An alarming decline in lung function testing has led to widespread underdiagnosis and undertreatment of Chronic Obstructive Pulmonary Disorder (COPD) in Australia, according to a new report by the Lung Foundation Australia (LFA). The condition affects an estimated 526,000 Australians, yet up to half may be unaware they have it, missing out on crucial early interventions.

COPD, a progressive lung disease that constricts airways and starves the body of oxygen, is a significant health burden in Australia. It ranks as the fifth highest cause of mortality and disease burden, claiming 20 lives daily and costing the nation nearly $25 billion annually in healthcare, support, and lost productivity. The LFA’s report highlights that the disease is “under-recognised, underdiagnosed, [and] undertreated.”

The primary driver of this underdiagnosis is the “alarmingly low” use of spirometry, the gold standard for diagnosing and monitoring COPD. While advised to pause testing during the height of the COVID-19 pandemic due to aerosol risks, testing rates have failed to recover to pre-pandemic levels. Medicare data reveals a staggering 64 per cent drop in spirometry testing in general practice between 2019 and 2025.

This decline means many Australians are diagnosed late, missing the window for the most effective treatments. Early detection through spirometry allows for the prescription of inhalers and vaccinations, significantly reducing the risk of debilitating “lung attacks” that can cause irreversible lung damage. Without timely diagnosis, patients like Bert Wessels, an 83-year-old living with COPD, face a steady deterioration in their quality of life.

General practitioners cite the low Medicare rebate for spirometry as a major disincentive, leaving practices out of pocket by approximately $25 per test, a figure exacerbated by the cost of single-use filters. Dr. Kerry Hancock, chair of the respiratory medicine group at the Royal Australian College of General Practitioners, described the drop in testing as “incredible” and a “false economy.”

The LFA has urged the government to increase the Medicare rebate for spirometry to between $85 and $100 and to invest in upskilling nurses, pharmacists, and First Nations health workers to administer the tests. This call for urgent action aims to reverse the trend of underdiagnosis and ensure more Australians receive the care they need.

In response to the LFA’s report and concerns, Health Minister Mark Butler has been briefed on the underutilisation of spirometry. The Department of Health indicated that the government is considering a 2023 review into the national strategic framework for chronic conditions. However, specific proposals for increasing the Medicare rebate for spirometry are currently the responsibility of the Medical Services Advisory Committee (MSAC), an independent advisory body.

The urgency of the situation is underscored by the fact that the costs associated with undiagnosed and untreated COPD far outweigh the investment required for improved diagnostic practices. Experts agree that a coordinated national approach is essential to address this critical public health issue and improve outcomes for the hundreds of thousands of Australians affected.

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Keywords: COPD diagnosis, lung function tests, spirometry, Lung Foundation Australia, underdiagnosis, undertreatment, Medicare rebate, chronic obstructive pulmonary disorder