New clinical risk tool could help GPs reduce COPD hospital admissions

A new clinical risk tool – the Birmingham Lung Improvement Studies (BLISS) score – could help GPs to identify patients with chronic obstructive pulmonary disease (COPD) who are most likely to require hospital treatment.

In a new study published in The BMJ, researchers found that the BLISS score outperformed all existing COPD scores in predicting which patients are most likely to experience a severe respiratory health event requiring hospital admission within two years.

The study was led by University of Birmingham researchers, including members of the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, in collaboration with Maastricht University, supported by funding from the NIHR.

The BLISS score was created using data from a primary care cohort of 1,894 patients of new and existing COPD patients and validated in two independent national and international datasets.

COPD is a major global health challenge, with 1.2 million people diagnosed in the UK and more than 400 million affected worldwide.

Professor Rachel Jordan, University of Birmingham

COPD is a long‑term lung condition that causes breathing difficulties due to chronic inflammation and damage to the airways. It’s ranked as the fourth leading cause of death globally, and in the UK, it is the second most common cause of emergency hospital admissions. As a result, COPD is one of the largest contributors to winter pressures on the NHS, which are increasing healthcare costs and affecting quality of life for millions of people in the UK.

Professor Rachel Jordan from the University of Birmingham said: “COPD is a major global health challenge, with 1.2 million people diagnosed in the UK and more than 400 million affected worldwide. It is also one of the most expensive conditions for healthcare systems, with over 120,000 hospital admissions per year in the UK – largely due to acute exacerbations triggered by respiratory infections and other environmental factors.”

Improving the accuracy of predictions for hospitalisation

Unlike other existing risk scores – which can be complex or predominantly rely on hospital-based tests – the BLISS score includes six common measures easily collected by GPs, including:

• Age
• COPD Assessment Test (CAT) score (the impact on patients’ lives)
• FEV1 % predicted (a measure of lung function)
• Body Mass Index (BMI)
• A record of respiratory-related hospital admissions in the previous year
• Diagnosis of diabetes

A combined score gives clinicians a personalised estimate of a patient’s risk of hospitalisation. The study showed that the BLISS score offers the most robust prognostic score of its kind to date, meaning it could improve patient care by supporting earlier, more targeted interventions for high‑risk patients.

The BLISS score provides GPs and other clinicians with an evidence-based way to target effective interventions to those patients with the greatest risk.

Professor Peymané Adab, University of Birmingham

Professor Peymané Adab, senior author on the study, said: “Not everyone has the same risk of being hospitalised, so the BLISS score provides GPs and other clinicians with an evidence-based way to target effective interventions to those patients with the greatest risk. This has the potential to reduce severe exacerbations – and avoidable admissions which lead to higher costs – whilst also optimising patients’ quality of life.”

Supporting patients who need it most

Once high‑risk patients are identified, they can be directed towards more intensive, personalised models of care. Targeted interventions, informed by a BLISS score, could include:

• Prioritised access to pulmonary rehabilitation
• More frequent clinical reviews or post‑exacerbation follow-up
• Prescribing of therapies for those most likely to benefit
• Access to integrated care services, community pharmacy support or digital monitoring
• Enhanced self‑management plans and preventative support

The score could also support shared decision-making, enabling clinicians to communicate individual risk with patients more clearly.

Professor Alice Turner, co-author and Respiratory Consultant, said: “COPD services are increasingly stretched as our population becomes older and frailer. Having a practical tool that enables prioritisation of cases at higher risk of poor outcome, like admission to hospital, would be incredibly useful to make widespread implementation easier and therefore more likely to occur.”

Siân Williams, CEO of the International Primary Care Respiratory Group said: “Many countries are facing the same challenges of finding the best ways to fit limited resources to the needs of people with Chronic Respiratory Disease. A tool that draws on routine primary care data to support prioritisation is the right way forward and it would be great to see its potential beyond the UK.”

The research team now plans to work on integrating the BLISS score into routine GP software systems across the country so that risk is calculated automatically during consultations. The next phase of research will involve testing implementation in real-world settings to determine the scores impact on patient outcomes, service use and NHS costs.

This paper summarises independent research funded by the National Institute for Health Research (NIHR), under its Programme Grants for Applied Research Programme and supported by the NIHR Birmingham Biomedical Research Centre.