Report: Fall in gold standard COPD test is cause for concern

A new national report released today by the Australian Commission on Safety and Quality in Health Care (ACSQHC) reveals a dramatic fall in the use of spirometry, a critical diagnostic test for chronic obstructive pulmonary disease (COPD).

A progressive, incurable lung condition that affects about one in 13 people over the age of 40 in Australia — although about half of them may not know they have it — COPD is associated with a significant number of preventable hospitalisations across the country and was the fifth leading cause of death in 2023. Yet, despite spirometry being the gold standard for confirming a diagnosis of COPD, the ‘Atlas Focus Report: COPD’ has found a 31% drop in spirometry testing rates between 2015–16 and 2022–23.

Fall in spirometry

A drop in the use of this test, ACSQHC said in a statement, is leaving Australians living with COPD exposed to greater health risks. “Without spirometry, patients are in danger of misdiagnosis and being prescribed medications that put them at unnecessary risk,” ACSQHC said; the condition often causes breathlessness, coughing and flare-ups that, if not managed effectively, can be life-threatening. Also revealed by the report is significant geographic variation in spirometry use.

Rates of spirometry services in 2022–23, for example, were higher in major cities than in many regional and remote areas — despite COPD prevalence being higher in remote areas. “These findings raise concerns about healthcare equity and suggest that people in areas of higher need may be missing out on an essential diagnostic test,” ACSQHC said. As to the possible cases for the fall, this has been linked to a combination of economic, clinical and operational barriers.

In primary care, equipment cost, infection-prevention protocols, result interpretation and lack of trained staff are among the ongoing challenges. These challenges can mean patients face delays or hurdles in receiving an accurate diagnosis, something ACSQHC said potentially leads to suboptimal treatment and avoidable complications. An increase in the use of ‘triple therapy’ — a combination of inhaled corticosteroids (ICS) with long-acting dual bronchodilators (LAMA and LABA) — is also cause for concern, ACSQHC said.

Rise in triple therapy

The report identified a 130% increase in triple therapy use, which ACSQHC said comes “despite guidelines recommending they be reserved for patients with severe COPD with frequent exacerbations and with significant symptoms despite optimal dual therapy; and for those with co-existing asthma. ICSs are a cornerstone of asthma treatment but are often much less useful and carry much higher risk for people with COPD — including the risk of pneumonia”.

Providing comment on the report’s findings is ACSQHC Medical Advisor and GP Dr Lee Fong, who said: “We now have clear national data showing that spirometry use has plummeted, and triple therapy, which should be reserved for a select group of COPD patients, has had a substantial rise. We must refocus efforts to ensure people receive the right care, based on accurate diagnosis and best practice.” Fong added: “Patients with COPD who are using triple therapy should check with their GP or pharmacist if it’s still the best treatment for them. COPD guidelines recommend adapting therapy in response to symptoms and exacerbations.”

Together with the standard

In October 2024, the COPD Clinical Care Standard was released, outlining the expected components of evidence-based care for people with COPD. The Atlas Focus Report: COPD complements this standard, ACSQHC said, with the two initiatives together supporting GPs, health services and policymakers to drive change and identify areas for improvement across the healthcare system.

“Interactive maps and regional data are available on the Commission’s website, enabling healthcare professionals and local health services to explore variations in care across Australia and take informed action to improve outcomes,” ACSQHC said. “The Commission is calling on healthcare leaders, primary care providers and policymakers to review the findings and consider actions that improve access to spirometry, support appropriate prescribing and ensure equitable, high-quality care for people with COPD.”

The Atlas Focus Report: COPD is available here and the COPD Clinical Care Standard here. There is also the Highlights Report: COPD, which is available here.

For more information, visit safetyandquality.gov.au/Atlas-COPD.

Image credit: iStock.com/stefanamer