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Asthma, a chronic respiratory disease characterized by chronic airway inflammation, bronchial hyperresponsiveness, and reversible airflow obstruction, poses a substantial economic burden on patients and caregivers alike. Moreover, the heterogeneous nature of the disease and the presence of various phenotypes make the treatment of asthma challenging and nuanced. Despite the availability of several approved pharmacological treatments, approximately half of patients with asthma in the United States experienced exacerbations in 2016, highlighting the need for effective add-on treatments. Furthermore, asthma control remains suboptimal due to low adherence to medications, poor inhaler technique, and several patient-related factors. Importantly, the primary care setting, in which pharmacists play an integral role, represents a critical environment for providing long-term follow-up care for the effective management of chronic diseases, such as asthma. Pharmacists are uniquely positioned to ensure optimal clinical outcomes in patients with asthma since they have the clinical expertise to educate patients on their disease state and the role of asthma medications, provide training on inhalation technique, address patients’ concerns about potential side effects of medications, and improve adherence to therapy. Therefore, in this review article, we discuss the overall role of pharmacists in effective asthma care and management.

The pharmacist and health promoter team management of uncontrolled diabetes among Latinos appears to be a feasible approach to improving medication management.

ObjectiveTo determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM) clinic services, by healthcare professionals in a large, urban, university medical care setting.MethodsThis was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application.ResultsSixty-two healthcare professionals (32%) completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as ‘excellent’, 44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise.ConclusionsIn a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, affecting as many as 24 million Americans and resulting in 1.5 million ED visits, 700,000 hospital admissions, and 124,000 deaths annually. This article, the first in a two-part series on COPD, outlines current guidelines and other evidence-based recommendations on diagnosing and managing stable COPD in the outpatient setting. Part 2 will appear in a future issue of AJN and will focus on managing acute exacerbations of COPD.

T obacco dependence is a chronic condition with efficient and cost-effective treatment available. All tobacco users should be offered one of the first-line agents for smoking cessation, except in special circumstances (Fiore, Bailey, & Cohen, 2000). Misconceptions and fears of using medications, for smoking cessation have greatly contributed to the under-utilization of these products. This is the third column in a three-part series on smoking cessation. This column addresses the various pharmacological agents used for smoking cessation. The first article in the series, which appeared in the February issue (Vol. 53, No.2, pp. 63-64), was a review of the epidemiology of smoking, the adverse effects of smoking, and an approach to identify individuals ready to quit. Part II appeared in the May issue (Vol. 53, No.5, pp. 194-197) and focused on smoking cessation couseling and behavioral therapies. Quitting smoking is very difficult. Only approximately 7% of clients who quit without any treatment, or

Purpose Despite international guidelines’ recommendations, spirometry is underutilized in the diagnosis and management of asthma and COPD. Spirometry may be an opportunity for trained pharmacists to meet the needs of patients with suspected or diagnosed lung conditions. The aim of this scoping review is to describe the literature including pharmacist provided spirometry services, specifically to identify: 1) the models of pharmacist provided spirometry services, and additional services commonly offered alongside spirometry, 2) pharmacist training and capability to obtain quality results, and (3) pharmacist, physician, and patient perspectives. Methods In September 2020, a comprehensive literature search in PubMed and EMBASE was conducted to identify all relevant literature on the topic of pharmacist provided spirometry services using the search term: “pharmacist or pharmacy” and “spirometry or pulmonary function test or lung function test.” Literature was screened using inclusion/exclusion criteria and selected articles were charted and analyzed using the themes above. Results A total of 27 records were included. The scoping review found that pharmacist provided spirometry has been conducted around the world in community pharmacies and clinic settings. Community pharmacists may increase access to spirometry screening; the lack of communication with primary care providers and remuneration are barriers that need to be overcome to optimize the utility of the service. Clinic-based services are interprofessional and collaborative, allowing a patient to receive the test, results, diagnosis, and medication changes in one visit. Following comprehensive training, pharmacists felt confident in their ability to perform spirometry and met quality standards at acceptable rates. Conclusion Spirometry is an opportunity for pharmacists to improve evidence-based practice for screening and diagnosing lung conditions along with providing comprehensive services to complement testing. Data around provider and patient perspectives is limited and should be further investigated to determine if providers and patients would value and collaborate with pharmacists providing spirometry services.

Objectives: Roflumilast is indicated for patients with moderate to severe Chronic Obstructive Pulmonary Disease (COPD). Information on the prevalence and risk of diarrhea, the most reported adverse event in clinical trials, among patients initiating roflumilast in real-world settings is limited. Methods: We selected patients aged $40 years with COPD who were new users of roflumilast and the active comparator group, triple therapy (inhaled corticosteroids (ICS), long acting beta agonists (LABA) and long acting muscarinic antagonists (LAMA)) from March 1, 2011 to December 31, 2017 in the Truven Health MarketScan Research Database. The study outcome was a primary diagnosis claim for non-infectious diarrhea within 14 days after treatment initiation. We estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for diarrhea risk using Cox proportional hazards models. Follow-up continued to the earliest of the occurrence of the outcome of interest (diarrhea), treatment discontinuation, end of 14-day follow-up, disenrollment from health plan or end of study period. We used high-dimensional propensity score (hdPS) matching and calculated the E-value to quantify unmeasured confounding. Results: The final cohort included 4,725 new users of roflumilast and 17,540 matched sample of triple therapy users with a mean (SD) age of 67.9 years (10.9) and 50.7% female. Roflumilast users had higher risk of diarrhea over the 14-day period after drug initiation relative to the comparator group [HR=2. 22, 95%CI (1.01, 4.89)]. The corresponding E-values for the HR and lower bound of the CI were 3.87 and 1.1 respectively. A similarly higher risk of the outcome occurred in the roflumilast group at 30 days [HR=2.06, 95%CI (1.22, 3.47)] and at 90 days [HR=1.40, 95% CI (1.01, 1.95)]. Conclusions: We observed a consistently higher risk of diarrhea in patients initiating roflumilast in the real-world settings and is the highest within the first 30 days post-initiation.