Respiratory disease
Our ambition for respiratory disease
We are focused on improving the outcomes of people with respiratory disease, including reducing premature mortality and the time people spend in crisis. The government’s 10 Year Health Plan for England seeks to move more care from hospital into the community by establishing neighbourhood health services. For people with respiratory disease, neighbourhood health services will:
- increase disease recognition to enable timely access to treatment
- provide equitable access to high-value interventions that keep people well and prevent deterioration – including innovative treatments for COPD and asthma
- encourage proactive action when people are in, or at the risk of, crisis, particularly during winter
About respiratory disease
Respiratory disease affects one in six people and is the third biggest cause of death in England (after cancer and cardiovascular disease), with asthma and chronic obstructive pulmonary disease (COPD) the most common long-term respiratory conditions.
Respiratory disease contributes to approximately 8% of hospital admissions and 10% of inpatient bed days, totalling around 6 million bed days and over 700,000 admissions annually. These admissions are predominantly unplanned and frequently peak during winter, placing intense seasonal pressure on emergency departments and inpatient capacity.
Asthma and COPD are estimated to cost the NHS £9.6 billion in direct costs each year, representing 3.4% of total NHS expenditure. These conditions also lead to annual productivity costs of around £4.2 billion and an overall economic burden of over £13 billion each year.
Incidence and mortality rates from respiratory disease are higher in disadvantaged groups and areas of social deprivation.. The most deprived communities have a higher incidence of smoking rates, exposure to higher levels of air pollution, poor housing conditions and exposure to occupational hazards.
Our work on respiratory disease
The respiratory programme aims to improve the treatment and support of people with respiratory disease and is aligned with the ambitions in the government’s 10 Year Health Plan for England.
Our specific aims are:
- Support early and accurate diagnosis of respiratory diseases, by improving access to tests such as spirometry.
- Increase the number of people completing pulmonary rehabilitation and encouraging services to become accredited to ensure good quality care.
- Enable equitable and sustainable roll-out of innovative new treatments such as biologics.
- Improve management of patients with respiratory disease at risk of admission to hospital, to optimise care and reduce winter pressures.
- Increase access to high quality and timely patient-level data and insight to support commissioning and management of services.
How we are working with partners
Our national respiratory programme is developing a clear approach with our partners, to improve outcomes for people with respiratory disease and meet the ambitions in the government’s 10 Year Health Plan for England.
We work closely with regional NHS England colleagues and Clinical Respiratory Networks to implement our programme of work and share best practice across the country.
A Respiratory Pathway Transformation Fund has been established by NHS England, with Health Innovation Oxford and Thames Valley (HIOTV) supporting delivery, to drive system-wide transformation in asthma and COPD care. 9 health systems have been awarded funding in 2025/26 to address the following national priorities:
- Early and accurate diagnosis – expanding access to quality-assured spirometry and restoring diagnostic pathways.
- Risk stratification and optimisation – proactively identifying and supporting rising-risk COPD patients with integrated, equitable care.
We are also working with the British Thoracic Society, Asthma + Lung UK, Primary Care Respiratory Society (PCRS), Getting It Right First Time (GIRFT) other arm’s length bodies (ALBs) and voluntary sector organisations to deliver a national programme of work.
Resources
Service improvement and commissioning
- Commissioning standards for spirometry: best practice guidance to help commissioners provide equitable access to high-quality, quality-assured spirometry services.
- FeNO testing for asthma diagnosis: information about the rollout of fractional exhaled nitric oxide (FeNO) testing to support the diagnosis of asthma.
- GIRFT guide to planning for seasonal respiratory illness: recommendations to help healthcare providers manage seasonal demand, reduce admissions and support timely discharge.
- Case study: improving access to palliative care: how The Royal Wolverhampton NHS Trust and Compton Care improved access to and coordination of palliative care for people with end-stage respiratory disease.
Clinical guidance and professional development
- NICE respiratory guidance and resources: evidence-based guidance and resources to support the delivery of high-quality respiratory care.
- British Thoracic Society clinical resources: guidance, standards and learning materials for healthcare professionals.
- Asthma + Lung UK resources: information, tools and downloadable resources for healthcare professionals and people living with lung conditions.
Data, audits and improvement tools
- Atlas of variation for respiratory disease: data and analysis to help local systems identify variation in respiratory care and improve outcomes.
- Respiratory prescribing dashboard: prescribing data and insights from the NHS Business Services Authority to support medicines optimisation.
- National Asthma and COPD Audit Programme (NACAP): information about the national clinical audit programme for asthma and COPD, which supports improvements in care and patient outcomes.
- Respiratory Futures: a digital platform bringing together respiratory news, guidance, case studies and examples of good practice.
Information and support for patients
- Breath Test: an online tool from Asthma + Lung UK that helps people understand whether they should seek advice from a healthcare professional about their lung health.
- Respiratory conditions on NHS.uk: information about respiratory conditions, symptoms, treatments and support.
If you would like any more information on the respiratory programme, please email england.clinicalpolicy@nhs.net.