The impact of respiratory disease
When we hear ‘respiratory disease’ we think of the big players. Asthma, Cystic Fibrosis and of course, the word that inevitably provokes instant terror. Cancer.
Respiratory diseases are the third biggest killer in UK, killing approximately one person every five minutes.1 2 Unlike other major disease areas, there has been no improvement in the mortality rates for respiratory diseases in over a decade.1 The impact of respiratory diseases on the national health service is substantial, costing the NHS an estimated £11 billion each year.2
During 2008-2012, respiratory diseases were responsible for 20% of all deaths in the UK.3 Of all the respiratory diseases, asthma is the most prevalent, with approximately 8 million of us in the UK having a history with the disease.3 Lung cancer is also a big player, being responsible for 35,419 deaths in the UK in 2012 alone. It remains to be the most common cause of cancer death in both men and women in the UK.3 4
Second and third place in terms of respiratory disease prevalence, go to bronchiectasis and chronic obstructive respiratory disease (COPD). With 211,598 people living with bronchiectasis and 1.2 million living with COPD, the stats are not something to be overlooked.3 In addition to this, COPD is one of the three most common causes of winter admission to hospital in adults, greatly contributing to the annual winter crisis.1 Both COPD and bronchiectasis increase the risk of a patient contracting non-tuberculous mycobacteria (NTM).5
What is the state of respiratory disease funding?
Research funding is not proportionate to the scale of the burden that respiratory disease has on society. In the UK Clinical Research Collaboration (UCRC) report for 2018, of the combined funding of all bodies included in the study, just 1.8% was invested into respiratory disease research. In comparison, cancer and neoplasms received £483M worth of funding, accounting for 18.9% of all funding. Respiratory diseases received more than ten times less at just £47M.6
End of year reports of other funding bodies mirror that of the UCRC report. The Medical Research Council Report of 2017-18 shows that respiratory diseases received just 2% of their yearly funding. The largest proportion of expenditure went to generic health relevance, receiving 29% of funding. Second place went to mental health and neurological conditions which received 18% of the funding.7
What does this mean for the patient?
For people living with respiratory diseases, health-related quality of life can be greatly impacted. In a recent study, 66% of patients with a respiratory disease also had anxiety. In the same study, 86.6% of patients with respiratory diseases had depression.8 The prominence of this has been noted by the British Lung Foundation (BLF), who made recommendations for this in their Taskforce long-term targets report. They have proposed that respiratory guidelines should involve positive interventions for people with mental health problems.2
How much does this cost?
Although the above recommendation from the BLF looks to be a step in the right direction, the cost to the National Health Service (NHS) of those living with a long-term respiratory disease is growing. An area which is suffering, is the rate of hospital admissions. Respiratory diseases results in more than 700,000 hospital admissions each year.9 The rate of hospital admissions for respiratory disease patients has increased continuously over the past seven years at three times the rate of admission for all other conditions with an increase of 77,142 patients between 2010-11 and 2016-17. This is the largest increase of admissions seen in any other of the most commonly diagnosed conditions.1
The time patients spend in hospital is also a contribution to the burden. In 2017, patients with respiratory diseases spent, on average, 7.3 days in hospital in the UK.10 With 6 million impatient bed days resulting from respiratory disease in the UK every year, it’s easy to see how the bill for this patient cohort can build up.9
Furthermore, the current outcomes for respiratory disease patients in the UK are some of the worst in the developed world and there has been no improvement for more than a decade.2 The avoidable mortality rates for respiratory diseases increased by 6% in England between 2014 and 2017, where avoidable deaths are those that could have been avoided through timely and effective healthcare or through public health interventions.11
Where do we start with tackling the problems?
With an increasing patient cohort and dwindling resources, the situation is growing in severity. The BLF has made recommendations in their ‘taskforce for lung health’ to help the millions of people living with respiratory diseases and to better use the resources and funding available. Ideas around early detection, creating clearer care pathways for respiratory disease patients and streamlining services to provide a more timely, accurate and complete service are ideals in the long-term targets that have been set out.2
Other strategies such as the wider use of enhanced recovery after surgery (ERAS) with the use of non-pharmacological treatments such as exercise and advice on diet and nutrition could help to reduce readmission after lung transplant and volume reduction surgery. Concepts such as ‘Clean Air Zones’ in cities and in towns have been recommended with a national system of pollution alerts with health advice being part of the long-term targets.2 Is this enough?