CCPS_Bull006

The Statements of Principles Monitoring, Aetiology and CCPS Commentary Unit

4th floor AMP Place, 10 Eagle St Brisbane Qld 4000.

Facsimile: 07 3223 8722.  email: smaccu@powerup.com.au

Bob Connolly	07 3223 8325  (Manager, Brisbane)	Dr Jon Kelley	07 3223 8412
Maureen Anderson	08 8290 0365  (Manager, Adelaide)	Sue Lee	08 8290 0227
Duncan Cape	07 3223 8757	Jan Ryan	07 3223 8393
Gaynor Cavanagh	07 3223 8331	Vicki Saunders	07 3223 8513
Dr Bev Grehan	07 3223 8376

SOP BULLETIN #6

14 January, 1998

Chronic Bronchitis and Emphysema SOPs

Feedback received by the SMACC unit indicates that these SOPs are causing confusion to some users.  The following notes and accompanying flow chart are an attempt to clear up that confusion.

1.(a)The SOPs cover all smoking-related lung disease, i.e.:

(i)chronic bronchitis

(ii)emphysema

(iii)combined chronic bronchitis and emphysema

(iv)obstructive airways disease due to chronic bronchitis and/or emphysema

(b)Category (iv) includes the following terms:

(i)chronic airflow limitation (CAL)

(ii)chronic obstructive airways disease (COAD)

(iii)chronic obstructive lung disease (COLD)

(iv)chronic obstructive pulmonary disease (COPD)

(c)Any one of these terms may be used as the diagnostic label for the claimed condition (as appropriate).  It is not necessary to restrict the diagnosis to only the terms “chronic bronchitis” and “emphysema”.

(d)The only exception to note is that obstructive airways disease due to asthma, bronchiectasis or extrinsic allergic alveolitis is not covered by these SOPs.

2. (a)Four types of chronic bronchitis are specified in the SOPs.  For practical purposes, in order to apply the SOPs, it is necessary to distinguish only two types:

(i)chronic bronchitis with obstruction

(ii)chronic bronchitis without obstruction

(b)Type (i), chronic bronchitis with obstruction, is present if the cough and sputum definition in the SOPs is met and the spirometry standard for FEV1 and FEV1/FVC in the SOPs is also met.

(c)Type (ii), chronic bronchitis without obstruction, comprises chronic simple bronchitis, chronic mucopurulent bronchitis and chronic asthmatic bronchitis.  This type is present if the cough and sputum definition in the SOPs is met and the spirometry standard in the SOPs is not met.

(d)If type (ii) is present the airborne irritants factors in the SOPs apply, otherwise they do not.  [Note that the smoking factors in the SOPs applying to chronic bronchitis without obstruction, 5(a)(ii) and 5(a)(iv) are redundant and can be ignored.]

(e)It is not necessary to specify the subtype of chronic bronchitis for the purposes of diagnosis.  Simply diagnose chronic bronchitis, identify if it is obstructive or not, then apply the SOPs accordingly.

3. INVESTIGATION FOR DIAGNOSIS

(a) Specialist assessment will not be warranted for diagnosis in the great majority of cases.  Most cases that are covered by the SOPs will meet the spirometry standard for FEV1 and FEV1/FVC.  Most of the remaining cases that are covered will meet the cough and sputum definition.

(b)To investigate:

• Obtain spirometry results and the cough and sputum history. 
• If either the spirometry standard and/or the cough and sputum definition are met then diagnose as appropriate and apply the SOPs.
• If both the spirometry standard and the cough and sputum definition are not met there are three options:

(i)if you have some available evidence of small airways obstruction (FEF25-75 ≤ 85% predicted), or impaired diffusing capacity (significantly reduced DLCO or DCO) then you will need specialist assessment to establish the appropriate diagnosis. [Note the availability of such results alone is not sufficient for diagnosis.]

(ii)if you have no such evidence consider whether any other respiratory condition not covered by the SOPs is present: discuss with a medical adviser and diagnose (or investigate) as appropriate.

(iii)if neither (i) nor (ii) applies diagnose “No Incapacity Found” (NIF).

(c)A new Diagnostic Report that will request the information needed to apply the above procedure will be generated by CCPS, once these SOPs are incorporated.  For interim use, a copy of that new Diagnostic Report accompanies this Bulletin.