Hospital Dr News

COPD audit reveals improvement but problems persist with smoking cessation

Care of patients with chronic lung conditions is improving but there are still significant deficiencies that need addressing, a COPD audit reveals.

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.

Findings from the RCP 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 1 in 5 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 2 hours after their admission were 23% more likely to stay in hospital longer than those who received it within 2 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 2 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.

“Offering patients simple, effective treatments can make a massive difference and must be made a priority.”

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.

Ten percent of those admitted to hospital died within 90 days of admission.

Read the report.

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