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New clinical risk tool could help GPs reduce COPD hospital admissions

The tool is the most accurate prognostic score of its kind and has the potential to improve COPD patient care whilst easing pressure on the NHS.

23 March 2026
A doctor showing an older patient information on a digital tablet

A new clinical risk tool - the Birmingham Lung Improvement Studies (BLISS) score - could help GPs to identify patients with chronic obstructive pulmonary disease (COPD) who are most likely to require hospital treatment.

In a new study published in The BMJ, researchers found that the BLISS score outperformed all existing COPD scores in predicting which patients are most likely to experience a severe respiratory health event requiring hospital admission within two years.

The study was led by University of Birmingham researchers in collaboration with Maastricht University, supported by funding from the National Institute for Health and Care Research (NIHR).

The BLISS score was created using data from a primary care cohort of 1,894 patients of new and existing COPD patients and validated in two independent national and international datasets.

COPD is a major global health challenge, with 1.2 million people diagnosed in the UK and more than 400 million affected worldwide.

Professor Rachel Jordan, University of Birmingham

COPD is a long‑term lung condition that causes breathing difficulties due to chronic inflammation and damage to the airways. It’s ranked as the fourth leading cause of death globally, and in the UK, it is the second most common cause of emergency hospital admissions. As a result, COPD is one of the largest contributors to winter pressures on the NHS, which are increasing healthcare costs and affecting quality of life for millions of people in the UK.

Professor Rachel Jordan from the University of Birmingham said: “COPD is a major global health challenge, with 1.2 million people diagnosed in the UK and more than 400 million affected worldwide. It is also one of the most expensive conditions for healthcare systems, with over 120,000 hospital admissions per year in the UK – largely due to acute exacerbations triggered by respiratory infections and other environmental factors.”

Improving the accuracy of predictions for hospitalisation

Unlike other existing risk scores - which can be complex or predominantly rely on hospital-based tests – the BLISS score includes six common measures easily collected by GPs, including:

  • Age
  • COPD Assessment Test (CAT) score (the impact on patients’ lives)
  • FEV1 % predicted (a measure of lung function)
  • Body Mass Index (BMI)
  • A record of respiratory-related hospital admissions in the previous year
  • Diagnosis of diabetes

A combined score gives clinicians a personalised estimate of a patient’s risk of hospitalisation. The study showed that the BLISS score offers the most robust prognostic score of its kind to date, meaning it could improve patient care by supporting earlier, more targeted interventions for high‑risk patients.

The BLISS score provides GPs and other clinicians with an evidence-based way to target effective interventions to those patients with the greatest risk.

Professor Peymané Adab, University of Birmingham

Professor Peymané Adab, senior author on the study, said: “Not everyone has the same risk of being hospitalised, so the BLISS score provides GPs and other clinicians with an evidence-based way to target effective interventions to those patients with the greatest risk. This has the potential to reduce severe exacerbations - and avoidable admissions which lead to higher costs - whilst also optimising patients’ quality of life.”

Supporting patients who need it most

Once high‑risk patients are identified, they can be directed towards more intensive, personalised models of care. Targeted interventions, informed by a BLISS score, could include:

  • Prioritised access to pulmonary rehabilitation
  • More frequent clinical reviews or post‑exacerbation follow-up
  • Prescribing of therapies for those most likely to benefit
  • Access to integrated care services, community pharmacy support or digital monitoring
  • Enhanced self‑management plans and preventative support

The score could also support shared decision-making, enabling clinicians to communicate individual risk with patients more clearly.

Professor Alice Turner, co-author and Respiratory Consultant, said: “COPD services are increasingly stretched as our population becomes older and frailer. Having a practical tool that enables prioritisation of cases at higher risk of poor outcome, like admission to hospital, would be incredibly useful to make widespread implementation easier and therefore more likely to occur.”

Siân Williams, CEO of the International Primary Care Respiratory Group said: "Many countries are facing the same challenges of finding the best ways to fit limited resources to the needs of people with Chronic Respiratory Disease. A tool that draws on routine primary care data to support prioritisation is the right way forward and it would be great to see its potential beyond the UK."

The research team now plans to work on integrating the BLISS score into routine GP software systems across the country so that risk is calculated automatically during consultations. The next phase of research will involve testing implementation in real-world settings to determine the scores impact on patient outcomes, service use and NHS costs.

This paper summarises independent research funded by the National Institute for Health Research (NIHR), under its Programme Grants for Applied Research Programme and supported by the NIHR Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham.

Notes for editors

Notes to Editor:

For media enquiries and more information please contact Holly Young, Press Office, University of Birmingham, tel: +44 (0)7815 607 157.

About the University of Birmingham

  • The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, educators and more than 40,000 students from over 150 countries.
  • England’s first civic university, the University of Birmingham is proud to be rooted in of one of the most dynamic and diverse cities in the country. A member of the Russell Group and a founding member of the Universitas 21 global network of research universities, the University of Birmingham has been changing the way the world works for more than a century.

About the research

This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (grant reference number RP-PG-0109-10061) and supported by the NIHR Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The Birmingham COPD Cohort study is part of the Birmingham Lung Improvement StudieS: BLISS.

About the National Institute for Health and Care Research

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

  • Funding high quality, timely research that benefits the NHS, public health and social care;
  • Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
  • Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
  • Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
  • Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
  • Funding applied global health research and training to meet the needs of the poorest people in low and middle-income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle-income countries is principally funded through UK international development funding from the UK government.

https://www.nihr.ac.uk/

About the NIHR Birmingham Biomedical Research Centre

The NIHR Birmingham Biomedical Research Centre (BRC) is part of the NIHR and hosted by University Hospitals Birmingham NHS Foundation Trust in partnership with the University of Birmingham. The BRC’s research programme focuses on inflammation and the diagnosis, prevention and treatment of its associated long-term illnesses.

Birmingham Biomedical Research Centre - University Hospitals Birmingham

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  • Professor Rachel Jordan

    Professor of Epidemiology and Primary Care

    Staff profile for Professor Rachel Jordan who is the Director of Global Engagement, College of Medicine and Health and Professor of Epidemiology and Primary Care at the University of Birmingham

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