LAUSR

In 2014, Lung Foundation Australia (LFA) first published the ‘COPD-X Concise Guide for Primary Care’ with the aim of distilling the more detailed ‘The COPD-X plan: Australian and New Zealand Guidelines for the management of chronic obstructive pulmonary disease’ into a pragmatic, point-of-care guide for primary care clinicians. Since then, the Concise Guide has been updated by the COPD-X Guidelines Committee, a multidisciplinary group of Australian clinicians that meets quarterly to review chronic obstructive pulmonary disease (COPD) literature and update the ‘COPD-X Plan’. In 2020, the ‘Concise Guide’ has been rewritten and ‘primary care’ has been removed from the title to reflect that a wide range of clinicians require succinct, evidence-based recommendations on caring for patients with COPD (https://copdx.org.au/). The format of the guide has been altered to improve readability with each topic beginning with a real-world question, such as ‘How can exacerbation risk be reduced?’ with dot-point answers, practice tips and key recommendations. The guide has been updated to ensure that levels of evidence and statements regarding the strength of recommendations are clear. For clinicians requiring more detailed information and a discussion of the evidence, hyperlinks to the full COPD-X guide are provided. The COPD-X Guidelines Committee reviews the quarterly changes made to the COPD-X Plan to identify key developments and incorporate the latest evidence into the Concise Guide. Key stakeholders and primary care representatives are also invited to submit feedback. The ‘Stepwise Management of COPD’, also published by LFA, is a single page, graphical summary of the pharmacological and non-pharmacological therapies across the severity spectrum of COPD (Fig. 1). The principle of stepwise management, beginning with one pharmacological intervention and assessing response before adding another agent, is consistent across all of the LFA COPD guides. Furthermore, the guides emphasize the vital role of reducing risk factors (particularly smoking), optimizing function with multidisciplinary care, optimizing treatment of comorbidities and referring symptomatic patients to pulmonary rehabilitation. Since its inception, the Concise Guide has provided recommendations around Case finding and diagnosis, Optimizing function, Prevention of deterioration, Development of care plans and management of eXacerbations. The 2020 update provides new evidence regarding the role of triple therapy (inhaled corticosteroid/long-acting beta-agonist/ long-acting muscarinic antagonist (ICS/LABA/LAMA)) and non-pharmacological options for symptom management including handheld fans and recovery positions. New level 1 data on interventions to reduce exacerbations have also been included with reference to oral mucolytics and COPD action plans. Guideline user surveys indicate that the suite of COPD-X guidelines is accessed by primary care physicians, practice nurses, allied health professionals and healthcare agencies. Results of a recent user survey indicated that the guidelines improved knowledge and understanding of COPD management, supported the delivery of patient-centred care and had relevance across hospital, primary and community care settings. Feedback from this survey, in addition to that provided by the LFA General Practice Advisory Group, supports the presentation of guidance in a brief, user-friendly format such as is presented in the Concise Guide and ‘Stepwise Guide’, underpinned by the full guidance provided in COPD-X. LFA is a peak body advocating for lung health for all Australians and supports the involvement of consumers with COPD and/or their carers/advocates in all its services, including in the development of the Concise Guide. The Concise Guide, as well as the rest of the Guideline Suite, incorporates feedback from key stakeholders including, importantly, members of the Thoracic Society of Australia and New Zealand, and is endorsed by the peak body for general practitioners, the Royal Australian College of General Practitioners. The diversity of aetiologies of COPD, complex presentations, gaps in available management and different healthcare systems provide barriers to implementation of best practice care for patients with COPD, both globally and in regions such as the Asia-Pacific. For clinicians providing day-to-day management, and for health policy makers shaping the system, keeping up-to-date with the everexpanding evidence in COPD epidemiology, diagnosis and management is a rewarding but never-ending challenge. Principles from international guidelines need careful adopting or adapting to ensure local relevance. In the paper by Rhee et al. on ‘Management of COPD in Asia: a position statement of the Asian Pacific Society of Respirology’, the case is made for fit-for-purpose adaptation of COPD guidelines in Asian populations, especially when recognizing the low use of spirometry in some Asian countries, high prevalence of smoking and other risk factors of importance (e.g. biomass smoke exposure and tuberculosis-destroyed lung). Whilst the COPD-X Concise Guide is written for a specific setting, its format may be useful educationally as another example of implementation of guidelines in the Asia-Pacific region. For example, the Concise Guide employs a pragmatic style of communication, including asking clinical questions in diagnosis and management, and visual representation of inhaled medicines. Clinical guidelines are but one element of an integrated system to promote health service delivery; other strategies include professional education, point-of-care