PHARM-PR
Research type
Research Study
Full title
The role of pharmacist-led medicine optimisation during pulmonary rehabilitation (PR) in people living with chronic respiratory disease: a qualitative study
IRAS ID
357751
Contact name
William Man
Contact email
Sponsor organisation
Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust
Duration of Study in the UK
0 years, 3 months, 28 days
Research summary
Respiratory disease is the third leading cause of death in the United Kingdom (UK) and accounts for more than 700,000 emergency hospital admissions per year. People living with chronic respiratory disease frequently have high healthcare utilisation, placing a significant strain on social healthcare resources and costing the UK 11 billion pounds a year in care costs.
Pharmacological management of chronic respiratory disease often involves the prescription of several different medications, which can lead to polypharmacy. Polypharmacy is typically defined as the use of five or more medications at the same time. Polypharmacy is more common in older individuals who live with multiple long-term conditions (the co-existence of two or more chronic health conditions). Polypharmacy is associated with negative outcomes including adverse drug reactions, poor drug adherence, increases in mortality and hospital admission, as well as an increased length of hospital stay and higher readmission rate.Furthermore, these medications are rarely reviewed, and the above risks increase with every additional prescription. It is important to note that in many cases the prescription of polypharmacy is considered clinically appropriate to manage patients with multiple long-term conditions, however, it is becoming increasingly important to identify patients with ‘’inappropriate polypharmacy’’ to counter the above negative outcomes and address the shifting risk benefit balance (particularly important in people living with frailty). Therefore, many studies have proposed adopting the term ‘’appropriate polypharmacy’’ to differentiate between those with inappropriate and appropriate prescriptions.
People who live with chronic respiratory conditions including COPD and asthma are at risk of polypharmacy. Furthermore, poor medicine adherence is a recognised challenge in. For example, studies have shown adherence in COPD to be as low as 15-30% and non-adherence in asthma to be as high as 80% resulting in poor symptom control and an increase in hospitalisations. Furthermore, even those who adhere to the dose and frequency of their regimens may not administer their medications correctly. For example, suboptimal inhaler technique is rife, with a systematic review purporting that only 31% of patients were able to use their inhalers correctly. National and international evidence-based guidelines for the management of chronic respiratory conditions stipulate the most appropriate medical management of people living with chronic respiratory conditions. However, there can be a discordance between evidence-based guidelines and real-world practice.
Medicines optimisation is defined as ‘a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines’. Despite the clear benefits of structured medicine reviews (SMR) and investment in the infrastructure to provide SMRs, there is evidence that primary care is moving away from their delivery, suggesting that SMRs may be underutilised. Furthermore, SMRs may also lead to deprescribing medications which is not without its challenges, including resistance from patients.
Pulmonary rehabilitation (PR) is an evidence based six to eight-week exercise and education programme for people with chronic lung disease that aims to improve breathlessness, exercise capacity and health-related quality of life and is widely recognised to be a cornerstone in the management of COPD. During this programme, people with chronic respiratory disease attend two assessments and up to 16 PR exercise and education sessions, supervised by expert healthcare professionals. As SMRs, delivery and optimisation require multiple weeks to be achieved, the PR programme provides a potentially ideal setting to introduce medicines optimisation.
The aim of this research is to explore the opinions of i) people living with chronic respiratory conditions; and ii) healthcare professionals who manage people living with chronic respiratory conditions on the role of pharmacy professionals reviewing and optimising medication of people referred for and attending pulmonary rehabilitation (PR). We will use the APEASE criteria (acceptability, practicability, effectiveness, affordability, side effects and equity) as a framework. Exploring this topic will help identify barriers/facilitators and potentially highlight any unintended consequences.
REC name
London - Harrow Research Ethics Committee
REC reference
25/PR/1527
Date of REC Opinion
19 Dec 2025
REC opinion
Further Information Favourable Opinion