Home' Australian Pharmacist : Australian Pharmacist January 2012 Contents 62 Australian Pharmacist January 2012 I ©Pharmaceutical Society of Australia Ltd.
Continuing Professional Development
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
What has research shown to date?
The substantial numbers of people
with clinically significant COPD who are
not diagnosed highlights the need for
targeted strategies to identify those at risk
of COPD. This will enable early detection
of COPD and will also avoid unnecessary
spirometry testing in those with normal
lung function.17,28 The Australian Lung
Foundation supports targeted COPD
screening in the community using COPD
screening devices to identify 'at-risk'
individuals for standard diagnostic
spirometry who are likely to benefit
from early intervention and disease
A Spanish study has shown that risk
assessment of COPD and spirometry
testing by community pharmacists is
feasible.31 Pharmacists were able to
identify high-risk individuals (i.e. those
with respiratory symptoms and/or a
history of smoking) in a population of
primarily middle-aged subjects who
had never been tested for COPD.31
Furthermore, the pharmacists were able to
supervise high quality spirometry testing
in 70% of subjects, finding one case of
airflow limitation for every five individuals
tested, a rate similar to that reported in
the primary care setting.32
A recent pilot study conducted by the
Australian Lung Foundation and The
University of Sydney as part of the Fourth
Community Pharmacy Agreement also
showed that lung function screening in
community pharmacy is feasible and has
been shown to have a positive impact
on early intervention for at-risk patients,
the pharmacist/patient relationship,
and pharmacist awareness of COPD. In
addition to this, the community pharmacist
is accessible and knowledgeable in
pharmacotherapy, and has been shown to
successfully screen, refer and collaborate in
the management of patients with COPD.33
Which at-risk patients may benefit
from risk assessment and screening?
It may be appropriate for pharmacists to
conduct a risk assessment and perform
screening in the following patient groups
aged > 35 years:13
• all smokers and ex-smokers
• patients with a family history of
emphysema or chronic bronchitis
• patients who have had prolonged
exposure to environmental tobacco
smoke, dusts, chemicals, indoor and
• patients with a history of repeated
episodes of bronchitis or respiratory
• asthmatics with a poor response to their
• patients who attribute breathlessness to
ageing or a lack of fitness.
Pharmacists' role in disease
In addition to risk assessment and screening,
pharmacists have a pivotal role in managing
COPD. Once a COPD diagnosis is confirmed
in a patient, it is important that pharmacists
promote the quality use of medicines
and support adherence. This is important
because initially, many patients do not
perceive any benefit when they start using
their inhaled maintenance medications.
Pharmacists should therefore:
• explain the benefits of treatment
• explain what to expect (especially from
long term maintenance treatments)
• explain how to use the medication and
how it is different to other treatments
• provide smoking cessation support
• develop a COPD action plan which
includes annual influenza vaccination
and scheduled pneumococcal
• refer to pulmonary rehabilitation and
support groups where appropriate.
The Australian Lung Foundation has a
number of tools designed for health
care professionals to assist them with
the identification, treatment and
management of patients with COPD.
These include but are not limited to:
• screening flow chart
• instruction sheets for the PiKo-6 and
copd-6 screening devices
• training videos on both the PiKo-6 and
• screening results form for pharmacy.
These tools and more information
are available to download at: www.
Mr Schmidt is a 47-year-old male with
a history of heavy cigarette smoking
and no other significant medical history.
He complains of cough which seems to
improve with each course of antibiotics
taken. His prescription record shows
frequent antibiotic use over the past six
months as follows:
Amoxycillin 500 mg
three times daily
875 mg/125 mg
Salbutamol 200 mcg
Roxithromycin 150 mg
Salbutamol 200 mcg
Roxithromycin 300 mg
Based on his smoking history, chronic
cough and frequent antibiotic use, you
decide to obtain his consent and use
a COPD screening device to determine
whether he is at risk of COPD and should be
referred to his GP.
1. Buist AS, et al. International variation in the prevalence of COPD
(The Bold Study): A population-based prevalence study. Lancet.
2. Lopez AD, et al. Chronic obstructive pulmonary disease: current
burden and future projections. European Respiratory Journal
3. Ward SA, Casaburi R. 21st century perspective on chronic
obstructive pulmonary disease. Respirology. 2001; 68 (6):557--61.
EVIDENCE IN PATIENT CARE
Once a COPD diagnosis is confirmed in a patient, it is
important that pharmacists promote the quality use of
medicines and support adherence.
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