Lung experts are calling for greater investment in specialist ‘lung teams’ to help ‘significantly reduce’ the high number of patients with chronic lung disease being admitted to hospital during the winter.
Data shows that:
- During each winter between 2008/9 – 2012/13, A&E hospital admissions across England for respiratory disease outstripped those for heart disease – as well as those for digestive, musculo-skeletal and genitourinary problems
- Respiratory diseases – such as pneumonia – were the underlying cause of death in a third of all excess deaths in England and Wales during the winter of 2014/15.
- During the past three winters (2012/13 – 2014/15) respiratory disease has had a greater ‘seasonal effect’ on deaths than either heart disease or dementia. In 2014/15 78% more people died from respiratory diseases in the winter period, compared with the non-winter period.
Some patients with pre-existing lung conditions such as chronic obstructive pulmonary disease (COPD) can experience ‘flare ups’ that require admission to hospital. They are more at risk of getting these during the winter from respiratory viruses and infections that are left untreated – or aren’t treated promptly enough.
The British Thoracic Society (BTS) argues that integrated ‘lung teams’ could help to improve a patient’s health and quality of life by providing better access to specialist care and expertise outside hospitals. The objective is to prevent future hospital admissions by providing the most effective treatment and support in the community.
The BTS has highlighted a number of successful initiatives – for example, the Whittington Health COmmunity REspiratory (CORE) multidisciplinary team has saved significant hospital costs by bringing together lung consultants, respiratory nurse specialists, physiotherapists, stop smoking counsellors and clinical psychologists to work together as a team.
A key focus for the team is providing greater support to people living with chronic obstructive pulmonary disease (COPD) who want to quit smoking, as this is often the best treatment for their condition. In a recent review half of the patients studied managed to quit smoking. The team has also helped to reduce hospital and GP costs by keeping people with COPD well or stable at home by greater use of pulmonary rehabilitation, which involves exercise and education on managing their condition. In a recent study estimated savings of £58,000 were made in seven months by avoiding hospitalisation of patients with severe COPD for acute exacerbations of their disease.
The King’s Health Partners Integrated Respiratory Team also runs respiratory virtual clinics in local practices. Before the initiative, the team were concerned that:
- Many patients had inaccurate or incomplete spirometry (a common lung function test) to be sure of the diagnosis, and did not always receive important support and treatment to help them stop smoking, and also exercise and education through a pulmonary rehabilitation programme.
- Local data showed an over-reliance on inhaled corticosteroids (ICS) in their treatment. This treatment is only effective with a small number of patients and there are increasing concerns about side-effects (e.g. pneumonia) and costs to the NHS
The clinics reviewed individual COPD patient case-notes and agreed treatment plans, including stepping down and stopping inappropriate treatments. In a recent study the team brought about a significant reduction in high dose ICS prescribing and a consequent saving of £200,000 to the local healthcare economy, while at the same time driving up referrals to pulmonary rehabilitation.
A new BTS committee is currently reviewing these ‘new models’ of providing care – but early signs indicate that many projects are gaining strong results in improving patient health and reducing NHS costs. The BTS is now calling on NHS England to meet and discuss the projects with a view to funding a number of dedicated ‘healthy lung’ pilots as part of their ‘Vanguard’ programme.
