Information for healthcare services - Chronic Obstructive Pulmonary Disease Clinical Care Standard

A person over 35 years of age with a risk factor and one or more symptoms of chronic obstructive pulmonary disease (COPD) receives high-quality spirometry to enable diagnosis. Spirometry is also performed for a person with a recorded diagnosis of COPD that has not yet been confirmed with spirometry.

What this means for healthcare services 

Ensure resources and systems are in place to enable access to high‑quality spirometry for COPD diagnosis (see below). Establish referral pathways to ensure clinicians can refer for spirometry when required. Ensure systems are in place to ensure spirometry results are accessible to clinicians across all care settings.

Ensure quality control processes are in place for the performance and interpretation of spirometry as outlined in the Thoracic Society of Australia and New Zealand (TSANZ) Standards for the Delivery of Spirometry for Resource Sector Workers. Spirometers should regularly undergo quality control and calibration to ensure they are consistent with ATS and ERS requirements.

Establish processes and systems to ensure that spirometry is performed and interpreted by suitably trained and competent clinicians acting within their scope of practice. Ensure that training is in line with the TSANZ Standards for Spirometry Training Courses. Consider the frequency of spirometry performance and the ability to maintain competence when determining who should perform spirometry and interpret results.

High‑quality spirometry is:

• Performed before and after administration of an inhaled bronchodilator
• Performed and interpreted by clinicians with appropriate training and competency
• Performed using spirometers that undergo regular quality control and calibration to meet current American Thoracic Society (ATS) and European Respiratory Society (ERS) Technical Statement specifications.

See our list of related resources for this quality statement

A person with a confirmed COPD diagnosis receives a comprehensive assessment to determine their individual care needs. This includes assessing their symptoms and disease severity using a validated assessment tool, history and risk of exacerbations, and comorbidities. Follow-up assessment occurs at least annually.

What this means for healthcare services 

Ensure policies, procedures and systems are in place to support clinicians to carry out and document the outcomes of comprehensive assessments for people with COPD on at least an annual basis. Provide clinicians with access to validated assessment questionnaires and tools (see Related resources). 

Ensure that pathways of care enable referrals to clinicians and services that may be required as part of the comprehensive assessment. Services may include social support, pulmonary rehabilitation, home medicines review, specialist respiratory care and palliative care. Support clinician understanding of, and enable access to, local guidelines and referral pathways (for example, through HealthPathways).

See our list of related resources for this quality statement

A person with COPD is supported to learn about their condition and treatment options. They participate in developing an individualised self-management plan that addresses their needs and treatment goals and includes an action plan for COPD exacerbations.

What this means for healthcare services 

Ensure that clinicians have access to consumer resources for COPD to enable clinicians to support patient participation in informed decision-making about treatment options and self‑management strategies. 

Establish and maintain policies and procedures to support the development of self‑management plans (including COPD action plans) by clinicians jointly with patients, and to ensure these plans are reviewed regularly (for example, following a deterioration, exacerbation or hospital admission). 

Ensure that clinicians have access to suitable templates for self‑management plans and COPD action plans (for example, the Lung Foundation Australia COPD Action Plan). In general practice, this may include General Practitioner Management Plans or Team Care Arrangements. 

Ensure that appropriate services and referral pathways are available to enable access to self‑management interventions (for example, smoking cessation and pulmonary rehabilitation).

See our list of related resources for this quality statement

A person with COPD is offered recommended vaccinations for respiratory and other infections including influenza, pneumococcal disease and COVID-19. They are asked about their tobacco-smoking status and, if currently smoking, offered evidence-based tobacco-smoking cessation interventions.

What this means for healthcare services 

Establish and maintain policies, procedures and protocols for clinicians to offer people with COPD vaccinations for respiratory and other infections as recommended in the Australian Immunisation Handbook. This includes vaccinations for influenza, pneumococcal disease and COVID-19 at appropriate intervals. Ensure the patient’s vaccination history is kept up to date on the Australian Immunisation Register and their healthcare record. Have systems and procedures in place to enable patient recall for subsequent vaccinations at the appropriate intervals.

Establish and maintain policies, procedures and protocols to support the provision and documentation of smoking cessation interventions. Provide clinicians with access to relevant training such as the Quit Centre online training modules to support discussions about smoking cessation with people with COPD. Have systems in place to organise referral to relevant services (for example, referral to Quitline). In hospital, ensure that patients have access to nicotine replacement therapy during admission.

