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Australian Journal of Pharmacy : October 2006
respiratory health ‘When problems occur all year, they are usually triggered by allergy to house dust mites, pets or mould,’ Associate Pro- fessor Mullins said. While complete allergen avoidance was not usually possible, exposure to common allergens could be reduced with relatively simple measures. (See AJP Vol.87 Sep- tember 2006 for more information.) GORD Patients with GORD were likely to present to the pharmacy with the predominant symptoms of heartburn or acid regurgita- tion. Because patient understanding of the term ‘heartburn’ is variable, the National Prescribing Service (NPS) suggests that FOUNDATION FACTS Bandana Saini, Faculty of Pharmacy, University of Sydney Sleep, health and the role of pharmacists S leep disorders are a significant public health issue. It is estimated that 1.2 million Australians suffer from sleep disorders and costs to the community have been calculated at $10.3bn dollars per year.1 Common sleep disorders include sleep apnoea, insomnia and sleep loss. Obstructive sleep apnoea syndrome affects at least 3 to 5 per cent of the population, and it is estimated that only 20 per cent of affected individuals have been diagnosed or treated.2,3,4 sleepiness and neurocognitive impairment.5 The condition is a source of morbidity from Evidence from epidemiological studies support its association with hypertension,6 events.7,8 as well as fatal and non-fatal cardiovascular Insomnia is another highly prevalent (4 to 20 per cent) sleep problem. South Australian data9 suggest that prevalence of chronic insomnia may be around 5 per cent.This is also reflected in medication usage. Latest PBS data suggests that benzodiazepines and other sedative hypnotics are among the top 20 most frequently dispensed medications.10 Sleep loss is another (poorly recognised) problem with serious sequelae including increased risk of cardiovascular events and serious traffic accidents. Sleep restriction and sleep fragmentation were highlighted as a major cause of drowsy driving by the US National Highway Traffic Safety Administration.11 In Australia, the impact of poor sleep and work-related safety has been much discussed.12 References available on request When evaluating sleep disorders as a risk factor for other diseases, they rank among the top ten in Australia.1 asked about a ‘burning feeling rising up from the stomach or lower chest towards the neck’ may identify GORD more accu- rately. Dr Bosnic-Anticevic said if GORD was a trigger, pharmacists could offer advice on how to avoid triggers, for example: • not eating large or fatty meals or foods which are known to precipitate symptoms (for example chocolate, spices, peppermints); • not eating two hours before lying down or going to bed; • limiting alcohol consumption; and • stopping smoking. Treatment guidelines for GORD rec- ommend a step-down approach, initiat- ing therapy with a proton pump inhibitor. Helping patients cope with COPD According to Dr Reddel, the most com- mon health issues associated with COPD were cardiac disease and peripheral vas- cular disease, diabetes, osteoporosis and eating. ‘People who are breathless with COPD are actually at risk of inhaling food when they eat because they have to hold their breath for long enough to have a proper swallow and get the food out of their mouth before they then take their next breath in,’ Dr Reddel said. She said a speech pathologist was the most appropriate person to help with that as they could teach patients how to co- ordinate breathing and swallowing. ‘With cardiovascular disease, there are The direct healthcare costs of sleep disorders account for only 2 per cent of their estimated economic impact ($10.3bn).1 This suggests that there may be too little investment in the prevention and treatment of sleep disorders. Suggested priority interventions include education and awareness raising, and testing cost-effective prevention, treatment and management options.10 Given the need to deploy these interventions, community pharmacies represent an ideal, yet underutilised, resource for people with sleep disorders. It is believed that many pharmacies already provide services such as the provision of CPAP devices for sleep apnoea, and may operate as ‘specialised’ pharmacies. An undergraduate honours project is currently underway at the University of Sydney to explore the breadth of services offered by ‘specialised’ pharmacists, the future roles they envisage, the resources required to operate effectively and possible barriers to the provision of sleep health services in community pharmacies. This study is being conducted jointly by researchers at the Faculty of Pharmacy, University of Sydney, and the Sleep and Circadian Rhythms Group, Woolcock Institute of Medical Research. The results of the study are expected to guide the development of interventions to test the feasibility of the community pharmacy as an alternative venue for the delivery of care for patients with sleep disorders. 44 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 OCTOBER 2006