New devices best for lung screening
GPs are being urged to use simple lung function screening devices rather than spirometry in a bid to boost targeted case finding among individuals from age 35 years who are at risk of COPD.
Updated guidelines say that while spirometry remains the gold standard for COPD diagnosis, there is a place in clinical practice for devices such as the PiKo-6 and COPD-6.
The Australian Lung Foundation (ALF) last week unveiled an updated COPD-X Plan, emphasising early diagnosis and covering new medications, advice on management of comorbidities and new level 1 evidence showing the benefits of smoking cessation in preventing FEV1 decline.
It advocates use of simple screening devices, which measure the amount of exhaled air in the first one and six seconds of expiration, and calculate the ratio of the amount of air forcibly exhaled in the first second relative to the first six seconds (FEV1/FEV6).
“Most GPs don’t have one yet but they are simple and cheap devices,” said Professor Michael Abramson, deputy head of epidemiology and preventive medicine at Monash University and chair of the ALF’s COPD Evaluation Committee.
In advice for targeted case finding the ALF recommended previously undiagnosed individuals aged 35 years or older should be screened with a symptom checklist, followed by a COPD screening device with a FEV1/FEV6 cut-off of <0.75 for formal diagnostic spirometry.
Among other advice, a new once-daily LABA, indacaterol (Onbrez, Novartis) has been added to the options for maintenance therapy.
“It’s good for patients who are breathless with COPD and need a long-acting bronchodilator to improve their symptoms,” said thoracic physician Associate Professor Ian Yang, a member of the COPD Evaluation Committee, but added it could not be used in patients with asthma.
Professor Abramson said the focus of the updated guidelines was on smoking cessation and pulmonary rehabilitation before pharmacological intervention. Management of comorbidities was important as medications used in COPD therapy could potentially impact on cardiovascular risk, but “these days beta-blockers are fairly safe” to use with COPD drugs.
One in five Australians aged 40 years and older have COPD however an Australian Institute of Health and Welfare report last week showed that male deaths from COPD had declined by a third since the 1970s.
Updates to the COPD-X Plan include:
- Discussion of the increased risk of cardiovascular events associated with acute COPD exacerbations
- New evidence use of beta-blockers is associated with mortality benefit in COPD patients
- Men with benign prostatic hyperplasia at risk of urinary retention on commencement of anticholinergics
- COPD patients with obstructive sleep apnoea have more frequent exacerbations
- Counselling combined with nicotine replacement therapy more effective than other combinations or single smoking cessation treatments in COPD
- Livestock farmers at increased risk for COPD likely due to exposure to animal feed.