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Australian Journal of Pharmacy : May 2008
ProfessionAl feATure | resPirATory cAre patients, through simple remedies, can be free of asthma symptoms and asthma disability. He said when control of asthma was surveyed in Europe, North America, Asia, Australia and Latin America it was discovered most patients, suffered needless disability: ‘Symptoms don’t get reported to doctors; doctors don’t go probing for symptoms. The disease is under-treated. unnecessAry disAbility ‘There is a real parallel in COPD with more disability than necessary. Patients should be aware that comprehensive therapies are available. This could be a vital role for the pharmacist. ‘If the patient is bringing in repeated antibiotic scripts for bronchitis and taking inhalers for COPD the pharmacist can advise the patient to talk to their GP. They could be on two inhalers, not one, for more effective control of COPD. ‘Pharmacists can help facilitate communications between the patient and the GP.’ In Canada, he said, pharmacists are trying out compliance reminders with one of the larger pharmacy chains calling patients when their prescriptions run out. ‘This certainly helps in the comprehensive treatment of diseases like asthma and COPD.’ As to the safety of therapies, Professor Chapman said inhaled drugs generally appear to be very safe. ‘Tiatropium has a number of minor side effects like dry mouth. A recent FDA review of clinical trials of tiatropium, however, found an excess incidence of stroke in tiatropium–treated patients compared to placebo–treated patients. ‘At this early stage no-one knows what this means. It may be random, it may be relevant. We will keep looking at this.’ Peter Holder, community The AusTrAliAn journAl of PhArmAcy vol. 89 mAy 2008 46 Pharmacists wanted for spirometry trial The Australian Lung Foundation is in the process of recruiting community pharmacists to participate in a 15-month pilot program to improve diagnosis of COPD. Supported by funding from the Fourth Community Pharmacy Agreement, the trial is taking place in the Newcastle and Hunter Valley region. Fifteen pharmacies will be recruited in the area to work with local GPs to help identify at-risk patients, particularly, those older than 35 with a smoking history who are chronic asthmatics. COPD is under-diagnosed with many people mistakenly believing As well as a reminder about influenza vaccine, ensure they are vaccinated against pneumococcal disease and suggges they have asthma when in fact they have COPD, said Heather Allan, executive director, COPD programs at the Foundation. ‘Pharmacists see at-risk patients regularly, either for asthma medications or a variety of other reasons, and are in a unique position to identify chronic asthmatics or those with breathlessness,’ Ms Allan told the AJP. These people will be invited to take a one-minute screening test using a small electronic spirometer called the PiKo-6. The device calculates if air from the lungs is appropriate to weight, height and age, and can detect a bronchial obstruction. This is when the pharmacist and National Asthma Council board member, said pharmacy’s role, like many others, is complementary to the management of COPD disease with the patient’s GP. This includes support with medication regimens and helping them understand how to use inhaler devices correctly. ‘People won’t get sufficient benefit if don’t know how to use the device properly. A lot of people with COPD are elderly and may need extra help. In some cases, where patients are not able to use these devices, we recommend they talk to their GP about using something else.’ winter chAllenges As to vaccinations, Mr Holder said people with COPD are at high risk of pneumonia. With winter approaching it was important for pharmacists to be alert, particularly in the COPD age group where people were more vulnerable to infection and at high risk of complications. ‘As well as a reminder about influenza vaccine ensure they are vaccinated against pneumococcal disease and suggest they discuss this with their GP. It is a good pharmacist can suggest the patient see their GP for a complete diagnosis. If COPD is diagnosed the pharmacist will be notified and paid for three follow– up visits with the patient to complement the GP’s management. The pharmacist will check medication compliance, encourage participation in pulmonary rehabilitation and ,where necessary, provide patients with access to smoking cessation interventions. Following this, the patient will be assessed to see if their management has improved to guideline standards. Pharmacists in the Newcastle/Hunter Valley interested in participating in the program can phone the Foundation on 1800 654 301. The recruitment campaign was due to begin now. idea to bring the benefit of both vaccinations to their attention. ‘A lot of COPD patients and asthmatics will present to pharmacy for OTC remedies such as cough, cold, allergy and flu symptoms. It is important to take their disease state into context. ‘Quitting smoking is something we can always encourage. It is never too late to quit, but it can be hard for many who have smoked nearly all their life. I have seen patients with advanced COPD who have quit. Sometimes forcibly after being hospitalised.’ Mr Holder said it was good advice for patients in this category to have back-up scripts for antibiotics and steroids. ‘Many patients would be aware that when they become symptomatic to have a script available at a time when they cannot get to a doctor. This is something pharmacy too should be aware of. When the patient comes to the pharmacy with a cough and a cold and we know they have COPD we can ask if they have a script for an antibiotic or inquire if the GP has given instructions on what action to take if they get a cold,’ Mr Holder said. n