Research

Objectives: To review the accuracy of diagnoses of chronic obstructive pulmonary disease (COPD) in primary care in Australia, and to describe smokers’ experiences with and preferences for smoking cessation. Design, setting and participants: Patients were invited to participate if they were at least 40 years old and had visited participating general practice clinics in Melbourne at least twice during the previous 12 months, reported being current or ex-smokers with a smoking history of at least 10 pack-years, or were being managed for COPD. Interviews based on a structured questionnaire and case finding (FEV1/FEV6 measurement) were followed, when appropriate, by spirometry testing and assessment of health-related quality of life, dyspnoea and symptoms. Results: 1050 patients attended baseline interviews (February 2015 – April 2017) at 41 practices. Of 245 participants managed for COPD, 130 (53.1%) met the spirometry-based definition (post-bronchodilator FEV1/FVC < 0.7) or had a clinical correlation; in 37% of cases COPD was not confirmed, and no definitive result was obtained for 9.8% of patients. Case finding and subsequent spirometry testing identified 142 new COPD cases (17.6% of participants without prior diagnosis; 95% CI, 15.1–20.5%). 690 participants (65.7%) were current smokers, of whom 360 had attempted quitting during the previous 12 months; 286 (81.0% of those attempting to quit) reported difficulties during previous quit attempts. Nicotine replacement therapy (205, 57.4%) and varenicline (110, 30.8%) were the most frequently employed pharmacological treatments; side effects were common. Hypnotherapy was the most popular non-pharmacological option (62 smokers, 17%); e-cigarettes were tried by 38 (11%). 187 current smokers (27.6%) would consider using e-cigarettes in future attempts to quit. Conclusions: COPD was both misdiagnosed and missed. Case finding and effective use of spirometry testing could improve diagnosis. Side effects of smoking cessation medications and difficulties during attempts to quit smoking are common. Health professionals should emphasise evidence-based treatments, and closely monitor quitting difficulties and side effects of cessation aids. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.

Jenifer Liang · Michael J Abramson · Nicholas A Zwar · Grant M Russell · Anne E Holland · Billie Bonevski · Ajay Mahal · Kirsten Phillips · Paula Eustace · Eldho Paul · Sally Wilson · Johnson George

Current recommendations to titrate oxygen administration are confirmed

Janine Pilcher · Michael Richards · Leonie Eastlake · Steven J McKinstry · George Bardsley · Sarah Jefferies · Irene Braithwaite · Mark Weatherall · Richard Beasley

Sensitivity to rye grass may predict susceptibility to thunderstorm-related asthma

Michael F Sutherland · Emma Le Portelli · Allison L Collins · Muhammad Aziz Rahman · Christine F McDonald

Priorities include all children aged 2 months–5 years, Indigenous children under 10, and adolescents (15–19 years)

on behalf of the Australian Technical Advisory Group on Immunisation (ATAGI) Meningococcal Working Party

Other factors, particularly rainfall patterns, play more significant roles

James D Stewart · Simon Smith · Josh Hanson

The burden of severe herpes zoster among Indigenous Australians in their 60s is higher than for non-Indigenous Australians

Meru Sheel · Frank H Beard · Aditi Dey · Kristine Macartney · Peter B McIntyre

As the epidemiology of MRSA changes, so must strategies for containing it

Jason W Agostino · John K Ferguson · Keith Eastwood · Martyn D Kirk

Public health campaigns should emphasise the detection of suspicious de novo lesions, as well as of changing lesions

Yan Pan* · Nikki R Adler* · Rory Wolfe · Catriona A McLean · John W Kelly

The burden of skin cancer is particularly high among patients with multiple lesions (about half of all patients)

Nirmala Pandeya · Catherine M Olsen · David C Whiteman

Diagnosing MODY and neonatal diabetes is important because their management (including family screening) and prognosis can differ significantly from those of types 1 and 2 diabetes

