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A role for pharmacists is emerging in chronic obstructive pulmonary
disease (COPD) screening and management.
Pharmacists from community and hospital
practice and pharmacists conducting Home
Medicines Reviews (HMRs) and Residential
Medication Management Reviews (RMMRs)
can all participate in screening and
Screening for COPD is important as
most people with the disease do not
become aware of symptoms until the
disease has progressed significantly.
Early identification and subsequent
appropriate management can lead to
a reduction in the rate of deterioration,
reduce and prevent symptoms,
decrease the frequency and severity of
exacerbations, improve quality of life,
and prolong survival.
are small and portable and can be used
in many environments such as the
community pharmacy and during HMRs.
Devices, such as the Piko-6, measure
FEV1/FEV6 to determine the patient’s risk
of COPD. FEV
is the forced expiratory
volume in the first second of expiration
and FEV6 is the forced expiratory volume
in the first six seconds of expiration.
Use of the Piko-6 meter is a screening
process only and is not diagnostic.
Diagnosis of COPD requires confirmation
Managing COPD is an area particularly
suited to assessment by pharmacists
conducting HMRs. I have found that
many patients do not really understand
what COPD is. They often speak about
seeing a relative or friend who has
required oxygen and it is easy to see the
fear they have of becoming this person.
Explain that each patient can take steps
to manage their condition which may
prevent or delay the need for measures
such as oxygen therapy.
During an HMR visit for a patient with
COPD, pharmacists should firstly assess
their understanding of the disease, as
this provides a foundation on which to
build and educate upon. They should
also ensure that they understand
the purpose of their medications.
Lack of knowledge about COPD and
medications for its management may
have a significant impact on adherence
The pharmacist can assess
patient adherence through the patient
dispensing history, assessing how much
medication a patient has at home and
the dates it was dispensed, and through
tools such as the 4-item Morisky score.
This score is based on four questions,
with each ‘yes’ answer scoring one point.
Patients who score two to four points
are considered to be non-adherent to
The questions in the 4-item Morisky
1. Do you ever forget to take your
2. Are you careless at times about
taking your medicine?
3. When you feel better do you
sometimes stop taking your
4. Sometimes if you feel worse when
you take the medicine, do you stop
The available medications for COPD
provide different benefits. For instance,
tiotropium improves shortness of breath,
improves quality of life and reduces the
number of exacerbations, while inhaled
corticosteroids reduce the number of
exacerbations. Explaining this to the
patient may provide further motivation
for adhering to therapy.
A role in managing COPD
BY KATIE HAYES
During an HMR, inhaler technique should
be assessed. Where applicable, the use
of a spacer should be recommended.
The pharmacist should ensure that the
patient can generate enough effort
for inspiration to obtain their dose
from breath-activated devices and dry
An important factor in managing COPD is
smoking cessation. Up to 90% of patients
with COPD in developed countries
have a history of cigarette smoking.
Smoking cessation is the most effective
means to slow disease progression and
reduces the rate of decline in FEV1 in
The stages of change
model can be a useful way to assess
patient willingness to quit smoking.
The pharmacist may be able to remove
patient barriers, such as cost of therapy,
by explaining that nicotine replacement
products are available on the PBS, and
also recommend support measures for
It is common practice for pharmacists
to assess the vaccination status of
patients during HMRs, and this is
particularly useful when applied in the
context of COPD. The Global Initiative for
Chronic Obstructive Pulmonary Disease
recommends vaccinations according to
In Australia, influenza
vaccine is recommended for patients with
COPD,8 and there some is evidence that
it reduces the number of exacerbations
experienced by patients with COPD.9
Pneumococcal vaccination is also
recommended in Australia for patients at
risk of pneumococcal disease.
Pharmacists play an important role in
COPD screening and management in a
variety of situations including medication
management reviews and in community
pharmacy and hospital practice,
providing a good opportunity to have a
positive effect on the health outcome of
patients. COPD training is available from
the Lung Foundation.
Katie Hayes is an accredited pharmacist and manager
of Risdon Vale Pharmacy in Southern Tasmania. She is
the 2013 PSA Young Pharmacist of the Year.
References are located on page 74.
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