COPD-X Methodology

COPD-X is produced by Lung Foundation Australia’s COPD Guidelines Committee, a multidisciplinary group which meets to evaluate the current literature and undertake quarterly updates of the guidelines for the Australian and New Zealand context. The Committee is comprised of a multidisciplinary group of national COPD opinion leaders with expertise in evidence-based medicine, as well as Lung Foundation Australia staff who represent consumer priorities and lived experience perspectives in relevant discussions as the national peak consumer organisation.

A PubMed systematic literature search is performed quarterly by the Guidelines Coordinator for new papers in COPD, emphysema and chronic bronchitis, encompassing systematic reviews, clinical trials, and cohort and case-control studies. Guidelines committee members also propose studies for inclusion in the screening and subsequent review process, noting their awareness of key evidence being published in their respective areas of expertise. The guidelines co-chairs screen all abstracts for inclusion. Relevant papers are critically appraised by a committee member with expertise in that area.

At the full committee meeting, a decision about whether to cite a paper is made by consensus, and wording for incorporation is discussed. When making changes to guideline recommendations, the Committee preferences randomised controlled trials and meta-analyses. The healthcare setting and patient population are also considered for relevance. Study methodology, bias, consistency of results, applicability to local practice and magnitude of benefit are all considered. Potential harms and side effects are also discussed and reported. The Committee discusses all potential guideline changes and always reaches a group consensus. Guideline updates are focused on changes that are likely to modify or influence practice. Any disagreement is resolved with discussion.

All recommendations are linked to the key evidence used in making the recommendation and this evidence is routinely reviewed and updated. Evidence summaries and tables are provided in the guidelines. Economic evaluation and funding implications are beyond the scope of the guidelines in their current format. The guidelines are not resourced to perform routine audit and analysis with regards to assessing the impact of the guidelines or guidelines adherence. However, independent investigators frequently use the guidelines to audit local practice.

The guidelines are endorsed by the Thoracic Society of Australia New Zealand (TSANZ). The TSANZ clinical care and resources sub-committee (comprised of subject matter experts) provides biannually external review and considers key findings and updates, and the strength of recommendations. The reviewers provide written feedback that is addressed by the co-Chairs and expert members as applicable. Furthermore, within the Lung Foundation Australia, key stakeholders such as general practitioners are also invited to provide regular feedback. Following the external approval process, the updated guidelines are uploaded quarterly to the COPD-X website (https://copdx.org.au/), including a summary of changes.

All members of the guidelines committee serve as volunteers. No funding body has any influence on content or recommendations. Where applicable, Lung Foundation Australia funds members’ travel and accommodation for in-person guidelines meetings. All committee members complete annual conflict of interest declarations that are openly available. Any relevant potential conflict is addressed during the quarterly meetings. Lung Foundation Australia provides administrative and technical support to the guidelines committee.