COPD Counseling Takes Center Stage

Leonard Nimoy’s recent death from end-stage chronic obstructive pulmonary disease (COPD) brought the condition into the spotlight, and may bring patients with questions to the pharmacy counter.

“Some of the issues we have off the bat, when patients are new, is confusion about how to use controller and rescue medications correctly,” clinical pulmonary specialist Wendy Bullington, PharmD, BCPS, adjunct associate professor at the South Carolina College of Pharmacy, told Pharmacy Times in an exclusive interview. “I teach pulmonary rehab, and a lot of patients in that group are using those medications incorrectly a lot of the time.”

Patients may not understand proper inhaler technique or how to use spacer devices, particularly if their physicians did provide explanations. In addition, differences in metered-dose versus dry-powder inhalers fall under the pharmacist’s expertise.

Misconceptions about controller medications can also hinder adherence, particularly when patients expect a noticeable difference in how they feel.

“I like to tell patients that their controller medications are kind of like blood pressure medications. You’re not going to feel an immediate change,” Dr. Bullington said. “I feel like a lot of patients take it, but they don’t feel any different, so they stop. Then, they are using their rescue inhalers a lot more.”

Again, pharmacists can educate patients about their controller and rescue medications, as well the importance of monitoring rescue medication use.

“One of the things you can potentially talk to your patients about and monitor is use of their rescue inhalers,” Dr. Bullington said. “If they’re using certain medications frequently, they may be a good candidate for long-acting medication.”

Cost can also be a concern for patients, since many COPD medications do not have a less-expensive generic alternative, Dr. Bullington said. She counters the cost issue by investigating lower tiers of a patient’s insurance plan for alternate therapies, as well as referring patients to the assistance programs many medication manufacturers offer.

Such patient assistance programs can easily be found on a product’s website, but may require a physician and pharmacist signature, in addition to a W-2 form, Dr. Bullington said.

COPD also places patients at greater risk for flu and pneumonia, making vaccination particularly important in this population, she added.

Pharmacists can also address the most common cause of COPD with their patients: smoking. In fact, Nimoy attributed his condition to the habit, despite quitting tobacco 30 years prior to his death.

“My first strategy for encouraging patients to quit is always ask. Every clinic visit, ask them if they thought about quitting smoking,” Dr. Bullington said. “Every time you ask them, it gives them a chance to say yes, they thought about it.”

That, in turn, can lead to a conversation about cessation strategies and resources that patients might not otherwise find.

Dr. Bullington also recommended that pharmacists stress the advantages of quitting, particularly to younger patients, as it may be the health change that allows them to live longer and prosper.

“You could tell them that, when it comes to lung cancer and COPD, how long you smoke still matters,” she said. “By stopping earlier, it decreases risk, and it improves your lung function…If you don’t, it’s a quicker downward trend.”