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DSU Bulletins

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 Bev Grehan

07 3223 8376

Maureen Anderson

08 8290 0365  (Manager, Adelaide)

Dr Jon Kelley

07 3223 8412

Duncan Cape

07 3223 8757

Sue Lee

08 8290 0227

Gaynor Cavanagh

07 3223 8331

Vicki Saunders

07 3223 8513

SOP BULLETIN

No. 8

9 February, 1998

The Statements of Principles for “chronic bronchitis and emphysema” have now been incorporated into CCPS.

A REMINDER

  • These SOPs revoke and replace the SOPs for chronic airflow limitation (CAL).
  • These SOPs cover CAL (also known as COAD) due to chronic bronchitis and emphysema, as before.
  • In addition, they cover chronic bronchitis and emphysema without airways obstruction.
  • The definitions in the SOPs contain specific requirements that must be met before the SOPs can be applied.

DIAGNOSTIC FEATURES IN CCPS

  • New Diagnostic Protocol:  This is displayed as commentary on the Confirm Diagnosis screen, and can also be viewed in the Research library.  This document explains the diagnostic requirements in detail.  Read it carefully!
  • New Diagnostic Report:  This report is designed to obtain the information generally needed to satisfy the diagnostic criteria.  Note that specialist assessment may be required in some cases.  See the Diagnostic Protocol for further information.

ICD CODING AND DIAGNOSTIC LABEL

Use any of the four or five digit codes beginning 491 or 492 to connect to the SOP rulebase.  Do not use code 496.  CCPS will then refer to the condition as chronic bronchitis and emphysema.  This label should be changed to an appropriate label for the particular case.  The terms chronic airflow limitation and chronic obstructive airways disease may be used.

SOP FACTORS

The following is a brief discussion of the differences between the two SOPs.

Being exposed to airborne irritants

  • This is a new factor which only applies if the claimed condition is chronic simple bronchitis, chronic mucopurulent bronchitis or asthmatic bronchitis.
  • Therefore CCPS will ask a preliminary question to establish whether the claimed condition is one of these types of bronchitis.  If it is not, then the airborne irritant factor will be disabled.
  • The RMA has not defined an airborne irritant.  Therefore whether a particular exposure constitutes an exposure to an airborne irritant will have to be determined by medical opinion in each case.

Smoking

  • The number of pack years required is the same.
  • CCPS does not incorporate the requirement, in cases of chronic simple, chronic mucopurulent or asthmatic bronchitis, that onset [or worsening] must be within one year of cessation of smoking.  This is because there is no cessation requirement in the other smoking factor in the SOP, which applies to all types of chronic bronchitis and emphysema. The RMA have been advised of this.

Being exposed to mustard gas or Lewisite

  • This factor has been altered only by the addition of Lewisite to the wording of the factor.
  • The definition of exposure to mustard gas has always included Lewisite vapours, and CCPS commentary now includes some information about Lewisite.  However, it is extremely unlikely that any veterans were exposed to Lewisite.
  • The requirement for exposure to be in the ten years before onset [or worsening] in reasonable hypothesis cases, and five years for balance of probabilities cases, remains unchanged.

Being exposed to an irritant gas

  • This factor replaces the chlorine gas factor in the Chronic Airflow Limitation SOP. The definition of an irritant gas includes chlorine.
  • The definition of symptoms following exposure to an irritant gas is less stringent than the definition used in the old chlorine factor. There is no requirement for hospitalisation following exposure.
  • The time requirements for balance of probabilities cases have also been changed. The chlorine factor required exposure in the 5 years before onset [or worsening]. The irritant gas factor requires exposure in the one year before onset [or worsening.

the s.m.a.c.c unit will be happy to answer any questions about the way the chronic bronchitis and emphysema sop works in CCPS