Pharmacists Play Important Role in COPD Management

About 16 million people in the United States have been diagnosed with chronic obstructive pul- monary disease (COPD), a chronic inflammatory lung disease that causes airflow blockage and breathing problems.¹

The COPD National Action Plan was published in 2017 and emphasizes the importance of pharmacists. The plan highlighted 5 ways pharmacists are vital, including analyzing and reporting clinical data; empowering families and patients; improving prevention, diagnosis, treatment, and management; increasing research; and supporting educational and public health efforts.²

COVID-19 CAN EXACERBATE COPD

Based on the evidence, people of any age with certain underlying medical conditions, including COPD, are at an increased risk of getting a more severe case of coronavirus disease 2019 (COVID-19).³

In an interview, Melissa Santibañez, PharmD, BCCCP, assistant professor at Larkin University College of Pharmacy in Miami, Florida, said that patients with severe COVID-19 have more COPD exacerbations.

“The risk [of complications] increases as oxygenation decreases and patients require mechanical ventilation, because then you are faced with simultaneously managing an acute hypercapnic respiratory failure [such as COPD exacerbations] and an acute hypoxemic respiratory failure [such as acute respiratory distress syndrome], both induced by [COVID-19] as the triggering event,” she said.

Pharmacists can improve medication adherence and health outcomes in patients with COPD through medication therapy management (MTM) services, especially during the COVID-19 pandemic, to reducethe risk of serious complications.

Evidence shows that community pharmacistscan play an important role in COPD management by improving inhalation technique and medication adherence.⁴ Proper inhaler technique ensures that adequate drug concentrations reach the lungs, and incorrect technique can result in poor medication adherence.⁴ In fact, up to 85% of patients use their inhalers incorrectly, so it is important for pharmacists to assess this during each MTM consult.^4.5 Reviewing the patient’s medication regimen and providing education during transitions of care can reduce the risk of hospital readmissions.⁵ Because smoking is a common cause of COPD, pharmacists can assist with smoking cessation through counseling and recommending nicotine replacement therapy (see the figure).⁵

One study evaluated the effects of dispensing inhalers to patients with COPD on hospital discharge through a targeted pharmacy program.⁶ Data were collected for the preintervention group, which had hospital orders for the study inhalers, and after implementation of dispensing inhalers on hospital discharge (postintervention group). The study results showed that dispensing inhalers upon discharge was associated with a significant reduction in 30-day readmissions (P= 0.0016) and 60-day readmissions(P = 0.0056).⁶

Using a multidisciplinary health care team is important for COPD management. One study evaluated pharmacists as part of the COPD Coordinated Access to Reduce Exacerbations (CARE) service.⁷ The goal of the COPD CARE service is to reduce 30-day readmissions to the emergency department (ED) or hospital, because of a COPD exacerbation. All veterans receiving primary care through the pilot clinic site with an ED visit or hospital admission for COPD exacerbation were offered the service, and those who declined were provided the standard of care. Patients enrolled in the COPD CARE service met with a pharmacist and nurse within 30 days of discharge, with a target follow-up of 2 to 3 weeks postdischarge. During the consult, the pharmacist provided disease management using evidence-based guidelines and developed a COPD plan to improve health outcomes. The study results showed no COPD hospital readmissions in the COPD CARE intervention group. Additionally, pharmacists adjusted drug therapy 58% of the time and corrected inhaler technique in 52.6% of patients in the COPD CARE service.⁷ This study emphasizes the importance of integrating a pharmacist as part of the health care team for COPD management.

CASE STUDY

EM is a 68-year-old man who was diagnosed with COPD 1 year ago. During a targeted medication review, the pharmacist inquired about his immunization history and discovered that he has never received the influenza or pneumococcal vaccines. The pharmacist discussed the importance of receiving an annual flu shot and explained that people with COPD are at higher risk of influenza complications.⁸ This is especially important because COVID-19 also will likely be circulating this flu season. The pharmacist advised EM to get his flu shot before the end of October and reminded him that it takes about 2 weeks for it to be fully effective from the time that it is administered.⁸ It also is important for EM to get his pneumococcal vaccine because having COPD puts him at higher risk of developing pneumonia.⁸ After the consult, EM said he would get his vaccines, and the pharmacist will follow up when flu shots are available at the pharmacy.

REFERENCES

• US Department of Health & Human Services. COPD. National Institutes of Health. Accessed July 3, 2020. https://www.nhlbi.nih.gov/health-topics/copd
• US Department of Health & Human Services. COPD national action plan. National Institutes of Health. Accessed July 3, 2020. https://www.nhlbi.nih.gov/health-topics/ education-and-awareness/COPD-national-action-plan
• CDC. Coronavirus disease 2019 (COVID-19): people with certain conditions. Updated July 17, 2020. Accessed September 15, 2020. https://www.cdc.gov/coronavi- rus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
• Hesso I, Gebara SN, Kayyali R. Impact of community pharmacists in COPD man- agement: inhalation technique and medication adherence. Respir Med. 2016;118:22- 30. doi:10.1016/j.rmed.2016.07.010
• American Pharmacists Association. Focus on COPD. 2017. Accessed July 4, 2020. https://www.pharmacist.com/sites/default/files/files/APhA_Focus_on_ COPD_012618.pdf
• Blee J, Roux RK, Gautreaux S, Sherer JT, Garey KW. Dispensing inhalers to patients with chronic obstructive pulmonary disease on hospital discharge: effects on prescription filling and readmission. Am J Health Syst Pharm. 2015;72(14):1204- 1208. doi:10.2146/ajhp140621
• Portillo EC, Wilcox A, Seckel E, et al. Reducing COPD readmission rates: using a COPD care service during care transitions. Fed Pract. 2018;35(11):30-36.
• CDC. Lung disease including asthma and adult vaccination. May 2, 2016. Accessed July 7, 2020. https://www.cdc.gov/vaccines/adults/rec-vac/health-conditions/lung-dis- ease.html