Care for COPD patients

Background

Chronic obstructive pulmonary disease (COPD) is a group of common lung diseases that makes breathing difficult. It is made up of lung conditions including chronic bronchitis and emphysema. About 1.2 million people in the UK have been diagnosed with COPD, but many more have it without knowing. Most people are diagnosed with COPD in their fifties or older, and it is much more common in people who smoke. COPD kills 30,000 people a year in the UK, making it the fourth largest cause of death. 

Here we use data from the National COPD Audit Programme to look at how the quality of care for people with acute exacerbations of COPD has changed over time.

The National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme publishes data on the care provided to patients admitted to hospital in England, Wales and Scotland with COPD exacerbations. The standards of care are based on National Institute for Health and Care Excellence (NICE) quality statements and clinical guidelines.

For the 2019-20 COPD Clinical Audit, a decision was made to only publish data for patients discharged between 1 October 2019 and 29 February 2020; this was due to the coronavirus pandemic and reduction in data quality for the rest of the reporting period (March to September 2020). For this reason, data from 2019-20 is not comparable with previous years. 

The provision of timely care for patients with COPD exacerbations has improved over time. The percentage of admissions that were reviewed by a member of the respiratory team increased from 77% in 2014 to 87% in 2018-19; in 2019-20, 88% of admissions were reviewed. There was also an increase in the proportion of admissions reviewed within 24 hours, from 49% in 2014 to 66% in 2018-19. The median time from admission to review by a member of the specialist respiratory team has also improved, decreasing from 21 hours in 2014 to 14.7 hours in 2018-19 (data not shown).

The recording of key clinical information has shown a mixed picture. In 2019-20, 64% of admissions were prescribed oxygen but only 48% of admissions had a spirometry result available. Further to this, the most recent audit shows that, of the admitted patients who were current smokers, only 53% were referred to a behavioural change intervention and/or prescribed smoking cessation pharmacotherapy during their admission.

Only 10% of admissions received acute treatment with non-invasive ventilation (NIV) in 2019-20; this demonstrates an area for improvement, as NICE guidelines state that approximately 20% of admissions are acidotic on arrival and therefore should receive NIV treatment. Of those who received it, 25% received NIV within two hours of arrival in 2019-20. The audit notes that patients who deteriorated later in the admission and were appropriately managed with late NIV cannot be distinguished from those that presented with acidosis and received inappropriate late NIV.

In terms of the discharge process, 76% of admissions received a discharge bundle in 2019-20. As part of the bundle, 71% of patients had their inhaler technique checked, but only 62% were assessed for suitability of pulmonary rehabilitation, which are both standard discharge components (data not shown).