Chronic obstructive pulmonary disease (COPD)

Introduction

Respiratory disease affects a persons air passages including the lungs. They include acute short term conditions such as influenza and pneumonia and chronic conditions such as emphysema. Chronic obstructive pulmonary disease (COPD) is a name given for a collection of chronic lung diseases including chronic bronchitis, emphysema, and chronic obstructive airways disease.

Respiratory disease is one of the top causes of death in England in under 75s and the most effective treatment is giving up smoking.  The risk of COPD increases with the number of cigarettes smoked and the number of years a person has been smoking.

COPD is progressive and the damage caused cannot be reversed, although medications and even surgery are available to reduce symptoms. Early detection and abstinence from smoking can reduce or prevent the damage to the lungs.

Key inequalities and risk factors

  • People over the age of 35 have higher prevalence of COPD
  • People who smoke have significantly higher prevalence of respiratory conditions
  • COPD is often associated with other conditions such as heart disease and depression. People suffering with one condition may therefore be more likely to suffer another
  • Deprived populations have higher smoking rates, increasing the risk of developing COPD and also higher rates of under-diagnosis
  • There is a social gradient in the prevalence of COPD and asthma and its risk factors

Facts, figures and trends

Respiratory conditions are mainly caused by smoking and therefore smoking cessation is a priority to reduce COPD.  Smoking and related issues are covered in more detail in the JSNA.

The 2011 Department of Health Outcomes Strategy for People with Chronic Obstructive Pulmonary Disease (COPD) and Asthma in England states that COPD is often under-diagnosed or misdiagnosed as asthma and whilst over 3 million people in England have COPD, only about 835,000, mainly those with severe disease, are registered with the NHS as having COPD.  Improvements in diagnosis and, in turn, treatment are recommended.

COPD is increasingly recognised as a treatable disease with large improvements in symptoms, health status, exacerbation rates and even mortality if managed appropriately. The awareness of health care professionals of current lung function, exacerbation history and degree of breathlessness (MRC dyspnoea scale) are important considerations when diagnosing, considering treatment options and changes to treatments at annual assessments.

COPD is often associated with other health conditions. For example, COPD and mental health impact on each other in two ways. Firstly, people with mental health problems are more likely to develop COPD because they are more likely to smoke than the rest of the population, and secondly, people who are diagnosed with COPD are prone to mental health problems such as depression and anxiety because of their diagnosis.  Approximately 40% of people with COPD also have heart disease.  Recognising and addressing these issues is an important aspect of COPD care.

Prevalence

According to data from Quality and Outcomes Framework 2014/15, 1.04% of patients registered with GP practices in the Bracknell Forest and Ascot CCG suffer with COPD. This is just below the national average of 1.82%. 

Emergency admissions

In 2013-14 there were 850,634 hospital admissions for respiratory illnesses of which 113,876 had a main diagnosis of respiratory disease (comprising 109,555 (96%) emergency admissions).

The rate of emergency admissions for COPD in 2012/13 (accessed 2 June 2016) in the Bracknell and Ascot CCG area was 1.24 per 1000 population. This is significantly better than the England average (2.06 per 1000) and similar to the south of England commissioning region (1.63 per 1000). 

Costs of care

In 2012/13, the mean length of stay for COPD emergency admissions was 5.6 days and the last available data for the cost per emergency admissions (2010/11) gave a figure of £2,286 (accessed 2 June 2016).

The IMPRESS Guide to the Relative Value of COPD Interventions (accessed 2 June 2016) reported that clinical interventions to help those people with COPD who smoke to stop improve their outcomes at a relatively low cost and therefore, given the number of people who smoke, offer value not just to the individuals but also to the population.  The same report also highlighted the dangers of overtreatment of inhaled medicines for patients with mild to moderate disease and that in some cases this could create health problems as well as increase costs unnecessarily.

Mortality

There were 66,572 recorded deaths due to respiratory disease in England and Wales in 2014 of which 26,267 (39.5%) were attributed to bronchitis, emphysema and other chronic obstructive pulmonary diseases. Males have a higher mortality rate than females. 

The Public health Outcomes Framework reports mortality for all people aged under 75 from respiratory disease as a rate per 100,000 people.  Note that respiratory diseases includes COPD, but is not exclusively COPD:

The mortality rate in 2012-14 in Bracknell Forest was 20.8 people per 100,000 people and has been falling over the last decade and is below the south east and England averages.

Mortality specifically from COPD in Bracknell Forest is statistically similar to the England average:

Ward level data prepared by the Berkshire Public Health Team shows that mortality from all respiratory disease is highest in Wildridings and Central and lowest in Warfield Harvest Ride:

Want to know more?

An Outcomes Strategy for People with Chronic Obstructive Pulmonary Disease (COPD) and Asthma in England (Department of Health, 2011) – the key document which sets out recommendations to improve services for people with COPD.

Chronic obstructive pulmonary disease in over 16s: diagnosis and management (NICE, 2010 update due 2016) - guideline covers diagnosing and managing chronic obstructive pulmonary disease or COPD (which includes emphysema and chronic bronchitis). It aims to help people with COPD to receive a diagnosis earlier so that they can benefit from treatments to reduce symptoms, improve quality of life and keep them healthy for longer.

NHS Lung Improvement programme and IMProving and Integating RESpiratory Services in the NHS – IMPRESS (NHS Networks, 2016) – a free subscription based national support network for the local improvement of respiratory services with access to research and case studies. This covers Chronic Obstructive Pulmonary Disease (COPD), asthma and home oxygen services. It is an initiative to support the implementation of the National Strategy for COPD Services in England.

 

This page was created on 19 March 2014 and updated on 21 June 2016. Next review date December 2016.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Chronic obstructive pulmonary disease (COPD). Available at: jsna.bracknell-forest.gov.uk/living-working-well/health-conditions/ chronic-obstructive-pulmonary-disease (Accessed: dd Mmmm yyyy)

 

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