Use of high-value COPD treatments in Wales still has room for improvement

A new report has found that two-thirds of chronic obstructive pulmonary disease (COPD) patients in Wales receive the flu jab - one of the most high-value treatments to stop exacerbations of the disease.

Planning for every breath, published by the Royal College of Physicians (RCP) as part of the Welsh government’s clinical audit and outcome review programme, also finds that although almost four out of five COPD patients were asked about their smoking status, only 12.5 per cent of current smokers were prescribed a smoking cessation pharmacotherapy and a behavioural change intervention in the last two years.

Tobacco smoking is the cause of COPD in the vast majority of people, and smoking cessation interventions help slow the decline of the lung function and reduce exacerbation rates.

It also finds that only half of patients most affected by breathlessness had a record of a referral to pulmonary rehabilitation (PR) in the last three years. NICE quality standards recommend that all patients with a MRC score of 3-5 be referred to PR, a treatment which has been demonstrated to be effective at helping patients manage their symptoms and reducing exacerbations.

The report, which is the second of the Welsh COPD primary care audit reports, makes key recommendations which include that: more cost-effective, high value treatments should be in treating patients with COPD; staff should receive adequate training in the diagnosis and management of people with COPD; Secondary care providers should support the integration of care between the sectors with improved communication on providing the best, most appropriate care for patients; healthcare workers should understand the importance of a comprehensive breathlessness assessment and action appropriately, to properly diagnose and identify COPD at the earliest stage; respiratory specialists in secondary care should work with primary care health professionals to agree a local or regional process for comprehensive respiratory symptom assessment and accurate diagnosis; and system managers should work with local and primary care specialists to select and use metrics that drive continuous improvement.

Noel Baxter, RCP clinical lead for the primary care workstream, said: “COPD is the fifth-biggest killer in the UK, which largely affects the poorest members of society. This report shows clearly that the many cost-effective and high-value ways to help treat and manage this disease, including providing flu jabs, supporting patients to live smoke free, and physical activity and supported self-management programmes, are underused.

“It is vitally important that patients are appropriately diagnosed, and that their diagnosis is clearly recorded, so that they can be provided with suitable treatments, that will help to improve their symptoms and quality of life. Simple options such as those listed above, as well as appropriate prescription of pharmacotherapy, would have this effect and, consequently, would be likely to impact upon exacerbation and admission rates. There is an urgent need to address the treatment COPD patients are receiving, and I ask that healthcare professionals and the NHS work to ensure that each patient receives the therapies they need.”

Robin Ghosal, RCP specialty lead for respiratory medicine in Wales and consultant physician at Prince Philip Hospital in Llanelli, said: “This report highlights the need to get the diagnosis right first, and also the importance of ensuring patients receive the right treatment. Flu jabs are a simple, cost-effective way of stopping exacerbations and more needs to be done to address the variance of patients who are getting this.

“Smoking is the leading cause of COPD and continues to have a detrimental effect on patient health. Health workers need to be given greater support to help patients stop smoking. I welcome this report and urge local health boards, clusters, practices, and primary healthcare professionals, to look at the clear recommendations to ensure patients get the best possible care.”