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Urgent action needed for long stay patients with severe mental heath problems suffering from lung disease

The rate of Chronic Obstructive Pulmonary Disease (COPD), a collection of mainly smoking-related lung diseases, could be substantially higher among people on long-stay psychiatric wards than the general population, according to new research being presented at the Winter Meeting.

The high prevalence of COPD among long-stay is a key reason why this group has a life expectancy 15-20 years less than healthy adults.

Researchers from Camden and Islington NHS Foundation Trust and Whittington Health reviewed case notes and assessed the lung health of 41 long-stay psychiatric patients between the ages of 22 and 78.

The results showed that

  • over 8 in 10 patients (83%) were smokers, in comparison to 19% of the general UK population
  • 17% of patients were found to have COPD, in contrast to just 1.7% of the general population
  • 7 % had undiagnosed COPD.

COPD is an umbrella term for a group of severe lung diseases including bronchitis and emphysema, and is mainly caused by smoking.

Evidence shows that:

  • people with disorders in England are more likely to smoke, and to smoke more heavily than the rest of the population
  • 42% of cigarette consumption is attributed to people with .1

COPD is the second most common cause of emergency admission to hospital and the fifth largest cause of readmission to hospital, but remains largely undiagnosed in psychiatric patients already in hospital.

Dr Daniel Hughes, a psychiatry trainee at Camden and Islington NHS Foundation Trust said:

“Our study clearly shows that we have a real and growing issue with the number of patients with severe mental health problems suffering from chronic lung disease. We must diagnose and treat it effectively and crucially give sensitive stop smoking advice and support.

We need greater integration between NHS services covering both physical and mental healthcare. Under the current system, there is substantial research to show that people with serious mental illness are at risk of their physical health needs being overlooked in preference of demanding mental health problems. The four new cases of COPD that we found represent a real need for more physical health measures in psychiatric settings.”

Professor Martyn Partridge, Professor of Respiratory Medicine at the National Heart and Lung Institute, Imperial College London, and Chair of The British Thoracic Society Working Party on Integrated Respiratory Care, said:

“There must be a joint approach to this issue from all parts of the health service to ensure that vulnerable patients are not slipping through the net.

Respiratory specialists are now working extensively, and in an innovative way, with other hospital specialities as well as GPs to educate and provide good practice on diagnosing and managing lung disease, and in other parts of the country Consultants in Integrated Respiratory Care have started to provide formalised in-reach into Mental Health Services. We very much support both joint working and appropriate training of psychiatric ward staff on respiratory issues and stop smoking advice.”

Source

1. National Centre for Social Research, Cigarette smoking and mental health in England (December 2010), p. 13. [http://www.natcen.ac.uk/media/21994/smoking-mental-health.pdf]

Source: British Thoracic Society