Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) is a progressive and disabling condition that limits airflow in the lungs. People with COPD experience increasing shortness of breath, a persistent cough with phlegm or mucus most days and a limited ability to complete everyday activities due to poor exercise tolerance. The incidence of COPD increases with age. In Australia, the prevalence is estimated to be 7.5% for people aged 40 years and over and 30% for people aged 75 and over. In Aboriginal people the prevalence of COPD is 2.3 times higher than the general population across all age groups.
The primary cause of COPD is active smoking or exposure to smoke. It is the second leading cause of avoidable hospital admissions, and a leading cause of death and disease burden in Australia after heart disease, stroke and cancer.
COPD is an area of significant healthcare variation, with high associated healthcare costs. Across Australia the number of admissions for people with asthma and COPD combined was 19.4 times higher in the highest admission rate area compared to the lowest. Possible reasons for variation include variable prevalence in populations based on age and Aboriginal and Torres Strait Islander status, smoking rates, pulmonary rehabilitation availability, the prevalence of geographic airborne allergens, and adherence to self-management and treatment.
There are a total of 75 hospitals in NSW that admit 50 or more people with COPD per year7. In 2014-15, there were 20,806 separations across the state, costing a total of $133 million8. In April 2017, the Bureau of Health Information (BHI) released a report exploring clinical variation in mortality in eight conditions including COPD.
In an effort to improve clinical best practice for people with COPD, the Australian Lung Foundation published The COPD-X Plan: Australian and New Zealand guidelines for the management of chronic obstructive pulmonary disease in 2016. These best practice guidelines are based on the highest levels of available evidence and aim to broaden treatment of COPD from a pharmacological focus to an emphasis on patient education, chronic disease self-management and pulmonary rehabilitation. Underlying principles of COPD management, outlined in the guidelines include: confirming the diagnosis, optimising function, preventing deterioration, developing a plan of care and managing exacerbation. Several recommendations within the guidelines relate to optimal inpatient care and coordination between acute and primary care providers. These recommendations may be implemented to contribute to a reduction in unwarranted clinical variation by providing a baseline to benchmark appropriate care and a mechanism for ensuring local interventions are in line with best practice.