ASHP Midyear: Pharmacists Play Key Role in Comprehensive COPD Management, Emphasizing Cost Considerations

Pharmacists play a crucial role in comprehensive chronic obstructive pulmonary disease (COPD) management, said Lourdes Cross, PharmD, BCACP, CDCES, associate professor at the Sullivan University College of Pharmacy & Health Sciences, who emphasized both pharmacological and non-pharmacological interventions. For non-pharmacological approaches, pharmacists should encourage COPD patients, especially those at high risk for exacerbations, to participate in pulmonary rehabilitation programs to improve exercise capacity and self-management. Smoking cessation is also a critical area where pharmacists can provide intensive counseling and recommend pharmacotherapy for better outcomes. Ensuring patients receive appropriate vaccinations is another key responsibility. Pharmacists must also monitor COPD patients for comorbidities like cardiovascular disease and diabetes, adjusting medications as needed and educating patients on managing conditions like osteoporosis and osteoarthritis.

Pharmacy Times: How can non-pharmacological interventions, such as pulmonary rehabilitation and smoking cessation counseling, be incorporated into a comprehensive COPD management plan?

Lourdes Cross: Non-pharm is going to be just as important as our medication therapy, definitely want to encourage pulmonary rehabilitation, especially for our COPD group B and E patients. Those are our high risks for like exacerbation types of patients. So, encouraging a program where we can help increase their exercise capacity, where we can help provide some educational like self management techniques is going to be important. Of course, smoking cessation is going to be one of our biggest areas where we can intervene, so offering that intensive counseling, but also encouraging the use of pharmacotherapy, where we see better outcomes when both are combined, and then, in addition to those 2, making sure these patients receive appropriate vaccinations is going to be key.

Pharmacy Times: How can pharmacists help to manage COPD in patients with comorbidities such as cardiovascular disease, diabetes, or osteoporosis?

Lourdes Cross: So all of those disease states, again, highly prevalent in our COPD population. So, pharmacists can play a key role in various aspects. So you mentioned cardiovascular disease, again, that's a big one that we definitely want to look at closely. One area where pharmacists may intervene is like looking out for drug interactions. So for example, if a patient is on a beta blocker, we want to make sure it's a cardioselective beta blocker, as well as looking at those systems closely, making sure that they're not like destabilizing. For diabetes patients, for example, in those that have an exacerbation, they may be put on systemic corticosteroids, so looking at their blood glucose closely, and making sure that we have a good action plan for those elevations, making sure patients know how to adjust their meds if they need to be adjusted. You also mentioned things like osteoporosis and we gotta think of things like osteoarthritis, making sure they have good bone health, so looking at calcium and vitamin D levels, including bone protective medications, if it's appropriate in the patient, and then being mindful of the devices that they're using if they have forms of arthritis, can they use the device appropriately. So education on appropriate technique is going to be important.

Pharmacy Times: What are the key components of managing acute COPD exacerbations, including pharmacotherapy and non-pharmacological interventions?

Lourdes Cross: In the latest 2025 GOLD report, again, no real big overhaul, especially when it comes to like exacerbation treatments. So we're still going to focus on bronchodilation, and that means increasing the frequency of those short-acting bronchodilators both can use, like inhaler or nebulized devices, kind of depending on the patient's like, complexity and capabilities of using either one. Also, these patients are typically started on a systemic steroid, and so again, we just kind of want to monitor that closely. Typically, the dose is a short-term prednisone of about 5 days, and then whether or not to use antibiotics depends on, like sputum color and volume and dyspnea. So some patients may benefit from that. From a non-pharm perspective, that pos-treatment care is going to be important. So really, giving a lot of education for the patient, again, reviewing that inhaler device technique, also potentially having the patient use like a symptom diary to track like triggers, and providing advice on how to like navigate exacerbations is going to be important.

Pharmacy Times: Is there anything else you would like to add?

Lourdes Cross: Actually, there is one area that is going to be very important, which is going to be cost considerations for these patients. So if a patient can't access the medication, then the best medication in the world is not going to help them, and so we definitely need to be mindful that we are proactive in our discussions with our patients, so making sure that you know if a medication is prescribed, that we go ahead and see if their insurance covers it, or if they're able to afford it before they leave. Because oftentimes I have patients that come months after you know, we've prescribed them a treatment and only to realize they've never been on that inhaler during that entire time. So they're definitely being proactive in our approach, looking out for coupons, patient assistant programs, etc, is going to help. In the summer, 3 big drug companies announced that they are going to cap the cost of inhalers to $35 a month, and so you know that's going to provide, hopefully,some good benefit for these patients who often struggle to afford their inhalers.