Prioritizing COPD care

Abstract

There are 835 000 people in England diagnosed with chronic obstructive pulmonary disease (COPD) and it is estimated that there are over 3 million people with the disease with one person dying every 20 minutes in England and Wales, amounting to 25 000 deaths every year (Department of Health, 2010). The burden of the disease is both at the individual level and society generally through long-term medical management and disability-related costs. The direct cost of COPD to the UK health system is estimated to be between £810-930 million a year. It is estimated that 2 million people have COPD who are not diagnosed so that they are not treated to minimize their disease progression with diagnosis being focused upon those with moderate or severe COPD. It is important that those with early disease are identified and commence a structured care pathway so that people are helped to manage their disease themselves through a carefully calibrated exercise programme and education. Importantly efforts need to be made to arrest the growing burden of COPD through a reduction of hospital admissions. Between 1991-2001 there was a 50% rise in the age-adjusted rates of admission for COPD with rates of readmission varying up to five times in different parts of England for no apparent reason. It appears that 15% of people with COPD who are admitted to hospital die within 3 months of admission with 25% dying within a year of admission with limited access to high quality end-of-life care. These statistics indicate a very poor prognosis for people with COPD and suggest that there is a gap between best practice and the reality of the care which is delivered. The evidence suggests that regular clinical review is the best mechanism for anticipatory disease management and provides the opportunity for detailed assessment of the adequacy of current treatment, identification of emerging complications and the need for support from social care and other services. If community nurses are to undertake these reviews they will need to be familiar with the National Institute of Health and Clinical Excellence (2010) guidelines and confident in FEV1 measurement and the interpretation of the data as well as the complexity of the medication regimes which sometimes cause secondary morbidities. BJCN