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Care for COPD patients in the UK has improved over the past six years, but is still not good enough

The national COPD report COPD: who cares matters, shows that some aspects of care have improved since the last audit in 2008, but is still not good enough in many areas.

COPD (Chronic Obstructive Pulmonary Disease) is the collective term for emphysema and chronic bronchitis, and is mainly caused by smoking. People with COPD have breathing difficulties, which can affect the quality of their everyday life. Flare-ups of COPD, also termed exacerbations, are a major cause of hospital admission, disability, and mortality. Treatment can help to manage COPD but there is no cure. COPD: who cares matters describes the care of 13,414 patients admitted to hospital as a result of their COPD flaring-up. The audit sample is believed to be the biggest collected worldwide to date, comprising patients from 183 acute units/142 NHS Trusts in England and 16 units/6 health boards in Wales (a 100% NHS Trust/health board recruitment rate) between 1 February and 31 April 2014.

The National COPD Audit Programme is commissioned by the (HQIP) as part of the (NCA)*. The National COPD Audit Programme is led by the , working closely with stakeholders, including the British Thoracic Society (BTS), the Primary Care Respiratory Society UK (PCRS-UK), the British Lung Foundation (BLF) and the Royal College of General Practitioners (RCGP).

It is encouraging that mortality in hospital has reduced from 7.8% in 2008 to 4.3% in 2014 (though the reason for this is far from clear) and that the median length of stay has reduced from five to four days over the same time. There has been a large rise in the number of patients able to leave hospital early due to early/supported discharge schemes – from 18% in 2008 to 40% in 2014. Management of the sickest patients has generally improved.

However, the audit found standards of care differ greatly across England and Wales, findings also observed in the survey of organisation and resourcing of COPD care, published in November 2014.# Both audits found that patients had variable access to specialist respiratory care. In the clinical audit, although patients were seen and treated promptly on admission, there were often significant delays in getting a specialist opinion from a member of the respiratory team to patients needing to stay in hospital. Many patients were managed on non-respiratory wards. Importantly, 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. The same audit showed patients received much better evidence-based care when seen by respiratory specialists.