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

Published: 13 Dec 2017

A new report published today by the Royal College of Physicians (RCP) finds that two thirds of Welsh Chronic Obstructive Pulmonary Disease (COPD) patients receive the flu jab – one of the most high value treatments to stop exacerbations of the disease.

The 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 two 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 (i.e. MRC scores 3-5) had a record of a referral to Pulmonary Rehabilitation (PR) in the last three 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. Full details of the report can be found at: www.rcplondon.ac.uk/COPD.

 Key recommendations from the report include:

• 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 primary care work stream 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 under used.

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 health care professionals, to look at the clear recommendations to ensure patients get the best possible care.”