This article describes the formation and development of the UK General Practice Airways Group (GPIAG), from its inception as a small respiratory special-interest group founded by six general practitioners in 1987 through to its transformation into the largest primary care specialist society in the UK. It highlights the historical context in which the GPIAG was founded - at a time when there was increasing concern about under-treatment and under-diagnosis of asthma in primary care - and describes the way in which its foundation was one of the major influences that led to profound innovation in the primary care management of respiratory disease as well as changes across the primary/secondary care interface. The GPIAG is now a registered charity, has an expanding membership, and has acquired a high profile both nationally and internationally as an advisory body on policy and strategy for the management of respiratory disease in primary care. This review is a 20th anniversary tribute not only to those who have contributed to the success of the GPIAG over the last twenty years, but also to its current membership who enable the GPIAG to continue working towards its charitable aim of "optimal respiratory care for all."