Respiratory health

National and local strategies (best practices)

Chronic Obstructive Pulmonary Disease (COPD)

  • NHS Outcomes Framework 2011-13 includes reducing premature death rate from under 75 from respiratory disease.  `Enhancing quality of life for people with long-term conditions’ relates to COPD outcomes (1)
  • An Outcomes Strategy for Chronic Obstructive Pulmonary Disease (COPD) and Asthma in England (July 2011) (2)
  • The NHS Companion Document to the Outcomes Strategy for COPD and Asthma – this describes what the NHS specifically can do to help meet the objectives in the Outcomes Strategy.  The document describes the key interventions and actions that commissioners and providers can take to improve outcomes in that area
  • NICE (2012).  Commissioning guide for people with Chronic Obstructive Pulmonary Disease (COPD) contains tools concentrating on pulmonary rehabilitation, assisted discharge, supportive & palliative care, commissioning and key clinical and quality issues (3)
  • NICE (2010).  Chronic obstructive pulmonary disease - Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update): (4)
  • Exacerbations: Long-Acting Muscarinic Antagonists (LAMA) or Long-Acting β-Agonists together with Inhaled Corticosteroids (LABA+ICS) were found to be the most cost-effective strategy.  The results indicate fairly low uncertainty within individual analyses.  However, the fact that between analyses there is a disagreement about the most cost-effective option indicates considerable uncertainty based on the available clinical evidence
  • O2 assessment: one report studied a cost minimization analysis of providing oxygen by concentrator or cylinder in the home (5).  Their conclusion is that as long as more than three cylinders a month are being used, independent of flow rate or duration of prescription, it is always to cheaper to prescribe a concentrator
  • Pulmonary rehabilitation: two studies estimated the cost effectiveness in the UK.  The cost per QALY was estimated at between £2,000 and £8,000 based on a minimum of four weeks rehabilitations (6) (7) undertook an economic evaluation alongside a clinical trial and estimated that pulmonary rehabilitation was cost saving and increased quality of life compared to usual care
  • NICE advises against:routinely using mucolytic drugs to prevent exacerbations in people with stable COPD
  • anti-cough therapy for the management of stable COPD
  • IMPRESS: Best Practice Models of Care (2008 and 2009) and IMPRESS Guide to the relative value of COPD interventions (2012)
  • IMPRESS: Best Practice Models of Care (2008 and 2009) and IMPRESS Guide to the relative value of COPD interventions (2012) (8)

In January 2015, NHS England published three new handbooks to support commissioners and practitioners in planning services for people with long term conditions (LTCs), in order to achieve more effective, personalised care for this group.  They are case finding and risk stratification, personalised care and support planning and multi-disciplinary team (MDT) working

Asthma

According to the Scottish Intercollegiate Guidelines Network on the management of asthma (SIGN, 2014):

  • A structured questionnaire should be used and it may produce a more standardised approach to diagnosing asthma in children
  • It is recommended moving straight to a trial of treatment in children with a high probability of asthma, reserving further testing for those with a poor response
  • In those children with a low probability of the condition, consider a more detailed investigation and specialist referral
  • Intermediate probability would be for those whose diagnosis was uncertain or poor response to asthma treatment. They should be considered for tests of lung function and atopy
  • The aim is to use a stepwise management to control chronic asthma as it has been shown to achieve early control maintain control
  • encourage a step up in treatment intensity when better control is necessary
  • encourage a step down in treatment intensity when control is good

References

(1) Department of Health

(3) Commissioning guide for people with Chronic Obstructive Pulmonary Disease, 2012. 

(5) National Institute for Health and Clinical Excellence.  NICE, 2010 CG101, full guidance, appendix B 

(6) Heaney LG et al.  Cost minimisation analysis of provision of oxygen at home: are the drug tariff guidelines cost effective?  29.  Br Med J.  1999; 319(7201):19-23

(7) The Wessex Institute.  Hospital based pulmonary rehabilitation programmes for patients with severe chronic obstructive pulmonary disease.  1999

(8) Griffiths TL, Phillips CJ, Davies S et al.  Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme.  Thorax.  2001; 56(10):779-784


Last updated Wednesday, 1st November 2017