Pharmacists Help Patients Stay Adherent to COPD Therapy, Improving Overall Quality of Life

Pharmacists are increasingly called upon as vital partners in managing chronic obstructive pulmonary disease (COPD), a condition that often leaves patients feeling overwhelmed by complex medication routines, frequent medical appointments, and the financial challenges associated with ongoing care.

“We have the face-to-face and opportunities to discuss their medications and maybe more importantly, what’s not covered by their insurance and what options might look like,” Steve Coomes, PharmD, owner of Aubrey Health Mart Pharmacy in Aubrey, Texas, said. “One of the problems with today’s treatment in COPD is a lot of the products being promoted and prescribed are really expensive.”

By addressing access issues, offering comprehensive medication counseling, and educating patients about disease management, pharmacists play a crucial role in helping individuals adhere to their therapy and enhancing their overall quality of life.

Nishita Hira, PharmD, CSP, clinical program manager for Walgreens Specialty Pharmacy in Tampa, Florida, noted that proactive education and ongoing support are key.

“Prior to starting therapy, medication education, including dosing and administration, inhalation technique, storage and disposal requirements, and [adverse] effects, should be reviewed,” she said. “Lifestyle modifications, such as smoking cessation, diet, and exercise, should be discussed as clinically appropriate. Monthly follow-up, including reassessing inhaler techniques, screening, and counseling for adverse events and adherence barriers, is important to ensure continued adherence.”

Collaboration among all parties involved in the patient’s care is essential to therapy success. Pharmacists should work with the patient’s health care team to obtain a complete medication profile to become aware of significant drug interactions before starting therapy.

“Keeping the health care team abreast of patient-reported medication-related [adverse] effects and adherence challenges will help to keep patients on therapy or adjust therapy as needed to ensure patients are receiving maximum benefit from their COPD regimen,” Hira said.

Joseph Falinski, PharmD, director of ambulatory clinical pharmacy at Boston Medical Center in Boston, Massachusetts, noted that recent data indicate that proactive pharmacist involvement in COPD management can significantly reduce hospital readmissions.

“COPD regimens are often complex, and errors in inhaler technique or poor adherence can greatly affect outcomes,” he said. “As medication experts, pharmacists monitor for [adverse] effects and drug interactions, ensuring treatment remains both safe and effective. With COPD being a progressive disease, timely pharmacist interventions can prevent exacerbations and improve quality of life.”

Caitlin Botelho, PharmD, a clinical pharmacist at Shields Health Solutions specializing in pulmonary health, noted that pharmacists are uniquely positioned to gather insights on patient preferences, physical capabilities, and insurance details, which can be shared with providers to facilitate a more efficient prescribing process.

“Respiratory therapists often use tools like the In-Check Dial to assess whether a device aligns with a patient’s inhalation capabilities,” Botelho said. “This information can be relayed to the pharmacist to support formulary checks and verify insurance coverage. For patients who struggle with hand-breath coordination, nebulized medications may be a more suitable alternative. Tailoring treatment to the patient’s individual needs and circumstances can significantly enhance adherence."

Botelho noted that in several states, pharmacists have the authority to prescribe tobacco cessation aids—including nicotine replacement therapy, varenicline, and bupropion—under statewide standing orders or protocols.

“Regardless of prescriptive authority, pharmacists can guide patients through available treatment options, discussing quit rates, potential [adverse] effects, and the benefits of combination therapy to improve outcomes,” she said. “Additionally, pharmacists play a critical role in identifying medications that may exacerbate COPD symptoms, such as nonselective β-blockers, drugs that cause respiratory depression, first-generation antihistamines, and nasal decongestants.”

Managing Medications

Chuman Xie, PharmD, ambulatory pharmacy clinical specialist, pulmonology at Boston Medical Center, noted that participation in multidisciplinary case reviews with physicians and respiratory therapists enables pharmacists to contribute to shared decision-making on inhaler selection, dose adjustments, and exacerbation prevention strategies.

“Pharmacists can also conduct covisits with physicians to assess patients’ physical capabilities and preferences,” she said. “This ensures inhaler regimens are appropriate, identifying issues such as insufficient inspiratory strength that may go unnoticed during brief provider visits. In addition, pharmacists address medication access barriers through prior authorizations, formulary adjustments, and cost-saving alternatives.”

The most common challenge Hira discussed was medication adherence, which can encompass a few different aspects of COPD medication management, including therapy burden, inhaler technique, and adverse events.

“Pharmacists can address adherence issues through frequent touchpoints throughout therapy,” she said. “The focus should be on addressing patient-reported issues with strategies that make sense for that specific patient. The goal is to help patients manage these challenges effectively to prevent medication discontinuations or a prolonged interruption in therapy.”

Coomes noted that his pharmacy used to get demonstration inhalers from drug representatives to show customers how to operate them properly. However, those have become less available in recent years, so his job is to educate them by showing them brochures and manufacturer websites that contain the instructions.

“If they can’t use the device properly, they don’t get the medication in their lungs where it works,” he said. “We suggest they bring in their inhaler, and we can help them once it’s open.”

Staying Informed

Amanuel Kehasse, PharmD, PhD, director of clinical programs and drug information at Clearway Health in Boston, Massachusetts, noted that some of the key risk factors for COPD also predispose patients to cardiovascular and oncologic disorders that lead to polypharmacy and disease comanagement challenges.

“Pharmacists provide targeted education to patients on the importance of managing comorbidities such as cardiovascular disease, diabetes, and osteoporosis alongside COPD, emphasizing the interplay between these conditions,” he said. “Furthermore, pharmacists facilitate coordination between multiple specialists and primary care providers to ensure cohesive, patient-centered care. This comprehensive approach supports safer, more effective treatment plans that address the full spectrum of patients’ health needs.”

COPD is evolving, so pharmacists must stay abreast of the latest clinical and pharmacotherapy updates.

“Pharmacists can monitor the COPD drug pipeline to stay up to date on potential new therapies in development,” Hira said. “Newer COPD medications are utilizing different delivery methods—for example, injectable formulations and nebulizers. It is important for pharmacists to receive training on how to use these formulations so that they may be adequately equipped to support their patients. COPD-related foundations and organizations can also serve as a valuable resource for pharmacists.

To read these stories and more, download the PDF of the Drug Topics September/October issue here.

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