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International Journal of Clinical Pharmacy

, Volume 37, Issue 5, pp 726–733 | Cite as

Pharmacists performing quality spirometry testing: an evidence based review

  • Michael J. Cawley
  • William J. Warning
Review Article

Background

The scope of pharmacist services for patients with pulmonary disease has primarily focused on drug related outcomes; however pharmacists have the ability to broaden the scope of clinical services by performing diagnostic testing including quality spirometry testing. Studies have demonstrated that pharmacists can perform quality spirometry testing based upon international guidelines.

Aim of the review

The primary aim of this review was to assess the published evidence of pharmacists performing quality spirometry testing based upon American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. In order to accomplish this, the description of evidence and type of outcome from these services were reviewed.

Methods

A literature search was conducted using five databases [PubMed (1946–January 2015), International Pharmaceutical Abstracts (1970 to January 2015), Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews] with search terms including pharmacy, spirometry, pulmonary function, asthma or COPD was conducted. Searches were limited to publications in English and reported in humans. In addition, Uniform Resource Locators and Google Scholar searches were implemented to include any additional supplemental information.

Results

Eight studies (six prospective multi-center trials, two retrospective single center studies) were included. Pharmacists in all studies received specialized training in performing spirometry testing. Of the eight studies meeting inclusion and exclusion criteria, 8 (100 %) demonstrated acceptable repeatability of spirometry testing based upon standards set by the ATS/ERS guidelines. Acceptable repeatability of seven studies ranged from 70 to 99 % consistent with published data.

Conclusion

Available evidence suggests that quality spirometry testing can be performed by pharmacists. More prospective studies are needed to add to the current evidence of quality spirometry testing performed by pharmacists and to measure health outcomes of the pulmonary patient.

Keywords

Literature review Pharmacist Pharmacy services Pulmonary function testing Spirometry 

Notes

Funding

The authors did not receive funding support for this project.

Conflicts of interest

The authors declare no conflict of interest.

