Care of patients with chronic lung conditions is improving but there are still significant deficiencies that need addressing, according to the world’s largest clinical audit of COPD (chronic obstructive pulmonary disease) patients, run by the RCP.
Data from almost 75,000 hospital admissions shows that more patients than ever are being seen by a specialist respiratory team – proven to reduce risk of dying from COPD, the collective term for emphysema and chronic bronchitis.
However, patients are still not getting the best possible care, with large numbers still not being provided help to stop smoking or having previous spirometry results available - a simple test of lung function required for a diagnosis of COPD to be confirmed.
Findings from the report show:
COPD is the fifth biggest killer in the UK and the only major cause of death that is on the increase. Approximately 3 million people in the UK have COPD, with approximately 600,000 bed days attributed to patients admitted with COPD (based on an average length of stay). Patients spend on average 4 days in hospital during each visit.
The RCP has called for hospitals to ensure that:
Professor John Hurst, RCP COPD audit clinical lead, said:
It is reassuring to see that some improvements in COPD care have been made, yet much more still needs to be done. COPD affects millions of people’s lives, their standards of living and has a tremendous impact on our health service - accounting for 600,000 bed days every year. Offering patients simple, effective treatments can make a massive difference and must be made a priority.
The results of a previous spirometry test to confirm the diagnosis of COPD was available in less than half of patients. Only a small proportion of smokers are being offered and accepting support to stop smoking – proven to reduce mortality rates. We must ensure all patients receive the best possible care to limit the effects of this condition.
Professor Stephen Bourke, British Thoracic Society, said:
The NACAP COPD audit provides essential information to help understand the care COPD patients receive in hospital. It is certainly encouraging to see the improvements that have been made since the previous report in 2018 and that NHS staff are providing high-quality care in line with BTS and NICE standards. However, there are clearly several areas where improvements could continue to be made, particularly smoking cessation, ensuring quality-assured spirometry has been performed and that the data is accessible from routine clinical stations, and timely provision of NIV.
Hearts and minds are also important; it is not sufficient to solely focus on COPD management. Better recognition and management of comorbidities, especially cardiac and mental health, will further improve outcomes. Frontline staff need to be supported to provide care in these areas. We support the quality improvement aims of the RCP coming from this report and hope that these can be addressed soon.
New longer-term outcome data from an earlier patient cohort (reported on in April 2018) found that COPD was the most common cause of all readmissions, with 43% of patients returning to hospital at least once within 90 days. Ten percent of those admitted to hospital died within 90 days of admission.