Home' Australian Pharmacist : October 2011 Contents Vol. 30 -- October #10, 2011
We note, with interest, the excellent
article on compounding (Compounding
takes pharmacy back to its roots in the
21st Century) in the July 2011 issue
of Australian Pharmacist, and have
concerns that the current pharmacy
board requirements for compounding
assessment during the intern year
may actually be promoting the very
practice issues that are highlighted in
Mr Serafin says 'You can't just make
these products on the back bench
of a community pharmacy without
proper equipment and environmental
controls. Pharmacists who do
this risk serious incident', yet our
current requirement for every intern
to undertake the compounding
assessment may be promoting the
notion that compounding on the back
bench of a community pharmacy is
In the Queensland public hospital
system we have established a
centralised manufacturing unit
with appropriate standards and
equipment. It has been a challenge
to conduct the activities for all of our
interns, as our hospital sites do not
routinely extemporaneously prepare
pharmaceuticals and we feel that
the exercise has, in many cases, not
been a good use of time during the
The board's requirement for approval
of compounding pharmacies and the
maintenance of special equipment
seem to be inconsistent with asking
interns to prepare products in working
environments which do not meet
Rather than the requirement for
preparation of products during the
intern year, which in most cases is a
repeat of skills assessed during the
university curriculum, it may be more
appropriate to ensure that tomorrow's
pharmacists are appropriately
appraised of the risks inherent to
compounding, understand that it
is not to be taken lightly and that
appropriate processes and facilities
will be needed.
On behalf of Director of Pharmacy Services
Queensland Health, Qld.
As a pharmacist with a special interest
in respiratory medicine in general and
COPD in particular and as a current
member of The Australian Lung
Foundation's COPD Co-ordinating
committee I read with great interest
COPD: the looming epidemic with
ageing by Professor Gregory Peterson
and Bonnie Bereznicki in Australian
Pharmacist September 2011. I should
like expand on this informative article.
That spirometry is the gold standard
for the diagnosis of COPD1--4 is
unquestioned and yet this test remains
under-utilised in clinical practice.5,6
A number of barriers arise in using
routine spirometry in primary care
settings, and these include equipment
and training costs, low Medicare
reimbursement and low confidence
in use and result interpretation.7--11.
Additionally, aged patients and
respiratorily challenged patients often
find spirometry confronting 12.
In the pharmacy setting I believe that
spirometry would present even greater
barriers. However, recent studies of
COPD screening devices in primary care
settings13,14 offer pharmacy a simpler
alternative. Tests measuring expiratory
volume at one and six seconds may now
be used with confidence to screen but
not diagnose. Two devices -- Vitalograph
copd-6 and the Piko-6 -- have been
approved which measure FEV at one
and six seconds and calculates the FEV1/
FEV6 ratio. Two validation studies 15,16
suggest a cut-off FEV1/FEV6 ratio <0.75
would provide optimal sensitivity for
screening purposes. The ALF is currently
formulating a screening algorithm and
check list for use of these devices by
allied health practitioners including
Secondly, a short discussion with our
respiratory patients explaining the
strong evidence supporting Pulmonary
Rehabilitation17 that is also very
underutilised, would be very beneficial.
5CPA and QCPP emphasise and
provide monetary incentives to
pharmacists to become actively
involved in 'Primary Health Care' and
so I would encourage my colleagues to
embrace these opportunities.
1. Global Initiative for Chronic Obstructive Lung Disease
(GOLD). Global strategy for the diagnosis, management
and prevention of chronic obstructive pulmonary
disease. 2009 update [cited Aug 2010]: Available from:
2. Levy ML, Quanjer PH, Booker R, Cooper BG, Holmes S,
Small I. Diagnostic spirometry in primary care: Proposed
standards for general practice compliant with American
Thoracic Society and European Respiratory Society
Recommendations. Prim Care Respir J. 2009;18:130--47.
3. Fabbri LM, Boschetto P, Mapp CE. COPD guidelines: the
important thing is not to stop questioning. Am J Respir
Crit Care Med. 2007;176:527--8.
4. Soriano JB, Zielinski J, Price D. Screening for and early
detection of chronic obstructive pulmonary disease.
5. Han MK, Kim MG, Mardon R, Renner P, Sullivan S, Diette
GB, et al. Spirometry unitilzation for COPD: How do we
measure up? Chest. 2007;132:403--9.
6. Joo MJ, Lee TA, Weiss KB. Geographic variation
of spirometry use in newly diagnosed COP Chest.
7. Wilt TJ, Niewoehner D, Kim C, Kane RL, Linaberry A,
Tacklind J, et al. Use of Spirometry for Case Finding,
Management of Chronic Obstructive Pulmonary
Disease (COPD). Summary, Evidence Report/Technology
Assessment No. 12 Rockville, MD: Agency for
Healthcare Research and Quality (prepared by the
Minnesota Evidence-based Practice Center) 2005. AHRQ
Publication No.: 05-E017-1, Contract No.:290-02-0009.
8. Johns DP, Burton D, Walters JA, Wood-Baker R. National
survey of spirometer ownership and usage in general
practice in Australia. Respirology. 2006;11:292--8.
9. Lwin AM, McKinley RK. Management of COPD in
primary care in Leicestershire. Prim Care Respir J.
10. Walters JA, Hansen E, Mudge P, Johns DP, Walters
EH, Wood-Baker R. Barriers to the use of spirometry in
general practice. Aust Fam Physician. 2005;135:991--8.
11. Bolton CE, Ionescu AA, Edwards PH, Faulkner TA,
Edwards SM, Shale DJ. Attaining a correct diagnosis of
COPD in general practice. Respir Med. 2005;99:493--500.
12. Bellia V, Sorino C, Catalano F, Augugliaro G, Scichilone
N, Pistelli R, et al. Validation of FEV6 in the elderly:
correlates of performance and repeatability. Thorax.
13. Kaufmann M, Hartl S, Geyer K, Breyer MK, Burghuber
OC. Measuring FEV(6) for detecting early airway
obstruction in the primary care setting. Quality and utility
of the new Piko-6 device. Respiration. 2009;78:161--7.
14. Frith P, Crockett A, Beilby J, Marshall D, Attewell R,
Ratnanesan A, Gavagna G, Simplified COPD screening:
validation of the Piko-6 R in primary care. Prim Care
Respir J. 2011;20:190--8.
15. Melbye H, Medbo A, Crockett A. The FEV1/FEV6 ratio is
a good substitute for the FEV1/FVC ratio in the elderly.
Prim Care Respir J.2006;15:294--8.
16. Vandevoorde J, Verbanck S, Schuermansd, Kartounian
J, Vincken W. Obstructive and restrictive spirometric
patterns: fixed cut-offs for FEV1/FEV6 and FEV6. Eur
Respir J. 2006;27:378--83.
17. David K McKenzie, Michael Abramson, Alan J
Crockett, Nicholas Glasgow, Sue Jenkins, Christine
McDonald, Richard Wood-Baker, Peter A Frith on
behalf of The Australian Lung Foundation. The COPD-X
Plan: Australian and New Zealand Guidelines for the
management of Chronic Obstructive Pulmonary Disease
2011. 2011; Vers 2.26 O6.4.
Letters to the Editor
Letters are invited from anyone
wishing to comment on articles
or issues relevant to pharmacy.
However, any letters judged by the
Editor to be potentially defamatory
will not be published. Letters should
be no more than 300 words long.
They can be emailed to the Editor at
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