When we get ill: respiratory diseases

Page last updated: 2019 - due to be refreshed in 2021.

 

1 Five key points

  1. Respiratory disease is the third biggest killer in the UK, behind cardiovascular disease and cancer. In Suffolk, respiratory conditions accounted for nearly 1 in 5 deaths in 2017. (2 Why are respiratory diseases important?
     
  2. Lung disease accounts for over 700,000 hospital admissions and over 6.1 million hospital bed days in the UK each year. Only cardiovascular disease accounts for more. (2 Why are respiratory diseases important?
     
  3. Smoking is the most important factor in the development of respiratory diseases. In England, 1 in 3 deaths from respiratory disorders are attributable to cigarette smoke. (2 Why are respiratory diseases important?
     
  4. Lung disease continues to be a factor in health inequalities. A person from the most deprived section of society is nearly twice as likely to develop lung cancer as someone from the least deprived section of society. (2 Why are respiratory diseases important?
     
  5. For people who already have a lung condition, quitting smoking is the single most effective action for improving health and quality of life. (2 Why are respiratory diseases important?)

2 Why are respiratory diseases important in Suffolk?   

Respiratory disease is one of the three biggest killer disease areas in the UK, behind heart disease and cancer. It kills 115,000 people each year, the equivalent of one person every five minutes.[1] These mortality figures are roughly the same as those reported by the British Thoracic Society a decade ago.[2] In comparison, the number of deaths from heart disease went down by 15% from 2008 to 2012.

Lung disease places a huge burden on health care services. It accounts for over 700,000 hospital admissions and over 6.1 million hospital bed days in the UK each year.[1] Only heart disease accounts for more. Better diagnosis and disease management would reduce this burden, particularly on emergency care. Lung disease continues to be a major factor in health inequalities. Someone from the most deprived section of society is two-and-a-half times more likely to have COPD (chronic obstructive pulmonary disease), and nearly twice as likely to develop lung cancer, as someone from the least deprived section of society.[1]

Smoking is the most important factor in the development of respiratory diseases. In England, one-third of all deaths from respiratory disorders are attributable to cigarette smoke and current smokers are 25 times more likely to die from lung cancer compared to those who have never smoked.[3]

Although lung disease includes a large range of conditions, this section focuses on three of the most prevalent and influential: COPD, asthma and lung cancer.

COPD, or chronic obstructive pulmonary disease, is a progressive disease that can cause coughing, wheezing, shortness of breath, chest tightness and other symptoms. More than 1.1 million people in England have a diagnosis of COPD.[4] Smoking is the main cause of COPD and is thought to be responsible for around 9 in every 10 cases. Some research has also suggested that being exposed to other people's smoke (passive smoking) may increase your risk of COPD.[5]

Lung cancer occurs when abnormal cells form into a tumour in the lung. Anyone can develop lung cancer but around 90% of cases occur in people who smoke or who used to smoke.[6] Passive smoking over a long period and environmental factors, such as exposure to asbestos, can also increase the risk of developing lung cancer. Lung cancer is the most common cause of cancer death in the UK.[7]

Asthma is a common, long-term disease which affects almost 3.5 million people in England.[4] People with asthma have very sensitive airways that become inflamed and tighten when they breathe in anything that irritates them. This can cause chest tightness, wheezing and difficulty in breathing. Asthma is not a progressive condition and most asthma deaths are considered to be avoidable.[8]

The major risk factors for chronic respiratory diseases are tobacco smoke (both first and second hand), air pollutants (both indoor and outdoor) and allergens.[9] For people who already have a lung condition, quitting smoking is the single most effective action for improving health and quality of life.[10]

3 What is the local picture?       

Note that Suffolk is covered by three Clinical Commissioning Groups (CCGs) and one of them spans Suffolk and Norfolk (Great Yarmouth and Waveney CCG). Figures are presented at CCG level because the data cannot be disaggregated into Great Yarmouth and Waveney.

