Falling testing rates for disabling lung disease concerns experts

Many Australians considered at-risk of having chronic obstructive pulmonary disease (COPD) - a lung disease that presents as gradually worsening shortness of breath - are failing to be diagnosed, and this is likely to have worsened since the COVID-19 pandemic, experts say.

Experts are calling for more patients to be referred to lung function laboratories, or to undergo spirometry testing in GP clinics.

COPD is a progressive lung disease that is incurable in its late stages, and often presents with gradually worsening shortness of breath, and a wheeze or cough that can be dismissed by patients as “just a smoker’s cough” or a symptom of old age.

Published recently in the BMJ Open Respiratory Research, lead author Dr Jennifer Perret from the University of Melbourne Allergy and Lung Health Unit in the Centre for Epidemiology and Biostatistics, reviewed several studies from primary healthcare settings around the world to illustrate the potential extent of under-diagnosis of the disease. Dr Perret said it is the first review of its kind, and raises a number of issues in clinical practice.

“There is growing concern that many people with COPD are not diagnosed until they present to hospital with advanced disease, and opportunities to intervene earlier can be overlooked in the community,” Dr Perret said.

“We have systematically searched the literature and found that 14-26 per cent of symptomatic adult smokers who were “active” patients of general practices and actually had COPD when tested by the studies’ researchers were undiagnosed, that is, they had symptoms and lung function changes of COPD but did not have the diagnosis documented in their health record.”

The review also found that around 25 per cent of people taking inhaled therapies had lung function deficits consistent with COPD, but that a diagnosis was not documented, or in some cases patients were unaware of the diagnosis.

Dr Perret said there is a need to refer more patients to lung function laboratories for spirometry - a test which measures lung function to confirm a diagnosis of COPD. Spirometry testing was halted at the onset of the COVID-19 pandemic and has not returned even to previously low pre-pandemic levels in primary care.

“Central to the issue of underdiagnosis is the lack of availability of testing, especially since there is now the need to comply with COVID-safe protocols.” Dr Perret said.

Dr Kerry Hancock, co-author and Chair of the Respiratory Medicine Specific Interest Network of the Royal Australian College of General Practitioners (RACGP), identified that poor rebates and lack of resources and testing expertise in general practice existed pre-COVID, but that these had been compounded by the pandemic.

“These figures are almost certainly worse in the living-with-COVID era after spirometry testing was restricted during the pandemic given it was an aerosol-generating procedure from inducing coughing,” Dr Hancock said.

“There is a pressing need to support GPs in accessing lung function testing for high-risk patients, to accurately diagnose COPD, to offer timely management and prevention, and to reduce the risk of prescribing inhaled therapies that may not be indicated.”