COPD ‘under-recognised’ and ‘under-treated’ in Australia

Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of death in Australia, but studies show about half of all people living with symptoms don’t know they have the condition. 

An umbrella term for lung conditions that includes emphysema, chronic bronchitis and chronic asthma, COPD causes narrowing of the bronchial tubes in the lungs, making it difficult to breathe.

Symptoms of COPD, such as shortness of breath, are often mistaken for signs of ageing or a lack of fitness, Debbie Rigby FPS, consultant clinical pharmacist and member of the Lung Foundation Australia’s COPD Advisory Committee, told Australian Pharmacist.  

‘COPD is under-recognised and under-treated,’ she said.

‘One of the things pharmacists can be involved in is case finding; identifying people who are at risk and should be referred to their GP for spirometry testing.

‘When people come in with shortness of breath, wheezing, reduced exercise tolerance or a persistent cough, we can ask questions to identify whether they should be referred.

‘One important question is whether the patient has a history of cigarette smoking … That’s the number one risk factor for COPD.’

As COPD patients frequently have other comorbidities, such as hypertension and diabetes, community pharmacists should be alert for signs of COPD in patients collecting other medicines.  

‘That’s the value of community pharmacy – we know these patients, they come into the pharmacy regularly, so we can pick up those signs and symptoms,’ Ms Rigby said.

‘For example, if someone is regularly asking for over-the-counter cough and cold medicine or bronchodilators.’

Technique training

This World COPD Day (18 November), Lung Foundation Australia is encouraging pharmacists to access best-practice and evidence-based resources, including the COPD-X Plan.

First published in 2003, this is updated every quarter to provide the latest clinical recommendations to aid all health professionals, including pharmacists, in the diagnosis and management of COPD. 

This includes information on supporting patients by encouraging medicine adherence and ensuring they are using their inhaler correctly. 

‘Up to 90% of people don’t have good device technique and adherence is also poor,’ Ms Rigby said.

‘If we can support patients to improve this, we can make their lives better.’

This is compounded by the growing number of inhaler devices that are available, all with different directions, which can lead to patient confusion.

Assessing a patient’s device technique is the ‘number one thing’ pharmacists should do at every opportunity, Ms Rigby said, including when a prescription is dispensed or SABAs are purchased over-the-counter.

‘All the evidence says that people are not using their devices properly and, even if they have mastered the technique, it tends to decline after 3 or 4 months.

‘When I’m doing Home Medicine Reviews I’ll do a range of things. I’ll ask the patient to demonstrate how they use it, I’ll demonstrate it, I’ll show them a video, give them a printed handout – it’s about taking the time to go through everything with the patient and help them understand why certain steps are important.’

For example, many people don’t breathe out before use as they don’t realise this will help them breathe in more air and get more of the medicine deposited in their lungs. 

For more on COPD, don’t miss PSA’s Pharmacists on the Frontline: COPD patient webinar on Wednesday 25 November at 8.30–9.30 pm AEDT.