3.1 Chronic obstructive pulmonary disease

Within the three CCGs areas that cover Suffolk, a total of 18,932 people (of all ages) had a GP registered diagnosis of chronic obstructive pulmonary disease (COPD) in 2017/18 (Table 1). Prevalence was lower in Ipswich and East Suffolk CCG compared to East of England, but higher in West Suffolk CCG and Great Yarmouth and Waveney CCG.[4]

These figures may underestimate the true number of people with COPD in Suffolk because a certain number of people will be living with the condition but have not been formally diagnosed. Based on prevalence estimates developed by Public Health England, between 2.9-4.3% of individuals in Suffolk have COPD.[11]

Table 1: GP registered prevalence of COPD among individuals of all ages, CCGs, East of England, England, 2017/18[4]

Geographical area

GP registered prevalence of COPD

Number

Prevalence

 Ipswich and East Suffolk CCG

 7,227

1.77%

 Great Yarmouth and Waveney CCG

 6,254

2.76%

 West Suffolk CCG

 5,451

 2.18%

 East of England

88,753

1.95%

 England

1,113,417

 1.91%

 

 

 

 

 

 

 

 

 

Source: NHS Digital. Quality and Outcomes Framework, Achievement, prevalence and exceptions data - 2017-18. (2018).

3.1.2 Hospital admissions

In 2017/18, the age-sex standardised elective hospital admission rate for COPD was significantly lower in Ipswich and East Suffolk CCG compared with East of England, and comparable in Great Yarmouth and Waveney CCG and West Suffolk CCG (Table 2). Elective admissions for COPD were less common than emergency admissions. The age-sex standardised emergency hospital admission rate for COPD was significantly lower in Ipswich and East Suffolk CCG and West Suffolk CCG than East of England, but higher in Great Yarmouth and Waveney CCG.

A possible reason for the higher emergency admission rates in Great Yarmouth and Waveney CCG could be the relatively higher smoking prevalence found in this area, which is relatively more deprived than the rest of the East of England region.

Table 2: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for COPD, CCGs, East of England, England, 2017/18[12]

Table 2: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for COPD, CCGs, East of England, England, 2017/18

Notes: CCG admission rates calculated per 100,000 registered patients; East of England and England admission rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

Source: Suffolk County Council & NHS Digital. Analysis of Hospital Episode Statistics. (2018).

3.1.3 Mortality

Within the three CCG areas that cover Suffolk, there were 443 deaths directly attributed to COPD in 2017/18. The age-sex standardised mortality rate from COPD was significantly lower in Ipswich and East Suffolk CCG compared with East of England, and comparable in West Suffolk CCG (Table 3). The standardised mortality rate was higher in Great Yarmouth and Waveney CCG compared to the East of England.[12] It is likely that relatively higher smoking prevalence in Great Yarmouth and Waveney CCG has an impact on the higher mortality rate linked to COPD.

More information on tobacco use and its impact in Suffolk is contained in the State of Suffolk's section on tobacco.

Table 3: Age-sex standardised mortality rate per 100,000 registered patients/residents from COPD, CCGs, East of England, England, 2017/18[12]

Table 3: Age-sex standardised mortality rate per 100,000 registered patients/residents from COPD, CCGs, East of England, England, 2017/18

Notes: CCG mortality rates calculated per 100,000 registered patients; East of England and England mortality rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

Source: Suffolk County Council & NHS Digital. Analysis of Hospital Episode Statistics. (2018).

3.2 Lung cancer

The prevalence of lung cancer is estimated as part of the UK Cancer Prevalence Project.[13] Within the three CCGs areas that cover Suffolk, a total of 935 people (of all ages) had a GP registered diagnosis of lung cancer in 2016 (Table 4). Compared to the Midlands and East of England, prevalence of lung cancer was lower in Ipswich and East Suffolk CCG and West Suffolk CCG, but higher in Great Yarmouth and Waveney CCG.[4], [13] It is likely that relatively higher smoking prevalence in Great Yarmouth and Waveney CCG has an impact on the higher prevalence of lung cancer.

Table 4: Estimated prevalence of lung cancer among individuals of all ages, CCGs, Midlands and East of England, England, 2016[4], [13]

Geographical area

Estimated prevalence of lung cancer

Number

Prevalence

 Ipswich and East Suffolk CCG

355

0.09%

 Great Yarmouth and Waveney CCG

336

0.15%

 West Suffolk CCG

 244

 0.10%

 Midlands and East of England

6,066

0.13%

 England

59,475

0.11%

Sources: NHS Digital. Quality and Outcomes Framework, Achievement, prevalence and exceptions data - 2017-18. (2018); Public Health England. The UK Cancer Prevalence Project. (2018).  

