Respiratory care improving in key areas – but progress remains uneven, new report shows

11 Jun 2026

A new report out today from the HQIP-commissioned National Respiratory Audit Programme (NRAP), which is hosted by the Royal College of Physicians (RCP), highlights improvements in chronic obstructive pulmonary disease (COPD) and pulmonary rehabilitation care, but warns of stalled progress in adult asthma and delays in treatment following acute admission.

Key findings include:

35.9% of COPD admissions are from the most deprived communities.
37% of patients hospitalised with COPD still smoke.
Only 38% of children receive the recommended treatment of steroids within one hour of admission following a severe or life-threatening asthma attack.
The average wait for people with stable COPD to start pulmonary rehabilitation is 100 days.
Only 38.8% of hospitals meet recommended asthma nurse staffing levels.

Room to breathe: a longitudinal review of respiratory data finds that care for people with respiratory conditions is improving in some key areas, but progress is inconsistent across services. The findings draw on data from around 100,000 hospital admissions and nearly 48,000 pulmonary rehabilitation assessments across England and Wales.

The report shows encouraging signs of improvement in several core aspects of care, particularly for people with COPD, children and young people with asthma, and those referred for pulmonary rehabilitation. These include safer oxygen prescribing, better access to tobacco dependence support and improvements in discharge processes.

However, there are ongoing challenges in delivering consistent, high-quality care at scale, and variation in care persists. Tobacco dependence continues to be a major driver of poor outcomes, with around 37% of hospitalised COPD patients still smoking – a figure that has remained largely unchanged over the past decade (although there has been important improvement in people who currently smoke being offered tobacco dependency advice, in line with NICE guidance). In addition, access to pulmonary rehabilitation is improving, but with room for improvement.

As such, the report calls for renewed focus on implementing proven interventions, including discharge bundles, early treatment in emergency care and system-wide approaches to tobacco dependency, alongside collaboration between specialties to improve care in the crucial first hours of hospital admission.

Professor Tom Wilkinson, HQIP Medical Director and former NRAP senior clinical lead, explains: “What this analysis makes clear is that progress in respiratory care is possible, but it is not happening at the pace or scale needed. Variation remains a major challenge, and the priority now must be consistent implementation of proven interventions. If we are serious about reducing avoidable admissions and improving patient experience, we must focus on embedding these approaches across the whole system.”

This report highlights the value of national clinical audit in improving healthcare and, ultimately improving and saving lives. The data and outputs from HQIP’s national programmes are an invaluable, publicly available resource that shine a light on where improvements will have the maximum impact; supporting healthcare providers to implement changes that will improve care and outcomes for everyone.

Chris Gush, HQIP’s CEO, expands on this: “National clinical audits like NRAP measure health services, comparing the care delivered against standards. Covering a wide range of common conditions, they provide robust, clinically-validated data, and shine a light on what is working well and what is not. The NHS cannot improve what it cannot see clearly. Audit gives clinicians, providers and systems the evidence they need to focus limited capacity on the interventions that work, reduce avoidable pressure, improve consistency, and deliver greater efficiency across services.”

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