RCP report finds there is still room for improvement in use of high-value COPD treatments in Wales

A new report published today by the Royal College of Physicians (RCP) finds that two-thirds of chronic obstructive pulmonary disease (COPD) patients in Wales receive the flu jab – one of the most high-value treatments to stop exacerbations of the disease.

The Planning for every breath report, published by the RCP’s National COPD Audit Programme as part of the Welsh government’s clinical audit and outcome review programme, also finds that although nearly four out of five COPD patients were asked about their smoking status, only 12.5% of current smokers were prescribed a smoking cessation pharmacotherapy and a behavioural change intervention in the last 2 years. Tobacco smoking is the cause of COPD in the vast majority of people, and smoking cessation interventions help slow the decline of the lung function and reduce exacerbation rates. 

It also finds that only half of patients most affected by breathlessness (ie MRC scores 3-5) had a record of a referral to pulmonary rehabilitation (PR) in the last 3 years. NICE quality standards recommend that all patients with an MRC score of 3-5 be referred to PR, a treatment which has been demonstrated to be effective at helping patients manage their symptoms and reducing exacerbations.

COPD is the fifth-biggest killer in the UK, with 1.2 million people in the UK diagnosed with the disease. Over 80,000 patients were included from 94% of Welsh general practices in the audit. Many patients suffer from at least one other long-term condition alongside COPD (such as cardiovascular diseases like hypertension and coronary heart disease, or diabetes), which can adversely impact their quality of life, as well as affect their diagnostic and treatment pathways.  

COPD patients were found to be eight times more likely to suffer from a severe mental illness than the general population. Those with a severe mental illness and COPD were less likely to be offered a flu jab or asked about their smoking habits – both of which are key interventions for COPD.

This is the second of the Welsh COPD primary care audit reports.

Key recommendations

  • More cost-effective, high value treatments should be used in treating patients with COPD.
  • Staff should receive adequate training in the diagnosis and management of people with COPD.
  • Integrated care is important in improving patient outcomes. Secondary care providers, in particular respiratory specialists and managers, should support the integration of care between the sectors, with improved communication on providing the best, most appropriate care for patients.
  • Healthcare workers should understand the importance of a comprehensive breathlessness assessment and action appropriately, to properly diagnose and identify COPD at the earliest stage.
  • Respiratory specialists in secondary care should work with primary care health professionals to agree a local or regional process for comprehensive respiratory symptom assessment and accurate diagnosis.
  • System managers should work with local and primary care specialists to select and use metrics that drive continuous improvement.

Dr Noel Baxter, RCP clinical lead for the primary care workstream, said: 

COPD is the fifth-biggest killer in the UK, which largely affects the poorest members of society. This report shows clearly that the many cost-effective and high-value ways to help treat and manage this disease, including providing flu jabs, supporting patients to live smoke free, and physical activity and supported self-management programmes, are underused. 

It is vitally important that patients are appropriately diagnosed, and that their diagnosis is clearly recorded, so that they can be provided with suitable treatments, that will help to improve their symptoms and quality of life. Simple options such as those listed above, as well as appropriate prescription of pharmacotherapy, would have this effect and, consequently, would be likely to impact upon exacerbation and admission rates. There is an urgent need to address the treatment COPD patients are receiving, and I ask that healthcare professionals and the NHS work to ensure that each patient receives the therapies they need.

Dr Robin Ghosal, RCP specialty lead for respiratory medicine in Wales and consultant physician at Prince Philip Hospital in Llanelli, said: 

This report highlights the need to get the diagnosis right first, and also the importance of ensuring patients receive the right treatment. Flu jabs are a simple, cost-effective way of stopping exacerbations and more needs to be done to address the variance of patients who are getting this.

Smoking is the leading cause of COPD and continues to have a detrimental effect on patient health. Health workers need to be given greater support to help patients stop smoking. I welcome this report and urge local health boards, clusters, practices, and primary healthcare professionals, to look at the clear recommendations to ensure patients get the best possible care.

Notes to editors

For more information or to arrange an interview please contact RCP communications advisers Amarinder Cooner (+44 (0)20 3075 2399) or Hannah Prime (+44 (0)20 3075 1466).

Chronic obstructive pulmonary disease (COPD) is a common and usually progressive disease and is a leading cause of mortality and morbidity globally: the World Health Organization estimates that COPD is responsible for 5% of annual deaths globally. It causes progressive breathlessness with cough and wheeze, punctuated by exacerbations (flare-ups) that may lead to hospital admission. While 1.2 million people in the UK have been diagnosed with the disease, as many as two-thirds of people with COPD may remain undiagnosed (British Lung Foundation, 2016).

COPD is the fifth-biggest killer in the UK and the only major cause of death that is on the increase. In 2012, approximately 30,000 people in the UK died from COPD (British Lung Foundation, 2016). This represented 5.3 per cent of the total number of UK deaths and 26.1 per cent of deaths from lung disease. Respiratory disease is one of the principal reasons for emergency admission to hospital (British Lung Foundation, 2016). 

The National COPD Audit Programme brings together primary care, secondary care, pulmonary rehabilitation and patient experience. This national audit programme comprises comprehensive multidisciplinary, collaborative working and aims to drive improvements in the quality of care and services provided for COPD patients in England and Wales. It is led by the RCP, working closely with a range of key stakeholders, including the British Thoracic Society (BTS), Primary Care Respiratory Society UK (PCRS-UK), British Lung Foundation (BLF) and Royal College of General Practitioners (RCGP).

Royal College of Physicians

The Royal College of Physicians (RCP) plays a leading role in the delivery of high‐quality patient care by setting standards of medical practice and promoting clinical excellence. The RCP provides physicians in over 30 medical specialties with education, training and support throughout their careers. As an independent charity representing over 33,000 fellows and members worldwide, the RCP advises and works with government, patients, allied healthcare professionals and the public to improve health and healthcare.

Healthcare Quality Improvement Partnership (HQIP)

The National COPD Audit Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme (NCA). HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands.