November 25, 2016

Spirometry is required for diagnosis of COPD

Lung Foundation Australia comments on AIHW latest report.

With World COPD Day being celebrated Wednesday 16 November, Heather Allan, CEO of Lung Foundation Australia, said the release of the Australian Centre for Airways disease Monitoring (ACAM) and Australian Institute of Health and Welfare (AIHW) report promoting spirometry as essential for the diagnosis of COPD was timely.

The report: The use of lung function testing for the diagnosis and management of chronic airways disease: Demonstration data linkage project using the 45 and Up Study: 2001–2014 shows that most COPD patients are given medication before a confirmed diagnosis by lung function testing.

Mrs Allan said, “COPD is defined by demonstration of airflow limitation which is not fully reversible, so spirometry is essential for diagnosis.  The evidence for this is clearly documented in our COPD Guidelines, The COPD-X Plan: Australian and New Zealand Guidelines for the Management of COPD.”

General practitioner Dr Kerry Hancock, an executive member of the coordinating committee for the Foundation’s COPD National Program, said COPD should not be diagnosed on symptoms or chest x-ray and prescribing COPD medicines to patients without a spirometry diagnosis is inappropriate clinical practice.

“We wouldn’t start treatment for diabetes without confirmatory testing.  COPD is no different.  There is also evidence1 that in a primary care setting, patients with comorbidities may be more commonly misdiagnosed with COPD. Performing spirometry is important in these patients so they are not prescribed unnecessary medicines and to clarify with more certainty the cause of their symptoms. They should be prioritised for thorough diagnostic assessment, including spirometry.”

Dr Hancock who is also on the thoracic medicine clinical review committee of the Medicare Benefits Schedule (MBS) Review Taskforce said the Medicare rebate for pre and post-bronchodilator spirometry offers a very poor rate of return for practices and the committee had proposed better remuneration.

“Access to spirometry in primary care needs to be improved.  It is not an attractive option financially and therefore it’s a barrier to the proper diagnosis of COPD,” said Dr Hancock.

Lung Foundation Australia estimates that one in seven Australians aged 40 and over have some form of COPD.2  Another 700,000 Australians2,3 are estimated to have a mild form  of COPD where symptoms may not yet be present. Many of these will go on to develop more severe COPD.

While there is currently no cure for COPD, evidence shows early diagnosis, combined with disease management programs at the early stages of the disease, can reduce the burden of COPD, improve quality of life, slow disease progression, reduce mortality and keep people out of hospital.4

REFERENCES

  1. Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice. Nicholas A Zwar, Guy B Marks, Oshana Hermiz, Sandy Middleton, Elizabeth J Comino, Iqbal Hasan, Sanjyot Vagholkar and Stephen F Wilson. Med J Aust 2011; 195 (4): 168-171.
  2. Toelle B, Xuan W, Bird T, Abramson M, Atkinson D, Burton D, James A, Jenkins C, Johns D, Maguire G, Musk A, Walters E, Wood-Baker R, Hunter M, Graham B, Southwell P, Vollmer W, Buist A, Marks G. Respiratory symptoms and illness in older Australians: The Burden of Obstructive Lung Disease (BOLD) study. Med J Aust 2013;198:144-148
  3. Based on ABS census data — CData Online 2011 Census, Australian population over 40.
  4. McKenzie DK, Frith PA, Burdon et al on behalf of The Australian Lung Foundation. The COPDX Plan: Australian and New Zealand Guidelines for the Management of Chronic Obstructive Pulmonary Disease 2014, found at copdx.org.au