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Practice comment

'Respiratory strategy must be acted on if care is to improve'

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The Department of Health’s publication of An Outcomes Strategy for Chronic Obstructive Pulmonary Disease(COPD) and Asthma in England last month is the culmination of several years’ persistent lobbying from health professionals and patient groups.

It is also a crusade to which respiratory nurse specialists have made a significant contribution.

As guidance on best practice, it outlines a vision for the future of COPD and asthma services that sees clinicians and patients collaborating to improve care. Termed the REACT approach, its focus covers some key areas of respiratory health and disease:

  • Respiratory health and good lung health;
  • Early accurate diagnosis;
  • Active partnership between people with COPD/asthma and health professionals;
  • Chronic disease management (and good control of symptoms);
  • Targeted evidence-based treatment for the individual.

Underpinning this are six objectives: improving respiratory health; minimising inequalities; preventing respiratory disease through awareness of lung health, avoidance of risk factors and addressing health inequalities; and reducing premature death of people with COPD through proactive management. Other aims are: enhancing quality of life through to the end of life; improving safe and effective care; and reducing the impact of asthma.

The objectives are referred to as “high level” with non-specific targets that relate to the general population. This could make influencing local commissioners tough but promotes a more proactive approach to
disease management, specifically integrated care and self-management. While nothing new to respiratory health professionals, it may help disseminate a consistent message to other healthcare staff.

The Association of Respiratory Nurse Specialists recognises the document as an important framework to guide commissioning and delivery of respiratory services. This is key in these turbulent economic times. But this is just a framework – the challenge is ensuring the strategy is put into action so treatment and care improves. This will be down to local commissioning groups and the respiratory leads already appointed.

One of the main strategy aims will be to tackle health inequalities. Arguably this document could widen those inequalities as care improves in some areas but not others. To make sure the framework is implemented, it is important that forthcoming quality standards on COPD from the National Institute for Health and Clinical Excellence and the development of a quality standard for asthma reflect similar goals. This in turn needs to be incorporated into the quality framework for GPs. Without this joined-up thinking, and accompanying incentives, this long-awaited strategy could be difficult to adopt.

The fruition of this campaign is welcome, but it is down to health professionals, especially nurses, to ensure it is implemented and continue improving the care of these neglected patient groups.

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