The Thoracic Society of Australia and New Zealand (TSANZ) has drawn up its list of low-value tests, treatments and procedures that should be phased out because they are ineffective, wasteful and harmful.
The top five ‘do not do’ respiratory practices have been developed by the TSANZ in conjunction with the RACP’s Evolve program that aligns with the Choosing Wisely campaign to promote high-value evidence-based care.
The Top 5 recommendations are:
1. Do not perform a D-Dimer in patients at high risk of pulmonary embolism.
Rationale: While a negative D-dimer result can rule out pulmonary embolism (PE) in a person with a low or moderate clinical probability for PE , it is not helpful in patients with a high probability it does not exclude PE in more than 15%.
2. Do not use long term systemic corticosteroids for management of chronic obstructive pulmonary disease (COPD).
Rationale: There is insufficient evidence regarding efficacy of systemic corticosteroids in the treatment of COPD without exacerbations. Given their well-known adverse effects, especially COPD patients who tend to be older, less active and have histories of smoking, their long term use cannot be recommended.
3. Do not initiate maintenance inhalers in minimally symptomatic COPD patients with a low risk of exacerbation.
Rationale: Inhalers only have evidence for reducing COPD exacerbations and do not modify disease. For COPD patients who are asymptomatic or minimally symptomatic, quitting smoking is often the only required therapy. The use of short- or long-acting bronchodilators on a regular basis is not generally recommended.