Thousands Of Kiwis With Common Lung Disease Could Benefit From New Care Standard- Specialist

A leading New Zealand health expert is calling for the adoption of a new Australian Government standard of care for chronic obstructive pulmonary disease (COPD), a debilitating condition and the fourth leading cause of death in NZ.1,2

COPD refers to a group of diseases like chronic bronchitis and emphysema that cause airflow blockage and breathing-related problems.

COPD is estimated to affect approximately 200,000 (15%) of New Zealanders aged over 45 years. The burden of the disease is inequitably borne by Maori and Pacific people who are more likely to be diagnosed with and are more severely impacted by COPD. The disease may be underdiagnosed with approximately 70% of people worldwide who have COPD unaware of their condition3

Dr Lutz Beckert, Professor of Medicine at the University of Otago and a respiratory specialist with Te Whatu Ora Canterbury says the new COPD Clinical Care Standard, which was launched last month by the Australian Government is designed to reduce hospitalisation and improve outcomes for those with the disease.

Dr Beckert, says the adoption of the new standard in Australia could present an opportunity for New Zealand to review its own approach to COPD patient care and consider whether this standard could be introduced here.

“Ensuring access to lung function testing i.e. spirometry is one of the key tenets of the new Australian Standard and given the high prevalence of the disease here, I believe funded spirometry should be available through every New Zealand GP - in the same way we have access to funded testing for diabetes or breast cancer.

“In Australia the new Standard identifies 10 critical areas of care essential for assisting those living with COPD, helping them manage symptoms and enhance their quality of life.

“COPD has no cure, the Standard offers various strategies to relieve symptoms, reduce exacerbation risks, lower hospitalisation rates and improve quality of life.

“Many people are unaware they have COPD making it crucial for clinicians to help patients recognise early signs, particularly when patients report breathing difficulties.

“Accurate diagnosis through spirometry is a key focus of the Standard, ensuring patients receive timely, effective treatment to manage their symptoms and help prevent health deterioration.

“One of the most effective interventions for slowing COPD progression is smoking cessation, and this is highlighted as a core focus area.

“The Standard also emphasises the importance of pulmonary rehabilitation, with solid evidence supporting its role in reducing symptoms, decreasing hospital admissions, and improving patients' quality of life,” he says.

Dr Beckert says we also need to raise awareness of COPD as an occupational lung disease.

“Exposure to vapours, gas, dust or fine particles (VGDF) in some occupations increases the chance of lung disease by 40%.4,5

“Smoking alone increases the chance of lung disease by 280%. However, the combination of smoking and VGDF exposure at work increases the chance by 620%.4,5

“It is of critical importance that we improve the protection of lungs from environmental and occupational exposures to help reduce rates of COPD,” he says.

Respiratory specialist Dr James Wethasinghe says COPD has not been given the focus it perhaps should because many of those diagnosed feel a sense of shame due to smoking.

He says awareness campaigns like World Chronic Obstructive Pulmonary Disease (COPD) Awareness Day on November 20 will help to put the spotlight on a disease which is devastating for those living with it.

COPD Awareness Day is a global initiative dedicated to raising the profile of the disease and communicating the need for prevention and importance of its early diagnosis and management.

“COPD can be debilitating and may go unrecognised for a long period. It often starts with a feeling of breathlessness which many patients dismiss as part of the ageing process. Even when it is diagnosed it can be difficult to get symptoms under control. Without intervention, the disease can severely impact someone’s quality of life, with daily activities like simply walking a flight of stairs or a small hill extremely difficult.

"Breathlessness is one of the main symptoms. So are recurrent chest infections and limited functional capacity. Patients often find they cannot do as much physical work. It troubles them because they were able to do so much more and all of a sudden they have to change the way they live their life. Without these faculties, life can become very insular and patients often feel isolated and alone.

