The Thoracic Society of Australia and New Zealand
The Thoracic Society of Australia and New Zealand (TSANZ) is the only health peak body representing a range of professions (medical specialists, scientists, researchers, academics, nurses, physiotherapists, students and others) across various disciplines within the respiratory/sleep medicine field in Australia and New Zealand. The TSANZ is a Health Promotion Charity. TSANZ is committed to serving the professional needs of its members by improving knowledge and understanding of lung disease, with the ultimate goals being to prevent respiratory illness through research and health promotion and to improve health care for people with respiratory illness.
10.
Do not perform a serum ACE for the diagnosis or monitoring of sarcoidosis
Sarcoidosis is a multisystemic disease with heterogenous clinical presentations. Diagnosis of sarcoidosis is often challenging because of the lack of reliable biomarkers and other gold standard tests. Unusually high serum angiotensin converting enzyme (ACE) is present in up to 75 percent of untreated patients. However, testing for high serum ACE level has been repeatedly demonstrated to have a poor sensitivity, insufficient specificity (including a false positive rate of around 10 percent) and inconsistent correlation with disease severity. As such, its general clinical utility is limited.
Supporting evidence
- Diagnosis and Management of Sarcoidosis. Natalia Soto-Gomez, md; Jay I. Peters, MD; and Anoop m. Nambiar, MD, University of Texas Health Science Center, San Antonio, Texas Am Fam Physician. 2016 May 15;93(10):840- 850
- Diagnostic Utility of Angiotensin-Converting Enzyme in Sarcoidosis: A Population-Based Study. Ungprasert P, Carmona EM, Crowson CS, Matteson EL Lung. 2016 Feb;194(1):91-5. Epub 2015 Nov 13
- Serum angiotensin converting enzyme in sarcoidosis--its value in present clinical practice. Studdy PR, Bird R Ann Clin Biochem. 1989;26 (Pt 1):13
- Pulmonary sarcoidosis. Baughman RP Clin Chest Med. 2004;25(3):521
How this list was made
In 2018 The Royal Australasian College of Physicians worked with a Lead Fellow nominated by The Thoracic Society of Australia and New Zealand (TSANZ) to review evidence for 12 paediatric thoracic recommendations on low-value care in paediatric thoracic medicine. These recommendations were the subject of email discussions and deliberation by members of the Paediatric Special Interest Group (SIG) of the TSANZ. They were further discussed at a workshop held at a meeting of the Asia Pacific Society of Respirology in 2017, which included TSANZ members. Based on the feedback provided at this workshop and through email discussions with members of the SIG, four were removed and two of the original 12 were considered for inclusion in the final recommendations with overwhelming support. Members of the Paediatric SIG were then invited to choose three out of the remaining six through an email based poll. This served as the basis for final recommendations, which were further refined and developed through successive drafts based on the input of the Lead Fellow, the results of consultation with other specialty groups and the views of the TSANZ Board.
In 2020 TSANZ worked with RACP’s Policy & Advocacy team as part of the Evolve program to develop a long list of low-value practices and interventions that pertain to the specialty. Through extensive research and redrafting under the guidance of the TSANZ Central Office and members of the TSANZ Board, the list was condensed to the top-5 recommendations for reducing low-value practices in adult thoracic medicine. After several rounds of internal consultations and revisions, the list of recommendations was subject to an extensive review process that involved key College societies with an interest in or professional engagement with thoracic medicine.
Per usual processes, the recommendations were then consulted with other medical colleges through Choosing Wisely Australia. Feedback received in the consultations led to further work and refinements by Policy & Advocacy and TSANZ, which approved these top-5 recommendations.
Related recommendations
- 1 Do not prescribe combination therapy (inhaled corticosteroids with long-acting beta2 agonist) as initial therapy in mild to moderate asthma before a trial of inhaled corticosteroids alone.
- 2 Do not prescribe antibiotics for exacerbation of asthma.
- 3 Do not use oral beta2 agonists as bronchodilators in asthma, wheeze or bronchiolitis.
- 4 For children with bronchiolitis without other co-morbidities, do not delay discharge from an inpatient admission based on oxygen saturations alone if saturations are ≥90%.
- 5 Do not delay immunisation/s based on presence of mild respiratory symptoms in the absence of fever.
- 6 Do not perform a D-Dimer in patients at high risk of pulmonary embolism
- 7 Do not use long term systemic corticosteroids for management of chronic obstructive pulmonary disease (COPD)
- 8 Do not initiate maintenance inhalers in minimally symptomatic COPD patients with a low risk of exacerbation
- 9 Do not routinely follow-up solid pulmonary nodules smaller than 6 mm detected in low- risk patients
- 10 Do not perform a serum ACE for the diagnosis or monitoring of sarcoidosis