Asthma and lung patients ‘trapped in a vicious circle as they seek treatment’

Martin Shipton

People with lung conditions are trapped in a vicious circle of late diagnosis, have limited access to vital treatments, and poor support to manage their conditions, according to a new report.

Asthma + Lung UK Cymru says this leads to avoidable emergency hospital admissions, causing pain for patients with lung conditions and their families, putting a significant and avoidable strain on NHS Wales.

The report – Saving your breath: how better lung health benefits us all in Wales – outlines recommendations that it claims could offer relief to people affected by lung conditions, deliver massive savings and reduce pressure on NHS Wales at a time when health boards are being asked to find savings in their budgets.

Diagnostic tests

These recommendations include ensuring diagnostic tests are funded, improving access to the right treatments such as pulmonary rehabilitation (PR), and providing people with the support they need to manage their lung condition to keep them well and out of hospital.

Using economic modelling by PwC, the report reveals that asthma and Chronic Obstructive Pulmonary Disease (COPD) cost NHS Wales more than £295m each year and have an overall impact of £772m on the Welsh economy. Lung conditions are one of the leading causes of winter pressures on the NHS, as people with these conditions are more vulnerable to respiratory viruses, including flu and Covid, and colder temperatures.

The analysis commissioned by Asthma + Lung UK Cymru says that despite lung conditions being the third biggest killer in Wales, simple diagnostic tests for common lung conditions aren’t widely available to GPs, creating delays and leading to misdiagnosis. The charity is now calling for all health boards to urgently restart spirometry in all parts of Wales and says fully funded diagnostic testing would result in more than £3m in direct NHS cost savings related to reduced exacerbations, with this achieved by patients receiving an accurate diagnosis and then given appropriate treatment.

One such treatment is PR which is a well-evidenced and high value physical exercise and education programme, which helps keep people’s lungs healthy. The analysis highlights the expansion of PR in Wales would result in £7.7m of direct NHS savings related to reduced exacerbations, as well as a reduction of 10,500 bed days, 3,500 of which would be saved over the winter period.

Workforce shortages

But current access to PR in Wales is limited, patchy and being held back by workforce shortages. Hywel Dda, Cardiff and Vale, and Betsi Cadwaladr University Health Boards are reporting the highest waiting lists of between two and three years. These waiting lists, says the report, are failing people with lung conditions and holding them back from leading a happier, healthier, and longer life.

This year the Welsh Government announced £30m of investment in community care to reduce pressure on hospitals. If properly implemented, Asthma + Lung UK Cymru’s recommendations would save significantly more than £19.5m a year and free up just under 14,000 bed days, 5,000 of which would be during the winter period, says the report.

Trystan Roberts, 47, from Powys, said being diagnosed with asthma and COPD was a huge shock. He said: “I’m an ex-smoker but never had any issues with my breathing. In 2007 I had a chest infection; it was so bad I was hospitalised and put on oxygen. While in hospital things took a turn for the worse and I contracted pneumonia. It was then when I experienced my first ever asthma attack. Five days of care and I left hospital with an asthma diagnosis. It was a huge shock.

“One minute I’m fine and the next I can’t even lift something without gasping for air. I was given medication after medication without any real answers. It was frustrating. I struggled with my breathing for around seven years before also being diagnosed with COPD. A nurse recommended pulmonary rehab. I had no idea what it was, so I took to YouTube to find out. I was sceptical because I thought exercise would make me worse as I struggle to breathe doing the simplest of tasks.

“Due to the pandemic I had to wait two years for the course to restart. It was then done virtually which was great as I work night shifts. It really boosted my confidence and I felt my health definitely improved. To think in some parts of Wales people are currently waiting up to three years is a travesty.

“When you have lung conditions like mine, your health can change so quickly so waiting that long for treatment is not acceptable. People need help sooner to help keep them out of hospital.”

Deadly

Joseph Carter, head of Asthma + Lung UK Cymru, said: “Winter is the deadliest season for people with lung conditions and diagnostic tests hold the key to giving someone an accurate diagnosis. Without these tests, many are missing out on the treatments they desperately need to live and stay well at home. People with lung conditions deserve better.

“It’s a year since the new Quality Statement for Respiratory Disease was published and extraordinarily little progress has been made to implement it. While the Cancer Quality Statement was supported by an Improvement Plan with clear measurable outcomes, the Welsh Government has refused to do the same for lung health. People living with a lung condition cannot afford to lose another year to inaction.

“There are huge savings to be made by improving the diagnosis and treatment of lung conditions such as asthma and COPD, in terms of direct NHS savings, including reducing hospital bed days. It doesn’t make sense that lung conditions aren’t given the same priority as other big killers such as heart disease.”

A Welsh Government spokesperson said: “We are committed to creating a healthier and greener Wales through a range of measures to improve air quality, reduce smoking rates and support people living with respiratory diseases. We also provide health boards with substantial funding each year to deliver a comprehensive package of support for people with lung conditions including asthma.”