EPOC

COMMENTARY
Concise guidance for COPD

Key words: chronic obstructive pulmonary disease, evidence- 1 data on interventions to reduce exacerbations have also
based medicine, practice guideline. been included with reference to oral mucolytics and COPD
action plans.
In 2014, Lung Foundation Australia (LFA) first publi- Guideline user surveys indicate that the suite of
shed the ‘COPD-X Concise Guide for Primary Care’ COPD-X guidelines is accessed by primary care physi-
with the aim of distilling the more detailed ‘The cians, practice nurses, allied health professionals and
COPD-X plan: Australian and New Zealand Guidelines healthcare agencies. Results of a recent user survey indi-
for the management of chronic obstructive pulmonary cated that the guidelines improved knowledge and under-
disease’ into a pragmatic, point-of-care guide for pri- standing of COPD management, supported the delivery of
mary care clinicians. Since then, the Concise Guide has patient-centred care and had relevance across hospital,
been updated by the COPD-X Guidelines Committee, a primary and community care settings.1 Feedback from
multidisciplinary group of Australian clinicians that this survey, in addition to that provided by the LFA Gen-
meets quarterly to review chronic obstructive pulmo- eral Practice Advisory Group, supports the presentation of
nary disease (COPD) literature and update the guidance in a brief, user-friendly format such as is pres-
‘COPD-X Plan’. ented in the Concise Guide and ‘Stepwise Guide’,
In 2020, the ‘Concise Guide’ has been rewritten and underpinned by the full guidance provided in COPD-X.
‘primary care’ has been removed from the title to reflect LFA is a peak body advocating for lung health for all
that a wide range of clinicians require succinct, Australians and supports the involvement of consumers
evidence-based recommendations on caring for patients with COPD and/or their carers/advocates in all its ser-
with COPD (https://copdx.org.au/). The format of the vices, including in the development of the Concise
guide has been altered to improve readability with each Guide. The Concise Guide, as well as the rest of the
topic beginning with a real-world question, such as ‘How Guideline Suite, incorporates feedback from key stake-
can exacerbation risk be reduced?’ with dot-point holders including, importantly, members of the Tho-
answers, practice tips and key recommendations. The racic Society of Australia and New Zealand, and is
guide has been updated to ensure that levels of evidence endorsed by the peak body for general practitioners,
and statements regarding the strength of recommenda- the Royal Australian College of General Practitioners.
tions are clear. For clinicians requiring more detailed The diversity of aetiologies of COPD, complex presenta-
information and a discussion of the evidence, hyperlinks tions, gaps in available management and different
to the full COPD-X guide are provided. healthcare systems provide barriers to implementation of
The COPD-X Guidelines Committee reviews the quar- best practice care for patients with COPD, both globally and
terly changes made to the COPD-X Plan to identify key in regions such as the Asia-Pacific. For clinicians providing
developments and incorporate the latest evidence into day-to-day management, and for health policy makers
the Concise Guide. Key stakeholders and primary care shaping the system, keeping up-to-date with the ever-
representatives are also invited to submit feedback. expanding evidence in COPD epidemiology, diagnosis and
The ‘Stepwise Management of COPD’, also published management2,3 is a rewarding but never-ending challenge.
by LFA, is a single page, graphical summary of the Principles from international guidelines need careful
pharmacological and non-pharmacological therapies adopting or adapting to ensure local relevance. In the
across the severity spectrum of COPD (Fig. 1). The paper by Rhee et al. on ‘Management of COPD in Asia: a
principle of stepwise management, beginning with one position statement of the Asian Pacific Society of
pharmacological intervention and assessing response Respirology’, the case is made for fit-for-purpose adapta-
before adding another agent, is consistent across all of tion of COPD guidelines in Asian populations, especially
the LFA COPD guides. Furthermore, the guides empha- when recognizing the low use of spirometry in some Asian
size the vital role of reducing risk factors (particularly countries, high prevalence of smoking and other risk fac-
smoking), optimizing function with multidisciplinary tors of importance (e.g. biomass smoke exposure and
care, optimizing treatment of comorbidities and refer- tuberculosis-destroyed lung).4
