Calls for breathlessness hub pilots to be expanded to improve COPD diagnosis

One-stop diagnostic hubs for patients with breathlessness should be rolled out across the UK to improve the speed and accuracy of COPD diagnosis, a charity has urged.

In its annual report on COPD care, Asthma and Lung UK said almost a quarter of patients wait five year or more before their condition is diagnosed and 12% of 6,500 patients surveyed had waited more than a decade.

Some community diagnostic centres have been piloting the use of a pre-diagnosis breathlessness pathway, the charity said, but this approach now needs to be rolled out nationally as a matter of urgency.

This would mean any patients presenting with breathlessness with no obvious diagnosis would be referred to a diagnostic hub to have an assessment by heart, respiratory and mental health experts before onward specialist referral and treatment where necessary.

The report said: ‘A pre-diagnosis breathlessness pathway is currently being piloted in England. We want to see this fully implemented within community diagnostic centres (CDCs), as well as across general practice and any other settings where COPD may be suspected (such as Accident and Emergency, walk-in centres, and non-respiratory specialities in secondary care).

‘In the devolved nations, we would like to see Scotland, Wales and Northern Ireland follow and implement their own breathlessness pathways, so no one in the UK experiencing key symptoms, such as being short of breath, is left behind.’

In addition, increasing the capacity for timely, quality assured spirometry across the system, particularly in primary care, should be an urgent priority, the charity warned.

Breathlessness is thought to affect up to 10% of the adult population in the UK, increasing with approximately two thirds of cases due to a pulmonary or cardiac disorder.

Around 70% with COPD remain undiagnosed with patients consulting their GP repeatedly with symptoms, a paper from the Primary Care Respiratory Society estimates.

More work is also needed on improving the fundamentals of care once people are diagnosed, said the Asthma and Lung UK report, with less than a fifth of people getting the full package of care recommended by NICE of smoking cessation, vaccination, pulmonary rehabilitation, personalised self-management planning, and optimised treatment for co-morbidities.

Sarah MacFadyen, head of policy and external affairs at Asthma and Lung UK, said: ‘The breathlessness pathway is the first symptom-based pathway for respiratory disease and aims to significantly improve and streamline the entire diagnostic process.

‘We are keen for it be rolled out as quickly as possible across the country.’

She added that all too often chronic breathlessness is not properly explored.

‘Under the new pathway, patients who present with breathlessness should be given a face-to-face examination, advice on how to manage their breathing, lifestyle support and help to stop smoking if needed. If a diagnosis of a specific condition cannot be made at this stage, they should be referred to a specialist.’

Dr Steve Holmes, a GP with special interest in respiratory medicine, said areas had been working to develop community diagnostic or investigations hubs at a PCN level to test for things like bloods, spirometry, ECGs, FENO, and possibly echocardiogram.

Depending on local circumstances, it may be that the hub just runs the tests before sending results back to the GP but in other places there may be an expert clinician or specialist team in the hub also making the diagnosis, he said.

‘The ideal thing would be I can get the test done in a timely fashion closer to my patients so they don’t have to travel long distances and the quality of the test is good.’

Professor Azeem Majeed, professor of primary care and public health at Imperial College London said some parts of England had already set up breathlessness clinics.

‘I think they are useful because when patients are referred to single-specialty clinics such as cardiology or respiratory medicine, they may not get their problem diagnosed if it falls outside the scope of the specialist. 

‘Breathlessness clinics overcome this problem by taking a multidisciplinary approach to diagnosing the cause of breathlessness.’

He also added on top of this there was scope to improve access to spirometry services in primary care.

‘But spirometry is not a core GMS service and NHS England and ICBs would need to commission and fund a local spirometry service.’