Recognizing Undiagnosed ILD in Patients With COPD and Emerging Trends in Specialty Pharmacy

In this interview, Tim Clifford, PharmD, clinical pharmacist at the University of Kentucky (UK) HealthCare and adjunct associate professor at UK College of Pharmacy discusses how pharmacists can spot signs that a patient with chronic obstructive pulmonary disease (COPD) may have an underlying condition that has been missed. Clifford points to persistent cough unresponsive to medication changes, more frequent exacerbations, worsening shortness of breath, and exercise intolerance as potential clues to undiagnosed or misdiagnosed interstitial lung disease (ILD). Clifford also reflects on the rapid growth of specialty pharmacy over the past 2 decades and highlights emerging trends, including new indications for existing therapies, such as inhaled treprostinil for idiopathic pulmonary fibrosis, and the rise of limited distribution drugs dispensed through niche specialty pharmacies.

Pharmacy Times: How can pharmacists help identify patients with fibrosing ILD earlier in the disease course?

Tim Clifford, PharmD: One thing pharmacists can look at is whether patients who have a diagnosis of COPD have a chronic cough that goes along with it, that’s just there all the time, and nothing really seems to make a difference, even if they’ve changed medications. Or maybe they’re suddenly starting to have exacerbations a little more often. When you talk to them, they’re having a little more shortness of breath or exercise intolerance. Those probably should be clues that something else may be going on.

It may simply be that they do just have COPD and need an additional therapy added. Or maybe further investigation needs to happen, or there’s an ILD that has been undiagnosed, misdiagnosed, or completely missed. So it comes down to looking at your patient, knowing your patient, and, when you find out they’re doing worse, asking what’s going on. Those are some things we can identify a little earlier in the process.

Pharmacy Times: What is the biggest trend you expect in specialty pharmacy in 2027?

Clifford: The biggest trends? There has been such an explosion of new medications in the last 15 to 20 years or so. Specialty pharmacy really didn’t exist when I first started practicing, so it’s been something to see the evolution of it.

I think new indications for older therapies, or therapies that are already on the market, will be big. I’m thinking of inhaled treprostinil potentially coming to market for idiopathic pulmonary fibrosis. I think a lot of newer medications are also going to be limited distribution drugs, so we’re going to see more niche specialty pharmacies being the sole source of different drugs. There may not be as much diversification of medications across the board, but I think there will be pharmacies that become very specialized in some very specific areas.