International Taskforce Publishes Critical Actions Required To Reduce Impact Of COPD Exacerbations
The group hope their recommendations will achieve stronger implementation of evidence-based guidelines by healthcare professionals; improving care for the estimated 1.5 million people in the UK with clinically relevant COPD[iv]. The Health Secretary highlighted recently that COPD is the number one cause of unplanned hospital admissions in this country[i], yet the respiratory condition remains a preventable and manageable disease.
"The average hospital stay due to COPD is now more than 10 days per visit[v]", said Professor David Price, Professor of Primary Care Respiratory Medicine, University of Aberdeen. "In addition, over one in three of these patients are readmitted within three months[vi]. Earlier diagnosis and improved management for patients' exacerbations as well as improved prevention would help reduce the strain these admissions place on already stretched resources."
The Exacerbations Taskforce, which is sponsored by an educational grant from GlaxoSmithKline, is calling for the following [iii]:
-- Increased awareness that many COPD exacerbations can be prevented or treated
-- Increased patient knowledge about their disease and provision of clearer terminology to define and explain exacerbations
-- Development of 'pathways' for the prevention and treatment of exacerbations
-- Provision of model programmes for multidisciplinary care
-- Greater use of spirometry in smokers and patients suspected of COPD, in particular those with a history of frequent exacerbations
Professor Bart Celli, chair of the Exacerbations Taskforce commented, "Our five key steps were developed to identify proactive ways of bridging the gap between evidence-based guidelines for the treatment and prevention of exacerbations, and current clinical practice. Given the growing global burden of COPD and consequently COPD exacerbations, immediate action is required to ensure that exacerbations are either prevented or are appropriately diagnosed and treated."
COPD is now the fourth leading cause of death in the UK, claiming over 22,000 lives annually[vii]. Exacerbations are a key factor in the downward spiral of ill health and are largely responsible for the vast majority of the 106,000 admissions, which cost the NHS a staggering �253m a year[i]. Prompt diagnosis and early intervention are crucial to reducing the impact of exacerbations and improving patient outcomes.
Despite the availability of many clinical practice guidelines and medications for the prevention and treatment of exacerbations[viii] [ix], around 50% of exacerbations remain unreported and consequently untreated[x]. As a result, many patients do not access the treatment needed to manage their condition and prevent further episodes.
In March 2006, the Health Secretary, Patricia Hewitt published new figures from the NHS Institute for Innovation and Improvement to illustrate how the NHS could improve services, reduce unnecessary emergency admissions and improve value for money. COPD was listed as the number one 'ambulatory care sensitive' condition, accounting for over 106,000 admissions, and costing the NHS �253m a year1.
In his 2004 annual report, On the State of the Public Health (published 19 July 2005), The Chief Medical Officer emphasised the burden of COPD and called for a National Service Framework for COPD2.
About the Exacerbations Taskforce
Professor Bartolome Celli (Chair)
- Chief of Pulmonary and Critical Care, St Elizabeth's Medical Centre, Brighton, Massachusetts, USA
Ms Sue Cross
- Associate Director of Primary Care Nursing, Bedfordshire and Hertfordshire, UK
Professor Ron Grossman
- Professor of Medicine, University of Toronto, Ontario, Canada
Dr Peter Kardos
- Lung and Allergy Specialist, Maingau Hospital, Frankfurt, Germany
Mr Svein-Erik Myrseth
- President, European Federation of Allergy and Airways Disease Patients Associations, Oslo, Norway
Professor Roberto Rodriguez-Roisin
- Head of Respiratory Medicine Unit, Hospital Clinic, Universitat de Barcelona, Spain
Professor J�rgen Vestbo
- Professor in Respiratory Medicine, Wythenshawe Hospital, Manchester, UK
[i] Improve healthcare by reducing unnecessary emergency admissions - Hewitt. Department of Health press release published: Monday 20 March 2006, reference number: 2006/0104
[ii] It takes your breath away: the impact of COPD. CMO Annual Report 2004
[iii] Celli B, Cross S, Grossman R, Kardos P, Myrseth SE, Rodriguez-Roisin R, Vestbo J. Improving the care of COPD patients - suggested action points for reducing the burden of exacerbations of COPD. Primary Care Resp J. June 2006.
[iv] Devereux, G. ABC of Chronic Obstructive Pulmonary Disease: Definition, epidemiology, and risk factors. BMJ 2006; 332; 1142-1144.
[v] Department of Health. Hospital Episode Statistics 2000/2001.
[vi] Report of the 2003 National COPD audit. The Royal College of Physicians and the British Thoracic Society. September 2004.
[vii] Data obtained from Office for National Statistics on mortality in the UK 2004.
[viii] Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2005. Accessed from www.goldcopd.com on 12 January 2006.
[ix] American Thoracic Society/ European Respiratory Society. Standards for the diagnosis and management of patients with COPD. 2004. Accessed from www-test.thoracic.org/copd on 12 January 2006.
[x] O'Reilly J, Williams AE, Rice L, Holt K. Incidence and impact of healthcare defined exacerbations amongst a cohort of primary care COPD patients. Abstract presented at ERS September 2004.
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