“Those living with COPD may often be in and out of hospital and require oxygen. Patients are often frail, suffer from malnutrition and are underweight. I do believe that as this disease affects older patients as a community we tend not to give it too much attention.

“Hospitalisation rates for Maori are nearly four times as high as those of European or other ethnicities (excluding Asian and Pacific people)

“When patients have symptoms, I want them to see their GP, and I want their doctors to consider COPD. Respiratory disease cost New Zealand $8 billion in 2019 - yet there is always room for better utilisation of funding in this area. We need more clinicians, nurse specialists and greater access to diagnostics.6,

"There are many COPD patients out there in the community who are struggling with daily symptoms needlessly and we have treatment options available to improve their quality of life,” he says.

Dr Wethasinghe agrees that earlier intervention is key in identifying and treating the disease and calls for greater access to spirometry to ensure patients are captured as early as possible.

Amanda Southcombe, GSK NZ General Manager, says funding for Trelegy Ellipta was recently announced, a single inhaler triple-therapy to treat the disease, which will see around 15,000 Kiwis suffering from moderate to severe COPD now able to access.7,8,9,

Southcombe says COPD is a disease that goes undetected but has a long-lasting health impact on patients.

“We know that early identification and greater use of tools such as spirometry can mean earlier intervention and better management of the impacts of COPD. We welcome initiatives like World COPD Awareness Day to raise the profile and better educate Kiwis on the risks of this deadly disease,” she says.

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1. Chronic Obstructive Pulmonary Disease Clinical Care Standard | Australian Commission on Safety and Quality in Health Care. (n.d.). https://www.safetyandquality.gov.au/standards/clinical-care-standards/chronic-obstructive-pulmonary-disease-clinical-care-standard

2.Asthma Foundation of New Zealand (2022, November 29). https://www.asthmafoundation.org.nz/research/key-statistics#:~:text=Chronic%20obstructive%20pulmonary%20disease%20(COPD)%20in%20New%20Zealand%3A,Broad%20%26%20Jackson%2C%202003 [Accessed August 2024

1. Diab, N., Gershon, A. S., Sin, D. D., Tan, W. C., Bourbeau, J., Boulet, L., & Aaron, S. D. (2018). Underdiagnosis and overdiagnosis of chronic obstructive pulmonary disease American Journal of Respiratory and Critical Care Medicine, 198(9), 1130-1139 https://doi.org/10.1164rccm.201804-0627ci

4 Blanc, P. D., Iribarren, C., Trupin, L., Earnest, G., Katz, P. P., Balmes, J., Sidney, S., & Eisner, M. D. (2008). Occupational exposures and the risk of COPD: dusty trades revisited. Thorax, 64(1), 6–12. https://doi.org/10.1136/thx.2008.099390

5 Murgia, N., & Gambelunghe, A. (2022). Occupational COPD—The most under-recognized occupational lung disease? Respirology, 27(6), 399–410. https://doi.org/10.1111/resp.14272

6 Barnard and Zhang 2024 The impact of respiratory disease in New Zealand: 2023 update. https://www.asthmafoundation.org.nz/assets/documents/Respiratory-Impact-Report-2023.pdf

7 GlaxoSmihKline. Trelegy Ellipta Consumer Medicines Information. https://www.medsafe.govt.nz/consumers/cmi/t/TrelegyEllipta.pdf. [Accessed August 2024].

8 GlaxoSmithKline. Trelegy Ellipta Data Sheet. https://www.medsafe.govt.nz/profs/datasheet/t/TrelegyElliptapowder.pdf. [Accessed August 2024].

9 Pharmac. (2024, April 12). Summary of decision: single inhaler triple-therapy for COPD - Pharmac | New Zealand Government. https://pharmac.govt.nz/news-and-resources/news/summary-of-decision-single-inhaler-triple-therapy-for-copd#:~:text=Fluticasone%20furoate%20with%20umeclidinium%20and,instead%20of%20two%20or%20three

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