Respiratory presentations contribute greatly to the burden of disease and are common presentations in Australian general practice. For children aged 0–14 years, the most common presentation to general practice is acute upper respiratory tract infections (URTIs). Eleven per cent of the population live with asthma, and 33% or these people use daily medication to manage their symptoms.1 A further 2.5% of the Australian population have chronic obstructive pulmonary disease (COPD)2 and lung cancer is the fifth most common cancer in Australia and a leading cause of cancer death.3 Early diagnosis of lung cancer leads to better survival outcomes.4 In addition, pandemic influenza and COVID-195 have added to the burden6 of respiratory presentations.
There are many factors that influence respiratory disease, these include the social and environmental determinants of health and geographical location, with rural and remote people having higher rates of prevalence than those living in urban areas.7 As such, general practitioners (GPs) in rural and remote communities may choose to undertake additional training relevant for their location. Those at increased risk of respiratory conditions include people with compromised immunity, pregnant women and Aboriginal and Torres Strait Islander peoples who have a higher burden of morbidity/mortality from respiratory disease.8
Respiratory illness outbreaks are common and can occur seasonally as happens with respiratory syncytial virus (RSV) and influenza. Climate change has impacted respiratory health through conditions such as bushfire smoke inhalation disease and thunderstorm asthma. Bushfire smoke inhalation disease leads to a significant increase in hospital presentations.9 Environmental sustainability initiatives in healthcare can have positive impacts, including the development of chlorofluorocarbon (CFC) free inhalers.10
Managing acute respiratory presentations requires skills in recognising the patient who needs hospital admission or those who can be managed at home. Discerning this can be challenging, especially in children. The COVID-19 pandemic has highlighted the public health considerations in managing acute respiratory illness. It has influenced practices with the increased use of telehealth, the added challenge of managing large-scale vaccination programs, screening for illnesses with a focus on prevention of spread, as well as the safe use of personal protective equipment and considerations about how best to protect clinic staff.
Chronic respiratory conditions, including asthma, COPD, bronchiectasis, cystic fibrosis and lung cancer, require management that considers physical, social and psychological impacts of illness. Asthma, COPD and bronchiectasis management guidelines and asthma action plans are advances in best practice management. Demonstration of correct use of inhaler devices and spacers is essential to the management of asthma and COPD. Ninety per cent of asthma patients use their inhaler devices and spacers incorrectly, increasing their risk of hospitalisation by 50%.11 The ability to interpret spirometry is important for GPs in the diagnosis of respiratory illness.
Public health approaches to respiratory disease management include disease exclusion times and vaccination schedules. Vaccination may be a consideration for groups beyond the individual, for example, the vaccination of adults in contact with babies to reduce the risk of pertussis.
In the prevention of respiratory disease, attention to factors such as smoking, consideration of current/past occupation and vaccinations are important. The GP requires skills in communication and motivational interviewing to avoid being judgemental and to provide compassionate support.