Tackling lung disease through holistic respiratory care

Advanced nurse practitioner Beverley Bostock outlines why the government must do more to promote a holistic, joined-up approach to support those with lung conditions and comorbidities

This summer, the impact of climate change has been felt more than ever. Many areas of the world have experienced significantly increased temperatures, periods of drought and devastating floods. For people living with respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD), climate change and poor air quality add to the burden of triggers they already face that can lead to poor disease control – pollens, moulds, thunderstorms and winter viruses are just some of the elements that can lead to an increase in symptoms, hospitalisation or even death. (1, 2)

This may sound worrying, but where there are threats, there are also opportunities. We have the diagnostic tools and treatments with the potential to improve respiratory wellbeing for many people. National and international guidelines are closely aligned and stress the importance of early, accurate diagnosis and the use of personalised treatments and supported self-management to optimise outcomes. (3, 4, 5, 6) Evidence-based approaches to respiratory care are improving and, recognising the increasing link between lung health and other long-term conditions such as cardiovascular disease, clinicians are encouraged to consider multimorbidity in clinical reviews, rather than focusing only on the lungs. (7)

Care disparities and lack of training put diagnosis and treatment at risk

Many people with a respiratory diagnosis will have coexisting conditions which can affect symptom burden and management. For example, people living with COPD often live with, or are at risk of, cardiovascular disease, heart failure, type 2 diabetes and mental health problems, so clinicians need to be aware of this to ensure that the care and treatment are holistic, appropriate and person-centred. (8, 9)

This means healthcare workers need appropriate training to competently and confidently recognise, diagnose, and treat different conditions. In primary care, where most healthcare takes place, access to training and protected time to undertake it can vary from practice to practice. Too often, this is because GPs are independent contractors within the NHS, who can set their own terms and conditions for employees, such as practice nurses, and who may therefore limit protected time for training and development. While some GP employers recognise the medicolegal and ethical need for adequately trained staff, others may not, leading to disparities in access that can cause significant dissatisfaction within the GP nurse community. (10)

Similarly, some practices will ensure that they have the correct equipment, endorsed by national guidelines, to support the diagnosis of a respiratory condition, such as fractional exhaled nitric oxide (FeNO) testing equipment and spirometers. However, far too many practices lack access to this equipment because they have decided not to acquire it due to budgetary constraints. This is frustrating not only for the staff trying to make the diagnosis, but also for the patient trying to get it. It seems inconceivable that a test recommended by national guidelines for the diagnosis of asthma in both adults and children is only available to the practices where the GP partners can afford to buy the equipment and the consumables. This is where the National Health Service becomes a Notional Health Service, increasing health inequality: people living in underserved areas risk a delayed diagnosis and access to treatment, potentially resulting in worse outcomes.

Trust and support across the whole care pathway is critical

Consider the uptake of vaccinations. People living with long-term conditions, including respiratory conditions, are at greater risk of a range of respiratory infections that can not only impact their existing condition, but which will also increase their risk of other health problems, specifically cardiovascular events. (11) If someone with COPD has a flare-up of their disease, often as a result of an infection, their risk of having a heart attack increases in both the short and long term. (7) Many of these infections can be prevented, or their impact reduced, through vaccinations, yet uptake remains worryingly low. (12) It seems that trust in healthcare advice has dropped significantly – but why is this? It’s not just people living with LTCs who are refusing their jabs – HCPs are failing in their duty to protect patients too.

Better respiratory health comes from supporting people to live healthier lives overall, with better nutrition, housing, air quality, and greater trust in the healthcare sector built through shared decision-making. Government, clinicians and the public need to work together to ensure that respiratory health gets the attention it deserves, from prevention through to cure.

References

1. European Environment Agency (2024) Air pollution and respiratory disease https://www.eea.europa.eu/en/analysis/publications/beating-chronic-respiratory-disease/air-pollution
2. World Health Organization (2026) Chronic Respiratory Diseases https://www.who.int/health-topics/chronic-respiratory-diseases#tab=tab_1
3. NICE (2024) Asthma pathway (BTS, NICE, SIGN) https://www.nice.org.uk/guidance/ng244
4. Global Initiative for Asthma (2026) Summary Guide for Asthma Management and Prevention https://ginasthma.org/wp-content/uploads/2026/07/GINA-Summary-Guide-2026-WEB-WMS.pdf
5. NICE (2019) Chronic obstructive pulmonary disease in over 16s: diagnosis and management https://www.nice.org.uk/guidance/ng115
6. Global Initiative for Chronic Obstructive Lung Disease (2026) 2026 Report https://goldcopd.org/
7. Shrikrishna, D., Steer, J., Bostock, B., Dickinson, S. W., Piwko, A., Ramalingam, S., Saggu, R., Stonham, C. A., Storey, R. F., Taylor, C. J., Thakkar, R., & Gale, C. P. (2025). Chronic Obstructive Pulmonary Disease and the Management of Cardiopulmonary Risk in the UK: A Systematic Literature Review and Modified Delphi Study. International journal of chronic obstructive pulmonary disease, 20, 2073–2090. https://doi.org/10.2147/COPD.S523865
8. Kotlyarov S. (2023). Analysis of the Comorbid Course of Chronic Obstructive Pulmonary Disease. Journal of personalized medicine, 13(7), 1179. https://doi.org/10.3390/jpm13071179
9. Wang, J. G., Bose, S., Holbrook, J. T., Nan, L., Eakin, M. N., Yohannes, A. M., Wise, R. A., & Hanania, N. A. (2025). Clinical Characteristics of Patients With COPD and Comorbid Depression and Anxiety: Data From a National Multicenter Cohort Study. Chronic obstructive pulmonary diseases (Miami, Fla.), 12(1), 33–42. https://doi.org/10.15326/jcopdf.2024.0534
10. Ashwood L (2024) The urgent need to address disparities in nurse T&Cs. Practice Nurse 54(6):7 https://practicenurse.co.uk/articles/nursing-practice/the-urgent-need-to-address-disparities-in-nurse-tandcs
11. Izquierdo-Condoy, J. S., Vásconez-González, J., Morales-Lapo, E., Tello-De-la-Torre, A., Naranjo-Lara, P., Fernández, R., Hidalgo, M. R., Escobar, A., Yépez, V. H., Díaz, A. M., Oliva, C., & Ortiz-Prado, E. (2024). Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases. Frontiers in cellular and infection microbiology, 14, 1293782. https://doi.org/10.3389/fcimb.2024.1293782
12. Tan PS, Patone M, Clift AK, et al (2023) Factors influencing influenza, pneumococcal and shingles vaccine uptake and refusal in older adults: a population-based cross-sectional study in England. BMJ Open 13:e058705. doi: 10.1136/bmjopen-2021-058705