Foreword

Chronic obstructive pulmonary disease (COPD) is a major cause of disability, hospital admission and premature death. More than half a million Australians are estimated to have moderate to severe disease,¹ and, as the population ages, the burden of COPD is likely to increase. In Australia, only heart disease and stroke contribute more to the overall burden of disease,² while, in New Zealand, COPD is second only to stroke. COPD ranks fourth among the common causes of death in Australian men and sixth in women. In New Zealand, it ranks third in men and fourth in women.³

Smoking is the most important risk factor for COPD. Further, smoking-related diseases are increasing substantially in women, and death rates from COPD in women are expected to overtake those in men. 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 $818–$898 million annually.⁴ This is a conservative estimate, based on 1993–1994 figures extrapolated to the year 2001. The addition of hidden costs, such as those related to carer burden, loss of productivity from absenteeism and early retirement, could increase the estimate to more than $1 billion per annum.

Because it is considered incurable, self-inflicted and relatively resistant to treatment, a sense of nihilism about COPD prevails. However, much can be done to improve quality of life, increase exercise capacity, and reduce morbidity and mortality in affected individuals. This guideline was developed according to the principles of the National Health and Medical Research Council,⁵ but differs from previous guidelines on COPD in that it draws from the recently published international Guideline for the Management of Obstructive Lung Disease⁶ as the primary evidence base. These Australian and New Zealand guidelines have a strong emphasis on the use of objective measures of function, the role of non-pharmacological interventions and promotion of self-management.

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

  Confirm diagnosis,
  Optimise function,
  Prevent deterioration,
  Develop a self-management plan and manage
eXacerbations.

Dr Robert L Edwards National Chairman, Australian Lung Foundation March 2003