References

  1. 1.
    Levy ML, Quanjer PH, Booker R, Cooper BG, Holmes S, Small IR. Diagnostic spirometry in primary care. Proposed standards for general practice compliant with American Thoracic Society and European Respiratory Society recommendations. Primary Care Respir J. 2009;18(3):130–47.CrossRefGoogle Scholar
  2. 2.
    Crapo RO. Pulmonary function testing. N Engl J Med. 1994;331(1):25–30.CrossRefPubMedGoogle Scholar
  3. 3.
    Kaminsky DA, Marcy TW, Bachand M, Irvin CG. Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians. Respir Care. 2005;50(12):1639–48.PubMedGoogle Scholar
  4. 4.
    Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319–38.CrossRefPubMedGoogle Scholar
  5. 5.
    Crapo RO, Hankinson JL, Irvin C, MacIntyre NR, Voter KZ, Wise RA, et al. Standardization of spirometry 1994 update. Am J Respir Crit Care Med. 1995;152:1107–36.CrossRefGoogle Scholar
  6. 6.
    Ferguson GT, Enright PL, Buist AS, Higgins MW. Office spirometry for lung health assessment in adults: a consensus statement from the national Lung health Education Program. Respir Care. 2000;45(5):513–30.PubMedGoogle Scholar
  7. 7.
    Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD. A meta analysis. Chest. 2004;125(6):2309–21.CrossRefPubMedGoogle Scholar
  8. 8.
    Lin K, Watkins B, Johnson T, Rodriguez JA, Barton MB. Screening for chronic obstructive pulmonary disease using spirometry: U.S. Preventative Services Task Force recommendation statement. Ann Intern Med. 2008;148(7):535–43.CrossRefPubMedGoogle Scholar
  9. 9.
    Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2014. [cited 2015 April 6]. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf.
  10. 10.
    National Heart, Lung and Blood Institute. Expert panel report 3: guidelines for the diagnosis and management of asthma. [cited 2015 April 9]. http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf.
  11. 11.
    Lusuardi M, De Benedetto F, Paggiaro P, et al. A randomized controlled trial on office spirometry in asthma and COPD in standard general practice: data from spirometry in asthma and COPD: a comparative evaluation Italian study. Chest. 2006;129(4):844–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Mikhail MN, Catania PN. Using a hand-held spirometer as a monitoring tool in chronic theophylline therapy. Drug Intell Clin Pharm. 1987;21(6):502–4.PubMedGoogle Scholar
  13. 13.
    DeTullio PL, Corson ME. Effect of pharmacist counseling on ambulatory patients’ use of aerosolized bronchodilators. Am J Hosp Pharm. 1987;44(8):1802–6.Google Scholar
  14. 14.
    Emmerton LM, Smith L, LeMay KS, Krass I, Saini B, Bosnic-Anticevich SZ et al. Experiences of community pharmacists involved in the delivery of a specialist asthma service in Australia. BMC Health Services Research 2012;12:164. [cited 2015 May 1]. http://www.biomedcentral.com/content/pdf/1472-6963-12-164.pdf.
  15. 15.
    Gibson P, Henry D, Francis L, Cruickshank D, Dupen F, Higginbotham N, et al. Association between availability of non-prescription B2 agonist inhalers and undertreatment of asthma. BMJ. 1993;306:1514–8.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Stergachis A, Gardner JS, Anderson MT, Sullivan SD. Improving pediatric asthma outcomes in the community setting: does pharmaceutical care make a difference? J Am Pharm Assoc. 1996;42(5):743–52.CrossRefGoogle Scholar
  17. 17.
    Solidoro P, Braido F, Baratta F, Bagnasco D, Esposito R, Aggeri M, et al. FEV6 assessment in spirometric abnormalities screening: the first population-based study in Italian pharmacies. Panminerva Med. 2013;55(1):87–92.PubMedGoogle Scholar
  18. 18.
    Gissing PM, Burton DL, Simpson MD, Burton MA, Bowman SL. Pharmaceutical care: impact on asthma medication use. J Pharm Pract Res. 2004;34:26–9.Google Scholar
  19. 19.
    Midodzi WK, Mayers I, Rowe B, Vathanayagam D, Chan M, Alwashmi M, et al. Validity of the Piko-6 portable device for screening for obstructive airways disease in a community pharmacy practice. American Thoracic Society International Conference. Poster B45. [cited 2015 May 3]. http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2013.187.1_MeetingAbstracts.A2846.
  20. 20.
    Hackbarth D, Cohen RA, Preckwinkel L, Younker L, McKee C, Solinski J, et al. Spirometry screening and an invitation to quit from a state tobacco quit line as motivators for smoking cessation among community dwelling adults. Chest. 2006;130:145S-a.CrossRefGoogle Scholar
  21. 21.
    Stratton TP, Williams RG, Meine KL. Developing a mobile pharmacist-conducted wellness clinic for rural Montana communities. J Am Pharm Assoc. 2005;45(3):390–9.CrossRefGoogle Scholar
  22. 22.
    Simpson M, Burton D, Burton M, Bowman S. Impact of spirometry on pharmacists decision to refer. Australian Pharm. 2005;24(12):964–8.Google Scholar
  23. 23.
