Chronic obstructive pulmonary disease (COPD) is a common lung disease that makes breathing difficult. It is made up of two lung conditions: 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 (from November 2018) with COPD exacerbations. The standards of care are based on National Institute for Health and Care Excellence (NICE) quality statements and clinical guidelines.
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. Over the same time period, there was an increase in the proportion of admissions reviewed within 24 hours, from 49% to 66%. 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 2018-19, 61% of admissions were prescribed oxygen. The percentage of admissions for whom a spirometry result was available was the same in 2018-19 as 2014, at only 46%. It is worth noting that in 2018-19, 14% of patient admissions in whom spirometry was recorded had no evidence of airflow obstruction, despite being managed for COPD exacerbation. Further to this, the most recent audit shows that, of the admitted patients who were current smokers, only 47% 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 2018-19 compared to 12% in 2014. 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, 24% received NIV within two hours of arrival in 2018-19, a slight improvement from 21% in 2017-18. 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, 74% of admissions received a discharge bundle in 2018-19.
About this data
This indicator uses data from the National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme. It is a continuous audit, which captures the process and clinical outcomes of treatment in patients admitted to hospital in England, Wales and Scotland with COPD exacerbations. Continuous data collection began on 1 February 2017 in England and Wales, and on 1 November 2018 in Scotland. All hospitals in England, Scotland and Wales that admit patients with acute exacerbations of COPD were eligible to participate in the audit.
It should be noted that in 2017, data were extracted prior to a full year of data collection in order for the report to be published in line with the National COPD Audit Programme’s contract end date. Therefore, data for 2017 presents the results for patients discharged between 1 February and 13 September 2017. Data for 2017-18 presents the results of patients discharged between 14 September 2017 and 30 September 2018 and data for 2018-19 presents the results of patients discharged between 1 October 2018 and 30 September 2019. For more information, please see the Royal College of Physicians’ website.