'Abysmal' lack of testing for lung conditions is forcing GPs to play a 'guessing game' with diagnosis

A new report by leading lung charity Asthma + Lung UK shines a light on the “dire state” of lung healthcare in England, often leaving people with breathing difficulties without a confirmed and accurate diagnosis, or receiving treatment for conditions they don’t have.

The analysis commissioned by Asthma + Lung UK reveals that despite being the third biggest killer in the UK, simple tests for common lung conditions aren’t widely available to GPs, forcing them to make educated guesses when it comes to diagnosis. The cost of this testing crisis in England alone amounts to an estimated £2.2 billion due to avoidable hospital stays and treatment.¹ Early detection is crucial for treating and managing lung conditions effectively and can help slow down the progression of incurable lung diseases such as chronic obstructive pulmonary disease (COPD), which includes emphysema, or protect people from potentially life-threatening asthma attacks.

Every year, thousands of people with suspected lung conditions across England miss out on tests. The majority of GP practices are not funded to carry out tests that can help diagnose lung conditions such as asthma and COPD. In contrast, testing for other common conditions, including heart failure, receive ample funding and have well-defined pathways leading to diagnosis.

Another fallout from this is people are being misdiagnosed and receiving treatment that they don’t need. The analysis shows that as many as 750,000 people in England are misdiagnosed with asthma, costing an estimated £132 million every year.²

The charity says people with lung conditions are trapped in a vicious circle of late diagnosis, a limited number and lack of access to treatments, and poor support leaving people to fend for themselves. This leads to avoidable emergency hospital admissions, causing pain for people with lung conditions and their families and putting a significant, avoidable strain on the NHS.

Economic modelling by PwC shows that lung conditions cost the NHS over £9.6 billion every year and are a leading cause of winter pressures on the NHS, as people with lung conditions are more vulnerable to respiratory viruses including flu and colder temperatures.

The government recently announced £250m in emergency funding to provide an extra 5,000 NHS hospital beds in England this coming winter.³ If properly implemented, Asthma + Lung UK’s three recommendations would save significantly more, £307 million a year and free up just under 273,000 bed days, of which, over a third would be during the winter period in England.⁴

Asthma + Lung UK’s report ‘Saving your breath: how better lung health benefits us all’ outlines three recommendations that, if adopted, could offer relief to people affected and reduce pressure and deliver massive savings for the NHS. These include ensuring diagnostic tests are funded, improving access to the right treatment and providing people the support they need to manage their lung condition to keep them well and out of hospital.

Lucie Irwin, a 36-year-old retail manager from Carlisle, started experiencing breathlessness when she was 29, but it was six years before she received proper tests and asthma diagnosis, and the help she needed to manage her condition well.

Lucie said: "When I was 29, I started struggling to breathe when I was just out walking or doing simple activities. Then one day I was struggling to breathe so much I was rushed to hospital, where I was given oxygen and was told I had asthma. I was given inhalers by my GP, but they did no tests and I had no real advice on how to manage my asthma.

“For years I suffered, using my blue inhaler very regularly. Between the ages of 30 and 33 I was rushed to hospital several times – I was terrified I was going to die. It wasn't until another person with asthma reached out to me on Instagram and encouraged me speak to a GP about seeing a specialist that I received the care I needed. After waiting six years, I was finally referred for tests. The tests not only told me that I has asthma, but what type of asthma and what the best treatment for my asthma was.

“Starting treatment in November last year changed my life.  I’m now living life to the full again, going out with friends and going walking. With the right care, we can regain control of our lives."

Dr Andrew Whittamore, Clinical Lead at Asthma + Lung UK and a practising GP, said:

“The barriers GP practices face are huge. These include lack of funding, workforce and training needed to carry out these tests properly and the physical space needed to do them. For people with lung conditions, it means delays to their diagnosis and sometimes progression of their lung disease to more advanced stages which can make treatment more challenging.

“In many areas of the country basic lung function tests are not easy to access. This means many healthcare professionals can’t get a full picture of what might be causing someone to cough, wheeze, have frequent chest infections or shortness of breath. 
“The ripple effect of this lack of testing means that patients are more likely to have a delay in their diagnosis or get an incorrect diagnosis leading to them being more seriously unwell. 

“Winter is the deadliest season for people with lung conditions and diagnostic tests hold the key to giving someone an accurate diagnosis and the right treatment which can help keep them well. We wouldn’t accept diagnosing someone with high blood pressure without checking their blood pressure. People with lung conditions deserve better.”

Sarah Woolnough, CEO of Asthma + Lung UK, said:

“Lung conditions remain the third biggest killer in the UK and cost the NHS billions of pounds every single year, but it is those who are living with lung conditions who are currently paying the highest price.

“The abysmal lack of testing and patchy basic care is causing avoidable harm to people with lung conditions and the NHS. Our report shows the urgent need for the government to take immediate action so that people with lung conditions get an accurate and timely diagnosis.

“There are huge savings to be made by improving the diagnosis and treatment of lung conditions such as asthma and COPD, in terms of direct NHS savings, including reducing hospital bed days. It doesn’t make sense that lung conditions aren’t given the same priority as other big killers such as heart disease.”

Read the full report: https://www.asthmaandlung.org.uk/saving-your-breath

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References

1. The cost of this testing crisis amounts to an estimated £2.2 billion due to avoidable hospital stays and treatment. PwC analysis shows that the total economic cost of COPD exacerbations in 2023 is £1,388,440,070 (Figure 32, p40 of technical report). PwC analysis shows that the per patient direct cost for an uncontrolled non-severe asthma patient is £611in 2023. This was multiplied by the uncontrolled non-severe asthma population in England (Table 5, p69 in appendix of technical report) which totalled 1,390,803. 

£611 x 1,390,803 = £849,780,633

£1,388,440,070 (COPD cost) + £849,780,633 (asthma cost) = £2,238,220,703 = £2.2 billion

2. The analysis shows that as many as 750,000 people in England are misdiagnosed with asthma, costing as estimated £132 million every year

PwC analysis, Figure 10, p 24

Figure 10: The number of false positive asthma diagnoses in the UK in 2023

PWC analysis, Figure 12, p 25

3. BBC News. 2023. £250 million for hospital beds in England this winter. Accessed here (August 2023)

4. If properly implemented, our three key recommendations would save significantly more - £307 million each and every year – and free up just under 273,000 bed days, of which 93,500 bed days would be over the winter period

PwC analysis

PwC analysis, Figure 21 (p31) for asthma and Figure 50 (p57) and Figure 52 (p60) for COPD