Our new report examines how the NHS England Adult Breathlessness Pathway is being rolled out across England, what is working and what is needed to support wider and more sustainable rollout. 

The report sets out five recommendations for NHS England, The Department of Health and Social Care (DHSC) and Integrated Care Boards (ICBs) to strengthen implementation and improve national rollout. 

The Challenge  

1 in 10 people in the UK live with chronic breathlessness, a symptom associated with poorer quality of life, functional decline, premature mortality and substantial healthcare utilisation. Breathlessness accounts for over 4% of GP consultations and is linked to 1 in 5 emergency admissions.  

Despite its prevalence and impact, chronic breathlessness remains underdiagnosed and undertreated, with many people facing delays in diagnosis, fragmented care and repeated hospital admissions before receiving appropriate support. 

The NHS England Adult Breathlessness Pathway was developed to address this challenge by enabling faster and more accurate diagnosis through a symptom-based approach that brings together multiple investigations. 

Our findings: 

Drawing on interviews with pathway leads, clinicians, commissioners and healthcare scientists across England, the report found that where the pathway is rolled out effectively, it can: 

• Reduce time to diagnosis from many months to weeks. 

• Deliver diagnosis at the first appointment for a significant proportion of patients. 

• Improve patient experience through coordinated, one-stop diagnostic assessment. 

• Reduce pressure on respiratory outpatient services by directing patients to the most appropriate care. 

• Create opportunities for earlier intervention and prevention of deterioration. 

However, roll out remains inconsistent across England. Success has too often depended on individual commitment, local champions and personal relationships, leading to variation in implementation and in access to care.

The report identified the following barriers to implementation: 

• Low prioritisation of respiratory care. 

• Loss of respiratory clinical leadership within ICBs. 

• Workforce shortages. 

• Short-term funding arrangements. 

• Lack of national implementation guidance and support. 

• Low awareness and engagement within primary care. 

• Fragmented digital infrastructure and poor interoperability. 

Our recommendations: 

Recommendation 1 

To the Department of Health and Social Care: Establish respiratory care as a national priority through a Modern Service Framework, giving ICBs and Trusts the mandate and support to prioritise respiratory pathways such as the Adult Breathlessness Pathway. 

Recommendation 2 

To NHS England, its successor bodies and Integrated Care Boards: Mandate and protect named clinical respiratory leadership roles at ICB level, providing a permanent and structured route to senior organisational leadership and accountability. 

Recommendation 3 

To NHS England and its successor bodies: Establish a national implementation and evaluation toolkit, including a national dataset and dashboard, ensuring that pathway leads have standardised guidance, tools and resources they need to implement, evaluate and promote the pathway. 

Recommendation 4 

To the Department of Health and Social Care: Deliver joined up digital infrastructure and national data standards, including implementation of the single patient record and joined up IT systems, enabling seamless information sharing and reliable data collection, evaluation and continuity of care. 

Recommendation 5  

To NHS England and its successor bodies: Commit to a multi-year funding model, giving pathway leads sufficient time to recruit staff, establish the pathway, demonstrate its impact and develop a sustainable business case for long-term delivery. 

For more information about the report, its findings or recommendations, or to discuss the Adult Breathlessness Pathway, please contact the Taskforce Secretariat at taskforce@asthmaandlung.org.uk.