Nelson/Marlborough have highest readmissions rate

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One in ten Nelson/Marlborough patients admitted to hospital for Chronic Obstructive Pulmonary Disease (COPD) are back in the hospital within 30 days – the third highest in New Zealand, according to a new study.

Data from the Nelson Marlborough District Health Board shows that 10 per cent of COPD patients were readmitted to a hospital within 30 days of discharge in 2012/13.

COPD is a progressive, obstructive lung disease characterised by chronic poor airflow. The most common cause of COPD is cigarette smoke in the lungs.

COPD is the fourth leading cause of death behind cancer, heart disease and stroke. The impact of COPD on the region is likely to worsen, with the disease set to become the third leading cause of death worldwide by 2030.

Figures on deaths as a result of COPD show the disease affects an estimated 15 per cent of New Zealanders over 45 years old.

An awareness campaign has been launched today, on World COPD day, to highlight the symptoms and risk factors of the disease.

Symptoms include frequent breathlessness and coughing and once established causes irreparable lung damage. COPD is treatable but not curable.

GP Dr Jim Lello says many people put off visiting the doctor because the symptoms of the disease are relatively common.

“Shortness of breath, a cough and sputum are all common and people are used to them, so it’s only when they get more severe or consistently affect someone’s life that they become noticeable,” says Jim.

New Zealand experts are calling for earlier diagnosis in order to provide a better quality of life for those living with COPD, as well as reducing the cost of the disease for the public health system.

Jim says it’s important for GPs to carry out the correct assessments for patients at high risk.

“COPD is a primary care illness, GPs are the ones seeing it in the community most often, and so we are working to encourage more GPs to train their staff in spirometry testing, which is an accurate test of lung function, and to use questionnaire assessment tools as well.”

New Zealand faces costs of $59.6 million per annum in COPD-related hospital admission costs alone. This is without taking into account loss of productivity and absenteeism, or ongoing support costs.

The COPD Assessment Test (CAT) online self-assessment test can be administered by a GP, or patients can do it themselves to get a score of how lung function is affecting their everyday life, he says.

“If it shows that it is negatively affecting you, then it’s important to visit your GP to discuss those results and start a dialogue about the potential treatments that we can prescribe to help alleviate symptoms, including medication and pulmonary exercises,” says Jim.

University of Auckland Associate Professor Rob Young, a specialist physician and clinical researcher, says early detection is crucial as treatments can slow the deterioration of lung function when damage is minimal if patients quit smoking and seek help early enough.

A study published in the New Zealand Medical Journal in January this year found that hospital admissions for COPD are costly and are overrepresented in high-risk groups including rural, elderly, socioeconomically deprived, and Māori and Pacific peoples.

“We estimate that up to 70 per cent of patients with COPD could be unrecognised or undiagnosed, which is why it’s important that families get involved and encourage family members who smoke to go to their GP for lung function tests,” says Rob.

The importance of identifying COPD is made even more important with the discovery that smokers with this disease are three to four times more likely to get lung cancer.

“What we now know is that if you are a current or former smoker and have developed COPD, your risk of lung cancer is much higher, so the earlier you can quit smoking and start dealing with the disease, the more you can reduce your risk,” says Rob.

For Māori, that message is even more important, with the Māori population at higher risk of COPD and an even greater risk of lung cancer. “Studies show that Māori develop these diseases 5-10 years earlier and at much lower smoking levels than non-Māori, so detecting COPD early becomes even more essential.”

Asthma NZ Executive Director Linda Thompson says an early diagnosis of COPD can markedly improve a patient’s quality of life.

“They can be supported to give up smoking, encouraged to participate in regular exercise, and be commenced on appropriate medication, which includes annual free flu vaccinations and other vaccinations if appropriate.”