Defined by NICE as “a common, treatable (but not curable) and largely preventable lung condition, characterised by persistent respiratory symptoms (such as breathlessness, cough and sputum) and airflow obstruction (usually progressive and not fully reversible)”, COPD is forecast to become the third-leading cause of death worldwide by 2030. 

COPD is managed through a combination of pharmacological therapy, pulmonary rehabilitation and smoking cessation. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2021 strategy report recommends initiation of pharmacotherapy based on an individualised assessment of a patient’s exacerbation history, symptom severity and blood eosinophil count. 

Long-acting bronchodilators (long-acting muscarinic antagonists [LAMAs] or long-acting beta-2 agonists [LABAs]), alone or in combination, are the mainstay of COPD treatment. Inhaled corticosteroids (ICS) are reserved for patients who are highly symptomatic and/or have a severe exacerbation history and eosinophil count ≥300 cells/mcl. 

More than 50 per cent of patients with COPD are unable to use their inhaler device properly and 40 per cent are smokers, so there is great potential for pharmacy teams to improve the health of patients through medicines optimisation as well as prevention through smoking cessation. 

Key facts

• COPD is both preventable and treatable yet remains a major cause of illness and death
• More than 50 per cent of patients with COPD are unable to use their inhaler device properly and 40 per cent continue to smoke 
• Very brief advice (VBA) on smoking is the key intervention community pharmacy teams can make
• GPs are incentivised to reduce COPD exacerbations by providing structured medication reviews
• The GP contract encourages doctors to “connect patients appropriately” to England's pharmacy new medicine service