The role of pharmacists in helping patients breathe better



Pharmacists have the potential to make a positive impact by screening patients, providing counseling, encouraging beneficial interventions, and helping to tailor patient regimens to individual needs.

More than 16 million Americans suffer from chronic obstructive pulmonary disease (COPD) and it is the fourth leading cause of death in the United States.1.2 Psychiatric disorders, activity limitations and complications from infection are all significant barriers within this patient population. Millions of emergency department visits and thousands of hospitalizations are linked to COPD, dramatically increasing the economic burden.1

Keys to managing COPD include smoking cessation, pharmacological therapy, preventive measures, and oxygen therapy.3. Medication adherence in patients with COPD ranges from 20 to 60% in field studies, and 54% of patients have poor inhalation technique.4.5 Many factors are important in finding the right treatment for the patient: type of inhaler and technique required; number of inhalations per day; and affordability.1.3 Pharmacists can help improve patient control of COPD and minimize complications.

Timely diagnosis of COPD leads to early intervention, in which pharmacists can play a vital role.2 The increase in spirometry tests leads to a faster diagnosis, leaving room for early interventions by pharmacists and a better quality of life.2.6 A health center study found that referrals for spirometry tests were significantly higher in the pharmacist’s intervention clinic compared to the control clinic (47.2% vs. 7.7%).6 Another study of physician-recommended patients showed that spirometry testing performed by pharmacists improved patient comfort, led to rapid diagnosis, optimized treatment regimens, personalized training plans, and improved patient care. better long-term management.7 Targeting patients in community pharmacies with frequent symptoms and reliever inhaler refills may lead to increased recommendations for diagnostic tools.2 A study comparing 2 community pharmacies (1 control group and 1 pharmacist intervention group) showed that when pharmacists target patients using high doses of steroids and antibiotics, treatment regimens are improved by initiating treatment and making the necessary adjustments.8

Counseling pharmacists in multiple settings has shown superior results in patients with COPD. Education that improves outcomes includes disease status, inhaler technique, medication adherence, and self-management through lifestyle changes. An outpatient study evaluating different methods of teaching inhaler technique showed that direct instruction from the pharmacist resulted in an inhaler technique that was much more accurate than reading the leaflet (72.2% against 16.7%). In addition, direct instructions from the pharmacist elapsed between watching videos (11.1%) or reading videos combined with reading the leaflet (16.7%).9

Pharmacist involvement can also reduce the need for acute care. One study found that advice from pharmacists in ambulatory care clinics, including a personalized action plan instructing patients to initiate certain treatments in the event of an exacerbation, reduced emergency room visits and exacerbations by 50%. hospitalizations approximately 60% (p = 0.02; p = 0.01).ten Another study evaluating the impact of 2 counseling sessions by community pharmacists 1 month apart showed a 72% decrease in hospitalizations (p = 0.003).11 It should be noted that the counseling factors consistently included a focus on treatment adherence and technique, which underscores the importance of including these components when counseling patients with COPD. Membership can be bolstered by pharmacists suggesting combination products, generic options, and patient assistance programs as they are the primary resource for patients when it comes to addressing affordability issues.2

Managing antibiotics in acute exacerbations of COPD is becoming an increasingly important responsibility for pharmacists as rates of antibiotic resistance continue to rise.12 One of the most common causes of COPD exacerbations is respiratory tract infections. Clinical guidelines recommend the use of antibiotics when cardinal symptoms (increased sputum purulence, increased sputum production, dyspnea) are present; however, a review of prescribing patterns in 2 large academic centers showed a 75% rate of inappropriate antibiotic use, the most common being fluoroquinolones (58.7%).12 Pharmacists can educate providers about appropriate indications for antibiotics, avoiding unnecessary antibiotics, choosing an appropriate agent, and de-escalating treatment.12

