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‘Game-changing’ COPD resource for GPs


Anastasia Tsirtsakis


11/06/2020 3:29:21 PM

A new concise guide gives GPs practical, evidence-based recommendations to diagnose and manage chronic obstructive pulmonary disease.

Older man coughing
GPs play a vital role in the early diagnosis and appropriate management of COPD, according to Chair of the RACGP Specific Interests Respiratory Medicine network, Dr Kerry Hancock.

It is Australia’s second leading cause of avoidable hospital admissions, and the fifth leading cause of death.
 
Yet research shows around 50% of people with chronic obstructive pulmonary disease (COPD) symptoms are not even aware they have it.
 
But as with many lung conditions, early diagnosis is critical to improving treatment options and outcomes for patients.
 
‘It really should be on GPs’ radar,’ Dr Kerry Hancock, Chair of the RACGP Specific Interests Respiratory Medicine network, told newsGP.
 
‘They need to be thinking about whether their patient’s symptoms might be indicating that they do have COPD because early diagnosis is really important to prevent deterioration.’
 
Symptoms of COPD – an umbrella term that includes emphysema, chronic bronchitis and chronic asthma – include shortness of breath (especially on exertion), persistent cough, and increased sputum production. 
 
The most important known risk factor is a history of smoking, while parental smoking, asthma, genetic factors, as well as socioeconomic, nutritional and environmental factors should also be considered.  

Prevalence of COPD also appears to increase with age. A study conducted in Australia estimated its prevalence to be 7.5% in people aged 40 years and older, jumping to 30% in those over 75 – a concerning figure given Australia’s ageing population.
 
In addition to the often-silent nature of the disease in its early stages, sub-optimal access to spirometry in primary care settings – a lung function test required to confirm a COPD diagnosis – also contributes to under diagnosis
 
The reasons for this, Dr Hancock says, are multifaceted. There is the initial outlay to purchase a spirometer, which can cost more than $3500, while the Medicare Benefits Scheme rebate for carrying out the procedure in general practice does not reflect the true cost.
 
Having appropriately trained staff is also an issue. 
 
‘We know that significant amounts of office-based spirometry that is not done properly; there’s an over- or under-diagnosis due to spirometry of somewhere between 20% and 30%,’ Dr Hancock said.
 
‘So the last thing we want is for nurses and or GPs to be undertaking spirometry that is not done properly and therefore leading to incorrect diagnoses.’
 
Winter is a particularly dangerous time for those living with COPD, as they are more likely to experience an exacerbation that can cause further damage to the lungs.
 
To assist GPs in diagnosing the condition earlier and to better manage the condition, Lung Foundation Australia has released the COPD-X Concise Guide.
 
The new resource provides a summary of the more comprehensive COPD-X Plan guidelines, highlighting the latest evidence, along with clinical recommendations and practice tips on:

  • case-finding and confirming diagnosis
  • optimising function
  • preventing deterioration
  • developing a care plan
  • managing exacerbation.
Dr Hancock, who is Chair of the Lung Foundation’s Primary Care Advisory Committee, says the guide is an invaluable resource, particularly for time-poor GPs.
 
‘This resource is critical to supporting healthcare professionals to upskill and, ultimately, improve outcomes for Australians impacted by COPD,’ she said.
 
‘I felt very strongly when I became involved in the Lung Foundation about having a resource that was significantly more GP-friendly than the whole COPD-X Plan, which is a very unwieldy document. You can sit down and read it [the concise guide] from cover to cover in probably half an hour.
 
‘COPD is a really important condition for us to be managing in general practice. If we can be managing our patients much more appropriately – and finding them to start with – we can prevent hospitalisations because the economic burden of COPD is quite significant as well.’
 
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