Advances and challenges in COPD care

The Irish Thoracic Society Annual Scientific Meeting recently heard that despite progress, regional inequalities persist in chronic obstructive pulmonary disease care. James Fogarty reports

Ireland has taken a “visionary approach” to care for people with chronic obstructive pulmonary disease (COPD), the Irish Thoracic Society Annual Scientific Meeting was told. However, regional inequalities remained.

At the meeting, which took place in the Galway Bay Hotel on 20–22 November 2025, Prof Breda Cushen, HSE National Respiratory Clinical Lead, gave a presentation on the changing face of COPD care.

Prof Cushen said that clinical outcomes are better when comprehensive multidimensional approaches are used to inform clinical decision making in complex conditions, such as COPD.

As is well known, COPD is a leading cause of morbidity and mortality. It is the most common chronic respiratory condition globally, affecting 200–300 million people worldwide.

She added that between 2010 and 2018, compared with similar-sized countries, Ireland has not fared well in terms of hospitalisations, far exceeding the OECD (Organisation for Economic Co-operation and Development) average.

Data

Furthermore, approximately 25 per cent of Irish COPD patients have two or more co-morbidities, which is important as these drive exacerbations. The mean age of Irish COPD patients is 72.9 years, with approximately 75 per cent over the age of 65 years.

The National Clinical Programme for COPD was established in 2010. Among its aims was to prevent or delay the onset of COPD, support patients across the continuum of care, and improve the delivery of care.

While Ireland has a lack of accurate prevalence data, it is estimated that approximately 400,000 people have a diagnosis of COPD. According to recent data from the structured chronic disease management programme in general practice, 12 per cent of the patients enrolled in the programme have a COPD diagnosis. 

“Most of our patients with a diagnosis of COPD would fall into the chronic disease management programme,” Prof Cushen said.

She praised the programme as hugely successful, adding that pulmonary rehabilitation is accessible to patients across Ireland.

Acute sector

Acute hospitals are still vital to support services for COPD patients, while outreach creates a bridge from hospital to home. There are 26 COPD outreach teams nationally, an increase on the 12 in 2021. These are all linked to model 3 or 4 hospitals. All the consultants are employed on a 50:50 basis and are supported by nursing and physiotherapy staff.

However, Prof Cushen noted that “unfortunately, changing national priorities have led to a lot of unfilled posts”.

“So initially, when this ECC [enhanced community care] was funded, there were 444.5 posts allocated to the respiratory integrated care programme. In the acute setting, the funding for 18 per cent of these posts was withdrawn, and in the community, 42 per cent of posts have been lost due to funding being withdrawn. In particular, our ability to deliver diagnostics in the community really suffered with the loss of 58 per cent of post funding.

“This has led to huge variation across the country in terms of staffing of our services and the service that each of our sites can deliver. This means that the implementation of our model of care for COPD has been hugely variable.”

She said that, in 2024, of the 27 model 3 and model 4 hospitals linked to ECC, only 12 were able to deliver to some degree all the components of the ECC quality care model.

“No site has been fully staffed, so no site has been able to deliver on the full vision of COPD care. Fifteen sites were unable to deliver in any form some of the components of the ECC quality care model,” she said.

“In particular, they had no access to GP spirometry, no consultant oversight, and no COPD outreach team.”

This variability has allowed clinicians to evaluate the ECC’s impact on COPD outcomes. When hospitalisation and 90-day readmission rates from 2024 were compared with pre-Covid-19 figures, sites that were able to provide diagnostic spirometry showed reductions in both hospitalisations and readmissions. The data also indicated that strong consultant leadership further improves these outcomes. In addition, the expansion of COPD outreach has doubled the system’s capacity to offer hospital-admission-avoidance pathways, with avoidance activity rising from 18.2 per cent in 2018 to 39.8 per cent in 2023. Prof Cushen added that increased staffing levels are directly associated with greater admission-avoidance capacity.

She noted that although the ECC programme is still in its early stages, COPD care in Ireland is already showing signs of improvement, with sites delivering the full ECC model outperforming others. She added that more scheduled care is now being provided closer to patients’ homes, accompanied by a reduction in unscheduled emergency care.

“Over Covid, between 2020 and 2022, there was a drop in COPD hospitalisations. But… they have trended back upwards. In 2024, there were 15,500 COPD hospitalisations, similar to our pre-Covid levels. But first appearances can be misleading. If you look at the proportion of hospital admissions due to COPD, it is falling.”

In 2018, COPD represented 5.5 per cent of unscheduled care through the emergency department, falling to approximately 4.5 per cent in 2024. The 90-day COPD readmission rates are reducing at complete ECC sites, with 1,064 potential admissions saved at completed ECC sites as of 2024. This translated into 7,874 bed days saved, equating to a saving of €9.9 million, based on the average cost of inpatient admissions.

In 2024, there were 13 consultants fully established in post and this has increased to 22 in post as of July 2025. One post is awaiting commencement and three posts remain vacant.

“Unfortunately, there has been a lot of half-staffing as well,” she noted.

“A lot of services are running with one WTE [whole-time-equivalent].”

The meeting also heard that clinicians’ understanding of COPD, a heterogeneous condition with multiple causes, has evolved, with multiple patient-specific treatment approaches now available.

“One size does not fit all,” Prof Cushen said.

She added that comprehensive multidisciplinary assessment reduces healthcare use, citing data from her own clinic in Beaumont Hospital, Dublin, for patients with more advanced COPD or high symptom burden.

“While it was a small number of patients (47), we found that even within six months… there was an almost 70 per cent reduction in hospitalisations, and at 12 months, this had persisted with a 42 per cent reduction,” the professor said.

In summary, Prof Cushen stated that Ireland has taken a “visionary approach” to tackling COPD, stating that this is something “we should be really proud of”.

However, despite the improvements that have occurred in diagnosis, treatment, and care, challenges remain.

Next steps

“Nationally, we have to overcome the huge regional inequalities which have arisen through funding restrictions,” she said. “We also need to adapt to meet the needs of all people with COPD, those who have more severe and complex symptoms, and also our younger patients.”

Nationally, we have to overcome the huge regional inequalities which have arisen through funding restrictions

Responding to questions and comments from the floor, Prof Cushen, who was commended for her talk, agreed that a national network of COPD multidisciplinary teams would be very beneficial.

“We know biologics are coming and there are lots of interventions that can now be offered to our severe COPD patients,” she said.

“I think there has been nihilism about COPD for years. But actually, there is a lot you can do to improve things, to break that cycle of exacerbations. It is really rewarding.”

In terms of COPD treatments, she said that for “some patients biologics are going to be revolutionary”.

“But I am not sure biologics are going to have the same impact in COPD as they have had in asthma.”

Prof Cushen also expressed support for the establishment of a COPD registry in Ireland. However, she stressed that registries require significant funding and buy-in from staff.

“We have good data from COPD outreach patients and pulmonary rehab data, and we will be looking to put in some structure whereby we can audit it, in terms of outcomes on outreach and outcomes on rehab over time. So that is a body of work that we are working on.”