National Audit finds there is room for improvement in COPD diagnosis and management

A new report published today by the RCP National COPD Audit highlights significant areas for improvement in COPD diagnosis and management in primary care.

It also reveals that the many cost-effective and high value ways to help treat and manage COPD, including providing flu jabs, supporting patients to live smoke free, and physical activity and supported self-management programmes, are under used.

The report ‘Planning for every breath’ analyses data from 82,000 patient records of patients with COPD from 94% of practices in Wales. 

Key Findings include:

• Accurate diagnosis and accurate coding of diagnosis continue to be an issue
• Less than one in four patients had a chest X-ray or CT scan within 6 months of their diagnosis as recommended by NICE to exclude other pathologies. 
• Some people are probably not getting the appropriate treatment - only 40% of patients had an MRC breathlessness test score recorded and 27% had a record of FEV1% predicted – indicators of severity, which may guide treatment choices.
• Coding of exacerbations was poor or inconsistent.  
• Greater use could be made of pulse oximetry as an indicator of severity and to guide appropriate treatment with oxygen.
• Nearly one in four patients were not asked about their smoking and only 12.5% of current smokers were prescribed a smoking cessation pharmacotherapy and a behavioural change intervention in the last two years.
• It is likely that inhaled steroids are being overprescribed for people with COPD
• Only half of patients affected by breathlessness (MRC scores 3-5) had a record of a referral to pulmonary rehabilitation in the last three years
• The report highlights significant inequalities, with COPD patients with mental health issues, current smokers, and those of lower socioeconomic status receiving less comprehensive management of their COPD than others.

Dr Noel Baxter, PCRS-UK Chair and RCP clinical lead for primary care work stream says: “PCRS-UK urges healthcare professionals working in primary and community care to look at these findings and review their own practice to identify areas for improvement.”

What you can do to improve COPD care in your practice:

• Start with a comprehensive breathlessness assessment. If the cause is COPD, then ensure that the correct spirometric test is documented and the reason for doing the assessment is clearly explainable to your patient’s satisfaction.
• If a patient has a co-diagnosis of asthma and COPD, ensure the rationale is documented.
• Use Read codes/recording systems consistently
• At the annual review ask about breathlessness and tobacco use, assess quality of life, and record exacerbations.
• Ensure parity and equity of care by working to deliver the most appropriate care to those more vulnerable or in need of more tailored care 

Read Planning for every breath HERE