Asthma and chronic obstructive pulmonary disease (COPD) represent the most prevalent chronic respiratory conditions worldwide, with over 260 million people affected by asthma and projections indicating that COPD prevalence will approach 600 million cases by 20501,2. COPD alone constitutes the fourth leading cause of death globally, responsible for 3.5 million deaths in 2021, with nearly 90% of mortality in individuals under 70 years occurring in low- and middle-income countries (LMICs)3. International strategies developed by the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) have played a pivotal role in standardising diagnosis and treatment across diverse health systems4,5. However, a persistent conceptual gap warrants attention: the lack of explicit recognition of the family physician as a central actor in the management of these conditions.

Both GINA and GOLD are clearly designed for implementation within primary care. Their recommendations emphasise early diagnosis, longitudinal follow-up, treatment optimisation, patient education, adherence monitoring, and timely referral to specialised care4,5—core competencies of family medicine. Nevertheless, both documents rely on generic terms such as primary care, primary care physician, or healthcare provider, without explicitly naming the family physician as a distinct and formally trained medical specialty.

This omission is not merely semantic. Family physicians—known variably as general practitioners (GPs), family doctors, or médicos de familia across different health systems—are uniquely trained to deliver continuous, comprehensive, and person-centred care, integrating respiratory disease management with multimorbidity, psychosocial determinants, and preventive strategies. Available evidence indicates that asthma and COPD together account for approximately 20% of visits to family physicians, and that primary care physicians manage over 80% of patients with chronic respiratory disease6,7. Health systems with strong primary care—particularly those led by family physicians—consistently demonstrate better health outcomes, improved equity, and lower overall costs8,9,10.

Notably, while primary care physicians remain unnamed, both GINA and GOLD explicitly recognise the role of specialised care. For instance, GINA 2024 states that patients with severe asthma should be referred to “a specialist or severe asthma clinic” and recommends “referral to a specialist center” for biologic therapy assessment4. Similarly, GOLD recommends referral for “specialist advice” and “expert assessment” in complex cases5. This asymmetry—explicitly naming specialists while using generic terms for primary care—reinforces a hierarchical view that undervalues the foundational role of family medicine in disease prevention, continuity of care, and exacerbation reduction.

It may be argued that generic terminology was intentionally chosen to encompass diverse healthcare professionals involved in respiratory care, including nurse practitioners, physician assistants, and community health workers. While this inclusive intent is understandable, it does not justify omitting family physicians—who represent the medical specialty most consistently responsible for chronic respiratory disease management globally. Explicit recognition need not exclude other professionals; rather, it would accurately reflect the disciplinary identity of those leading primary care teams.

The implications are particularly relevant in LMICs, where access to pulmonologists or specialised respiratory centres is limited. In these settings, family physicians represent the backbone of chronic respiratory care. When international guidelines do not clearly identify them as key stakeholders, there is a risk of reduced ownership, weaker implementation, and fragmented care pathways that rely excessively on referral rather than strengthened first-contact management.

From a health systems perspective, strengthening primary care is a core recommendation of the World Health Organization and a cornerstone of sustainable health systems11. Organisations such as the International Primary Care Respiratory Group (IPCRG), which serves as the Special Interest Group for Respiratory Care for WONCA, have emphasised that guidelines should be developed by those who will implement them12,13. Aligning asthma and COPD guidelines with this evidence requires more than operational recommendations—it requires explicit recognition of who is expected to deliver them.

We therefore suggest that future updates of GINA and GOLD: (1) explicitly name family physicians (and equivalent primary care medical specialists) alongside other healthcare professionals as key actors in respiratory disease management; (2) include family medicine representatives in guideline development committees to ensure balanced stakeholder participation; and (3) develop implementation toolkits specifically designed for family practice settings. Such recognition would not diminish the role of specialists; rather, it would reinforce coordinated care, improve guideline implementation, and reflect the realities of clinical practice worldwide.