Facilitating and encouraging smoking cessation is another essential duty of the pharmacist. Smoking cessation is the main modifiable risk factor for COPD and the only proven way to slow the progression of the disease.3.13 The benefits of smoking cessation on the progression of COPD are measurable during the first year of abstinence. After several years, the rate of decline in lung function becomes similar to that of individuals who have never smoked, which is evidenced by a reduced risk of hospitalization and total mortality.13 Pharmacists may recommend personalized over-the-counter nicotine replacement therapy or pharmacological interventions to help achieve and maintain withdrawal while minimizing potential side effects.2

Finally, as the primary vaccine supplier, it is the pharmacist’s responsibility to ensure that patients with COPD receive their pneumococcal, COVID-19 and annual influenza vaccine, as COPD patients are at high risk for complications. of these infections.3.14.15 For example, in a study of geriatric COPD patients followed for 3 influenza seasons, when influenza and pneumococcal vaccines were given simultaneously, the reduction in pneumonia hospitalizations (63%) and deaths (81%) was greater than for either vaccine.15

The month of November is known to encourage awareness of COPD. Pharmacists have the potential to make a positive impact by screening patients, providing counseling, encouraging beneficial interventions, and helping to tailor patient regimens to individual needs. The increase in these interventions by pharmacists could be a breakthrough in the management of COPD, which should be a major priority for our profession.

THE REFERENCES

  1. Centers for Disease Control (CDC). Chronic obstructive pulmonary disease. 2021.
  2. Bluml BM. White Paper on Expanding the Role of Pharmacists in Chronic Obstructive Pulmonary Disease. J Am Pharm Assoc. 2011; 51 (2): 203-11.
  3. Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD). Report on the Global Strategy for the Diagnosis, Management and Prevention of COPD. 2020.
  4. Bengston LGS, Bancroft T, Schilling C. et al. Development and validation of a drug adherence index for COPD. J Manag Care Spec Pharm. 2021; 27 (2): 198-209.
  5. Sanaullah T, Khan S, Masoom A. et al. Technique of inhaler use in patients with chronic obstructive pulmonary disease: mistakes, practices and obstacles. Curéus. 2020 Sep; 12 (9).
  6. Whitner JB, Mueller LA, Valentino AS. Pharmacist-led spirometric screening to target high-risk patients in a primary care setting. J Prim Care Community Health. 2019; 10: 2150132719889715.
  7. Hudd TR. Emerging role of pharmacists in the management of patients with chronic obstructive pulmonary disease. Am J Health Syst Pharm. 2020; 77 (19): 1625-30.
  8. Ottenbros S, Teichert M, de Groot R. et al. Pharmacist-led intervention study to improve drug therapy in asthma and COPD patients. Int J Clin Pharm. 2014; 36: 336-344.
  9. Axtell S, Haines S, Fairclough J. Effectiveness of different methods of teaching proper inhalation technique: the importance of pharmacist advice. J Pharm Pract. 2017; 30 (2): 195-201.
  10. Khdour MR, Kidney JC, Smyth BM, McElnay JC. Clinical pharmacy-led disease and medication management program for patients with COPD. Brother J Clin Pharmacol. 2009; 68 (4): 588-98.
  11. Tommelein E, Mehuys E, Van Hees T, et al. Efficacy of pharmaceutical care for patients with chronic obstructive pulmonary disease (PHARMACOP): a randomized controlled trial. Brother J Clin Pharmacol. 2014; 77 (5): 756-66.
  12. Dietrich E, Klinker KP, Li J et al. Management of antibiotics for acute exacerbation of chronic obstructive pulmonary disease. Am J Ther. 2019; 26 (4): 499-501.
  13. Wu J, Sin DD. Improving patient outcomes with smoking cessation: when is it too late ?. Int J Chron Obstruct Pulmon Dis. 2011; 6: 259-67.
  14. Arabyat RM, Raisch DW, Bakhireva L. Influenza vaccination for patients with chronic obstructive pulmonary disease: implications for pharmacists. Res Social Adm Pharm. 2018; 14 (2): 162-69.
  15. Nichol KL. The additional benefits of influenza and pneumococcal vaccinations during influenza seasons in older people with chronic lung disease. Vaccine. 1999; 17 Suppl 1: S91-S93.


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