Respiratory Conditions

‘Respiratory conditions’ is the general term for disorders that include airway, lung tissue, and lung circulation diseases, some of which may lead to respiratory failure, reduced quality of life, and increased mortality and morbidity. It covers a wide variety of conditions, the common ones include asthma, chronic obstructive pulmonary disease (COPD), lung cancer, pneumonia, flu and COVID. Respiratory disease affects one in five people and is the third biggest cause of death in England (after cancer and cardiovascular disease). Lung cancer, pneumonia  and chronic obstructive pulmonary disease (COPD) are the leading causes of death (Source: NHS England). 

Respiratory diseases are a major driver of health inequalities, and much of the disease is largely preventable (Respiratory disease: applying All Our Health – GOV.UK).  Morbidity and mortality due to respiratory disease are not evenly distributed within the population but instead concentrated within deprived and other population groups.  People with severe mental illness, people with learning disabilities and the homeless are at high risk. Some respiratory diseases, such as COPD, are progressive meaning that symptoms will generally worsen, especially if not addressed or treated. Some treatments help to dilate major air passages, improving shortness of breath, and so help control symptoms, increasing quality of life. 

In England, one third of all deaths from respiratory disorders are attributable to cigarette smoking (including second-hand smoke), but other risk factors for chronic respiratory diseases include air pollution, allergens, occupational risks, poor housing, and frequent lower respiratory infections during childhood. Outdoor, and indoor air pollution (often caused by cooking with solid fuels) are also common causes (Source: World Health Organisation). 

Hospital admissions due to respiratory conditions are a major factor in the winter pressures faced by the NHS. The annual economic burden to the NHS for asthma is estimated at £3 billion, and £1.9 billion for COPD. In total, all lung conditions (including lung cancer) directly cost the NHS in the UK £11 billion annually (Source: NHS England).

• The 10 Year Health Plan for England recognises the role of addressing respiratory health as part of the Plan’s focus on neighbourhood health and prevention (smoking and standard of rented homes to focus on damp and mould) (10 Year Health Plan for England – GOV.UK). 
• NICE provides clinical guidance for respiratory conditions, for example, asthma, COPD and COVID. 
• The UKHSA has guidance for living safely with respiratory infections, including COVID-19 (Living safely with respiratory infections, including COVID-19 – GOV.UK). 
• The Quality and Outcome Framework (QOF) financially rewards general practices for providing quality care, helping to standardise improvements. There are a wide range of clinical and public health domains that support respiratory health, for example, asthma and COPD management and smoking. 
• The Core20PLUS5 approach to reducing health inequalities identifies chronic respiratory disease as one of five clinical areas for improvement, particularly for vaccination uptake. 
• Lincolnshire’s Joint Health and Wellbeing Strategy focusses on prevention – supporting people to improve their  health and wellbeing. 
• The delivery plans of the NHS Lincolnshire Joint Foward Plan 2023-2027 include respiratory health in a number of the priorities, for example, primary care, urgent care, health inequalities and prevention, children and young people. 
• The National influenza immunisation plan, which details the eligibility for the current year’s programme. 
• The national NHS vaccination strategy details the national approach to improving and delivery vaccination programmes, which sits alongside the Lincolnshire iteration. 
• There are a number of pieces of legislation which describe the obligations private and social landlords must meet when renting out homes, and guidance which advises on the construction of new homes to ensure that they support health and wellbeing.  Some of this includes the Housing Act 2004, Environmental Protection Act 1990, the Landlord and Tenant Act 1985 and Awaab’s Law.

The Tobacco and Vapes Bill will:

• Make it illegal to sell tobacco products to children born on or after 1 January 2009, to prevent the next generation from becoming addicted to tobacco. 
• Give the government powers to stop vapes and other consumer nicotine products (such as nicotine pouches) from being deliberately branded and advertised to appeal to children. 
• The Bill is also expected to give the government powers to extend the ban on smoking in public places to some outdoor spaces and introduce vape-free areas. A further consultation will determine exactly how these powers will be implemented. (Source: https://ash.org.uk/campaigns/the-tobacco-and-vapes-bill) 

In Lincolnshire the age under 75-year mortality rate from respiratory disease and deaths that are considered preventable from smoking and other environmental factors are both similar to the England rate. In 2022-24, of the 767 respiratory deaths in Lincolnshire (under 75 years), 466 were considered preventable. The Lincolnshire GP QOF registers for COPD and asthma shows an overall higher prevalence that England (2024/25 data). 

