Respiratory diseases are a major cause of mortality and hospital admission in Herefordshire.
In 2016, 12.3% of deaths in Herefordshire had respiratory disease recorded as the underlying cause; lower than nationally and regionally, but not significantly so. In Herefordshire, for the period 2014/16 there were 706 deaths from respiratory disease among people aged 65 and over, representing a rate of 533.2 per 100,000; significantly lower than nationally (629.1 per 100,000) and regionally (634.8 per 100,000).
People living in the most deprived areas are over two and half times likely to die prematurely (under 75 years of age) of chronic lower respiratory disease than those in the least deprived areas.
Respiratory diseases remain the most prominent underlying cause of excess winter deaths. Respiratory as a cause of death as a category in the Excess Winter Mortality index scored 41% in 2015/16. This means that there were 41% more deaths from respiratory deaths in the winter months than there were in the non-winter months, equating to 8,600 deaths, and accounting for 35% of all excess winter deaths.
Chronic obstructive pulmonary disease (COPD) and asthma are both types of respiratory disease.
Chronic obstructive pulmonary disease
COPD is the fifth biggest killer in the UK and accounts for 5% of all deaths each year. Around 86% of these deaths are caused by smoking, and hence are preventable. As many as 3 million people suffer from COPD in the UK, of which only around a third of cases have been diagnosed. People with COPD have difficulties breathing, primarily due to the narrowing of their airways and destruction of lung tissue. Typical symptoms include breathlessness when active, a persistent cough and frequent chest infections.
In 2016/17 the rate of emergency hospital admissions for COPD in Herefordshire was 286 per 100,000; significantly lower than nationally (417 per 100,000) and regionally (434 per 100,000). With the exception of a modest fall in 2015/16, the rate has been rising since 2010/11.
In Herefordshire, the age-standardised rate of mortality from COPD in 2014/16 was 45.9 per 100,000 of population; lower than nationally (52.2 per 100,000). The rate has however been rising since 2010/12.
The number of people with COPD in Herefordshire has increased steadily since 2005/06. Since 2011/12 the local prevalence has been higher than the national figure whereas prior to 2009/10 the opposite pattern was observed. In 2016/17 the Herefordshire COPD prevalence was 2.2% compared to 1.9% across England as a whole. For Herefordshire GP practices COPD prevalence varied between 1.1% and 3.6%.
Asthma is a common condition which responds well to appropriate management and which is principally managed in primary care. It affects people of all ages and often starts in childhood, although it can also develop for the first time in adults. Common asthma triggers include; allergies – to house dust mites, animal fur or pollen, for example; smoke, pollution and cold air exercise, and infections like colds or flu.
The local prevalence of asthma has shown little change since 2005/06 and has been consistently higher than the national figure; in 2016/17 the local asthma prevalence was 6.3% compared to the England figure of 5.9%, ranging between 4.6% and 7.8% across GP practices in the county.
In 2012/13, the crude rate for all inpatient and day case admissions for asthma, in Herefordshire was 0.75 per 1,000 of practice population; significantly lower than nationally (1.21 per 1,000) and regionally (1.50 per 1,000). The mean length of stay was 2.71 days, lower than in England as a whole (2.40 days).
 Statistical methods in cancer research, volume II: The design and analysis of cohort studies. NE Breslow and NE Day, International Agency for Research on Cancer, World Health Organization; 1987:69.
 Asthma, NHS Choices.