Masons Chemist, Hugglescote, Leicestershire
We took part in the SIMPLE study, which involved identifying patients with COPD in the pharmacy through their medication before offering them a review with a pharmacist. SIMPLE stands for Smoking cessation, Inhaler technique, Monitoring, Pharmacotherapy, Lifestyle and Education.
We had one lady who was a bit reluctant to take part, but once we had done the initial check she changed her mind completely. She was very much of the opinion that she knew what she was doing with her medication, as she had had the condition for a long time. But when we checked, her inhaler technique was shocking.
We are all guilty of getting a bit sloppy, but the key to all of it is correct inhaler technique. One thing in particular we were able to show her was putting lots of puffs of her inhaler into her spacer.
Just this simple bit of re-education has made a big difference to her – ever since, she has been using a lot less rescue medicine.
She also told us about a trip to Skegness where she had been unable to breathe – if she hadn’t known the trick with the spacer she would have been in big trouble.
She now comes in or phones up quite often to ask about her medication or whether she can change the dose if she’s struggling.
SIMPLE was a brilliant study – this is what we should be doing, but it is about finding the time.
Anderson’s Pharmacy, Portadown, Northern Ireland
I am a pharmacy prescriber and I trained in respiratory medicine. I have also run a spirometry clinic in the local GP practice since 2008. The GPs refer patients to me when they suspect COPD.
I had one man last month in his 50s who had presented for a couple of years with chest infections in the winter months. He was a smoker – 40 plus a day – and once the chest infection had cleared up, he was sent to me for diagnosis. I performed spirometry, proved it was non-reversible and that he had a fixed obstruction. I diagnosed COPD and did a physical examination.
I went through the condition with him and how to manage it. In his case, he was not very pleased as he had a family member who had passed away with COPD, so it was not a diagnosis he wanted. However, after the initial shock I was able to reassure him.
The GP had already started him on salbutamol, so I prescribed a long-acting bronchodilator and I will be seeing him again next week to see how he is getting on.
I also referred him to local smoking cessation services. Essentially, stopping smoking will be the most important thing he can do. But people react differently – while some find it a great motivator, other people say, “What’s the point?”.
We always try to follow up after a few weeks and you find that people have questions once the news has sunk in. From my point of view, offering this service is great.
We all need to do things that are a bit different to keep ourselves stimulated from a professional point of view – it is what keeps your brain going. And it gives you extra confidence to deal with patients.
Boots pharmacist, Plymouth, Devon
We often end up seeing patients with COPD during the course of carrying out medicines use reviews (MURs) and new medicine service (NMS) appointments.
I saw one patient for an MUR quite recently and she was on two inhalers. I asked her to go through inhaler technique using the placebo inhalers and all seemed fine, but because of a couple of symptoms she had mentioned I also decided to check using the In-Check DIAL device, which is like a peak flow but you breathe in as if using an inhaler.
Quite a lot of people don’t realise that there are different ways of breathing for different inhalers. It turned out that at one point she had an Accuhaler, for which you have to breathe in quite forcefully, and she had been keeping up that same level of force for the pressurised metered dose inhaler she was now using. She had even had a check with the nurse recently using the placebo inhaler and all had seemed fine.
At all the check-ups with the GPs, she had believed she was using the correct technique and this had been going on for years. Basically, all the medicine was
hitting the back of her throat and she had been getting a lot of oral thrush – it now all made sense.
We don’t often see people again after an MUR but she came in a week later just to say thanks. Even at that point she was still in disbelief she had been doing it wrong all that time. It had felt brilliant to be able to help her. We are the experts in medicines and something as subtle as this can make a big difference to the patient.