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'Why do so many patients with COPD still have no access to specialist nurses?'

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Patients with chronic obstructive pulmonary disease (COPD) must come to terms with having a progressive and incurable disease that will increasingly limit their capacity for physical activity, and is almost certain to cause their death. And the fact that it affects the ability to breathe means they are constantly reminded of this frightening prospect.

But these patients also experience acute exacerbations, in which their condition worsens in a terrifyingly short time – often requiring emergency admission to hospital.

Like many long-term conditions, the progression of COPD can be slowed, and its effect on quality of life can be minimised. This requires patients to have a good understanding of their condition, how to manage it themselves and when to call in specialist help – and for that specialist help to be available when needed.

The fourth national COPD secondary care audit, published last week, reveals that care for this group of patients has improved since the last audit in 2008. Unfortunately, it also reveals that specialist help is not always available.

Patients with COPD need to be cared for by a multidisciplinary respiratory team – particularly in times of crisis. These teams can help to slow disease progression and maintain patients’ quality of life. By teaching patients to manage their own condition and recognise the early signs of deterioration they can also reduce admissions to hospital of patients with COPD exacerbations that could have been averted with early intervention.

The audit reveals a range of aspects of care in which there are variations across the country. It is depressing to see that access to respiratory specialist nurses has declined; only 71% of units audited have access to these nurses for all their patients, compared with 80% in 2008. However, the audit also suggests this is not necessarily due to budget cuts: a total of 551 specialist nursing posts were vacant when the audit was completed.

It would be useful to investigate the reasons for this high level of vacancies – is the shortage due to staff levels lagging behind rising patient numbers, a shortage of funds to train respiratory nurses, or a large proportion having left the specialty in a short time?

Whatever the reason, patients with COPD – and other long-term respiratory conditions – need this gap in services to be filled as quickly as possible.

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