NICE impact respiratory conditions

Why focus on respiratory conditions?

• 1 in 5 people are affected
• £9.9 billion cost to the NHS each year
• 3rd biggest cause of death
• 850,000 emergency admissions
• 4.9 million days in hospital
• 80% more admissions in winter

What we've published on this topic

This page provides a summary of the findings from the report. It includes insight from Kay Boycott, chief executive of the Asthma UK and British Lung Foundation Partnership, about NICE's role in improving outcomes for people with respiratory conditions.

The report looks at the impact of our guidance before the COVID-19 pandemic. It highlights where new COVID-19 resources have been developed to help the NHS and social care take action.

Asthma and chronic obstructive pulmonary disease (COPD)

Key points

• Agreeing a personalised action plan can help adults and children over 5 to self-manage their asthma and reduce the risk of exacerbations. Since our asthma quality standard was published in 2013, the proportion of people who agreed a written plan has doubled. However, young people are less likely to agree a plan. Only 42% of people aged 6 to 17 agreed a plan compared to 59% of people aged 18 and over.
• Our COPD quality standard says that people with suspected COPD should have post bronchodilator spirometry to identify abnormalities in lung volume and air flow for early diagnosis. In 2018/19, 81% of people had their COPD diagnosis confirmed by spirometry.
• The quality standard also says that pulmonary rehabilitation should be available for people with stable COPD and exercise limitation because of breathlessness, and people who have been admitted to hospital for an acute exacerbation of COPD. While people have good outcomes after rehabilitation, waiting times remain too long. In 2019, 44% of hospitals did not make rehabilitation available within 4 weeks of discharge for people with COPD.

Pneumonia

Key points

• In response to the COVID-19 pandemic, we have published a COVID-19 rapid guideline on antibiotics for pneumonia in adults in hospital and a COVID-19 rapid guideline on managing suspected or confirmed pneumonia in adults in the community. They aim to ensure the best treatment and use of resources during the outbreak.
• Viruses such as flu are a common cause of pneumonia in young children, but uptake of the flu vaccination is low in people aged under 65. In 2020 we published a quality standard on increasing uptake of flu vaccination among people who are eligible, to address this trend. In 2018/19, uptake of flu vaccination was 48% of eligible people aged 6 months to 65 years and 72% of people aged 65 and over.
• The cost to the NHS of emergency admissions to hospital for pneumonia is over £300 million a year. Emergency admissions have increased for people under 65. If more people under 65 who are eligible had the flu vaccination, this could help to slow the trend.

Tuberculosis (TB)

Key points

• The most deprived 10% of the population experience an incidence rate 7 times higher than the least deprived 10%.
• Our quality standard on TB highlights that rapid assessment results in treatment starting earlier (within 2 months of onset) for people with pulmonary TB. However, in 2018, 30% of people experienced a delay of more than 4 months.
• The quality standard also says that people with active TB who have a history of homelessness, drug or alcohol misuse and those who are in prison or have been in the past 5 years should be offered directly observed therapy (DOT). However, since 2016 there has been a reduction in the proportion of people receiving DOT. New technologies have been developed to securely and remotely monitor TB patients taking their medication, referred to as video observed therapy (VOT). VOT has enabled higher levels of treatment observation than DOT in under-served populations with TB in England, and has been shown to be more acceptable and cheaper for supervision of doses.

NICE and the environment

Key points

• Air pollution is associated with an estimated 28,000 to 36,000 deaths and costs the NHS and social care system £43 million each year.
• Our guideline on outdoor air pollution makes recommendations on reducing emissions from public sector transport services and vehicle fleets. We also recommend active travel such as on foot or by bicycle, reducing reliance on vehicles and increasing exercise. Almost 10,000 new cases of asthma could be avoided by 2035, if there was a small reduction in air pollution.
• We have produced a patient decision aid on inhalers for asthma to help people and their healthcare professionals decide which inhaler is best for them. It includes the carbon footprint of the inhaler, which can vary greatly between products. If it is a viable option, people can choose a more environmentally friendly inhaler which can contribute to cutting the NHS’s carbon footprint. Two puffs of an inhaler with propellant has almost the same estimated carbon footprint as 2 miles in a typical car.

This report highlights progress made by the health and care system in implementing NICE guidance. We recognise that change can sometimes be challenging and may require pathway reconfiguration. It may also require additional resources such as training and new equipment.

We work with partners including NHS England and NHS Improvement, Public Health England and other relevant organisations to support changes. We also look for opportunities to make savings by reducing ineffective practice.