Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

Figures & data

Table 1 Demographic characteristics of pharmacists and patients

Characteristics	% (n) or Mean ± SD (range)
Pharmacists (n=20)a
Age in years	40.0±10.1 (25–56)
Gender – male	45 (9)
Prescriptions dispensed per day	190.0±93.5 (4–350)
Pharmacy type
Stand-alone	40 (8)
Shopping center	30 (6)
Shopping strip	20 (6)
Owner/employee	55 (11)/45 (9)
Patients (n=167)
Ageb in years (n=162)	58.7±15.5 (35–87)
Gender – malec (n=163)	49 (79)
Smoking: current/ex-smoker	44 (73)/47 (78)
Exposed to occupational airborne pollutants:d	47 (78)
Total ISQ score	3.9±1.9 (1–9)
High ISQ (score of >3)	55 (91)
Low ISQ (score of ≤3)	45 (76)

Notes: All data are % (n) unless otherwise specified.

a Demographic data missing for three pharmacists;

b Age information missing for five patients.

c Gender information missing for four patients.

d Reported exposures included coal dust (mine work), lawn mowing or cooking on coal while growing up in Fiji.

Abbreviations: SD, standard deviation; ISQ, Initial Screening Questionnaire.

Figure 1 Results of the COPD case finding and referral process.

Notes: Red = High COPD risk. Yellow = Medium COPD risk. Green = Low COPD risk.
Abbreviations: ISQ, Initial Screening Questionnaire; LFT, lung function test; GP, general practitioner; NRT, nicotine replacement therapy; pMDI, pressurized metered dose inhaler.

Table 2 Relationship between ISQ score and COPD risk assessed by LFT

ISQ section scores	High COPD risk (LFT), mean ± SD	Low COPD risk (LFT), mean ± SD	P-values
ISQ risk factor exposure score	1.8±0.5	1.7±0.6	0.63
ISQ symptom score	3.0±1.7	1.5±1.6	<0.01
ISQ total score	4.8±2.0	3.2±1.7	<0.01

Notes: High COPD risk, LFT FEV₁/FEV₆<0.75; low COPD risk, LFT FEV₁/FEV₆>0.75; ISQ risk factor exposure score 0, low; ISQ risk factor exposure score 3, high; ISQ symptom score 0, low; ISQ symptom score 6, high; ISQ total score 0, low; ISQ total score 9, high.

Abbreviations: ISQ, Initial Screening Questionnaire; LFT, lung function test; SD, standard deviation; FEV₁, forced expiratory volume in 1 second; FEV₆, forced expiratory volume in 6 seconds.

Table 3 Patient symptoms and their COPD risk based on the LFT results

Variable	Low COPD risk	Medium COPD risk	High COPD risk	P-valuesa
Age in years (n=157), mean ± SD	53±13.9	65±14.3	68±12.9	P<0.001
Male (n=157), n (%)	52 (54)	16 (44)	10 (40)	P=0.68
Are you bothered by a persistent cough, phlegm, wheezing or mucous?b n (%)
Yes	30 (31.2)	19 (52.7)	20 (80)	P<0.001
No	66 (68.8)	17 (47.2)	5 (20)
Do you avoid any activities to prevent or limit breathlessness?b n (%)
Yes	19 (19.7)	22 (61.1)	13 (52)	P<0.001
No	77 (80.20)	14 (38.9)	12 (48)
Do you get short of breath more easily than others of your age?b n (%)
Yes	26 (27.1)	29 (82.9)	17 (68)	P<0.001
No	70 (72.9)	6 (17.1)	8 (32)
Do you have a family history of chronic bronchitis or emphysema?b n (%)
Yes	17 (17.7)	5 (13.9)	4 (16)	P=0.95
No	79 (82.3)	31 (86.1)	21 (84)
Do you ever link breathlessness to aging or poor fitness?b n (%)
Yes	17 (68)	21 (58.3)	33 (34.4)	P=0.002
No	8 (32)	15 (41.7)	63 (65.6)
Do you have a history of repeated episodes of bronchitis or respiratory infections?b n (%)
Yes	17 (17.7)	7 (19.4)	8 (32)	P=0.47
No	79 (82.3)	29 (80.6)	17 (68)

Notes: Total number of patients completing LFT =157.

a Chi-square tests – P-values <0.01 were considered as statistically significant between the three risk categories.

b Total number of people completing initial risk assessment questionnaire =167.

Abbreviations: LFT, lung function test; SD, standard deviation.

Table S1 Initial COPD screening questionnaire

Patient approached but declined	□
Name:
Pharmacist, please complete the following questionnaire on behalf of the patient, only if the patient is 35 years or older and has no diagnosis of chronic bronchitis, emphysema or any other serious illness.
Are you currently a smoker?	□ [1] Yes	□ [0] No
Have you ever smoked in the past?	□ [1] Yes	□ [0] No
Are you, or have you ever been exposed to passive smoking, dusts, chemicals or indoor or outdoor pollutants?	□ [1] Yes	□ [0] No
Total score (section 1):
Are you bothered by a persistent cough, phlegm, wheezing or mucous?	□ [1] Yes	□ [0] No
Do you avoid any activities to prevent or limit breathlessness?	□ [1] Yes	□ [0] No
Do you get short of breath more easily than others your age?	□ [1] Yes	□ [0] No
Do you have a family history of chronic bronchitis or emphysema?	□ [1] Yes	□ [0] No
Do you ever link breathlessness to aging or poor fitness?	□ [1] Yes	□ [0] No
Do you have a history of repeated episodes of bronchitis or respiratory infections?	□ [1] Yes	□ [0] No
Total score (section 2):
If the patient answered YES to: ➢ one or more in section 1 AND/OR ➢ one or more in section 2 … they are eligible for a lung function assessment.

Table S2 Change in pharmacists’ confidence in delivering the screening

Aspects of the screening service	Mean confidence level at baseline	Mean confidence level at study end	Significance level
Confidence in identifying patients at risk of COPD	3.8±0.8	4.0±0.6	0.38
Confidence in conducting LFT	3.8±1.0	4.0±0.9	0.41
Confidence in interpreting LFT results	3.6±0.8	4.0±0.7	0.08
Confidence in referring at-risk patients to GP for further assessment	4.0±0.6	4.3±0.4	0.17
Confidence in supporting patients in COPD management	4.0±0.6	4.1±0.8	0.49

Notes: Paired sample t-tests conducted to compare mean values in pharmacists’ confidence pre–post study. Confidence was rated on a 5-point scale: 1, not at all confident and 5, extremely confident.

Abbreviations: LFT, lung function test; GP, general practitioner.