Pollution and flu bring steep rise in lung-related illnessesIvy Madziva
Shortage of specialists adds to worries that surge in respiratory diseases is putting pressure on A&Es
Accident and emergency departments have seen attendances due to lung-related illnesses almost double in under a decade as increasingly virulent flu strains and a rise in air pollution take their toll.
A shortage of lung specialists means services can be patchy, with some respiratory teams over-stretched, however. The huge increase is adding to the significant pressures on hospitals, especially during the winter months, and has prompted calls for a new national strategy to tackle the problem that the British Lung Foundation estimates costs the UK economy £11bn a year.
A data review, shared with the Observer by the British Thoracic Society (BTS), reveals that last year there were 913,646 attendances at A&E departments in England for lung illnesses – including pneumonia, flu, chronic obstructive pulmonary disease (COPD) and asthma – a near doubling since 2011.
The rise has seen a corresponding increase in hospital admissions. In December 2016 the BTS data shows there were 32,492 admissions resulting from A&E attendances for respiratory disease – more than three times the average for any of the 20 most common complaints that regularly trigger an admission.
The findings will reinforce concerns about the threat to public health posed by flu outbreaks – and the NHS’s ability to cope – this coming winter. They show that, in the 12 months to April 2017, 62% more people died from a respiratory condition in the winter than in other seasons.
“Nearly every winter the NHS struggles to cope with a surge of people with lung disease being admitted to hospital through A&E,” said Dr Jonathan Bennett, incoming chair of the BTS board and a lung specialist. “This surge is to some extent predictable, as cold weather can weaken the immune system and make us more prone to viruses that circulate.”
“We’re not geared up to run the peaks, we’re geared up to run the averages”
However, he said that, although the NHS knew the surge was coming, not enough was being done to tackle it.
“If you think of winter pressures, there’s a doubling of the acute and emergency admissions, but there’s not a doubling of the respiratory physicians to manage them. We’re not geared up to run the peaks, we’re geared up to run the averages.”
Lung specialists identify several factors behind the rise in lung-related A&E admissions. These include an increase in the number of older people who may be frail because of lung disease or other health problems, the contribution of indoor and outdoor air pollution to lung disease flare-ups, and the potency of flu strains and other viruses in winter.
In addition, the BTS claims a lack of investment in treatments that could prevent people with pre-existing lung disease needing hospital admission, such as stop smoking support, is taking its toll. The society has also called for further increases in flu vaccination, especially for at-risk groups.
It also wants a national plan to diagnose lung disease earlier and for patients discharged from hospital with respiratory diseases such as pneumonia and COPD to have thorough assessments – including a review of their medication and inhaler technique to promote better self-management of their condition.
A shortage of funding and experts is also a factor, says the BTS. Last year about four in 10 hospitals in England had at least one vacant respiratory consultant post, partly due to an insufficient number of lung specialists being trained at a time when demand for their services is rising.
In 2014, the UK government spent about £28m on respiratory research – half as much as was spent on cardiovascular disease research and a third of what was spent on research into cancer.
If spending by charities is analysed, the BTS said the gap was even wider. It claims that only 2% of all medical research spending by charities goes on respiratory disease, compared with 30% to cancer and 10% to cardiovascular disease.
The number of attendances at A&E departments in England last year for lung-related illnesses
The estimated annual cost to the UK economy due to respiratory conditions and their treatment
The estimated amount of medical research spending by British charities on respiratory illness
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