Interview: respiratory care needs a holistic and team-based approach

Analysis of NHS data by Asthma + Lung UK has shown a staggering 25.4% increase in cases of pneumonia requiring emergency hospitalisation in the last two years. It found that cases rose from 461,995 between April 2022 and March 2023 to 579,475 between April 2024 and March 2025.

Dr Andy Whittamore, Asthma + Lung UK’s clinical lead and a practising GP, discussed what needs to be done to address the problem with Cahal McQuillan.

Cahal McQuillan (CM): What could be happening in primary care to prevent escalation of pneumonia that isn’t happening now?

Dr Andy Whittamore (AW): There’s lots of things that the NHS can do better. Firstly, I think improving patient access is a good thing. That means that we can see who’s struggling with minor chest infections, minor flares of their asthma, or COPD and get it treated and controlled earlier.’

The problem is when patients present later, they’re more likely to be harder to treat and to be more unwell and develop into pneumonia and end up in hospital.

Secondly, we need to make sure that every eligible patient is vaccinated against everything that they can be vaccinated against.

That includes flu vaccines, the pneumococcal vaccine, pertussis vaccine, RSV vaccine, and the Covid-19 vaccine for those who are eligible.

As well as that, we need to be doing more to make sure that we are keeping on top of people’s long-term conditions, especially asthma and COPD. Because we know that people with poorly controlled asthma and COPD are more likely to develop exacerbations, chest infections, and end up in hospital with conditions like pneumonia.

That includes doing good quality asthma and COPD reviews, making sure people have the right medicines and they’re using them correctly, and making sure people have action plans to know what to do to stay well and what to do when things are not going well. Especially in winter, when people are most likely to get unwell.

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CM: Why do you think pneumonia cases and hospitalisations have risen?

AW: Well to start, there’s a large number of people with poorly controlled asthma and COPD, which makes them more vulnerable to infection.

Additionally, lower vaccination uptakes for respiratory diseases, increases the chance of people becoming unwell.

And we’ve got an aging population – a demographic with more diseases, more complexity, and more medication.

Then, because of the pressure the NHS is under, there’s access challenges that we know the patients do face.

As a result, we’re prone to treating the acute episode as quickly as possible. This means that we may not be treating the patient holistically, dealing with future risk, or helping to prevent future acute episodes.

CM: What are the key challenges in how respiratory conditions are currently managed across primary and specialist care?

AW: Well, the delegation of much of the work involved in managing long-term conditions to other members of the team, like practice nurses and pharmacists, has de-skilled a lot of generalists and clinicians with regards to respiratory medicine.

That delegation has meant that GPs and other healthcare professionals don’t see asthma and COPD regularly, and many are unsure about the medications and the type of inhalers

While it’s absolutely appropriate for nurses and pharmacists to assess, manage, and treat asthma and COPD where they have had appropriate training, long-term conditions are a spectrum of routine-to-complex cases. So, having the support of the wider multidisciplinary team is essential, but the GP needs to have enough respiratory knowledge to support the team effectively.

Similarly, as I’ve mentioned before, the rise in people presenting to primary care with acute issues has meant that we’ve split acute and chronic diseases so that we’re not treating patients holistically.

CM: How can we better integrate specialist respiratory care with primary care?

AW: There’s a lot of talk now about how the NHS is going to be changing its approach to how it works, with more emphasis on prevention and on keeping people out of hospital and treating them in the community.

So, we’ve got a really big opportunity over the next year or two. Opportunities to redesign how we structure care around our patients and to break down traditional barriers so that hospital specialists can support appropriate patients sooner and closer to home.

Ideally, we’ll redesign services around specific populations as well – for example, hard-to-reach groups, so that we can support them better and increase their access to healthcare.

I’d also like to see a greater amount of teamwork and multidisciplinary team working.

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CM: Asthma + Lung UK have called for a national respiratory strategy in England, in line with the government’s 10-year health plan, what should this strategy look like?

AW: Fourteen years ago, I was involved in the national strategy for asthma and COPD, we’d be calling for lots of the same things now as we were calling for then.

For example, clear data and standards-of-care for people with asthma, COPD, bronchiectasis, interstitial lung disease, early accurate diagnosis; better access to treatments that are tailored to the patient; and strong prevention programmes, including vaccination, air quality, and smoking.

[We should also use] data to identify higher-risk patients, those with more specific needs, and underserved populations.

It’s very disappointing that we’re still calling for the same things after 14 years and that respiratory has still not been given the platform to improve the prevention, care, or research that it deserves – especially given the high prevalence of respiratory conditions and the high proportion of unscheduled care that inadequate attention has created,

CM: Why do you think there was no specific respiratory strategy included in the 10 year plan?

AW: One thing I always highlight to people is, with diabetes or heart disease or many other conditions, there are some very clear markers that you as a patient or as a clinician need to aim for. Whether that’s cholesterol levels, blood pressure, HBA1c  levels. They’re all easily measurable. They’re very objective… and easily auditable by the NHS, which makes a big case for their admission to NHS strategy.

But with respiratory, it’s a bit more vague. There’s not really clear objective measures that can be used to say whether somebody is having very good treatment or not. It’s much more subjective… and potentially less appealing for targeted efforts by the NHS.

CM: What is the role for nurses and wider primary care teams in this area?

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AW: We’ve already got clinical pharmacists and specialist nurses working as part of the primary care team, but what we need to be doing is working together better.

What we need is a holistic and team-based approach to looking after and supporting people with respiratory conditions.

As the NHS has become more stretched in time and resources, we’ve become more likely to narrow our thinking and [define] patients by one condition when we should be considering the whole individual in front of us.

We need to look at patients as a whole, not a series of tick boxes. We can’t continue to blindly apply guidelines. We need to be taking into account patients’ lives and living – their working circumstances, their health and social needs.

A version of this article was first published on our sister title, The Pharmacist.