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Summary: Structured medicine reviews are an incentivised element of the 2020/2021 NHS England plan. What is your local implementation plan? Have you considered respiratory and specifically medicines optimisation of patients with COPD on multiple medicines as part of your local plan? Alongside a downloadable PDF poster, this brief article outlines the evidence to support the case for a focus on respiratory care and the associated medicines optimisation opportunity in COPD. It includes scenarios comparing spend reduction in triple therapy and impact on environmental emissions. In addition, data is presented on overall respiratory spend and variation by NHS England region.