Audit shows key targets in asthma and COPD missed

Performance of objective tests for people with a diagnosis of COPD or asthma is falling a long way short of current targets, according to the latest report from the National Respiratory Audit Programme (NRAP).

The Wales primary care clinical audit report for 2023-2025 found that less than a quarter (23.5%) of patients diagnosed with COPD in the last 2 years had a post-bronchodilator spirometry code available.

During 2023-2025, only 62% of adults, and 47% of children and young people (CYP) diagnosed with asthma had a record of at least one objective test, and only 29% of adults and 24% of CYP had a personalised action plan in the last 15 months.

Only 16% of patients with COPD and breathless (MRC score 3 – 5) had been referred to pulmonary rehabilitation in the last 3 years. And while around 30% had their smoking status recorded in the last 15 months, only a handful (less than 2%) had a record of their vaping status.

The same applies to adults with asthma – 98.2% did not have a record of their vaping status in the last 15 months, although smoking status was recorded in 36%.

The report gives results from an analysis of asthma and chronic obstructive pulmonary disease (COPD) primary care data in Wales from the Welsh primary care audit component of the National Respiratory Audit Programme (NRAP). Data were obtained from 371 general practices in Wales in August 2025 and captured activity between 1 August 2023 – 31 July 2025.

The authors say: ‘There has been an improvement in the proportion of patients with COPD receiving spirometry and patients with asthma undergoing objective assessments, however performance still falls short of the previously established targets. Specifically, the ongoing goal for at least 70% of patients with COPD to have undergone quality-assured post-bronchodilator spirometry to confirm airflow obstruction, and for 70% of individuals diagnosed with asthma within the past 2 years to have at least one documented objective measurement, are a long way from being met.’

Royal College of Physicians. https://www.rcp.ac.uk/improving-care/national-clinical-audits/the-national-respiratory-audit-programme-nrap/current-nrap-reports/wales-primary-care-clinical-audit-report-23-25/