MANAGEMENT OF ASTHMA-COPD OVERLAP SYNDROME: CLINICAL PHARMACIST PERSPECTIVE

Patients with asthma-COPD overlap have more severe symptoms than those with either asthma or COPD alone, experiencing more frequent and more severe exacerbations and more frequent hospitalizations. This relatively recent interim disease has several phenotypes and consequently different prevalence which ranged from 12% - 55% of patients with chronic obstructive airway diseases. Appropriate Asthma–COPD overlap diagnosis and management are needed to achieve control of such progressive disease.
Objective: The study compares the effect of Asthma–COPD overlap patient care by clinical pharmacist intervention versus conventional care on disease control.
Patients and Methods: A 2-month ethically approved randomized, controlled trial was conducted in outpatient clinics of Ain Shams University Hospitals, Cairo, Egypt. Patients signed information consents then they were randomly assigned to receive conventional care (n=28) or a pre-defined pharmacist intervention (n=26). This intervention mainly focused on patient education, improving inhalation technique and medication assessment. Primary outcome was the level of disease control, as assessed by the COPD Assessment Test (CAT).
Results & Discussion: By the end of the study, the patients who received a clinical pharmacist education and medication assessment (intervention group) showed significantly improved outcome regarding their CAT-scores than routine care group who did not receive clinical pharmacist intervention (p=0.0001). The intervention also reduced reliever medication use. Inhalation technique and adherence to medication were significantly better in the intervention group. Patients in the intervention group experienced less exacerbations with decreased need for emergency department visits and/ hospitalization than conventional care patients despite similar doses of corticosteroids in both groups. This suggests that the improvement in symptom control seen in the intervention group can be attributed to beneficial patient education and not to changes in pharmacotherapy.
Conclusion: The present study results provide supportive evidence concerning clinical pharmacists’ favorable effects on asthma-COPD overlap patient care and support clinical pharmacists as members of the health care team.