Respiratory disease affects 1 in 5 people and is strongly associated with social deprivation.

This report highlights progress made by the health and care system in implementing NICE guidance on respiratory conditions. 

Published July 2020

Why focus on respiratory conditions?

  • 1 in 5 people are affected
  • £9.9 billion cost to the NHS each year
  • 3rd biggest cause of death
  • 850,000 emergency admissions
  • 4.9 million days in hospital
  • 80% more admissions in winter

What we've published on this topic

Key findings from the report

This page provides a summary of the findings from the report. It includes insight from Kay Boycott, chief executive of the Asthma UK and British Lung Foundation Partnership, about NICE's role in improving outcomes for people with respiratory conditions.

The report looks at the impact of our guidance before the COVID-19 pandemic. It highlights where new COVID-19 resources have been developed to help the NHS and social care take action.

NICE is uniquely placed to drive improvements in respiratory care, and their guidance is indispensable for anyone caring for people with lung conditions.

Kay Boycott, chief executive of the Asthma UK and British Lung Foundation Partnership

Asthma and chronic obstructive pulmonary disease (COPD)

Key points

  • Agreeing a personalised action plan can help adults and children over 5 to self-manage their asthma and reduce the risk of exacerbations. Since our asthma quality standard was published in 2013, the proportion of people who agreed a written plan has doubled. However, young people are less likely to agree a plan. Only 42% of people aged 6 to 17 agreed a plan compared to 59% of people aged 18 and over.
  • Our COPD quality standard says that people with suspected COPD should have post bronchodilator spirometry to identify abnormalities in lung volume and air flow for early diagnosis. In 2018/19, 81% of people had their COPD diagnosis confirmed by spirometry.
  • The quality standard also says that pulmonary rehabilitation should be available for people with stable COPD and exercise limitation because of breathlessness, and people who have been admitted to hospital for an acute exacerbation of COPD. While people have good outcomes after rehabilitation, waiting times remain too long. In 2019, 44% of hospitals did not make rehabilitation available within 4 weeks of discharge for people with COPD.

Insight from Kay Boycott

"Asthma and COPD limit quality and length of life but surveys and audits show substantial gaps in care and unmet need. If fully implemented, NICE guidance would improve the standard and safety of care for those at higher risk to COVID-19.

Two thirds of asthma deaths could be prevented with better basic care, which 3 out of 5 people are still not receiving. Standards in acute care are also being missed. Likewise, focusing on the '5 fundamentals' of COPD care - smoking cessation, flu vaccination, pulmonary rehabilitation, self-management and treatment of multi-morbidity - could address these gaps, but only if implemented."


Key points

Insight from Kay Boycott

"Pneumonia is a leading cause of death and hospitalisation yet is often preventable. Uptake of the pneumococcal and flu vaccines remain worryingly low among people with health conditions such as lung disease.

Once bacterial pneumonia is diagnosed, antibiotic treatment should be started as soon as possible for the best chance of recovery. Recent audits have shown steady improvement over the last decade in the percentage of people receiving antibiotics within 4 hours of hospital admission. With the threat of antimicrobial resistance, NICE’s guidelines on antimicrobial prescribing are essential reading to ensure more people get prompt access to the right antibiotics."

Tuberculosis (TB)

Key points

  • The most deprived 10% of the population experience an incidence rate 7 times higher than the least deprived 10%.
  • Our quality standard on TB highlights that rapid assessment results in treatment starting earlier (within 2 months of onset) for people with pulmonary TB. However, in 2018, 30% of people experienced a delay of more than 4 months.
  • The quality standard also says that people with active TB who have a history of homelessness, drug or alcohol misuse and those who are in prison or have been in the past 5 years should be offered directly observed therapy (DOT). However, since 2016 there has been a reduction in the proportion of people receiving DOT. New technologies have been developed to securely and remotely monitor TB patients taking their medication, referred to as video observed therapy (VOT). VOT has enabled higher levels of treatment observation than DOT in under-served populations with TB in England, and has been shown to be more acceptable and cheaper for supervision of doses.

Insight from Kay Boycott

"Significant progress has been made in reducing rates of TB in England. The drop in new cases by 45% between 2011 and 2018 should be commended. NICE’s recommendation to screen for latent TB in people arriving from high-incidence countries, along with pre-arrival screening, has undoubtedly helped decrease incidence among this group.

National efforts are now moving to reduce the interval between symptom onset and diagnosis. The upcoming TB strategy, due to be published shortly, should set out plans for the next 5 years to further reduce and ultimately eliminate TB as a public health problem in England."

NICE and the environment

Key points

  • Air pollution is associated with an estimated 28,000 to 36,000 deaths and costs the NHS and social care system £43 million each year.
  • Our guideline on outdoor air pollution makes recommendations on reducing emissions from public sector transport services and vehicle fleets. We also recommend active travel such as on foot or by bicycle, reducing reliance on vehicles and increasing exercise. Almost 10,000 new cases of asthma could be avoided by 2035, if there was a small reduction in air pollution.
  • We have produced a patient decision aid on inhalers for asthma to help people and their healthcare professionals decide which inhaler is best for them. It includes the carbon footprint of the inhaler, which can vary greatly between products. If it is a viable option, people can choose a more environmentally friendly inhaler which can contribute to cutting the NHS’s carbon footprint. Two puffs of an inhaler with propellant has almost the same estimated carbon footprint as 2 miles in a typical car.

Insight from Kay Boycott

"Air pollution is a public health emergency and is linked to a wide range of health problems. The NICE guideline on outdoor air quality provides a strong list of recommendations for tackling the impact of emissions from transport sources, and its focus on a holistic approach is welcome.

The recent addition of guidance on indoor air quality at home is a big step forward in raising awareness of this issue. However, if these guidelines are to be adopted, we would like to see NICE go beyond acknowledging the problem to providing more detail on how implementation can be improved."

More information

This report highlights progress made by the health and care system in implementing NICE guidance. We recognise that change can sometimes be challenging and may require pathway reconfiguration. It may also require additional resources such as training and new equipment.

We work with partners including NHS England and NHS Improvement, Public Health England and other relevant organisations to support changes. We also look for opportunities to make savings by reducing ineffective practice.