More than one in 10 patients admitted to hospital with a serious respiratory disorder is dead within 90 days, a study has found.
Serious lung disease affect thousands
And a third of patients with chronic obstructive pulmonary disease (COPD) are readmitted within this time.
The Royal College of Physicians and the British Thoracic Society audited COPD care across the UK.
The BTS's Professor Andrew Peacock said it was "really worrying" and underlined the need for more specialists.
The survey found patients had a better chance of survival if they were seen by a specialist respiratory consultant.
The presence of a specialist also helped to cut the length of hospital stays.
An umbrella term to describe lung disease associated with airflow obstruction
Includes emphysema, chronic bronchitis and chronic asthma
Fifth most common cause of death in England and Wales
Accounts for more than 10% of acute hospital admissions
900,000 people diagnosed in UK
Estimated that 1.5m people remain undiagnosed
But the report found that only 30% of patients were admitted under a respiratory specialist, and more than half (52%) were not under specialist care while in hospital.
One in three NHS trusts had fewer than the minimum of two specialists recommended by the BTS.
Non-invasive ventilation to help breathing was available in 89% of units, but the audit showed that it was not always being used for patients who needed it.
Less than one in seven patients who died in hospital received added ventilation support.
Professor Andrew Peacock, from the BTS, called for a National Service Framework for respiratory disease to ratchet up standards across the NHS.
He said: "This research is really worrying and underlines the need for more lung specialists across the board."
Dr Mike Roberts, of the RCP, said: "Care received by COPD patients remains a lottery with many not benefiting from the potentially life-saving and life-enhancing care provided by a specialist respiratory team."
A Department of Health spokesperson said COPD was covered by recent guidelines on improving care of people with long-term conditions.
Extra investment in the NHS should enable primary care trusts to commission quality services for lung patients.
However, the spokesperson stressed the best way to prevent COPD was to stop smoking.
Shadow health secretary Andrew Lansley said the government targets had pushed management of chronic conditions such as COPD to the "margins of the NHS".
Paul Burstow, for the Liberal Democrats, said COPD had been given a "shocking lack of priority".
"Sadly in an NHS so dominated by political targets and ministerial diktat, lung diseases come low down the pecking order for investment."
The audit, hailed as the first of its type, involved 234 hospitals.