Management of respiratory disorders and the pharmacist's role: COPD

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable chronic lung disease characterized by persistent respiratory symptoms and airflow limitation. It is caused mainly by chronic exposure to inhaled irritants, especially through tobacco smoking. COPD is projected to be the 3rd leading cause of death by 2020. More than 3 million people died of COPD in 2012 accounting for 6% of all deaths globally. Exacerbations are a major cause of morbidity and mortality in patients with COPD, with adverse effects on quality of life and lung function. Pharmacists have a key role to play in the prevention, diagnosis, and management of the disease and symptoms. Short-acting and long-acting bronchodilators (beta agonists, muscarinic antagonists) alone or in combination, antiinflammatory agents (oral and inhaled corticosteroids), mucolytics and antibiotics (as required) are central to COPD management. Vaccination (influenza and pneumococcal), pulmonary rehabilitation and patient self-management guided by action plans may reduce the burden of COPD. Pharmacists can be actively involved in delivering smoking cessation interventions, case-finding of COPD (i.e., screening of high risk people with symptoms) using symptom questionnaires and handheld devices, and rationalize COPD management in both primary and secondary care settings by optimizing medicine use by both prescribers and patients.