One in four of all hospital admissions are due to respiratory disease and half of these are due to chronic obstructive pulmonary disease (COPD). In Wigan this has been tackled using 'The Wigan Model', which incorporates acute COPD assessment and early discharge. The service, established in 1999, is specialist nurse-led with referrals from GPs, the A&E department and the medical assessment unit. Specialist nurses instigate investigations and perform a clinical assessment; suitable patients are discharged with treatment dispensed and administered by the nurse and are visited at home for two weeks. A recent survey of patient satisfaction questionnaires has shown that most patients are happy with the service and find it beneficial to have their acute episode managed at home.