Infection Prevention Updates

New Data Reveals 'silent Scandal' Of Missing Lung Tests Across England

Patients in some of the most deprived areas of England, where respiratory conditions including chronic lung disease (COPD) and asthma are most prevalent, have limited or no access to vital diagnostic tests to confirm their diagnosis, reveals a survey by The BMJ today.

Despite NHS England's promise of access via Community Diagnostic Centres (CDCs), journalist Sally Howard speaks to GPs in some of the worst affected areas who say having no means of referring patients for lung function tests is "troubling" and "a silent scandal."

Last month, a report by the charity Asthma + Lung UK warned that without timely and accurate diagnosis, people with lung conditions do not get treatment for their symptoms, suffer acute and long term deterioration, and die early.

Lung conditions are the third biggest killer in the UK. The government's Major Conditions Strategy highlights the need for early and accurate diagnoses of lung conditions, and one of the aims of NHS England's Core20PLUS5 initiative is to "narrow health inequalities" in chronic respiratory disease.

A 2019 NICE guideline update also states that spirometry (a lung function test) should be performed for diagnosis of COPD and asthma and FeNO testing (an airway inflammation test) for the diagnosis of asthma. But there is currently no central data available on spirometry provision.

In an attempt to address this, The BMJ requested information on access to spirometry from England's 42 integrated care boards (ICBs). It also looked at information the boards had put into the public domain around access to spirometry from general practice and corroborated some ICBs' depiction of availability of diagnostics in their regions by speaking with local GPs.

Of the 25 ICBs that responded, The BMJ found that provision was patchy and the full picture unclear in West Yorkshire and that spirometry was no longer commissioned in Hampshire and the Isle of Wight.

Humber and North Yorkshire ICB told The BMJ that it "did not commission spirometry as a local enhanced service" and did not have a clear picture of provision in its region. Derby and Derbyshire ICB also could not give a picture of availability in its area, but a Derbyshire-based GP said that she has no access to services to which to refer her patients.

In Devon, spirometry is not available for some patients, while in Cornwall, a region with high levels of deprivation and long waiting lists for lung diagnosis, the ICB does not commission spirometry and cannot give a clear picture of provision, although it says there is some coverage by CDCs.

The BMJ also found disparities of access to diagnostic services between more and less deprived areas within ICBs, including in London.

Of the ICBs that didn't respond to The BMJ's request for information, the picture is bleak in Rotherham and Doncaster, two regions with high historic levels of diagnosis of COPD due to large communities of former miners.

In contrast, areas with good respiratory diagnostic availability included NHS Surrey Heartlands ICB, Nottingham and Nottinghamshire ICB, and Buckinghamshire, Oxfordshire and Berkshire West ICB.

Asthma + Lung UK said that the lack of clear data around spirometry gaps, as highlighted by The BMJ's findings, "needs to be addressed urgently by ICBs" so they can plan services and make sure workforces are adequately trained for current and future demand on their services. Crucial in the charity's view is for NHS England to provide funding for quality-assured spirometry at a primary care level, incentivizing spirometry as a paid-for diagnostic test within the GP contract.

However, London GP Rammya Mathew worries for the nation's many undiagnosed, and the stress on overstretched GPs, of the crisis in respiratory diagnostics. "In many parts of the country, spirometry access is sparse or even non- existent," she says. "This has been the case for at least three years now and it's high time this was prioritized by the government and NHS England."

Mathew is crossing her fingers that a new CDC at Willesden in Northwest London, in the process of being built, will accept referrals from her practice when it opens.

Meanwhile, in Doncaster, GP Dean Eggitt has negotiated off-label diagnostics for the patients who are most at-risk of COPD, which he calls "a sticking plaster tactic" in the face of an emergency. What we need, he argues, "is to commission spirometry, which is needed here and now for patients who will die of heart failure as their lungs are rotting."

More information: 'Silent scandal' of missing lung diagnostics in England's most deprived areas—where respiratory disease is most prevalent, The BMJ (2023). DOI: 10.1136/bmj.P2140

Citation: New data reveals 'silent scandal' of missing lung tests across England (2023, September 27) retrieved 27 September 2023 from https://medicalxpress.Com/news/2023-09-reveals-silent-scandal-lung-england.Html

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Silicosis Symptoms As Disease Destroys Lungs And Kills Workers Who Cut Countertops

Cutting countertops produces a fine silicone dust which gets in workers' lungs and causes long term health nightmares including silicosis which can even kill

Some workers are often not provided with adequate protection (

Image: Getty Images)

Experts have revealed the symptoms of the severe and incurable disease silicosis as workers making stone countertops die at an alarming rate.

Traditionally, silicosis has been associated with older workers, but alarmingly, it's now affecting younger individuals in their 20s, 30s, and 40s, with some succumbing to the disease in their 30s, and receiving terminal diagnoses.

Latino immigrants work on heavy slabs of engineered stone, producing countertops in California's Pacoima region. These workers are exposed to hazardous levels of silica dust while cutting and grinding these stones, putting them at risk of developing silicosis, a severe and incurable lung disease.

Silicosis is a lung disease caused by breathing in tiny bits of silica, a common mineral found in many types of rock and soil. According to the American Lung Association, the disease develops over time, often after "many years of exposure".

For all the latest news, politics, sports, and showbiz from the USA, go to The Mirror US.

Cutting stone produces silica dust (

Image:

Getty Images)

Approximately 2.3 million workers in the US are exposed to silica in the workplace, including 2 million in construction and 300,000 in other industries. In early stages of the disease, symptoms include cough, mucus build up and shortness of breath.

But as the disease develops, so do the symptoms. Once the lung scarring has become more severe, symptoms include bronchitis-like symptoms such as persistent cough, shortness of breath and difficulty breathing. People also suffer from weakness, fatigue, fever, night sweats, leg swelling and bluish discolouration of the lips.

The longer it goes without treatment, the worst the outcomes are for the patient. As it affects the immune system they are vulnerable to developing tuberculosis, lung cancer, COPD and kidney disease.

Respirators make a huge difference in protecting lungs (

Image:

Getty Images)

There is no cure for silicosis, but treatment is available, and employers and workers can take steps to prevent it.

A study conducted by physicians from UCLA and UCSF found that almost 20 per cent of California workers who contracted silicosis from grinding countertops had died. Their median age at death was 46. More than half of those diagnosed with the disease experienced delays due to misdiagnosis as bacterial pneumonia or tuberculosis, and over a third had severe lung scarring at diagnosis.

One of the workers in California's countertop region, Leobardo Segura Meza, is a 27-year-old father who was once an active individual but now struggles to breathe due to his exposure to silica dust. He received inadequate protection in the form of a dust mask while working with the dust-laden stone slabs.

Segura Meza expressed his concerns and fears about silicosis. He told the Los Angeles Times: "There's no cure for this illness. The only thing they can do is a lung transplant."

He also shared his apprehension that as more workers become ill, there might not be enough available lungs for transplantation, highlighting the severity of the disease's impact on affected individuals in the industry.

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