Castillo D, Burgos F, Guayta R, Giner J, Lozano P, Estrada M, Soriano J B, Flor X, Barau M, Casan P
Hospital de la Santa Creu i Sant Pau, Department of Respiratory Medicine, Institut d'Investigació Biomèdiques Sant Pau (IB-Sant Pau), Universitat Autònoma de Barcelona, Facultad de Medicina, Barcelona, Spain.
Respiratory Diagnostic Center, Department of Respiratory Medicine (ICT), Hospital Clínic i Provincial, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Barcelona, Spain.
Respir Med. 2015 Apr;109(4):475-82. doi: 10.1016/j.rmed.2015.02.009. Epub 2015 Feb 20.
Community pharmacies (CP) have access to subjects at high-risk of suffering Chronic Obstructive Pulmonary Disease (COPD). We investigated if a COPD case finding program in CP could be a new strategy to reduce COPD underdiagnosis.
Prospective, cross-sectional, descriptive, uncontrolled, remotely supported study in 100 CP in Barcelona, Spain. Pharmacists were trained in a four-day workshop on spirometry and COPD, and each was provided with a spirometer for 12 weeks. The program included questionnaires and forced spirometry measurements, whose quality was controlled and monitored by web-assistance.
Overall 2295 (73.5%), of 3121 CP customers invited to participate in the program accepted, and 1.456 (63.4%) were identified as "high risk" for COPD using the GOLD questionnaire. Only 33 could not conduct spirometry, and a pre-bronchodilator airflow limitation (FEV1/FVC ratio <0.7) was confirmed in 282 (19.8%); 244 of these were referred to their primary care (PC) physician for further diagnostic and therapeutic work-up, but only 39 of them (16%) fed-back this information to the pharmacist. Clinically acceptable quality spirometries (grade A or B) were obtained in 69.4% of the cases.
This study shows that adequately trained and supported community pharmacists can effectively identify individuals at high risk of having COPD and can thus contribute to ameliorate underdiagnosis in this disease. Links between PC and CP should be improved to achieve a useful program.
社区药房能够接触到慢性阻塞性肺疾病（COPD）高风险人群。我们调查了社区药房中的COPD病例发现项目是否可作为减少COPD诊断不足的新策略。
在西班牙巴塞罗那的100家社区药房开展前瞻性、横断面、描述性、非对照、远程支持研究。药剂师参加了为期四天的肺活量测定和COPD研讨会培训，每家药房配备一台肺活量计，为期12周。该项目包括问卷调查和用力肺活量测量，其质量通过网络协助进行控制和监测。
在受邀参加该项目的3121名社区药房顾客中，共有2295名（73.5%）接受邀请，使用慢性阻塞性肺疾病全球倡议（GOLD）问卷，1456名（63.4%）被确定为COPD“高风险”人群。只有33人无法进行肺活量测定，282人（19.8%）确诊存在支气管扩张剂使用前气流受限（第一秒用力呼气容积/用力肺活量比值<0.7）；其中244人被转诊至其初级保健医生处进行进一步诊断和治疗检查，但只有39人（16%）将该信息反馈给药剂师。69.4%的病例获得了临床可接受质量的肺活量测定结果（A级或B级）。
本研究表明，经过充分培训和支持的社区药剂师能够有效识别COPD高风险个体，从而有助于改善该疾病的诊断不足情况。应加强初级保健与社区药房之间的联系，以实现一个有用的项目。