ring symptomatic patients to pulmonary rehabilitation. Whilst the COPD-X Concise Guide is written for a
Since its inception, the Concise Guide has provided rec- specific setting, its format may be useful educationally
ommendations around Case finding and diagnosis, Opti- as another example of implementation of guidelines in
mizing function, Prevention of deterioration, Development the Asia-Pacific region. For example, the Concise Guide
of care plans and management of eXacerbations. The 2020 employs a pragmatic style of communication, including
update provides new evidence regarding the role of triple asking clinical questions in diagnosis and management,
therapy (inhaled corticosteroid/long-acting beta-agonist/ and visual representation of inhaled medicines.
long-acting muscarinic antagonist (ICS/LABA/LAMA)) and Clinical guidelines are but one element of an inte-
non-pharmacological options for symptom management grated system to promote health service delivery; other
including handheld fans and recovery positions. New level strategies include professional education, point-of-care
© 2020 Asian Pacific Society of Respirology Respirology (2020)
doi: 10.1111/resp.13934
2 Commentary
Figure 1 Continued.
Concise guidance for COPD 3
Figure 1 Stepwise management of stable chronic obstructive pulmonary disease (COPD). The Stepwise Guide summarizes key rec-
ommendations for diagnosis and both non-pharmacological and pharmacological management of stable COPD in Australia. Current
inhaled medicines available in Australia are listed on the back page of the Stepwise Guide. Available from URL: https://copdx.org.au/
(April 2020 version shown). Reproduced from Lung Foundation Australia, with permission.
4 Commentary
reminders in electronic health records and computer Vanessa McDonald, Brian Smith and Nick Zwar), Lung Founda-
decision support systems.5 Considerable effort is tion Australia staff (Juliet Brown and Kelcie Herrmann) and
required to effectively translate evidence to practical members of the COPD Advisory Committee, Lung Foundation
Australia, for their input to the updates of the COPD-X Concise
management in our community.
Guide.
In day-to-day clinical practice, clinicians therefore
mostly turn to trusted, local guidelines to help manage
their patients with COPD. Involvement of stakeholders Disclosure statement: E.D., C.F.M. and I.A.Y. are members of the
and end-users is a critical enabler for guideline develop- Lung Foundation Australia COPD-X Guidelines Committee,
ment. Evidence-based resources for COPD management— which produces the ‘COPD-X Concise Guide’. C.F.M. directed
speaker fees from Menarini and Astra Zeneca to her institution
whether in the form of a pragmatic 2-page stepwise wal-
in 2018.
lchart/digital desktop tool, a directed 40-page guidance for
primary through to tertiary care practitioners or a compre-
hensive, nuanced critical appraisal of evidence-based REFERENCES
recommendations—are all essential tools to achieving
high-quality care for patients with COPD. 1 Brown J, Dabscheck E, George J, Herrmann K, Jenkins S,
McDonald C, McDonald V, Smith B, Yang I, Zwar N. Evaluating the
use of the Australian and New Zealand COPD guidelines in clinical
Eli Dabscheck, MBBS (Hons), M Clin Epi, FRACP,1
practice: a user survey. Respirology 2020; 25(Suppl. 1): 139 [Abstract
Christine F. McDonald, AM, MBBS (Hons), PhD,
ID – TPL004].
FRACP, FCCP, FThorSoc2 and Ian A. Yang, MBBS 2 Sin DD. Contemporary concise review 2019: chronic obstructive
(Hons), PhD, FRACP, FAPSR, FThorSoc, Grad Dip Clin pulmonary disease. Respirology 2020; 25: 449–54.
Epid3 3 Ko FWS, Sin DD. Twenty-five years of Respirology: advances in
1
Alfred Hospital, Monash University, Melbourne, VIC, COPD. Respirology 2020; 25: 17–9.
Australia; 2Austin Hospital, Institute for Breathing and 4 Rhee CK, Chau NQ, Yunus F, Matsunaga K, Perng D-W; COPD
Sleep, University of Melbourne, Melbourne, VIC, Assembly of the APSR. Management of COPD in Asia: a position
Australia; 3The Prince Charles Hospital, The University statement of the Asian Pacific Society of Respirology. Respirology
of Queensland, Brisbane, QLD, Australia 2019; 24: 1018–25.
5 Overington JD, Huang YC, Abramson MJ, Brown JL, Goddard JR,
Bowman RV, Fong KM, Yang IA. Implementing clinical guidelines
for chronic obstructive pulmonary disease: barriers and solutions.
Acknowledgements: We thank the other members of the J. Thorac. Dis. 2014; 6: 1586–96.
COPD-X Guidelines Committee (Johnson George, Sue Jenkins,
© 2020 Asian Pacific Society of Respirology Respirology (2020)

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COMMENTARY

Concise guidance for COPD

© 2020 Asian Paciﬁc Society of Respirology Respirology (2020)

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