3.2.2 Hospital admissions

In 2017/18, the age-sex standardised elective hospital admission rate for lung cancer was significantly lower in Great Yarmouth and Waveney CCG and West Suffolk CCG compared with East of England, but higher in Ipswich and East Suffolk CCG (Table 5). Elective admissions for lung cancer were more common than emergency admissions, because of planned treatment such as chemotherapy. The age-sex standardised emergency hospital admission rate for lung cancer was comparable to East of England in all CCG areas that cover Suffolk.

The higher elective admission rates in Ipswich and East Suffolk CCG may be linked to treatment pathways available to patients in this area.

Table 5: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for lung cancer, CCGs, East of England, England, 2017/18[12]

Table 5: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for lung cancer, CCGs, East of England, England, 2017/18

Notes: CCG admission rates calculated per 100,000 registered patients; East of England and England admission rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

Source: Suffolk County Council & NHS Digital. Analysis of Hospital Episode Statistics. (2018).

3.2.3 Mortality

Within the three CCG areas that cover Suffolk, there were 463 deaths directly attributed to lung cancer in 2017/18. The age-sex standardised mortality rate from lung cancer was significantly lower in Ipswich and East Suffolk CCG compared with East of England, and comparable in Great Yarmouth and Waveney CCG and West Suffolk CCG (Table 6).[12

Table 6: Age-sex standardised mortality rate per 100,000 registered patients/residents from lung cancer, CCGs, East of England, England, 2017/18[12]

Table 6: Age-sex standardised mortality rate per 100,000 registered patients/residents from lung cancer, CCGs, East of England, England,

Notes: CCG mortality rates calculated per 100,000 registered patients; East of England and England mortality rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

Source: Suffolk County Council & NHS Digital. Analysis of Hospital Episode Statistics. (2018).

3.2.4 Stage of diagnosis

Cancer staging is a classification system used to categorise how far a cancer has progressed. This provides information to tailor treatment plans and estimate prognosis. In general, stages one and two indicate a less developed cancer, with better prognosis and a higher successful treatment rate. Stages three and four indicate more advanced cancers, which generally have poorer outcomes for the patient. Early diagnosis of cancer increases the likelihood of successful treatment.

Across England (49.1%) and East of England (50.3%), around half of people with lung cancer were diagnosed at stage 1 and 2 in 2012-15. Great Yarmouth and Waveney CCG (51.0%) and West Suffolk CCG (50.6%) follow this trend, but Ipswich and East Suffolk CCG has a lower proportion of cases identified at an early stage (47.2%) (Table 7). This could partly explain why Ipswich and East Suffolk CCG has a higher elective hospital admission rate than comparable areas – if people are diagnosed at a later stage then they may require additional admissions to receive treatment.

Table 7: Lung cancer diagnoses by stage of diagnosis, Suffolk CCGs, East of England, England, 2012-15[13]

Geographical area

Stage at diagnosis of lung cancer

1

2

3

4

Unknown

Ipswich and East Suffolk CCG

38.8%

8.4%

22.0%

30.8%

-

Great Yarmouth and Waveney CCG

51.0%

-

23.8%

25.2%

-

West Suffolk CCG

39.2%

11.4%

27.8%

21.5%

-

East of England

36.7%

13.6%

22.2%

24.5%

3.0%

England

35.4%

13.7%

21.4%

23.9%

5.6%

Source: Public Health England. The UK Cancer Prevalence Project. (2018).

3.3 Asthma

3.3.1 Prevalence

Within the three CCGs areas that cover Suffolk, a total of 59,531 people (of all ages) had a GP registered diagnosis of asthma in 2017/18 (Table 8). Prevalence was higher than East of England in all Suffolk CCGs; possible reasons could include that the prevalence of asthma is higher in Suffolk, or that a higher proportion of people with asthma have been given a GP diagnosis compared to other areas.[4]

Table 8: GP registered prevalence of asthma among individuals of all ages, CCGs, East of England, England, 2017/18[4]

Geographical area

GP registered prevalence of asthma

Number

Prevalence

Ipswich and East Suffolk CCG

26,735

6.56%

Great Yarmouth and Waveney CCG

15,237

6.71%

West Suffolk CCG

17,559

7.01%

East of England

284,937

6.28%

England

3,463,893

 5.93%

Source: NHS Digital. Quality and Outcomes Framework, Achievement, prevalence and exceptions data - 2017-18. (2018).

3.3.2 Hospital admissions

This section includes hospital admissions for people of all ages and people aged under 20 with asthma.

