Pharmacists are ideally positioned to monitor COPD patients, especially upon refills of their prescription medication. COPD is a chronic and ultimately debilitating condition. Monitoring medication use and disease progress can uncover opportunities for the pharmacist to intervene or refer the patient to his/her physician. Monitoring parameters include:
Prescription medication refill history
Over-the-counter (OTC) cough suppressants and expectorant use
Symptoms
Quality of life
Coping skills
Whether smoking cessation attempts have been successful
Pharmacists can take a disease management approach in helping their COPD patients. Disease management suggestions are provided below:
1.
Explain the COPD disease process and provide educational materials.
2.
Encourage smoking cessation and recommend smoking cessation products if necessary.
3.
Remind patients about the annual influenza vaccination each fall.
4.
Advise patients to avoid or minimize their exposure to the following:
Inhaled irritants known to worsen their breathing (e.g., smoke, exhaust and gas fumes, pollutants, strong perfumes). (Note: Patients should be advised to stay indoors with air conditioning on bad air-quality days.)
Extremes in temperature.
People with respiratory infections (especially children who may have Respiratory Syncytial Virus (RSV)).
5.
Suggest weight reduction if the patient is obese or proper nutrition if the patient is underweight. Refer to a dietician or the Health Canada Food Guide.
6.
Remind patients of the importance of taking certain medication on a regular not an intermittent schedule.
7.
Teach patients how to recognize a COPD exacerbation.
8.
Generally, over-the-counter cough and cold preparations are not recommended for COPD.
OTC cough suppressants should be avoided unless prescribed by a physician.
Expectorants, such as guaifenesin, have no proven usefulness.(45)
9.
Watch for signs of disease progression; use a pharmacy callback system. Refer to the physician if there is a need for reassessment.
10.
Suggest patients see their physician for a Plan of Action that can be used when symptoms become worse. For example:
Which medications to increase
Which medication to add
How to recognize when medications are not helping.
11.
Refer patients to community organizations with COPD programs (e.g., Lung Association).
Referral to specialized pulmonary rehabilitatiion programs that include physiotherapy, nutrition and education can be done via the physician. Signs and symptoms of worsening COPD and general medication use can be the focus of ongoing discussions between pharmacists and their COPD patients.
