First ever COPD Clinical Care Standard launched

The Australian Commission on Safety and Quality in Health Care (ACSQHC) has published the first national standard of care for chronic obstructive pulmonary disease (COPD).
 
Released on Thursday, the COPD Clinical Care Standard was designed to inform practitioners on the accurate diagnosis of the condition – as awareness of this incurable lung disease ‘lags considerably behind other serious chronic health conditions’.
 
Australian Institute of Health and Welfare data shows that in Australia more than 7600 people die from COPD and 53,000 people aged 45 and over are hospitalised every year.
 
‘Our hospital admissions are a staggering 1.7 times higher than the OECD average,’ the ACSQHC statement reads.
 
ACSQHC Medical Advisor and GP Dr Lee Fong told newsGP the guide holds plenty of useful information for general practice.
 
‘The first one would be accurate diagnosis and so, for GPs, what does that mean?’ he asked.
 
‘It means being diagnosed with spirometry, because that’s the gold standard.
 
‘That’s the only way to diagnose whether or not the patient’s got COPD, and we need to differentiate it from other potential things.’
 
It also includes COPD action plans, Dr Fong explains, which will help inform patients about what to do when experiencing symptoms and provide advice that will help manage anxiety and risks.
 
‘This is the empowerment piece,’ he said.
 
‘If you’ve got a COPD action plan, that’s a reference sheet for a patient to say “okay, hang on, let me literally take a deep breath here and pause for a second and think, what’s on the plan here?”
 
‘Because the fact that it feels like you can’t breathe, combined with anxiety, equals escalate, escalate, escalate.’
 
Thirdly, Dr Fong said GPs should note the particular focus on pulmonary rehabilitation for COPD patients.
 
‘I didn’t realise how much evidence there was to support the benefits of pulmonary rehab,’ he said.
 
‘It’s good for every patient with COPD, there is a particular focus on patients that have been hospitalised, but it does so much to help patients in terms of controlling the symptoms, improving the quality of life and decreasing hospitalisations.’
 
The ACSQHC says the guidance ‘explains best practice care throughout a patient’s journey with COPD’.
 
‘Starting with correct diagnosis, through to using medicines and pulmonary rehabilitation to stay well, managing flare-ups, and palliative care techniques to ease symptoms throughout the person’s illness,’ it said.
 
‘The Standard aligns with current evidence-based Australian guidelines for COPD management, including the COPD-X Guidelines and Therapeutic Guidelines.’
 
Something of particular relevance for GPs also in the guide, Dr Fong adds, is around prescribing.
 
‘There’s a very clear escalation pathway to follow in there and we’ve highlighted the appropriate use of oral corticosteroids and the appropriate use of antibiotics,’ he said.
 
The Lung Foundation Australia, who established the COPD-X Guidelines with the Thoracic Society of Australia and New Zealand in 2001, welcomed the new resource.
 
‘The Standards will provide comprehensive, evidence-based instructions for the diagnosis, management, and treatment of COPD, including exacerbations,’ it said.
 
‘The Standards will not only help improve the quality of care for people living with COPD, but also reduce potentially preventable hospitalisations to alleviate pressure on Australia’s healthcare system.
 
‘In 2018–19, an estimated $935 million was spent on COPD, representing 21% of the disease expenditure on respiratory conditions in Australia.’
 
Although the clinical steps outlined might seem simple, Dr Fong says, there is a lot more to it for GPs managing the condition.
 
He said he recently had a new patient, who had been with his practice for 20 years or more, who is now undergoing testing for COPD for the first time after being reviewed under this new guideline.
 
‘COPD management is a competing topic amongst the million other things we’re trying to catch up with and stay current on in general practice,’ he said.
 
‘If I hadn’t been immersed in this stuff for the last 12 months, I don’t think I would have picked up on any of that.’
 
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ACSQHC Australian Commission on Safety and Quality in Health Care chronic obstructive pulmonary disease clinical standards COPD