Why is it a priority?

Chronic Obstructive Pulmonary Disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease, 80-90% of which is caused by smoking (around 25% of smokers will develop COPD).

Greenwich residents are nine times more likely to die of COPD compared to people living in the local authority in England with the lowest COPD rate. Whilst death rates have been falling in men since the early 1990s, they have remained largely unchanged in women, killing 106 people in 2011 and are significantly higher than the national average.

There are an estimated 8907 (3.25%) people with COPD, but only 3748 (1.7%) are recorded on registers by GPs, meaning that there are over 5,000 people living with undiagnosed COPD. The overall rate of emergency admissions for COPD in Greenwich is significantly higher than the national average. Smoking prevalence amongst people with COPD is 33%, compared to around 18% for the general population.

COPD (2)     COPD (1)

What could make a difference at a local level?
  • Stopping smoking halves the decline of lung function and it the most effective treatment for COPD, so systematic identification and referral of smokers with COPD to smoking cessation services will improve outcomes
  • Finding the “missing” or undiagnosed people with COPD and supporting them to self-manage their conditions
  • Improving the proactive management of those with COPD in the community to improve quality and reduce costs and reducing unwarranted variations in care, especially referral into pulmonary rehabilitation

What are the opportunities for improvement in Greenwich?

Prevention:

  • Support behavioural change training for health and social care professionals and others to enable effective conversations about healthy lifestyle and effective signposting to available support e.g. stop smoking
  • Reduce stop smoking rates prompted through individuals’ regular contacts with health and social care and others (e.g. Make Every Contact Count) and wider stop smoking campaigns
  • Integrate prevention and lifestyle modification as part of all clinical care pathways and strengthen pathways to maximise referrals into stop smoking support
  • Create an environment which reduces smoking (e.g. through local planning, licensing, and other leverages etc.)

Detection & Management

  • Develop approaches to improve opportunistic and systematic case finding in primary care e.g. Long Term conditions contract, NHS Health Checks, Lifestyle checks
  • Local leadership and action planning for system change, to tackle particular areas of local variation (smoking rates in COPD patients, pulmonary rehabilitation post admission rates, observed/expected prevalence ratios) and achieve models of person-centric care e.g. Year of Care, Local Care Networks

COPD (3)