Ensure clinicians document the outcomes of discussions with people with COPD about smoking cessation in the patient’s healthcare record (and My Health Record where available).

See our list of related resources for this quality statement

A person with COPD is referred for pulmonary rehabilitation. If the person has been hospitalised for a COPD exacerbation, they are referred to a pulmonary rehabilitation program on discharge and commence the program within four weeks.

What this means for healthcare services 

Ensure that systems, processes, and resources are in place to support and monitor referral and access to pulmonary rehabilitation programs for all patients with COPD in all care settings. 

Healthcare services discharging patients after a COPD exacerbation should ensure the patient has a referral for pulmonary rehabilitation and provide adequate handover to the clinician responsible for the patient’s ongoing care. This includes handover of the need for the patient to commence pulmonary rehabilitation within four weeks of discharge.

Ensure that clinicians have access to information about local pulmonary rehabilitation programs and relevant referral pathways (for example, in primary care this may be through HealthPathways). 

Where a pulmonary rehabilitation program is not available locally, identify alternative pathways or programs for patients. This may include pulmonary telerehabilitation programs, local exercise programs, or referring patients to a clinician in primary care with expertise in pulmonary rehabilitation such as a physiotherapist or accredited exercise physiologist. 

In primary care, set up systems that support clinicians to provide Team Care Arrangement items where appropriate, to help patients access clinicians with expertise in pulmonary rehabilitation.

See our list of related resources for this quality statement

A person with a confirmed COPD diagnosis is offered individualised pharmacotherapy in line with the COPD-X stepwise approach. Inhaler technique is demonstrated, assessed and corrected when starting treatment and regularly thereafter, including after any change in treatment or a COPD exacerbation.

What this means for healthcare services 

Establish and maintain systems, processes, and resources to support clinicians to offer people with COPD individualised pharmacotherapy, according to the COPD-X stepwise approach outlined in the Lung Foundation Australia’s COPD-X Handbook.

Ensure that clinicians are trained and competent in explaining and demonstrating correct inhaler and spacer technique to patients. This includes providing access to relevant training, including access to placebo inhaler devices and other resources (for example, inhaler device technique training videos) as appropriate. 

Establish systems to ensure inhaler technique and adherence are regularly and routinely assessed, and outcomes documented in the patient’s healthcare record (and My Health Record where available). This includes before an escalation of therapy, after any change in inhaled medicines or a COPD exacerbation.

See our list of related resources for this quality statement

A person having a COPD exacerbation receives short-acting bronchodilator therapy at the onset of symptoms and, if indicated, oral corticosteroids in line with the current COPD-X Guidelines. Antibiotics are only considered if criteria for prescribing are met, and they are prescribed according to evidence-based guidelines.

What this means for healthcare services 

Ensure that systems, resources and pathways are in place to support clinician management of COPD exacerbations in line with COPD-X Guidelines. Provide access to, and ensure that antibiotic prescribing is in line with, Therapeutic Guidelines: Antibiotic or locally endorsed evidence-based guidelines and the Antimicrobial Stewardship Clinical Care Standard.

Ensure systems and processes are in place to support appropriate use of antibiotics when managing COPD exacerbations, with particular emphasis on: 

• Using antibiotics only when in line with the criteria for prescribing antimicrobials described in the current Therapeutic Guidelines: Antibiotic or locally endorsed evidence-based guidelines 
• Selecting appropriate antibiotics if treatment is indicated – using amoxicillin or doxycycline first-line, and avoiding broad-spectrum antibiotics (for example, amoxicillin plus clavulanate, macrolides or cephalosporins) for initial therapy 
• Using an appropriate route of administration, reserving intravenous therapy only for patients who cannot take oral therapy 
• Reviewing appropriateness of dose, route, and the antibiotic’s microbial spectrum of activity within 48 hours of the first prescription (as per the Antimicrobial Stewardship Clinical Care Standard).

In acute care settings, evaluate antimicrobial prescribing and use in line with the NSQHS Preventing and Controlling Infections Standard Actions 3.18 and 3.19. Ensure that antimicrobial stewardship systems are effective in supporting the appropriate use of antibiotics for COPD exacerbations and consider the findings of local antimicrobial audits.

See our list of related resources for this quality statement

A person experiencing hypoxaemia during a COPD exacerbation receives controlled oxygen therapy, ensuring that oxygen saturation levels are maintained between 88% and 92%. Non-invasive ventilation is considered in anyone with hypercapnic respiratory failure with acidosis.

