Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung conditions including chronic bronchitis and emphysema. COPD leads to damaged airways in the lungs. This causes the airways to become narrower, making it difficult for air to move in and out of the lungs.
COPD is treatable, but not curable. Identifying and treating COPD early can slow down the decline in lung function, and so lengthen the period of time in which someone can enjoy an active life. The most important intervention for both preventing and treating COPD is not smoking.
Asthma is a common, long-term condition that affects the airways in the lungs. Classic symptoms include breathlessness, tightness in the chest, coughing and wheezing.
Asthma differs from COPD in that restrictions to the airflow are largely reversible, whereas in COPD the restriction is only partially reversible as there is permanent damage to the airways. The goal of treatment for patients with asthma is to be free of symptoms, and able to lead a normal, active life. The causes of asthma are not well understood, so prevention of asthma is not currently possible.
Respiratory conditions are one of the main contributors to reduced life expectancy in both males and females compared to England. If the death rate from respiratory conditions was the same as that for England, males would be expected to live 0.42 years longer and females 0.34 years longer (Life expectancy).
The local picture
All data is taken from Public Health England: Inhale - INteractive Health Atlas of Lung conditions in England .
In Calderdale an estimated 2.1% of the population have COPD and 6.6% have asthma. This equates to 4,575 with COPD and 14,421 with asthma. Both these figures are significantly higher than for England. The prevalence of COPD has increased steadily since 2005/6 when it was 1.5% and asthma has increased from 5.5%.
The premature mortality rate from respiratory conditions is higher in Calderdale than the England rate. The under 75 respiratory conditions mortality rate in Calderdale is 40.4 deaths per 100,000 (Directly standardised rate (DSR)) compared to 28.1 in England.
Under 75 mortality rate from respiratory disease - NHS England
Premature mortality from respiratory conditions is influenced by gender. The Calderdale under 75 respiratory conditions mortality rate in men is 52.6 per 100,000 (DSR) compared to 37.6 in women. Both these figures are higher than the regional (43.8 and 33.8) and national (38.3 and 27.4) rates ( Public Health Outcomes Framework: Overarching indicators ).
A new integrated respiratory service with a single point of contact was launched on 5 May 2015 to support all patients with long term respiratory issues in Calderdale.
The Community specialist respiratory service (CSRS) offers clinical support to patients with existing respiratory issues and works with them to manage their own conditions in the community. This reduces the need for hospital admittance, and supports those hospitalised with respiratory conditions to be discharged earlier where appropriate.
The Community specialist respiratory team is supported by a respiratory consultant and a daily 'hot service'. Since 1 September 2015, patients can be referred by the CSRS or A and E (Accident and emergency) doctors if they need immediate consultant assessment or diagnosis.
The service has been set up by the Calderdale and Huddersfield NHS Foundation trust and the Calderdale Clinical commissioning group (CCG). It has members based in the upper valley, lower valley, central Halifax areas of Calderdale, plus the Calderdale Royal Hospital, giving patients direct access to the service.
Between November 2012 and January 2013, an engagement exercise took place with users of healthcare services, carers and members of the public as part of the ongoing Calderdale and Huddersfield health and social care strategic review. Part of this exercise involved consultation with 15 Kirklees COPD patients and those attending a COPD pulmonary rehabilitation programme. Key issues that emerged were:
- Little or no prior knowledge of the disease and risk factors associated with COPD before diagnosis;
- Significant physical and emotional impact of the disease;
- Support and information from General Practitioners (GPs) and other health professionals is sometimes limited (very common theme);
- Education programmes and information on services and facilities available to help people with self-management of their disease were highly valued, though not all patients were aware of what was available. (Health Needs Assessment (HNA) reported low completion rates (25 to 30%), for the pulmonary rehabilitation programme - something which needs to be addressed);
- Support groups and networks are valuable for information exchange and emotional wellbeing;
- More services should be community based/led, community matron role highly valued;
- Facilities made available at home to facilitate self-care;
- Assistive technology had not been widely experienced, but was mostly seen as beneficial where used;
- Help with transport;
- Need more awareness and easy access to support mechanisms.
COPD and asthma are called ‘ambulatory care sensitive conditions’ – chronic conditions for which it is possible to prevent acute attacks and reduce the need for hospital admission through active management in the community.
The number of emergency admissions for people with COPD was 541 in 2010/11 which is 14.8 per 100 on the disease register. This is significantly higher than the England rate of admissions which was 12.0 per 100.
The number of emergency admissions for people with asthma in 2010/11 was 260, which is 1.95 per 100 on the disease register. This is similar to the England figure, which was 1.83 per 100.
Projected future need
If current trends hold, it is projected that the number with asthma will increase to 16,400 in the next 5 years and the number with COPD will increase to 5,200. This equates to just under 2,000 extra people with asthma and around 700 more with COPD.
Key considerations linked to the known evidence base (what works?)
In 2011, the National institute for health and clinical excellence (NICE) produced a quality standard to improve the assessment, diagnosis and management of COPD in adults. This quality standard consists of 13 concise and measurable statements based on existing guidance that are designed to improve the quality of care for people with COPD. The 13 statements contained in the standard cover:
- smoking cessation;
- oxygen therapy;
- hospital care;
- rehabilitation; and
- palliative care.
In 2013, NICE produced a similar quality standard to improve the diagnosis and treatment of asthma in adults, young people and children aged 12 months and over. The 11 statements in the standard cover:
- personalised action plans;
- inhaler technique;
- asthma control;
- assessing severity;
- follow-up in primary care; and
- difficult and acute asthma.
References and further information
- Public Health England: Inhale - INteractive Health Atlas of Lung conditions in England ;
- Public Health Outcomes Framework: Overarching indicators
More information on health can be found in the Further resources .
Paula Holden, Public Health Information Manager, Public Health, Calderdale Council.