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Where did all the asthma and COPD go?

As Professor John Hurst takes over as senior clinical lead for the National Asthma and COPD Audit Programme, he reflects on the current state of care for these common diseases and sets out his priorities for the programme.

You may have been wondering what happened to all the admissions with exacerbations of asthma and chronic obstructive pulmonary disease (COPD). There is now abundant data showing that admissions have fallen by 50% during the COVID-19 pandemic. Reassuringly, this does not seem to be because patients were too scared to attend, rather that vulnerable people with respiratory disease, shielding from coronavirus, were also at reduced risk of contracting other viruses that are important causes of airways disease exacerbations.

However, as society re-opens, we will likely see a rise in admissions again. So, as I take over as senior clinical lead at the National Asthma and COPD Audit Programme (NACAP), it seems an opportune time to reflect on the state of care for these common respiratory disorders. There are positives from the past 18 months – respiratory health is in the public mind like never before, and the skills of multi-professional teams caring for people with respiratory disease have been widely appreciated. But, as we highlighted in a recent Lancet Respiratory Medicine perspective, simply resuming old ways of working in asthma and COPD will do nothing to address well recognised and long-standing inequalities and challenges around accurate diagnosis, timely management and effective discharge. 

Addressing these is critical to improving outcomes such as mortality and re-admissions, which have been stubbornly resistant to change. In adult asthma for example, only 28% of cases have a peak-expiratory flow recorded as part of initial assessment. And for our sickest patients with COPD requiring non-invasive ventilation, fewer than one in four receive this within two hours of arrival at hospital. Specialist care makes a real difference – we’ve recently shown a 31% reduction in mortality in COPD patients receiving specialist review - but this needs systems in place to support respiratory teams working closely with colleagues caring for acute medical admissions.

Demonstrating effective care requires clinical audit.  NACAP, run from the RCP Care Quality Improvement Department, aims to improve the quality of care, services and clinical outcomes for people living with asthma and COPD. Whilst our primarily purpose is to provide near real-time audit data back to front line clinical teams – members and fellows - to support local quality improvement (QI) initiatives, the data we collect are highly regarded and inform national policy such as the NHS Long Term Plan. We do much more than support local QI. For example, NACAP is at the forefront of providing education and training for QI. You can read more about our QI resources here.  Supporting teams to restart QI is currently our top priority.

I’d like to take this opportunity to pay tribute to my predecessor, Professor Mike Roberts, who built the case for, and led, national audit in airways disease for more than twenty years. He’s a hard act to follow. I’d also like to thank the team of project managers and analysts who make NACAP happen. We are here to support your teams provide better care to your patients with asthma and COPD. Please feel free to be in touch with comments and suggestions.