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Spirometry is a component of the diagnosis and management of respiratory conditions in primary care and should ideally be performed via referral to a primary care network respiratory diagnostic service or community diagnostics centre (CDC) with expertise in the diagnosis of the most common respiratory conditions and of less common diagnoses. Where limited resources create a challenge for testing everyone with a new suspected diagnosis of asthma, those with an intermediate probability should be prioritised for spirometry and also FENO where available.

Primary care should seek to identify and provide proactive support to older people living with frailty. An extended consultation should be considered that should ideally include the patient’s usual carer to enable a comprehensive review, confirmation of current diagnoses, and review of all medications. Appropriateness of self-administered medication should be considered if dexterity or cognitive issues are present. Patients should have a clear, concise management plan that is available to and understood by all those providing care.

Dr Fiona Mosgrove (GP with special interest in respiratory medicine) is joined by Professor Mona Bafadhel (Director for King's Centre for Lung Health and Chair of Respiratory Medicine at King's College) and Christine Mwasuku (Research Nurse and First Year PhD candidate funded by Asthma+LungUK) to discuss lung health specifically in women. Their conversation includes whether there are phenotypes of certain lung diseases that are more common in women, the discussions that should be had around menopause, contraception, and lung disease.

PCRS believe that it is the responsibility of every healthcare professional to treat tobacco dependency systematically and effectively. PCRS advocate that people wishing to quit using tobacco should be offered the most effective but also the least harmful methods first to support a quit attempt. Delivery of stop smoking treatment is challenging due to reduced stop smoking services and a current lack of licensed pharmacotherapies. Prescribed NRT, combining short and long acting versions, along with behavioural support is currently the primary treatment choice.

PCRS recognises a need for improvement in the timely diagnosis of people living with chronic breathlessness and generally welcomes the NHS England diagnostic pathway support tool. PCRS has some concerns that a diagnostic algorithm can communicate an oversimplification of diagnosis. We are disappointed that this pathway will not be accompanied by the long awaited and hoped for, but now deprioritised, NICE Breathlessness guideline.

Concerns about the environmental impact of the propellant gases used in pressurised metered dose inhalers (pMDIs) and the plastics used in all single-use inhaler devices have made them an important focus for efforts to reduce the environmental impact of the NHS. Patients themselves may also be concerned about the environmental impact of their inhalers and express a preference for alternatives. PCRS do not support ‘blanket switching’ of patients from one inhaler type to another.

The Medicines and Healthcare Products Regulatory Agency (MHRA) has for the first time approved the use of a dual (ICS/Formoterol) combination treatment to be used as a reliever therapy for people aged 12 and over with the therapy choice situated early in the asthma treatment pathway as an alternative to its current use as a preventer or MART therapy sitting later in traditional treatment pathways.