Australian Institute of Health and Welfare (2020) Chronic obstructive pulmonary disease (COPD), AIHW, Australian Government, accessed 01 December 2022.
Australian Institute of Health and Welfare. (2020). Chronic obstructive pulmonary disease (COPD). Retrieved from https://www.aihw.gov.au/reports/chronic-respiratory-conditions/copd
Chronic obstructive pulmonary disease (COPD). Australian Institute of Health and Welfare, 25 August 2020, https://www.aihw.gov.au/reports/chronic-respiratory-conditions/copd
Australian Institute of Health and Welfare. Chronic obstructive pulmonary disease (COPD) [Internet]. Canberra: Australian Institute of Health and Welfare, 2020 [cited 2022 Dec. 1]. Available from: https://www.aihw.gov.au/reports/chronic-respiratory-conditions/copd
Australian Institute of Health and Welfare (AIHW) 2020, Chronic obstructive pulmonary disease (COPD), viewed 1 December 2022, https://www.aihw.gov.au/reports/chronic-respiratory-conditions/copd
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The Department of Health’s National Strategic Action Plan for Lung Conditions (the Action Plan) provides a detailed, person-centred roadmap for treating and managing COPD, among several other lung conditions (Department of Health 2019). The Action Plan outlines a comprehensive, collaborative and evidence-based approach to reducing the individual and societal burden of lung conditions and improving lung health (Department of Health 2019). The Action Plan can be found on the Lung Foundation Australia website.
Also, the COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease (the COPD-X Guidelines) summarises current evidence around optimal management of people with COPD, and provides a decision support aid for general practitioners, other primary health care clinicians, hospital-based clinicians and specialists working in respiratory health. The evidence published in the COPD-X Guidelines is systematically searched for, identified and reviewed on a regular basis (Lung Foundation Australia 2019).
COPD-X stands for:
The latest COPD-X Guidelines can be found Lung Foundation Australia website.
General practitioners (GPs) are often the first point of contact for people who develop COPD. According to the Bettering the Evaluation and Care of Health (BEACH) survey, in the ten-year period from 2006–07 to 2015–16, the estimated rate of COPD management in general practice was around 0.9 per 100 encounters (Figure 1) (Britt et al. 2016).
Source: Britt et al. 2016 (Data table).
Currently, the only intervention that has been shown to slow the long term deterioration in lung function associated with COPD is assisting smokers to quit (Mosenifar 2019). Other interventions for COPD that can help maintain quality of life and reduce symptoms are: immunisations, pulmonary rehabilitation, medications, and, for people with very severe disease, long-term oxygen therapy.
Some information is available on use of medications by patients with COPD, however, there is currently a lack of nationally comparable information about access to and utilisation of pulmonary rehabilitation and oxygen therapy. Options for improving data about these interventions are discussed in the report Monitoring pulmonary rehabilitation and long-term oxygen therapy for people with chronic obstructive pulmonary disease (COPD) in Australia – a discussion paper.
The most beneficial step in any treatment plan for COPD patients is to stop smoking. Stopping smoking is the only intervention that has been shown to improve the natural progression of COPD. For example, it helps to improve a patient’s cough, ease breathlessness and slow down further lung damage (Lung Foundation Australia 2020).
Vaccination reduces the risks associated with influenza and pneumococcal infection, which are leading causes of exacerbations and healthcare visits. Therefore, influenza immunisation and pneumococcal immunisation is recommended for all patients with COPD (Lung Foundation Australia 2019).
Pulmonary rehabilitation is one of the most effective interventions for COPD, and is recommended for all patients with COPD who are short of breath on exertion, including in the period following an acute exacerbation (Spruit et al. 2013; Alison et al. 2017). According to Spruit and others (2013), pulmonary rehabilitation is a comprehensive intervention, mainly involving exercise training, education, and behaviour change. It is designed based on a thorough patient assessment followed by patient-tailored therapies (Spruit et al. 2013). Strong evidence supports that pulmonary rehabilitation is effective for COPD patients to improve their physical and emotional condition, long-term adherence to health behaviours, quality of life and reduce hospitalisations, thus helping them improve their independence and functioning in the community (Gordon et al. 2019; McCarthy et al. 2015; Puhan et al. 2016).
Pulmonary rehabilitation is commonly delivered by an interdisciplinary team of therapists, and may comprise various associated supportive strategies (Lung Foundation Australia 2008). It mainly includes the following components:
Pulmonary rehabilitation may be provided in hospital outpatient departments, in community facilities or at home. Hospital-based programs are often considered ‘usual care’, however community-based programs of equivalent frequency and intensity can be offered to people with COPD as a suitable alternative (Lung Foundation Australia 2017). Home-based pulmonary rehabilitation programs should include regular contact with an exercise specialist to facilitate appropriate participation and progression.
Medications are used in COPD treatment to prevent and control symptoms, reduce the frequency and severity of exacerbations and improve exercise tolerance. Some drugs used to treat COPD are also used to treat other respiratory conditions such as asthma. For more information, see Respiratory medication use in Australia 2003–2013: treatment of asthma and COPD.
Several medications are available for treatment of COPD in Australia, including long-acting bronchodilators used both separately and in combination with inhaled corticosteroids or other bronchodilators. Bronchodilators are drugs that can relax and dilate the bronchial passage ways and therefore improve the passages of air into the lungs. It is worth mentioning that the majority of the medications used in COPD treatment are delivered via inhalers, so good inhaler technique and adherence to treatment are important for optimal treatment outcome (George & Bender 2019).
