The impact of the UK General Practice Airways Group (GPIAG) over the past 20 years is discussed from an international perspective. The formation of the International Primary Care Respiratory Group (IPCRG) following the GPIAG conference in 2000, and the role of the Primary Care Respiratory Journal in publishing high quality primary care respiratory research, have been seminal elements in the development of the discipline of primary care respiratory medicine internationally. Research, guidelines development, education, and advocacy, are other areas where the GPIAG has provided a model or shown the way. At a more pragmatic level, the experience of the GPIAG in building a relationship with sponsors and in negotiating the regulatory maze in order to establish an incorporated legal company and charity saved the IPCRG much anguish. The differing roles of national and international organisations are contrasted to illustrate the constructive tension that has impacted on both organisations over the past five years. The IPCRG has built on the foundations of national organisations, particularly the GPIAG, but is charting the way internationally to support the delivery of better health outcomes for people with respiratory disease.