The NPA has created a resource pack to help community pharmacists and their teams with diagnosis, care
and management of patients with chronic obstructive pulmonary disease

 Chronic obstructive pulmonary disease (COPD) is a common and usually progressive disease that affects
the lungs. UK governments have identified COPD as an increasing public health issue due to the numbers of undiagnosed individuals, premature deaths, hospital admissions and deaths that result from this disease.

As the UK population continues to increase, people are also living longer and, as a result, more individuals are affected long term by being exposed to the risk factors associated with COPD.

Community pharmacists are easily accessible healthcare professionals and experts in medicines and are in an ideal position to help identify, improve and manage patient outcomes with COPD.

The National Institute for Health and Care Excellence (NICE) clinical guideline (CG101) states, “COPD is now the preferred term for the conditions in patients with airflow obstruction who were previously diagnosed as having chronic bronchitis or emphysema.”

COPD is not fully reversible and is characterised by persistent airflow obstruction that does not noticeably
change over a period of months. Exposure to harmful particles or gases may cause a chronic inflammatory response in the lungs. As a result, lung parenchyma (functional lung tissue) can be destroyed and fibrosis in the small airways can develop.

Together, these lead to progressive airway obstruction; and affected patients develop persistent breathlessness, chronic and productive cough, and a limited exercise capacity.

Causes

A number of risk factors have been associated with the development of COPD. These include:

• Tobacco smoke – this is a major risk factor for COPD and includes smoking from cigarettes, pipes or cigars, as well as through passive smoking
• Occupational exposure – this includes prolonged exposure to chemicals, dust, fumes, irritants or particles
• Air pollution – both indoor and outdoor air pollution can contribute to COPD; this can include pollution from cooking or heating with fuel (biomass) and wood, particularly in developing countries or where homes may be poorly ventilated
• Genetic predisposition – a severe hereditary deficiency of alpha-1 antitrypsin is the most documented genetic risk factor for the development of COPD, although this accounts for less than 1 per cent of all cases
• Age – there is also an association between COPD and increasing age.

Prognosis

COPD is treatable but it is usually a progressive disease. Limiting a patient’s exposure to the noxious agents mentioned above may slow the progression of the disease, and early diagnosis and treatment can also slow the rate of lung function decline; however, a patient with COPD cannot be cured.

The NPA COPD pack is a comprehensive new resource that has been created with the support of GlaxoSmithKline (GSK), specifically to help community pharmacists and their teams to improve the diagnosis, care and management of patients with COPD. It includes crib sheets to help members carry out the Chronic Medication Service Pharmaceutical Care Risk Assessment (Scotland), Discharge Medicines Review (Wales), MUR (England, Northern Ireland and Wales) and NMS (England).

All NPA members will have received a hard copy of the pack at the end of December, and it can also be downloaded from npa.co.uk/services.