The Lincolnshire Primary Care Network (PCN) profiles provide information on the demographics and health of the PCN population. They provide a wide range of information in relation to respiratory health, which includes: 

• The Global Burden of Disease (GBD), which shows that in Lincolnshire, COPD is one of the main causes of years of (premature) life lost and years lived with disability. The profiles provide information for each PCN. 
• The disease prevalence for asthma and COPD for each GP practice and how this compares to Lincolnshire and England. Some of the highest levels of respiratory disease prevalence are in the areas of highest deprivation, for example the First Coastal PCN (East Lindsey). 
• The estimated total prevalence of COPD compared to the actual prevalence, with the highest actual prevalence. 
• The slope index of inequality for COPD (aged 35 years and over) hospital admissions, which shows a strong correlation between increased COPD admissions as deprivation increases. 
• The top 5 causes of death at PCN and Lincolnshire level which includes lung cancer. 
• The level of prescribing for respiratory conditions. 

Smoking is a key risk factor for some respiratory conditions, for example COPD and lung cancer: 

• Lincolnshire has a higher smoking prevalence than England (2022-24 data).
• Lincolnshire has a percentage of women smoking at the time of delivery than England (2024/25). 
• Lincolnshire has a higher prevalence of smoking in routine and manual occupations than England (18-64 years). 
• The proportion of the Lincolnshire smoking population who successfully quit smoking is higher than England (2024/25). 

(Source: OHID) 

The uptake of vaccinations is provided as part of the Public Health Outcome Framework (PHOF) data. This includes, for example, the eligible people in Lincolnshire who had had their flu vaccination. 

In England, influenza-attributable excess mortality was estimated at 7,757 deaths, which was higher than in the 2023 to 2024 season (3,555 deaths) but lower than the 2022 to 2023 season (15,867 deaths). (Source: UKHSA)

In England, there were 53 paediatric deaths (influenza mentioned on death certificate or deaths 28 days after a registered positive influenza test), which was higher than in the 2023 to 2024 season (34 deaths) but lower than in the 2022 to 2023 season (72 deaths). (Source: UKHSA) 

Much like many other healthcare systems, Lincolnshire has seen a general decline in vaccination uptake rates over the last decade, and whilst some rates have remained constant, they are still below desired national targets of 95%, set by the World Health Organisation (WHO) to maximise the likelihood of preventing infectious diseases spreading, or ‘herd immunity’. It is also widely appreciated that the national headline data for Lincolnshire masks significant disparity in uptake in certain communities, particularly among deprived communities, minority ethnic groups and inclusion health groups. 

Seasonal vaccination rates for flu continue to drop nationally and within Lincolnshire, causing significant pressures on local systems specifically the health and care work force. From 1 September 2024 to 29 February 2025 in England, cumulative influenza vaccine uptake in GP-registered patients shows a downward trend in most categories, other than pregnant women. Further information on vaccines/immunisations can be found at the relevant JSNA Immunisation topic. 

The Lincolnshire Pharmaceutical Needs Assessment (PNA) provides information on pharmaceutical services against local health needs.  It is a useful resource for respiratory health because of the role that pharmaceutical services have in supporting people manage their respiratory conditions, in the provision of their essential, advanced and enhanced services, for example, smoking cessation and influenza vaccinations. 

The Building Research Establishment (BRE) has completed a health impact assessment of poor condition homes, based on housing stock modelling, to provide an indication of that effect of respiratory conditions.

A wide range of services take place to support with the prevention, management and treatment of respiratory conditions.

Stopping smoking reduces the risk of mortality and ill health due to smoking, which includes lung cancer and COPD. A comprehensive approach to tobacco control is required to reduce smoking, with a combination of activities, including prevention programmes and smoking cessation support alongside legislative measures and regulation. One You Lincolnshire provides smoking cessation support as part of an Integrated Lifestyle Service, which is commissioned by Lincolnshire County Council. The Lincolnshire Integrated Care Board (ICB) also commissions smoking cessation services for people in hospital and those accessing maternity services. Lincolnshire’s Tobacco Control Steering Group deliver their enforcement and legislative responsibilities, helping reduce smoking and access to uncontrolled, harmful/illicit substances. Further details on smoking can be found on the relevant Tackling Tobacco JSNA topic. 

The NHS Health Check programme, provided by Lincolnshire GPs seeks to improve the health and wellbeing of eligible adults aged 40-74 years (those without certain pre-existing conditions) who will be invited for an NHS Health Check, through the promotion of early awareness, assessment, and management of the major risk factors, including smoking. 

Access to diagnostics is the foundation to early intervention and management. Following a clinical review in respect of respiratory disease, Lincolnshire ICB has set out its ambition to provide community-based Spirometry, through both Community Diagnostic Centres (CDCs) and General Practice, to ensure there is provision across this population.  This is a key diagnostic tool but also helps support decision making in relation to novel therapies, and progression of the condition. 

