late diagnosis, not just medically, but also emotionally and socially. Many of our patients have low health literacy and may not actively seek out care. That’s why our approach is different: instead of waiting for individuals to present themselves, we proactively reach out, offering appointments directly.

To address this urgent and unmet need, the FRONTIER project, a collaboration between Chiesi Ltd and Hull University Teaching Hospitals, was launched in October 2023. Designed to reduce the burden of late diagnosis, it aims to intervene earlier and improve outcomes for those most at risk.

Background

COPD affects an estimated three million people in the UK, with two million of these remaining undiagnosed.^[2] It is the second most common reason for emergency hospital admission.^[3] The importance of timely and accurate diagnosis has been widely acknowledged and is essential for improving outcomes in COPD, yet access to diagnostic testing remains problematic with many patients waiting over five years for a diagnosis, subsequently leaving them feeling abandoned and invisible.^[4],^[5]

We provide spirometry and a comprehensive respiratory assessment for participants of the Hull Lung Cancer Screening programme who were unable to receive spirometry during the COVID-19 pandemic. Invitations to our one-stop clinic are offered to individuals who reported symptoms and/or had emphysema on low-dose CT scan.

The process

Our nurse-led clinic, supported by a clinical support worker and weekly respiratory consultant supervision, offers a full respiratory assessment within a single one-hour appointment. Assessment includes clinical history, physical examination, blood tests, pre- and post-bronchodilator spirometry, pre and post bronchodilator N-Tidal, symptom questionnaires, diagnosis, education and treatment initiation. This one-stop approach avoids multiple appointments, which can delay care and pose challenges for our patients, many of whom struggle with attending multiple appointments, due to a lack of transport, work commitments, or other barriers such as living in deprivation.

Empowering those invited to our clinic to understand the purpose of the review has been vital. Early in the project, we identified several challenges to clinic attendance, such as negative attitudes towards hospital appointments, financial barriers, and clinic location. By calling patients before their appointments to explain its purpose and offer flexibility, we reduced our “Did Not Attend” rate in the first few months, something that has continued to fall.

As nurses however, we regard FRONTIER as far more than just a COPD diagnostic clinic. We feel timely diagnosis and treatment initiation provides the opportunity for multifaceted prevention aiming to reduce disease progression, improve quality of life, and reduce strain on the NHS. It allows us to provide preventative measures to prevent airflow limitation in those with normal spirometry who still smoke and offer education in relation to co-morbid conditions through a holistic model of care. We find far more than just COPD in the clinic with some individuals receiving a diagnosis of asthma, interstitial lung disease, obstructive sleep apnoea or heart failure following our review.

Research

Research has been integral to this project. We have successfully embedded research into practice via the Beyond – FRONTIER study, using N-tidal, a novel respiratory diagnostic technology to investigate the potential for N-Tidal to improve COPD diagnosis and enable detection of pre-COPD.^[6] Individuals can also consent to a sub-study which investigates blood biomarkers in our clinic population to identify early indicators of COPD.

This project has allowed us, as respiratory nurse specialists, to develop professionally. We have presented our work to peers within NHS England, lobbied for change at a parliamentary meeting and presented our data on a regional, national and international level. Presenting real world evidence from our clinical service has gained positive external interest and opinion in England and Wales. Notably, Jim Shannon, MP, highlighted the project during a debate in Westminster on Respiratory Health in November 2024, stating that the minister and NHS England should look closely at its outcomes.^[7]

Conclusion

We are incredibly proud of this project; collaborative working has enabled us to support the setup of a service that allows us to make a real difference to our community. We have shown that with the right equipment, facilities and attitude as well as the  determination to make it work – great things can be achieved. Working on the FRONTIER project has been a huge privilege. Our unique, one-stop, nurse-led COPD diagnostic clinic aligned to lung cancer screening has provided our community with access to specialist respiratory reviews and diagnostic testing that were previously difficult to obtain.

Any advice given and opinions expressed in this article are those of the author and do not reflect the view of Chiesi Limited (Chiesi).  All content in this article is for informational and educational purposes only.  Although Chiesi strives to always provide accurate information, it is not responsible for and does not verify for accuracy any of the information contained within.

[1]. Hull Health and Wellbeing Board. Respiratory Disease 2024 Available from: https://www.hulljsna.com/adults/health-factors-adults/respiratory-disease/.

[2]. Chronic obstructive pulmonary disease: How common is it? Available at: https://cks.nice.org.uk/topics/chronic-obstructive-pulmonary-disease/background-information/prevalence-incidence/

[3]. Thomas S. A matter of life and breath A consultation exercise to understand the needs and insights of people with lived experience of chronic obstructive pulmonary disease (COPD) 2025 Available from: https://www.kcl.ac.uk/sims/assets/copd-voices-final-29042025.pdf.

[4]. Howard S. “Silent scandal” of missing lung diagnostics in England’s most deprived areas—where respiratory disease is most prevalent. BMJ. 2023;382:p2140.

[5]. COPD in the UK: Delayed diagnosis and unequal care. Available at: https://www.asthmaandlung.org.uk/sites/default/files/2023-03/delayed-diagnosis-unequal-care-executive-summary.pdf

[6]. Tidal Sense. Respiratory leaders join forces in bid to address UK’s respiratory diagnostic crisis 2023 Available from: https://tidalsense.com/posts/chiesi-aluk-hull/.

[7]. Debate: Respiratory Health. Westminster Hall, House of Commons, 2024. Available at: https://www.parallelparliament.co.uk/mp/jim-shannon/debate/2024-11-14/commons/westminster-hall/respiratory-health.