COPD - in conversation with Dr Kerry Hancock
To mark the end of the collaborative Chronic Obstructive Pulmonary Disease (COPD) project, General Practitioner Liaison Officer Dr Srishti Dutta spoke with Dr Kerry Hancock from Lung Foundation Australia, about effective and practical ways to improve outcomes for patients with COPD.
Challenges in performing spirometry in general practice
Dr Hancock has seen GPs experience various challenges when performing spirometry in general practice settings; including staff who are not appropriately trained, time constraints, and poor remuneration.
In response to the poor remuneration, the Lung Foundation continues to advocate on behalf of practitioners and practices for compensation to appropriately reflect the skills, cost of training staff, cost of equipment, time taken to perform the test and improved outcomes involved for patients with lung conditions.
Performing spirometry in general practice has its advantages though, including the convenience of being assessed closer to home for patients, clinical decisions being made in a timely manner, and getting a correct diagnosis when patients present with respiratory symptoms to their GP.
Spirometry dos and don’ts
Spirometry remains an underutilised test and the infrequent use often does not allow clinicians to maintain their interpretation skills. Dr Hancock’s advice to clinicians is to “become familiar with your machine – the hardware and the software, so you are confident when doing the test.
“Consider the need for having your machine calibrated regularly and have a practice protocol in place for this,” Dr Hancock said.
Other dos and don’ts include:
- do use the Global Lung Initiative predicted values
- do ensure the use of correct demographics including gender, age, height and race
- do consider repeating the test in the case of poorly performed results
- do ensure patients are seated to avoid a syncopal episode
- don’t rush patients
- don’t make mistakes with MBS billing
- don’t make an interpretation on poorly performed results.
Recent changes for inhaled medication
The following changes to respiratory medicine PBS restrictions came into effect on 1 August 2018:
- the restriction level of ICS/LABA medicine has been elevated from Restricted Benefit to Authority Required (Streamlined)
- addition of clinical criteria to allow use of LAMA/LABA medicine in patients who have not previously had their symptoms controlled by either
- administrative advice updated around inhaler device technique and diagnostic confirmation.
Full details of these changes are available on the Pharmaceutical Benefits Scheme website at www.pbs.gov.au.
Addressing the Asthma and COPD overlap
Dr Hancock spoke to the challenge of diagnosing asthma and COPD and the overlap between the two.
“It is increasingly important that patients are diagnosed correctly—do they have asthma? Do they have COPD? Do they have clinical features of both, or do they have something else altogether?” Dr Hancock said.
The treatment for asthma and COPD differ; patients with asthma need to be on ICS (inhaled corticosteroids) while patients with COPD require long acting bronchodilators, which reduce dynamic hyperinflation and manage breathlessness and the demands of physical activity.
Patients with co-existing asthma and COPD require ICS and bronchodilator therapy. Additionally, it is vital that those with a previous diagnosis of asthma who go on to have confirmation of COPD should not be withdrawn from ICS therapy.
Australia (NACA) have an information paper called Asthma – COPD Overlap, available on their websites.
Both these organisations have resources and tools to assist GPs and practice nurses with asthma and COPD including GP friendly guidelines, inhaler device technique fact sheets, videos and information about lung function testing.
Health professionals can subscribe to the Lung Foundation’s clinical electronic newsletter, Airwaves Clinical Update, via their website. NACA also have an electronic asthma and allergy newsletter that health professionals may find useful and informative.
The Lung Foundation also offers the following COPD webinars:
- Who really has COPD?
- Right medicine, right time, in the right way
- Keeping patients out of hospital.
To access these webinars and further COPD resources visit https://lungfoundation.com.au/health-professionals/training-and-education.
GPs can access the COPD health pathway via https://brisbanenorth.healthpathwayscommunity.org. To access login details contact your PCLO or phone 07 3630 7300.