Planning resilient winter care for people with chronic lung disease
Did you know that rates of chronic obstructive pulmonary disease (COPD) in South West England exceed the national average?
What’s more, access to spirometry – a lung function test and a key tool in diagnosing COPD – is limited or non-existent in some areas of our region and where it is available, patients often need to travel long distances across rural or coastal areas for testing.
On World COPD Day 2025 (19 November) we shine the spotlight on Lung Health @home – a proactive, year-round approach that is supporting more people to manage their COPD at home. Launched in 2021, the programme is co-designed with patients and clinicians across four test sites in the South West and beyond.
In 2024-25, Lung Health @home focused on winter planning for COPD management. People with COPD are particularly vulnerable during the winter season, when rates of respiratory infections are high. The Lung Health @home Winter Planning approach was developed in response to regional and national evidence calling for greater support for people living with respiratory conditions during winter months.
The approach involved identifying rising-risk patients using Population Health Management data, optimising their care through a holistic review (OPTIMISE), supporting self-management with remote monitoring and education, and strengthening service access to those experiencing winter respiratory challenges.
Over 300 people with COPD at risk of exacerbation were identified and their care optimised, including referrals to the myCOPD app to support patients to better self-manage their condition.
As lead delivery partner for Lung Health @home, Health Innovation South West has reported on the positive impact of the COPD Winter Planning approach and other Lung Health @home initiatives across the four national test sites.
An evaluation has shown increased access to evidence-based treatments for patients at greatest risk of exacerbating, and increased referrals to pulmonary rehabilitation, smoking cessation and self-management interventions. Staff are more capable in COPD care through training and upskilling. The evaluation has also found COPD Winter Planning has led to a reduction in respiratory-related GP visits and hospital admissions, and less travel for patients to their appointments – meaning lower carbon emissions too.
Health Innovation South West is continuing to provide support for scaling and spreading this innovative approach with health and care partners in Cornwall and the Isles of Scilly, through the involvement of NHS England’s Pathway Transformation Fund. One of only nine pilot sites throughout England, Cornwall and Isles of Scilly colleagues are working throughout this coming winter to identify and diagnose adults with severe asthma and COPD, as well as managing the support for people with COPD to make sure they have access to the right care at the right time close to home. Find out more.
