Introduction Asthma and COPD account for a significant burden of disease in the UK. Despite comprehensive guidelines, over a 1000 people continue to die from asthma each year and COPD accounts for a leading cause of emergency admissions in the UK.
A joint initiative between a tertiary centre for respiratory disease and commissioning support unit (CSU), asthma and COPD reviews were undertaken by a specialist respiratory pharmacist in GP practices. This study assesses the impact of these reviews.
Aims and Objectives This study aims to assess the impact of the specialist asthma and COPD reviews in accordance with national guidelines and standards of care.
Methods The study was carried out during eight clinical sessions over a two month period, across three GP surgeries. The reviews included the following assessments:
Quality of life: ACT and CAT scores
Assessing adherence to maintenance inhalers based on GP prescription records
Assessing if patients were on the correct therapy in accordance with their diagnosis, symptoms and severity of disease
Patients were identified for review based use of high dose inhaled corticosteroid and bronchodilator preparations (ICS/LABA) and/or frequency of A&E and hospital admissions.
Results During the eight clinical sessions, 84 patients with asthma or COPD were reviewed (42.5% male). 63% of patients had asthma (n = 53) with 37% COPD (n = 31), with a mean age 56.3 and 67.0 years respectively.
Table 1 shows a significant proportion of patients had uncontrolled disease based on their quality of life scores (QoL), use of reliever inhalers and frequency of exacerbations. Despite use of high dose medicines, this was likely to be due to poor adherence to maintenance inhalers and poor inhaler technique in a large proportion of patients. Interventions were made in most patients, including reducing the beclomethasone dipropionate (BDP) equivalence in the asthma group by 60.4%. Follow up showed that despite a reduction in inhaler therapy, QoL, peak flow measurements and reliever use all improved.
Conclusions Tailored reviews by the pharmacist resulted in significant interventions that improved QoL, adherenc to therapy, reduced unnecessary over prescribing of high dose medicines and resulted in a large proportion of patients to successfully stop smoking.
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