People continue to wait too long for chronic obstructive pulmonary disease (COPD) treatment despite improvements in the organisation of care for patients according to three new reports released by the Royal College of Physicians (RCP).
The Pulmonary rehabilitation: An exercise in improvement report shows that only 60% of people with COPD referred for pulmonary rehabilitation (PR) were enrolled to a PR programme within 90 days, and more than a third (38%) do not complete the treatment course once assessed. In addition, conduct of routine exercise assessments were not performed according to accepted standards in over 50% of patients.
However, the report also highlights some important improvements: 84% of services provide a written discharge exercise plan (compared to only 65% in 2015) and more services have a standard operating procedure detailing local policies (84% in 2017, compared with 67% in 2015).
Overall, the report reveals many areas of good quality PR treatment and, for patients that do complete therapy, meaningful improvements are seen in their quality of life.
84% of services provide a written discharge exercise plan (compared to only 65% in 2015) and more services have a standard operating procedure detailing local policies (84% in 2017, compared with 67% in 2015).
Professor Michael Steiner, national COPD audit clinical lead for pulmonary rehabilitation and a consultant respiratory physician, said:
The audit demonstrates the substantial health benefits received by people who complete PR. I hope the findings of this report and other PR audit reports will widen access to PR services and in turn, improve care for people with COPD.
Patients and commissioners can also now begin to use these results in a practical way to understand the quality of their local services.
Secondary care reports
Two secondary care reports – COPD: Time to integrate care and COPD: Working together – find that patients have greater access to specialist respiratory staff than ever before:
- 85% of hospitals provide COPD patients with access to specialist respiratory nurses, up from 71% in 2014
- over half of admissions are also reviewed by a member of the respiratory team within 24 hours, up from 2014.
However, while 46% of hospitals report pulmonary rehabilitation was available to patients within 4 weeks of discharge from hospital, up from 38% in 2014, over half of patients are still waiting longer than a month to receive this treatment.
These reports also find that, of those admissions that were current smokers, only a quarter were prescribed smoking cessation pharmacotherapy. Smoking cessation services are one of the most effective ways to reduce exacerbations of COPD, but nearly half of hospitals (46%) no longer provide this service.
Dr Robert Stone, RCP COPD clinical lead said:
It is very encouraging to see more hospitals than ever are providing specialist respiratory care for COPD patients. However, there is still clearly much more work to be done to ensure COPD patients are being seen in the correct ward and much more support is given to the already overstretched respiratory staff.
It is paramount that there is greater collaboration across teams to provide the best care possible, including the provision of really effective services such as PR and smoking cessation help.
Dr Lisa Davies, chair of the British Thoracic Society (BTS), said:
This audit is really important in understanding the care COPD patients are receiving in secondary care. It is pleasing to see that NHS staff are providing such high quality work in line with BTS standards, but more clearly needs to be done in supporting staff to provide care for patients. We support the recommendations of the RCP coming out of this report and hope that these are addressed soon.
85% of hospitals provide COPD patients with access to specialist respiratory nurses, up from 71% in 2014
The RCP has called for PR services to:
- enrol 85% of patients referred for PR within 90 days
- ensure all exercise assessments are performed to the recommended standards
- aim for at least 70% of patients assessed to have completed PR.
The An exercise in improvement report also identifies the need for PR programmes to adapt their services to increase convenience and acceptability. This includes:
- offering flexible start dates
- increasing the provision of rolling programmes
- ensuring that the location at which PR is held is accessible to as many people as possible.
Key recommendations from the Time to integrate care and Working together reports include ensuring that:
- pulmonary rehabilitation is available to all appropriate patients, including early post-discharge
- all current smokers are identified, offered, and if they accept, prescribed smoking cessation pharmacotherapy
- a spirometry result is available for all patients admitted to hospital with an acute exacerbation of COPD.
- all patients requiring NIV on presentation receive it within 60 minutes of the blood gas result associated with the clinical decision to provide NIV and within 120 minutes of arrival for those who present acutely.
Notes to editors
For more information or to arrange an interview please contact Joanna Morgan, communications manager, RCP Care Quality Improvement Department, on +44 (0)20 3075 1354, or Amarinder Cooner, communications adviser, RCP Care Quality Improvement Department, on +44 (0)20 3075 2399.
Chronic obstructive pulmonary disease (COPD) is the collective term for emphysema and chronic bronchitis, and is mainly caused by smoking. It is a common and usually progressive disease and is a leading cause of mortality and morbidity: the World Health Organization estimates that COPD is responsible for 5% of annual deaths globally. People with COPD can suffer from progressive breathlessness with cough and wheeze, punctuated by exacerbations (flare-ups) that may lead to hospital admission, which can affect the quality of their everyday lives and prevent normal physical activity. While 1.2 million people in the UK have been diagnosed with the disease, as many as two-thirds of people with COPD may return 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% of the total number of UK deaths and 26.1% of deaths from lung disease. Respiratory disease is one of the principal reasons for emergency admission to hospital (British Lung Foundation, 2016).
Pulmonary rehabilitation (PR) is a combination of exercises to improve physical activity and fitness, together with advice and education about self-care: all of which help patients with COPD to cope with this long term medical condition. Exercise programmes include a mixture of strength and aerobic exercise training. PR has been proven to reduce breathlessness and to help those who live with COPD to undertake everyday activities like walking or climbing stairs.
PR is an accepted standard of care for people with COPD and its lack of availability or a lack of referral to PR can affect the quality of care for patients. PR is one of the few therapies that has shown to reduce patients’ time spent in hospital and it is a cost-effective treatment for COPD. Therefore, PR programmes should be a high priority for national and local health policymakers.