Identifying lung disease early
The earlier we diagnose lung disease, the better it is for those affected by it. It means any treatment can begin before the disease has progressed. Patients are better placed to manage their condition and to take positive choices, such as quitting smoking, that could add years to their life.
We know that many people live with undiagnosed COPD, so they are not getting the care they need. We want health care professionals in general practice to identify those who may be at risk of COPD, such as those with a history of smoking, of asthma or bronchitis, and those with frequent chest infections. This is a practice known as targeted case finding, and we know that it is an effective way to ensure that COPD is not missed.
Personal perspective: missed chances to diagnose my COPD
Margaret Storey lives with COPD, which went undiagnosed and untreated for many years. By the time she received a formal diagnosis her lung capacity had fallen to just 15%. Five years earlier she had been admitted to hospital with pneumonia, but doctors did not identify the primary cause of her ill health, nor warn her about COPD.
“I am not blaming anyone,” says Margaret, from Sunderland. “My COPD was caused by smoking and smoking was my choice. But if at the time of my first encounter with chest specialists they had been totally honest with me and gave me good written information about my condition, I would have taken steps to manage my health in a different way.”
Five years after her initial hospital admission, Margaret was again taken ill. This time doctors diagnosed COPD. Although they spoke to her about her condition, it was through reading a letter sent to her employers explaining the extent of the damage to her lungs that she truly understood how ill she was. “At hospital it was so difficult to take everything in, but seeing it written down like that in plain English was easy to understand.”
Margaret stopped smoking immediately, and in the 13 years since her diagnosis her condition has not deteriorated. Today at the age of 72, and on oxygen, Margaret does what she can to campaign to raise awareness of COPD. “Lung disease isn’t prioritised like cancer or diabetes. If health professionals thought of lung disease in the same terms we could do more to prevent it or diagnose it earlier.”
We want to see nationwide lung cancer screening, for people at higher risk, because this is an effective way to find people who have lung cancer but do not yet know. When diagnosed at its earliest stage, more than 1 in 3 people with lung cancer will survive their disease for five years or more, compared with around 5 in 100 of people when diagnosed at a later stage. A national programme for screening for lung cancer in America has reduced lung cancer deaths by 20%.
Personal perspective: a lung health check identified my cancer
Michael Brady, 64, was diagnosed early with lung cancer after attending a lung health check at a mobile CT scanner unit parked at his local shopping precinct in Manchester. Michael was already being treated for COPD and had regular X-rays to monitor his condition. He was invited to attend the lung health check as he was aged between 55 and 74, had previously smoked and was registered with a participating GP practice. Checks were being carried out as part of a pilot project led by the Macmillan Cancer Improvement Partnership in Manchester (MCIP), in collaboration with the lung cancer team at the University Hospital of South Manchester (UHSM).
Michael says: “I know I’ve got cancer and it is scary, but I’d rather know. I know what I’m dealing with and I’d rather know now than in a few months or years when it will be too late. I honestly feel as though this lung health check has saved my life.”
Michael has since undergone radiation treatment at The Christie NHS Foundation Trust, Manchester.
Measure of success
All GP practices to be actively case-finding for COPD, to be reported by CCGs.
Increase in people registered as having COPD by 1 million from just under 1.1 million in 2016-17 to 2.1 million, using the Quality and Outcomes Framework (QOF) data currently available.
Data need: National Asthma and COPD Audit programmes to replicate, as far as possible, the primary care audit (Wales) in England to collect more accurate data on number of people with COPD, identified in primary care, from 2019.
Decrease in the number of patients diagnosed with lung cancer at stage 3 or 4 from 67% to the future benchmark established in the International Cancer Benchmarking Partnership SURVMARK-2 project (due in early 2020).
Survival rates for lung cancer to double at one year (from 39% to 78%), five years (from 16% to 32%), and 10 years (from 4.9% to 9.8%).