Australia is facing a silent but growing health crisis, with hundreds of thousands of people potentially living with undiagnosed or undertreated chronic obstructive pulmonary disease (COPD), according to a new report endorsed by Lung Foundation Australia (LFA).
The report warns that failures in diagnosis and early treatment are costing lives, overwhelming the health system and condemning patients to avoidable suffering.
For 83-year-old Bert Wessels from Hervey Bay in Queensland, everyday life has become a test of endurance. Walking just 22 steps to his car leaves him gasping for breath. Simple tasks such as dressing, making the bed or meeting friends require long pauses to recover. Bert was diagnosed with COPD at 71, but says earlier detection could have spared him years of worsening lung damage and repeated “lung attacks”.
COPD is a progressive disease in which lung tissue and airways become damaged and constricted, starving the body of oxygen. It is already the fifth leading cause of death and disease burden in Australia, responsible for around 20 deaths every day. Health modelling by Evohealth estimates COPD costs the Australian economy $24.98 billion annually, factoring in healthcare costs, disability support, lost productivity and reduced life expectancy.
Yet despite its impact, the Evohealth report found that up to 50 per cent of Australians with COPD may not even know they have the disease. The report, launched in Parliament and endorsed by the Lung Foundation, describes COPD as “under-recognised, underdiagnosed and undertreated”.
Professor Christine Jenkins, a respiratory medicine specialist at the University of New South Wales and a contributor to the report, said urgent action is needed.
“We have every reason to be very concerned,” she said. “The disease is under-recognised, underdiagnosed and undertreated. Australia is not doing well.”
Collapse in lung testing after COVID
Central to the problem is the dramatic decline in the use of spirometry, a simple lung function test that measures how much air a person can breathe in and out. Spirometry is considered the gold standard for diagnosing and monitoring COPD.
During the COVID-19 pandemic, spirometry testing was suspended in general practice due to fears that exhaled aerosols could spread infection. Although guidelines were updated in 2020 to allow testing to resume with appropriate filters, testing rates have never recovered.
Medicare data shows that spirometry testing in general practice fell by 64 per cent between 2019 and 2025. The report warns that this collapse means COPD is frequently detected too late, when lung damage is already irreversible.
Early diagnosis allows doctors to prescribe inhalers, vaccinations and lifestyle interventions that can significantly reduce flare-ups and slow disease progression. Without early treatment, repeated infections and pollution-triggered attacks permanently scar the lungs.
Bert Wessels says his own condition worsened dramatically after a bout of pneumonia. “None of the breathing devices help anymore,” he said. “It just gets worse and worse.”
Medicare rebates blamed for failure
Medical leaders say low Medicare rebates are a major reason spirometry testing remains rare in GP clinics. The rebate for a diagnostic spirometry test is currently $40, leaving practices around $25 out of pocket once staffing and equipment costs are factored in. Mandatory single-use filters further increase losses.
Dr Kerry Hancock, chair of the respiratory medicine group at the Royal Australian College of General Practitioners, described the situation as “unacceptable”.
“When you see a 64 per cent drop in GP-billed services, it’s incredible,” she said. “It’s a false economy not to diagnose COPD early.”
Government under pressure
Lung Foundation Australia chief executive Mark Brooke raised the issue directly with Health Minister Mark Butler at the report’s launch. The Foundation has called for Medicare rebates for spirometry to be increased to $85–$100, and for nurses, pharmacists and First Nations health workers to be trained to administer the test.
While the Department of Health says it is reviewing the national strategy for chronic conditions, no application to increase spirometry rebates is currently under consideration.
For patients like Bert, the debate feels painfully abstract.
“You live with it. You manage it as best you can,” he said. “But it just keeps getting worse.”
