0
Reviews
Pharmacist-managed chronic obstructive pulmonary disease screening in a community setting
Leah Fuller; Wayne F. Conrad; Pamela C. Heaton; Ralph Panos; William Eschenbacher; Stacey M. Frede
J Am Pharm Assoc (2003) 2012:e59-e66. doi:10.1331/JAPhA.2012.11100

Abstract

Objectives  To implement a spirometry-based chronic obstructive pulmonary disease (COPD) screening in a community pharmacy chain, determine whether pharmacists can accurately perform spirometry screenings and interpret results, and determine whether performing screenings improved enrollment in smoking cessation programs.

Design  Prospective study.

Setting  Kroger pharmacies in the Cincinnati–Dayton Kroger Marketing Area and off-site screening events in Cincinnati, OH, from March to December 2010.

Patients  Consenting individuals older than 35 years who met inclusion and exclusion criteria.

Intervention  Specially trained community pharmacists administered a validated COPD screening questionnaire and performed spirometry. The results were interpreted, given to the patient, and faxed to the primary care physician. Any patient who was currently smoking was offered smoking cessation counseling.

Main outcome measures  Spirometry technical quality and interpretation accuracy, screening questionnaire scores in relationship to spirometry results, number of patients enrolled in smoking cessation programs.

Results  Of the 185 patients, 10 were excluded due to inability to perform spirometry. After review, 174 (99%) of the spirometries were judged acceptable and 157 (90%) demonstrated reproducible results. The mean (±SD) score on the COPD Population Screener questionnaire was 2.3 ± 1.6 (range 0–8). Airflow limitation (defined as forced expiratory volume in 1 second/forced vital capacity < lower limit of normal) was detected in 16 (9%) of the patients. Although 12 (75%) of these patients were former or current smokers, only 3 (19%) were at increased risk for COPD based on their screening questionnaire scores. Of the nine current smokers who participated in a follow-up interview, two had successfully abstained from smoking for 6 months after the screening and five others had made an attempt to quit.

Conclusion  This study demonstrated that pharmacists are able to perform accurate and reproducible spirometry in a community pharmacy setting.

Sign In
APhA Members 
Welcome to JAPhA.org! Please log in below using your APhA username and password. Update your APhA profile.
Not a Subscriber
New to JAPhA? Become an APhA member to receive a full subscription to both the print and online editions.

OR

Register for a FREE limited account to benefit from personalization features such as alerts.

References

 Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2009. Accessed at www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=2003,  December 10, 2009.
 
Carmona RH.  The health consequences of smoking: a report of the Surgeon General.  Washington, DC:  Department of Health & Human Services;  2004.
 
National Heart, Lung, and Blood Institute.  Morbidity and morality: 2007 chartbook on cardiovascular, lung, and blood disease.  Bethesda, MD:  National Heart, Lung, and Blood Institute;  2009.
 
Pleis JR, Lucas JW.  Summary health statistics for U.S. adults: National Health Interview Survey, 2007.  Vital Health Stat 10.  2009; 240: 1– 159. [PubMed]
 
Mannino DM, Gagnon RC, Petty TL, Lydick E.  Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988–1994.  Arch Intern Med.  2000; 160: 1683– 9. [CrossRef]
 
American Thoracic Society.  COPD guidelines (2004): standards for the diagnosis and management of patients with COPD. Accessed at  September 12, 2009.
 
Bednarek M, Gorecka D, Wielgomas J, et al.  Smokers with airway obstruction are more likely to quit smoking.  Thorax.  2006; 61: 869– 73.
 
Parkes G, Greenhalgh T, Griffin M, Dent R.  Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial.  BMJ.  2008; 336: 598– 600.
 
Wilt TJ, Niewoehner D, Kane RL, et al.  Spirometry as a motivational tool to improve smoking cessation rates: a systematic review of the literature.  Nicotine Tob Res.  2007; 9: 21– 32.
 
Anthonisen NR, Connett JE, Kiley JP, et al.  Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1: the Lung Health Study.  JAMA.  1994; 272: 1497– 1505.
 
Burchfiel CM, Marcus EB, Curb JD, et al.  Effects of smoking and smoking cessation on longitudinal decline in pulmonary function.  Am J Respir Crit Care Med.  1995; 151: 1778– 85.
 
Duong-Quy S, Hua-Huy T, Mai-Huu-Thanh B, et al.  Early detection of smoking-related chronic obstructive pulmonary disease in Vietnam.  Rev Mal Respir.  2009; 26: 267– 74.
 
DeJong SR, Veltman RH.  The effectiveness of a CNS-led community-based COPD screening and intervention program.  Clin Nurse Spec.  2004; 18: 72– 9.
 
Bednarek M, Plywaczewski R, Gorecka D, et al.  Early detection of COPD in smokers from Warsaw using spirometric screening.  Pneumonol Alergol Pol.  2002; 70: 139– 47.
 
Geijer RM, Sachs AP, Hoes AW, et al.  Prevalence of undetected persistent airflow obstruction in male smokers 40–65 years old.  Fam Pract.  2005; 22: 485– 9.
 
Tinkelman DG, Price D, Nordyke RJ, Halbert RJ.  COPD screening efforts in primary care: what is the yield? Prim Care Respir J.  2007; 16: 41– 8.
 
