Introduction Asthma and chronic obstructive pulmonary disease (COPD) account for a significant burden of disease in the UK. In a local initiative, a respiratory pharmacist carried out structured asthma and COPD reviews aimed at improving clinical outcomes in a primary care setting.
Aims and objectives This study aims to assess the impact of asthma and COPD reviews in accordance with national guidelines and standards of care.
Methods The study was carried out prospectively, during one day a week basis, over a twelve month period across six GP surgeries. Patients were included based on use of high dose inhaled corticosteroid and bronchodilator preparations (ICS/LABA) and/or presence of previous exacerbations, accident and emergency (A&E) or hospital admissions.
Results 231 patients with asthma (n = 146, 63.2%) and COPD (n = 85, 36.8%) were reviewed, with 370 consultations carried out (62.4% follow up). 20.8% (n = 48) patients were followed up at the 6 or 12 month stage. Mean age was 53.0 and 67.6 years, with 34.2% and 56.5% males in the asthma and COPD groups respectively.
Table 1, below, shows a significant proportion of patients had uncontrolled disease. 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 all patients, including reducing the beclomethasone dipropionate (BDP) equivalence in the asthma group by 625.8 mcg (37.5%).
Annual drug cost savings attributed to appropriate step down and cessation of therapy showed amounted to £51.8 K (asthma: £36.4 K; COPD: £15.4 K). Follow up exacerbation data is ongoing, with 48 patients (20.8%) having been seen at the 6 or 12 month stage, showing significant reductions from 1.7% to 0.04% and 3.0% to 0.14% in asthma and COPD respectively.
Conclusions Structured asthma and COPD reviews have shown that a significant proportion of patients have uncontrolled disease despite use of extensive and high dose pharmacological therapy. Structured reviews by the pharmacist resulted in significant interventions that improved ACT and CAT scores and reduced unwarranted healthcare utilisation. Furthermore, it showed that appropriate prescribing and disease management in line with national standards of care also resulted in significant drug cost savings.