    Kennedy DT, Paulson DM, Eddy TD, Patel PC, Patkar AD, Holdford DA, et al. A smoking-cessation program consisting of extensive counseling, pharmacotherapy, and office spirometry: results of a pilot project in a veterans administration medical center. Pharmacotherapy. 2004;24(10):1400–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Mann RP, Zaiken K. Management of chronic obstructive pulmonary disease by pharmacists in an internal medicine department. Am J Health Syst Pharm. 2009;66(10):890–3.CrossRefPubMedGoogle Scholar
  25. 25.
    Wright D, Twigg M, Thornley T. Chronic obstructive pulmonary disease case findings by community pharmacists: a potential cost-effective public health intervention. Int J Pharm Pract. 2015;23:83–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Corlett SA, Howes K, Salter M, Krska J Evaluation of a community pharmacy spirometry testing service for current and recent ex-smokers. In: 9th pharmaceutical care network Europe working conference 2015. Abstract #32. [cited 2015 April 22]. http://www.pcne.org/script25.php?abstractid=32.
  27. 27.
    Burton D, Simpson M, Wettenhall J, Armour C, Bosnic-Anticevitch S, Saini B, et al. Acceptability and utility of spirometry measurements in the pharmacy asthma care program. In: 2006 annual scientific meetings, the thoracic society of Australia and New Zealand and The Australian and New Zealand Society of Respiratory Science, Western Australia: Asian Pacific Society of Respirology. [cited 2015 April 8]. http://www.nddmed.com/downloads/Download_00132_00.pdf.
  28. 28.
    Castillo D, Guayta R, Giner J, Burgos F, Capdevila C, Soriano JB, et al. COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study. Respir Med. 2009;103:839–45.CrossRefPubMedGoogle Scholar
  29. 29.
    Burton MA, Burton DL, Simpson MD, Gissing PM, Bowman SL. Respiratory function testing: the impact of respiratory scientists on the training and support of primary health care providers. Respirology. 2004;9:260–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Armour C, Bosnic-Anticevich S, Brillant M, Burton D, Emmerton L, Krass I, et al. Pharmacy asthma care program (PACP) improves outcomes for patients in the community. Thorax. 2007;62:496–502.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Burton DL, LeMay KS, Saini B, Smith L, Bosnic-Anticevich S, Southwell P, et al. The reliability and utility of spirometry performed on people with asthma in community pharmacies. J Asthma. 2015;7:1–27.CrossRefGoogle Scholar
  32. 32.
    Fuller L, Conrad WF, Heaton PC, Panos R, Eschenbacher W, Frede SM. Pharmacist-managed chronic obstructive pulmonary disease screening in a community setting. J Am Pharm Assoc. 1012;52:e59–66.Google Scholar
  33. 33.
    Licskai CJ, Sands TW, Paolatto L, Nicoletti I, Ferrone M. Spirometry in primary care: an analysis of spirometry test quality in a regional primary care asthma program. Can Respir J. 2012;19:249–54.PubMedCentralPubMedGoogle Scholar
  34. 34.
    Cawley MJ, Pacitti R, Warning W. Assessment of a pharmacist-driven point-of-care spirometry clinic within a primary care physicians office. Pharm Pract. 2011;4:221–7.CrossRefGoogle Scholar
  35. 35.
    Willey VJ, Simon S, Akkineni S, Reinhold J, Kelly BL, Kim EA, et al. Preliminary evaluation of comprehensive pharmacist-led services to patients with respiratory diseases within a community-based medical home. Value Health. 2013;16:A198.CrossRefGoogle Scholar
  36. 36.
    The Global Asthma Report (2014) [cited May 6, 2015]. http://www.globalasthmareport.org/burden/burden.php.
  37. 37.
    World Health Organization. Chronic respiratory diseases. Burdon of COPD, [cited May 2, 2015]. http://www.who.int/respiratory/copd/burden/en/.
  38. 38.
    Han MK, Kim MG, Mardon R, Rennner P, Sullivan S, Diette GB, et al. Spirometry utilization for COPD: how do we measure up? Chest. 2007;132(2):403–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Esteban C, Quintana JM, Aburto M, Moraza J, Egurrola Espana PP, et al. Predictors of mortality in patients with stable COPD. J Gen Intern Med. 2008;23(11):1829–34.PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Ekberg-Aronsson M, Pehrsson K, Nilsson JA, Nilsson PM, Lofdahl CG. Mortality in GOLD stages of COLD and its dependence on symptoms of chronic bronchitis. Respir Res. 2005;6(1):98. doi: 10.1186/1465-9921-6-98.PubMedCentralCrossRefPubMedGoogle Scholar
  41. 41.
    Yawn BP, Enright PL, Lemanske RF, Isreal E, Pace W, Wollan P, et al. Spirometry can be done in family physicians’ offices and alters clinical decisions in management of asthma and COPD. Chest. 2007;132(4):1162–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Enright PL, Skloot GW, Cox-Ganser JM, Udasin IG, Herbert R. Quality of spirometry performed by 13,599 participants in the world trade center worker and volunteer medical screening program. Respir Care. 2010;55(3):303–9.PubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  1. 1.Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of PharmacyUniversity of the SciencesPhiladelphiaUSA
  2. 2.Family Medicine Residency ProgramCrozer-Keystone Center for Family HealthSpringfieldUSA

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