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Australian Journal of Pharmacy : December 2005
training system needed to add more value. He noted that Divisions of General Practice in each state had identified the requirements of doctors and provided information to GPs on various health issues. 'Possibly pharmacy needs something similar---perhaps in partnership with Quit Campaigns and Quitlines in each state. Quit Victoria, for instance, is very active in this area. 'Now NRT can legally be sold in super- markets, more needs to be done to pro- mote smoking cessation in pharmacies. NRT companies have indicated they don't want to place these products in super- markets, so the support is there for phar- macy to continue in this role. 'All the research tells us that in order to get the most out of NRT you need some- one to explain the importance of behav- ioral support and resources. Pharmacy is in the perfect position to do this,' Mr Edwards said. Commenting on the trial results, chief investigator for the project, Professor Andrew Gilbert, agreed pharmacy was ideally placed to become more involved in smoking cessation programs in the community. Professor Gilbert, who is a director at the Quality Use of Medicines and Phar- macy Research Centre at the University of South Australia, said a series of recom- mendations was given in a report to the Guild in September. He told the AJP that there were many opportunities for pharmacy to help smok- ers quit the habit, particularly for those people with chronic conditions like heart and respiratory diseases where smoking makes the condition worse. 'Pharmacists are in the position to ask customers if they are smokers and, if they are, refer them to Quitline, which we believe to be a very simple thing to do in community pharmacy practice. We know Quitline is very effective and has good results in terms of smoking cessation. Effectively equipped and incentivised 'This is an outline of one of our recom- mendations to the Guild, but, in order to make them happen, some processes ACCORDING to Professor Matthew Peters, head of thoracic medicine at Sydney's Concord Hospital, 25 per cent of smokers will get 'meaningful' chronic obstructive pulmonary disease (COPD) during their life. And the numbers are rising, he said, because people are living longer and becoming symptomatic. Mortality is increasing too. 'In terms of the major chronic physical disabilities, COPD is the only major disease that is increasing, while strokes and heart attacks are going down,' Professor Peters told the AJP. COPD is long-lasting obstruction of the airways that occurs with chronic bronchitis and emphysema, or both. Professor Peters said more men than women suffer from COPD, reflecting the fact that historically more men have smoked, although it is likely that female smokers are more susceptible than male smokers. And the reason? 'If you look at first-degree relatives, for example, people with emphysema, and look for early onset emphysema, it will be there more commonly in smokers but especially more commonly in women. So there are true genetic factors, particularly for early onset severe emphysema.' Professor Peters said although emphysema and COPD were different manifestations of smoke-related damage to lungs, most patients with COPD would have airways disease and emphysema. 'You very rarely get pure emphysema or pure airways disease---they tend to go hand in glove.' There are no early symptoms for COPD: 'By the time patients develop symptoms it's usually moderately severe because most people are not using 100 per cent of their lung function,' Professor Peters said. People with COPD should stop smoking, get fit through appropriate exercise and rehabilitation programs, and understand the disease, he added. A variety of medications---puffers in the main--- can be helpful in improving lung function, improving exercise capacity and reducing the rate of exacerbations. 'Bronchodilator medications and, for certain people, inhaled steroids are useful and it is important that people understand their medication---ensuring that if they have an inhaler device, they are competent in using it, especially in an older population not necessarily adept with their hands.' He said if people quit smoking before they are 30, they will not get COPD to any clinically meaningful extent. 'Fortunately most people who have COPD quit smoking---in the presence of disease it is generally easier for people to quit. Some people with COPD continue to smoke despite all advice. However, the great majority quit, but the prognosis depends on the level of lung function abnormality at the time of quitting. 'The best way to think of it is that smoking causes accelerated ageing of the lung and once a person stops smoking then the lung ages from then on at the rate everyone's lung ages but from a lower level. However, the accelerated ageing ceases at the point of quitting.' Commenting on the observations that smokers with COPD are likely to be at greater risk of depression Professor Peters said it was a complex issue. 'Smoking causes depression, depression causes smoking and smoking is tightly related to COPD and, like any severe chronic illness, depression can be a complicating factor in COPD.' Smoking and COPD THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 DECEMBER 2005 955