February 18, 2013

2013 February 18 – Better diagnosis needed for chronic obstructive lung disease

The prevalence of chronic obstructive lung disease (COPD) in Australian men is among the lowest in the world, according to a new study published in the Medical Journal of Australia today.

The study of over 3000 people aged 40 or over, randomly selected from electoral rolls across six locations, found that 7.5% of participants overall met international criteria for moderate to very severe COPD. The prevalence in men was 6.9%, but the news was not so good for women, with a prevalence of 8.1%.

The results put Australian men at the lower end of the international range, with prevalence in 11 other countries ranging from 8.5% in Reykjavik, Iceland, to 22.2% in Cape Town, South Africa.

The results for Australian women were in the middle range, with international prevalence ranging from 3.7% in Hanover, Germany, to 16.7% in Cape Town.

Professor Guy Marks, from the University of Sydney’s Woolcock Institute of Medical Research, and colleagues conducted the study in a bid to clarify the prevalence of COPD, which is “under-recognised by doctors and underreported by patients”.

The authors used spirometry testing as a diagnostic tool, and found that many participants with confirmed airflow obstruction consistent with COPD had not previously received a diagnosis.

“(This) suggests greater effort is needed in making high-quality spirometry available in all health care settings”, the authors wrote.

“COPD is a common and serious health problem, particularly among older people”, they wrote, after finding that COPD was highly prevalent in participants aged 75 or older, at the rate of 29.2%.

“It is often not recognised, in part because the diagnosis requires spirometry, a procedure that is not widely used in primary care.

“(These) findings will also be integral in informing the ongoing development of treatment services … (including) access to smoking cessation programs, pulmonary rehabilitation, lung volume reduction and lung transplantation”, they wrote.

An accompanying editorial by Professor Christine McDonald, a respiratory physician from the Austin Hospital, Melbourne, and Professor Nicholas Glasgow, Dean of Medicine at the Australian National University, said the findings had important implications, including “the unnecessary risk of adverse effects from treatment for a condition the patient does not have, the possibility that the true cause of the patient’s respiratory symptoms may not be identified and treated, and the cost implications for the patient and the health system”.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACTS:

Professor Guy Marks – 0419 251 565
Prof Christine McDonald – 0413 703 533
William Darbishire (Lung Foundation) – 0418 742 801
Prof Michael Abramson – 03 9903 0573