Abstract

Background:
Dudley in the West Midlands has some of the highest rates of hospital admissions and deaths related to asthma and COPD in the country. Several factors can lead to poorer respiratory outcomes for patients, such as delays in early and accurate diagnoses, incorrect diagnoses and suboptimal treatment and management.

Aims and Objectives:
Early and accurate diagnosis of asthma and COPD.
Identify misdiagnoses.
Identify and manage suboptimal asthma and COPD control including concurrent comorbidities.
Identify patients suitable for treatments such as asthma biologics.
Improve the patient experience and health journey.

Method:
The clinic adopted a population health approach, using targeted searches to identify, risk-stratify and manage high-risk respiratory patients and vulnerable groups. Primary care clinicians can also make referrals to the service for patients who are difficult to treat or when there is uncertainty in diagnosis. A holistic approach was taken to manage patients including addressing concurrent comorbidities.

Patient experience was measured using a qualitative questionnaire and improvements in the management of symptoms based on quantitative outcomes such as better symptom scores and reduction in reliever inhaler use.

Results:
• 376 patients were reviewed in the clinic.
• 99% of patients were successfully managed in the clinic without needing a secondary care referral.
• Out of 87 patients who were on SABA monotherapy without a confirmed respiratory diagnosis, 68 were diagnosed with asthma and 19 with COPD.
• 19 patients were identified as having a misdiagnosis of asthma or COPD.
• 19 patients were referred for consideration of biologic therapy following joint difficult asthma MDT meetings involving secondary/tertiary care.
• 69 patients were prescribed treatments to manage their comorbidities.
• Feedback from all patients was excellent.

Conclusion:
The clinic’s targeted approach demonstrates a successful and scalable model for integrated respiratory care.