What this means for healthcare services 

Ensure there are systems, policies and pathways in place to enable access to controlled oxygen therapy for patients experiencing a COPD exacerbation, and non‑invasive ventilation for patients with hypercapnic respiratory failure with acidosis. 

Acute healthcare services should have local policies and protocols in place that provide guidance on assessment for hypercapnic respiratory failure with acidosis in COPD patients, and the use of non‑invasive ventilation in these patients. These should be appropriate to the context of service delivery and consistent with the patient’s care goals. 

Clinicians who prescribe or administer controlled oxygen therapy and non‑invasive ventilation must be suitably trained and competent in: 

• The use of oxygen delivery devices and non‑invasive ventilation equipment 
• Administering both therapies at the appropriate settings. 

Ensure that protocols are in place for oxygen therapy which include: 

• Checking patient history for COPD for any patient receiving oxygen therapy 
• Appropriate documentation of oxygen prescriptions 
• Guidance on appropriate target oxygen saturation levels for people with COPD (that is, SpO2 between 88% and 92%)
• Amended calling criteria for rapid response (as provided by medical emergency teams) in line with target oxygen saturation levels.

Ensure that there are systems, policies and procedures in place to: 

• Enable assessment for hypercapnic respiratory failure in patients with a COPD exacerbation 
• Provide non‑invasive ventilation for patients with hypercapnic respiratory failure with acidosis and invasive mechanical ventilation when indicated 
• Ensure the person’s goals of care are considered and a senior clinician is involved in the decision to use non‑invasive ventilation or mechanical ventilation 
• Support documentation of advance care planning discussions and the patient’s expressed goals of care for the episode of care, including plans for non‑invasive and mechanical ventilation, endotracheal intubation and resuscitation, and advanced care plan.

See our list of related resources for this quality statement

A person who has been hospitalised for a COPD exacerbation is offered a follow-up assessment within seven days of discharge, facilitated by timely and effective communication between their hospital and primary care providers.

What this means for healthcare services

Hospitals

Ensure that clinical information systems support clinicians to provide discharge summaries to the patient’s nominated primary care provider (for example, general practitioner or Aboriginal Medical Service) and other community providers (for example, residential aged care facility) and communicate the need for follow-up within seven days of discharge or sooner if indicated. Where local clinical information systems allow, upload this information to the patient’s My Health Record where the patient has given permission. 

Establish effective communication systems between the hospital network and community care providers. 

Primary care

Ensure that systems, processes and resources are in place to enable follow-up assessment of patients who have been hospitalised due to a COPD exacerbation within seven days of discharge, or sooner if required.

See our list of related resources for this quality statement

A person with COPD is offered symptom support and palliative care that meets their individual needs and preferences.

What this means for healthcare services

Ensure that systems, processes, and resources are in place to: 

• Enable timely palliative care support for people with COPD, including after hospitalisation for an exacerbation 
• Enable patient referrals to suitable clinicians or specialist palliative care services if required 
• Support discussions about advance care planning and documentation of the patient’s advance care plan in their healthcare record or My Health Record 
• Enable documentation of goals of care for admitted patients with a COPD exacerbation, including plans for ventilation and resuscitation.

See our list of related resources for this quality statement

Aboriginal and Torres Strait Islander people generally experience poorer health outcomes than the rest of the population, with systemic racism a root cause. The considerations for improving cultural safety and equity throughout this clinical care standard focus primarily on overcoming cultural power imbalances and improving outcomes for Aboriginal and Torres Strait Islander people through better access to health care.

When providing care for Aboriginal and Torres Strait Islander peoples, particular consideration should be given to:

• Taking a collaborative approach to planning treatment and management of COPD to ensure that interventions are suitably tailored to the individual’s personal needs and preferences for care
• Supporting people to self‑report their Aboriginal and Torres Strait Islander status and ensure appropriate systems and processes are in place to promote self‑identification
• Engaging interpreter services and cultural translators when this will assist the patient
• Engaging Aboriginal and Torres Strait Islander Health Workers and Aboriginal and Torres Strait Islander Health Practitioners as part of a patient’s multidisciplinary team
• Encouraging the inclusion of a carer, family member or friend in all aspects of care, including decision making and management planning
• Providing flexible service delivery to optimise attendance and help develop trust with individual Aboriginal and Torres Strait Islander people and communities.

See additional resources for supporting culturally safe and equitable care.