This is Life + Breath: why the Quality Statement for Respiratory Disease needs to be implemented urgently

Our new report marks two years since the publication of Welsh Government’s Quality Statement for Respiratory Disease (2022) and makes the case that urgent action must be taken to ensure respiratory care improves.

Read our report

1 in 5 people in Wales have a lung condition and they remain in the top three causes of death in our nation.  The cost to Wales is a staggering £772 million per year, including both direct and indirect costs and  Wales remains the worst nation in Western Europe for respiratory deaths.

The quality statement aims to ensure that respiratory care in Wales is equitable, safe, effective, efficient, person-centred and timely.

Our key findings are as follows:

  • Equitable: Better quality patient information is needed to ensure inequalities are minimised, while access to innovative therapies such as biologics and rehabilitation are required.
  • Safe: Less than 10% of respiratory patients received a discharge bundle when they were sent home from hospital, while only 27.9% of adults with asthma and only 24.1% of children with asthma receive an asthma action plan
  • Effective: While smoking rates have declined, 12.6% of people in Wales still smoke. Rates of routine vaccine uptake in Wales are declining. NRAP’s 2024 survey showed that just 13% of patients across with COPD Wales had been referred for pulmonary rehabilitation (PR) . 
  • Efficient: Just 21.4% of patients with COPD had any spirometry test. 39.8% of children and 54.4% of adults with asthma had a recorded measurement.
  • Person-centred: NHS Wales has produced a range of self-help apps for asthma and COPD, however there is inconsistency in patient awareness and use. Referral rates for PR are low and yet waiting lists are up to four years in some areas.
  • Timely: The total number of in-patients receiving a review within 24 hours is just 30.8% (NRAP). Welsh Government reports that in Winter 2022/23, there were 14,603 admissions due to these respiratory infections.


We therefore recommend the following:

  1. A comprehensive improvement plan for respiratory care in Wales similar to that available for cancer.
  2. Welsh Government need to prioritise the diagnosis of respiratory patients by providing a spirometry recovery fund of £1.1 million over the next two years.
  3. General practice needs to prioritise lung conditions, steadily increasing the proportion of people with asthma and COPD receiving good year-round basic care, so that the majority of people receive it by the end of the next Senedd.
  4. Expand community respiratory teams to prevent hospital admissions and reduce winter pressures.
  5. Increase access to pulmonary rehabilitation (PR) for all those eligible - develop All-Wales standards, sign up to the Pulmonary Rehabilitation Services Accreditation Scheme (PRSAS), develop an opt-out direct referral system and utilisation of digital PR.

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