Urgent action is needed to tackle rising inequalities in respiratory care

The UK is falling behind its European counterparts on respiratory disease and the poor and disadvantaged are hit hardest.¹ Not only are people from the most deprived communities more exposed to the triggers of respiratory disease, but they are also less likely to receive optimum care – potentially contributing to worse outcomes.²

In chronic obstructive pulmonary disease, for example, UK mortality rates are the third worst in Europe³ and the 10 per cent most deprived areas have nearly double the prevalence of those in the least deprived.⁴ The situation is similar for asthma, where the UK death rate is 50 per cent higher than the EU average⁵, and people from disadvantaged backgrounds are more likely to be exposed to triggers such as air pollution – and 1.5 times more likely to die from the disease.⁶

Inequalities persist when it comes to care and treatment. Research commissioned by Sanofi and conducted by the York Health Economic Consortium to investigate the relationship between social deprivation and the use of oral corticosteroids found that GP practices in more deprived areas were associated with greater levels of OCS prescribing for asthma and COPD patients.² Although OCS can be life-saving, long-term use can lead to serious side effects, including osteoporosis, diabetes, obesity, depression, and sepsis – further entrenching health inequalities.⁷

So what can – and should – the NHS and others be doing to tackle this?

In November, a panel of experts came together for a roundtable discussion on health inequalities in respiratory care. The event, sponsored by Sanofi and facilitated by Wilmington Healthcare, brought together senior voices from across the health and charity sectors and academia.

Collectively, they painted a picture of a system that fails some patients and requires action on a number of fronts, for example, to educate primary care professionals on the best available treatments, and to encourage and enable people from all backgrounds to seek and expect the best care.

The panel called for more research on respiratory disease, and recommended a model of care that would reduce exacerbations of COPD and asthma, delivering cost-effectiveness to the NHS. Support for primary care – and a focus on self-management – would be key to this. NICE guidelines in respiratory care should be urgently updated to reflect the current evidence base, the panel agreed.

They drew up a series of recommendations – based on their personal experience of what they had witnessed on the ground – with the aim of transforming respiratory care and narrowing the current health inequalities gap. Fundamentally, the panel’s recommendations focused on how to level the playing field to lessen the burden on society’s most disadvantaged. Practical measures would include increased proactive testing of lung function in deprived areas, including reintroduction of spirometry services which were halted during the pandemic, and ensuring that services are accessible to those for whom English isn’t a first language.

Respiratory disease is a major problem for the NHS. It accounted for 1.1 million hospital admissions in England in 2019-20 – this was pre-covid – and the British Lung Foundation points out that lung disease costs the UK £11bn per year.¹ It is also a major contributor to health inequalities.

The roundtable’s conclusions ring true to Hitasha Rupani, a consultant respiratory physician at University Hospital Southampton Foundation Trust. “I have seen first-hand the impact that respiratory disease has on disadvantaged communities,” she said. “It is imperative that we take urgent action to ensure that all patients have access to the best available treatments and care, through measures such as increased proactive testing, supporting shared decision making and shaping our services so that they are accessible for all who need them.”

Implementing the recommendations from the roundtable discussion would be a valuable start.

References

¹ Public Health England. Respiratory disease: applying All Our Health. Last updated 19 May 2022. Available at: https://www.gov.uk/government/publications/respiratory-disease-applying-all-our-health/respiratory-disease-applying-all-our-health [Accessed 14 December 2022].

² York Health Economics Consortium. Analysis of the relationship between the use of prednisolone for asthma and COPD and deprivation. Data held on file. 2022

³ British Lung Foundation. COPD Statistics. 2022. Available at https://statistics.blf.org.uk/copd [Accessed 8 February 2023]

⁴ House of Commons Library. Research Briefing: Support for people with chronic obstructive pulmonary disease. 2021. Available at https://commonslibrary.parliament.uk/research-briefings/cdp-2021-0188/. [Accessed 8 February 2023]

⁵ Asthma UK. UK asthma death rates among worst in Europe. 2022. Available at: https://www.asthma.org.uk/about/media/news/press-release-uk-asthma-death-rates-among-worst-in-europe/ [Accessed 8 February 2023]

⁶ Alsallakh MA, Rodgers SE, Lyons RA, Sheikh A, Davies GA. Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study. PLoS medicine. 2021;18(2).

⁷ Sullivan PW, et al. Oral corticosteroid exposure and adverse effects in asthmatic patients. Journal of Allergy and Clinical Immunology. 2017;141(1):110–6