Asthma and chronic obstructive pulmonary disease (COPD)
Asthma affected almost 1 in 5 (18%) 14-year olds in 20091 and 1 in 9 (11%) adults in Kirklees in 20122. The irritants that can trigger asthma can be very different for each person; however cigarette smoke, housing conditions and air quality are common triggers. Children whose parents smoke are twice as likely to develop asthma.
Locally in 2012:
- People with asthma were more likely to do no moderate physical activity.
- Older people with asthma were more likely to be obese, and more likely to smoke.
- 1 in 5 people with asthma smoked.
- 1 in 4 people with asthma thought their poor health was due to inadequate housing.
Asthma: Why is this issue important?
Asthma is a common condition. Its symptoms include breathlessness, tightness in the chest, coughing (particularly at night) and wheezing which is reversible. Asthma differs from chronic obstructive pulmonary disease (COPD) in that the airflow restriction is mostly reversible, whereas in COPD it is only partially reversible as there is permanent damage to the airways. Asthma is caused when there is inflammation or swelling in the airways of the lung, so they become narrower. The inflammation causes the airways to become twitchy or irritable and they can narrow easily in response to a wide range of triggers. Experiencing wheeze indicates the severity and lack of control of the condition.
The most common triggers for asthma are:
- Cold or warm air.
- Allergies e.g. dogs, cats, house dust mites.
- Irritants such as cigarette smoke, fumes, dusty atmospheres.
- The common cold.
Some of these triggers can be prevented or avoided.
Locally, in 2012, 1 in 9 (11%) people aged 18-44 years had asthma. Nearly 1 in 10 (10%) of those aged 45-64 years and aged over 65 years had asthma2. Asthma accounted for approximately 234 emergency hospital admissions in 2011, a decrease from 20103.
Asthma: What significant factors are affecting this issue?
Those with asthma who did less than the recommended level of physical activity (11%) were slightly more than Kirklees overall (10%)2. Not doing enough physical activity can lead to those with asthma being more likely to be overweight or obese.
Smoking and tobacco use
About 1 in 5 (23%) people with asthma smoked, similar to overall in Kirklees2.
4% of people with asthma said that their house was not suitable due to damp, compared with 3% of non-asthmatics2.
Air pollutants like cigarette smoke and car and industrial exhaust fumes release gases and particles into the atmosphere which can irritate the airways of people with asthma. Ozone levels can be a problem for some asthmatics; these are more likely to be higher on hot days.
Asthma: Which groups are most affected by this issue?
Locally, in 2009, nearly 1 in 5 (18%) 14-year olds had asthma1, higher than nationally4. Those under 18 had the highest rate of hospital admissions for asthma at 2.4 per 1,0003. Children are more likely to be admitted for asthma during September than any other time of year4. 1 in 11 children in the UK received treatment for asthma in 2006/74. Out of 56 countries worldwide, the UK had the highest occurrence of severe wheeze in children aged 13-14 years4.
Exposure to a number of the risk factors happens in early life. Mothers smoking during pregnancy and babies having a low birth weight can increase the risk of developing asthma in childhood by four to six times5. Children whose parents smoked were twice as likely to develop asthma than children whose parents did not smoke6.
Working age adults
Locally in 2012, of those people with asthma aged under 65 years, 3 in 5 (59%) were overweight compared to half (51%) of non-asthmatics. This had nearly doubled since 2008 (32%)7. Over 1 in 4 (28%) were obese, compared to less than 1 in 5 (18%) non-asthmatics, the same as 2008. Over 1 in 7 (13%) working age adults with asthma were slightly more likely to not do moderate physical activity at all than 6%2 overall.
Of those aged under 65 years with asthma 1 in 4 (26%) smoked, similar to overall. Over 1 in 4 (27%) people aged under 65 years with asthma had sleep disturbance from wheezing, compared to 3% overall2.
The symptoms of asthma in older people are less likely to be triggered by allergies such as house-dust mites, animals and pollen. They are more likely to be triggered by flu, colds or other viral infections and irritants such as smoke, air temperature change, perfumes and chemical fumes. For older people, shortness of breath may be the only symptom. However it can be difficult to tell the difference between asthma and other conditions that cause similar symptoms, such as bronchitis, emphysema, heart disease and COPD.
Locally, in 20122, of those aged over 65 years with asthma, over 1 in 4 (25%) were obese, compared to 1 in 7 (17%) of non-asthmatics, similar to 20087. 1 in 4 (25%) people with asthma aged over 65 years did no moderate physical activity similar to non-asthmatics, 14%2.
Asthma: Where is this causing greatest concern?
Dewsbury and Huddersfield South had the highest rates of those with asthma of 1 in 8 (13%)2.
Asthma: What could commissioners and service planners consider?
- Ensure stop smoking programmes target people with asthma and those with children.
- Improve access to physical activity programmes designed for those with respiratory illness and asthma.
- Ensure that those diagnosed with asthma have a self-management plan.
- Implement an awareness campaign targeted towards parents of children with asthma reminding them to take their medication during the summer holidays.
- Work with housing providers to improve housing quality, particularly for people with asthma.
- NHS Kirklees, Kirklees Council and West Yorkshire Police. Young People’s Survey, 2009.
- NHS Kirklees and Kirklees Council. Current Living in Kirklees Survey, 2012.
- Secondary Uses Service (SUS). WYCSA; 2011.
- Asthma UK. Available from: http://www.asthma.org.uk/
- European Respiratory Society Annual Congress 2009. Childhood Asthma: Smoking Mothers and Low Birth Weight Increases Asthma Risk by Factor 6. September 16-19th. Vienna; 2009.
