Pharmacy Interventions Can Improve COPD Exacerbations

Nonadherence to chronic obstructive pulmonary disease (COPD) treatment worsens patient health outcomes and increases related costs.

Medication monitoring and optimization is a targeted pharmacy-involved approach to address adherence, cost-effectiveness, and patient satisfaction. This allows clinicians to select patients who are most likely to benefit from improved adherence: those with poor adherence track records.

An article recently published online in the Current Medical Research & Opinion explored interventions to improve COPD adherence and health outcomes. The authors recruited patients from 22 community pharmacies with integrated multidisciplinary teams between October 2013 and February 2014.

All patients had a physician-confirmed COPD diagnosis. Their records indicated suboptimal adherence to inhaled respiratory maintenance medication, with the evidence showing at least 1 short course of oral corticosteroids with or without antibiotics in the past year.

Some of the pharmacy interventions included inhalation instruction, education on medication, and motivational interviewing to encourage smoking cessation and adherence.

After 1 year, the study authors recorded significant improvements related to COPD exacerbations and overall health care expenses—at the cost of a small increase in medication expenses. However, the researchers did not discover clinically significant improvements in adherence or quality of life.

There were some increases in adherence among patients who had decreased exacerbations, and the sickest patients saw the greatest improvements in clinical outcomes.

This study has a wider target than others involving medication monitoring and optimization because the researchers emphasized several things continuously over the year, including the frequency of medication intake, the quality of inhalation technique, smoking cessation, and physical activity.

The study has strong external validity because the protocol included patients with confounding comorbidities, unlike many other trials. Its yearlong duration also minimized seasonal influences.

The small sample size (88 patients) and lack of a control group were the main factors limiting this study.

New inhalation monitoring technology that could track adherence and exacerbations would be a powerful tool in these efforts. The study authors recommended a follow-up randomized controlled trial to confirm the effect of medication monitoring and optimization on adherence and quality of life.