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 and Wales 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 slightly from 77% in 2014 to 78% in 2017. There was an increase in the proportion of admissions reviewed within 24 hours, from 49% in 2014 to 55% in 2017. 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 16.2 hours in 2017 (data not shown).
The recording of key clinical information has shown a mixed picture. There was a marginal improvement in the percentage of admissions being prescribed oxygen: 55% in 2014, rising to 57% in 2017. But a problem was identified in the recording/noting of spirometry. A spirometry result was available for only 40% of admissions in 2017, compared to 46% in 2014. It is worth noting that in 2017, 12.4% 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 25% were prescribed smoking cessation pharmacotherapy during their admission.
Only 11% of admissions received acute treatment with non-invasive ventilation (NIV) 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, only 30% received NIV within three hours of arrival in 2017. 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 an acidosis and received inappropriate late NIV. It also found a strong association between time to treatment with NIV and increased patient mortality.
In terms of the discharge process, only 53% of admissions received a discharge bundle in 2017, and 18.8% had 'no follow-up arrangements apparent' given as a dataset response.
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 and Wales with COPD exacerbations. For more information, please see the Royal College of Physicians website.