Long term oxygen therapy (LTOT)—the provision of supplemental oxygen therapy for 15 hours per day or more—can be prescribed for people with persistently low levels of oxygen in the blood, including from chronic lung disease, most commonly advanced COPD. LTOT reduces mortality in COPD and may also have a beneficial impact on aspects of quality of life (Yang et al. 2018). Although effective, it is a potentially expensive and cumbersome therapy that should only be prescribed for those in whom there is evidence of benefit (Yang et al. 2018). In Australia, LTOT is mostly delivered in the home using an oxygen concentrator, a device that removes nitrogen from room air, thereby increasing the concentration of oxygen. Sometimes oxygen cylinders are provided for short-term or portable use.
Non-invasive ventilation (NIV) refers to the administration of ventilatory support using a face mask, nasal mask, or a helmet, rather than an invasive artificial airway (such as a tube). Air, usually with added oxygen, is given to patient through the mask under positive pressure, where the amount is alterated depending on whether the patient is breathing in or out. NIV has now become an integral tool in the management of acute and chronic respiratory failure, in both the home setting and in the critical care unit.
The current evidence shows that NIV is effective in preventing respiratory failure after extubation (removal of a tube previously inserted into a patient's body) (Ferrer et al. 2009), and treating patients with an acute exacerbation of COPD and other disorders characterised by hypoventilation (Ram et al. 2004; Osadnik 2017).
Patients may require admission to hospital for severe acute exacerbations of COPD. Acute exacerbations of COPD (flare-ups) are frequently due to respiratory tract infections. They have also been associated with increases in exposure to air pollution and changes in ambient temperature. Episodes that are life threatening sometimes require temporary assistance with breathing.
Data from the AIHW National Hospital Morbidity Database (NHMD) show that in 2017–18 there were 77,660 hospitalisations of people 45 and over where COPD was the principal diagnosis. The rate of hospitalisation for COPD among those aged 45 and over was 732 per 100,000 population.
The hospitalisation rate for men aged 45 years and over declined 8% in the ten years from 2008–09 to 2017–18, from 864 to 792 per 100,000 population (Figure 2). In contrast, the hospitalisation rate for women increased by 11% from 624 in 2008–09 to 690 per 100,000 population in 2017−18.
The line chart shows COPD hospitalisation rates among people aged 45 and over from 2008─09 to 2017─18. During the last decade, the hospitalisation rate for men aged 45 years and over declined from 864 per 100,000 population in 2008–09 to 792 per 100,000 population in 2017–18. In contrast, the hospitalisation rate for women increased from 624 per 100,000 population in 2008–09 to 690 per 100,000 population in 2017−18.
Admissions to hospital for COPD are highest in winter and early spring and are consistent with the trend for acute respiratory infections, such as rhinovirus (common cold), influenza, pneumonia and acute bronchitis (Figure 3).
The line chart shows hospitalisation rates of ARI and COPD among people aged 45 and over in different seasons from 2013 to 2017. The admissions to hospital for ARI and COPD are highest in both winter and early spring, and lowest in late summer.
Alison JA, McKeough ZJ, Johnston K, McNamara RJ, Spencer LM, Jenkins SC et al. 2017. Australian and New Zealand Pulmonary Rehabilitation Guidelines. Respirology 22 (4): 800-819.
Britt H, Miller GC, Bayram C, Henderson J, Valenti L, Harrison C et al. 2016. A decade of Australian general practice activity 2006–07 to 2015–16. General practice series no. 41. Sydney: Sydney University Press.
Department of Health 2019. National Strategic Action Plan for Lung Conditions. Canberra: Department of Health.
Ferrer M, Sellares J, Valencia M, Carrillo A, Gonzalez G, Badia JR et al. 2009. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. Lancet 374(9695): 1082-8.
George M & Bender B 2019. New insights to improve treatment adherence in asthma and COPD. Patient Prefer Adherence 13: 1325-1334.
Gordon CS, Waller JW, Cook RM, Cavalera SL, Lim WT & Osadnik CR 2019. Effect of Pulmonary Rehabilitation on Symptoms of Anxiety and Depression in COPD: A Systematic Review and Meta-Analysis. Chest 156(1): 80-91.
Lung Foundation Australia 2008. A manual for pulmonary rehabilitation in Australia: Evidence base and standards. Milton: Lung Foundation Australia.
Lung Foundation Australia 2017. The Australia and New Zealand Pulmonary Rehabilitation Guidelines. Milton: Lung Foundation Australia.
Lung Foundation Australia 2019. The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2019. Milton: Lung Foundation Australia.
Lung Foundation Australia 2020. Full COPD-X Guidelines. P1.1 Smoking cessation. Viewed 28 February 2020.
McCarthy B, Casey D, Devane D, Murphy K, Murphy E & Lacasse Y 2015. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD003793.
Mosenifar Z 2019. Chronic Obstructive Pulmonary Disease (COPD) Treatment & Management. Medscape. Viewed 20 February 2020.
Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA & Smith BJ 2017. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD004104.
Puhan MA, Gimeno-Santos E, Cates CJ & Troosters T 2016. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD005305.
Ram FS, Picot J, Lightowler J, Wedzicha JA 2004. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Systematic Review 1: CD004104.
Spruit MA, Singh SJ, Garvey C et al. 2013. An official American Thoracic Society/European Respiratory Society Statement: Key concepts and advances in pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine 188(8): e13-64.
Yang IA, Brown JL, George J, Jenkins S, McDonald CF, McDonald V et al. 2018 The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2018. Version 2.55, August 2018. Viewed 30 April 2019.
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