Chronic Obstructive Pulmonary Disease (health and wellbeing needs in South Tyneside)

Key clinical and quality issues in providing effective services for people with COPD include:

• Identification and accurate diagnosis of COPD in people presenting with symptoms and signs of COPD, and confirmation by performing post-bronchodilator spirometry
• Optimally supporting people with COPD to stop smoking by providing brief interventions at the point of contact, and making appropriate referrals to specialist services
• Offering pulmonary rehabilitation,including physical training, disease education, and nutritional, psychological and behavioural interventions
• Providing effective pharmacological treatment,including inhaled and oral therapies and oxygen therapy
• Early identification and partnership working to meet the supportive and palliative care needs of people with COPD,including managing disabling breathlessness, identifying patients at risk of oxygen poisoning and providing information about non-invasive ventilation and end-of-life care
• Educating people with COPD, their families and carers about their condition and providing options for supported self-management
• Ensuring that services for people with COPD are integrated with other services to provide a holistic patient-centred approach to care with good communication and multidisciplinary working
• Ensuring that people with COPD are aware of and have access to relevant services,including psychological therapies, secondary prevention, and voluntary and other community service support
• Reducing inequalities and providing the best possible outcomes for individual patients, their carers and local communities
• Providing a quality assured service

Tobacco smoking remains the biggest preventable cause of death and disease in the UK with over 8 million (20% of adults) Britons still smoking. Of the 80,000 deaths per year attributed to smoking, approximately 50% are caused by respiratory disease. 5% of hospital admissions are attributable to smoking, and smoking is estimated to cost society ~£13.4billion/ year. There is clear evidence from NICE and the British Thoracic Society that smoke-free hospitals and helping people to stop smoking prior to their elective surgery are key priorities to health "treat" smoking in patients.

In 2011 'IMPRESS' reported that pulmonary rehabilitation had been shown to reduce the 90 day readmission rate for COPD from 33% to 7%. According to Impress, pulmonary rehabilitation is the only intervention which has been shown to cut the readmission rate for COPD.

There is very strong evidence that multi-component approaches to managing COPD reduce hospital admissions and are cost effective.[1] The key to this is having a multi-component offer which includes inhaler technique, smoking cessation, flu and pneumococcal vaccination, support to be physically active, selfcare support, and personal care plans. Without clarity of the local offer then patients may not access the full range of services available in South Tyneside.

There is high quality systematic review evidence that multi-component approaches to COPD self care improve patient satisfaction, reduce emergency admissions, and are cost effective (Health Information and Quality Authority (2015) Health technology assessment of chronic disease self-management support interventions).

Directory of Ambulatory Emergency Care for Adults, highlights that 10 - 30% of COPD patients admitted to hospital could be treated in ambulatory care. In addition 'Community Acquired Pneumonia 10 - 30% of admissions could be seen in ambulatory care and Lower respiratory tract infections between 30 and 60% of admissions could be treated in ambulatory care as an appropriate alternative.