Chronic obstructive pulmonary disease pathway

NHS RightCare has published RightCare Pathway: COPD.  This pathway defines the core components of an optimal service for people with chronic obstructive pulmonary disease (COPD).  It includes resources to support local health economise to concentrate their improvement efforts where there is greatest opportunity to address variation and improve population health.  It contains a number of key messages for commissioners.


Report highlights alarming level of readmission for COPD patients

COPD: Who cares when it matters most? | National Chronic Obstructive Pulmonary Disease Audit Programme

A new report from the Royal College of Physicians and the British Thoracic Society shows that 43% of patients admitted for hospital treatment of chronic obstructive pulmonary disease (COPD) were readmitted at least once in the 3 months following discharge, representing a considerable increase from 33% in 2008.

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COPD: Who cares when it matters most?,  demonstrates that, although COPD was the single most common cause of readmission, over 50% of readmissions were in older people with multiple health conditions.

The report also highlights improvements in the safety and efficiency of COPD care. The report shows that inpatient mortality has decreased from 7.9% in 2003 to 4.3% in 2014.

Fewer patients are dying after discharge from hospital. There has been a marked decrease in the average length of stay in hospital for acute exacerbation of COPD, which fell from 6 days to 4 days in the same period.

Recommendations to improve treatment and care of patients with COPD include:

  • early identification of individuals at risk of deterioration
  • careful assessment of patients with multiple healthcare needs and conditions
  • improved discharge planning, particularly for vulnerable and frail patients
  • the development of integrated approaches to COPD care.

Download the full report here

Long-Term Oxygen for COPD

Rothaus, L. Now@NEJM Blog. Published online: 27 October 2016

Image source: Now@NEJM

Two trials that were conducted in the 1970s showed that long-term treatment with supplemental oxygen reduced mortality among patients with chronic obstructive pulmonary disease (COPD) and severe resting hypoxemia. In the 1990s, two trials evaluated long-term treatment with supplemental oxygen in patients with COPD who had mild-to-moderate daytime hypoxemia; neither trial showed a mortality benefit, but both were underpowered to assess mortality. The effects of oxygen treatment on hospitalization, exercise performance, and quality of life are unclear. The Long-Term Oxygen Treatment Trial assessed the potential benefits of supplemental oxygen among patients with COPD and moderate resting desaturation or exercise-induced desaturation. In this trial, long-term supplemental oxygen treatment did not result in longer survival than no use of supplemental oxygen among patients with stable COPD and moderate resting desaturation (Spo2, 89 to 93%) or moderate exercise-induced desaturation. A new Original Article explains.

Clinical Pearl

What are the estimated oxygen-related costs for patients with COPD in the United States?

Medicare reimbursements for oxygen-related costs for patients with COPD exceeded $2 billion in 2011. If long-term treatment with supplemental oxygen reduces the incidence of COPD-related hospitalizations, increased use could be cost-effective. Reliable estimates of the number of prescriptions for supplemental oxygen that are written for the indication of exercise-induced desaturation are unavailable. Data suggest that many patients with advanced emphysema who are prescribed oxygen may not have severe resting hypoxemia.

Clinical Pearl

What Spo2 values (oxyhemoglobin saturation), as measured by pulse oximetry, are consistent with moderate resting desaturation and moderate exercise-induced desaturation?

In the Long-Term Oxygen Treatment Trial, a total of 14 regional clinical centers and their associated sites (a total of 47 centers) screened patients who had stable COPD and moderate resting desaturation (Spo2, 89 to 93%) or moderate exercise-induced desaturation (during the 6-minute walk test, Spo2 ≥80% for ≥5 minutes and <90% for ≥10 seconds).

Read the full overview here

Read the original research article here

Pulmonary Rehabilitation: Steps to breathe better

The National COPD Audit Programme has published Pulmonary Rehabilitation: Steps to breathe better National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of Pulmonary Rehabilitation services in England and Wales 2015.

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This is the second COPD pulmonary rehabilitation audit report. Its recommendations are directed collectively to commissioners, provider organisations, referrers for pulmonary rehabilitation and to pulmonary rehabilitation practitioners themselves. The report identifies two broad areas for improvement: firstly action to improve referral and access to pulmonary rehabilitation; and secondly action to improve the quality of treatment when patients attend pulmonary rehabilitation.


New NICE Quality Statement: Chronic obstructive pulmonary disease in adults

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement.
This quality standard covers the assessment, diagnosis and management of chronic obstructive pulmonary disease (COPD). It does not cover prevention, screening or case finding. For more information see the COPD topic overview.

This quality standard was previously called chronic obstructive pulmonary disease quality standard.

In February 2016, this quality standard was updated. A new statement on emergency oxygen during an exacerbation has been added and the other quality statements have been updated.

Read the full guidance here