Guidance

Respiratory disease: applying All Our Health

Updated 19 May 2022

Note that the Public Health England (PHE) team leading this policy transitioned into the Office for Health Improvement and Disparities (OHID) on 1 October 2021.

Introduction

This guide is part of ‘All Our Health’, a resource which helps health professionals prevent ill health and promote health and wellbeing as part of their everyday practice.

We also highlight actions that managers and staff holding strategic roles can take.

This guide does not cover the impact of the COVID-19 pandemic on respiratory conditions. Respiratory hospital admissions and deaths included in this guide do not include a primary diagnosis or underlying cause of death for COVID-19. See Coronavirus (COVID-19) guidance and support for further information.

Prior to the COVID-19 pandemic, respiratory diseases (those affecting the airways and lungs) were diagnosed in 1 in 5 people in England and were the third biggest cause of death. They are also a major driver of health inequalities, and much of this disease is largely preventable. Respiratory disease covers a wide variety of conditions, including common conditions such as asthma and chronic obstructive pulmonary disease (COPD), lung cancer, infections such as pneumonia and flu, and less common diseases such as interstitial lung disease and mesothelioma.

Why you should focus on respiratory disease prevention in your professional practice

Impact on health outcomes

• 68,000 people a year died from respiratory disease on average between 2013 and 2019 in the England, equivalent to 1 person every 8 minutes
• England has among the highest mortality rates from respiratory disease in Europe
• health outcomes for respiratory disease have not improved over the last 10 years to the same extent as other disease areas such as cardiovascular disease and cancer

Impact on health inequalities

Mortality considered preventable from respiratory disease in the under 75s (2017 to 2019) was 2.9 times higher in the most socioeconomically deprived areas in England compared to the least deprived.

Respiratory disease is, therefore, a major contributor to the overall life expectancy gap between the rich and the poor, a gap that is widening. This inequality is related to a multitude of factors, such as greater exposure to risk factors (such as smoking, air pollution, poor housing, and occupational hazards) as well as variation in healthcare quality and access.

Specific groups are at significantly higher risk of respiratory illness, such as people with severe mental illness, people with learning disabilities, and the homeless.

Impact on the health system and wider economy

• prior to COVID-19 pandemic, respiratory disease accounted for 1.1 million hospital admissions in 2019 to 2020, a rise of 49% on respiratory admissions in 2009 to 2010
• hospital admissions due to respiratory conditions are a major factor in the winter pressures faced by the NHS
• lung disease alone costs the UK more than £11 billion per year including the impact on the NHS (£9.9bn), and wider economy through working days lost (£1.2bn)

Core principles for health and care professionals

Health and care professionals and managers should:

• understand specific activities which can prevent, protect, and promote public health
• understand their role, and the roles of system partners, in prevention and population-level approaches
• understand the needs of their patients, communities and populations and the services available to address those needs
• consider the resources available in health and wellbeing systems and the potential impact of earlier diagnosis and better management
• recognise and investigate unwarranted variation in activity and outcomes

Taking action

Front-line health and care professionals

Health and care professionals can have an impact on an individual level by:

• understanding the risk factors and exposures that increase risk of respiratory illness, and providing advice to patients to reduce or avoid these exposures
• understanding the populations at risk, and the symptoms and signs of respiratory illness, in order to detect and diagnose these conditions early
• implementing best practice guidelines around the diagnosis and management of people with respiratory conditions
• referring patients for specialist services where appropriate, such as smoking cessation services and pulmonary rehabilitation
• providing personalised care to support individuals manage and live with their condition while maintaining high quality of life
• promoting uptake of the flu and pneumonia vaccinations among eligible groups

Team leaders and managers

Community health and care professionals and providers of specialist services can have an impact by:

• promoting staff awareness, education and training on respiratory disease and prevention
• adopting best practise guidelines around case detection and management of people with respiratory conditions
• ensuring appropriate referral pathways and promote uptake of specialist services such as smoking cessation and pulmonary rehabilitation
• promoting uptake of vaccines amongst eligible patient and staff groups, such as the flu vaccine and pneumococcal vaccine
• investigating and acting on unwarranted variation in care quality or health outcomes

