Association of Respiratory Nurse Specialists’ response to consultation
ARNS is committed to raising the profile of lung disease and ensuring consistent and comprehensive access to care for all patients and their families. However, the issue of screening holds several dilemmas.
Screening can be help to detect COPD early, facilitating early treatment and intervention and improving prognosis. Yet many issues in practice still need to be resolved before a national screening programme could be considered effective. In this respect ARNS supports the expert review.
A primary concern would be the current use of fixed ratio FEV1/FVC <70% in place of LLN (lower levels of normal) to diagnose obstructive lung disease. A screening programme would need to address the potential for under and over diagnosis in the young and the elderly.
Secondly, there is currently an over-reliance on FEV1 as a marker for disease severity. FEV1 has been shown to have no correlation with health-related quality of life and does not take in to account the complexity of COPD as a disease spectrum.
A third issue is the training of health professionals and the assurance of quality-controlled spirometry. Evidence suggests that much spirometry performed in primary care is of poor quality and training is inconsistent, with a poor uptake. A large-scale screening programme must be underpinned by access to quality-assured standardised spirometry and will depend on access to high-quality benchmarked training with clear standards and national policies.
Finally, those responsible for interpreting and diagnosing lung disease need to be proficient in understanding the complexities of the disease and the impact on individuals and carers. Standards of care and access to resources have been found to be widely variable throughout the UK.
To summarise, while ARNS applauds the effort to improve recognition, early diagnosis and treatment for all individuals with COPD, these unresolved issues need to be addressed. A national screening programme, reliant on spirometry, could be seen to condone the current approach of a “one size fits all” assessment for COPD. We feel a movement towards a more comprehensive strategy of an individualised approach to multiple, clinically relevant aspects of disease management based on symptoms and assessment of future risk, will be more beneficial to current and future patients. In order to achieve this full implementation, current guidelines and strategies needs to be a priority.
Response compiled by Carol Kelly on behalf of ARNS
The UK National Screening Committee is consulting on whether there should be a national screening programme for COPD after an expert review recommended there was not the evidence for national screening. The consultation closes on 26 July 2013.
Find out more here.
The Association of Respiratory Nurse Specialists (ARNS) was established in 1997 as a nursing forum for respiratory nurse specialists and now has over 1000 members across the UK. Its mission is to promote a higher level of respiratory nursing practice through leadership, education and professional development. ARNS also works to influence the direction of respiratory nursing care.
For more information, please visit www.arns.co.uk