In 2017/18, for people of all ages and people aged 20 and below, emergency admissions for asthma were more common than elective admissions. An elective admission is an admission "that has been arranged in advance (not an emergency admission, a maternity admission, or a transfer)". An emergency admission is one that "is unpredictable and at short notice because of clinical need."[18]

The standardised elective hospital admission rate for asthma among people of all ages was significantly lower in Ipswich and East Suffolk CCG and West Suffolk CCG compared with East of England, but higher in Great Yarmouth and Waveney CCG (Table 9). The reasons for higher elective admissions occurring in one area are unclear and will be investigated by Public Health Suffolk. The standardised emergency hospital admission rate for asthma among people of all ages was comparable to East of England in all CCG areas within Suffolk.

Table 9: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for asthma (all ages), CCGs, East of England, England, 2017/18[12]

Table 9: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for asthma (all ages), CCGs, East of England, England, 2017/18

Notes: CCG admission rates calculated per 100,000 registered patients; East of England and England admission rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

Source: Suffolk County Council & NHS Digital. Analysis of Hospital Episode Statistics. (2018).

Hospital admission rates for asthma among people aged 20 and below were higher than among the population as a whole. The standardised elective hospital admission rate for asthma among people aged 20 and below was significantly lower in Ipswich and East Suffolk CCG and West Suffolk CCG compared with East of England, and comparable in Great Yarmouth and Waveney CCG (Table 10). The age-sex standardised emergency hospital admission rate for asthma was higher in West Suffolk CCG compared to East of England. The reasons for higher emergency admissions occurring in one area are unclear and will be investigated by Public Health Suffolk.

Table 10: Elective and emergency age-sex standardised hospital admission rate per 100,000 registered patients/residents for asthma (aged 20 and below), CCGs, East of England, England, 2017/18[12]

Table 10: Elective and emergency age-sex standardised hospital admission rate per 100,000 registered patients/residents for asthma (aged 20 and below), CCGs, East of England, England, 2017/18

Notes: CCG admission rates calculated per 100,000 registered patients; East of England and England admission rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

Source: Suffolk County Council & NHS Digital. Analysis of Hospital Episode Statistics. (2018).

3.3.3 Mortality

The number of Suffolk deaths directly attributed to asthma are low, totalling 23 in 2017/18. The age-sex standardised mortality rates from asthma were comparable to East of England in all Suffolk CCGs (Table 11).[12] There were no deaths attributed to asthma among people aged under 20 in Suffolk CCGs in 2017/18.

Table 11: Age-sex standardised mortality rate per 100,000 registered patients/residents from asthma, CCGs, East of England, England, 2017/18[12]

Table 11: Age-sex standardised mortality rate per 100,000 registered patients/residents from asthma, CCGs, East of England, England, 2017/18

Notes: CCG mortality rates calculated per 100,000 registered patients; East of England and England mortality rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

Source: Suffolk County Council & NHS Digital. Analysis of Hospital Episode Statistics. (2018).

4 What policies affect respiratory diseases?

The NHS Long Term Plan sets out a vision for a sustainable service model which focuses on prevention and health inequalities.[14] The plan sets out that over the next ten years the NHS will target investment in improved treatment and support for those with respiratory disease, with an ambition to transform our outcomes to equal, or better, our international counterparts.

The NHS Health Check programme offers free of charge health check-ups for adults aged 40-74. It is designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes or dementia. Where early signs of respiratory disease are identified, a healthcare professional can give advice to help reduce the risk of the disease developing.[15]

The Taskforce for Lung Health brings together representatives from 30 national organisations, representing patients, health care professionals, the voluntary sector and professional associations. In 2018, the Taskforce published a five-year plan setting out a framework to improve the nation’s lung health and provide better care for people with lung disease.[16]

5 Further information

NICE pathways allow users to navigate the breadth and depth of NICE recommendations on a given subject through topic-based diagrams, linking to the tools and resources that NICE has produced to support the implementation of the guidance. There are several pathways relating to respiratory conditions, both in general and specific conditions.  pathways.nice.org.uk/pathways/respiratory-conditions

INHALE is an online tool showing data from a range of sources about respiratory disease (mostly COPD and asthma). It includes data from the Quality and Outcomes Framework, Hospital Episode Statistics, the Public Health Outcomes Framework and NHS Comparators. fingertips.phe.org.uk/profile/inhale

