Currently in Dudley, patients who are diagnosed with COPD are assessed and managed in the Community by one, or more of the following:
Many people with an exacerbation of COPD can be treated at home. Admission to hospital is recommended if any of the following signs or symptoms is present:
[NICE, 2004; National Collaborating Centre for Chronic Conditions, 2004]
Morbidity from COPD is high:
Up to one in eight hospital admissions may be due to COPD. Admissions are more common in the winter. The mean length of inpatient stay in England in 2001-2 was 9.1 days.
In primary care, consultation rates for COPD are at least twice as high as for angina. An average GP's list will contain 200 people with COPD (some of these will be undiagnosed).
Exacerbations of COPD requiring hospital admission are associated with an inpatient mortality rate of 3-4%, which increases to 11-24% for those who require treatment in an intensive care unit [Bach et al, 2001].
Of people admitted to hospital with an exacerbation, 34% were readmitted and 14% died within 3 months [National Collaborating Centre for Chronic Conditions, 2004].
The true mortality rate due to COPD is difficult to quantify, as many people with COPD die with the disease rather than because of it. In 1999 there were approximately 30,000 deaths due to COPD in the UK (5.9% of all male deaths, and 4.3% of all female deaths). Mortality rates in men have fallen over the last 30 years; in women they have increased slightly over the last 20 years.
Predictors of mortality in people with COPD are:
Five-year survival from diagnosis is 78% in men and 72% in women with mild disease. This falls to 30% in men and 24% in women with severe disease.
In the UK, the mean age of death of people with severe COPD is 74.2 years; for people with mild COPD it is 77.2 years; and for people without COPD it is 78.3 years.
[National Collaborating Centre for Chronic Conditions, 2004)