Policy briefing

Improving respiratory health in Wales

The Welsh Government's plan to improve accuracy and diagnosis speeds for chronic obstructive pulmonary disease

The Welsh Government's plan to improve accuracy and diagnosis speeds for chronic obstructive pulmonary disease


Nurses can teach patients self-management skills. Picture: Neil O'Connor

Essential facts

One in 12 adults in Wales has a respiratory condition and respiratory diseases caused more than 16% of all deaths in 2016. Wales has the highest prevalence of asthma in Europe. The National Survey for Wales 2016/17 found that 19% of adults smoke and 59% of adults are overweight or obese. Smoking and obesity are major contributory factors to the levels of respiratory disease.

What’s new?

Improving the accuracy and speed of diagnosis of chronic obstructive pulmonary disease (COPD) is part of the Welsh Government’s Respiratory Health Delivery Plan 2018-2020. The plan also includes enhancing early supported discharge for patients with COPD admitted to hospital, developing an All-Wales COPD care and prescribing pathway and ensuring access to pulmonary rehabilitation programmes.

Professionals involved in supporting individuals with COPD should be trained to diagnose and monitor the disease with precision and promote techniques that tackle health-related behaviours such as smoking, obesity and lack of exercise, the document says. Health boards have also committed to appointing a flu jab champion and offering action plans to people with asthma.

Implications for nurses

Early diagnosis needs urgent improvement, the plan says. The National COPD audit 2014 found that 27% of people on the COPD register with a forced expiratory volume-one second/forced vital capacity ratio recorded had a value that was not consistent with the condition.

COPD care is aimed at supporting patients and their families, helping them to come to terms with the diagnosis, adjust to their condition and stay as well as possible. Much of the nurse’s role will be centred on teaching patients self-management skills. Self-management includes stopping smoking, keeping active, maintaining a healthy balanced diet, receiving regular immunisations, encouraging compliance with medication, seeking prompt medical advice, responding during flare-ups of symptoms and, most importantly, using their inhaler devices correctly.

Expert comment

Louise Walby is primary care respiratory nurse facilitator at Cwm Taf University Health Board

‘This important plan is led by clinicians and is patient-centred. When it comes to chronic obstructive pulmonary disease (COPD), the plan focuses on early diagnosis and access to treatment to improve patients’ experience and outcomes. There are numerous people with symptoms of COPD who are unaware of the implications and put their breathlessness down to several factors, including ageing. All the while their lung function is deteriorating.

‘Early diagnosis and subsequent access to treatment and education will reduce symptoms, improve outcomes and reduce hospital admissions. With more than 80% of COPD management happening in primary care, it is important that practice nurses and healthcare support workers are trained and accredited in spirometry.

'After the last respiratory health delivery plan in 2014 there has been a huge push on this throughout Wales, which is making a big difference. It is important that nurses have access to training to maximise this opportunity.’


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