2.1 Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a serious lung disease. It causes shortness of breath, coughing and wheezing. People with COPD have reduced quality of life and lower life expectancy.

COPD includes chronic bronchitis and emphysema.

Smoking is the most common cause of COPD. Other factors can also increase a person’s risk of developing COPD.

COPD symptoms sometimes get worse suddenly. This is called an exacerbation. People with COPD exacerbations may need to go to hospital for treatment.

Better health care can sometimes keep people with COPD well enough to not have to go to hospital.

In 2017–18:

• There were 77,754 hospitalisations for COPD, representing 260 hospitalisations per 100,000 people of all ages (the Australian rate)
• The number of hospitalisations for COPD across 328 local areas ranged from 56 to 1,013 per 100,000 people
• The number of hospitalisations varied across states and territories, from 218 per 100,000 people in the Australian Capital Territory to 693 per 100,000 people in the Northern Territory
• The rate of hospitalisation was 18.1 times as high in the area with the highest rate compared with the area with the lowest rate
• The rate of hospitalisations for Aboriginal and Torres Strait Islander people (1,178 per 100,000 people) was 4.8 times as high as the rate for other Australians (243 per 100,000 people)
• Rates of hospitalisation were much higher in remote areas and in socioeconomically disadvantaged areas than elsewhere.

Between 2014–15 and 2017–18:

• The rate of COPD hospitalisations nationally increased by 8%
• For Aboriginal and Torres Strait Islander people, the rate of COPD hospitalisations nationally increased by 16%.

Rates are standardised to remove age and sex differences between populations.

Variation in rates of COPD hospitalisation is likely to be due to differences in: 

• Smoking rates – the pattern of COPD hospitalisations is the same as the pattern of smoking in different population groups. Smoking rates increase with socioeconomic disadvantage, psychological distress, Aboriginal and Torres Strait Islander status, and remoteness
• Patient factors – these include the ability to self-manage exacerbations, social supports, frailty and comorbidities.
• Access to services – the hospitalisation rate may decrease if more people with COPD can access lung care services in the community. These services are not easily accessible in rural and remote areas. These services also need to be affordable and culturally appropriate, especially for Aboriginal and Torres Strait Islander people.

Improve access to pulmonary rehabilitation services. Pulmonary rehabilitation is a program of exercises and education to improve breathing and lung function. These programs are led by health professionals, and can reduce the risk of hospitalisation in people with COPD by 36% to 56%. These programs need to be culturally safe for Aboriginal and Torres Strait Islander people, and accessible for people in remote areas.

Continue to reduce smoking rates through smoking cessation services.

Develop and test integrated models of care for people with chronic conditions. These models should include community care, primary care and hospital care.

The Commission consulted widely, but is solely responsible for making the recommendations; as such, the recommendations may not reflect the views of all contributors to the Atlas.

2a. Consistent with the commitments made under the National Health Reform Agreement and building on the activities set out in the 2017 Bilateral Agreement on Coordinated Care, Local Hospital Networks, Primary Health Networks and the Aboriginal Community Controlled Health Service sector to implement the following principles in developing chronic disease management programs consistent with the National Strategic Framework for Chronic Conditions:



i. Patients, families and carers as partners in care, where patients are activated to maximise their knowledge, skills and confidence to manage their health, aided by technology and with the support of a healthcare team



ii. A risk stratification approach that supports identification of patients with high coordination and multiple provider needs, to ensure personalisation of service provision 



iii. Flexible service delivery and team-based care that supports integrated patient care across the continuum of the health system through shared information and care planning



iv. A commitment to care that is of high quality and safe, including care planning and clinical decisions that are guided by evidence-based patient healthcare pathways, appropriate to the patient’s needs 

v. Data collection and sharing by patients and their healthcare teams to measure patient health outcomes and improve performance.

2b. The Commission, the Independent Hospital Pricing Authority and the Administrator of the National Health Funding Pool to identify and develop alternative approaches to funding for chronic disease and infection that could be applied to the National Health Reform Agreement Pricing and Funding model so that pricing and funding are aligned with best-practice guidelines. The alternative models could include bundled payments, capitation payments or regionally coordinated service responses.

 

COPD

2c. Local Hospital Networks, Primary Health Networks and the Aboriginal Community Controlled Health Service sector to implement appropriate care for the management of people with chronic obstructive pulmonary disease (COPD) using the COPD-X Plan: Australian and New Zealand guidelines for the management of chronic obstructive pulmonary disease 2020 as the routine model of care. 

Download the COPD hospitalisations section of the Atlas to read more about context, data, key findings, interpretation and addressing variation:

Contents:

Context

• Who is at greater risk?
• COPD and Aboriginal and Torres Strait Islander people

About the data

What do the data show?

• Magnitude of variation
• Analysis by remoteness and socioeconomic status
• Analysis by Aboriginal and Torres Strait Islander status
• Trends over time

Interpretation

• Smoking rates
• System factors
• Primary care

Reducing COPD hospitalisations

• Pulmonary rehabilitation
• Reducing COPD hospitalisations among Aboriginal and Torres Strait Islander people
• Expanding use of spirometry
• Primary Health Network support
• Integrated care
• Pharmacist interventions
• Nutrition
• Telehealth
• Palliative care

Resources

Australian initiatives

References