Australians living with chronic obstructive pulmonary disease (COPD) are facing worsening health outcomes as use of a vital diagnostic test falls, at a time when the Western NSW region records the highest rate of COPD treatment in the country.

COPD is a progressive, incurable lung disease that includes emphysema and chronic bronchitis and causes persistent breathlessness, coughing, and flare-ups that can become life-threatening if not managed effectively.

The condition damages and inflames lung tissue, narrowing airways and making it harder to breathe.

A new report by health advisory firm Evohealth, Change that can’t wait: Reducing the human and economic burden of COPD in Australia, found the disease kills more Australians each year than breast and prostate cancers combined.

It costs the health system $1.67 billion annually, with more than 7,600 deaths recorded each year.

Rates rising and testing falling

The number of Australians living with COPD is expected to rise from 526,000 to over 843,000 by 2050.

About one in 13 people aged over 40 are thought to have the condition, yet half remain undiagnosed.

At the same time, the Atlas Focus Report: COPD released by the Australian Commission on Safety and Quality in Health Care revealed a 31 per cent drop in spirometry testing between 2015-16 and 2022-23.

Spirometry is a simple breathing test that measures lung function and is considered the gold standard for confirming a COPD diagnosis.

Without it, patients risk being misdiagnosed and prescribed unnecessary or potentially harmful medications.

“Everybody with recurrent shortness of breath, wheeze or cough, and a risk factor like smoking, should talk to their GP about getting a spirometry test,” said Dr Lee Fong, the Commission’s Medical Advisor.

“The Atlas highlights opportunities to improve early and accurate diagnosis, which is essential to ensure people receive the right treatment at the right time.”

Western NSW treatment rates highest in Australia

The report also revealed a worrying trend: as spirometry rates decline, use of complex COPD medications is surging.

The Western NSW Primary Health Network (PHN) covering Dubbo, Bourke, Coonamble, Nyngan and Brewarrina, recorded the highest rate of triple-therapy prescriptions in Australia.

Dust exposure and agricultural work are just two risk factors for Chronic Obstructive Pulmonary Disease.

According to the Commission’s Atlas, 3,765 prescriptions per 100,000 people were dispensed in 2015-16, rising to 8,846 per 100,000 in 2022-23 - more than doubling in just seven years.

These figures refer to the dispensing of triple-therapy medicines (a combination of three inhaled drugs used in severe COPD).

The Commission notes these rates indicate treatment intensity, not prevalence, showing that more people in the region are living with advanced, difficult-to-manage disease.

Respiratory specialist Professor Christine Jenkins, from The George Institute, said people in rural and remote communities often face delayed diagnosis and inconsistent access to care, leaving them reliant on long-term medication or emergency hospital visits.

“Patients often face delayed diagnosis and inconsistent access to specialist treatment, pushing them into hospital time and again,” she said.

A disease of inequity

COPD rates are three times higher in the most disadvantaged areas compared with affluent ones and significantly higher in regional and remote regions.

Dust exposure, smoking, air pollution and agricultural work all contribute to the rural burden.

First Nations people are also disproportionately affected, particularly in regional and remote communities, where structural and socioeconomic disadvantage remains a major health determinant.

“The combination of disadvantage, environmental exposure and limited healthcare access means people in the bush are more likely to live with COPD, and die from it earlier,” said Evohealth Managing Director Renae Beardmore.

Experts say falling spirometry rates and rising use of triple therapy underline an urgent need to refocus on early, evidence-based diagnosis and appropriate prescribing.

“COPD is one of the leading causes of preventable hospitalisations in Australia,” Dr Fong said.

“We now have clear national data showing spirometry use has plummeted, while triple therapy which should be reserved for severe cases has risen dramatically.”

The Commission’s new COPD Clinical Care Standard, released in 2024, outlines steps for improving access to diagnosis, specialist care and treatment consistency across the country.

For regional Australians, experts say, the challenge is ensuring those standards reach the patients who need them most and before a cough becomes a crisis.