Expanding nursing practice: what are the challenges? The increasing social and financial burden of COPD has driven the interest in clinical service innovations with regard to the management of patients. Nurses have considerably expanded their practice in recent years, particularly outside hospital settings. However, we believe that obstacles still need to be overcome in order to allow nurses to further strengthen their role and thereby contribute to the delivery of high-quality cost-effective care. The results of a nationwide survey which characterised the role of primary care respiratory nurses in the UK revealed that 20% of nurses performing spirometry to diagnose coPD had undertaken formal training." Furthermore, 45% of nurses working in an advanced role who did not have accredited coPD training also did not have routine access to a doctor. This is of particular concern as UK practice nurses providing advanced-level care are routinely recommending or prescribing drug treatments.