Mind the gap

How industry and the NHS can work together to bridge the diagnostic gap in COPD

Lord Darzi’s recent report on the state of the NHS outlined multiple issues and laid bare a health system in severe distress.

With the NHS under such pressure, the benefit of collaborative working to alleviate some of the burden wherever possible is clear.

As the Secretary of State observed, “if we can combine the care of the NHS and the genius of our country’s leading scientific minds, we can develop modern treatments for patients and help get Britain’s economy booming”.

Partnership working between industry and NHS is a key component of supporting a sustainable healthcare model now and in the future.

At Chiesi, we have a long history of supporting patients with chronic and genetic diseases, many of whom face significant challenges around diagnosis and access to appropriate care.

In chronic obstructive pulmonary disease (COPD) for example, it is estimated that two million people are currently living with undiagnosed COPD in the UK, with one in five of these having a severe or very severe form of the disease.

However, it is likely there are even more people living with undiagnosed COPD than we realise, with evidence to suggest that the true prevalence of the condition is underestimated.

Breathe easier

COPD currently costs the NHS £1.9 billion annually and early diagnosis presents an opportunity to not only ensure patients are put on the correct care pathway as soon as possible, but also to potentially provide significant cost savings.

COPD worsens with every exacerbation and the damage is irreversible. Uncontrolled COPD often requires emergency care, and the average length of stay for a patient requiring hospitalisation is seven days.

These experiences cost the NHS, the patient and the planet as such use of emergency care is carbon heavy.

To look at how we may address this challenge, Chiesi has been working with NHS Humber Health Partnership on a project called FRONTIER, identifying patients who were identified as high risk for COPD during Hull Lung Health Check appointments, such as those where emphysema was present on a CT scan, and inviting them for spirometry testing.

In the first cohort of 201 people, there was a COPD diagnosis rate of nearly 70%, with all those diagnosed now receiving appropriate treatment and support to manage their condition and keep them well at home (for example, smoking cessation and pulmonary rehab), reducing the need for hospitalisation.

Professor Michael Crooks, who is the FRONTIER project clinical lead and Professor of Respiratory Medicine at Hull York Medical School, explains:

“The FRONTIER project demonstrates not only the opportunity for implementing targeted case-finding hubs, but the prospective benefits to patients and the NHS – both in cost and resource. Our goal is to share our learnings with NHS England and other relevant decision-makers to discuss the potential benefits of a such targeted, case-finding approach nationwide.”

While we hope to bring the FRONTIER project to more NHS hubs in the future, our ultimate goal is to find the best long-term approach for the NHS and its patients.
The findings in Lord Darzi’s report outlined a need to shift focus to community care to alleviate pressure on hospitals.

As such, the next phase of our efforts has been to launch COMET, an additional collaborative project with Wirral Primary Care Collaborative Limited building on the learnings of FRONTIER and testing the approach in an alternative clinical setting, i.e. primary care.

COMET has been designed to perform spirometry testing in a community setting (whereas FRONTIER takes place in secondary care) and assess its impact on COPD diagnostic rates.

By comparing the results of both COMET and FRONTIER, we can present the NHS with a truly robust solution to the diagnostic gap in COPD and support it as its embedded into practice in the future.

Chiesi will continue to champion earlier diagnosis of COPD and appropriate care.
This is in the interest of everyone including the NHS in terms of savings in time and resources by moving to a more preventative model, as well as patients across the nation by improving outcomes and their quality of life.

Shish Patel is Senior Director, Medical Affairs at Chiesi UK. Go to chiesi.com.uk