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Health Overview and Scrutiny Committee:
25th January 2011
AGENDA ITEM 9
CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATHWAY
1.0
Matter for consideration
1.1
The Committee to consider an update report on the Blackpool Chronic Pulmonary
Disease (COPD) Pathway.
2.0
Recommendation
2.1
To note the update report, asking questions and making any recommendations that
are considered appropriate.
3.0
Summary of key issues
3.1
Background
3.1.1 Chronic obstructive pulmonary disease (COPD) is an umbrella term encompassing a
range of chronic, disabling, often co-existing breathing disorders including chronic
bronchitis, emphysema and small airways disease. Characterised by airflow
obstruction which is not fully reversible, it is a progressive and incurable condition.
Whilst there are a number of recognised risk factors associated with COPD, including
occupational exposures, genetic factors, air pollution and medical conditions such as
recurrent lower respiratory tract infections, it is overwhelmingly dominated by current
or former cigarette smoking, with over 80% of cases attributable to this.
3.1.2 Emergency hospital admissions due to COPD have been increasing by about five per
cent per year, but many of these admissions are thought to be preventable with
improved pathways involving diagnosis and treatments. The five-year survival rate for
sufferers is about 75 per cent in mild cases and 27 per cent in severe cases. COPD
Mortality contributes significantly to Blackpool’s lowered life expectancy.
3.1.3 NHS Blackpool has been an active partner on a respiratory steering group consisting
of Fylde Coast Acute, Primary Care and PCT representatives. NHS Blackpool has led
on engagement with its patients about proposed service developments.
3.2
Progress to date
3.2.1 Education and Prevention
Although not part of the pathway, education and prevention are key activities. The
delivery of Health MOTs incorporating lung age checks, and referral to the stop
smoking service assists in preventing COPD in current smokers. Stopping or avoiding
smoking is one of the ‘Altogether Now’ initiatives ‘Tangerine Targets’ which
encourages healthy lifestyle choices. To support this, stop smoking services have
increased accessibility of services via a choice of venue and opening times.
3.2.2 Diagnosis
Diagnosis has improved with the increased availability and uptake of training for health
professionals to use spirometry to test lung volume. This reveals accurate information
about a patient’s condition and enables the required treatment to begin immediately.
Diagnosis will reveal either a mild, moderate, or severe level of COPD.
3.2.3 Assessment and Treatment
Self Management - Treatment of COPD centres on a thorough and informative self
management plan, and depending on the level of disease, may include medications.
Typically this plan will include;
 Referral to Stop Smoking Service (if patient is a current smoker).
 COPD Assessment Test (CAT Score) for patients to self assess their condition.
 Ongoing pulmonary rehabilitation (exercise and breathing programmes).
 Inhalers and other devices.
 For patients diagnosed with an unstable condition, a ‘rescue course’ of steroids
or antibiotics for use in an emergency.
 In the most severe cases of COPD patients can access supplies of oxygen.
 Self help groups.
 For the over 65’s, signposting to agencies such as Age UK and Vitaline.
3.2.4 COPD Management
Points is an IT based system which has been adopted by 16 GP practices to evaluate
the management of COPD from a practice perspective.
3.2.5 Crisis Management
GP practice nurses and the Urgent Care Centre can provide 24 hour telephone
assistance to patients, including assessing their CAT scores. COPD can be
exacerbated by, for example, temperature changes or secondary infections.
3.2.6 Emergencies
As always, patients who believe their life is at risk are advised to dial 999. Some
emergency admissions are inevitable.
3.3
Next Steps
3.3.1 The next steps in the pathway development are to measure the impact of the work so
far against the aims of the work, which are;




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To increase the quality of life of COPD patients.
To reduce the number of emergency hospital admissions for COPD.
To increase levels of identification of COPD, and identify it earlier.
To increase levels of effective self management in COPD patients.
To reduce inappropriate use of oxygen.
3.3.2 A patient survey will be facilitated to check that the pathway is making a difference to
patients’ lives.
3.3.3 A survey of clinicians will measure their perceptions of the benefits of the new
pathway.
3.3.4 Hospital admissions data will validate the pathway’s effectiveness in reducing COPD
related emergency hospital admissions.
3.3.5 A ‘concordance report’ will assess the use of oxygen, and adjust its allocation to best
meet clinical need. We can now assess 25 patients per week as opposed to the 7
previously.
3.3.6 Practices are continuing to monitor their management of COPD patients through the
points system.
3.3.7 We will develop our work as part of the ‘Lung Improvement Programme’ in partnership
with the National Lung Foundation.
4.0
Witnesses / representatives
4.1
As requested by the Committee members, the following persons have been invited to
attend the meeting to speak on the matter:
 Ian Treasure, Deputy Director of Partnerships, NHS Blackpool
Relevant officer:
Ian Treasure, Deputy Director of Partnerships, NHS Blackpool
Tel: (01253) 651490, e-mail: [email protected]
Appendices attached:
None.
Background papers:
None.
Websites and e-mail links for further information:
http://www.patient.co.uk/health/Chronic-Obstructive-Pulmonary-Disease.htm
Glossary:
COPD – Chronic Obstructive Pulmonary Disease