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A national clinical care standard is set to improve outcomes and reduce potentially avoidable hospital admissions for the incurable lung condition, chronic obstructive pulmonary disease (COPD).
COPD is a significant public health challenge in Australia, affecting an estimated 1 in 13 people over the age of 40 years.
Characterised by chronic airflow limitation that makes breathing difficult, COPD can severely limit everyday activities and reduce quality of life. It is also a leading cause of potentially preventable hospital admissions, with significant impacts on long term patient outcomes, as well as our health care system.
An estimated 50% of people living with COPD do not know they have it, so the burden of disease is likely to be far greater than current estimates. This may be due to limited community awareness about COPD, and the overlap in symptoms with conditions such as asthma and congestive heart failure.
Recognising the substantial impact of COPD in Australia, and the scope to improve care and reduce unwarranted variation and inequity, the Australian Commission on Safety and Quality in Health Care (the Commission) released the Chronic Obstructive Pulmonary Disease Clinical Care Standard (the Standard) in October 2024.
This is the first national standard for COPD and aims to improve the quality of care and overall outcomes for people living with this chronic condition.
What is the COPD Clinical Care Standard?
The Standard includes ten quality statements describing evidence-based practice for the diagnosis and management of COPD, including exacerbations (see Box 1).
Unlike clinical practice guidelines, which address the full spectrum of care for a particular condition, the Standard focuses on priority areas where the potential for quality improvement is greatest.
As measurement is crucial to quality improvement, each quality statement is accompanied by clinical indicators that can be used by clinicians and health care services to monitor how well they are implementing the care described in the Standard and help target local improvement priorities.
Let’s consider some key aspects of the Standard and its potential to transform COPD care across Australia.
| Box 1: Ten quality statements for COPD |
| The Standard contains ten quality statements that describe the health care that should be provided to people living with COPD.
1 – Diagnosis with spirometry |
Accurate diagnosis with spirometry
Early and accurate diagnosis of COPD is key to ensuring appropriate management and preventing deterioration. A COPD diagnosis can only be accurately made using spirometry, yet spirometry testing rates have fallen considerably since the COVID-19 pandemic.
To enable diagnosis, the Standard emphasises the importance of performing spirometry for anyone over the age of 35 years with a risk factor (for example, current or past tobacco smoking) and one or more symptoms of COPD (for example, chronic cough).
Education and self-management
Understanding COPD and its management can help people with COPD to better live with their condition. In line with the COPD-X Guidelines, the Standard addresses the need for clinicians to empower people living with COPD with information about their condition, treatment options and self-management strategies.
This includes sharing information about non-pharmacological strategies for managing breathlessness (for example, using a handheld fan, or breathing techniques) and establishing a COPD action plan for exacerbations. The plan should clearly outline what people should do if their symptoms worsen (including which medicines to take, and when to seek help), and can help them to avoid a hospital admission.
Pulmonary rehabilitation
Pulmonary rehabilitation is an important intervention demonstrated to improve exercise capacity, improve quality of life and reduce hospital admissions for people with COPD.
Because of the strong evidence, the Standard encourages clinicians to refer all people with COPD for pulmonary rehabilitation, especially those who have been hospitalised due to a COPD exacerbation. It also recognises that clinicians may need to consider alternative options to centre-based pulmonary rehabilitation programs — for example, telerehabilitation programs or local exercise programs — particularly in areas where access is limited.
Stepwise approach to pharmacotherapy
While medicines are an important part of COPD care, it is vital that they are used judiciously to maximise effectiveness and minimise the risk of adverse effects. The Standard recommends that clinicians adopt a stepwise approach to pharmacotherapy, as described in the COPD-X Guidelines. Briefly, this involves stepping up (or stepping down) therapy in response to patient symptoms and the nature and history of their exacerbations.
Due to the risk of adverse effects, inhaled corticosteroids should only be considered for patients with a history of severe exacerbations and who continue to experience severe symptoms, despite dual long-acting bronchodilator therapy.
Regular checking and correcting of inhaler technique should be a core part of pharmacological management, especially before any escalation in treatment or after a COPD exacerbation.
Judicious use of antimicrobials
Approximately 50% of all in-patient antimicrobial prescriptions for COPD exacerbations are inappropriate. This includes inappropriate antimicrobial choice, treatment duration and route of administration.
Antibiotic therapy is not routinely recommended for COPD exacerbations and as stated in the Standard, should only be considered if the prescribing criteria in the current Therapeutic Guidelines or other locally endorsed evidence-based guidelines are met.
Conclusion
The release of the Standard marks a significant development in COPD care in Australia and has the potential to make a big difference to the quality of life for more than 600 000 Australians who live with this progressive disease.
The ten areas of focus provide a clear pathway that can be used by clinicians, health care services and systems to improve and measure their care. This will ensure more accurate diagnosis and greater use of evidence-based interventions to improve symptoms, quality of life and reduce the risk of exacerbations.
We encourage clinicians and services from all sectors to find out about the new Standard and use it to improve outcomes for people living with COPD.
Find out more
Download the Standard and supporting resources for clinicians and health care services.
Dr Rana Ahmed is a senior project officer in clinical care standards, Australian Commission on Safety and Quality in Health Care.
Dr Lee Fong is a general practitioner and medical advisor, Australian Commission on Safety and Quality in Health Care.
Dr Maria Sukkar is a senior project officer in clinical care standards, Australian Commission on Safety and Quality in Health Care.
Dr Alice Bhasale is the director of clinical care standards, Australian Commission on Safety and Quality in Health Care.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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