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Respiratory disease

Leicester Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with respiratory disease, 2016.

Introduction

Diseases of the respiratory system include disorders of the upper respiratory tract, lung, pleural cavity, bronchial tubes, trachea, and of the nerves and muscles of breathing. Respiratory diseases range from a mild common cold to life-threatening conditions such as bacterial pneumonia or pulmonary embolism.

One in seven people in the UK are affected by some form of chronic lung disease, most commonly chronic obstructive pulmonary disease (COPD) or asthma.

Who’s at risk and why?

Many risk factors for chronic respiratory diseases have been identified and can be controlled or treated to prevent the onset of disease.

Among those modifiable factors, tobacco smoke is a major contributor to respiratory disease. There are also several indoor air pollutants that are associated with asthma and COPD. Occupational dusts, chemicals and fumes are a factor for many people with COPD.

Viral or bacterial infections, such as pulmonary tuberculosis, also increase the risk of COPD. Unhealthy diet and physical inactivity contribute to the development of respiratory disease, and to cardiovascular ill-health.

Advancing age, genetic predisposition or low socio-economic status are the main non-modifiable factors in the development of many respiratory conditions.

The level of need in the population

In March 2015, there were 19,770 patients with asthma recorded on GP registers in Leicester; which is equivalent to a recorded prevalence of 5.2%, slightly below the England average of 6.0%. There were 5,473 patients recorded on GP registers with COPD in March 2015. This is equivalent to a recorded prevalence of 1.4%, which is below the national average of 1.8%.

COPD prevalence estimates indicate that the majority of cases are found among people aged over 40, and prevalence increases steeply with age, with the highest rates found in those over 75. This age-related increase in prevalence is due to lifelong, cumulative exposure to tobacco smoke and other risk factors.

Deaths from respiratory diseases account for over 13% of all mortality in Leicester (2014), which is similar to the national rate.

Local data for 2014/15 show around 14% of all emergency hospital admissions are for respiratory diseases.

Current services in relation to need

Respiratory disease is addressed on 3 levels - prevention, primarily achieved through reducing smoking levels; ascertainment, delivered via diagnosis in primary care; and management, provided across the health community with different aspects undertaken by primary care, specialist nursing and acute care. More detailed information can be found in the full Respiratory Disease section downloadable below.

Projected services use and outcomes in 3-5 years and 5-10 years

Based on diagnosed prevalence of diseases in Leicester GP practices (March 2014), and population growth projections (mid-2012 population projections), the number of people with asthma could rise to over 18,000 and the number of people with COPD could be over 5,000, by 2025.

Unmet needs and service gaps

Evidence suggests that a large proportion of COPD cases are preventable, principally through reducing exposure to smoking and adequate treatment of asthma, thus preventing the onset of irreversible changes. Even after the onset of the disease, smoking cessation has significant potential to halt disease progression and improve patients’ quality of life, thus reducing the overall disease burden.

Prevalence modelling seems to suggest that the rates of COPD detection in Leicester are relatively low. Early detection and treatment can slow disease progression and reduce the level of disability in patients. Therefore, every effort should be made to enable patients to recognise early symptoms and seek medical help.

Within primary care, consistent efforts need to be made to identify patients at risk, targeting populations most likely to be affected. However, on-going attempts in Leicester to identify potentially undiagnosed patients have met with only limited success.

Recommendations for consideration by commissioners

Recommendations for commissioners include: Promoting a wider understanding of links between risk factors and the development of COPD; focusing on earlier detection of respiratory disease in the community; developing community-based care for patients with asthma and COPD; and ensuring that primary and secondary prevention strategies are well-resourced and firmly embedded in respiratory care pathways.

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