Foreword

Chronic obstructive pulmonary disease (COPD) is very common and a major cause of disability, hospital admission and premature death.

The criteria used to determine the presence of COPD vary and are responsible for differing estimates of prevalence. Separate studies from both Australia and New Zealand showed that 14% of Australians and 14.2% of New Zealanders aged 40 years or more had some degree of COPD using Global Initiative for Obstructive Lung Disease (GOLD) criteria (Toelle 2013, Shirtcliffe 2012). However using a different definition to identify cases, the prevalence of COPD was 9% in people aged 40 years or more (Shirtcliffe 2007). As the population ages it is likely more people will be affected by COPD.

The Australian Institute of Health and Welfare estimated that COPD was the fifth greatest contributor to the overall burden of disease, accounting for 3.6% of disability-adjusted life years (DALY) in 2003 (Australian Institute of Health and Welfare 2008). Chronic obstructive pulmonary disease ranks sixth among the common causes of death in Australian men and sixth in women (Australian Institute of Health and Welfare 2008). In New Zealand, it ranks fifth in both men and women (Ministry of Health 2010).  The death rate from COPD among Indigenous Australians is five times that for non-Indigenous Australians. In New Zealand, the age standardised death rate for Maori (46.1 per 100,000) is more than double that for non-Maori (18.1 per 100,000). The disease costs the Australian community an estimated $8.8 billion annually in financial costs, including health and hospital costs, lost productivity, premature death and a low rate of employment (Access Economics Pty Limited for The Australian Lung Foundation 2008).

Chronic obstructive pulmonary disease is commonly associated with other chronic diseases including heart disease, lung cancer, stroke, pneumonia and depression.

Smoking is the most important risk factor for COPD. In 2011/12, 18.2% of Australian males and 14.4% of Australian females over the age of 18 years smoked daily (Australian Bureau of Statistics 2012). Smoking-related diseases have increased substantially in women, and death rates from COPD in women are expected to rise accordingly. Smoking is a leading cause of healthy years lost by Indigenous people both in Australia and New Zealand.

As with any chronic disease, optimum management of COPD requires health system reform in order that both anticipatory care (e.g. developing self-management capacity) and acute care (e.g. treating exacerbations) are planned for. It is beyond the scope of these guidelines to address all the health system reforms that may be required for chronic disease care. Such reforms will require changes of approach in micro-systems (e.g. a general practice or community physiotherapy service), in organisational structures and systems that coordinate care in regions (e.g. Primary Health Networks; Primary Health Care Organisations, Local Hospital Networks) as well as in national and state health policy making institutions.

Much can be done to improve quality of life, increase exercise capacity, and reduce morbidity and mortality in individuals who have COPD. This Australian and New Zealand guideline seeks to summarise current evidence around optimal management of people with COPD. It is intended to be a decision support aid for general practitioners, other primary health care clinicians, hospital based clinicians and specialists working in respiratory health. Published evidence is systematically searched for, identified, and reviewed on a regular basis. The COPD Guidelines Evaluation Committee meets four times a year and determines whether the reviewed evidence needs incorporation into the guideline.

The key recommendations are summarised in the “COPDX Plan”:

Case finding and confirm diagnosis,

Optimise function,

Prevent deterioration,

Develop a plan of care,

Manage eXacerbations.

Professor Nicholas Glasgow (on behalf of the COPD Evaluation Committee), December 2011