With the majority of the population unaware of COPD, many people fail to recognise key symptoms of the disease early enough. This can result in delayed diagnosis, meaning COPD is often well advanced in a patient by the time they visit their GP.
Sadly, this means people will have been struggling with a lower quality of life, because a late diagnosis means they will not be getting the right treatment. The GP has a big role to play in diagnosing COPD early, helping patients adapt, and assisting them in finding the right support and care. Early diagnosis would also mean a huge saving in human misery and the cost of treating the disease in the NHS. To do this, as GPs, we must be at the forefront of improving awareness and early diagnosis systems.
The British Lung Foundation (BLF) encourages people never to ignore suddenly feeling out of breath doing everyday tasks. Their simple online breath test advises people on whether they may need to seek expert medical advice. Over 300,000 people have taken the test so far. This, along with Public Health’s England’s ‘Be Clear on Cancer’ campaign, which raises awareness of the signs of cancer and lung disease, will likely see more people coming through our doors.
Our response to a person presenting with breathlessness should follow a structured approach so that all possible conditions are considered. There are specific clinical care pathways for treating the more common conditions such as COPD, asthma and heart failure and these should be used as a guide. Over 80% of people with COPD have at least one other long-term condition, so their breathlessness may have multiple causes. Any approach to breathlessness therefore, needs shared decision making in order to prioritise choices of therapy.
There is one vital step anyone with COPD can do to immediately manage their condition. Steer clear of smoke. We know that smoking makes breathlessness worse and triggers COPD flare-ups. Stopping smoking is the most important step people can take to improve their health. It will not reverse the damage already done, but it will slow down the progress of the disease. GPs must support patients by giving them all the information they need in terms of treatments to help them quit or access local stop-smoking services.
Regardless of the cause, and severity of the condition, a range of generic therapy options are also available to us:
- Prescribe physical activity, cardiac and pulmonary rehabilitation (PR)
- Promote and provide an annual flu vaccination as a core part of the treatment plan
- Help patients live with breathlessness by ensuring they see a symptoms expert
- Support patients with treatments recommended by specialist colleagues
- Treat anxiety and depression
- Attend to carers’ needs. Education and support is essential for the person who does most for the person with chronic breathlessness.
A Royal College of Physicians (RCP) audit showed that in 2013/2014 around 68,000 PR referrals were made for patients with COPD though around 446,000 patients were eligible, showing that there is significant under-referral. Of those referred, a quarter did not attend assessment. PR is a cost-effective way of enhancing the health and quality of life of people living with COPD. All those who could benefit should be put on a course. Health care professionals must also do a much better job of selling its benefits to patients. In those who complete treatment, clinically and statistically significant increases in walking performance are seen.
Taking care of a patient’s mental health needs as well as that of their carer is another therapy that can be easily overlooked.
Having limited mobility can often lead to isolation, anxiety and depression. But there are a variety of social opportunities designed for people with lung conditions: do you have a local patient choir? We know singing reduces anxiety, lengthens the out-breath, and reduces sensitivity to breathlessness. If you don’t have such a group, lobby your joint commissioners to get one set-up. The British Lung Foundation already runs a number of singing groups and over 230 Breathe Easy support groups throughout the UK. So wherever you’re based, you should be able to find a local group for your COPD patients.
Education and support is essential for the person who does most for the patient with chronic breathlessness. Carers should be aware of charities like the BLF who provide advice on issues ranging from practical tips for caring to financial support and looking after themselves.
Working with patients in prioritising the goals that are important to them, and giving them information about services and support beyond the clinic or hospital, will play a big part in helping them adapt to living with COPD.
Dr Noel Baxter is a GP in South London, chair of the Primary Care Respiratory Society and a member of the NICE clinical guideline group for asthma management.