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 Royal College of Physicians (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:
- 75% of patients are now being seen by a specialist respiratory team, with 64% seen within 24 hours. Patients who received a specialist review were 14% less likely to die as inpatients, and six times more likely to be offered smoking cessation therapy
- Two-thirds of smokers with COPD are offered help to stop smoking, however only 38% of these patients accept it. Smoking cessation is the single most important treatment for smokers to either prevent COPD or reduce its impact
- There was no record of a spirometry test for 60% of patients. This test is required for a diagnosis of COPD to be confirmed
- 12% of admissions where a spirometry result was recorded showed no evidence of airflow obstruction (suggesting that these patients may not have COPD at all), despite them being managed for a COPD flare up
- Only one in five patients who received non-invasive ventilation (NIV) treatment did so within the recommended standard of 2 hours of admission – those that received NIV more than two hours after their admission were 23% more likely to stay in hospital longer than those who received it within two hours.
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 all patients requiring NIV on presentation receive it within two hours of arrival
- Ensure that a spirometry result is available to confirm the diagnosis, for all patients admitted to hospital with an acute exacerbation of COPD
- Ensure that all current smokers are identified, offered, and if they accept, prescribed smoking cessation pharmacotherapy.
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, added: "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. A total of 10% of those admitted to hospital died within 90 days of admission.
Image courtesy of RCP