Structured support in primary care lowers preventable asthma and COPD attacks

Asthma and Chronic Obstructive Pulmonary Disease (COPD) together affect more than 13% of Australians. Yet research consistently shows that many of the most serious flare-ups — the ones that send people to emergency departments or keep them in hospital — are preventable with better management in primary care.

New research co-authored by Institute for Respiratory Health Research Leader Professor John Blakey puts some numbers behind that idea, and the results are encouraging.

The study evaluated the ACAER (Achieving Clinical Audits with Electronic Records) program, developed and delivered by Optimum Patient Care Australia (OPCA). The program works by drawing on patients’ existing electronic health records to identify those most at risk of a serious exacerbation, then prompting GPs to review and adjust their care before things escalate.

Across 21 GP practices and nearly 2,000 high-risk patients, the impact was significant. Monthly exacerbation rates more than halved in the high-risk asthma group following the intervention — dropping from 74.8 to 32.4 per 1,000 patients per month. In the high-risk COPD group, rates fell from 122.9 to 91.2 per 1,000 patients per month. Crucially, these reductions held up over years of follow-up, not just in the short term.

The program also prompted widespread treatment changes. In the first year after the intervention, nearly half of high-risk asthma patients and more than half of high-risk COPD patients had their medications adjusted — changes that appear to have contributed directly to fewer attacks.

Professor Blakey, who is also Head of the Department of Respiratory Medicine at Sir Charles Gairdner Hospital, said the findings reinforced the importance of primary care in managing these conditions well.

“The findings from this study highlight the crucial role of the Australian primary care system for enhancing the care of patients with asthma and COPD. Getting the basics right reduces the harm experienced by individuals from both exacerbations and their treatments, and helps take pressure off stretched emergency care services.”

The research was conducted in collaboration with OPCA and the Observational and Pragmatic Research Institute (OPRI), and published in the Journal of Asthma and Allergy.

Read the full paper here.