GPs too passive in their approach to COPD

GPs hold back on formerly diagnosing people with COPD and delay offering interventions such as smoking cessation or pulmonary rehabilitation, a survey shows.

The findings from 233 mostly urban GPs found most (60%) delay recording a formal diagnosis of COPD until after a trial of treatment, referral to a specialist or a diagnosis in hospital.

The recommendation to quit smoking was almost universal among GPs (99%) however a significant proportion (22%) did not broach the subject on the patient’s initial presentation with respiratory symptoms.

Less than a third of GPs (28%) routinely recommend patients attend pulmonary rehabilitation.

Lung Foundation Australia’s General Manager – COPD National Program Ms Kirsten Phillips said the issue may not be lack of awareness of the effectiveness of pulmonary rehabilitation but limited access to local programs.

She said currently available programs could only service about 5% of the estimated 750,000 patients who would benefit from pulmonary rehabilitation.

“Lung Foundation Australia is currently working to improve this situation by applying for the pulmonary rehabilitation program to be subsidised on the Medicare Benefits Scheme. If approved, this means more programs will be available in the community, especially in rural and remote areas, resulting in more patients accessing these vital programs.”

The study also found less than half of GPs (49%) base their management on evidence-based clinical guidelines such as COPD-X.

Dr Kerry Hancock, a GP and Chair of Lung Foundation Australia’s COPD General Practice Advisory Committee said there were a number of factors that influence GPs making a timely diagnosis of COPD – including the capacity to review patient notes to identify undiagnosed cases.

“Guidelines for pharmaceutical management of the patient with COPD have had a major overhaul in the last few years and understandably it takes a while for GPs to catch up with these new changes,” she said.

“Especially when the average GP may be managing only 1-2 patients per week with COPD compared to managing mental health, diabetes, lipids and ischaemic heart disease on a daily basis,” she added.

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