Respiratory health

Recommendations

Chronic Obstructive Pulmonary Disease (COPD)

In accordance with National guidance, cost effectiveness and locally identified gaps (see best practice) the following should be considered.

Central Bedfordshire Council

  • Promote the smoking cessation services.  COPD is predominantly caused by smoking so reducing the amount of smoking will result in lower COPD prevalence and mortality in the long-term
  • Ensuring that domiciliary care providers are competent to deliver services that meet the needs of people with COPD, eg reablement, wound dressing
  • Ensuring that Adult Services supports plans contain accurate records of their health issues and their medication and makes sure that care providers adhere to people’s medication regimes
  • Ensuring that unpaid carers of people with COPD are identified and referred for statutory and non-statutory support

Bedfordshire Clinical Commissioning Group

  • Maintain the Smoking cessation services.  COPD is predominantly caused by smoking so reducing the amount of smoking will result in lower COPD prevalence and mortality in the long-term.  Smoking cessation is a treatment for COPD
  • The times the ARAS service operates is changed to 11am-8pm, 7 days a week and to expand ARAS to include asthma, bronchiectasis and pulmonary fibrosis.  It has been found that patients do not access the service during the working week and if it is to reduce urgent admissions it should increase its opening hours
  • Maintain and strengthen links with Breathe Easy, a support group to help patients self-manage

Asthma

Bedfordshire Clinical Commissioning Group

  • Consider giving a ‘steroid card’ or similar to support communication of the risks associated with steroid treatment and specific written advice to consider corticosteroid replacements during an episode of stress
  • Local asthma guidelines, incorporating asthma treatment pathways, should be produced to support the local implementation of the BTS/SIGN guidelines, recommendations made in the NRAD report and medicines optimisation
  • The Bedfordshire CCG should plan to meet the NICE quality standards for asthma (QS25) by 2016
  • Patients on regular inhaled corticosteroids being issued with less than 12 inhalers in the last 12 months should be actively sought for urgent review of their asthma management
  • New Medicine Service and Medicines Use Review services provided by community pharmacists are highlighted to patients by primary care health professionals when they prescribe a new inhaler or if they consider a patient would benefit from further support in using their existing inhalers.  These services are little used and we need to optimise their use
  • All Bedfordshire community pharmacies should consider participating in the ‘Complete the Cycle’ scheme that recycles inhalers and use the return of partially used or full inhalers as a prompt for a medicines use review
  • Review of the transition from paediatric to adults services (L&D)
  • Consider review of diagnostic pathway, eg oesophageal manometry and ENT input (L&D)
  • Monitor asthmatics discharged from A&E to develop a process of respiratory referral (L&D)
  • More structured management in difficult asthma (MDT in L&D)
  • Good communication should be ensured between primary and secondary services, especially within 48 hours of discharge and self-management plan on leaving hospital, for example a single IT system

Last updated Friday, 22nd April 2016