Although Irish death rates for chronic obstructive pulmonary disease are among the highest in Europe, a new audit shows an improvement in services, writes DR MUIRIS HOUSTON
THE RESULTS of the first European COPD audit suggest patients with the chronic lung disease are experiencing better services than they were some four years ago.
The 2008 COPD (chronic obstructive pulmonary disease) strategy said patients could not access hospital respiratory expertise when they needed it, leading to unnecessary attendances at emergency departments and avoidable hospital admissions.
Less than half of the Republic’s acute hospitals had pulmonary rehabilitation programmes (PRP). As a result, a tiny proportion of people with COPD (about 350 patients per annum) were able to access PRPs, with waiting times of two to 18 months.
“Given the prevalence of COPD, it is clear that there is currently insufficient capacity to provide this essential service to large numbers of people with COPD,” the report said.
A progressive disease leading to an obstruction to the flow of air in and out of the lungs resulting in difficulty breathing, more than 400,000 people in Ireland have COPD.
It is an umbrella term for two diseases: chronic bronchitis (inflammation and narrowing of the airways) and emphysema (weakening of the structure of the lung). A progressive disease most often linked with smoking, it causes chronic breathlessness that can lead to severe disability.
Essentially, COPD limits the flow of air leading to excess air being trapped in the lungs after a person has breathed out. Known as “airtrapping”, it is the main cause of breathlessness in a person with COPD.
Perhaps the most sobering statistic about the chronic lung condition is the finding in the recent European audit that half of all patients admitted with COPD in Ireland are either dead or readmitted to hospital within 90 days of their previous admission.
Usually the end result of years of smoking, the typical person with well-established COPD is somewhat barrel-chested, with a blue colour to his lips and face. Lips pursed in an attempt to get air into his lungs, they may find it more comfortable to stand with their arms outstretched and with their palms taking their weight. This manoeuvre improves the function of the diaphragm.
Although Irish death rates for COPD are among the highest in Europe, the audit just published by the European Respiratory Society offers some shadows of hope.
Across Europe, pulmonary rehabilitation for discharged patients is available in 50 per cent of hospitals; the figure for the Republic is now 91 per cent. However, the audit found no examples of home-based PRPs here, which compares poorly with countries like Belgium and Switzerland.
Away from the statistics, the benefits of a PRP for individual patients are significant: it improves exercise capacity and quality of life; it reduces both the number of subsequent hospitalisations and the length of admission; the anxiety and depression felt by house-bound patients with severe COPD is reduced; and, perhaps most important of all, the person’s survival improves.
The National COPD Programme, led by Prof Tim McDonnell, consultant in respiratory medicine at St Vincent’s Hospital, Dublin, is helping to drive further improvement for patients. An important element of this is the COPD Outreach Strategy, which aims to improve the length and quality of patients’ lives while keeping them out of hospital.
While the latest audit focuses on hospital resources and experience, it seems likely that some improvement has taken place in GP access to hospital for patients whose COPD is deteriorating.
Back in 2008, some 86 per cent of GPs said they found it either difficult or impossible to rapidly access a hospital respiratory clinic on behalf of a patient with COPD whose condition was deteriorating.
Let’s see more patients now being able to access a full range of services in the community.
More than
400,000
people in Ireland have COPD
50%
of all patients admitted with COPD in Ireland are either dead or readmitted to hospital within
90
days of their previous admission