Respiratory high impact interventions

Download these high impact interventions as a table (PDF).


Spirometry in diagnosis of asthma and chronic obstructive pulmonary disease (COPD)

Targeted testing in primary care to identify and further explore reduced lung function, providing the opportunity for preventative and/or treatment

Evidence suggests that earlier detection and diagnosis of COPD, asthma and other lung conditions allows the targeted use of early primary prevention interventions (like support to stop smoking) and secondary prevention interventions (like pulmonary rehabilitation).

NICE estimates there are 115,000 new diagnoses of COPD and 80,000 (average) asthma diagnoses per year.

Strong clinical consensus that an earlier diagnosis provides greater opportunity for proven clinical interventions.

Cost of intervention / Return on investment

£500 cost for training for quality assured spirometry, see below for illustrative cost of respiratory diagnosis bundle (one model): Local enhanced service respiratory diagnostic provision in the South West of England:

Cost per case based on county-wide activity

  • FeNO: £25.13
  • Spirometry: £17.37
  • Respiratory champion: £9345.16 per PCN/annum

Available evidence suggests that spirometry is likely to be a cost-effective measure. Lambe et al (2019)

The annual economic burden of asthma and COPD on the NHS in the UK is estimated as £3 billion and £1.9 billion respectively.  In total, all lung conditions (including lung cancer) directly cost the NHS in the UK £11billion annually.

Impact on demand

Both under and over diagnosis of respiratory conditions leads to delayed treatment and increased chance of acute admissions.

  • Under-diagnosis of moderate and severe asthma was recognised as a key factor in the National review of asthma deaths, 30% of all those that died had a diagnosis of mild asthma.
  • Children and young people without a diagnosis of asthma, but on an inhaler have poorer outcomes / cost more than those with an asthma diagnosis.

The ARCTIC observational cohort study: Late COPD diagnosis is associated with higher exacerbation rate and increased comorbidities and costs compared with early diagnosis. The study shows late diagnosis incurred a 15.7% increase in direct costs per patient during 2 years after COPD diagnosis. The study also highlights the need for accurate diagnosis of COPD in primary care in order to reduce exacerbations and the economic burden of COPD.

Expected outcomes

With targeted use of the interventions mentioned above, this burden can be offset by:

  • reduction in emergency and acute admissions
  • reduction in pharmaceutical costs
  • increased referral into education & self-management programmes reduces downstream intensive interventions.

By reducing misdiagnosis, the NHS could save an estimated £1.5-7.5 million per annum.



Inhaler and medicines optimisation

Action to ensure appropriate medicines use, particularly inhalers, to reduce exacerbations and mortality

Appropriate medicines use, particularly inhaler, is evidenced to reduce exacerbations and mortality.  With optimal therapy, 90% of people with asthma could be well controlled.

Evidence that widespread implementation of inhaled corticosteroids decreases unscheduled healthcare utilisation.

5.4 million people with asthma could potentially benefit from optimal use of inhalers and reduce the environmental impact of inhalers.

Cost of intervention / Return on investment

Inhaler prescribing is part of routine care as recommended by NICE. This applies to annual reviews where there is an opportunity to improve quality.

The optimisation of inhaler use is being incentivised through the Primary Care Network Impact and Investment Fund.  It is also incentivised for community pharmacists via the Pharmacy Quality Scheme.

Impact on demand

Regular use of inhaled corticosteroids, as part of a broader national focus on asthma, was effective in reducing costs associated with asthma in Finland, including hospital utilisation falling by 54% over a ten-year period.

Expected outcomes

Optimisation of inhalers is associated with better disease control, shown to improve clinical outcomes and reduces unscheduled healthcare usage.



Pulmonary rehabilitation (PR) for COPD

Support and exercises to improve lung function following exacerbations of COPD

Cochrane Review of PR following exacerbations of COPD, showed PR prevented further deterioration and exacerbations, and reduced admissions for 90% of patients who complete the programme.

Cost of intervention / Return on investment

PR is a cost-effective intervention for COPD, shown at £2,000-£8,000 quality adjusted life years.

£14 million (of NHS Long Term Plan funding) has been allocated to systems in 2022/23 to expand PR service provision and achieve the LTP objectives for PR.

Impact on demand

Approximately 2 million people have COPD in England and most will require PR.  If the LTP objectives for PR are fully implemented this could prevent 500,000 exacerbations and 80,000 admissions (modelling provided for the NHS Long Term Plan, p66).

Expected outcomes

Completion reduces hospital admissions and primary care appointments, and leads to clinically significant improvements in breathlessness, activity, exercise levels and quality of life for 90% of participants who complete.


NICE Guidance (2018) Chronic obstructive pulmonary disease in over 16s: diagnosis and management

British Thoracic Society – Quality Standards for pulmonary rehabilitation

Personalised Asthma Action Plan (PAAP) for all children and young people (CYP) with asthma

Ensuring CYP and their families have support and education to manage their conditions

The UK has one of the highest prevalence, emergency admission and death rates for childhood asthma in Europe.

Reviews of asthma deaths identified that educating staff on the use of PAAP and reviewing inhaler techniques could reduce exacerbations and prevent deaths from asthma.

Cost of intervention / Return on investment

Free PAAP templates and e-learning for health training modules available for all staff (tiers 1-3 are free to access and tier 4 costs £450 per learner).

Hospital admissions due to asthma range from £1516 to £2473 per night. Reducing admission by half would save the NHS c£9.8 million.

Impact on demand

Preventing CYP asthma exacerbations could save a further 50% of bed days to 6,000, £9.6m of saving.

Asthma deaths are largely attributable to avoidable factors.

Implementation of interventions will lead to increased quality of life, reductions in hospitalisations.