New report reveals steep rise in lung disease admissions to emergency departments during winter

Dec 12 2017

An 80% rise in lung disease admissions to emergency departments in winter plays a major part in pushing our A&E services over the edge. Yet, only 10% of hospital trusts who responded to an FOI request had plans in place to make more beds available for respiratory patients warns a new report from the British Lung Foundation.

Out in the cold: Lung disease, the hidden driver of NHS winter pressure, warns that a failure to address what is clearly a predictable and obvious seasonal variation in respiratory admissions is at the heart of our A&E winter crisis and potentially causing patients needless harm.

The report analyses, for the first time, monthly hospital episodes statistics data for each of the major disease areas over the past seven years. It also examined FOI data from hospital trusts across England on their plans for winter care.

In 2015-16, there were more than 676,000 attendances at emergency departments for respiratory conditions. Of this group, 41% of attendances resulted in a hospital admission.

In 2016-17, there were over 287,000 admissions for respiratory. 87,000 were made in the winter months, which represents 80% more admissions than in spring.

The most common causes of these admissions were pneumonia, lower respiratory tract infections (LRTIs), chronic obstructive pulmonary disease (COPD) and bronchiolitis in children under five.

The British Lung Foundation analysis reveals that this annual fluctuation has consistently repeated over the last seven years. Yet, many hospitals have failed to adapt their services to cope with the surge in respiratory admissions. This creates a significant struggle to find available beds during winter and patients suffer.

Many people have an image of emergency departments being filled with fractures from slippery winter conditions. This study shows that lung disease is almost unique in its high seasonal variation, far greater than heart disease and fractures.

For people with a lung condition cold weather can exacerbate their condition to the point that they are left suddenly gasping for breath. A tightening of the chest can leave them feeling as though they are suffocating or drowning.

The report states that without strong community care and support outside of hospital, patients feel unable to manage their condition and turn up at emergency departments frightened. It’s vital that we improve care in the community for these patients outlines the report.

It recommends that people leaving hospital are given consistent and reliable assessment, treatment and follow up in the community to reduce the risk that they’ll need to be re-admitted to hospital.

Key findings and recommendations:

• In 2016/17, respiratory admissions peaked in December at 32,492 – far above the average of 10,652 for the 20 most commons disease areas.
• Infants and children aged one to four, and older people aged 65 and above made up 71% of all respiratory admissions in 2016-17.
• Respiratory disease has the greatest seasonal variation of mortality. In 2016/17, 61.9% more people died from a respiratory condition in the winter compared with the non-winter months.
• Respiratory conditions were the underlying cause for 12,500 excess winter deaths (36.4%) of all excess winter deaths in 2016-17.

Out in the cold makes a series of recommendations that Government, NHS England, commissioners and healthcare professionals must adopt in order to tackle what is a ‘highly obvious, seasonal and combatable problem.’ This includes:

• We must improve our prevention strategy to reduce general respiratory infections and help people who have existing lung conditions to better manage it themselves. This includes: ensuring people get the flu jab and take part in pulmonary rehabilitation.
• It’s vital we acknowledge the growing number of respiratory admissions in winter and adapt our hospital services to address accordingly by allocating more beds for respiratory patients.
• We must end the long term neglect of the 12 million people with a lung disease in the UK. NHS England and the Government need to support a Taskforce for Lung Health and a national five year plan to improve outcomes and care for patients.

Dr Penny Woods, Chief Executive of the British Lung Foundation, said:

Year after year we are seeing an influx of patients admitted to A&E with respiratory conditions. Despite this our analysis reveals that many hospitals are woefully unprepared. This is at a great cost to patients who suffer as a result. Taking a more seasonal approach to supporting people with lung disease will reduce needless attendances and admissions and ultimately improve patient care and outcomes.

Government and NHS England need to take on board measures to tackle this seasonable and predictable crisis and support a Taskforce for Lung Health. This will improve all aspects of care for the 12 million people with lung disease.