Chronic Obstructive Pulmonary Disease (COPD): best practice guide

1. Introduction

Every winter the delivery of unscheduled healthcare is challenged by changes in the profile and volume of emergency presentations. In advance of winter 2015 an analysis was made of the admissions trends for the most frequent conditions presenting to emergency care, which revealed that respiratory illness featured as a key diagnosis in three of the top five emergency presentations in those over 65 years old. Underpinning a significant proportion of these is chronic lung disease, of which the most frequently encountered is Chronic Obstructive Pulmonary Disease ( COPD).

COPD is a leading cause of death and disability internationally that affects approximately one in ten adults in the developed world and is increasing in prevalence globally; in this respect WHO now predicts COPD will be the third most common cause of mortality worldwide by 2030. An estimated three million people have COPD in the UK so it is unsurprisingly the commonest cause of presentation to Emergency Departments ( ED) with a respiratory emergency; in Scotland COPD accounts for 122,000 emergency bed days annually with an average inpatient stay lasting 4-8 days and costing £3000. And with an increase in the life expectancy of the population, the over 75s are the highest user of the NHS so ageing is also changing the disease profile of COPD making it a more complex multi-morbid condition. This adds further to the challenges of how to manage the condition more effectively.

Forecasts for the years ahead indicate a steady rise in admissions from respiratory disease – and in particular COPD - so that if the current model of care were to remain unchanged we would expect an almost 29% increase in admissions by 2034. Similarly if length of stay remains the same, bed days will increase from 519,898 in 2014 to 669,920 by 2034. By 2033, the number of people over the age of 75 in Scotland will increase by 60% ^[1] .

Admissions for COPD exacerbations, defined as episodic deterioration in respiratory health, not only present a significant financial burden to health services but are also associated with a stepwise deterioration in an individual's quality of life as well as psychosocial health and further contribute to disease progression and severity of the disease.

This best practice guideline and series of case studies bring a strong focus to streamlining COPD management, using the Six Essential Actions of Unscheduled Care, and in particular essential actions 5 and 6.

This is not a 'clinical guideline'

Healthcare Improvement Scotland produced a Clinical Standards publication ^[2] for COPD services across Scotland in 2010, which focuses on clinical aspects of the disease and optimum management and should be referenced in any discussions on services; NICE have also produced a guideline on optimal clinical management ^[3] . This best practice document provides healthcare professionals and patients alike the opportunity to see how this condition could be best managed from the unscheduled care perspective so that individuals living with COPD enjoy structured and better care that is safe, effective and person-centred at every point of the patient journey.