New national report reveals critical gaps in asthma and COPD care

A new NRAP report has highlighted persistent and widespread gaps in the care of people with asthma and chronic obstructive pulmonary disease (COPD) across England and Wales, calling on integrated care boards and local health boards to mandate all eligible services to participate in NRAP to achieve 100% service participation and a minimum of 50% case ascertainment by all services in NRAP audits by May 2026. This will require all services to have named NRAP clinical leadership and dedicated audit support.

The Catching our breath report, which analyses data from over 126,000 patient records between April 2023 and March 2024, highlights that:

• only 10% of adults with asthma had their peak flow measured within one hour of arrival at hospital
• just 18% of people with COPD who received non-invasive ventilation were treated within the recommended two-hour window
• a mere 4% of patients entered into the pulmonary rehabilitation (PR) audit were referred to PR upon discharge following a hospital admission for acute exacerbation of COPD
• fewer than half of adults with asthma (47%) received all recommended discharge bundle elements.

For the first time in one of their reports, the NRAP has highlighted regional variability in the delivery of key aspects of care, both to flag unmet need and to support service development and strategies for ongoing healthcare improvement at a local and regional level.

Professor Tom Wilkinson, senior clinical lead, NRAP said:

‘Respiratory conditions remain one of the most common reasons for emergency hospital admissions. Yet over a decade since the landmark National Review of Asthma Deaths, and despite clear evidence and national guidelines, we are still failing to deliver timely and equitable care to thousands of people every year. Essential treatments and good practice interventions are still not being delivered consistently.

‘National policymakers, healthcare regulators and commissioners must now support the respiratory community by acting on our recommendations to improve outcomes. This should include the development of an acute care bundle which would ensure rapid assessment and delivery of medication and treatment to people with asthma and COPD on arrival to hospital wherever they are in the country.’

There are four key overarching themes in the report:

1. Improve data availability and quality.
2. Ensuring timely access to optimal care.
3. Deliver essential treatment for tobacco dependency.
4. Improve discharge planning.

The report also shines a light on innovation through the NRAP Healthcare Improvement Programme which was launched in 2024. 30 respiratory services and 10 quality coaches have already begun to drive local change, piloting improvements in acute care, discharge planning and tobacco dependency treatment.

Dr Irem Patel, COPD clinical lead, NRAP explained: 

‘People who smoke know that it is not in their best interests; most want to stop and have tried many times. This can cause feelings of frustration or guilt, or a lack of hope, especially if someone has already developed a health problem related to smoking. However, most people are not offered the right treatment and support for their smoking.

‘An admission to hospital is an important time to think about this, and there are now new medications and treatments that work, as well as free NHS support available in hospitals. Acute nicotine withdrawal is also uncomfortable and can impact a patient’s care, and we should offer treatment for this to all inpatient smokers. We want to encourage clinical teams to make sure tobacco dependence treatment is offered to all patients with COPD and asthma and to support where this is not happening.’

Dr Hannah Burke, COPD clinical fellow, NRAP added: 

‘Too many people with COPD are still waiting too long for life-saving interventions – from timely non-invasive ventilation in hospital to access to pulmonary rehabilitation after discharge. These delays represent missed chances to prevent readmissions and improve lives. We urgently need the NHS to turn our recommendations into action, ensuring every person with COPD receives the care they need. 

‘All integrated care boards and local health boards should regularly review NRAP data on discharge planning for CYP and adult asthma and COPD with their providers. If there are gaps in care, or poor data quality, they should collaborate to identify solutions.’

Key recommendations from the report include:

• mandating participation in NRAP for all eligible services to improve data quality and accountability
• developing a national acute care bundle for asthma and COPD admissions, led by the British Thoracic Society
• rolling out comprehensive tobacco dependency treatment services across all hospitals.

The findings come as NHS England prepares to publish a new 10 Year Health Plan – a critical opportunity to embed NRAP recommendations into future respiratory care strategies.

Dr John Dean, RCP clinical vice president concluded: 

‘This report is a stark reminder that we are still falling short in delivering the care that people with respiratory conditions need and deserve. We continue to see critical delays in treatment and missed opportunities to intervene early. We now need urgent investment, national leadership and local action to ensure respiratory care is not left behind as the NHS sets out its new 10 Year Health Plan.
 
‘It’s essential that the NHS develops a more joined-up approach to respiratory health – one that addresses both clinical care and the wider determinants of lung disease. 
 
‘We need stronger, evidence-led action on the environmental drivers of respiratory illness. On Clean Air Day next Thursday, the RCP will also launch a major new report on air quality and health, setting out recommendations to clean up our air and protect health.' 

The NRAP is hosting a webinar for respiratory care teams on 15 July, 12.45pm – 2pm. This webinar will run through the report with commentary from the NRAP clinical team on how the recommendations can be implemented at a local level and a summary of the key data and takeaways. There will also be opportunity to ask questions during a short Q&A session.