Diagnosis and management of early COPD in Australia: views from the coal face

Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of disability, hospital admission and premature death in Australia. Approximately 1.45 million Australians are estimated to have COPD, although half of these people do not have a doctor’s diagnosis. Under-diagnosis and under-treatment contribute to the burden of human misery and healthcare costs.

Aims: To gain insight into the diagnosis and early management practices of COPD amongst Australian general practitioners (GPs), and highlight any problem areas and management gaps for future intervention.

Methods: One thousand GPs in Australia were invited to take part in a postal survey, which collected demographics and practice details, familiarity with contemporary practice guidelines, method of diagnosis of COPD, use of lung function tests, treatment preferences, advice offered and patient follow-up.

Results: Two hundred and thirty-three GPs responded and were eligible for inclusion (23.3% response rate). While 83.7% of GPs indicated that they base a diagnosis of COPD according to guideline recommendations, 60.1% of respondents indicated that they delay the diagnosis. Overall, 87.6% of respondents routinely communicate the diagnosis to patients, although the preferred descriptive diagnostic terms differed, with one-third using terms other than ‘COPD’ to describe the condition to patients. Inhaled bronchodilators were the preferred treatment in initial management of COPD by approximately 90% of GPs; however, only 27.5% indicated that they routinely recommend pulmonary rehabilitation. GPs indicated that they routinely record patients’ smoking status and offer smoking cessation advice, but the timing of this advice varied. Less than half of the respondents indicated that their management of COPD is informed by guidelines, and only 7.3% indicated that they were familiar with tools and resources provided by the Australian Lung Foundation.

Discussion: There is considerable scope for improvement in GPs’ use of and familiarity with COPD management guidelines, tools and resources. Compilation and dissemination of guidelines and focused education on some areas in need of improvement (such as delayed diagnosis, delayed smoking cessation advice and underutilisation of pulmonary rehabilitation) are important strategies for improving patient outcomes in COPD.