RESPIRATORY


COMMUNITY PHARMACISTS ARE INCREASINGLY TREATING RESPIRATORY CONDITIONS SUCH AS CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN BESPOKE CLINICS CARRIED OUT IN PHARMACY. OVER THE NEXT FEW ISSUES, WE WILL FEATURE SEVERAL PHARMACISTS, WHO ARE ALREADY SEEING POSITIVE OUTCOMES FOR THEIR PATIENTS. IN THIS ISSUE WE SPEAK TO BERNADETTE BROWN FROM CADHAM PHARMACY IN GLENROTHES.


COPD: CARE IN THE COMMUNITY


The challenges provided by chronic obstructive pulmonary disease (COPD) are well documented. According to World Health Organization statistics, it is estimated that, globally, 3.17 million deaths were caused by the disease in 2015 – a shocking fi ve per cent of all deaths globally in that year. More than 90 per cent of the deaths occurred in low and middle-income countries.


The primary cause of COPD is exposure to tobacco smoke (either active smoking or through second- hand smoke), but can also be the result of conditions such as long-term asthma. The primary cause of COPD is exposure to tobacco smoke (either active smoking or second-hand smoke).


As a result of the huge public health impact of COPD, there is, naturally, increased need for appropriate management of patients with the disease and, as a result, many community pharmacists are now taking responsibility for that management to reduce the pressure on the overburdened healthcare system.


As an independent prescriber, 42 - SCOTTISH PHARMACIST


Bernadette Brown has always been very keen to use her prescribing skills to run clinics in her Glenrothes business, Cadham Pharmacy. For the last four years, Bernadette has been running a very successful respiratory clinic from the pharmacy, working closely with her COPD and asthma patients.


‘I’m delighted to say that, when it comes to running our clinics,’ Bernadette told SP, ‘I work very closely with the local GP practice. With regard to the respiratory clinics, I have an agreement with the practice manager and the GPs from the nearby Leslie Medical Practice to review (through Chronic Medication Service) all of the asthma non-attenders and the patients who use more than twelve inhalers per year.


‘The main focus of the clinic is, as you would imagine, to optimise the patients’ COPD treatment and to facilitate patients’ concordance and compliance. We review patients after twelve months although, if there’s any medication change, we review after four weeks. We also provide information on related issues such as smoking cessation and diet.


‘I’m very fortunate that, in providing pharmaceutical care for COPD patients, I am ably supported by Margaret, a respiratory nurse, who gives up her time to assist us with our specialist respiratory clinic. To have a specialist respiratory nurse give up her time in this way is just wonderful, and is a great way of showing the community what can be achieved by healthcare professionals working collaboratively.


‘Through the clinic, Margaret and I offer spirometry testing and adjust patients’ treatment in accordance with their clinical management plan. We discuss the projects that are current so that we are both on the same page and agree protocols for switches with our patients. On occasion, I have also shadowed Margaret in her clinics so that we can get a true understanding of both of our roles so that we can provide even more integrated care.


One of Bernadette’s patients, Denise Wallace, has already had her faith in Bernadette’s clinic more than justifi ed. ‘In June 2015 whilst collecting my routine repeat prescription at Cadham Pharmacy, Bernie suggested that I make an appointment with her for an asthma review. As a brittle asthmatic (using symbicort twice per day), my symptoms had taken a downward spiral due to seasonal rhinitis, and, as a result of this, my Ventolin usage had increased greatly. During the period


April-June, I was lucky if my peak fl ow reading hit 330 most days, so Bernie suggested that I may be a suitable candidate for a new inhaler (Relvar Elipta).


‘I went for the review on Monday 22 June, where my ACT score was nine and my peak fl ow was 340. As Bernie had thought, I was a suitable candidate for this medication, so I started taking it that afternoon. Within 90 mins of taking it for the fi rst time, my peak fl ow (for the fi rst time in approximately fi ve years) hit 410.


‘I am now on my second inhaler and at the moment still need my Ventolin fi rst thing in the morning and occasionally during the day. My peak fl ow is yet to stabilise, however it is persistently 350+. I have allergies to mould, damp, and dust, as well as several antibiotics, so time will tell how effective this new inhaler will be for me in the long term, although so far so good.


‘I lost faith in my asthma nurse at our GP practice a few years ago. Each time I went to see her, I was told that she would see me again in six months. I was getting persistent chest infections and was constantly on amoxicillin (which had no effect), then Doxycycline and steroids. Eventually, I was sent to the respiratory clinic at the hospital where it was discovered that I had a pneumonitis in my right lung.’•


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