Spirometry testing in general practice ‘plummets’

A significant decline in spirometry testing to diagnose chronic obstructive pulmonary disease (COPD) alongside a jump in the prescribing of triple therapy inhalers has been flagged by the safety commission in its latest report.
 
The Australian Commission on Safety and Quality in Health Care’s Atlas Focus Report: COPD shows that between 2015–16 and 2022–23, spirometry testing nationally fell by 31% despite it being the ‘gold standard for confirming a diagnosis of COPD’.
 
The largest declines in spirometry were seen in office-based testing in general practice, with spirometry services decreasing by 68%, compared to a 7% drop in laboratory-based testing.
 
There were also significant geographic variations. In 2022–23, rates of spirometry services were higher in major cities than in many regional and remote areas, despite COPD prevalence being higher in remote areas, the report notes.
 
During the same period, prescriptions for ‘last-line triple therapy inhalers’, which comprise a combination of inhaled corticosteroids with long-acting dual bronchodilators, rose by 130%.
 
Triple therapy, with inhaled corticosteroid should be reserved for patients with frequent exacerbations and significant symptoms despite optimal dual therapy, and for those with co-existing asthma, the Commission explained in its report.
 
The Commission pointed to several reasons for this drop in spirometry testing, including barriers to provision in primary care such as the cost of a machine, consumables, and a lack of time and staff.
 
It also pointed to ‘patient factors’ such as cost, lack of time, being unwell, and difficulty travelling to other locations if the test is not in a GP’s rooms.
 
GP and Medical Advisor to the Commission Dr Lee Fong said without spirometry testing to confirm a COPD diagnosis, there is a risk patients are being prescribed medication that might not be effective or could be putting them at risk.
 
‘Probably the biggest risk we know is that in a patient with COPD, if they have corticosteroids then there’s an increased risk of pneumonia. So, it’s not without potential adverse side effects,’ he told newsGP.
 
While the report highlighted where spirometry services are not ideal, Dr Fong said it provides an opportunity for healthcare leaders, primary care providers and policymakers to consider ways to improve access to spirometry, support appropriate prescribing and ensure equitable, high-quality care for people with COPD.

‘We now have clear national data showing that spirometry use has plummeted, and triple therapy, which should be reserved for a select group of COPD patients, has had a substantial rise,’ he said.
 
‘We must refocus efforts to ensure people receive the right care, based on accurate diagnosis and best practice.’
 
Dr Fong said there are numerous reasons for the fall in spirometry in general practice, including clinical space limitations, the MBS rebate, equipment costs and infection-prevention protocols.
 
For GPs who do not provide in-house spirometry testing, it is important to refer patients for laboratory testing for a diagnosis, he said.
 
‘What are your public pulmonary function lab options, and what are your private pulmonary function laboratory options?’
 
‘Probably the easiest advice to give to GPs in that context is have a look on your local HealthPathways – there’s a good chance your local HealthPathways will give you some direction.’
 
Dr Fong said it is also important for GPs to review their current patients being treated with COPD to ensure they’ve had spirometry to confirm a diagnosis and that their mediation is still the best treatment for them.
 
‘If there’s no evidence of spirometry, then try and map it out, see what the possibilities are in terms of getting that spirometry done, whether that’s in your practice or outside of your practice, or start a conversation with the Primary Health Network about that,’ he said.
 
He said that the Commission is also working towards circulating further COPD resources for GPs, but reminded practitioners of the recently released COPD Clinical Care Standard as well as the MedicineInsights program.
 
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ACSQHC Australian Commission on Safety and Quality in Health Care chronic obstructive pulmonary disease clinical standards COPD