Advancing Quality NHS Advancing Quality Alliance

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease, commonly referred to as COPD, is the collective term for emphysema and chronic bronchitis, and is mainly caused by smoking. People with COPD have breathing difficulties, which can affect the quality of their everyday life. Flare-ups of COPD, also termed exacerbations, are a major cause of hospital admission, disability, and mortality.

Royal Collage of Physcians

A diagnosis is based on poor airflow as measured by lung function tests. In contrast to asthma, the airflow reduction does not improve significantly with the administration of medication. COPD can be prevented by reducing exposure to the known causes. This includes efforts to decrease rates of smoking and to improve indoor and outdoor air quality.

Through research, clinical input and clinical guidelines Advancing Quality has developed eleven measures that, when applied at the appropriate time, can greatly increase the outcomes for patients. Advancing Quality uses these measures to monitor the quality of care given to patients across the North West with the aim of improving standards and reducing variation in care.

COPD was launched in September 2014. Participating trusts had a three month data collection period to ensure their systems were accurately recording the care patients received. COPD became part of the AQ conditions in December 2014.

Data for your local hospital will be available by February 2016.


1. Oxygen levels in the blood checked and targeted oxygen prescribed within four hours of hospital arrival

Pulse oximetry is a non-invasive procedure to check oxygen levels in the blood, if required target oxygen should be prescribed to help prevent respiratory failure.

2. Steroids should be appropriately administered within four hours of hospital arrival

Corticosteroids are an effective treatment to prevent or reduce the symptoms of COPD.

3. Inhalers administered within four hours of hospital arrival

Inhalers contain medicines known as bronchodilators; they are an effective treatment to reduce the symptoms of COPD.

4. Antibiotics administered within four hours of arrival at hospital (Retired Apr 2016)

Antibiotics can reduce the symptoms of any infection that you may have and prevent infection from developing.   In 2016 the decision was taken by clinical leads in the North West to retire this measure. Patients eligible for this measure will not always have an infection therefore this will avoid any unnecessary prescribing of antibiotics.

5. Help to stop smoking

If you are a smoker you will be offered support and advice to stop smoking. Stopping smoking reduces the chance of further health problems. Stopping smoking can halt progression of COPD.

6. Offer of referral to pulmonary rehabilitation (Retired Apr 2016)

Pulmonary rehab improves exercise performance, quality of life and slows the rate of deterioration of COPD. It is a multidisciplinary approach to care of patients with this condition. In 2016 clinical experts from the North West decided that this would be better measured as part of the primary care element of AQ COPD it was therefore retired from secondary care COPD which focuses on the treatment patients receive within hospital.  

7. Inhaler techniques reviewed

Reviewing your technique when taking an inhaler assesses how well you can use an inhaler. It ensures that you are getting the most out of your medication to treat the symptoms of your condition.

8. Written self-management plan (Retired Apr 2016)

You should be provided with a written self-management plan to help you with any future exacerbations of your condition. It should include an appropriate treatment plan, use of rescue medication and contact numbers for key clinical staff. In 2016 clinical experts in the North West concluded that adherance to a self-management plan is part of the primary care management of COPD, therefore it was retired from the secondary care COPD measure set.

9. Home oxygen therapy assessment made (Retired Apr 2016)

If your oxygen saturation is 92% or less, home oxygen therapy assessment should be arranged. This is an effective treatment to increase the amount of oxygen in your arterial blood. In 2016 clinical experts within the North West decided that this measure should be retired as in its current state it does not allow a response for the care of patients who smoke or have no permanent address.

10. Spirometry referral made (Retired Apr 2016)

If appropriate you may be referred to have a spirometry, this test measures the capacity of your lungs for inhaling and exhaling air. In 2016 clinical experts in the North West decided that this measure did not fit within the secondary care of a patient with an exacerbation of their COPD as a spirometry must be performed when a patient's condition is stable, this measure was therefore retired.

11. Plans for managing end stage of the disease (Retired Apr 2016)

If you have advanced COPD, a joint approach between clinicians, you and your family or carers to manage the condition and an agreement documented as to the most invasive therapeutic intervention offered. In 2016 clinical experts in the North West decided that this measure sits well within the secondary care of patients with COPD. However emphasis should be on identifying who should receive Non-Invasive Ventilation, this forms part of the data collection measures, therefore this was retired from the measure set.
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