Lincolnshire Community Health Services (LCHS) provide a range of services for patients with respiratory conditions including: 

• A community based Children’s Rapid Response Service supporting children with complex physical disabilities that have additional respiratory problems. 
• Acute Respiratory Assessment Service (ARAS), provided by Respiratory Nurse Specialists in partnership with hospital staff, community nursing teams, GPs, and social services. For patients experiencing an acute exacerbation (‘flare up’) and supports patients and their carers in their own home, preventing admission to hospital. 
• Early Assisted Discharge service involves the community respiratory team providing specialist treatment and support at home to facilitate early discharge from hospital. 
• A countywide respiratory service of Pulmonary Rehabilitation is provided by LCHS for COPD patients. This involves education and exercises to improve: physical fitness, exercise tolerance, breathlessness management, quality of life and mood. 
• Respiratory Physiotherapy to assess, treat and educate patients in managing breathlessness and sputum clearance. 
• Several patient self-support groups are established across the county. 
• Oxygen Assessment services, ensuring assessment and provision for oxygen is facilitated. 
• Lincolnshire residents experiencing symptoms of Post-COVID Syndrome are being supported by Lincolnshire Community Health Services (LCHS) Post-COVID Rehabilitation Service. 

For winter 2025/26 Lincolnshire ICB set out its commissioning intentions in respect of two GP led services.  This first is a proactive service for high-risk COPD patients. This will enable patients within this identified cohort to receive a proactive review of their care, to ensure they are winter ready based on individual needs.  For example, it may provide an additional opportunity to offer vaccination, smoking cessation support, dietary advice, or link to a social prescriber to provide intervention to enable them to stay well. Every patient will have an escalation plan as part of this service. 

The second is a responsive Acute Respiratory Infection (ARI) service based within General Practice. It is an inevitability that some patients will become sick, but the impact of an ARI can be more significant for some segments of the population. Therefore, high-risk COPD patients (identified through the corresponding proactive service), and Under 5s will be able to benefit from continuity of care through same day access to their GPs, that aims to support them to manage the episode outside of an acute setting. 

A system wide approach to improve seasonal vaccination uptake has been deployed in Lincolnshire to improve access and uptake across the life course. An initiative to provide immunisations closer to home, at a convenient time and place has been developed. 

Good Home Lincs has resources to help residents to maintain a good home, and these are available on Connect to Support Lincolnshire. For further details relating to housing conditions please see the relevant JSNA Housing Standards topic.

A respiratory review, involving a range of stakeholders, has been undertaken that has led to a range of programmes of activity in Lincolnshire, for example, improving uptake of pulmonary rehabilitation.

Healthwatch are commissioned to ensure the public can engage with and feedback on all health services, including respiratory services. The service providers also gather the views of service users. 

The Multi Hazards to Health Outcomes group formed by the University of Lincoln is helping to improve intelligence and research on environmental and atmospheric pollutants, having recognised that people living with more than one factor impacting risk are more likely to develop long term conditions. 

Improving immunisation uptake rates requires input from all system partners. Currently individual vaccination programmes are commissioned to be given in specific defined settings. Engagement with teams that currently provide vaccination services highlighted that the current model is seen as prohibitive and there is agreement that introducing more flexibility in where and how vaccinations take place is a big step in improving uptake rates. 

During engagement sessions, providers have fed back that patients are now more interested in vaccinations and want to know more information about the vaccines they are eligible for before agreeing to have them.  This is something that they say has occurred since the start of the Covid vaccination programme. Understanding how best to share this information and educate patients will be key focus. 

The overall feedback from the wider stakeholder engagement is that changes and innovation are required if we are to improve uptake in line with the WHO targets.

The Respiratory Atlas of Variation identified variation in respiratory health, and it is essential that organisations continue to work together to address these variations in prevention, diagnosis, management and treatment. 

Targeting homes in poor condition occupied with people with respiratory conditions is an aspiration of the Housing Health and Ageing Well Delivery Group. This hasn’t yet been actioned. 

There has been more focus on outdoor air quality to date, and more research around factors impacting indoor air quality and its effect on people with respiratory conditions is needed. 

In addition to diagnosing respiratory conditions there is a need to continually identify and offer interventions to people at risk, through the NHS Health Check Programme and other risk assessment tools.

Research is needed into the risks of exposure and incidents of workplace hazards in Lincolnshire, focussing on industries pertinent to Lincolnshire such as agriculture, quarrying, plastics manufacturing, and the food industry.

• Continue to support people to stop smoking, via the range of services that are available in Lincolnshire. 
• Continue to deliver the respiratory parts within the Delivery Plans for the NHS Lincolnshire Joint Forward Plan. 
• Embed the prevention, identification, management and treatment of respiratory conditions in the Lincolnshire Neighbourhood Health Service developments. 
• Continue the work of the Housing, Health and Ageing Well Delivery Group around improving housing conditions and indoor air quality to reduce the likelihood of causing or exacerbating respiratory conditions. 
• Continue to develop Lincolnshire’s Joint Research Agenda, particularly using the opportunities within the Lincoln Institute for Rural and Coastal Health.