Timothy ME Davis · Ashley E Makepeace · Sian Ellard · Kevin Colclough · Kirsten Peters · Andrew Hattersley · Wendy A Davis

Clinical trials in maternal and perinatal health care can be valuable if their findings are adopted in clinical practice

Clarabelle T Pham · Jonathan D Karnon · Philippa F Middleton · Frank H Bloomfield · Katie M Groom · Caroline A Crowther · Ben W Mol

The untapped potential in Australia for DCD, particularly of kidneys and lungs, is significant

Sandeep S Rakhra · Helen I Opdam · Laura Gladkis · Byron Arcia · Michael A Fink · John Kanellis · Peter S Macdonald · Gregory I Snell · David V Pilcher

Joint replacement outcomes do not justify the costs of inpatient rehabilitation for many patients

Justine Maree Naylor · Andrew Hart · Rajat Mittal · Ian Harris · Wei Xuan

The availability and use of cataract services in Indigenous communities must be improved

Joshua Foreman · Jing Xie · Stuart Keel · Peter van Wijngaarden · Jonathan Crowston · Hugh R Taylor · Mohamed Dirani

Fatality rates have been reduced, but greater attention to preventing serious injury is needed

Ben Beck · Peter A Cameron · Mark C Fitzgerald · Rodney T Judson · Warwick Teague · Ronan A Lyons · Belinda J Gabbe

Reducing unnecessary objective testing of patients at low risk of an ACS should be encouraged

Louise Cullen · Jaimi H Greenslade · Tracey Hawkins · Chris Hammett · Shanen O'Kane · Kimberley Ryan · Kate Parker · Jessica Schluter · Emily Dalton · Anthony FT Brown · Martin Than · W Frank Peacock · Allan Jaffe · Peter K O'Rourke · William A Parsonage

An evidence-based accelerated diagnostic protocol achieved significant benefits for both patients and hospitals

William A Parsonage · Tanya Milburn · Sarah Ashover · Wade Skoien · Jaimi H Greenslade · Louise McCormack · Louise Cullen

Improving the rates of diabetes testing could achieve better health outcomes for Indigenous Australians

Christine L Paul · Paul Ishiguchi · Catherine A D'Este · Jonathan E Shaw · Rob W Sanson-Fisher · Kristy Forshaw · Alessandra Bisquera · Jennifer Robinson · Claudia Koller · Sandra J Eades

Rural clinical schools are critical for increasing the proportion of local graduates in the rural workforce

Denese Playford · Hanh Ngo · Surabhi Gupta · Ian B Puddey

Improving early diagnostic strategies is required to facilitate early administration of antivenom

Christopher I Johnston · Nicole M Ryan · Colin B Page · Nicholas A Buckley · Simon GA Brown · Margaret A O'Leary · Geoffrey K Isbister

CLBRs for complete cycles are meaningful estimates of success, reflecting contemporary clinical practice and encouraging safe practice

Georgina M Chambers · Repon C Paul · Katie Harris · Oisin Fitzgerald · Clare V Boothroyd · Luk Rombauts · Michael G Chapman · Louisa Jorm

Antibiotic prescribing in Australian general practice could be substantially reduced

Amanda R McCullough · Allan J Pollack · Malene Plejdrup Hansen · Paul P Glasziou · David FM Looke · Helena C Britt · Christopher B Del Mar

Good pathology test ordering habits need to be instilled early in a GP’s clinical career

Parker J Magin · Amanda Tapley · Simon Morgan · Kim Henderson · Elizabeth G Holliday · Andrew R Davey · Jean Ball · Nigel F Catzikiris · Katie J Mulquiney · Mieke L van Driel

Improving the quality, continuity, and cultural appropriateness of care is also important

Megan Carroll · Matthew J Spittal · Anna R Kemp-Casey · Nicholas G Lennox · David B Preen · Georgina Sutherland · Stuart A Kinner