Chronic Obstructive Pulmonary Disease (COPD) places an enormous burden on people living with this lung condition and on the Australian healthcare system. The prevalence of COPD in Australians over the age of 40 is estimated to be 7.5% (Toelle 2013). COPD was the 5th leading cause of death in Australia in 2017 (AIHW 2021). In 2015–16, COPD cost the Australian health system an estimated $977 million (AIHW 2020). The Australian Institute of Health and Welfare estimates that COPD is the foremost cause of preventable hospitalisations amongst chronic health conditions (AIHW 2019). Furthermore, COPD was the third leading specific cause of total disease burden in Australia in 2015 (AIHW & NIAA 2020).
There is a great deal of work to be done to better understand the prevalence and outcomes of COPD in Indigenous Australians. The prevalence of COPD among Indigenous Australians is estimated to be 2.3 times as high as in non-Indigenous Australians (AIHW 2020). The mortality rate of COPD among Indigenous Australians was 2.7 times as high as the non-Indigenous Australians rate (AIHW 2020). The ultimate aim of these guidelines is to improve health outcomes for all Australians with COPD by translating the latest evidence-based recommendations into everyday clinical practice.
In 2001 a multidisciplinary steering committee was convened by the Thoracic Society of Australia and New Zealand (TSANZ) and Lung Foundation Australia (LFA) to write guidelines for the management of COPD, specific for the Australasian context. The guidelines were launched as ‘COPD-X’ and first published as a supplement to The Medical Journal of Australia in 2003. The guidelines strive to provide clear recommendations relevant for Australian healthcare workers, accompanied by a discussion of the evidence.
COPD-X provides guidance for Case finding and confirming diagnosis, Optimising function, Prevention of deterioration, Development of care plans and management of eXacerbations. COPD-X highlights the critical role of reducing risk factors (particularly through smoking avoidance and cessation), optimising function with multidisciplinary care, improving treatment of comorbidities and referring symptomatic patients to pulmonary rehabilitation. The guidelines promote the concept of ‘stepwise management’; beginning with one pharmacological intervention and evaluating response before adding another agent. The guidelines also emphasise the importance of non-pharmacological therapy for COPD. The recommendations made in the guidelines are applicable across multiple care settings. The guidelines recognise that a patient-centred approach involving a team of healthcare workers is required for optimal outcomes.
The COPD-X Guidelines Committee is a multidisciplinary group of clinicians convened by LFA, that meets quarterly to review the current COPD literature and update the guidelines. With such frequent updates and literature reviews, COPD-X should be seen as an early example of ‘Living Guidelines’. This approach allows the guidelines to constantly evolve in order to meet the needs of people with COPD.
All changes and updates to the guidelines are made by consensus and quarterly digital updates are published online. TSANZ endorses the quarterly updates and the Guidelines have received endorsement from The Royal Australian College of General Practitioners. Across the entire spectrum of COPD care, the Guidelines aim to provide a detailed discussion of the evidence followed by a summary of recommendations. The Guidelines are freely accessible via the LFA website in an easily searchable web-based format and offered as a pdf.
To accompany the comprehensive Guidelines, LFA has launched a complementary suite of resources to assist Australian health care practitioners caring for individuals with COPD. In 2014, the ‘COPD-X Concise Guide for Primary Care’ was published with the aim of providing a practical point-of-care guide for primary care physicians. In 2020, this was relaunched as the ‘Concise Guide’ acknowledging that the guidelines provide a wide range of clinicians with succinct, evidence-based recommendations. ‘Stepwise Management of COPD’ is a graphical, single page summary of the pharmacological and non-pharmacological therapies across the severity continuum of COPD that encapsulates the management principles outlined in COPD-X.
Our greatest challenge lies in guideline implementation. Our key goal is to translate the evidence-based recommendations in COPD-X into everyday practice across Australia. For this knowledge translation to occur, a multi-faceted approach across platforms will be required. Strategies will need to include digital integration, such as software for clinical decision support systems and prompts in electronic health records that aid with management decisions accompanied by professional education delivered by traditional and innovative techniques. Dimensions of impact of uptake of the guidelines should be measured, to enhance reach and impact of key recommendations, and maintenance of knowledge translation.
It is our hope that these Guidelines will advance clinical practice and standardise COPD care. The ultimate aim of these Guidelines is to improve health outcomes and optimise quality of life for people with COPD.
Professor Ian Yang and Associate Professor Eli Dabscheck, Co-Chairs (on behalf of the COPD-X Guidelines Committee), July 2021
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