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Given the direct impact of COVID-19 on those with existing breathing difficulties, the ‘newly breathless’ – those whose lung function has been impaired by Covid – as well as rising levels of air pollution, the need for social prescribing solutions in respiratory healthcare has never been greater.

The transformation of out of hospital services has been identified as a key element of the NHS recovery plan. Patient care delivered closer to or in their own homes was identified as a priority in the NHS Long Term Plan. It is envisaged that NHS funding will increase to support systems to increase the capacity of community services, address waiting lists and expand models of care in the community to aid hospital discharges.

The formation of Integrated Care Systems in July 2022 has given us as healthcare professionals an opportunity to improve and shape respiratory care in our area for patients with respiratory disease. However, for many the focus has appeared to have been on protecting and improving secondary care – prompted by stories of 12 hour ambulance waits outside emergency departments and long surgery waiting lists. We asked two HCPs from across primary and secondary care to tell us about their experiences of transformation.

It can be a challenge to keep up with the rapid changes in how the NHS is governed and organised across all the nations of the UK. It is however important to understand where to look to understand strategic plans for respiratory, where future plans are made and at what level you might need to target, or find someone to listen to you, if you aspire to influence for better primary and community respiratory care.

The one-minute sit to stand test (1-MSTST) has become the test of choice during the pandemic for measuring exercise capacity, both at in-person and virtual appointments due to the inability to conduct robust six minute or incremental / endurance shuttle walk tests (6MWT/ ISWT/ ESWT). It can easily be conducted in the patient’s home or a small clinic room, requires little equipment, is quick to undertake and yields useful information about the patient’s physiological response to exercise.

Non-tuberculous mycobacteria (NTM) are a group of bacteria that are capable of causing opportunistic lung infections and the development of NTM pulmonary disease (NTM-PD). They are distinct from Mycobacterium tuberculosis (TB) and Mycobacterium leprae and are found in the natural environment and water supplies such as taps and shower heads.

In this article we review the major changes in the 2023 GOLD report as they impact on the initial and ongoing pharmacological management of COPD and consider the implications for primary care in the UK. Dr Fiona Mosgrove is a GP in Aberdeen and Clinical Lead for the Grampian Respiratory Improvement Programme. Dr Tracey Lonergan is the Policy Coordinator for the Primary Care Respiratory Society and Medical Writer with a special interest in respiratory disease.

This pragmatic guide on the identification, referral and ongoing management of adults and children with severe asthma has been developed by an expert group led by Dr Steve Holmes, a GP based in Shepton Mallet, Somerset and including Will Carroll, University Hospital of the North Midlands, Stoke-on-Trent, Fiona Mosgrove, Clinical Lead Grampian Respiratory Improvement Programme, Angela Pugh of the University Hospital of Llandough Cardiff & Vale University Health Board and Robert Stone, Taunton and Somerset NHS Foundation Trust.

This issue of PCRU introduces our latest pragmatic guide on severe asthma which guides you through this process ensuring the right patients end up in the right place with the right care. Also in this edition, there has been a major shift in how COPD is assessed and classified announced by GOLD. Fiona Mosgrove takes you through the implications of these changes and for anybody writing or updating their local guidelines this will be invaluable reading.