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Respiratory disease affects 1 in 5 people and is the third biggest cause of death in the UK. For the purpose of this example respiratory disease does not include all respiratory diseases, but does include chronic obstructive pulmonary disease (COPD) and asthma.
Asthma affects people of all ages. Approximately 20% of those diagnosed are children and young people. The aim of treating adults and children with asthma is to prevent unnecessary deaths each year, and support people to control their symptoms. Asthma is not a progressive condition but the condition can worsen. Most asthma deaths are considered to be avoidable.
Patients with COPD tend to be older than those with asthma. 13% of people over 35 years of age may have changes in their lung function indicating a diagnosis of COPD. Many people with COPD are or have been smokers. The condition is a deteriorating one and the number of deaths from COPD is much higher than from asthma. Model of care should be proactive by focusing on prevention and earlier diagnosis and treatment.
Facts about respiratory disease
Chronic obstructive pulmonary disease (PDF, 193KB, 18 pages) estimates that there are currently around 900,000 people diagnosed with COPD in the UK and an additional 2.2 million people who remain undiagnosed.
World Health Statistics (2008) (PDF, 3.7MB, 112 pages) reported that COPD kills 25,000 people in England and Wales each year, and it is expected to be the third leading cause of death globally by 2030.
It is estimated that COPD causes the annual loss of:
- between £810 and £930 million from the UK healthcare system
- 24 million working days
- £3.8 billion through reduced productivity
People with mental health problems are more likely to have COPD because they are more likely to smoke, and people diagnosed with COPD are more likely to experience depression and anxiety.
The number of people affected by asthma in the UK is amongst the highest in the world with up to 5.4 million people in the UK estimated to have asthma.
Royal College of Physicians found that during 2011 to 2012, there were over 65,000 hospital admissions for asthma in the UK.
The UK has one of the highest asthma mortality rates in the Europe.
Core principles for healthcare professionals
Healthcare professionals should:
- know the needs of individuals, communities and population and the services available
- consider the resources available in health and wellbeing systems and the potential impact of earlier diagnosis and better management
- understand specific activities which can prevent, protect, and promote public health
- recognise and investigate unwarranted variation in activity and outcomes
Healthcare professionals should be aware of the interventions at population level, which include:
- raising awareness of health issues and influencing policies that affect health
- minimising the impact of seasonal temperature on health by using the cold weather plan and heatwave plan for England
Community healthcare professionals and providers of specialist services can have an impact by:
- supporting patients to quit smoking through direct action and referral
- supporting the uptake of flu and pneumonia vaccinations to reduce complications and avoidable hospital admissions (also individual)
- referring patients to pulmonary rehabilitation when appropriate; this is a treatment that has been shown to reduce admissions, improve exercise capacity and improve quality of life
- supporting post-discharge to ensure patients who have been admitted to hospital with an exacerbation of COPD or asthma attack are given support by the appropriate healthcare professional to prevent readmissions
Family and individual level
Healthcare professionals can have an impact on an individual level by:
- promoting and checking inhaler techniques in all children and adults on an annual basis
- following NICE Quality Standard QS43 when providing advice and support for smoking cessation
- providing a personalised action plan for all patients as these reduce readmission rates, increase patient wellbeing, and reduced attacks
The Quality and Outcomes Framework (QOF) (PDF, 1.7MB, 162 pages) is the annual reward and voluntary incentive programme detailing GP practice achievement against specific indicators. Since its introduction in 2004, the QOF has included indicators related to the identification and management of COPD and asthma, to incentivise high quality management and care by GP practices.
There are 18 Public Health Outcomes Framework respiratory disease indicators.
The Health and Social Care Information Centre includes:
- 48 outcome measures relevant to COPD
- 42 outcome measures relevant to asthma
Examples of good practice
The Association of Respiratory Nurse Specialists provides latest updates and network support for nurses.
The British Lung Foundation (BLF) supports professionals to encourage their patients to self-manage their COPD. The BLF offers study days and workshops to increase professionals’ knowledge and outline the BLF self-management tools.
The BLF has issued a COPD patient passport so everyone living with COPD can check with their health care professional that they are getting the recommended care.
The British Thoracic Society produces a number of guidelines to support NICE clinical guidelines and quality standards.
The British Thoracic Society also produces clinical audit tools and undertakes research studies to support the quality of care provided.
Asthma UK provides tools and resources for healthcare professionals to use in their support and management of patients with asthma.
The Primary Care Respiratory Society UK produces improvement tools that provide a structured, systematic way of reviewing the respiratory care being delivered and identifies ways in which the standards of care can be optimised within a single practice or across multiple practices in a given locality.
NICE guidance and quality standards
Chronic Obstructive Pulmonary Disease (COPD)
COPD in over 16s: diagnosis and management (CG101) is written for people with COPD but it may also be useful for their families or carers or for anyone with an interest in the condition.
COPD in adults (QS10) defines best clinical practice for COPD.
NICE has also published a COPD Pathway.
Guidance on the use of inhaler systems (TA10) is useful for children under the age of 5 years with chronic asthma. Inhaler devices for routine treatment of chronic asthma in older children (TA38) covers children aged 5 to 15 years.
Asthma (QS25) covers the diagnosis and treatment of asthma in adults, young people and children aged 12 months and older.
Smoking: supporting people to stop (QS43) covers smoking cessation, which includes support for people to stop smoking and for people accessing smoking cessation services.
London Asthma toolkit is to help improve children and young people’s asthma care in London.
The BLF provide information leaflets for healthcare professionals to order copies or download including:
Living with COPD for families, friends and carers
Asthma which describes the common causes of asthma, symptoms, treatment options and tips for managing your asthma
Smoking and your lungs: why it’s never too late to give up which explains the benefits of giving up smoking and the steps you can take to quit
Living with a lung condition which provides useful information about living with a lung condition
COPD patient passport which can help you to find out whether you’re receiving the care you’re entitled to, and what to do if not