Date: 2 June 2017
Community pharmacists have a pivotal role in helping to educate consumers about pneumonia, in addition to helping patients manage their treatment regimens as well as being well placed to identify and act on early symptoms of the disease.
Pneumonia can strike anyone but at-risk groups include many of the most-frequent users of pharmacies. These include people over the age of 65 years; people with asthma, cystic fibrosis, chronic obstructive pulmonary disorder (COPD, sometimes called emphysema) or another lung disorder; and people with a weakened immune system due to an illness such as HIV, or medicines that suppress the immune system (e.g. after an organ transplant or chemotherapy for cancer).
Also at risk are people with heart, kidney or liver disease; people who smoke; and babies and very young children, especially premature babies or those who have a heart or lung problem (from birth defects), leukaemia, or a condition that weakens their immune system.
One of the issues facing health professionals is public ignorance about the disease.
Spokesperson for the Lung Foundation of Australia, Dr Richard Kidd, who is Clinical Lead and GP at Metro North Brisbane Medicare Local, said raising public awareness of the disease was critical.
“The Lung Foundation’s ‘Know Pneumonia’ survey found a large percentage of the Australian population just don’t know about pneumonia,” Dr Kidd said.
“So we need to raise awareness of this disease.
“We particularly need to educate the at-risk groups wherever we can – whether through posters, conversations or other means.
“Generally community pharmacists see these at-risk groups more often than doctors do.
“You will find pharmacists often see diabetics, people who have had a stroke, people with lung disease, people with renal disease or heart disease and people over the age of 65, or even younger people with any of these conditions.
“And all of these people are at risk.
“So the first thing is around prevention and raising awareness that those people who are at risk need to do something about it.
“I believe community pharmacies have a huge role to play there because we know so many people don’t identify themselves as having a risk of getting pneumonia.
“As a result I see a main role of community pharmacies in the area of pneumonia as being to raise awareness - there is a fairly desperate need to raise awareness.
“We have a big job to raise awareness and understanding.
“There is an opportunity for us all to be a bit better trained in identifying the patients who should be approached and educated about their risk of pneumonia. We should all be helping to get people better educated about pneumonia.”
Dr Kidd said part of the awareness raising needed to be to educate people, especially the at-risk groups, about the availability of a vaccine to protect against pneumonia.
He said the Lung Foundation’s ‘Know Pneumonia’ survey found many people were ignorant of the existence of a pneumonia vaccination.
“We know that less than half, about 46 per cent of people over the age of 65, who should all be vaccinated, are in fact vaccinated, Dr Kidd said.
“The same for at-risk groups - less than half who should be vaccinated are in fact vaccinated.
“This is a perfect example of where community pharmacies and GPs can be working collaboratively to help patients.
“If the pharmacist is concerned about a patient they should refer them to the GP and if they feel the need is urgent they can ring the GP and ask that the patient be seen immediately.
“If this cannot happen – for instance if it is after hours – then the patient should be sent to an emergency department.
“I know most of the pharmacists in my area and I talk to them and they often call me to talk about a patient they are concerned about. It’s a very good collaborative effort.”
In addition to the at-risk groups, community pharmacists can often find patients presenting with symptoms which may be indicative of pneumonia.
Even with the at-risk groups, because many of these patients will be undergoing treatment for other conditions, their visits to the pharmacy for medicines and treatment can provide an opportunity for the pharmacist and pharmacy staff to detect early symptoms of pneumonia.
NPS Medicinewise and Health Direct advise that the common symptoms of pneumonia include:
Some people may also experience headaches, coughing up blood or blood-stained mucus, nausea, vomiting, muscle and joint pain, tiredness, and confusion and disorientation (mainly in older people).
Dr Kidd said some signs were quite clear.
“In terms of someone who has pneumonia the pharmacist will notice they look sick, they may look grey, they may have a temperature or fever and they may be experiencing chest pains and shortage of breath when they cough, breathe or talk,” he said.
“These are the sorts of things a non-medical person can pick up, particularly across the counter.”
One of the challenges for pharmacists noticing early symptoms is that pneumonia can share some of the symptoms of a cold, acute bronchitis and asthma. However, ignoring such early warning signs is dangerous as even a cold and cough can trigger pneumonia.
In about half of all pneumonia cases, no definitive cause is ever found but, according to the Victorian Government’s Better Health site, some of the micro-organisms that can cause it include:
Once a diagnosis has been made, the pharmacists’ role can also include ensuring medicines compliance and adherence to health regimens.
Apart from helping the patient in the management of the disease, such oversight from the community pharmacist can have a wider and long-lasting impact, according to Dr Kidd.
“I think pharmacists have a very big role in medicine compliance in regard to pneumonia,” he said.
“They have an important role to help ensure that a patient completes the course.
“Too often people don’t complete their courses and this is contributing to the growing instances of antibiotic resistance.“
“We are see increasing problems of multi-drug resistance and we need to do something about it.
“Pharmacists do this well but we have to keep reminding patients to complete their courses and then go back to the GP for clinical review – particularly with pneumonia.”
Smoking cessation programs based in pharmacies are an important factor in lung health, and healthy lungs help resist diseases such as pneumonia.
A study published in the Journal of Clinical Pharmacy and Therapeutics in 2014 confirmed the “pivotal role” that community pharmacies can play in implementing smoking cessation services.
The study was conducted jointly by researchers at the University of Sydney and the Naresuan University in Thailand and involved a meta-analysis of over 1,000 articles and an in-depth analysis of five major smoking cessation studies from around the world.
The researchers concluded that “pharmacist-led interventions can significantly impact abstinence rates in smokers”.
They pointed to four critical attributes of community pharmacists that make them ideal in providing smoking cessation interventions:
Benzodiazepines use warning
New research from Finland suggests pneumonia should be added to the list of potential harms associated with use of benzodiazepines in people with dementia.
The study, Risk of pneumonia associated with incident benzodiazepine use among community dwelling adults with Alzheimer disease, was published in the Canadian Medical Association Journal and looked at almost 50,000 elderly people with Alzheimer’s disease.
It found those taking benzodiazepines had a 30 per cent increased risk of pneumonia.
The authors suggested one explanation for this could be as a result of the more pronounced sedative effects of these drugs in this population.
The report concludes: “Benzodiazepine use was associated with an increased risk of pneumonia among patients with Alzheimer disease. Risk of pneumonia should be considered when weighing the benefits and risks of benzodiazepines in this population.”
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