Foreword

Chronic obstructive pulmonary disease (COPD) is a major cause of disability, hospital admission and premature death. Some two million Australians are estimated to have COPD.¹ Of those with COPD, it is estimated that 1.2 million have moderate to severe COPD and 900,000 have mild COPD. As the population ages, the burden of COPD is likely to increase. The Australian Institute of Health and Welfare estimated that COPD was the seventh greatest contributor to the overall burden of disease, accounting for 3.3% of disability-adjusted life years (DALY) in 2003.² In New Zealand, 1996 data indicated that for men, COPD was the second most common cause of years lost to disability (YLD) and for women, the seventh most common cause. 2003 estimates suggest that the prevalence of COPD in New Zealand women had increased substantially with COPD possibly being the leading overall cause of death and disability ³. COPD ranks sixth among the common causes of death in Australian men and seventh in women.² In New Zealand, it ranks third in men and fourth in women ⁴. COPD is commonly associated with other diseases including heart disease, lung cancer, stroke, pneumonia and depression.

Smoking is the most important risk factor for COPD. In 2007, 18% of Australian males and 15.2% of Australian females over the age of 18 years smoked daily.⁵ Smoking-related diseases have increased substantially in women, and death rates from COPD in women are expected to rise accordingly. The death rate from COPD among indigenous Australians is five times that for non-indigenous Australians, and smoking is a leading cause of healthy years lost by indigenous people both in Australia and New Zealand.

COPD costs the Australian community an estimated $8.8 billion annually in financial costs, including health and hospital costs, lost productivity, premature death and lower employment.¹ If the less tangible costs due to loss of wellbeing are calculated, this could bring the total economic impact of COPD in Australia to $98 billion.

Health systems in Australia and New Zealand have historically been oriented toward the treatment of acute diseases and/or acute exacerbations of chronic diseases with a dominant reactive episodic model of care. The challenges posed by the increasing burden of chronic diseases on health systems require development of health service models that have a fundamentally different orientation toward anticipatory and proactive care in addition to acute reactive care not only for individuals with a particular chronic condition (like COPD), but also for individuals with multiple morbidities ⁶.

Wagner and colleagues have articulated domains for system reform in their Chronic Care Model. These include Delivery System Design (e.g. multi-professional teams, clear division of labour, acute vs. planned care); Self Management Support (e.g. systematic support for patients / families to acquire skills and confidence to manage their condition); Decision Support (e.g. evidence-based guidelines, continuing professional development programs) and Clinical Information Systems (e.g. recall reminder systems and registries for planning care).

Much can be done to improve quality of life, increase exercise capacity, and reduce morbidity and mortality in individuals who have COPD. This Australian and New Zealand guideline is written as a decision support aid primarily for general practitioners and other primary health care clinicians managing people with established COPD. It is regularly updated as new evidence is published.

The key recommendations are summarised in the "COPDX Plan":

C: Confirm diagnosis

O: Optimise function

P: Prevent deterioration

D: Develop support network and self-management plan

X: Manage eXacerbations.

Professor Nicholas Glasgow (on behalf of the COPD Evaluation Committee)

February 2008