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IntroductionUp to half of all smokers develop clinically significant chronic obstructive pulmonary disease (COPD). Gaps exist in the implementation and uptake of evidence-based guidelines for managing COPD in primary care. We describe the methodology of a cluster randomised controlled trial (cRCT) evaluating the efficacy and cost-effectiveness of an interdisciplinary model of care aimed at reducing the burden of smoking and COPD in Australian primary care settings.Methods and analysisA cRCT is being undertaken to evaluate an interdisciplinary model of care (RADICALS — Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers). General practice clinics across Melbourne, Australia, are identified and randomised to the intervention group (RADICALS) or usual care. Patients who are current or ex-smokers, of at least 10 pack years, including those with an existing diagnosis of COPD, are being recruited to identify 280 participants with a spirometry-confirmed diagnosis of COPD. Handheld lung function devices are being used to facilitate case-finding. RADICALS includes individualised smoking cessation support, home-based pulmonary rehabilitation and home medicines review. Patients at control group sites receive usual care and Quitline referral, as appropriate. Follow-ups occur at 6 and 12 months from baseline to assess changes in quality of life, abstinence rates, health resource utilisation, symptom severity and lung function. The primary outcome is change in St George’s Respiratory Questionnaire score of patients with COPD at 6 months from baseline.Ethics and disseminationThis project has been approved by the Monash University Human Research Ethics Committee and La Trobe University Human Ethics Committee (CF14/1018 – 2014000433). Results of the study will be disseminated in peer-reviewed journals and research conferences. If the intervention is successful, the RADICALS programme could potentially be integrated into general practices across Australia and sustained over time.Trial registration numberACTRN12614001155684; Pre-results.

Background and objective Respiratory symptoms are recognizable to patients and may be markers of chronic disease and mortality risk. This risk may be easier to conceptualize if presented as remaining life expectancy (LE) rather than hazard ratios. We aimed to predict the remaining LE of older people with respiratory symptoms using data from the Australian Longitudinal Study of Ageing (ALSA). Methods The ALSA is a prospective longitudinal cohort of older Australians (n = 2087) with 22 years of follow‐up. The symptoms analysed were cough, shortness of breath (SOB) and wheeze. The implied impact on LE was estimated using a parametric survival function. Results SOB predicted shorter LE irrespective of smoking status. Cough predicted shorter LE in former smokers and wheeze predicted shorter LE in current smokers. The estimated remaining LE of a 70‐year‐old male never smoker with no symptoms was 16.6 (95% CI: 14.8–17.7) years. The years of life lost for a 70‐year‐old male current smoker with cough, SOB and wheeze compared to a never smoker with no symptoms was 4.93 (95% CI: 2.87–7.36) years with only 2.99 (95% CI: 1.35–4.97) years being attributed to their current smoking and the remainder to their respiratory symptoms. Conclusion Respiratory symptoms predict mortality in older people. Cough in former smokers, wheeze in current smokers and all those with SOB require further investigations and disease‐specific management.

Purpose Spirometry is necessary to confirm COPD, but many patients are diagnosed based on clinical presentation and/or chest x-ray. There are also those who do not present to primary care for case finding and remain undiagnosed. We aimed to identify: (a) factors that are associated with undiagnosed COPD; and (b) factors that are associated with a potential misdiagnosis of COPD. Patients and Methods This analysis used data from the Burden of Obstructive Lung Disease (BOLD), a cross-sectional study of community dwelling adults randomly selected from six study sites, chosen to provide a representative sample of the Australian population (n= 3357). Participants were grouped by COPD diagnostic criteria based on spirometry and self-reported diagnosis. Odds ratios for predictors of undiagnosed and misdiagnosed were estimated using logistic regression. Results Of the BOLD Australia sample, 1.8% had confirmed COPD, of whom only half self-reported a diagnosis of COPD. A further 6.9% probably had COPD, but were undiagnosed. The priority target population for case finding of undiagnosed COPD was aged ≥60 years (particularly those ≥75 years), with wheezing, shortness of breath and a body mass index (BMI) <25kg/m 2 . The priority target population for identifying and reviewing misdiagnosed COPD was aged <60 years, female, with no wheezing and a BMI ≥25kg/m 2 . Conclusion Challenges continue in accurately diagnosing COPD and greater efforts are needed to identify undiagnosed and misdiagnosed individuals to ensure an accurate diagnosis and the initiation of appropriate management in order to reduce the burden of COPD.

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