The Global Burden of Disease (GBD) study[17] provides a tool to quantify health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and disparities can be eliminated. The tools allow decision-makers to compare the effects of different diseases, such as malaria versus cancer, and then use that information at home. To make these results more accessible and useful, a suite of interactive data visualizations are available to analyse the data. Data on various measures of death and disability is now available at local authority level. vizhub.healthdata.org/gbd-compare

As people age, their risk of developing conditions like cardiovascular disease, diabetes, cancer, dementia and respiratory disease increases. The NHS Health Check programme[15] helps to spot early signs and help prevent these diseases developing. www.healthcheck.nhs.uk

One Life Suffolk is a healthy lifestyles organisation who can offer free tips and practical advice on a number of health and wellbeing topics, including smoking cessation. onelifesuffolk.co.uk

A variety of charities provide information and support about respiratory diseases. In addition, the British Lung Foundation and Asthma UK provide policy and statistics about specific conditions. Reports from both of these organisations were used when researching this report. www.asthma.org.uk
www.blf.org.uk

6 References

[1]         British Lung Foundation, “The battle for breath: the impact of lung disease in the UK,” 2016. Available: https://cdn.shopify.com/s/files/1/0221/4446/files/The_Battle_for_Breath_report_48b7e0ee-dc5b-43a0-a25c-2593bf9516f4.pdf

[2]         British Thoracic Society, “The Burden of Lung Disease: 2nd Edition,” 2006.

[3]         Action on Smoking and Health (ASH), “Smoking and respiratory disease factsheet.” [Online]. Available: http://ash.org.uk/information-and-resources/fact-sheets/smoking-and-respiratory-disease/. [Accessed: 18-Mar-2019].

[4]         NHS Digital, “Quality and Outcomes Framework, Achievement, prevalence and exceptions data - 2017-18,” 2018. [Online]. Available: https://digital.nhs.uk/data-and-information/publications/statistical/quality-and-outcomes-framework-achievement-prevalence-and-exceptions-data/2017-18. [Accessed: 07-Feb-2019].

[5]         NHS, “Chronic obstructive pulmonary disease (COPD) - Causes.” [Online]. Available: https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/causes/. [Accessed: 18-Mar-2019].

[6]         British Lung Foundation, “Causes of lung cancer,” 2019. [Online]. Available: https://www.blf.org.uk/support-for-you/lung-cancer/causes. [Accessed: 07-Feb-2019].

[7]         Cancer Research UK, “Lung cancer mortality statistics,” 2016. [Online]. Available: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/mortality#ref-. [Accessed: 07-Feb-2019].

[8]         Public Health England, “Respiratory disease: applying All Our Health,” 2015. [Online]. Available: https://www.gov.uk/government/publications/respiratory-disease-applying-all-our-health/respiratory-disease-applying-all-our-health. [Accessed: 07-Feb-2019].

[9]         World Health Organisation, “Risk factors for chronic respiratory diseases.” Available: https://www.who.int/gard/publications/Risk factors.pdf

[10]      British Lung Foundation, “Why should I quit smoking?” [Online]. Available: https://www.blf.org.uk/support-for-you/smoking/why-should-i-quit. [Accessed: 07-Feb-2019].

[11]      Public Health England, “Public Health Profiles,” 2018. [Online]. Available: https://fingertips.phe.org.uk. [Accessed: 02-Nov-2018].

[12]      Suffolk County Council and NHS Digital, “Analysis of Hospital Episode Statistics.” 2018.

[13]      Public Health England, “The UK Cancer Prevalence Project,” 2018. [Online]. Available: http://www.ncin.org.uk/about_ncin/segmentation. [Accessed: 11-Feb-2019].

[14]      NHS England, “The NHS Long Term Plan,” 2019. Available: https://www.longtermplan.nhs.uk/

[15]      NHS, “NHS Health Check.” [Online]. Available: https://www.nhs.uk/conditions/nhs-health-check/. [Accessed: 26-Nov-2018].

[16]      Taskforce for Lung Health, “Our five year plan.” [Online]. Available: https://www.blf.org.uk/taskforce/plan. [Accessed: 07-Feb-2019].

[17]      Institute of Health Metrics and Evaluation, “Global Burden of Disease 2017 Compare tool,” 2018. [Online]. Available: https://vizhub.healthdata.org/gbd-compare/. [Accessed: 19-Dec-2018].

[18]      NHS, “NHS Data model and dictionary for England (version 3),” 2019. [Online]. Available: https://www.datadictionary.nhs.uk.