AIMS Telehealth may offer opportunities to support primary and secondary care of patients with respiratory disease. This study examined the potential for applying telehealth in a region of the UK by exploring the distribution of patients and examining attitudes to implementation of telehealth. METHODS The distribution of patients with asthma, COPD, lung cancer and obstructive sleep apnoea (OSAS) in the NHS Highland Region (309,900 residents, 12,507 square miles) was determined from Quality and Outcomes Framework data and disease registers. Qualitative interviews with health professionals (n=20) focussing on the potential for telehealth in respiratory medicine were analysed using the Normalisation Process Model. RESULTS The most remote general practices accounted for 40% of patients with asthma (7198/17822), 45% of those with COPD (2145/4721), 33% of lung cancer (199/605) and 35% of OSAS (169/489) patients. Urban figures were 28% of asthma patients, 26% of COPD patients, 25% of lung cancer and 31% of OSAS patients. Interviewees identified a range of telehealth applications they considered potentially beneficial including management, information and communication systems. However, they also identified challenges - mainly related to training, costs and infrastructure. CONCLUSIONS Tailoring telehealth to support management of respiratory diseases in primary care requires knowledge of patient distribution, which will impact on the nature and feasibility of services. Individual and organisational capacities and attitudes are also likely to influence successful implementation.