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Five year lung plan calls for wider use of spirometry

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5148 (Published 05 December 2018) Cite this as: BMJ 2018;363:k5148
  1. Jacqui Wise
  1. London

Spirometry should be used much more by general practices to improve the diagnosis of lung disease, says a five year plan for lung health in England.1

The Taskforce for Lung Health recommends changes in the whole patient pathway, including lung health MOTs for high risk groups, time targets to improve early diagnosis, and public awareness campaigns about the symptoms of lung disease.

The taskforce is independent of government. Its membership includes 29 organisations representing healthcare professionals, patients, professional associations, and respiratory charities. An industry forum provides evidence for the taskforce, and eight companies provide financial backing.

A spirometry test usually takes under 10 minutes and can be used to help diagnose lung conditions such as chronic obstructive pulmonary disease (COPD). The report says that spirometry tests are underused because the equipment is not to hand, health professionals are not trained to use it, or they do not have the time to do the test. The equipment costs less than £1000 (€1122; $1273) a year.

Steve Holmes of the Royal College of General Practitioners commented, “Spirometry tests are extremely effective, but we need to see general practices supported to fund the one-off cost, and subsequent training sessions are needed for practice staff to use them and interpret the results. A relatively small amount of funding has the potential to save lives.”

Undiagnosed COPD

Some 1.1 million people currently have a COPD diagnosis in England, but the report says that at least another million cases are undiagnosed. The taskforce wants all general practices to be actively case finding for COPD, including among patients with a history of smoking, asthma, or bronchitis and those with frequent chest infections.

The report cites a successful pilot project at two GP surgeries in Hampshire, which involved a search of patient records to identify those with a history of smoking who had also had an inhaler prescribed within the previous year, had been admitted with a respiratory infection, or had presented with unexplained respiratory symptoms.

Patients with symptoms but no diagnosis were invited to a clinic led by a respiratory specialist nurse, where full diagnostic spirometry and a respiratory assessment were carried out. The nurse suggested a potential diagnosis, referred to the GP where appropriate, and offered smoking cessation advice.

Respiratory conditions are responsible for a major part of the gap in life expectancy between the poorest and wealthiest people in the UK, the report says. Despite this a comprehensive national plan for lung health has never been undertaken, as it has not been considered a priority. Outcomes have not improved in over 10 years, and research into lung disease is underfunded.

The taskforce makes several recommendations on prevention, including more funding for high quality stop smoking services, the introduction of clean air zones in the most polluted towns and cities, and action to increase flu vaccination rates.

The report also recommends introducing targets to improve early diagnosis of lung disease. It calls for 93% of patients to be referred to a specialist if appropriate within two weeks and for 96% to start treatment within 31 days of diagnosis. It also advises action to improve access to antifibrotic drugs for idiopathic pulmonary fibrosis, medicines for cystic fibrosis, and monoclonal antibody treatments for severe asthma. In addition, all people with lung disease should have a personalised care and support plan.

Lisa Davies, consultant lung specialist and chair of the British Thoracic Society’s board, said, “In this country we often diagnose lung conditions too late, when treatment is less likely to be effective. Spirometry, delivered by trained healthcare staff, is a critical tool in a wider national push to achieve early and accurate diagnosis of lung disease.”

References

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