Vandevoorde J, Verbanck S, Gijssels L, et al.  Early detection of COPD: a case finding study in general practice.  Respir Med.  2007; 101: 525– 30.
 
Stratelis G, Jakobsson P, Molstad S, Zetterstrom O.  Early detection of COPD in primary care: screening by invitation of smokers aged 40 to 55 years.  Br J Gen Pract.  2004; 54: 201– 6.
 
Stav D, Raz M.  Prevalence of chronic obstructive pulmonary disease among smokers aged 45 and up in Israel.  Isr Med Assoc J.  2007; 9: 800– 2.
 
Zielinski J, Bednarek M.  Know the age of your lung study group: early detection of COPD in a high-risk population using spirometric screening.  Chest.  2001; 119: 731– 6.
 
Tovar JM, Gums JG.  Monitoring pulmonary function in asthma and COPD: point-of-care testing.  Ann Pharmacother.  2004; 38: 126– 33.
 
Burton MA, Burton DL, Simpson MD, et al.  Respiratory function testing: the impact of respiratory scientists on the training and support of primary health care providers.  Respirology.  2004; 9: 260– 4.
 
Castillo D, Guayta R, Giner J, et al.  COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.  Respir Med.  2009; 103: 839– 45.
 
Stratton TP, Williams RG, Meine KL.  Developing a mobile pharmacist-conducted wellness clinic for rural Montana communities.  J Am Pharm Assoc.  2005; 45: 390– 9.
 
Mann RP, Zaiken K.  Management of chronic obstructive pulmonary disease by pharmacists in an internal medicine department.  Am J Health Syst Pharm.  2009; 66: 890– 3.
 
Weinberger M, Murray MD, Marrero DG, et al.  Effectiveness of pharmacist care for patients with reactive airways disease: a randomized controlled trial.  JAMA.  2002; 288: 1594– 1602.
 
American Pharmacists Association Foundation.  White paper on expanding the role of pharmacists in chronic obstructive pulmonary disease.  J Am Pharm Assoc.  2011; 51: 203– 11.
 
Egervary A.  No ‘I’ in ‘Pharmacy’.  Pharmacy Today.  2008; 14: 42– 4.
 
Martinez FJ, Raczek AE, Seifer FD, at al.  Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS).  COPD.  2008; 5( 2): 85– 95.
 
Miller MR, Hankinson J, Brusasco V, et al.  ATS/ERS Task Force: standardization of lung function testing: standardization of spirometry.  Eur Respir J.  2005; 26: 319– 38.
 
Hankinson JL, Odencrantz JR, Fedan KB.  Spirometric reference values from a sample of the general U.S. population.  Am J Respir Crit Care Med.  1999; 159: 179– 87.
 
Swanney MP, Ruppel G, Enright PL, et al.  Using the lower limit of normal for the FEV1/FVC ratio reduces the misclassification of airway obstruction.  Thorax.  2008; 63: 1046– 51.
 
Morris JF, Temple W.  Short report: spirometric “lung age” estimation for motivating smoking cessation.  Prev Med.  1985; 14: 655– 62.
 
Mannino DM, Gagnon RC, Petty TL, et al.  Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1984–1994.  Arch Intern Med.  2000; 160: 1683– 9.
 
Eaton T, Withy S, Garrett JE, et al.  Spirometry in primary care practice.  Chest.  1999; 116: 416– 23.
 
Walters JA, Hansen EC, Johns DP, et al.  A mixed methods study to compare models of spirometry delivery in primary care for patients at risk of COPD.  Thorax.  2008; 63: 408– 14.
 
Summaries for patients.  Screening for chronic obstructive pulmonary disease: U.S. Preventive Services Task Force recommendations.  Ann Intern Med.  2008; 148: I46.
 
Lin K, Watkins B, Johnson T, et al.  U.S. Preventive Services Task Force. Screening for chronic obstructive pulmonary disease using spirometry: summary of the evidence for the U.S. Preventive Services Task Force.  Ann Intern Med.  2008; 148: 535– 43.
 
Soriano JB, Zielinski J, Price D.  Screening for and early detection of chronic obstructive pulmonary disease.  Lancet.  2009; 374: 721– 32.
 
Enright PL, Crapo RO.  Controversies in the use of spirometry for early recognition and diagnosis of chronic obstructive pulmonary disease in cigarette smokers.  Clin Chest Med.  2000; 21: 645– 52.
 
Cawley MJ, Pacitti RJ, Keenan DP.  Reaping the rewards of a pharmacist-run spirometry clinic.  Pharmacy Purchasing & Products.  2010; 7: 24.
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Please read the other comments before you post yours. Comments are moderated and will appear on the site at the discertion of the editorial staff.
* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content

Customize your page view by dragging & repositioning the boxes below.

JAPhA Articles
Topic Collections
PubMed Articles
Advertisement
 
  • Print
  • PDF Download
  • Email
  • Share
  • Get Citation
  • Submit Comment
  • Article Alerts
    Please Wait... Processing your request... Please Wait.
    You must sign in to sign-up for alerts.

    Please confirm that your email address is correct, so you can successfully receive this alert.

  • Letters To Editor
  • Reprints