John Hurst Profile picture
Jan 13, 2023 11 tweets 6 min read Read on X
NEW

Yesterday we published our first combined asthma and COPD 'Drawing Breath' @NACAPaudit report.

I thought I'd highlight a few key themes.

First, it's important to note that these data reflect care during the pandemic period when front line clinical teams were stretched...
We have four key recommendations, each relevant to #asthma in adults, asthma in children and young people and #COPD, including #PR services.

The first area is that everyone should be able to access early and accurate diagnosis. Here are some key findings; we need to do better:
The second theme is the need for TIMELY care when a person has been admitted to hospital, for example receipt of systemic steroids in asthma, or #NIV in COPD for those who need it.
Here is some more data on timely care.

What are YOU doing to make improvements to these metrics where you work?
Next, we believe people with respiratory disease should receive care from an appropriately trained clinician, at each stage of the care pathway. How are we doing? The data here are more positive, especially around leadership for services in hospitals.
And this is translating to some, but not all people admitted to hospital with asthma or COPD receiving specialist input. Providing this 7 days a week is a particular challenge, but it's important as it associates with better process outcomes.
The final these is about better integration of services for people with asthma and COPD across primary community and secondary care, and for young people with asthma transition to adult services. Here are the headline data:
And here are some more...
Data is power. Knowing how your own service performs compared to the national picture and peers enables local solutions to drive healthcare improvement. And that's what NACAP is all about.

The data here represent >103K records from >700 clinical services in England and Wales.
Huge credit to the clinical teams who, despite the pressures of COVID and COVID recovery, continued to strive to drive healthcare improvement in people living with respiratory disease.

We've lots more to do. But together we can, and people living with lung disease deserve this.
Huge thanks to all from the @RCPhysicians team, and particularly to our partners: @BTSrespiratory, @RCPCHtweets, @asthmalunguk, @PCRSUK, @ARNS_UK, @rcgp and @imperialcollege.

I hope this thread was useful. Here's a link to download the full report:

rcp.ac.uk/projects/outpu…

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More from @ProfHurst

Nov 14, 2022
👀it’s out! The llatest 2023 @GOLD_COPD guidance has been released...

🌟There are BIG changes this year. Here are my first thoughts… but lots to digest:

TL/DR:
1. Revised #COPD defn
2. Etiotypes
3. ABCD is out, ABE is in
4. Farewell ICS-LABA
5. New exacerbation defn

1/n👇
1. Definition of COPD now *includes* emphysema…

'heterogeneous lung condition characterized by chronic respiratory symptoms due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction’
Etiotypes??👀👇
An alphabet soup from COPD-A (asthma), through 'C (cigarette smoking), 'D (abnormal lung development) and 'G (genetic #alpha-1), to 'I (infections), 'P (pollution) and U (unknown).

What do you make of this? A similar approach has helped in pulmonary hypertension!
Read 7 tweets
Jul 3, 2020
POST #COVIDー19 RECOVERY.

How do you know if someone is on an expected trajectory post hospital discharge?

Here is a first look at our needs assessment and service evaluation, from a collaboration across @RoyalFreeNHS and @uclh.

We wanted to help others doing similar work 1/n:
WHAT WE DID.
Mostly 📞 follow-up of people who had COVID-19 (swab+), aiming for 4-6 weeks after discharge. Phone script delivered by an amazing group of @UCLMS medical students and doctors in training. People with abnormal bloods or imaging on discharge invited to repeat them.
WHAT WE FOUND:
This is 384 people followed a median of 54 (47-59) days from discharge.

69% had fatigue.
53% had breathlessness.
34% had cough.
14% experienced symptoms of depression.
Read 6 tweets

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