- National Asthma Campaign Asthma Audit, Out in the Open. A True Picture of Asthma in the UK Today. Asthma J 6; September 2001.
- NHS Kirklees and Kirklees Council. Current Living in Kirklees Survey, 2008.
Asthma: Date this section was last reviewed
The most common cause of chronic obstructive pulmonary disease (COPD) is smoking. Once a smoker stops smoking the risk of developing COPD reduces. COPD cannot be cured but stopping smoking will slow down its progression.
Locally, COPD caused 1 in 20 deaths in 2011.
Nationally, about 4.7% of people over 16 have COPD, yet only 2.1% are recorded locally. This means that fewer than half of people with COPD have a diagnosis and are therefore being appropriately managed.
COPD: Why is this issue important?
COPD is an umbrella term for chronic bronchitis, emphysema and chronic asthma. It is a debilitating and progressive lung disease characterised by obstruction to a person’s main airways (bronchi). COPD causes 1 in 14 deaths nationally and is the second highest cause of emergency admission to hospital1.
Locally, in 2011, COPD caused 1 in 20 deaths2. COPD accounted for approximately 812 local emergency admissions to hospital in 20113, an increase from 2009-10.
In Kirklees, 2.1% of those over 16 were recorded on GP registers as having COPD in 2011-124. Although this had increased slightly from 1.9% in 2009-105, the rate of COPD was estimated to be 4.7% of those over 16 in 2011. So fewer than half (45%) of people with COPD had a diagnosis6 and were therefore being appropriately managed.
Total deaths are projected to increase by more than 30% in the next 10 years without interventions to cut risks, particularly exposure to tobacco smoke7.
COPD: What significant factors are affecting this issue?
Smoking is the most common cause of COPD. Stopping smoking reduces the risk of developing COPD as smoking is responsible for 4 in 5 cases of COPD. For those already suffering COPD, it cannot be cured, but stopping smoking will slow down its progression1.
COPD can also be attributed to some occupational exposures associated with the mining and textile industries8, so it is an issue locally due to a history of these industries.
There are a number of support groups such as Expert Patients and Pulmonary Rehabilitation that local people find beneficial in helping manage their condition9. In addition, there is extensive smoking cessation provision throughout Kirklees. The stop smoking service is also carrying out work to raise awareness and aid early detection of COPD.
COPD: Which groups are most affected by this issue?
Men are at greater risk of COPD than women, although the disease is increasing in women because of the link to smoking. See Tobacco section and Lung cancer section. Many people who used to work in the textile industry are more likely to have COPD as they get older, because of occupational exposure.
COPD: Where is this causing greatest concern?
Batley and Dewsbury had the highest rate of respiratory illness requiring hospital admission, particularly in those aged over 65 in Batley. Dewsbury also had the highest rate of deaths from COPD at 20 per 100,000, followed by Colne Valley at 17 and Batley at 16, all above the Kirklees rate of 13 per 100,000. In addition, Dewsbury had the highest rate of smoking, 1 in 4, compared with1 in 5 across Kirklees10.
COPD: Views of local people
Local people who were diagnosed with COPD expressed the following views9:
- Expert Patients/Pulmonary Rehabilitation programmes are beneficial and important and help people manage their condition.
- A perceived lack of awareness of resources and information.
- A perceived lack of awareness of available services such as Expert Patients programme and Breathe Easy groups.
- How debilitating their disease is and how it impacts on their day to day living. Many participants also commented on how COPD was causing them depression and impacting negatively on their emotional wellbeing.
- A significant delay in diagnosis from first experiencing symptoms.
- A need to make it easier to make appointments with their GP and to see the same GP.
- A need for more help and awareness for depression and emotional wellbeing.
COPD: What could commissioners and service planners consider?
- Raise awareness amongst those at greater risk of COPD of the risk factors and their impact.
- Focus on addressing the variation in the quality of care provision for people with respiratory illness across Kirklees, especially amongst people who are housebound and/or at the end of life. This should include the provision of training and education opportunities to ensure that a skilled workforce can provide excellent respiratory management within primary care and ensuring adequate availability of community matrons and case managers for people with complex effects of respiratory disease or who are high intensity service users.
- Encourage improvement in the diagnosis of patients with COPD including identifying those at more risk.
- Ensure that those with COPD are supported to stop smoking.
- Encourage respiratory patients to self manage their condition.
- Ensure that pulmonary rehabilitation sessions are accessible, convenient and tailored to patients needs in order to maximise uptake and adherence.
COPD: Date this section was last reviewed
- British Lung Foundation: COPD. http://www.lunguk.org/you-and-your-lungs/conditions-and-diseases/copd.htm
- Public Health Mortality Files: ONS. 2011.
- Secondary Uses Service (SUS); WYCSA. 2011.
- Quality and Outcomes Framework Prevalence Data 2011/12.
- Quality and Outcomes Framework Prevalence Data 2010.
- Association of Public Health Observatories. Disease prevalence models. http://www.apho.org.uk/resource/view.aspx?RID=48308
- World Health Organisation (2011) COPD Factsheet number 315. http://www.who.int/mediacentre/factsheets/fs315/en/
- Health and Safety Executive (2010) Chronic Obstructive Pulmonary Disease. http://www.hse.gov.uk/statistics/causdis/copd/
- NHS Kirklees health needs assessment for COPD. 2010.
- NHS Kirklees and Kirklees Council. Current Living in Kirklees (CLIK) survey. 2012.