Initial diagnosis and management of chronic obstructive pulmonary disease in Australia: views from the coal face

BACKGROUND:Early diagnosis and management can mitigate the long-term morbidity and mortality of chronic obstructive pulmonary disease (COPD).AIM:To gain insights into the initial diagnostic process and early management of COPD by Australian general practitioners (GPs).METHODS:A random sample of Australian GPs was invited to complete a postal survey, which assessed familiarity with and use of contemporary practice guidelines, diagnostic criteria, and management preferences for COPD.RESULTS:Two hundred and thirty-three GPs completed the survey. While most GPs based a COPD diagnosis on smoking history (94.4%), symptoms (91.0%) and spirometry (88.8%), only 39.9% of respondents recorded a formal diagnosis of COPD after the patient's first symptomatic presentation. Tiotropium was the preferred treatment in 77.3% of GPs for the initial management of COPD, while only 27.5% routinely recommended pulmonary rehabilitation. GPs routinely recorded patients' smoking status and offered smoking cessation advice, but the timing of this advice varied. Less than half of the respondents routinely used COPD management guidelines, or tools and resources provided by the Australian Lung Foundation.CONCLUSION:There is scope for major improvement in GPs' familiarity with and use of COPD management guidelines, and readily available tools and resources. Some systematic issues were highlighted in the Australian primary care setting, such as a reactive and relatively passive and delayed approach to diagnosis, potentially delayed smoking cessation advice and under-utilisation of pulmonary rehabilitation. There is an urgent need to devise strategies for improving patient outcomes in COPD using resources that are readily available