Breathing at a Distance: Telemedicine’s Achievements and Pitfalls in Respiratory Disease Management—A Narrative Review

Background/Objectives: Telemedicine (TM) has become an increasingly important tool in the management of respiratory diseases, offering the potential to improve access to care, support long-term monitoring, and reduce the burden of in-person visits. This narrative review aims to critically summarize the current evidence on the achievements and limitations of TM across major areas of respiratory medicine. Methods: A non-systematic search of PubMed and Scopus was performed for English-language studies published up to April 2026, using combinations of keywords related to TM, telemonitoring, and respiratory diseases. Relevant articles were selected based on their clinical relevance and contribution to understanding the role of TM in diagnosis, monitoring, and management, and additional studies were identified through manual screening of reference lists. Results: The TM has shown consistent benefit for objective, device-derived outcomes—most notably CPAP adherence in obstructive sleep apnea—and for process outcomes such as reduced travel burden and improved cost-effectiveness primarily demonstrated in obstructive sleep apnea and COPD, with limited systematic evidence of cost-effectiveness in interstitial lung disease, home mechanical ventilation, cystic fibrosis, and smoking cessation. However, evidence for hard clinical endpoints such as hospitalization and mortality remains inconsistent, and successful implementation depends heavily on the surrounding care model rather than on technology alone. Conclusions: The TM represents a valuable complement to conventional respiratory care with demonstrated achievements in adherence, patient satisfaction, and healthcare efficiency, but its adoption remains limited by heterogeneous evidence, workforce and resource constraints, and the risk of widening digital disparities. Larger, adequately powered trials with harmonized outcomes and sustained investment in integrated care pathways are needed to fully realize its potential.