Commissioning guides
Published 01 October 2011

Services for people with chronic obstructive pulmonary disease

This is an extract from the commissioning guide. The complete commissioning guide is available at

1 Commissioning services for people with chronic obstructive pulmonary disease

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Chronic obstructive pulmonary disease (COPD) is characterised by airflow obstruction that is not fully reversible. The airflow obstruction does not change markedly over several months and is usually progressive in the long term. COPD is predominantly caused by smoking although other factors, particularly occupational exposures, may also contribute to its development. Exacerbations often occur, in which there is a rapid and sustained worsening of symptoms beyond normal day-to-day variations.

Around 640,000 people in England have been diagnosed with COPD[1], and it is estimated that up to a further 1.3 million people may have COPD that has not yet been diagnosed[2]. Prevalence increases with age (it is rare before the age of 35)[3]. COPD remains one of the most common causes of death in England; in 2009 more than 23,500 deaths were primarily attributable to COPD[4]. It is the fifth largest cause of emergency hospital admissions; in 2009/10 there were more than 100,000 emergency admissions to hospital in England for exacerbations of COPD[5]. COPD also accounts for more than 750,000 'bed days' each year in hospitals in England[6].

1.1 Commissioning for outcomes

Commissioners also should refer to NICE clinical guideline 101, 'chronic obstructive pulmonary disease' (2010) and the NICE quality standard for COPD when commissioning services that contribute to delivering the following objectives from an outcomes strategy for chronic obstructive pulmonary disease (COPD) and asthma in England:

  • Objective 1: To improve the respiratory health and well-being of all communities and minimise inequalities between communities.

  • Objective 2: To reduce the number of people who develop COPD by ensuring they are aware of the importance of good lung health and well-being, with risk factors understood, avoided or minimised, and proactively address health inequalities.

  • Objective 3: To reduce the number of people with COPD who die prematurely, through a proactive approach to early identification, diagnosis and intervention, and proactive care and management at all stages of the disease, with a particular focus on the disadvantaged groups and areas with high prevalence.

  • Objective 4: To enhance quality of life for people with COPD, across all social groups, with a positive, enabling experience of care and support right through to the end of life.

  • Objective 5: To ensure that people with COPD, across all social groups, receive safe and effective care that minimises progression, enhances recovery and promotes independence.

Achieving outcomes set out in an outcomes strategy for chronic obstructive pulmonary disease (COPD) and asthma in England will help the NHS to improve against the measures in the NHS Outcomes Framework:

  • preventing people from dying prematurely, for whichthe indicator 'under 75 mortality rate from respiratory disease' will be used

  • enhancing the quality of life for people with long-term conditions

  • helping people to recover from episodes of ill health or following injury

  • ensuring that people have a positive experience of care.

Commissioners will also need to take account of 'No health without mental health: a cross-government mental health outcomes strategy for people of all ages' and 'Transparency in outcomes: a framework for quality in adult social care' when commissioning services for people with COPD.

1.2 Key clinical and quality issues

Key clinical and quality issues in providing effective services for people with COPD include:

  • Identification and accurate diagnosis of COPD in people presenting with symptoms and signs of COPD, and confirmation by performing post-bronchodilator spirometry.

  • Optimally supporting people with COPD to stop smoking by providing brief interventions at the point of contact, and making appropriate referrals to specialist services.

  • Offering pulmonary rehabilitation, including physical training, disease education, and nutritional, psychological and behavioural interventions.

  • Providing effective pharmacological treatment, including inhaled and oral therapies and oxygen therapy.

  • Early identification and partnership working to meet the supportive and palliative care needs of people with COPD, including managing disabling breathlessness, identifying patients at risk of oxygen poisoning and providing information about non-invasive ventilation and end-of-life care.

  • Educating people with COPD, their families and carers about their condition and providing options for supported self management.

  • Ensuring that services for people with COPD are integrated with other services to provide a holistic patient-centred approach to care with good communication and multidisciplinary working.

  • Ensuring that people with COPD are aware of and have access to relevant services, including psychological therapies, secondary prevention, and voluntary and other community service support.

  • Reducing inequalities and providing the best possible outcomes for individual patients, their carers and local communities.

  • Providing a quality assured service.

[1] Quality and outcomes frame work (2010) 2009/2010 QOF data. Leeds: The NHS Information Centre for health and social care

[4] Office for National Statistics (2009) Statistical Bulletin: Death registrations by cause in England and Wales. Office for National Statistics

[5] The NHS Information Centre (2010) Hospital episode statistics. Leeds: The NHS Information Centre for health and social care

[6] The NHS Information Centre (2010) Hospital episode statistics. Leeds: The NHS Information Centre for health and social care