This report represents the first comprehensive application of strategic foresight to the intersection of CRDs and nicotine use. By bringing together expert voices and rigorous scenario planning, it explores four plausible futures and charts a course toward the one we must strive for.
Over the past decade, Chronic Respiratory Diseases (CRDs) have silently claimed millions of lives, placing an immense strain on health systems world wide. As the third leading cause of death globally, conditions like Chronic Obstructive Pulmonary Disease (COPD) and asthma continue to escalate significantly, driven by the evolving landscape of nicotine consumption.
Now is a critical moment to reassess how we prevent and manage CRDs, before the challenges deepen further. CRDs already affect at least 550 million adults every single day, yet they remain too often invisible in global health discussions.
This report arrives at a moment when we still have time to shape the future, but only if we act urgently.
In convening global stakeholders from clinicians and patient advocates to policymakers and behavioural scientists, the Copenhagen Institute for Futures Studies (CIFS) has leveraged desk research and interactive workshops to map the key uncertainties shaping our trajectory.
The resulting narratives do more than describe potential worlds, they offer early warning signals, tipping points, and concrete trade-offs that demand our attention today. Whether it is the promise of breakthrough cessation treatments, the threat of tobacco industry interference, or the power of youth-led activism, each scenario underscores the urgency of sustained, coordinated action.
As you explore these four futures, ranging from an “Endgame Generation” triumph to the stark warning of an “Ashtray Planet”, you hold in your hands both a mirror and a compass. Let this work inspire you to look beyond the conventional, to engage with uncertainty as opportunity, and to champion the strategic actions that will safeguard respiratory health for generations to come.
The time to act is now.
Disclosures
This report was commissioned by Sanofi and Regeneron. The Copenhagen Institute for Futures Studies (CIFS) independently conducted the research, expert interviews, workshop facilitation, and the development of all scenarios and recommendations. While Sanofi and Regeneron provided financial support, CIFS maintained full editorial independence. Neither the Copenhagen Institute for Futures Studies nor Sanofi and Regeneron have any affiliation with the tobacco or nicotine industry.
Acknowledgements
The project team would like to thank the following Advisory Board members of the Respiratory Health Initiative for the contribution of their insights, guidance, and professional support of this report: Dr. Anders Løkke Ottesen, Eric Sutherland, José Luis Castro, Dr. Min Zhang, Dr. Ricardo Baptista Leite, Siân Williams, Tonya Winders, Dr. William Checkley.
We would like to thank the experts who contributed their time and knowledge through interviews and workshops, helping shape the scenarios and recommendations presented in this report.
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