35,000 GPs just received a letter about their COPD prescribing

What just happened

This week, 35,000 Australian GPs received a personalised letter from the Australian Commission on Safety and Quality in Health Care (ACSQHC) detailing their own COPD prescribing patterns — alongside national PBS data that puts the picture into context.

The data shows that triple therapy — combining an inhaled corticosteroid (ICS), a long-acting beta-agonist (LABA), and a long-acting muscarinic antagonist (LAMA) — has more than doubled in dispensing volume between 2015-16 and 2022-23. More specifically, only 30% of patients now initiated on COPD therapy are started on dual therapy before escalating to triple. Seventy per cent go directly to the more complex regimen, bypassing the step the COPD-X guidelines specify as the recommended intermediate.

Under COPD-X — the Australian and New Zealand standard for COPD management — treatment follows a stepwise approach. Most patients begin on a single long-acting bronchodilator. Those with ongoing symptoms or who meet criteria for more intensive management move to dual therapy (LABA + LAMA, or in specific circumstances ICS + LABA). Triple therapy is a step-up reserved for patients who continue to exacerbate despite dual bronchodilation, or who have elevated blood eosinophil counts that indicate likely ICS response.

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The both-and

Why this matters beyond guidelines

The problem with bypassing dual therapy is not procedural. It is biological. Inhaled corticosteroids in COPD — unlike in asthma, where they are first-line — are indicated for a specific clinical phenotype: patients with frequent exacerbations, or those with eosinophil counts above thresholds that predict benefit. Outside that phenotype, ICS carries a risk profile that accumulates without proportionate benefit: pneumonia risk, oral candidiasis, and — at high cumulative doses — bone density loss.

When triple therapy is initiated from the outset rather than reserved for step-up, it becomes harder to identify which patients are actually benefiting from the ICS component. The patients who are gaining nothing from ICS continue to be exposed to its risks indefinitely, with no clinical prompt to revisit the decision. The ACSQHC’s intervention is a prompt to revisit it.

Prescribing feedback as a quality tool

The strategy of sending personalised prescribing data to GPs has reasonable evidence behind it for shifting prescribing patterns at population level. The key is personalisation: each GP sees their own data relative to peers, not just a national average. This is more likely to prompt reflection than a guideline reminder because it answers a different question — not “what does the guideline say?” but “is my practice an outlier?”

That said, PBS data captures dispensed medicines, not the clinical rationale behind them. A GP who prescribes triple therapy appropriately — because their patient exacerbates regularly, or has an eosinophil count that predicts ICS response — will appear in the data identically to one who escalated without those indications. The letters provide the aggregate picture; the clinical judgement about what it means for each individual patient belongs to the treating doctor.

What this means for women with COPD

COPD affects an estimated 1 in 13 Australians over 40. Women represent a growing proportion of the burden — historically undercounted because the condition was perceived as a disease of male industrial workers and heavy smokers, while women’s exposure through biomass fuels, occupational risks, passive smoke, and smaller airway anatomy (producing proportionally greater damage from the same exposure) was underappreciated. Women with COPD were also more likely to be misdiagnosed with asthma, leading to late initiation of appropriate bronchodilator therapy.

The prescribing quality conversation applies to COPD patients regardless of sex. But it is a reminder that the condition’s clinical presentation varies by patient, and that the standard stepwise approach — when followed — is designed precisely to match therapy intensity to individual clinical need.

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My two cents

The ACSQHC intervention is a well-designed quality improvement move. National data showing that 70% of patients bypass the recommended intermediate step puts a number on a problem that clinicians and researchers have observed for years: the pressure of complex consultations, guideline fatigue, and the genuine difficulty of explaining step-up therapy to a breathless patient all contribute to reaching for the full regimen early.

For patients currently on triple therapy: this is not a signal to stop any medication without medical advice, and it is not a recall. It is an invitation — at the next GP visit — to review whether all three components remain clinically justified. The questions worth asking: Have I had an exacerbation in the last year that required antibiotics or oral steroids? Has my eosinophil count been checked? Has anyone asked whether I could trial stepping down to dual therapy?

These are clinically reasonable questions. The system is now actively prompting GPs to ask them too.

Verdict: yes — significant national quality initiative backed by PBS data, directly relevant to the 1 in 13 Australians over 40 managing COPD and to GPs weighing ICS indications in a condition where it matters.

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Sources cited

1. 35,000 GPs sent letters on their COPD prescribing as data show 70% of patients skip dual therapy. AusDoc, 24 July 2026. https://www.ausdoc.com.au/news/35000-gps-sent-letters-on-their-copd-prescribing-as-data-show-70-of-patients-skip-dual-therapy/
2. COPD-X Plan: Australian and New Zealand Guidelines for the Management of Chronic Obstructive Pulmonary Disease. https://copdx.org.au