Acknowledging that in its treatment of asthma and COPD, “we deliver health outcomes that fall some way behind those achieved by the best-performing countries, or the outcomes public health specialists and clinicians tell us are achievable,” the UK’s National Health Service (NHS) has issued a new strategy for treatment of those diseases. The document says that it aims to “focus on how patients and service users can best be empowered to make the right care decisions themselves, and on how clinicians on the frontline can best be supported to deliver what matters to patients and service users.”
The report cites World Health Organization data showing that the 25,000 English people who die prematurely from COPD each year represent a rate of premature death from the disease that is twice as high as the rest of Europe and that premature mortality from asthma is more than one and a half times higher than in the rest of Europe. Approximately 90% of the 1000-1200 premature deaths from asthma each year, it says, are from preventable causes. In addition, COPD “is one of the most costly diseases in terms of acute hospital care in England,” and the second leading cause of emergency hospital admission.
The new guideline espouses an approach based on the acronym REACT: “Respiratory health and good lung health, Early accurate diagnosis, Active partnership between healthcare professionals and people with COPD, Chronic disease management (or control of symptoms) and Tailored evidence-based treatment for the individual.”
To promote respiratory health, the government has set a goal of reducing adult smoking rates to less than 18.5% and teenage smoking rates to 12% or less by the end of 2015. Employers will also be expected to take responsibility for minimizing inhalation risk; workplace exposure to dust or gases accounts for 15% of the COPD cases in the country according to one study cited by the guidance.
The strategy does not recommend specific treatment plans for COPD but affirms a commitment to a “no decision about me without me” attitude for patients. Clinical commissioning groups (CCGs) will seek input from groups like Asthma UK and “clinical senates” composed of health professionals in order to “design joined-up services, and optimal care pathways, that make sense to patients, families and the public.”
Early diagnosis is critical, the report asserts, especially in light of the fact that only 835,000 patients in the country have been diagnosed with COPD out of the 3.2 million people estimated to have the disease. Underdiagnosis is a particular problem in London and other urban areas.
Although the outcome strategy includes no specific treatment guidance, the National Institute for Health and Clinical Excellence (NICE) plans to issue a COPD quality standard by the end of 2011, notes the document. Specific outcomes for COPD treatment being considered by NICE include:
• the percentage of patients with COPD and Medical Research Council (MRC)
Dyspnoea Scale ≥3 at any time in the preceding 15 months, with a record of oxygen
saturation value within the preceding 15 months
• the percentage of patients with COPD and Medical Research Council (MRC)
Dyspnoea Scale ≥3 at any time in the preceding 15 months, with a record of a
referral to a pulmonary rehabilitation programme (excluding patients on the palliative
care register)
A review of NICE’s COPD Clinical Guideline is scheduled to take place in 2013, at which time the quality standard is likely to be reviewed as well.
The NHS strategy includes a commitment to research, including funding through the National Institute for Health Research (NIHR) and Policy Research Programme and consultation with the the UK Respiratory Research Collaborative chaired by Stephen Holgate of the University of Southampton.
For asthma, the NHS has requested a quality standard from NICE and is developing good practice guidelines for both adults and children. The Asthma Steering Group, it says, is adapting “the excellent British Asthma Guidelines from Scottish Intercollegiate Guidelines Network (SIGN) and the British Thoracic Society (BTS)” for the adult guideline. A National Review of Asthma Deaths, conducted by a consortium headed by the Royal College of Physicians will review every asthma death over the course of a one-year period, beginning in 2012/13.
Read the outcomes strategy document.