Senior and strategic leaders

Senior and strategic leaders, including health professionals, should be aware of the interventions at population level, which include:

• raising awareness of respiratory health issues in their organisations, and influencing wider policies that affect respiratory health, such as air pollution, housing, and transport
• understanding the burden of respiratory disease in their local population and ensuring that resources and services are best utilised to meet those needs
• seeking opportunities to work collaboratively with local partners through sustainability and transformations partnerships (STPs), integrated care systems (ICSs), and primary care networks (PCNs), and ensuring there is clarity on shared priorities with local partners
• investigating and acting on unwarranted variation in care quality or health outcomes
• establish plans to mitigate and minimise the impact of extreme seasonal temperatures (heatwaves and cold winters) on respiratory health

Understanding local needs

Public Health England provides data for health professionals, managers and commissioners to understand local population needs and whether these are being addressed by services. This includes:

• Local Tobacco Control Profiles: an online tool which provides local areas with data on tobacco use, tobacco-related harm and outcomes
• INHALE: an online tool which provides indicators on Asthma and COPD around prevention, diagnosis, management, outcomes and cost
• Atlas of Variation: a data series that explores variation in access and quality of care between different local areas in England. The 2nd Atlas of variation for respiratory disease has recently been released, covering 64 indicators

Measuring impact

As a health and care professional there are a range of reasons why it makes sense to measure your impact and demonstrate the value of your contribution. This could be about sharing what has worked well in order to benefit your colleagues and local people, or help you with your professional development.

The Public Health Outcomes Framework examines indicators that help us understand long term trends in public health at a local level. Many of the PHOF indicators relate specifically to respiratory health, including premature and preventable mortality due to respiratory disease (4.07), smoking prevalence (2.09, 2.14), mortality attributable to air pollution (3.01), and flu vaccination coverage (3.03).

The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results. It is not about performance management but resourcing and then rewarding good practice. It includes clinical domains for asthma and COPD, and a public health domain for smoking.

Further reading, resources and good practice

Advice for patients and the public

Asthma + Lung UK (previously the British Lung Foundation and Asthma UK) provide information leaflets for health and care professionals to order copies or download.

Professional resources and tools

• the Taskforce for Lung Health is a five-year plan endorsed across the respiratory community to improve the nation’s lung health and provide better care for people with lung disease

• NICE has a range of guidance and quality standards for respiratory conditions

• The British Thoracic Society has produced quality improvement resources including links to guidance and quality standards, lung disease registries and clinical audits

• the Royal College of Physicians runs the National Asthma and COPD Audit Programme

• the NHS Respiratory Prescribing Dashboard which helps to explore variation in the prescribing of respiratory medicines across England

• NHS Digital provides a range of datasets, including a compendium on mortality from respiratory disease

The NHS Long Term Plan sets out clear milestones for respiratory health in Chapters 2 and 3, including ambitions and commitments on smoking (2.8), air pollution (2.21), health inequalities (2.23), lung cancer (3.56), and respiratory conditions (3.82 to 3.88).

The NHS RightCare aims to provide data and evidence to support local systems to improve patient outcomes and reduce care variation. They have produced a RightCare Pathway for COPD and CCG-level focus packs providing respiratory data at a local level.

Wider resources

• Health Matters is a collection of facts, resources and infographics on major public health issues, including many that are relevant to respiratory health

• Public Health Matters is the official blog of the UK Health Security Agency (UKHSA), providing expert insight on the organisation’s work, including many topics that are relevant to respiratory health

• The SHAPE tool is an interactive mapping tool that can be used to support the strategic planning of services and health assets across local health economies

• The Health Outcomes Travel Tool allows NHS organisations to measure the impact their travel and transport has in environmental, financial and health terms

• The Heatwave Plan and cold weather plan include guidance and resources for protecting the population from weather and temperature-related harms to health

Good practice examples

The Respiratory Futures website share best practice around respiratory initiatives and new models of care taking place around the country.