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Chronic Obstructive Pulmonary Disease (COPD) Symptoms And Care

Author: Neil Fearn    Dated: 25/2/2015

Chronic Obstructive Pulmonary Disease (COPD) refers to a number of progressive conditions including chronic bronchitis, emphysema as well as chronic obstructive airways disease. Whilst treatment can help to manage COPD, there is no cure.

The British Lung Foundation lists the symptoms as:

• Wheezing, particularly breathing out
• Breathlessness when resting or active
• Tight chest
• Cough
• Producing more mucus or phlegm than usual

The recently published national COPD clinical audit report COPD: who cares matters, highlights that there have been some important improvements in the care for COPD patients over the past six years, it is still not good enough.

Statistics show that hospital deaths caused by COPD have reduced from 7.8% in 2008 to 4.3% in 2014 and that the duration of hospital admissions have reduced from five to four days over the same time.

The audit found that:

1. Fewer patients are being treated inappropriately with high‐flow oxygen at the time of admission.
2. The management of acute respiratory failure has improved, with the overwhelming majority of patients receiving prompt assessment.
3. There has been a significant increase in the number of patients referred into early/supported discharge services and a concomitant reduction in the length of stay since 2008.

Standards Of NHS Care Differs Nationwide

Despite this, it was found that the standards of care differ greatly across England and Wales and which has resulted in some patients having little or no access to specialist respiratory care.

The audit found that 45% of patients were discharged within three days, many of whom had no contact with respiratory specialists, and one in five patients were not seen by a respiratory expert at all during their stay.

Weekend care was also identified as an issue, with less chance of being seen by the respiratory team and fewer patients being discharged.

The audit showed that patients received much better evidence-based care when seen by respiratory specialist and the conclusion was that there appears to be less emphasis on whole‐case management and the important application of evidence‐based care during hospital admission, which will impact upon the longer‐term outcomes.

Recommendations for commissioners and for hospitals were made, including:

• Patients admitted with COPD exacerbation should receive a respiratory specialist opinion within 24 hours, seven days a week.
• Hospitals should appraise carefully their staff rosters at weekends and on Mondays, the former having the lowest rate of discharges and the latter the highest rate of admission and longest times to clinical review.
• Patients with COPD exacerbation who need onward hospital care after their stay on the medical admissions unit should be managed in a respiratory ward.
• Hospitals should reappraise their complement of respiratory beds to ensure it reflects their size and respiratory/COPD admission burden.
• There needs to be better coordination of care at the point of discharge, and better linkage into community COPD services, so that COPD patients benefit from onward expert respiratory care after they have left hospital

For more information: https://www.rcplondon.ac.uk/projects/national-copd-audit-programme-starting-2013

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